Patient Transport Today
I was recently working with a Health Service envisioning the future of a Digital Health System. During the course of the workshops one of the delegates brought up a perennial, and somewhat controversial issue: Patient Transport.
Patients, mostly chronically ill, with little or no means to transport themselves to Outpatients appointments require this service, provided in the most part by Ambulance Services. But the service is not a smooth ride (pun intended).
For one thing there’s scheduling. Often there is little, or no, scheduling between the clinical staff and the transport service. Whiteboards don’t reflect clipboards nor rosters. Patient appointment times consider a clinician’s schedule, rarely transport windows.
This results in patients waiting either for their appointment or their lift home, sometimes for hours. Sometimes the driver has to wait for a consultation or treatment to conclude, delaying other patients in the bus. Sometimes, admittedly rarely, patients miss treatment windows entirely and have to return the following day.
For most of us, waiting for a couple of hours is a minor annoyance. One we kind’ve expect and plan for anyway when we have so much as a dental visit.
But imagine you needed dialysis 4 times per week. Or chemotherapy.
And this gets worse when a patient has more than one co-morbidity and need to see more than one specialist.
Then there’s the cost. Have you ever seen the bill for an Ambulance Service? It’s more than a taxi, and falls into a convoluted system of claims and gaps. Often this racks up bills you simply cannot avoid putting strain on cashflow even if you can claim it back later.
And that’s not looking at the cost to the Health Service. Wages, vehicle maintenance, insurance.
I learned that Ambulance Services often use part-time, contract, and even volunteer drivers for these transport services. Which adds additional burdens of payroll and rostering systems.
Haven’t We Solved That?
My initial thought was “Imagine we had an app that an outpatient could use to summon an available transport?” And of course, we have that app. It’s called Uber.
So my question is,
“Could Uber improve the patient transport service?”
Think about it:
- We remove the burden and cost from a stretched ambulance service.
- We provide more employment opportunities in the community
- The community (Uber drivers tend to live in areas they service) works together for the common good
- Hospital staff could literally see where patients are in transit and when they’ll arrive
- You could negotiate “frequent flyer” discounts
- There’s the granular, GPS tagged, time-stamped record of every trip that would drive down costs
- Uber would be providing a service for government, rather than disrupting government monopolies. This has to improve their governmental relationships.
And that is all entirely besides the “get transport when you need it, and only then” benefit that would go a long way to easing waiting times, scheduling and patient satisfaction.
As the payment account is registered on the system, Uber could easily build in an approval workflow whereby you can only order transport when you have an appointment. Cancelled or rescheduled appointments (by the clinic) automatically cancel or change the pick-up.
Another Tier of Service
Transporting a chronically ill patient is certainly not the same as a harried businessman. Some patients will need vehicles that can support wheelchairs, oxygen tanks, potentially IV’s. And many will need personal assistance into and out of the vehicle.
But so what?
There could be an UberHealth [(c) Roger Lawrence 2016 :-)] service that has higher criteria for vehicles and drivers. Perhaps even a tier that requires a driver and assistant.
The next question is,
“Why wouldn’t an Ambulance Service just write their own app?”
Which, as an idea is entirely reasonable.
Except it’s not.
Uber already have most of the technology available. They could literally turn on the service. Today. In fact for many, if not most out-patients, they could use one of their current tiers and just make a deal for the payment account.
Developing the technology is not trivial. In fact only a handful of companies have done this successfully. Because this is more than merely an electronic “ride hail” and payment system. It’s a real-time logistics service.
Another benefit is that Uber is global. So whilst outpatients visits tend to hub within a community, an Ambulance Service developed application would be local, regional at best. Uber could turn this on for an entire state, or country.
There are two that I can see:
1. Available Vehicles
Uber relies on serendipity. They offer their drivers maximum flexibility, and increasingly I ride with drivers that literally turn on the app twice a day. During their commute.
But after 10:30pm at Wellington Airport there are no cars available. (Ironically at 4am there are – go figure)
With something as critical as Patient Transport, you simply cannot have the system tell you “No cars available.”
2. No Pre-booking
I’ve mentioned this frustration before. It would be nice to be able to book my ride at the same time I book my flights. I can only imagine the anxiety of someone needing treatment having to wait until they leave to order their transport.
So Pre-Book With Data
Both of these are resolved by Uber simply knowing the demand (from the appointments system) and publishing this to their verified UberHealth(tm) drivers beforehand. Yes, pre-booking. But determined by the clinic rather than the passenger.
Out of the Box
Ok. I don’t think Local, State, or Federal Governments are going to approach Uber any time soon. Rather they’ll probably try to legislate waiting times and penalties for the already stretched services.
Services that are staffed by awesome people who do a great job with limited resources.
But what about licencing the technology? An Uber White Label?
The value of this is not simply reduced waiting times, better patient experience, reduced cost, and more employment. Over time Health Departments and Governments would be able to derive rich insights from the Uber data.
Everything from environmental impacts on chronic illness, to real-time congestion and traffic analysis.
Of course eventually this will all be driverless. Transport on demand. But we don’t have to wait for the vehicles, not to mention the legislation hurdles, to get to Transport-as-a-Service. Especially for the most vulnerable in our communities.
What do you reckon?