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  • Lloyd Price

'imPatients': the new battleground in 2023



As we enter 2023 following another frustrating year post covid, the next generation of healthcare entrepreneurs need to focus less on outpatients and inpatients, instead focus on designing and building solutions addressing 'impatients'….


The last 24 months has seen a lot of waiting, frustration and anxiety build up on both sides of the healthcare market as patients become “impatient” as healthcare professionals focus on addressing the ever increasing backlogs, primary care, elective care, cancer, surgery etc..


Patients are growing increasingly impatient by the day, what they want from digital tools and services is the following:


1. Access

2. Advice and guidance

3. Self Management

4. Reassurance

5. Peace of mind


One potential way of addressing the "impatient economy" and addressing all 5 factors above is a four stage appointment process based on new, existing and old technology.


Stage 1: Triage – Q&A, pre visit questionnaire


Patients answer standard question sets which are read and reviewed by a nurse, doctor, consultant etc.. Not AI based.


Stage 2: Async – asynchronous video messaging


Patient sent link to record a 30 second video message describing symptoms etc.. Healthcare professional replies with personalized 30 second video offering advice, update on treatment process etc…


Stage 3: Virtual Care – phone based or telemedicine


Following the review of both pre visit questionnaires//Q&A plus Async video messages, the patient has a telemedicine appointment scheduled


Stage 4: Face to face – in person visit or appointment


Following the review of all 3 previous stages and interactions, the patient has a traditional face to face, in person appointment scheduled


Four Stage Model


The Problem: Waiting Game


Digital health products and services need to address the first big problem, the waiting game.


Patients feel like they are always waiting, on a waiting list, waiting to receive a letter in the post, waiting for an appointment to be confirmed, waiting for a call back, waiting for blood test results, waiting for lab test results etc..



The Expectation: On Demand


Working from home, living the decentralised, remote environment has “conditioned” patients to on demand services in all aspects of their lives, healthcare is no different, simply frustrating in their eyes


On demand music, TV, communication, messaging …. Neflix, spotify, BBC iPlayer, Deliveroo, Uber – everything is on demand now, so why can’t healthcare be?


Dr Jonathan Griffiths, a cheshire GP says patients' 'Amazon Prime mentality among patients is contributing to increased pressure' on GPs and A&E.


"We talk all the time about the ‘Amazon Prime’ mentality that we all now have – high expectations and inability to wait for anything. There are significant numbers of people aged 30-50 presenting to the ED with undifferentiated symptoms that are possibly better managed by GPs. These individuals do not want to wait for GP assessment and want everything investigated and sorted in one trip. This is what they get in the ED."


https://www.cheshire-live.co.uk/news/chester-cheshire-news/cheshire-gp-says-patients-amazon-21954594



The Solution: Hybrid Model ?


Thinking about the current elective care backlog, is there a potential new way of approaching the problem based on patient need?


First Appointments - asynchronous messaging

Follow Up Appointments - group appointments

Flare Ups - nurse led telephone based


To go forwards, we probably need to go backwards first and utilise what we have in healthcare, make use of the infrastructure, tools, staff and assets available.


Step back to basics then forwards using technology as an enabler not a disruptor – for example ...


1) Asynchronous messaging – very time efficient for both sides, practical and personal advice from a doctor, nurse, allied health professional.


Examining the impact of an asynchronous communication platform versus existing communication methods: an observational study : “A statistically significant figure (p<0.01) of 20.1 minutes’ reduction in average task completion was seen with asynchronous communication, saving 58.8% of time when compared with traditional synchronous methods.”


https://innovations.bmj.com/content/7/1/68


2) Group appointments – learn from Kaiser Permentae in the US, one to many model, one healthcare professional to many patients.


Proven to be very effective for chronic conditions, for example hypertension and diabetes mellitus.


“In Northern California Kaiser Permanente for over ten years we have successfully implemented group medical appointments as one of our tools for working with our patients. We have been impressed with the benefits to our patients, to our medical care providers and to the system.


This tool is especially useful in treating patients with chronic medical conditions, and both the methodology and the co-leadership team combine to ensure the success of this model of care.”


http://www.ehcca.com/presentations/cachroniccare/1_03_3.pdf


3) Nurse led telephone appointments – operationally very efficient, digitally inclusive, easy to set up and run for staff.


Telephone calls are convenient for both patients and staff, easy to set up, change, manage and report outcomes from. As reported by eConsult in a blog post, there are also serious accessibility and inclusivity issues to consider ...Two in Five People Can't Do Video Consultations.


“We can’t achieve remote consultation targets with video or telephone alone – we need both.”

https://econsult.net/blog/we-cant-achieve-remote-consultation-targets-with-video-or-telephone-alone-we-need-both



So in summary, should we take a technological step back in 2023 to move forwards at pace and scale? Making a real difference to backlogs, patients frustrations and impatience?


What do you think? Let's debate @lloydgprice :)

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London, England, UK
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