My experience with healthcare, Drupal, and webforms
For the past 20 years, I have worked in healthcare helping Memorial Sloan Kettering Cancer Center (MSKCC) evolve their digital platform and patient experience. About ten years ago, I persuaded MSKCC to switch to Drupal 6, which was followed by a migration to Drupal 8. More recently, I have become the maintainer of the Webform module for Drupal 8. Now, I want to leverage my experience and expertise in healthcare, webforms, and Drupal, to start exploring how we can improve patient and caregiver’s digital experience related to online appointment requests.
It’s important that we understand the problem/challenge of requesting an appointment online, examine how hospitals are currently solving this problem, and then offer some recommendations and ways to improve existing approaches. Instead of writing one very long blog post, I’m going to break up this discussion into a series of three blog posts. This initial post is going to address the patient journey and experience around an appointment request form.
These blog posts are not Drupal-specific, but my goal is to create and share an exemplary "Request an appointment" form template for the Webform module for Drupal 8.
Improving patient and caregiver’s digital experience
Improving the patient and caregiver digital experience is a very broad, massive, and challenging topic. Personally, my goal when working with doctors, researcher, and caregivers is…
Make it easier for patients to find the care they need as well as make it easier for caregivers to give the care that patients need.
Making things "easy" for patients and caregivers in healthcare is easier said than done. Healthcare systems are complex machines with multiple players dealing with different siloed technologies. Complexity in healthcare leads to a lot of frustration, which has become expected and accepted when entering into a doctor's office or hospital, or going online to file an insurance claim. The best way to make something easier is to simplify it.
Patients and caregivers want a simpler digital experience
In technology, the biggest disruptors of different industries share a commonality of making things simpler. Ride-sharing services, like Uber and Lyft, have disrupted the taxi and limousine industry by making it simple and easy to book-a-ride using a phone. In healthcare, services like ZocDoc, empower patients to book doctor appointments on a computer or phone. Healthcare systems and hospitals need to recognize that a simpler digital and in-person experience is what consumers want. Simpler digital experiences need to be thought about and provided by all aspects of a healthcare organization. Stepping back, we need to remember that digital is one part of a patient’s journey through a healthcare system.
Where does a patient’s journey begin?
There are dozens of doors that a patient may enter to get care; it could be a referral from a friend, an ambulance pulling into an ER, a banner advertisement, or a comprehensive search on the internet. Online searches inevitably lead to a hospital's website. A hospital's website is where many patients digital journeys begin.
A hospital's website is its digital entrance to the hospital
The notion that a hospital should envision their website as another entrance to the building gives people a tangible comparison for a patient's digital experience. The hospital should view the digital and the physical experiences as equally important. A hospital's lobby and website both need to be clean, organized, and easy to navigate. When a patient walks into a hospital or clicks on a link, we want them to know where they need to go as well as how to get the care they need. Both the website and the lobby need to have clear, straightforward instructions lest they find they have a frustrated and annoyed patient in their midst.
To get care, patients need to provide information about themselves; Who are they? What is wrong? Do they have insurance? The questions are answered using paper or digital form, which begins a patient's journey.
Forms are important to healthcare
Healthcare is driven by information. This information needs to be collected and stored. The more information that can be collected about a patient, the easier it is to provide them with the care they need. At the same time, it is also important to add that it is equally important to collect the "right" information about a patient at the "appropriate time." Obtaining the "right" information requires asking the "right" questions and collecting the most complete and accurate answers. Knowing when is the "appropriate time" to ask a question is even more challenging. For example, collecting a patient's entire medical history is not required to book a patient's first appointment. Many patient's digital experiences begin with an appointment form.
Knowing when is the "appropriate time" to ask a question is more challenging. For example, collecting a patient's entire medical history is not required to book a patient's first appointment. Many patient's digital experiences begin with an appointment form.
An appointment form begins or ends a patient's journey
Many years ago, while discussing the usability of some minor aspect of a request an appointment, I noted that:
If someone wants to request an appointment, they are going to fill out this form no matter what.
There is some truth to this statement because patients have lots of patience (pun intended) when dealing with healthcare. Would an unusable request an appointment form ultimately end a patient's journey? Probably not.
The hospital that provides the cleanest, simplest, and most accessible digital experience will distinguish themselves.
Appointment forms set the tone for a patient's experience with a hospital.
Types of appointment form
Booking an appointment online is not an easy task. Most hospital websites offer a "request an appointment'" form that collects a potential patient's contact information, which leads to someone calling the patient back to "schedule an appointment." Services like ZocDoc, allow patients to "schedule an appointment" without having to interact with a physical person. Even though we are primarily talking about a patient digital journey, we can't forget that people still pick up the phone and call to schedule an appointment. We should never underestimate the power of a phone call. For example, parents of pediatric patients need the caring voice of a live person telling them everything is going to be okay.
We are going to focus on a hospital's request for an appointment, which is used to collect the information needed to for a patient to schedule an appointment.
Recommendations for all forms
Before diving into healthcare specific forms, it helps to step back and understand what makes a form easy to understand and use. Drupal and the Webform module follows industry standard best practices around ensuring that forms are accessible to people with disabilities, available to mobile and desktop users, and provide a clean and predictable layout with standard error validation. For example, in the Webform module for Drupal, forms are laid out vertically with top-aligned labels, which have been shown make it easier for users to complete forms.
My top three general recommendations for building webform are
Keep it simple. This will reduce frustration and ensure that users will complete the webform.
Group and organize labels and inputs. The visual and information layout of a form matters. Grouping related inputs with proper labeling help users to understand what information is needed to complete a form.
Communicate what information is expected, required, and optional. Users need visual indicators that show how to complete a form and with clear error messages when data is missing.
Using the Webform module, or any other enterprise form builder, can significantly help when building accessible and usable forms. The challenge for a building a request an appointment form is asking the right questions using the best approach.
The best approach for a request an appointment form
Figuring out who is filling out the form should be the first question on any request appointment form. Knowing this single piece of information makes it possible to present the user with a form that asks the right questions. Once we know who someone is, a form can be customized, or we can direct the user to the appropriate form. For example, international appointment requests tend to require additional contact information, including callback times, which can be better addressed in a dedicated form.
Request appointment forms ask questions that lead to conversations.
Request an appointment forms are conversations
Appointment request forms result in a call back from a person, which results in conversation. Forms are essentially a digital conversation with an end user. Appointment request forms should start with general questions and lead to more specific information. The three questions that need to be answered are…
Who are you?
What brought you here today?
How can we help you?
Not surprising these questions are identical to what a nurse or doctor asks when in-taking a new patient. These questions lead to the collection of different types of information which can be organized into groupings. For example, the answer to "Who are you?" is mainly contact information and the answer to "What brought you here today?" is healthcare information. Appointment requests form should guide patients through the discussion about their specific health-related issue.
In-person, when a nurse or doctor asks a question, based on the patient's answer, they will choose which question should or should not be asked next. Online forms can provide a similar user experience by using conditional logic to hide and show questions based on previous answers. Conditional logic can also be used to determine which questions should be required vs optional.
If a request an appointment form is a digital conversation, nothing about this experience should be frustrating. We want to ensure that a patient can book an appointment. With this goal in mind, every appointment form should include a phone number that a patient or caregiver can call to schedule an appointment.
Once the conversation has ended via the patient submitting the form, make sure to confirm their appointment request. Then, tell the patient what to expect next.
How top US hospitals approach their online appointment request form?
My next blog post is going to examine how top US hospitals (ranked by US News) are handling online appointment requests. Before reading my evaluations and opinions, you might want to visit the Mayo Clinic, Cleveland Clinic, Johns Hopkins Hospital, and Massachusetts General's appointment request form and ask yourselves if I was a new patient…
How would I feel when filling out these request an appointment form?
Are these appointment request forms providing a good digital experience?
What type of patient journey would one expect at this institution?