A few years ago I shared with my perspective on how men dress, and we spent way too much time discussing socks, especially black socks. If aliens ever entered an elevator in a New York office building they would conclude that all American men wear dark suits, white shirts, red ties, black shoes, and black socks.

I never got that memo. On that fateful day a few years back, as I was packing for a business trip, my wife said, “You can’t wear those socks!”

“Why not? I asked.

“Because they are arrogant.”

“No,” I replied. “They are cotton.”

Fast forward to this morning. I am packing for yet another trip to the city of dark suits and black socks. To avoid another confrontation with my wife I had hidden my arrogant socks inside my can of shaving cream. As I put on my blazer, a cobalt blue number (photo 1) woven from organic Italian silk worms, I turned to look at my wife. To her credit, she was doing her best not to comment, but she was about to bite off her tongue.

“What?” I asked.

“You haven’t earned the right to wear that,” she said. “Earned it from whom? You?” I asked. “Not me. From the people with whom you are meeting. You can’t do bold colors with people you don’t know.”

“Well, with whom may I wear this jacket?”

“Unless your meeting is with the Queen, and you are going lawn bowling at a place that cuts the crusts off of cucumber sandwiches, you probably can’t wear it anywhere.”

I turned and looked at my suitcase. I knew immediately that even if I removed my socks from the can of shaving cream, there would not be room for the jacket.

So, I arrive in New York for my meeting and learned quickly that everything I thought I knew about how New York men dressed was outdated. Gone were the dark suits and black socks. I think this may be how Dorothy felt when she landed in Oz. While there were no Lilliputians, I had entered the land of Skinny Pants being worn by skinny people.

And to top it off—this is absolutely true; my female co-presenter was wearing a blazer. A cobalt blue blazer. One that was probably woven from relatives of the same organic silk worms used in mine. (photo 2)

So, now that you have grown tumescent with anticipation, let’s get to work.

Can you manage my health as well as you manage my bill? Don’t just manage my claim, partner with me to manage my wellness. Probably not. Actually, you do manage my bill; you do not manage my health.

You are all over the bill thing; down to the farthing. You can do everything except explain it. You are itemizing my bill from the moment I hit the front door. Tylenol; eight dollars. Band-Aids; four-fifty each. You can tell me the date it was issued; the date it is due, how much is past due. You know when to send me a dunning notice the amount of interest I owe. For an outfit that cannot tell me what anything cost, you seem to know an awful lot about what you are going to charge for those things.

You can help me set up a payment plan. But you cannot help me set up a wellness plan. Yours is a healthcare company, not a bank. Yet it does not itemize my health. My watch knows more about my current health than does my provider.

People and firms pay attention to what is important.

Maybe my bank can help me manage my wellness.

Seven A.M., Saturday morning on the high school’s outdoor running track.  It reminded me of the way a community swimming pool looks during the time for the adult swim.  A dozen or so older adults were stretching and starting to circle the track’s artificial surface.  I hung the bag containing my workout gear on the pole of the chain-link fence. Next to the fence rested several canes and walkers.  I halfway expected to see a box of Depends and a stack of AARP magazines. So this must be what life looks like in the not-so-fast-lane.

After running for an hour I paused and I grabbed my water bottle.  A woman a few years younger than me also reached for her bottle of water. When I asked her how far she was running she said she and her father were running for eight hours. They were training for a one hundred mile run. I almost swallowed my water bottle, and knew I appeared nonplussed. It turns out she and her father, the much older man circling the track, were ultra marathoners. My ego thought about resuming my run but I decided I did not want to die that day.

An article on one of the twenty-four hour news channels mentioned Frontier and Spirit Airlines rated among the worst in customer experience—did anyone need a news article to learn that?  The article went on to mention the two airlines had almost accomplished what many people believed was impossible; they almost managed to rank below Comcast and Time Warner Cable in customer service.  I’m guessing Spirit and Frontier must have had committees working around the clock for months to trying to beat out Comcast—“If we are going to offer bad customer experience, we may as well be the best at it.”  When the results were announced the airline executives tried to maintain a stiff upper lip. “They have not heard the last from us, there is always next year.  We will marshal our resources.  We will cancel more flights and buy smaller seats,” stated an anonymous employee.

Offering a poor customer experience requires hard work.  It doesn’t happen by accident, and it doesn’t happen overnight.  It requires time and dedication.

And it requires indifference. And that indifference starts at the top of the organization.  Leadership either knows the experience is poor and doesn’t care, or it doesn’t know and it doesn’t care.

Improving the consumer experience should be on every health system’s CEO’s plate. If it isn’t, it is time to get a new plate. Patients don’t leave their health system because they receive poor care; they leave because they perceive their health system doesn’t care.  Doesn’t care about whether they answer your calls, doesn’t care about whether it’s inconvenient for you to call while you are working, or how many times you have to call to schedule an appointment.

That same health system will have a committee studying how to reduce cancellations and no-shows.  They will have another committee performing a root-cause analysis of leakage—patients who disappear.  And they will spend a lot of money on consultants to help them find answers to nagging questions like, “Why did Mr. Waldo skip his procedure today, and why didn’t he let us know? He is scheduled for back surgery in two months. Will he show up for that? What do we have to change to prevent this from happening again and again?”

Here is how to save a million dollars studying how to answer those questions. I think all of the Mr. Waldo kinds of stories go something like this.

Mr. Waldo spent considerable time online educating himself about where to go to have two discs repaired.  He studies hospital websites, reads patient blogs and Facebook, and even watches a few YouTube videos.  And after all of that work he selected your health system.  He called and called, and he eventually made an appointment and saw a specialist.  The specialist gave him a number to call for an initial procedure.  The specialist also scheduled Mr. Waldo for surgery in two months.

It took Mr. Waldo several calls to schedule the procedure. He wasn’t happy. In fact, he was so unhappy with the experience of scheduling the procedure that he skipped it and did not even bother to cancel it.  Mr. Waldo learned that not showing for a procedure meant he no longer had to waste time calling the hospital; now they called him.  He rescheduled the procedure and completed it.

Two months to go.  The health system reserved the OR, booked the anesthesiologist and the surgeon and the surgical team, and reserved a single room for Mr. Waldo.  While the health system was doing all of those things, Mr. Waldo kept himself busy.  Mr. Waldo knew his surgeon was one of the highest rated surgeons in the city. He read more about the hospital; it was also highly rated.  But his perception was that nobody in the hospital really cared one way or the other about whether he gave it his business.  He visited more social media sites, posted his own YouTube video about his experience, and rescheduled his surgery with another hospital.  The only thing Mr. Waldo did not do was to call your hospital and cancel his surgery.

On the appointed day everything was ready.  The doctors and nurses were on standby, the OR was nice and clean, and the single room on the fourth floor—the one overlooking Walmart—was ready to receive Mr. Waldo.  The only problem was Mr. Waldo never arrived.  A chorus of “Where’s Waldo?” echoed throughout the hospital.

People, patient people and consumers, people like Mr. Waldo do not like to call a health system any more than you do. Calling requires work. It requires work because calling doesn’t work. It requires multiple calls. And callers often give up their quest before their needs are met.  So when consumers finally muster the energy to call, it is not to chat.  Their call is important to them in part because it is the only call to a health system they are going to make that day.

Conversely, to the person answering the call, Mr. Waldo’s call, Mr. Waldo is just one of dozens and dozens of people they will speak with that day. This one conversation will be just a blur in their day. It’s not a blur for all of the Mr. Waldos who call each day.  They remember the call.  They tell others about the call.  And then they call some other health system.

If your system does not make consumerism a big deal, your consumers will take it upon themselves to do so.

A few weeks ago, five miles into my run, I was feeling pretty good about myself. I had passed seven runners, had a nice comfortable rhythm, no insurmountable aches, and Crosby Stills & Nash banging away on my phone. I don’t like being passed—never have. Some people say I’m competitive. They say other things too, but this is a family show.

I’m a mile away from my car when I see a slight blurring movement out of the corner of my left eye. A second later I am passed by a young woman wearing a blue and yellow, midriff-revealing spandex contraption. Her abs are tight enough that I could have bounced a quarter off of them. She is pushing twins in an ergonomic stroller that looked like it was designed by the same people who designed the Big Wheel. I stared at her long enough to notice that not only was she not sweating, she didn’t even appear winded. She returned my glance with a smile that seemed to suggest that someone my age should consider doing something less strenuous—like chess. Game, set, match.

Having recovered nicely from that ego deflation,  today at the gym I decide to work out on the Stairmaster, the one built like a step escalator. I place my book on the reading stand, slip on my readers—so much for the Lasik surgery, and start to climb.

Five minutes into my climb, a spandex-clad woman chipper enough to be the Stepford twin of the girl I encountered on my run mounts the adjoining Stairmaster. We exchange pleasantries, she asks what I’m reading, and we return to our respective workouts. The first thing I do is to toss my readers into my running bag. I steal a glance at the settings on her machine and am encouraged that my METS reading is higher than hers, even though I have no idea whether that is good or bad.

Fifteen minutes, twenty minutes. I am thirsty, and water is dripping off me like I had just showered with one of Kohler’s full body shower fixtures. I want to take a drink and I want to towel off, but I will not be the first to show weakness. Sooner or later she will need a drink. I can hold out, I tell myself. Twenty-five minutes—she breaks. I wait another two minutes before drinking, just to show her I really didn’t need it.
She eyeballs me. Game on. She cranks up her steps per minute to equal mine. Our steps are in sync. I remove my hands from the support bars as a sign that I don’t need the support. Without turning my head, I see she’s noticed. She makes a call from her cell to demonstrate that she has the stamina to exercise and talk.

When she hangs up I ask her how long she usually does this machine—we are approaching forty minutes and I have lost all feeling in my legs. She casually replies that she does it until she tires, indicating she’s got a lot left in her. I tell her I lifted for an hour before I started; she gives me a look to suggest she’s not buying that. I add another ten steps a minute to my pace. She matches me step for step.

Fifty minutes. I’m done toying with her. I tell Spandex I’m not stopping until she does. She simply smiles. Her phone rings and she pauses her machine—be still my heart—and talks for a few minutes. I secretly scale down my pace, placing my towel over the readout hoping she won’t notice. She steps down from the machine. My muscles are screaming for me to quit, but I don’t until I see that she’s left the gym.

Victory at any cost. What’s the point? For what was lost, for what was gained. Men versus women. Customers versus call centers. Most groups deny that animus exists; yet neither will yield. Customers want help; agents are forced to follow rules that hurt the business. The customer is always right; or not. Turns out the phrase makes a better bumper sticker than it does a business philosophy. Nobody’s business policies reflect that attitude. Listen to how call center agents are instructed to respond to callers. Compare that with what they are instructed not to do for the callers.

Agents are never told, ‘Do whatever it takes to please the caller.’ Most agents are mandated to minimize the negative impact of the call to the firm, without regard to the negative impact to the customer. Remember the last time you tried to dispute a health insurance claim? Death by a thousand cuts—or a thousand calls. As it turns out, death occurs usually by the seventh call. If your organization can manage to continue to deny the claim seven times, there is almost no chance that the person will ever call again.

And that is why, given the choice, over fifty percent of the people who have to interact with your company, always go to your website first. They do not want to talk to you—not you personally, but someone from your organization. They’ve already been there, done that, and the experience has never been pleasant. If you doubt me, call your payer just for fun. While the experience may bring on several feelings, the one word that will not come to mind is ‘fun.’

This has been the case since way back when Al Gore invented the telephone. Nobody ever calls just to pass the time. In fact, prior attempts to call have left them with a bad experience. And so people delay calling until they have no other choice. Ask your customers, they will confirm that.

May I leave you with a question? What would happen to health systems and payers if their call centers agents were given one simple rule to follow? Do whatever it takes to do what the caller is asking of you.

Just to ensure you come away with something worthwhile from the piece, did you know there is only one number whose value is the same as the number of digits used to spell the number?

I did not like chocolate ice cream until I ate it the first time. I think customer experience is like that. You don’t know what a good experience is until you’ve had one. And once you have, you have a great barometer from which to measure all other experiences.

Sometimes the quality of the experience you have can all be traced back to the effectiveness of the tool you used. Spoons, for example. With a spoon, I can stir my coffee, eat soup, dig a hole, or get it to stick to my chin. It’s a highly functional tool.

Take smart phones. With one I can talk to someone, text them, take pictures and listen to music. Oh, and I can also do all of my banking, buy airline tickets, track my Amazon order, cancel my cable service, and order my groceries. A formidable tool. (It may or may not be useful for eating soup.)

Smart phones can also be used in healthcare. You can use it to call your payer or provider provided you do so between 8 and 5 Monday through Friday. In healthcare, a smart phone is neither functional nor formidable.

Today at most health systems the ability of a person to interact with the organization is functional, at best. The effort required, however, is often quite formidable. Functional means that some of the time people can get their needs met as long as they are willing to walk over hot coals while juggling hamsters. Usually, nothing the person needs to accomplish during that interaction is easy, certainly not from their perspective.

To patients and consumers, easy is important. In fact, it is critical. There are many different reasons a patient or a prospective patient or a caregiver or a family member or a referring physician needs to interact with your system.

Before we continue, take a minute and see if you can find your personal fax machine, and then take another minute to warm it up, read the manual, and try to remember how to use it. Using it is complicated.

So, we have all kinds of different people who need to interact with your system every day—this also applies to payers and retail pharmacies. And most of those interactions, nearly one hundred percent of them happen in one of three ways; by phone, by fax, and by snail mail. Now, check with whoever runs your call center, and ask how many faxes and pieces of mail they receive each day. Now here is a really fun fact. The number of faxes your organization receives each day is probably about equal to the number of phone calls it receives.

If you were to ask someone why they send your organization a fax or why they write a letter instead of calling, they will tell you they do so because it is easier than calling. Can you imagine how poor an experience people must be getting from your call center to have concluded that faxing is easier than calling?

For those consumers who are interested in improving your health, do this.

1. Download the data from your health apps and wearable devices to your laptop.
2. Print the data
3. Fax the printout to your provider

If they reply to you please let me know. We may have just created the world’s first interactive, cognitive wellness model.

Patent pending.

The April 1 issue of Healthcare Informatics contained an article titled,  ‘Study: 75% of Adults Will Use Personal Health Records By 2020.’

We’re not in Whoville anymore. Maybe we should have stayed there when we had the chance.

I don’t believe everything I read. Given its publication date, at first, I wondered if the article was intended as an April Fools joke.  I have a ‘Show me,’ attitude. So you might believe me when I write to say that I almost fell out of my chair when I read the results of a recent study projecting that 75% of adults will use a personal health record (PHR) by 2020.

My first reaction to the article for the title to have any relevance was, “Well, somebody had better define ‘use‘ and what is meant by ‘Personal Health Record.’

The information available about someone’s health tells how somebody was. Very little is known about how they are.  Knowing that someone had their gall bladder removed three years ago–based on data contained in the EMR–says nothing about what other health conditions the person had during that period–are they showing signs of hypertension, diabetes, heart disease? Also, the EMR has no information about how that person is today.

And we know nothing about the health of anyone who is not currently under treatment.

The one health service nobody can pay for today is to manage their wellness; not from their provider, not from their payer, and not from their retail pharmacy. Nobody in an individual’s healthcare food chain can tell an individual how they are today, and that is because nobody has any information about how an individual is.

And what is most ironic about this issue is that current and habitual health data exists for millions and millions of people.  The problem is that nobody other than the individual who is collecting that data even knows that it exists.  That data is collected daily through health apps and wearable devices. But nobody in a clinical organization can see it, assess it, or respond to it.

All of that data could be turned into information.  It could be used to populate a PHR.  Individuals cannot ‘use’ the data.  If I have a heart attack during a run, RunKeeper won’t tell me to sit down and dial 911.  It will tell me I am still 2,000 steps short of my daily goal.

For a PHR to be effective it has to be relevant.  For it to be relevant it has to be current, and it has to contain habitual data. It has to be linked to a cognitive tool that can provide proactive information like, “Based on the data we collected about you over the last 4 months, we’ve noticed that your resting heart rate has increased by 30 beats per minute, as had your blood pressure. We think you need to be examined for hypertension.”

Without that, people are simply collecting numbers.

As a married man, and the father of a daughter, I find myself wondering, if I speak my mind when I am alone in a forest and neither of them hears me, am I still wrong? The vote was 2-0, and it did not encourage me to continue to speak my mind. Which is why I write my blog.

Have you ever wondered about whether Shakespeare had an English teacher? And if so, what that experience must have been like for the teacher? These are the types of questions that keep me up at night. “William, put down your pencil and pay attention. And quit making up so many nonsense words.”

Creativity is easily killed by those who are afraid to make mistakes or to be seen as foolish.

This weekend my son and I attended the Rochester Institute of Technology’s student orientation day. The dean showed a series of cartoons related to designing a perpetual motion machine. Slide 1: A falling cat always lands on its feet. Slide 2: A piece of bread covered in jelly will always fall jelly-side-down when dropped on a white rug. Slide three: Tape the jellied bread to the back of the cat. Slide 4: Hold the breaded cat over a white rug and drop the cat. The cat is designed to always land on its feet. The jelly bread will always land on the white rug. If the cat is about to land on its feet, the jelly bread will cause the cat to spin so that the jelly will hit the rug. If the jelly is about to hit the rug—meaning the cat will land on its back—the cat will spin around so that it will land on its feet. So the cat and the bread spin in perpetuity, never hitting the ground.

To the one percent of you who are thinking, “That makes sense,” kudos to you. To those who are inclined to argue that the jelly bread could not possibly make the cat turn over, perhaps that reflects a need to spend more time coloring outside of the lines. In order to do anything creative, you have to be prepared to be wrong. And that is important because we have all witnessed the results of not being creative, of being afraid to be wrong. The fear of being wrong more often than not delivers results that are lukewarm.

Then there is the story of the young girl who never paid attention in school except in art class. As she was drawing the teacher asked her what she was drawing. “I’m drawing God,” she replied. “But nobody knows what God looks like,” the teacher told her. (To give credit where credit is due, I borrowed the Shakespeare and art class illustrations from Sir Ken Robinson’s TED talk.)

“They will in a minute.” Now there is an example of someone whose imagination wasn’t controlled by what someone may have thought.

If you want to see an example of a group of someones whose imaginations were controlled by the thought police you need look no further than your firm’s website—the place where imagination went to die. Your website is your organization’s digital representation of your brick and mortar facilities. The big difference between the two is that when someone enters your building you meet their needs, and you do that close to one hundred percent of the time. Chances are, however, that when someone goes to your website you meet their needs less than ten percent of the time.

A key measure of the effectiveness of your website is called Conversion Rate Optimization (CRO). CRO includes figuring out what the person’s needs are and meeting them. If you cannot do that there is no business reason to have a website. And to meet a person’s needs you have to know what those needs are. And to know what those needs are you have to ask. Chances are high that nobody in your organization ever asked a visitor why they went to your website. Chances are also high that visitors will not visit your site more than once.

Half of the people who call your organization have been to your website and could not complete whatever transaction they needed to complete. That is why they are waiting on hold to talk to someone who does not even have the tools to recognize that the person calling is a patient undergoing chemotherapy.

So, let’s drift back to the idea of design, imagination, and creativity. And let’s see if we can tie that into the black holes that exist in healthcare and customer experience. Think back to some of the most recent meetings you attended. I’ve been in many of those meetings. After a few hundred of those meetings, I began to notice a pattern; a pattern of what is unspoken, and yielding to my self-appointed title of ‘Chief Imaginist,’

I yield the floor to whoever the person was in the meeting at CVS who raised his or her hand and proposed, “What if we quit selling cigarettes.” A pin-drop question. An ‘Imagine a World,’ moment.

I have never witnessed a pin-drop question in a meeting, and I’d wager that neither have you. There are no ‘Imagine a World moments.” That is because there are no imaginists. There are no dreamers—at least in the area dealing with how do we make it easier to do business with us; how do we improve wellness.

We need meetings where someone says, ‘Great idea. Run with it.’ Where someone asks, ‘If you could change anything, what would you do?’ Where nobody says, ‘That would never work here.’

The reason those things would never work here is that they do not fit the corporate rubric. The people who raise those ideas are culled from the herd—sausage. The ideas wind up as the discarded detritus of your organization’s business strategy. When imagination and creativity are pushed aside, so is the organization’s ability to compete.

What would your system have to do to attract everyone who was not aligned to a health system, everyone who was not currently under treatment, to make your system his or her provider of choice?

In the recesses of my mind, the answer lies with your consumers; more specifically with each consumer. Consumers can’t be grouped into neat little piles like republicans and democrats. Viewing consumers, as a ubiquitous whole does not solve the problem, it worsens it.

People, your customers, and patients are not interested in eCare. They are not interested in population health, or value-based purchasing, or your ACO. Their only interest is in me-care. My health. And it appears that they are alone in that pursuit. After all, can you name a single provider, or payer, or retail pharmacy, or life sciences firm that can demonstrate their interest in how you are right now?

People will pay for me-Care. They will queue up around the block. None of them finds solace in the fact that your EMR recorded the removal of their gall bladder three years ago. None of those people finds solace in the fact that you prescribed them amoxicillin last year for their ear infection, or that you paid their claim for that prescription.

What the me-care patients want to know is whether you can tell them how they are today; right now.

And you can’t. And the reason you can’t is that you haven’t invested a dime in trying to ascertain that.

While I was eating sushi, a lion-fish in the room-size aquarium was eyeballing me through the thick glass.  Ironic?  Or,  was I simply exercising poor judgment? I think the fish looked a lot like Phil Specter.

Well, it has happened again. I came up with another new idea, and I thought perhaps I could try it out on you to see if it has legs.

When I run on the treadmill I pass the time by listening to TED talks. To me, the common feature of TED talks is ideas. Ideas about concepts that are in many ways common, but that are presented in a new way.

And that is how today began. The gentleman was speaking about the fact the much of the evolution between people and computers has been directed at shortening the distance between them. During the era of punch cards, people were not even in the same room as the computer.

That changed with the introduction of DOS and the CRT—the green screen—computer monitors. The CRT was physically connected to the computer, albeit by wires, and the distance shortened. And then came the mouse and the personal computer, and the distance between and person and his or her computer shortened to the distance of a mouse click. The most recent change has been that of the touch screen, a distance of .7mm now separates us from our computer.

Today the only commonality of shortening the distance between the individual and the computer, whether typing punch cards, or using a touch screen, is that for someone to interact with the computer they still have to use their hands.

That requirement no longer exists. “Hey, Alexa. Order paper towels.” Look ma’, no hands.

And so I thought about this evolution, and I thought about the theme of my writings to improve access and consumerism. The point I make often in my writing has to do with making it easier for people to access their health system. Making access easier, I reasoned, would improve care, patient acquisition, and patient retention.

And it would.

But this morning I began to question, what if, by applying the same concepts, instead of simply making access to the institution easier, is there a way to make being healthy more equitable? Regardless of social standing. Independent of affluence. Can the consumerism discussion move from just improving care to improving wellness? And could doing so make wellness accessible to more people?

Clearly, those with the most means can afford the best care. Equal care does not exist. And neither does equal health, in part because those with less means are often not as healthy as those who are well off.

I think that is due in part to the fact that neither you or I, and neither the wealthy nor the poor can buy wellness. You cannot hire someone or some organization to manage your health or your wellness. We are all equally disadvantaged when it comes to having the ability to have some one or some organization habitually manage our wellness.

It occurred to me that if wellness were available to everyone, then the disparity between the affluent and the disadvantaged, with regard to needing care, would be lessened because healthy people inherently need less care.

So what if everyone had equal access to wellness? What would that look like?

Instead of: “Ok, Google. What is the cheapest way to fly to Cleveland?” or, “Hi Siri, who was the 13^th president?” or, “Hey Alexa. Order paper towels,” someone could ask, “Ok, Google. Am I healthy today?”

“Am I healthy today?” Today a person could ask this of their 8-Ball, they could use Tarot Cards, or they could hire a psychic. Today those are their best options for managing their wellness.

But the technology exists. OnStar uses a version of it. And artificial intelligence, when applied to that technology gives us Siri and Alexa. “Look ma’, no hands.”

A personal concierge. For paper towels and cheap flights and learning about presidents.

Why not use that same technology to help people manage their wellness? Most of us reading this are probably tracking some aspect related to our health using a smart app or a wearable device. We tracked it yesterday and we will track it tomorrow.

And if I check back six months from now we will still be tracking the same data. And how has your health been during those six months? Did any of those apps or wearable devices tell you to go for a checkup? Of course not. Did anyone trained to evaluate health data evaluate yours? Of course not.

I asked myself, why am I tracking this data?  And I rethought the question to one I felt is more relevant–what do I want to know; what do I need to know? I want to know if I am healthy. Am I healthier today than I was yesterday?

One value of having habitual health data would be seeing how the data did or did not change over time. Routine exams only compare this year’s data to last year’s. Wouldn’t it be better to compare today’s data to last month’s, or to the last ninety days? While knowing your resting pulse is 103 may be helpful, it would be better to know that it climbed steadily from 70 to 103 over the past three months. The same holds true for your blood pressure and other data people are tracking.

And many, many people store that data. Many more would store it if they felt doing so would aid them in their effort to manage their health.

There is more health data that is not being assessed than there is data that is being assessed. This begs the question: If it is worth assessing the data clinicians have, wouldn’t it be worth assessing the data they don’t have?

Why not store that data in the cloud instead of on a phone? And once it is there, why not look at it cognitively, and react to it? Organizations like DoctorOnDemand rely on having someone initiating contact because that person thinks they need to see a doctor. Wouldn’t it be better if instead of having someone with no clinical training saying, “I need to see a doctor,” a clinician said, “I think you need to see a doctor.”

More people have smart devices than have doctors. If all of those people with smart devices had access to an interactive, cognitive healthcare concierge perhaps they would be healthier.  Why not manage wellness through a system of PatientOnDemand?

Of course it couldn’t. But it couln’t make them any worse.

So, last weekend I’m driving to pick up my daughter at her friend’s house, a friend who lives nine miles away. I fire up the GPS on my phone; estimated drive time of seventeen minutes.

The route is mostly back roads, and as soon as I reach the ‘backest’ of the back roads I am informed, “GPS signal lost.” Speaking my mind to the recording, I continue to drive. And drive. And you know the rest. I head to places with higher elevations, find a signal, and am directed to roads that even I know have nothing to do with where I am headed.

I pass a flock of Eurasian Wigeons; a species that frequents the west coast of America–I started my drive in the Philadelphia suburbs.

My route is again transferred to another back road, and so forth and so on. I reach the backest of the back roads I am informed, “GPS signal lost.” After speaking my mind to the recording, I continue to drive. And drive. And you know the rest. I head to places with higher elevations, find a signal, and am directed to roads that even I know have nothing to do with where I am headed.

I am talking to myself, and yelling at drivers who look like they know where they are going. Chipmunks on the side of the road point at me, and double over in laughter—I hope they choke on their acorns. After an hour and two minutes, I arrive at the house, upon which my phone chirps, “You have arrived.” I started screaming epitaphs at the chipmunks, one of whom looks like Alvin.

An hour and two minutes is four minutes longer than I spent the other day trying to schedule an appointment with a large east-coast health system. The person with whom I spoke the longest seemed to have a pulse equal to that of a hibernating bear, and had he been a household pet he would have been put down purely for aesthetic reasons.

I find it helpful to trace everything back to a seminal point, a point like just prior to when the random swirls of gases in the chartless universe got together and formed the earth; or not, depending on which side of the Darwin bed you sleep.

From the side of the bed on which I sleep, the seminal point for healthcare consumerism can be traced to the phone. If the people manning your health system’s phones cannot meet the caller’s basic needs and solve the problems of its callers, very little else matters because the callers will call somebody else.  GPS signal lost.

Hammers, like phones, are very evolved tools. They haven’t changed since they were invented. (Niether has consumerism, but then again, I may be boased.) And why would hammers change? Nails haven’t changed. Nails have been the same forever. Therefore, a hammer’s necessary features were worked out long ago. A heavy metal head, and a handle. All you need, and nothing you don’t. And for hammers to be effective they only need a single user.

Phones are also very evolved tools. The primary difference between a hammer and a phone is that if you do not have capable people on both ends of the phone call, both phones are useless.  GPS signal lost.

And this is relevant to healthcare because?  Because the way healthcare access exists today, 100% of it occurs by phone. GPS signal lost.  Try to access your health system online–GPS signal lost.

And this is relevant to healthcare because?  Because the callers may be patients, and if you cannot meet their needs, care suffers. Or, the callers may be trying to buy healthcare from your system, and they cannot.  And that is sort of the reason your system built a big room and bought a bunch of phones.

Transferred calls, dropped calls, callers placed on hold, being told my call would be recorded for quality purposes—an illusory promise of something unseen. When I heard the recorded voice inform me of that tidy bit of news I yelled back, “Wouldn’t I actually have to speak to someone to make recording my call worthwhile?” The entire scheduling process—I am overstating the concept as there was no process, just a series of random interactions. By the time the process had concluded I had developed nictating membranes over both eyes and my thought process had recessed to the lizard part of my brain.

Maybe the process was designed to wear people out, to get them not to call back. Sort of like the customer experience models used by payers.

Just to be clear, there are no catastrophic consumerism or patient access failures. The failures people suffer through are made up of a series of small things that accumulate and become big things, much the same way that individual snowflakes become an avalanche.

Here is how real people—patient people and consumer people—figure out how to call a given health system. They go online; they see a number, cross their fingers, and dial. They do this process again and again until they either give up or until they declare themselves cured and no longer need to purchase healthcare.

Twenty-four. Forty-eight. Seventy-two.

Baptist Health, St. Vincent, Aurora, Reading, Butler, Park West, St. Alexius, Evergreen, Anchor, Hoag, Sindecuse, Grady, Lubbock, Bradford, Eau Claire, Texas Women’s, Temple, Crozer, St. Mary’s, Veractiy, Eisenhower, St. Peters, Wheaton, Hillcrest, Methodist, Reading, Unity Point…and that is the point.

It took less than a minute to find health systems whose contact us form on their website indicated that someone would respond to a person’s request within 24, or 48, or 72 hours.

If you do not hear from us within that time please call us. Some systems only promise to reply to your phone call within that same period. For one of my clients, ninety-nine percent of the people who called to speak with a clinician had their call transferred voice mail. The voice mail message stated someone would return his or her call within 48-72 hours.

The Saturn rocket made it to the moon within that same number of hours.

Whether the total time it takes to answer someone’s question is a minute or an hour, the extra hours or days that elapse between the time the request is made and the time the answer is provided are harmful to the patients, the prospective patients, and the providers.

I am sure that the organizations who added a Contact Us section to their website did so because they were trying to be helpful.

Look at the issue from the perspective of the person requesting help from your system. Whether they are asking about a refill, scheduling an appointment, or a billing question, making them wait a day or two for a reply crushes their perspective of how important they are to your system.

In two hours an individual could have gone to the Minute Clinic, received a prescription, and been seen in urgent care. Or, they could simply have decided to go to your ED.

Since it takes no longer to answer the question the moment it is asked than it takes to answer it two days later, why not implement online chat on your website? And while you are at it, add a click-to-call button on the site.