What We Have, Is a Failure to Communicate

Communication is essential to success. Telephones—even smartphones—are not communication; phones are tools that we use to communicate with patients, staff members, referring physicians, consultants, insurance companies, pharmacies, and—the list is virtually endless. We absolutely need good communication tools, but tools without skills and training are a waste of money.

Failure to communicate effectively yields poor outcomes, unhappy patients, and burned-out clinicians and staff. We have to develop good communication protocols and use these in a timely and effective manner. A user-friendly and powerful communications system ties all of these components together.

All too often, physicians, administrators, and certainly phone system salespeople refer to their expensive phone systems as communications systems. A true communications system is much more than the old-fashioned phone system or even a modern integrated voice-over-internet protocol (VOIP) computer-based system. In this column, we discuss the elements of an effective communications system and ways to fully leverage technology to improve outcomes and satisfaction.

Goals of Communication

The key goal of communication is timely and accurate information sharing, which is vital for patient engagement. Delayed calls and poor communication increase callbacks, waste staff time, irritate patients, and result in less effective care. Before purchasing a communication system, including devices and software or apps, decide how your practice wants to communicate not only with patients but also with staff, ancillary care groups, and referring physicians. Make sure whatever systems you purchase truly help you meet the goal of effective communication—accuracy and timeliness.

Building an effective team, in the office and with ancillary care groups, requires careful coordination and strong relationship building. Poor communication erodes teamwork and frustrates staff. Weave your communications system into the fabric of your team and include the staff in the system design so communication facilitates teamwork.

Designing a multifaceted communication system should improve communication speed and satisfaction, enhance care, improve your reputation, and decrease daily stress. Websites, social media, email, text messaging, and the phone system are component building blocks of an effective communications system and each should make it easier to share information. The cornerstone of communication, however, is still the office visit with in-person discussion and planning, and this must never be forgotten.

Communication Systems

Patients Can Love Your Phone System

The phone system is a disaster for many offices. Patients, referring physicians, and staff alike complain about these systems regularly. A fortune can be spent on an outstanding system with no guarantee it will be used effectively and efficiently.

In the good old days, each office had an operator to answer the incoming calls. Patients became familiar with this person as the voice of the practice. Calls were then distributed to the appropriate staff member. Voice mail was unheard of, and calls were answered in turn without prolonged wait times. Or at least is this the narrative we have heard time and again. Nostalgia is wonderful.

Even if that rosy view of the past represented reality, it would not be practical in today’s telecommunications-heavy world. The typical office receives several times more calls than a similar practice did just 20 years ago—and that’s not taking e-mails or text messaging into account. Our staff is also much more heavily burdened with bureaucratic paperwork. Having an operator who forwards calls or takes messages to be answered or responded to within an acceptable timeframe is, except in very rare cases, just not feasible. The trick is to leverage the more appealing and personal components of this approach within a modern medical communications center.

Depending on the size of the office, several modern phone system options are available and the advantages and disadvantages of each should be weighed carefully—there is no one-size-fits-all approach. A standard midsize office phone system usually has a multiline phone exchange (PBX). Another option is a VOIP system that routes phone calls across the office computer systems. The VOIP option has more flexibility and cost saving possibilities; however, the sound quality has only recently improved, and these systems are dependent on high-speed internet access.

Any of these systems can, and typically do employ the dreaded phone tree—a series of prerecorded messages that prompt users to press a specific number key when they reach the option they need. Many phone trees have multiple layers that leave patients feeling frustrated over the complexity of getting a simple answer to a common question. The fewer layers there are and the easier it is for patients to access a live person, the more acceptable they will find the experience. Of course, the easier it is for callers to reach a person, the more staff time is spent on the phone. Mediocre or poor design will aggravate anyone calling the office and can easily drive patients away. Every component of the system must be considered and optimized for the best user experience that still allows efficient, accurate, and timely communication.

A mixture of high technology, careful system integration, and foremost, thoughtful planning, can create a phone system that makes your office shine. Patients want to be able to call the office and quickly get answers for simple questions, order refills knowing they will be handled in a timely way, leave a message for nonurgent issues, schedule an appointment, or reach a person for complex questions that require conversation. Your clinical partners and affiliated team members want the same thing. No one wants to press a half-dozen buttons only to wait on hold for an indefinite amount of time. Although most people don’t mind recorded prompts or leaving messages, almost everyone has been in a situation when they wanted their important concerns addressed by a human rather than a robot. Simple tasks are better managed by advanced voice systems like those being developed by Magic Medical Solutions.

Likewise, everyone appreciates a timely response when they do leave a message. Try not to cluster your time for return communications at the beginning or end of the day. This leaves your patients waiting for answers and floods your staff with required next steps all appearing at once. Create times for returning calls throughout your workday.

If you design your communication system and protocols with the user experience in mind, your patients are more likely to have a good experience with your phone system. That good experience can equal multiple positive web posts and comments to friends—free advertising that cannot be matched. A good phone experience for the staff at referring practices will increase referrals while minimizing office workload. Your office will have some unique communication needs. A one-size-fits-all approach is unlikely to provide adequate answers. Much like treating Ms. Smith’s diabetes will not be exactly the same as caring for Mr. Brown’s diabetes, developing a communication system must be customized.

Advanced healthcare communications systems expand far beyond the phone system and website, linking users to secure communication with the staff and allowing information to be integrated into the electronic health record (EHR). Although such features require Health Insurance Portability and Accountability Act (HIPAA) compliance and significant security that requires investment, these advanced systems can create a more positive and efficient experience to increase revenue while controlling overhead.

Telephone systems for physician offices often seem to have radically inflated prices, but your answers don’t always have to be expensive. A VOIP system can be less expensive to purchase and less expensive to operate. The older systems had significantly worse sound quality than traditional phones. The newer systems have improved markedly.


Adding secure text messaging into your communications suite adds flexibility and speed. Although there are security issues with text messaging that need to be addressed, doing so is not as complicated as you might think or as some would have you believe. Using a HIPAA-compliant messaging application for sensitive communications is simple and as easy as standard texting.

Texting with staff to coordinate office functions enhances clinic efficiency. If names and other identifiers are avoided, traditional text messaging can be used for this purpose. If patient-specific information is being sent, then secure messaging will be necessary.

Chat Rooms and Chatbots

Some new corporate chat rooms are being certified for HIPAA compliance and medical practice use. These systems are far more than email and text messages—designed to organize workflow, centralizing all forms of communication within a single platform. Chatbots can be added to your website to answer simple questions and direct people to specific areas of your website (eg. neurologysleepmedicine.com). Chatbots are akin to the phone tree but may be more appealing because of the conversational interface. These systems certainly hold promise but should not be thought of as the complete answer.

The Answering Service

The traditional answering service is still ubiquitous. Almost every physician office forwards phones to the answering service at the end of the day and on weekends. Some offices even go on service during a lunch period. This is certainly a convenience for the office staff during the day. This method has been used for many years and has its benefits. It allows access when the office is closed. Unfortunately, it also places your practice’s reputation in the hands of individuals who are frequently overwhelmed and underpaid.

The standard call center is very inefficient. Calls are routed to the service. Patients may be placed on hold before the message is taken, transcribed, and sent to the physician. The message has various amounts of information of questionable validity. Then the physician contacts the patient to ask about the problem but may also need to retake portions of the history for context. On-call services need not be so tedious. In fact, they should enhance care and elevate the user experience. Intelligent voice technology fully integrated with the EHR can offer a powerful answer with improved user experience.

What We Need Now

We need systems that support efficient and effective communication—exchanging information accurately in a timely manner. We need happy patients who feel they have warm and strong relationships with the practice. We need the components of communication systems to be priced reasonably. We should not settle for less. Although there is no single perfect answer, there are powerful and cost-effective approaches that will produce an excellent user experience for staff and patients alike.

Use your website and the integrated social media outlets to improve your communication with patients and the community. Consider local and cloud-based VOIP systems and secure texting to speed interaction with patients, caregivers, and other providers. The phone system, texting programs, and the answering service all need to be integrated into the EHR platform to improve documentation and care while decreasing the workload.