The ROI of Reaching Patients Before the System Loses Them
Healthcare often tries to reconnect with patients after they have already left.
We send portal invitations after discharge
We ask patients to create accounts from home
We provide instructions when they are tired, anxious or focused on getting out the door
We expect them to remember which portal belongs to which organization, locate an email, create another password, verify their identity and determine what to do next
Then we measure adoption—and wonder why patients disappear. The problem is not necessarily a lack of interest.
In 2025, 89% of Canadians said they were interested in electronically accessing their health information and using digital tools to manage their care. Yet only 13% reported access to all three core components of their health record, and approximately 10 million Canadian adults reported having no electronic access to any of their health information.
There is a significant gap between wanting to be connected and actually becoming connected. That gap has a cost.
We began with the wristband
The first series, Patient Identity & Safety: From Barcode to Behaviour, began with a familiar object: the hospital wristband.
We examined how barcodes communicate identity to clinical systems, how visual information supports the care team and what happens when the wristband leaves the patient. We looked at scanning failures, workarounds, overrides and the hidden audit trail that most organizations do not capture. We also asked whether the patient could become an additional identity factor—not by assuming responsibility for preventing errors, but by being given a meaningful role in confirming and understanding their care.
That led to a larger possibility.
What if the wristband did more than help the healthcare system identify the patient?
What if it also helped the patient securely connect to the healthcare system?
The second series followed that connection beyond identity.
We explored onboarding as prevention, the family as healthcare’s forgotten interface, the difference between owning a portal and having a patient strategy, and the way every transition tests the strength of the first connection.
This final article brings both series together.
The return on investment does not begin with the portal, it begins with reaching the patient before the system loses them.
The highest-value moment may already exist
When a patient is registered, the healthcare organization has something it may not have again:
The patient is physically present
Their identity has been established
Their encounter is known
Staff can provide help if needed
A family member or caregiver may be available
The patient has an immediate reason to engage
This is the moment of lowest identity uncertainty and highest clinical relevance.
Yet many digital strategies allow that moment to pass.
The patient receives a brochure, a discharge instruction or an email invitation to complete later. Each added step creates another place for the connection to fail.
The patient may never see the email
The invitation may expire
The phone number may be incorrect
The registration process may be available only in English
The patient may need a family member to help but have no clear way to delegate access
Or the patient may successfully activate the portal but find no immediate reason to return. By the time the healthcare organization realizes the patient has not connected, the patient is already outside its walls.
The cost of losing the connection
The cost is rarely recorded as one line in a budget.
It is distributed across the organization:
Staff calling patients to confirm appointments
Patients calling for results or instructions
Information being collected more than once
Paper forms being manually entered
Missed follow-up appointments
Incomplete patient-reported outcome measures
Unanswered surveys
Family members trying to coordinate care without appropriate access
Patients returning because they did not understand what to do next
Not every missed appointment or readmission is caused by failed digital onboarding. It would be irresponsible to make that claim.
But connectivity affects whether patients can receive reminders, review instructions, complete forms, ask questions, share information with family and respond when their condition changes.
A 2026 systematic review found that appointment reminders produced a statistically significant improvement in hospital attendance compared with usual care. Reminders only work, however, when the organization has a trusted and usable way to reach the patient.
CIHI also recognizes that urgent readmissions are influenced by the effectiveness of care transitions and coordination. Not all readmissions are avoidable, but interventions during and after hospitalization can reduce risk. The connection created during care is therefore not simply a communications convenience.
It is infrastructure for continuity.
Activation is not the ROI
Digital health programs frequently report registrations, downloads or portal accounts.
Those numbers are useful, but they are not the return.
A patient can have an account and still be functionally disconnected.
One randomized study of orthopedic patients compared providing portal information in discharge paperwork with actively enrolling and teaching patients while they were still in hospital. Guided enrolment increased portal use from 16.4% to 62%.
Importantly, enrolment by itself did not independently improve follow-up. The patients who were enrolled and then actually used the portal had the highest likelihood of completing follow-up.
That distinction matters. The objective is not to create accounts. It is to create a connection that patients can use.
The true measurement should follow the entire journey:
Was the patient offered a connection?
Did the patient securely activate it?
Did the patient or authorized family member use it?
Did they complete the intended next step?
Did the organization avoid work, delay or preventable utilization as a result?
If measurement stops at registration, healthcare organizations see the beginning of the funnel but not its value—or its failures.
Five places where the return appears
A serious ROI model for patient onboarding should measure at least five forms of return.
1. Greater digital activation
How many eligible patients become connected before leaving the care environment?
This should be segmented by age, language, geography and other relevant equity measures. A high average activation rate can conceal populations that are still being left behind.
A 2024 study at the University of California, San Francisco found that text-based automatic portal enrolment increased activation across the adult population and helped reduce racial, ethnic and language-related disparities. It did not eliminate those disparities, but it demonstrated that workflow design can materially change who becomes connected.
Digital inequity is not always a patient characteristic. Sometimes it is a process outcome.
2. Reduced administrative work
How much staff time is spent:
Repeating registration instructions?
Resetting accounts?
Making reminder calls?
Re-entering patient information?
Chasing incomplete forms?
Responding to questions that could have been answered through accessible digital instructions?
Minutes saved across thousands of encounters become meaningful capacity. This does not necessarily mean reducing staff. It means allowing staff to spend more time on work that requires human judgment, reassurance and care.
3. Better completion of the next step
Does immediate onboarding improve:
Appointment confirmation?
Follow-up attendance?
Completion of pre-visit forms?
Access to discharge instructions?
Medication reconciliation?
Patient-reported outcome measures?
Response to symptom checks or micro-surveys?
Every workflow should have an intended patient action. That action—not the account—is the outcome that should be measured.
4. Earlier visibility into patient risk
A connected patient can report confusion, worsening symptoms or an unmet need before the only remaining option is an emergency department visit. This does not mean that every digital interaction prevents an acute-care encounter. It means the system has another opportunity to detect risk sooner.
The ROI may appear as a question answered, an instruction clarified, a follow-up accelerated or an avoidable escalation prevented.
5. Stronger continuity across organizations
Patients do not experience healthcare as a collection of databases. They experience one health journey.
A patient may move from emergency care to diagnostic imaging, specialist care, primary care, rehabilitation, home care and community services. At each transition, the system frequently asks the patient to begin again. A strong first connection can provide a trusted path into each next step—even when the destination changes. The portal may be one destination.
It should not have to be the entire strategy.
The wristband can become the bridge
The hospital wristband is already issued at one of the most important points in the patient journey -- the beginning.
Today, it helps the system identify the patient.
Add a secure, temporary digital token, it could also help the patient authenticate into the right workflow while they are present, known and supported.
The objective is not to place more personal information on the wristband. It is to use the verified encounter behind it to launch a secure connection.
That connection might help the patient:
Activate an existing hospital or regional portal
Confirm contact information
Choose a preferred language
Add an authorized family member
Access visit-specific instructions
Complete a short assessment
Receive the next appointment or transition step
Understand how the organization will communicate after discharge
The wristband does not need to become the patient record. It can become the bridge to it.
How to prove the ROI
Healthcare organizations should not be asked to accept a theoretical return.
A pilot can establish a baseline and compare connected and unconnected patient journeys using measures such as:
Percentage of eligible patients offered onboarding
Successful identity verification and activation
Time required per activation
First meaningful digital action
Family or caregiver delegation
Messages and instructions accessed
Forms or assessments completed
Appointment attendance
Support calls and manual interventions
Unscheduled returns within a defined period
Patient understanding and confidence
Results by language, age and other equity measures
The financial calculation is then straightforward:
Net value created = operational work avoided + additional workflow completion + avoidable utilization reduced − implementation and operating costs
Clinical outcomes must be evaluated carefully, and attribution requires appropriate study design. But operational improvements can be measured immediately. The goal is not to promise that one connection will solve every transition. It is to determine what happens when the healthcare system stops leaving connection to chance.
From identity to continuity
Across these two series, the argument has evolved.
A barcode can tell the system who the patient is.
A wristband can help the care team act safely.
The patient can become an active participant in identity assurance.
A secure token can turn a physical identifier into a digital starting point.
Immediate onboarding can connect the patient and family to what happens next, and that connection can be measured not only as engagement, but as operational, clinical and economic value.
The wristband may be one of the last universal physical connections between a patient and the healthcare system. We should not allow that connection to end when the wristband is removed. The real opportunity is to use the moment when the patient is present, identified and engaged to build continuity beyond the encounter because once the patient has left, every attempt to reconnect becomes harder.
And the most expensive patient to reach may be the one the system could have connected the first time.
The next test: a real patient journey
Across the first two series, I have examined how healthcare identifies patients and how it can connect them and their families to what happens next.
The next series will move from system design to lived experience.
It will follow my father’s journey through Toronto hospitals during a healthcare crisis: an 87-year-old living with dementia and dysphagia, a serious deterioration, clinical information that did not accurately describe him, and a family trying to understand and correct the record while care continued around them.
This will not be a story about naming or blaming an institution.
It will be an examination of what happens when patient identity, clinical documentation, digital access and family involvement all exist—but fail to create a reliable, shared understanding of the patient, because reaching the patient is only valuable if the information travelling through that connection is accurate, timely and belongs to the right person.
About Medirex Systems Inc.
Medirex Systems Inc. (Medirex) is a Canadian-owned and operated business connecting patients to health information systems. Being an industry leader for over 50 years, Medirex has evolved to bridge the gap between patient identification and engagement by cultivating patient connections with ease, security, and no errors. Providing a positive patient identification experience for over 10 million Canadians, Medirex adopts technologies ensuring that the patient has a voice in their healthcare journey. Medirex aids in the adoption of digital health resources and data to improve the patient experience for your healthcare organization.
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Medirex Communications
Medirex Systems Inc.
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