Kiosks Let Patients Register Themselves
Jane Gray, CPA, assistant vice president for MCCG’s
patient business services, and Kim Whitley, RN, director of
patient access, tell why the 603-bed medical center introduced
patient kiosks in two busy locations in 2007—and plan to install
additional kiosks elsewhere in the medical center. “My dream is
to have a kiosk at every registration site,” says Whitley.
What prompted you to introduce patient kiosks?
Whitley: The space configuration of our new heart
services tower was going to require additional staff members to
handle registration. There had been some reluctance to move to
kiosks when we suggested it earlier because senior management
worried how patients would react. Our second attempt to consider
a kiosk solution was more readily accepted because it was
compared to an investment of five new staff members.
Have your patients benefited from the kiosks?
Gray: In the old system, staff members could only check
in two patients at a time. So patients sometimes waited 20 or 25
minutes just to see a registration person, and the registration
process could take 10 to 20 minutes. The kiosks allow 10
patients to be checking in simultaneously, so there is no wait
to start registering. Patients go immediately to a kiosk or to
get a tablet (similar to a laptop computer) if they prefer to
sit.
Whitley: Assuming the patients have preregistered, which
is our goal, the registration process at the kiosk primarily is
verifying data on a few screens, making changes if necessary,
and writing their electronic signature. They can also pay
upfront for services, if they owe money. The registration
process takes an average of six to seven minutes for Medicare
patients and three to four minutes for non-Medicare patients.
Because we started in our heart services unit, where our
patients tend to be somewhat older, their willingness to accept
the kiosks was a concern. Generally, it has been very well
accepted. Some people need a little more assistance than others.
People who are technology-savvy really don’t need much
assistance at all.
Gray: We are very concerned about patient satisfaction
with these kiosks, so we use an on-screen satisfaction survey at
the end of the kiosk check-in process. Responses have been
positive, and patients report that the technology is easy to
use, even though a high percentage of our patients are senior
citizens. We monitor these surveys closely and immediately
respond to any negative feedback.
How have kiosks affected your staffing?
Gray: We have a staff person who monitors the kiosk
activity and is available for assistance as needed, but instead
of having that 1:1 staff-to-patient ratio, we can have 1:4 or
1:6 ratio. This allows our registration staff to spend their
time preregistering patients by telephone, which is what makes
the kiosk check-in go so quickly.
The change in workflow increases the accuracy of our
registration information since patients seem to review and
correct the information we gathered during the preregistration
process more vigilantly on the kiosks than they do in rote
responses when the same questions are asked verbally in the
traditional face-to-face model.
Instead of managing paperwork behind a desk, the role of our
staff members has become friendlier—providing support,
direction, and assistance, as needed. Having the staff
side-by-side with the patient has helped to enhance our rapport
with our customers and has served to improve both patient and
staff job satisfaction.
Do patients have the option of registering the traditional
way?
Whitley: When we researched how other hospitals had been
successful with kiosks, we learned that kiosks should not be
offered as an option. If a patient comes in and absolutely
refuses to use the kiosk, then our staff person will do it, with
the patient providing the information needed to move through the
screens. But that is rare. Generally speaking, when you come to
our site, the only option for registration is via self-service
through the kiosk.
How do kiosks affect your workflow?
Gray: We went from registering two patients at one time
to registering 10 patients at one time. On the first day that we
used kiosks, our clinical staff went from having to wait on
their patients to get through registration to telling us, “Wait
a minute—you’re going too fast.”
Reducing registration waits has helped improve patient
throughput. We were able to move patient arrival times closer to
the actual case time, instead of batching arrivals up to two
hours in advance to ensure the physicians had enough patients
ready to stay productive in the cath labs. Once the volumes in
our new heart tower stabilize, it will be interesting to review
our case load to see if the reduced wait times have actually
translated into increased capacity and increased revenue.
What advice do you have for hospitals who are considering
kiosks?
Whitley: Make sure that you budget for enough development
hours to address the unanticipated updates that will allow you
to make the most of the technology. This requires reengineering
the registration process totally. As you move through the design
phase of creating storyboards—which determine what information
will be on each screen and how the screens will be ordered—and
building the new work flow, you will probably find things you
want to do that were not in the original scope of the project.
You need to have very strong project managers with experience on
the vendor’s side and a staff person who can organize internal
tasks, keep things going, and meet project plan deadlines. You
want to have somebody who is going to keep everybody focused
through testing and implementation. Starting from scratch, it
took us about six months to design, develop, test, and implement
our first kiosk site. The next site was much quicker—less than
two months—because the initial look and feel of the kiosks had
been established.
You must be very selective of staff in the kiosk area. They have
to be able to multitask, and they have to be very customer
service oriented. They have to be comfortable with the
technology themselves, the type of person who uses self-service
options around town.
Gray: If your executive team is hesitant to invest in an
enterprisewide solution initially, a pilot license targeting one
key area will give you the opportunity to try the technology on
your patient populations without making a gigantic software
investment up front. In our case, the ROI was favorable when
comparing the pilot purchase price to the potential salary and
benefit expense associated with adding five new FTE’s to do the
work. You might ask your vendor to apply the cost of the pilot
license to the cost of an enterprise implementation, if your
trial is successful and you decide to move forward with kiosk
registration across the organization.
This
article originally appeared in HFMA’s Patient Friendly
Billing newsletter.
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