Case Study:
Urological Physicians of San Diego

UPSD Captures Diverse Benefits from Innovative Approach to Using Its Internet Platform

September 2008

Summary

Urological Physicians of San Diego (UPSD), a three-physician group in a highly competitive market, achieved a wide range of benefits to their practice by going beyond a practice website to create an on-line Internet platform. Working with NorthPoint Domain, UPSD created a web presence that projected the image desired by the physicians, increased administrative efficiencies, and enhanced the quality of clinical encounters. With the help of the Strategy & Implementation consulting services available from NorthPoint Domain, UPSD was able to focus on achievable objectives, develop and implement a project plan that made efficient use of physician and staff time, and optimize workflows to make effective use of web-based tools and interventions.

1. History and Initial Steps

Urological Physicians of San Diego is a three-physician urology group in a highly competitive Southern California market. Led by Evan Vapnek, MD, UPSD focuses on operative urological care in laparoscopic surgery, endourology, and open urologic procedures. UPSD worked with NorthPoint Domain to develop their practice website, serving as their e-Storefront on the Internet — highlighting key areas of differentiation and focus to referring physicians and patients in the community.

The UPSD site promotes the practice with information that highlights key capabilities and presents the physicians’ philosophy of care — areas of clinical specialization, physician backgrounds, educational information for consumers and patients, and logistical information such as directions and contact information. With NorthPoint Domain as a partner, UPSD was able to work with a company focused on urology and committed to providing excellent turnkey service. NorthPoint Domain’s approach enables specialty medical practices to build and maintain a high-quality website, and use their Internet presence as a platform to make the Internet an integral part of the patient care process.

The initial step of this transformation was to build an e-toolkit for the practice staff — creating a more efficient way to provide callers with routine information and documents such as address, driving directions, pre-visit forms and procedure instructions.

Just as they are committed to improving their clinical capabilities to provide the most excellent care possible, the physicians of UPSD are also committed to doing all they can to provide the best possible patient experience while coping with the ever-present pressures to control costs and maintain efficiencies. Working with NorthPoint Domain to include the right e-Tools in their website design, and making use of the website part of the front desk routine, enabled UPSD to meet this goal.

2. Beyond Marketing and Promotion

Looking for the next stage of Internetdriven improvement for their practice, Dr. Vapnek met with his local NorthPoint Domain Strategy & Implementation Consultant and learned about the opportunity for e-Interventions — using the NorthPoint Domain features in the UPSD website for information-based “Interventions” for a more patient-centered approach to care.

With this approach, UPSD would be able to reach out to patients via the Internet as soon as they schedule their first visit, and throughout the rest of the care process, using the website as a platform to exchange information with patients, making them more active, well-informed participants in their own care.

The NorthPoint Domain Consultant collaborated with Dr. Vapnek and the UPSD staff to develop a plan to use e-Packets — NorthPoint Domain’s tool to engage patients with information tailored to specific conditions and moments in the care continuum, customized for each patient’s individual needs. Recognizing that a busy medical practice can only absorb a certain amount of change at a time, the UPSD plan was designed to achieve specific, realistic goals. Dr. Vapnek and the Consultant agreed to target specific patient groups for e-Intervention and to focus on a specific component of the patient workflow — pre-visit paperwork — rather than re-engineering an entire process. This approach would likely provide the biggest “bang for the buck” by making implementation manageable while simultaneously touching several different aspects of UPSD’s operations.

3. Implementation

The NorthPoint Domain Strategy & Implementation Consultant worked with the UPSD staff to implement the agreed plan. They defined the contents of e-Packets for general New Patient Paperwork, as well as specifically for new patients coming to the practice for Erectile Dysfunction, Urinary Incontinence, and Vasectomy. As part of the process, UPSD decided to update their pre-visit documents — Medical History, HIPAA Notification and Acknowledgement, and Consent Forms. These were converted to PDF files so they could be included in e-Packets. In addition, the Patient Registration form was converted to a web-based electronic form so patients can submit information from home (or anywhere else they have Internet access) using NorthPoint Domain's Secure Messaging Center.

To enable UPSD to use e-Packets effectively, the NorthPoint Domain Consultant worked with the practice staff to identify the key workflow steps where Internet-based interventions would be most valuable, and trained individuals to use e-Packets in their daily routines. More important, Dr. Vapnek plays a visible role in reinforcing UPSD’s commitment to this new approach. When he observes someone missing an opportunity to take advantage of e-Packets or the other web-based tools available to them, Dr. Vapnek reminds them there’s a better way. As Dr. Vapnek explained, “Changing how people do things takes some time. They need regular reminding that there is an alternative way of doing things, but once they see its value, their interest picks up.”

To add to Dr. Vapnek’s coaching, the NorthPoint Domain Strategy & Implementation Consultant is able to track UPSD’s use of e-Packets remotely, and follows up with the practice via telephone calls and on-site visits to reinforce the use of e-Packets and provide supplemental training when needed. NorthPoint Domain's Member Services Advisor is also available by telephone for routine support and assistance to UPSD’s staff and patients.

4. Outcomes

Most organizations look to a website as a promotional tool, making themselves visible to consumers who use the Internet to find information about a particular subject. By going beyond the e-Storefront, Urological Physicians of San Diego has realized benefits from their website in several different dimensions of their practice. UPSD has used their website not only to make information available with a highquality look and feel for patients, but also to reach out and establish a perception of innovation and sophistication. Making the website part of the routine workflow has generated operating efficiencies for the administrative staff, and enhanced the experience for patients in the office and outside. Finally, and perhaps most significant, the e-Interventions based on NorthPoint Domain’s e-Packets capability has enhanced the clinical experience for patients and physicians.

Practice Image and Marketing: The UPSD website is a high quality e-Storefront, giving visitors a clear understanding of who UPSD is, the areas of urological care they specialize in, their patient care philosophy, as well as the typical logistical information website visitors expect. NorthPoint Domain’s turnkey approach helps to ensure that that the site remains up-to-date with prompt implementation of changes requested by the practice, as well as features like regular updates of urology-focused medical news provided by NorthPoint Domain. But by working with NorthPoint Domain to take their web strategy to the next stage, UPSD has differentiated themselves from other practices. While many medical practices have developed attractive websites with good information, UPSD uses e-Packets to reach out to patients from their very first contact with the practice. “Patients absolutely notice the technology sophistication,” observed Dr. Vapnek. And, he said, in UPSD’s competitive market, “It lets a small practice project themselves as a larger organization.”

Staff Efficiencies:

With the launch of their practice website, UPSD began treating it as a repository of e-Tools, a place the staff could send people to for routine information such as driving directions, standard forms, FAQs, etc. The website is promoted on the practice’s telephone greeting message and where possible, callers with simple questions are referred to the website for answers. This has helped with call volume, and enabled the front desk and scheduling staff to handle telephone calls more quickly and efficiently. Better service for people on the telephone has also improved service for patients in the office. As Dr. Vapnek observed, “Everyone is better served if you can finish a phone conversation a little faster when a patient is standing there waiting to check out.”

Taking the next step to e-Interventions with NorthPoint Domain e-Packets adds a new level of staff efficiency and patient service for UPSD. In less than a minute, information can be delivered to a patient electronically, and the e-Packet’s standard set of information can be easily tailored for each specific patient at the point of contact. The patient receives a non-confidential notification email almost immediately, and can log in to the UPSD website for confidential access to their documents and information at their convenience. This saves on costs and staff time for printing and mailing documents out, and puts important information in the patient's hands right away.

While each of these improvements look small, they have had a big cumulative impact. “All the little, routine things you do on the phone that may seem trivial really add up,” said Dr. Vapnek. “We’re a small practice of three physicians, but we have big volume. Improving efficiency in the front office has been an important step in making our operations smoother.”

Physician and Patient Experience:

In addition to efficiencies for the staff, patients and physicians have also benefitted because UPSD now uses e-Interventions to begin the care process before patients arrive at the office. This patient-centric approach of engaging a patient at home to prepare for their appointment, instead of using a waitingroom clipboard, improves clinical quality and patient satisfaction.

Completing pre-visit forms at home can help the patient provide better information — as just one example, they can check the medicine cabinet if they don’t remember the name or dosage of a medication they’re taking. In addition, having patient forms filled in ahead of time can reduce or eliminate the difficulties created when a patient doesn’t have long enough to fully complete their paperwork in the waiting room, or takes too long and disrupts the schedule. And doing paperwork in advance is more convenient for the patient. “Patients like not having to come in early tofill out forms in the waiting room,” Dr. Vapnek observed.

Perhaps most significantly, UPSD’s clinical encounters have been enhanced with the use of e-Interventions. For Dr. Vapnek, building a website with clinical education information was not one of UPSD's objectives. “We don't need to be another WebMD,” he commented. But Dr. Vapnek observed a new level of knowledge in his patients after UPSD started using e-Packets to proactively interact with patients using clinical education and other information tailored to that individual’s particular condition and stage of care. New patients started coming in with a better understanding of their disease. As a result, “I’m not starting at square one with those patients,” he said. “You can start sooner talking about their specific situation, so it's much more efficient.”

UPSD’s experience reflects the difference in impact between good quality educational information offered on a public website without physician intervention; and good information selected for a specific patient, delivered individually from the patient's physician, and accompanied by opportunities for the patient to respond and interact. The importance of these communication characteristics has been well documented in the scientific literature of health communications and other fields, and adopting these principles has resulted in more satisfying consultations for UPSD patients and better overall relationships with their physicians.

5. Follow-up and Future Objectives

As Dr. Vapnek and Urological Physicians of San Diego know, a medical practice website should be much more than an attractive electronic brochure. Building on the benefits they have already realized, UPSD will be making plans to use their website as a platform for further patient-centered initiatives to enhance administrative efficiency, patient satisfaction, and clinical quality. Among their goals for the future are:

• Gaining further administrative efficiencies by steering more routine inquiries to the website and encouraging greater use by patients of the NorthPoint Domain Secure Messaging Center for non-urgent confidential communications.
• Using the Secure Messaging Center to let patients submit medical history forms electronically.
• Sending patients their test results with Secure Messaging Center.
• Differentiating UPSD and strengthening relationships by promoting the practice website and its capabilities to referring physicians.
• Using the UPSD website and Secure Messaging Center to collect Patient Satisfaction and clinical follow-up surveys.

Using web-based tools to collect e-Intelligence provides an entirely new array of opportunities for a specialty practice. Clinical follow-up data can be used for improved coordination of care for patients and better relations with referring physicians, as well as for evaluating a practice’s overall clinical effectiveness. Patient satisfaction data can document the impact of process improvements, and identify areas for new initiatives. Both types of data can equip a practice to participate more effectively in the growing number of pay-for-performance and related programs that will play a larger role in future contracting, credentialing, and reimbursement.

6. Lessons Learned

Each of these next goals could be a significant project for UPSD, or for any medical practice. But UPSD's experience demonstrates a number of important factors for successfully achieving change.

Don't tackle everything at once.

Be careful how much you try to accomplish at one time. Medical practices are very busy operations, and people have a limited capacity for absorbing change. If you are making major changes, divide the project into a series of sub-projects that are more achievable. Remember that the first stage of a project is often bigger than you expect. People may not be accustomed to changing long-standing procedures, and they may also need to learn how to use new software and other tools. Overcoming those hurdles at the beginning will pay dividends in later stages of a large project, or even in somewhat unrelated projects. Success breeds success, and if the staff is successful with one project, the next one will be easier.

Set specific goals.

Make sure you know what you want to accomplish, and how it will benefit the practice. Having specific metrics can give you a way to monitor progress and enable you to identify when you’ve succeeded. Also, if the staff understands the rationale and expected outcomes for a project, they can see when things are going in the right direction and will be more motivated to contribute to the project’s success.

“Change Champions” are essential.

Champions are required at two levels to make change successful. First, an executive champion will show the entire practice that the project is important and should be taken seriously. This can occur with a project kick-off meeting led by the senior members of the practice management and staff. For a project occurring over an extended time, regular status updates involving senior leadership will reinforce the message of high-level support. Second, a day-to-day champion such as an area supervisor or manager needs to provide regular coaching and counseling to make sure that change is taking place in the daily operations. Staff members who take a strong interest in a project can often make the best day-to-day champions with their peers.

At a small practice like UPSD, Dr. Vapnek was able to fill both roles. As one of the three physicians in the practice, his support and involvement made it clear the new UPSD website and the use of e-Packets were important projects. On an operational level, Dr. Vapnek reminded individuals about the new resources at their disposal with informal comments in the course of his regular interactions with practice staff.

Have realistic time expectations.

Change takes time. Take the time up front to plan your project, and do the advance preparation. It will take people a little while to learn new ways of doing things, and to make them established routine.

Two or three months is a good timeline for a project — long enough for proper planning and to let changes take hold, but not so long that momentum is lost. It also takes time for new ways of doing things to become fully ingrained in people’s habits. Make sure people have the opportunity to climb the learning curve successfully, and find ways to provide support and encouragement along the way. Even after a project is “completed” the need for coaching and guidance is likely to continue, so the job of the project change champions should continue, at least unofficially.

Use the right external support:

Outside help can provide expertise and resources that many practices do not have internally. An outsider’s perspective can bring a fresh eye to identifying opportunities for improvement, and ideas for making change.

An external consultant can also focus on keeping a project on track, pushing for completion of required tasks, providing guidance and support to management and staff, not to mention providing an additional set of hands to assist with the project specific work that practice personnel cannot accommodate in their own workloads.

7. Conclusion

Urological Physicians of San Diego has achieved a broad range of benefits for their practice — clinical, administrative, and marketing — by realizing that their website was a platform for making the Internet an integral part of their workflows.

More important, they acted on their realization with a carefully planned approach, and the knowledgeable guidance and support of NorthPoint Domain. As a result, the stage is set at UPSD for further gains in efficiency and competitiveness based on innovative uses of their practice website and the Internet.

Expertise