Rules of engagement

Adopting new technology and communication tools is crucial to patient engagement—as long as you don’t lose sight of what your patients want and need.

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By Jennifer Lubell, AOA Focus, October, 2014, pages 39-45

When optometrists think about modernizing their practices, they don't necessarily turn to the habits of teenagers for insight.

But perhaps they should, says Alan Glazier, O.D., CEO of a four-doctor practice in Rockville, Maryland. ODs who want to improve how they engage with patients can learn a lot from young consumers.

"Whatever the 16-year-olds are adapting gradually finds its way into the community—and to the patients," says Dr. Glazier, the founder of "ODs on Facebook," a social media group including more than 12,000 eye care professionals.

Many ODs have come to realize the need to get Internet savvy. They've learned the importance of earning a prime spot in Google searches, of reaching an audience on social media, and of simply keeping pace with the latest in communications tools.

Dr. Glazier knows this firsthand. His practice currently has a strong presence on Facebook, Twitter and LinkedIn, plus a YouTube channel and a blog on his website. But he also advises ODs to pay attention to smaller but emerging social tools such as Snapchat, Instagram and Vine . Each small effort contributes to a larger digital presence that makes you more visible to both current and future patients.

Other ODs agree. "Electronic technology gives us much better access to patients, and you can tailor communications and marketing to a population group or patients with certain conditions," says Morris Berman, O.D., M.S., chair of the AOA's Ethics and Values Committee.

On the other end of communications, patients have become much more comfortable with new formats, such as text messages or emails that remind them of appointments. More and more patients expect to be able to use tablets and smartphones rather than landlines and letters to communicate with doctors, Dr. Berman says.

How do patients want to hear from you?
In the shift in practice communications, patient preference is a major factor.

Dr. Glazier recommends collecting patients' email addresses for communications but also asking permission to use newer tools such as text-messaging systems.

"Many people prefer text over email," he notes. "And [optometrists] should find an efficient way to use these tools maybe one of the free tools like Genbook, an online appointment scheduler—to get started."

In addition to Genbook, there are numerous customer communications software tools available, such as Demandforce, WebSystem3, Solutionreach and 4PatientCare, Dr. Glazier says. What system a practice chooses will vary, but the idea is similar: Text- or email-based reminders prompt patients to take action, such as booking an appointment.

Chad Fleming, O.D., who practices in Wichita, Kansas, uses a system that sends out email reminders for appointments and notifies patients that their contact lenses or glasses are ready for pickup. "The system also gives us the opportunity to text them if they approve of us using texts to communicate with them," says Dr. Fleming.

A staff member who works in Dr. Fleming's office says the process has made it more efficient for patients to pick up their glasses or contacts.

"The majority of patients have appreciated receiving a text message, letting them know that their glasses and/or contact lenses are ready to be picked up," says Jeanne Grieser, an optician and contact lens specialist. "Many people have their cell phones easily accessible and we are communicating with them where they are, instead of the patient going home, getting a message, then having to wait until the next day to get their glasses or contacts."

If patients don't pick up their orders within two weeks, the office manually sends a reminder text, "which is successful in getting the patients into our office within one or two days," adds Grieser.

Christi Cupp, Dr. Fleming's front desk receptionist, says patients find the e-communications helpful when they're scheduling appointments a year in advance. Automated reminders are sent a month ahead, then again a day or two ahead of appointments.

Such tools have been phasing out the need to send out patient appointment reminders on postcards. After testing various communication methods among his patients, Nathan Bonilla-Warford, O.D., who owns an optometry practice in Tampa, Florida, says results seem to confirm they prefer the ease and efficiency of electronic reminders and confirmations.

His practice has used electronic records and text message and email reminders for several years now. "To make sure we weren't missing anyone, we went back and added actual letters to see if it made a difference," he notes. "What we found, at least for our practice, is it was not worth the time and expense of printing and postage."

Electronic reminders also help to modernize the look and feel of a practice, Dr. Glazier says. "It says something about your whole practice, how you're presenting yourself." Patients under the age of 45 will especially appreciate a more modern approach—and they'll respond to it, he observes.

Communication that adds value
An OD starting a new practice should cover the basics of having a website and creating social media profiles, of course. However, Dr. Glazier notes that simply creating these tools is not enough to guarantee success.

Electronic modes of communication are all about visibility, he emphasizes. If you have no digital visibility, you will have a harder time remaining relevant. Because of that, filling your website and social profiles with valuable content is increasingly important.

"Creating content that is tied to your Internet presence—your website, your social media, blogs, etc.—helps Google recognize you and elevate you in your vicinity when people are searching for products and services," he says.

For example, Dr. Fleming's practice has done well with online searches, but not necessarily because of ads on Google or Facebook. The reasons are more organic, he says.

To create his website, he enlisted a company that specializes in optometry. Once a structure was in place, he employed best practices for creating content to boost his presence.

For example, updating blogs frequently—weekly at the absolute bare minimum but ideally much more often—keeps a site relevant both for human readers and for search engines.

Think about your patient population, too. An OD who treats many patients with diabetes might consider topics such as why regular dilated eye exams are strongly recommended for all patients with diabetes. It's relevant, and it's valuable to that doctor's patients, not to mention search engines looking for specific keywords.

Posting blog or other content on Facebook, Google Plus and other networks also helps boost traffic and search results, Dr. Fleming notes. In his view, ODs aren't investing enough in these incremental efforts, which add up to a much larger whole.

For another example, videos also can play a part in creating a strong Internet presence—and educating your patients.

"If you have vibrant videos and interesting things online, if you're giving away some of your knowledge, people appreciate that," Dr. Glazier says. "You look like an expert and they're more likely—if they find you—to seek out your services and products." Patients who find you on YouTube can watch your videos, like what they see, and learn about your services in the process.

None of this is as difficult or expensive as it sounds, he adds. "A blog post only has to be two paragraphs. Anybody in optometry can write two paragraphs on what astigmatism is."

For videos, ODs can empower staff to capture "happy patient" moments on their phones, for example. His own practice includes video testimonials on his YouTube site, which is called the EyeInfo Channel. Such testimonials only have to be about 10 to 15 seconds. A patient may gush about how they "love the look of this frame," or be seen leaving a practice with a new pair of glasses and smiling. The message should be authentic, though, so let patients play a part in coming up with what they'd like to say.

Always get permission
Whether you're sending an email or posting a YouTube testimonial, don't skip the crucial step of obtaining written permission from the patient first, Dr. Berman says. Before communicating with patients, it's simply good policy to ask for permission to contact them via email or other technology. Nobody wants to receive unsolicited emails, he says.

Dr. Fleming's office uses software that allows staff to check whether they can communicate with patients through these technologies. The practice also has a one-page laminated sheet that explains the "e-communication process" and that patients can request more information if they need it. "That goes on every desk in our dispensary and our front desk. Patients are very well aware of how they're communicating and that they can opt out if they want to."

As for marketing efforts, Dr. Berman points to helpful guidelines the AOA Ethics and Values Committee released in 2013 on how to interact with patients on social media.

"ODs have to be mindful of patient privacy and the issues that surround HIPAA and steer clear of identifying patients with your marketing strategies," Dr. Berman emphasizes.

For videos, for example, "the most appropriate way is to get the patient's permission, quote the person, but never give the name." Because of HIPAA, practices have to be cautious about this, Dr. Berman says.

Social media and other technologies can help educate patients about you, your staff and the practice as well. "I think it's important to provide information about people who work in your office and the office philosophy, but to be cautious with personal details. Keep communication on a professional level and always avoid potential HIPAA violations," Dr. Berman says.

Don't forget patients with limited technology
Even the biggest enthusiasts of social media and electronic communication say they continue to accommodate patients who haven't adopted new technology.

Dr. Fleming learned just how important this is when dealing with a new patient portal that allows patients to access their records. The main objective was to improve communication, but the portal's usage procedures caused some confusion and frustration among patients.

"It's revealing how many of these patients struggle with the simplicity of usernames, passwords and resetting passwords," he notes. "We get multiple calls a day."

The practice took steps to remedy the issues, but he learned that an OD must be careful in leading a practice through technology changes. There's always a risk of alienating certain patients.

"The people we're going to potentially lose are the people who don't embrace technology that quickly," he says. "They make upgrades when they're forced to make upgrades. They make changes in technology when they can't function anymore."

Knowing the demographics of your patient population is key, he continues. His practice, for example, which is spread out generationally, still does its "one-month ahead" phone calls on appointments for all patients. This way, the practice touches bases with patients who are technology-savvy and those who may not have email addresses.

Dr. Bonilla-Warford recalls technology fallout from his text messaging system. A patient had ordered specialty contact lenses but hadn't heard from the office. "We realized that he hadn't been getting the text messages. He had a cell phone but never knew how to activate text messages," he says.

Despite the results of his earlier survey on email reminders, Dr. Bonilla-Warford has kept some of his mailing materials for such needs. "We do still send out some reminder postcards, but not nearly like we used to."

Similarly, Dr. Glazier says his practice tries to be mindful of all of its patients' needs. "In our practice, we keep paper charts parallel to an electronic health record for patients who may not utilize technology."

In the end, it comes down to patient needs and desires once again. "We are sure to communicate with them via their preferred means.