I know I’m just one of many people who loves the website and app OpenTable. It has become the dominant service for potential diners to find open times and make reservations for a meal in the next few hours or in just about any major metropolitan area. I find all sorts of new places and experiences, and I can be confident in my foray into a new experience because of the dozens to hundreds of user reviews and ratings that accompany the search results. But as other industries delight customers with new technology experiences and disrupt sclerotic systems, health care is the last domain that still plods along using pagers and fax machines. Our hospital IT folks remind us that they put the NO in innovation.
But just imagine how amazing it would be for the health care industry if it wasn’t dragged kicking and screaming into the 21st century, let alone cutting edge technology. What if user interfaces in health care didn’t suck?
Beyond awaiting the next EPIC upgrade, which is always a promise on the distant horizon that we’re told will make us less inclined to put a gun in our mouths after trying to overcome its disdainful, sadistic current implementation, it is easy to envision a couple of easy ways to improve the UI for patient care and research, because we already have it in another setting. We just need OpenTable for physician visits and clinical trials.
Everyone is familiar with the archaic approach we still use for making physician appointments. A patient, caregiver, or referring physician’s scheduler calls a doctor’s office, is put into a byzantine phone tree or on hold for several minutes, then pursues a back and forth about whether that physician takes their insurance, has an open appointment in a timely interval, and (in some cases) whether their expertise matches the patient’s problem. For the patient or physician seeking clinical trials, it may be possible to root around Google for a relevant trial, but the cornerstone is the website ClinicalTrials.gov, which has an austere aesthetic that can at least be said to be more welcoming than its usability. If you can identify appropriate search terms, you are rewarded with a laundry list of trials that are not filtered for even whether they are enrolling patients or not, let alone geographic location or eligibility criteria.
If we just had “OpenClinic” for these functions, patients could specify the type of physician they are looking for, potentially with specific terms for an expertise of that physician. They could identify the geography in which they want to focus, along with an acceptable radius beyond that. Their profile could include their insurance provider and limit search results to physicians who are “in network” or those with an accept co-payment. Patients could see which physicians have available dates and times, along with ratings and reviews, details from that physician’s website (which could even include their training, CV, languages spoken, etc.).
In fact, the company Zocdoc and some other companies have initiated this effort, with limited success thus far. I think a key limiting factor has been that so many physicians are self-employed today, with most now employed by large networks that have not lent themselves to these efforts. If a few larger networks embraced this approach, I think it would help create a critical tipping point for the strategy and a windfall for the physicians and network that embraces the opportunity. An alternative setting that would facilitate a new tremendous utility for an OpenClinic is the disruption of the current industry by the oft-envisioned “Uber-ification” of health care in which physicians become independent agents no longer employed by health care systems, newly able to be found by an app that, like Uber, brokers the connection between patients needing a physician and the physician best able and available to serve them, whether with a live visit or a virtual one via telemedicine.
Another extremely valuable element of OpenTable, as with TripAdvisor, hotels.com, Amazon, and other “winner take all” (or at least most) online services, is that they have cultivated large enough user bases to have formed a critical mass of invaluable reviews that leave other users confident largely by the number of ratings creating a sense of confidence in their reliability. We should expect that if there are only 5-10 reviews of a physician, they are most likely to be a poorly representative sample of the broader patient population – instead, they are often a very polarized subgroup of a few patients who adore the doctor or had a very bad experience. Too often, these negative physician reviews focus on an unkind medical assistant or crowded waiting room, rather than the physician directly; it would be far more helpful to have more refined ratings that distinguish among the office staff, the office, and the physician interaction, just as OpenTable reviews invite separate ratings for food, service, and décor. Finally, whether coming from the app or the group it serves, it will be critical to encourage ratings from a MUCH greater proportion of the patient population, perhaps by reducing or eliminating the co-payment on the next visit or explicitly having the office or system clearly request a rating, good or bad, to help provide valued feedback for the future. The success of such an OpenClinic service would be predicated on the robustness of the collection of reviews received.
For trials, if sponsor companies and institutions could provide searchable eligibility requirements, treatment locations, and contact information, patients could complete a brief form to help clarify their medical setting and personal characteristics, then specific a disease or molecular marker, location and geographic reach, and “OpenTrial” could provide search return results that automatically compare the patient’s condition, prior treatments, other medical issues, and location with eligibility requirements and participating sites (there is a pilot effort called OpenTrials, spearheaded by Ben Goldacre that has a laudable but different goal of aggregating all of the data, published and unpublished, about clinical trials, but it is focused on learning what happened more than a great user interface for patients to find clinical trials to pursue). While this process would require the effort of setting up and uploading the relevant criteria for each trial, sponsor companies could save so much time and effort in enrolling eligible patients for their trials that it would accelerate the pace of new drug testing and approval for clinical use – a huge win for patients as well as the sponsor companies.
These services already exist in other settings, so these aren’t pie in the sky concepts. The right company developing this online service has the potential to become the huge, dominant player, the OpenTable of healthcare. Doing so would not only be great business but a great service to improve the efficiency of health care and clinical research.
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