From The Editor | January 8, 2013

Is Healthcare Entering An Era Of Technology Discrimination?

Ken Congdon, Editor In Chief of Health IT Outcomes

By Ken Congdon, Editor In Chief,
Follow Me On Twitter @KenOnHIT

Last week, in my column The ROI In Patient Self-Service, I described how Memorial Hermann is leveraging an online scheduling portal to provide patients with a real time view of available ER appointment times, allowing them to reserve a spot in line. This functionality provides a wealth of benefits to both the health system and its patients … well most patients.

This story immediately evoked a personal experience I had using similar portal technology. Following a recent physical, my doctor ordered some blood work. Nothing serious … just a simple lipid panel. I had to fast for at least 12 hours prior to the tests, so I wanted to make sure I got my blood drawn as early as possible in the morning to avoid having to go too long into the day without eating. I was pleased to learn that the lab in our area offered an online scheduling portal.

About a week prior, I went online and reserved an appointment time for 8 AM on a Saturday morning. I figured I’d stop eating after dinner on Friday night, wake up and drive to the lab to have my blood drawn the next morning, and grab some breakfast on the way home. If things went according to plan, I would barely even experience the hunger pangs commonly associated with a fast. It would be great.

And it was … for the most part. I arrived at the lab at my scheduled time. And, instead of having to take a “deli ticket” and wait for my number to be called to be seen, I was escorted right in. I didn’t have to sit in the waiting room … the already very crowded waiting room. What I didn’t anticipate was the reaction of the other patients (many of whom had already been waiting for quite some time) to my “red carpet treatment.”

As I was being ushered back to the lab, many of the other patients began to raise a stink. Some confronted the receptionist, demanding to know why I was being seen before them, even though they had arrived first. Some muttered that my race and background (i.e. the fact that I’m a relatively clean-cut, middle-aged, white man) must be the reason why I was being given preferential treatment.

The receptionist calmly explained to the angry mob that I reserved my appointment online, and that was the reason I didn’t have to wait. She also explained that any of them could have used the portal and received the same treatment I did. The response to this news was mixed. Some patients said they didn’t realize the lab offered a portal service and returned to their seats. Obviously, they felt they were now informed, and would take advantage of the portal the next time they needed to visit the lab. Others were still outraged. Some lamented about how they couldn’t afford a home computer, smartphone, or Internet access. How could they benefit from the service if they had no way to access the portal? These patients didn’t think they were being treated fairly. They felt discriminated against because they didn’t have the technology necessary to use the scheduling portal.

As the patient responsible for creating this uproar, I felt a bit guilty. In particular, there was a mother with her obviously ill infant daughter among the patients waiting. She seemed at her wits end, and since I wasn’t sick, I offered her my place in line.  However, the lab would not allow it. Both the receptionist and the lab technician thanked me for the gesture, but stressed the importance of strict adherence to the new policies. They felt disturbances like these were necessary to promote awareness and adoption of the online scheduling portal, which was a primary component of their ongoing operational improvement strategy.  

So, I sat down, had my blood drawn, and got breakfast on the way home as planned. The technology worked as intended for me. It provided me with the convenience and reassurance we all seek as patients. However, since the incident, I can’t stop thinking about those that felt slighted by the lab’s new procedures. Similarly, I can’t help but feel a bit sorry for the patients that walk into Memorial Hermann’s ERs with a serious medical issue, and are forced to wait while those who reserve their appointments online are given priority.

Technology is going to be instrumental in transforming healthcare for the better. It is going to improve patient outcomes and help lower costs. No one is a bigger proponent of this technological revolution than I am. However, I’m just beginning to realize that all of this technology still doesn’t provide an even playing field. The level of care people receive is largely dependent upon the ease with which they can access and use these new technology-based services.

Furthermore, I believe the disparity between the technology “have’s” and the “have not’s” is more pronounced in healthcare than it is in other industries. For example, those that can’t access online banking services can still go to their local branch to conduct their business and be treated the same as any other in-office customer. The fact that online banking customers are getting things done more efficiently isn’t as blatant as it is in healthcare where a patient that reserves an appointment online is seen before a series of walk-in patients.

Clearly, we are entering a technological era in healthcare, and culturally, we will all need to adjust. However, this transition may prove more difficult for specific groups of people (e.g. the poor, the elderly, etc.) than it is for others. Since technology is positioned to play such a large role in care delivery going forward, are we as a society obliged to ensure these technology-based healthcare services are more accessible to the masses (e.g. via free/inexpensive Internet cafes, etc.)? Or, do individuals with limited access to technology need to change their behavior to ensure they access these services? For example, even if an individual doesn’t have a home computer or smartphone, they can still log onto the Internet at their local library or FedEx Office to access patient portals and receive the same benefits. In any case, expect the technological revolution in healthcare to be met with opposition by specific segments of your patient population. The way providers manage this change with patients will be instrumental in their success.