Scheduling a Colonoscopy Shouldn’t Be This Hard

I recently hit a milestone birthday. Depending on whom you ask, I’m either “has a slightly better chance of qualifying for the Boston Marathon” years old or “needs to schedule a preventive colonoscopy” years old.

Fortunately, my patient portal happily reminded me of the latter. (I won’t say which portal it is, but I will say it rhymes with “Chai Mart.”) My portal even went a step further and surfaced a Request Appointment button.

“Hooray!” I said to myself as a classic borderline Gen X / millennial who likes talking to a stranger on the phone about as much as, well, getting a colonoscopy. I eagerly clicked the button.

My portal gave me three options for scheduling the procedure: My current PCP, my previous PCP, and my podiatrist. Now, all three are good doctors and lovely people – and not the least bit qualified to give me a colonoscopy.

There’s a cost of being too convenient

For years, keynote speakers have talked about making healthcare more convenient, much like many other industries. If you can order a burrito or plane ticket from your phone, the argument goes, then why not schedule an appointment?

I’d argue, though, that being too convenient does a disservice to the healthcare organization and the consumer / patient. The portal isn’t the ideal place to give patients free rein to schedule an appointment with anyone within a provider network, especially one as large as mine. (Again, I won’t name it, but it’s the one based in the Boston area that likes to spend a lot on both rebranding and construction projects.)

Limiting that functionality to providers with whom a patient has an established relationship is annoying, but it’s also a sensible business practice. What’s the business value of not just suggesting but making it possible for patients to do something they simply can’t and shouldn’t do?

If I tried to schedule a colonoscopy with any of those providers from the portal, it would probably trigger a six-step workflow that ends in some poor administrative staffer calling me when they should be eating lunch to recite a phone number that I could find after approximately 3 seconds of sleuthing online. (Finding the page with the phone number is one thing; scheduling the appointment is another. It took a while, but I got it done.)

More isn’t better, especially when it gets messy

I went through this experience as I started in earnest on my next eBook, which attempts to unpack the long and winding road for patient engagement technology over the last 10 years. (The timeline is only somewhat arbitrary; I made the move from journalist to research analyst in June 2015.)

There’s a duality at play here. On one hand, technology such as the portal is a lot better than it was a decade ago. It’s possible to schedule (some) appointments, log in for video visits, communicate with providers, view test results, and even link records from external sources such as your pharmacy. Each of those tasks used to require a different application or website, along with some combination of phone calls, CDs, faxes, and expletives. Some of this stemmed from portals developing these features natively; in other cases, they acquired the functionality from a once-burgeoning ecosystem of patient engagement point solutions.

On the other hand, there’s still a long way to go. For starters, more isn’t necessarily better. Just because I can do all that in my portal doesn’t mean I should, or that I want to. In fact, seeing a list of 20-odd things I can do is quite intimidating, especially if I’ve logged in with a very specific task in mind.

In addition, though there are clear benefits to having far fewer point solutions for patient engagement, we’ve lost a little bit along the way. For good or ill, those products were purpose-built to solve a single problem. They become homogenized once they’re folded into a portal trying to serve the needs of a patient population that may number in the millions.

The third issue is the general messiness of patient workflows. Effective technology needs automation, and automation is extremely challenging when workflows differ for quite literally every end user. Case in point: I called Large Affiliated Boston Hospital No. 1 to schedule my colonoscopy, only to find out my PCP has placed the order at Large Affiliated Boston Hospital No. 2, which then set up my procedure at Affiliated Boston-Area Outpatient Facility No. 13-A. (I think it’s near a Wegman’s. I may go there for lunch.)

Stop ignoring small problems with easy fixes, please

Here’s the thing. We can accept (albeit begrudgingly) that the workflow above is bewildering, and unlikely to be made simpler without systemic change irrespective of what technology is in place. But why do we have to accept that smaller problems with easier solutions have been largely ignored?

Let’s go back to the “Schedule a Colonoscopy” kerfuffle within the portal. If a patient clearly cannot go through with the workflow – in my case, not being able to receive a clinical service from my current roster of providers – then why not make that “Schedule” button go away? Or, leave it there but make it point to a page that says, “Hey, to schedule this procedure, you need to call this number?” Heck, I’d wager an error page would be preferrable for most users than a prompt to do something that’s straight up not possible. At least that way, the patient and the person they inevitably have to call on the phone can have a hearty guffaw at how the $1.2 billion EHR implementation can’t do something that’s laughingly basic and also a well-accepted clinical recommendation.

Is it extra custom coding? Yes. Is it difficult custom coding? At the risk of sounding like an overconfident and mediocre middle-aged white dude, I’m guessing it probably takes less time than it would take the provider organization and EHR vendor to get on the phone and argue over who, under their contract, is responsible for completing such work.

I know the industry isn’t going to solve the patient engagement problem quickly, with existing technology, and/or for the majority of patients, especially given the current reimbursement and regulatory environment for preventive care and the general state of balance sheets for digital health companies. Plus, let’s be honest: From patients getting kicked off insurance to funding streams drying up to the basic tenets of science and medicine facing an all-out assault, the industry has bigger fish to fry than ensuring a fairly seamless colonoscopy-scheduling experience for overconfident and mediocre middle-aged white dudes.

Still, when you hear leaders at all levels at all healthcare stakeholders talk about focusing on the proverbial low-hanging fruit in improving the patient experience – small fixes that could have a big impact – it’s hard to look at examples like this one and wonder why no one’s bothered to look under the hood.