Real-Time Revolution?

ARC Expanding Electronic Patient Feedback System After Successful Pilot Program

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Practice Management Feature — March 2016 

Tex Med. 2016;112(3):35-39.

By Joey Berlin

Austin Regional Clinic (ARC) physicians and officials know patient feedback is important, but getting patients to provide it can be a challenge. In fact, historically, ARC is lucky if one-tenth of its patients use the clinic's surveys to weigh in on the service and care they received.

But a pilot program of a new, real-time feedback system provided ARC patients a high-tech convenience previous attempts lacked and produced participation numbers dwarfing those past efforts. ARC's initial results with the system, in which patients answer five to seven questions on a computer tablet and can leave free-text comments, were so successful the clinic is already planning to expand it to all of its locations by the end of June.

Some physicians say the tablet-based approach is a harbinger of the future. But in the near term, questions remain about the cost/benefit balance for single clinics and smaller practices.

"I think what we see coming is much more interaction between patients and health care providers through the Internet and through technology," said Manish Naik, MD, an internal medicine physician at ARC's Cedar Park Medical Plaza, which participated in the pilot program. "Whether it's doing a telemedicine visit over the phone or over video or whether it's having a device that's measuring their pulse and blood pressure … to me, this electronic capture of patient feedback is part of that."

In-Room Wins Out

Lynae Harrison, ARC's electronic health records operations manager, says past approaches ARC took to gathering patient satisfaction data asked for input "way after the fact."

"The patient would either receive a call or they'd receive a letter or a request that was not in real time from their actual visit with the physician," she said.

The technology from Austin-based vendor Humm offered more immediate feedback. Humm started in 2012 by providing customer feedback technology for full-service restaurants that take reservations, seeking to fill the massive feedback gaps in traditional methods such as online reviews and comment cards. 

Humm took its technology to the health care industry in 2014 when it began a pilot program at Yale-New Haven Hospital in Connecticut. Since then, according to Humm Chief Operating Officer Scott Grubb, the company has also entered agreements with Partners HealthCare in Boston and Tennessee-based Saint Thomas Health and has initiated pilot programs with Indiana University Health and Texas Health Resources.

Mr. Grubb says the company aims to find "psychologically appropriate" moments when customers would be open to providing feedback. He says old-fashioned approaches traditionally garner input from just 1 percent to 3 percent of customers, and online reviews represent "probably a similar percentage" of an overall client base.

"If you think about it, if you're at a restaurant and you're checking out, that's the perfect twiddle-your-thumb moment to ask somebody about how their experience was," Mr. Grubb said. "And we're finding more of these perfect, psychologically appropriate moments in the health care space. People will never be more inclined to tell you about their experience than when they're in the moment, with their emotions at their peak."

ARC launched a three-month pilot program using the Humm platform in late June 2015. Each of the three participating ARC clinics tried the system with a different approach. At the Cedar Park clinic, patients provided feedback at checkout. At ARC's Pflugerville location, they provided the feedback on a tablet in their exam room. A third location, ARC Anderson Mill, featured a larger 10-inch tablet on kiosks located in different parts of the clinic. 

In addition to questions about the physician's performance, the ARC feedback platform asks patients to rate ease of scheduling and how helpful the staff was. (See "How Are We Doing?") Patients also had an opportunity to leave free-text comments, and the system can detect the sentiment behind the comments.

The three ARC clinics continued collecting feedback after the pilot project ended. Through early December 2015, ARC had collected patient feedback on about 6,000 sessions.

During the pilot, the participation rate among the three clinics was about 80 percent. Ms. Harrison says that's an extremely high rate compared with many of ARC's previous attempts, when "you would get 10 percent if you're lucky, maybe 15 percent."

"Now we are cognizant of the fact that it was a new policy and [with] something that's new, at the beginning everything's really great, and everybody's trying to get that feedback session, but over time that will diminish," Ms. Harrison said. "But we're still very excited about the 80 percent, and if it only goes down a little, then we'll be very happy."

The real-time aspect of the system means when scores fall below a certain organization-set threshold, designated members of the organization receive an alert. Those alerts are configurable so members of a certain department at a hospital or clinic can choose to receive only alerts that apply to them. For example, a clinic's environmental services team could choose to receive only alerts about negative feedback on the cleanliness of the clinic.

At the beginning, Dr. Naik says, the tablet system made physicians and staff at the pilot locations nervous.

"There was a little bit of reluctance when we first presented the concept," he said. "But as they started to do it, and they just started to see the kind of feedback that was coming back, it was actually very well accepted. Once they got rolling, they were very excited; they wanted patients to give them feedback."

ARC intended for the pilot to measure not only how many patients participated but also which of the three presentation styles would be best to implement. ARC concluded it will ask patients to provide feedback in the exam room at the end of their visit.

Ms. Harrison says at the beginning of the pilot, ARC was hesitant about the in-room option because of uncertainty for how long it would take the patient to deliver feedback and leave the room. The average session time is just 26 seconds, she says, and patients giving feedback in the room were more likely to use the free-text option to leave comments.

"Then from a patient standpoint, just from a comfort level, sitting in the lobby with a device in your hand or even standing at a kiosk, it's a little awkward," Ms. Harrison said. "We felt that maybe the patient wasn't as comfortable leaving data or was just trying to hurry and get it done and then be able to leave. Whereas in the room, they have a little bit more privacy; they've been there for a little while. They're already comfortable with the space, so it just felt like we got a truer response from them."

Considering Cost and Value

While traditional pencil-and-paper feedback methods are staples of health care operations small and large, one big question is whether a higher-tech feedback option is affordable for a smaller practice.

Mr. Grubb says Humm's pricing is customized according to each clinic's needs, but it generally includes three components: a one-time setup fee, a monthly subscription fee, and the cost of the hardware. 

He says Humm has starter packages for single-location, single-physician clinics starting at $99 per month, while some larger, multilocation clients pay around $800 per month for Humm's full-feature set.

Other health care vendors offer their own versions of real-time patient feedback options. Press Ganey Associates' Point of Care survey product, for example, allows patients to submit feedback from any mobile device while they are still at a visit, according to the Press Ganey website, The company declined to provide pricing guidelines, saying through its marketing agency that it often bundles its products.

Eric Weidmann, MD, a family physician at South Austin Medical Clinic, says smaller clinics should examine the feedback platform's return on investment (ROI). Dr. Weidmann, a member of the Texas Medical Association Council on Practice Management Services, says South Austin Medical Clinic has traditionally collected "completely paper-based and low-tech" feedback for two quarters per year.

"We've used two different systems that we've tested briefly, tablet or online surveys, and decided that since our volume of data sampling was so darned small, it was just not worth tooling up for a series of 50 to 100 survey results per year," he said.

Dr. Weidmann says the percentage of patients who participated in the clinic's paper-based surveys has been well below 50 percent, but he says the written comments patients leave are useful for the clinic to take as constructive criticism. The rest of the survey has been somewhat helpful, he says, but mostly validates what Dr. Weidmann and his colleagues already knew about their customer service. As a smaller shop, he says, South Austin has a good sense of what its clientele is experiencing.

"We feel how the day goes," he said. "When you're a larger or multisite clinic, one has less feel of what is happening with other areas or sites until you get metrics coming through. So [for us] survey analysis gave us a few comments that [showed] … we're having some rough spots, bad days, and that was useful."

Dr. Weidmann says his practice isn't tightly focused on profit or satisfaction scores but has to "have a sustainable business, so I have a very practical approach to this." If an electronic system improves the practice's patient satisfaction scores, he says he'd need to see the tangible effect in quality of care and/or economics.

"There's a perspective for our established practice that we're busier than we can handle," he said. "Would I like to do better at customer service and hear and feel some feedback? Yes. Is that worth any money to me? You've got to show me the ROI. It doesn't sound useful for my operations; let's put it that way."

San Antonio rheumatologist Chelsea Clinton, MD, chair of the Council on Practice Management Services, says as long as it's affordable, an electronic review system would be a good method to gauge patient satisfaction.

Using her own written feedback system in the past, Dr. Clinton says she offers patient surveys periodically, rather than throughout the year.

"For patients who come in for follow-ups, when the option to write another review is made available to them, they often say, 'I wrote a review last time,' and they choose not to write another review," she said.

She says the benefits of the tablet system could include early resolution of patient grievances and enhancing patient care while reducing the likelihood of unexpected complaints later.

"When patients are provided the opportunity to express dissatisfaction with an experience, it makes the patient feel that they've had a more satisfying experience, and it also provides the clinic with an opportunity to improve," she said. "Sometimes with these surveys, clinics might find that there is something that can be changed very easily that they have been missing."

"Ongoing Need"

Dr. Clinton says electronic customer service surveys are part of the future of health care.

"Medicine is, at this point, not just a physician treating a patient; it's also about customer service," she said. "I think that a way to ensure practices are providing customer service will be necessary to implement in the future and that this is a good strategy to implement that."

Platforms like the one ARC has adopted can potentially help practices earn better standing and payment incentives from the Centers for Medicare & Medicaid Services (CMS). 

CMS uses Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient surveys for various quality programs, such as the Physician Quality Reporting System. For more information on the use of CAHPS surveys in CMS evaluations, visit

Humm isn't yet a CMS-approved vendor but is planning to begin earning CAHPS certifications. 

As of Dec. 1, 2015, CMS listed 14 approved CAHPS for PQRS vendors on its website.  

CMS releases the results of its patient experience surveys to the public; for more information, visit

Dr. Naik says he envisions an eventual extension of ARC's feedback system to the clinic's online presence.

"There's no question in my mind that this [feedback] will be an ongoing need, and I think it will become more public-facing data," he said. "Meaning at some point, what I envision we do is, we have basically kind of a running live feed on our website of the reviews that we're getting."

He says he can see good data from patient reviews leading to rewards for the physicians and other clinic associates who earn raves.

"In a group where you're trying to build a practice, you're trying to attract new patients to your medical group; those folks who are real patient pleasers bring more patients to our group and improve the business," Dr. Naik said. "There ought to be recognition for that, just like there ought to be recognition for taking good care of patients and meeting clinical quality metrics."

Joey Berlin can be reached by phone at (800) 880-1300, ext. 1393, or (512) 370-1393; by fax at (512) 370-1629; or by email.


How Are We Doing?

Items on Austin Regional Clinic's electronic patient feedback system include:  

  • Rate how easy it was to make your appointment.  
  • Rate the helpfulness of the staff in general.
  • Rate the helpfulness of the doctor's nurse or medical assistant.
  • Did the doctor provide you with the care you expected?

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