Ready or Not, Tech-Savvy e-Patients are Coming

The patient of the future—also known as the e-Patient—is technologically savvy, information hungry, and has a sense of entitlement about the level of service and the types of services they want. They'll demand up-to-date, easy-to-understand, and easy-to-access information about the cost of care and billing, online appointment scheduling, the ability to e-mail their physicians, and hospital Web sites that have more information than can be found on Google maps. The patient of the future will put plenty of demands on  healthcare organizations in general and healthcare IT departments in particular.

Donna Cryer is one such patient. A liver transplant recipient who's had to deal with multiple and complex health issues starting when she was just 13, she wants to be cared for in ways that can only be delivered with data-sharing and expedited communication.

I interviewed Cryer for this month's HealthLeaders magazine cover story, Time to Put Patients First: How America's hospitals have lost touch with their top priority—and what healthcare leaders are doing to fix it. The story is about the patient of the future—including how technology can help meet some of their needs. Unfortunately, we didn't have room to run her comments, so I want to share some of what she said here.

"Patient-centered care is individualized, personalized treatment decisions that [are] placed in the context of the patients' entire life," she says. Each person has individual goals for who they want to be, how healthy they want to be, what their own risk benefit analysis is for a given treatment, she says. For example, when Cryer was still in her teens, her surgeons recommended she have her colon removed.

"I just really wasn't able to face that . . . spending my teenage years with an ostomy bag. So we did it in my twenties," she says. "My medical team works with me and I work with them . . . It was my decision to make and they were coaching me through that calculus."

Although Cryer has good things to say about how patient-centered her healthcare provider is, she says the organization falls down in other areas, especially when it comes to technology.

"The Web site is totally inadequate—I can't get any useful information," she says. No online appointment bookings, difficulty finding parking, wait times that range from several weeks to months long waits for results of labs tests that were finally delivered via snail mail. And when she finally got them? "They weren't shared with, well, anybody."

After getting the test results, she went to an appointment with a specialist. She didn't bring the lab results or her "truckload of files" because she had heard they were finally instituting an electronic medical record.

She should have brought them.

"I am the conduit for all tests results and information to my physicians. That is my current challenge in healthcare—meaningful access to my physicians [is] supported by the most meager amount of technology," she says. "Patient responsibility—I'm a big fan, but it's too much even for me . . . it's not really appropriate for me to take on that role . . . This role as über-coordinator is beyond even someone like me who can do it pretty much full time."

Cryer, an attorney who is now CEO of CryerHealth, a Washington, DC, organization that advocates for patients' rights and to make healthcare more patient-centric, did finally find a physician that "gets" the patient of the future. The doctor works with her to solve problems, and discusses results and trends. She gives Cryer electronic copies of her medical information. She even gave Cryer her e-mail address. "It was like I discovered the Holy Grail," Cryer says.

Frankly, it shouldn't be that way. And soon, hospitals won't be able to do it that way … assuming they want to remain competitive and that they care about their patients.

For example, the demanding patient of the future isn't going to stand for the kind of telephone conversation I had yesterday with a health system billing department. When I asked if I could get a discount for paying cash up front for a procedure that's not covered by my insurance, instead of getting information I got a condescending little lecture about how lucky I am to have insurance at all and that paying for anything that's not covered is my responsibility. This despite the fact that several people within the organization told me that such discounts were routine.

(I wanted to ask the lecturer in the billing department what the organization's self-pay collection rates were, but resisted. I might send them the link to this month's magazine story by Senior Finance Editor Karen Minich-Pourshadi, Self-Pay and the Bottom Line: New approaches put patients back into POS collections.)

Like many patients would do, as soon as I hung up the phone I went straight to the organization's Web site. Not much help there—no estimates of how much the procedure would cost, and just a few vague lines stating that the hospital can help those who are uninsured or underinsured pay their bills. There was mention of interest-free payment plans. Gee, thanks. I could get the same from a furniture or appliance store—the difference is they'd tell me up front how much I'd be financing.

That inability to disseminate consistent, accurate information is a problem, Cryer says. "Communications, how you're greeted, patient throughput, everything matters," she says. "Information needs to be shared and not hoarded."