Web Helps Handle Demand

Robert Redling is the editor of practice management for Physicians Practice.

Nearly every industry but one has hopped on the Web bandwagon to offer consumers online services. Lagging in the field of offering Web access, but rapidly catching up thanks to new technologies, are healthcare providers — and dermatology practices are no exception.

Initially, most dermatologists saw the World Wide Web as a marketing and education tool — a way to show off the practice's physicians and services, and perhaps provide a little education to patients. Until recently, an interactive map to the office was the most advanced user option you'd find on the typical dermatologist's Web site. But now, many dermatology practices are discovering that the Web can be an effective tool to help redirect patient demand and keep formerly clogged telephone lines open for patients with more critical questions and concerns.

"It took a while for medical practices to see what a Web site and the online options could really do for them but now they seem to see the ways that it can help cut down on phone calls, and the need for staff to be answering the same questions over and over," says Chris Richter, founder and CEO of the medical Web site development firm, Health Presence (www.healthpresence.com).

A high volume of incoming calls from patients makes your staff spend more time answering telephones, taking messages, tracking down answers, and making return calls. That flurry of daily activity leaves less time for them to tackle the many other critical tasks related to patient flow, such as taking patient histories, rooming patients, or helping dermatologists with other tasks. Scurrying around to answer nonurgent telephone inquiries also means staff cannot give the highest level of service to patients who are actually onsite.

Streamlining information flow

The array of new Web-based software products that allow dermatology practices to handle everything from patient inquiries to prescription renewals can be grouped under the broad heading of "clinical messaging."

To many dermatologists, the phrase "clinical messaging" means unleashing an avalanche of incoming e-mail from patients, not to mention all of the related liability risks, time demands, and HIPAA concerns. However, much of the new crop of clinical messaging services is aimed at steering patients into taking on more of the responsibility for prescription refills, office appointments, registration and filling out various forms. And the more patients do for themselves, the more time staff can devote to more urgent care.

At the front desk, online tools are helping practices speed up obtaining test results and getting patient information from referring physicians. Linking the online tools to a dermatology practice management or EMR system further reduces the potential errors and delays of data entry. Many tools can be added to an existing Web site regardless of what EMR or practice management system you have. But the ideal situation is for patient information and inquiries to flow seamlessly into an electronic record.

"Once these systems get more integrated, you'll see a very wide and rapid adoption of these tools because then much more of the administrative aspect of collecting and verifying information is taken care of by the patient essentially, assisted by technology," says Elizabeth Petrone, MHSA, founder and president of Practis Inc. (www.practisinc.com), a firm that provides Web design, development, and maintenance services for more than 75 practices, including dermatology practices.

What benefit does a dermatology patient gain from completing an online registration form or tapping in a password to get lab results from a secure Web site? The same as millions of Americans who prefer to do their banking, shopping, and research online: convenience. Don't forget: as much as the glut of incoming telephone calls may bog down your staff, your over-capacity telephone system also bothers patients who feel their requests should get the full and immediate attention of you and your staff. Online services can actually be a patient satisfier.

So, is it time to jump into the waters and start putting more of the administrative load on willing online patients? Or should you wait until the information technology industry gets its act together and provides much better integration between online tools and existing EMR and practice management systems? The answer, many experts say, is to do a little of both.

E-requests for refills

Eliot N. Mostow, MD, a dermatologist from Akron, Ohio, credits his practice's Web site with meeting patients' demands for prescription refills and office appointments.

Handling between 15 and 20 refill requests a week on the Web has been a great help, Mostow told a session at the American Academy of Dermatology's annual meeting last February in Washington, D.C. "It means that up to 20 of these requests each week can be shifted to more convenient times for the staff and the doctors to complete."

But "more convenient times" doesn't mean next week, Mostow explains. He recommends assigning staff to monitor and shepherd Web refill requests — which appear as incoming e-mails when they arrive at the practice — and setting strict daily deadlines to either complete or respond to requests. Mostow keeps a lid on the demand by requiring patients to register and use passwords before sending their requests. Staff who are designated to handle the incoming requests also must sign into secure accounts before retrieving the text of incoming mail.

Requiring patients to register to use Web services is vital. The registration process on sites like Medem (www.medem.com) sometimes can appear cumbersome to patients — the patient must await a return e-mail from the dermatology practice to gain authorized access. Worse, the Web service may not be compatible with your EMR, so things like patient refill requests may not flow into the patient's electronic record.

If you don't have a readily available way for information to transfer right into your electronic medical record, you must either hand key it or scan it in. Of course if you still use paper records in your dermatology practice, the incoming refill requests can be printed out and clipped into the patient's paper chart. But the lack of integration may be one reason why clinical messaging tools, including online refill requests, are used by less than 8 percent of the more than 90,000 physicians who opted for the free Web sites offered by Medem, a company formed by the AMA and several medical specialty societies.

Forms, forms, forms

Many dermatology practices mail new patients extensive pre-registration packets containing history and demographic forms. But what about saving yourself the effort of mailing and office processing by putting those forms online?

If you can't afford to hire a designer to create slick looking online versions of all the forms you want on your Web site, then try products like OmniForm. The software, available from Scan Soft (www.scansoft.com), will convert a scanned image of your form into an electronic version that can be posted on your dermatology practice's Web site as a downloadable document or an interactive form.

"You'll probably have to do a little massaging to get the form just right, but you only have to do it once," says Rosemarie Nelson, a senior consultant with the Medical Group Management Association Health Care Consulting Group. "If all you have on your Web site so far is maps, brochures, and provider information, a little tool like this can very quickly put some functionality on the site."

Richter, of Health Presence, adds that since some patients hesitate to fill out medical forms online, many of his company's dermatology clients are supplementing their interactive online forms with downloadable forms that patients can print out, fill in, and bring with them to their appointments.

One dermatology practice estimates about 20 percent of its patients fill out and submit the registration and patient history forms via the Web site. A similar number of patients download the forms and fill in the blanks in handwriting. But many patients still are concerned about Web security, which may take more time to overcome.

Next appointment, please

Forms, test results, and refill requests are one thing, but what about letting patients select their own appointments online? So far, few dermatology practices have gone in that direction.

Most dermatology practices will be wary of patient-directed appointment scheduling because few practices want to open up their schedules because of no-shows or the wrong type of appointments getting scheduled," she says.

Yet there's no reason to fear letting patients request appointments on certain days, says Stephen N. Malik, CEO of Med Fusion (www.medfusion.net). "It's just a request. It's taking some of that phone traffic off the operators but you are still in control of when you offer that appointment to the patient," says Malik.

What is the most popular of today's Web options that help deflect patient demand away from telephones and busy office staff? According to Malik, it's the provider directory.

"I've looked at the stats on the 300 sites we're now managing, and the most traffic is to the CV's of the provider, especially if it's a large group," he says. "A woman who speaks Spanish might prefer to have a female [dermatologist] who speaks Spanish, so why not help her find that person in your group?"

While the number of patients who visit their doctors' Web sites is far smaller than those who go online to shop, those who do so are interested in prescription refills, lab results, tracking insurance information, and other types of transactions, concludes a 2003 Forrester Research Group report, "Why Consumers Visit Physician Group Sites."

"There are some really good options out there now, whether it's the smaller players who can develop very affordable Web sites, or the companies that sell software you can add on to an existing site," says MGMA's Nelson.

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Disclaimer: The material above has been prepared by Physicians Practice. It has not been reviewed by the DermQuest Editorial Board for its accuracy or reliability. Reference to any products, service, or other information does not constitute or imply endorsement, sponsorship, or recommendation by members of the Editorial Board.