Developing and Maintaining Patient Communication Strategies

Physician's Practice®: Practices are still recovering from the rapid drop in patient activity earlier this year, and with secondary waves of COVID-19 infections popping up across the country, now might be one of the best times to establish patient communication strategies, if you haven't already.

Today, we will hear from Dr. Tashfeen Ekram, a diagnostic radiologist and co-founder of Luma Health, on how solo and small group practices can evolve their patient communication strategies during the pandemic and set themselves up for success long after this tumultuous year is over.

You might be wondering. Why now? With the pandemic still effecting patients and unpredictability still rife in various industries, why should now be the best time to develop these strategies?

Dr. Ekram says that, with the onset of the pandemic, a lot of efficiency gaps in the practice's communication efforts with patients were brought to the light.

Dr. Tashfeen Ekram: I think previously, there was not a strong need to be able to do mass communication with patients. The kind of form of communication that was either was done one-off around, “hey, you know, I need to send you a message about your prescription refill,” or “there's a new result that's coming in,” or “let's schedule your appointment or one-off,”—that was kind of in the sense of appointment reminders or regular appointment messages that may go out.

But I think what certainly surfaced was the need to be able to mass message a large group of patients for a variety of reasons that could relate to scheduling. So suddenly, you know, the governor of your given state says, “Hey, you know, we want medical practices to cool down except for urgent appointments.” And so suddenly, you've got to figure out “how am I going to message all the patients I've scheduled for the next month?”

So I think in the pandemic, as it's come out of practice, I've learned that a you know, we need to have a fast way to be able to adapt to all the ways you know, whether it's what we are currently experiencing in our own practice, or this is a government mandate that I need to be able to mass-message patients to educate them to let them know what the changes are. And so, I think that has been a really big impetus and getting practice to look at ways that they can do this because it just isn't scalable, to have to pick up the phone and call every patient.

Physician's Practice®: Dr. Ekram's personal practice was actually already set up for Telehealth long before the pandemic became an unfortunately reality, providing him with the necessary insights and experience to weather the storm.

Ekram: It’s very interesting because things are shifting constantly. And so a lot of our clients have become very agile, and being able to shift their appointments from one appointment type to another appointment type. They've got a good sense of when for a particular visit, it's better for it to be done in person versus it's better to work to be done virtually. But what they've done is they've designed a workflows to be able to kind of take the waves of the different mandates that come from the government.

For these practices that have already scheduled in-person visits, they have created ways to be able to suddenly transition a lot of those patients to telehealth visits and back and forth. And I think that's really important because the end of this is not really clear.

So I think it's really important for practices to understand that you need to figure out how telehealth can take a stronger hold. But what's even more important than that, is being able to figure out how you can kind of shift from one from one model to the other as on a needed basis, because it's going to happen where, we're going to see more waves of the infection coming in. So suddenly, it'll be safer and better, better delivery of health care for the patient to do that visit from home. But then once the infection rates kind of coming down, it's probably better for the patient to come back in.

Understanding the nuances and maybe having facile workflows in place so that you can kind of quickly shift from one to another. And so I think that's really important to make that quarter strides because what we've seen is that in the early phase, when all the clinics started shutting down, they started looking at telehealth and then they invested in a telehealth vendor and they started using it. And now as clinics are starting to open up, they're kind of closing that part of their practice or they're scaling it down. But I think what's really important is that you have to figure out how you can kind of shift from one to the other because it's going to happen where, infection rates are starting to go up and you’re gonna have to figure out how to shift all the way back one way or the other. And so to be able to, to kind of take the waves and ties that come with this is gonna be really important.

Physician's Practice®: Dr. Ekram has published with physician's practice this year. His article concentrated on a three-pillared approach to establishing a streamlined communication strategy with patients.

Up next, Dr. Ekram describes this approach and how practices can meet each pillar's requirements.

Ekram: So, we talked about three things which was educate, identify, and treat. We think this is kind of core to your messaging strategy, particularly in the COVID phase, but I think this is something that, you know, as practices and physicians, we can learn and take outside of COVID once we are able to leave this acute phase.

So the first phase is educate and what we really found was that, particularly early on when the virus was hitting, a lot of patients just didn't know what to do. And, you know, just like any patient does, if you go search on the internet, you're gonna get some truth, some lies, and everything in between—it's kind of hard to figure out.

And so really the source of truth for a lot of patients is their doctor who they have trust in. What we saw was that a lot of practices that we currently work with, and other others were coming to us, just wanted a way to be able to distribute information to their patients. This could be just educating them on what services are available during this time; is the clinic open; what can you do if you start getting symptoms; but also just basic things like, what [they] should be doing.

You know, there's a lot of theories about how you can prevent the spread of infection and stuff. So a lot of patients were looking for genuine information and it was hard to digest what was out there. So, the first pillar is educating—educating about what the virus was about.

The next step was identification and this is really where I think providers took a lot of vantage of how can I figure out the legislative as a physician. As a primary care doctor, I may have 3000 patients on my panel, how do I figure out those who is at risk for the infection and so that way, I can make sure that their needs are met because now I'm going to be closed for the next month or two months. But at the same time, I want to make sure that their needs are met, not only related to the COVID or Coronavirus, but also to their chronic conditions that may be going on.

And so I'm getting a way to be able to mass communicate to a group of patients that could be either high-risk patients that could be all your diabetic patients and be able to ask them the right questions to identify, “hey, is there a subset of these patients who are experiencing covid-like symptoms? Are you having shortness of breath, you have a fever, are you having cough?”

So we're using this mass-message ability to identify who amongst maybe my 3000 patients need attention now while I'm closed or while I'm running services kind of trimmed down relative to normal services.

The third pillar is treat. So now once I have identified those patients that are in high risk or that may need attention, what do I do with them? A subset of patients, for example, going down the COVID example, some COVID patients do well at home. But some need more urgent or more attention in a more acute phase or an acute setting. And so being able to figure out which treatment path they're going to go down, and again, it's about messaging them to figure out to track their symptoms and be able to identify amongst those who will need a more urgent set of treatments.

Physician's Practice®:A recent report by Luma health said that patients communications increased by at a factor of 37 between March 1st to April 5th.

While Dr. Ekram says that a lot of these communications correlated with those of this three-pillared approach, a lot of them likely related to figuring out scheduling.

Ekram: I think what we saw was that suddenly, you know, again, government mandate came on board and patients didn't feel comfortable, there was a lot of appointment cancellations that happened.

Some of it was driven by the patients and their not being comfortable and coming in, because, you know, they have their annual visit coming up. But you know, if I do it this month, or next month or three months later, you know, I don't really see why I need to do it now. And so you had a lot of patient-driven cancellations; but also, practices are close.

So they did mass cancellations for the next two to three days, or sorry, two to three months or weeks depending on which state you are and how dense the cover detection was. And so a lot of the communication that we saw was this peak around this kind of mass messaging around scheduling issues, telling patients, “hey, look, we're all closed,” or “we're closed, but except for these things that we're still offering.

We saw the reverse happen on the other side, where now they were mass-messaging patients and saying, “Hey look, now that we've kind of gotten over the big hump of the COVID infection, we are now looking at ways to open up. And so here are things we're offering more of now.”

It was basically a lot of scheduling and kind of informing patients about service lines that they had. And this kind of thing obviously didn't happen before. A lot of the routine communication that was happening kind of had to sort of shut down a little bit. And it was more of doing mass messaging to educate patients about the service lines that are available and service lines that are not, or if the practice is closed that day.

Physician's Practice®: During initial reopening phases, a big concern for many practices was how to communicate safety to patients to encourage a return for elective, though essential, procedures and check-ups.

Ekram says that, as practices are opening up, they are experiencing some patients that are very hesitant to return out of fear–but there are a lot of ways to encourage their return.

Ekram: One thing that we work on very strongly with our clients is that when you're messaging your patients about reopening, it's really important not just to let them know that you’re opened and closed and that's it. Let them know what you're actually doing to make sure that their safety is at the center of the focus.

There’s a lot of different ways of performing zero contact check-ins and being able to do as much of the process as you can while the patient is sitting in their own car. So we were offering a solution where, when patients arrived for their physical appointment, they can do a lot of that pre-appointment paperwork and things right in their car so they're not unnecessarily exposed by sitting in the waiting room. And then right when the doctor is ready to see them, the patient will get a message and the patient can proceed right from the car right into the exam room and not have to get any unnecessary exposure.

I think explaining these kinds of processes that you've put into place is really important. I've talked to a lot of folks from both on the east coast and the west coast and they've done a lot of surveys for patients, asking them if they are ready to comine. Most of it’s around routine checkups, and a vast majority of patients. And this is true for even in areas that are not impacted by COVID

They just don't want to take unnecessary risk, and particularly when the appointment is kind of like an annual wellness visits like an annual mammogram, where for the patient, there's no urgent need to do it today. And it can be delayed, so a lot of patients are delaying it. And so I think it's important for us when we are trying to get patients back in the door, that we educate them that we are doing things to help ensure that their exposure is low and that they can still get the health care they need without being unnecessarily put at risk of getting a covid infection.