In an increasingly competitive and consumer-driven healthcare environment, members of the executive team at Chapel Hill Pediatrics and Adolescents in North Carolina realized that they had a great resource at their fingertips — their Web site. At the same time, they recognized that they were not making the most of its potential as: a patient communication and education tool; a method for streamlining administrative processes; and, a strategic weapon that would give them an edge in a high-tech community.

In 2007, Chapel Hill Pediatrics successfully upgraded its Web site, working with an external vendor that provided technical direction and support. The practice also developed designated internal resources to ensure that content could be updated quickly in order to provide the most effective and responsive information to its patient base.

Problem

The Chapel Hill Pediatrics Web site was, by our own admission, antiquated. It was difficult for patients and staff to navigate, and failed to showcase even minimal information that might be interesting or valuable to patients. The Web site was also static and hard to update, so we were unable to quickly respond to emerging healthcare issues or provide timely information to patients and their families. Members of the executive team came to the conclusion that having an inadequate Web site was worse than not having one at all.

We discussed [with patients and families] the types of information that would soon be available, and provided overviews about how the Web site would make the patient experience easier and more satisfying because routine paperwork and administrative processes could be completed online.

At the same time, we were dealing with a number of trends that our executive team felt could be addressed with expanded Web site functionality. Over the past few years, triage nurses had noticed a distinctive upswing in the number of incoming phone calls that posed basic parenting questions: “How long should I breast feed my infant? Is a fever of 101 something to be concerned about? Can I send my child to school with a respiratory infection?”

Our staff speculated that this increase in basic questions reflected societal changes. Fewer young adults live in close proximity to their families of origin, for instance, and thus don’t have the automatic source of information (and reassurance) that previous generations did. Neighborhoods are not as tightly knit as they were a generation ago and unlikely to provide new parents with a network of veterans for support and input. Instead, parents turn to their healthcare providers for this information. As a result, our call center was inundated with routine questions during peak hours, making it difficult for triage staff to uncover truly urgent calls.

In the midst of these challenges and realizations, we discovered that an enhanced Web presence could offer great benefits. It could help patients to complete paperwork and submit routine requests online. It could serve as a vehicle for disseminating both routine and urgent education and information, which in turn would make parents true “partners” in their children’s healthcare. And it could promote the capabilities and services offered by our practice providers. Because of Chapel Hill Pediatrics’ location in the Research Triangle region of North Carolina, we recognized that presenting a high-tech profile was also highly desirable.

Solution

In 2007, our executive team established new goals for the Chapel Hill Web site. We wanted it to be user friendly, both for families seeking pediatric care from the group and for the staff who would be responsible for maintaining it. In addition, we wanted to ensure that all information was timely, and that providers could quickly address emerging issues and educational needs. This meant that no time or resources could be wasted during the process of updating or modifying the site. Finally, we wanted to relieve the volume of incoming phone calls, and provide online resources for patients to complete forms and pay their bills.

These objectives led us to search for a partner that would remove the burden of development from Chapel Hill, while enabling our internal staff to augment the site quickly and easily. We recognized that while our staff was expert at caring for pediatric patients, they had no aptitude for Web design. We quickly launched a search for professional guidance.

During the selection process, our clinical and IT staff networked with colleagues, and reviewed other pediatric and school Web sites (both of which were geared to resolve child-related issues). After several months of casual shopping, we discovered Medfusion, and were quickly convinced that the product offered was the best available and would be easy to manage.

Implementation

Our staff worked closely with the vendor to develop the functionality, content and graphic presentation of the Web site — always keeping their eyes on our main objective: to make the site highly informative and navigable for the patient.

A committee comprised of two physicians, one nurse and a member of the administrative staff collected information prior to the “go live” date. To encourage support and buy-in, each pediatrician contributed specific pieces of the content — the home page or answers to FAQs, for instance. The nurse and staff member were responsible for developing biographies for employees in their division. Vendor staff was available by phone to guide development and answer questions. Medfusion technical representatives then took the content created internally and built a Web site to our specifications.

During this period, our staff began to promote the Web site to patients and their families. We discussed the types of information that would soon be available, and provided overviews about how the Web site would make the patient experience easier and more satisfying because routine paperwork and administrative processes could be completed online.

Results

Almost immediately, we began to see increased traffic to the Web site and expanded use of online functionality. In June 2007, for instance, we logged 526 visitors to the site. In April 2008, that had increased to 1,806. The number of individual pages visited increased from 3,817 in June 2007 to 24,256 in April 2008 – and had risen to 95,379 near the end of May. Additionally, 183 new patient accounts were created in April 2008, as compared to only 70 a year earlier. In April 2008, 113 patients completed routine forms online, compared to 18 in April 2007.

[The original Chapel Hill Pediatrics Web site] was difficult for patients and staff to navigate, and showcased minimal information that might be interesting or valuable to patients.

The launch of the Web site has provided users with information that they would normally get from our “Advice Room.” Parents of patients phone the Advice Room and leave messages for our trained, experienced advice nurses. It takes these nurses considerable time to sort through all the issues to find the problems that need immediate attention. The Web site now contains basic and routine information — everything from immunization schedules, to parenting tips, to determining whether a fever is serious. Parents are using this resource and becoming more actively involved in their children’s care. They’re also turning to the Advice Room more often only for more significant clinical concerns such as questions about severe asthma attacks.

Now, when parents leave a message on the Advice Room answering machine, they are advised to check the Web site for relevant material. Often, when our nurse calls back, the parent already has the answer, and the nurse merely needs to hit the high points or fill in a minor detail.

Content on the Web site assists parents as they deal with chronic or recurrent issues, as well. When a child is diagnosed with seasonal allergies, for instance, parents are provided with comprehensive information. Shortly thereafter, the allergies might abate, only to recur the following year. In the past, parents might have forgotten what they were told about managing the condition. Now, they can simply access “refresher” information online. Concerns about tick bites are another prime example of recurrent concerns that can easily be alleviated through the Web site.

Beyond The Basics

The Web site did create one “Catch 22” late in 2007. When Merck announced its recall of 10 lots of Hib vaccine, we passed along the information on the Web site — recognizing that if any of our patients were affected, they would have already presented with symptoms. However, publication of the warning heightened parents’ concerns instead of alleviating them, prompting an influx of phone calls.

The Web site also allows parents to download paperwork that needs to be completed prior to a visit — such as registration and history forms, or developmental assessments. This saves parents significant amounts of time, and reduces wait times in the lobby and exam rooms. To encourage use of this functionality, our schedulers instruct parents about the online capability when appointments are made. When reminder calls are made, staff members again urge parents to fill out forms prior to the visit.

Patients can pay their bills online, as well, for greater convenience. This option has not been adopted as readily as other functions, however, with only 34 families paying online in April 2008 (compared to 14 in May 2007). We have not uncovered reasons for this reluctance.

The Web site also contains a news section to alert patients to emerging issues of interest — like recent warnings about over-the-counter cold/cough medications. We are also able to provide information regarding various community resources of interest to parents (e.g., seminars on raising teenagers, Internet safety and supporting special needs children).

Almost without exception, patients have been enthusiastic about the site and note that they are using it heavily as a resource. Our staff likewise believes it is providing superior information that will keep our “customers” better informed and healthier. To that end, we plan to expand our Web presence to make it even more consumer-friendly — offering more information and resources, as well as features like online prescription refills.

Kathy A. Merritt, M.D., is a pediatrician and Jill French is the advanced nurse educator at Chapel Hill Pediatrics, with offices in Chapel Hill and Durham, N.C. Contact them at [email protected]  or [email protected].