Wow- now that is the billion dollar question! We have transitioned to a new, arguably more demanding E H R within the last 14 months requiring additional documentation by all care providers and frankly many believe that it has only slowed things down and NOT improved care. We are struggling to demonstrate the added value to our providers outside of ease of external reporting of measures, compliance and ease of billing. As a research organization, our hope was to extract large amounts of clinical data to enhance clinical research and that has proven far more difficult than initially planned- further undermining support for the new E H R. My only suggestion is to identify quick wins in specific areas where documentation has clearing improved safety (e.g. near miss) or improved care and showcase those events. Hopefully, you can develop a small core group of supporters who will influence the remaining providers toward a tipping point of wide spread adoption.
We have piloted this and hope to increase its utilization, however like you have found that the more complex the medical visit the less likely the patient is to be comfortable with the kiosk. For routine or simple visits (e.g. lab draws, f/u visit, chest x-ray) is can help with registration, but if the patient has multiple visits on the same day, or many questions, or a complex issue , it has not been of much help.
I love the strategy of medical tourism if your organization is in a position to provide higher value healthcare than the competition. Either your outcomes are better, or your cost structure is lower, or both. The logistics can be a challenge, but the financial rewards can be very, very good. Many large US Centers have competed for medical tourists for many years, however, these have historically represented extremely high net worth individuals who can pay retail cash rates that are staggering. As the out of pocket costs for healthcare increases in many western countries, the market for medical tourism is expanding and will likely include those patients of much more modest means. It is not unthinkable that many elective surgeries from cardiac to orthopeadic may go the way of medical tourism–this pie will definitely increase. A organization can likely learn from those who have provided care to both the wealthiest in the world as well as the Medicaid population in the same facility , albeit on different floors! Undoubtedly , cash paying medical tourists will have different expectations than those who are receiving subsidized national care, but the organizational and logistical changes required to meet these expectations are not overwhelming and may be well worth the investment.
We have had the same experience. Super specialized providers who only see a limited subset of patients, and often expect those patients to undergo prescreening by other (RN or APP) that further complicates online or patient driven scheduling. Frankly, we have only had success in a very limited number of screening and simple scenarios (e.g. mammography, skin cancer screening check). However, discussion has started to put the burden of the solution on the providers– within this section/division/group of subspecialists they need to create a coverage model whereby they provide certain inpatient/outpatient services with consistency. Once this has been completed (currently in process), they then would be expected to create outpatient scheduling templates to reflect those visit types and open these online to patients (likely will be a pilot in one of our more innovative centers).
Is it possible to ‘virtually’ connect the rural and urban environments? We have had some success with rotating staff in the organization so that the rural folks have the opportunity to spend time and develop relationships in the urban center, then keeping them connected via web conferences and multi disciplinary care conferences done remotely. This has increased the professional satisfaction of those in the rural areas , and also improved the care provided in the more remote locations.