Adopting tablet technology can enable healthcare organizations to decrease paper use and improve patient satisfaction.
There’s no doubt that we live in a sophisticated age, where affordable technology is making life easier, with the ability to meet needs instantly and on demand. The advancement and ubiquity of technology is giving health systems the option to rapidly migrate to tablet-based technology platforms that increase patient engagement and deliver measurable ROI.
Over the past decade, on-site kiosks have helped hospitals and health systems to efficiently manage patient waiting rooms, reducing operating expenses, increasing patient satisfaction, and streamlining staff workflows. Now, tablet technology platforms can deliver operational efficiencies with sizeable returns. Leading enterprise healthcare systems have expanded their use of tablets across a variety of registration settings, which has enabled them to standardize registration processes.
The Elephant in the Waiting Room
For health systems, registration forms have long been a component of overhead costs and a cause of operational inefficiencies. In addition to the cost of the paper, these costs involve the labor to process the forms, which includes the staff hours dedicated to ordering and distributing the forms, as well as to delivering, scanning, reviewing, filing, and archiving the signed forms.
Technology platforms not only eliminate paper forms but also allow enterprise health systems to standardize the forms and workflow for patients across their enterprises, ensuring each patient enjoys a consistent and efficient experience.
A Case Study in Implementing Tablet Technology
The benefits of the use of tablet technology in place of paper are exemplified by the experience of a leading national health system that has more than 50 hospitals. The health system’s first step was to identify the numerous forms and questionnaires that could be delivered electronically on a tablet-based platform.
Although the actual number of pages and paper forms varied by location and department, the health system determined that, on average, patients signed nine forms each visit, requiring 11 to 20 sheets of paper per visit. Working with registration staff across multiple locations, the health system calculated the cost of labor per patient visit and the cost of paper. For just one location, the hard and soft costs of paper forms during registration added up to $100,000 per year. It also was clear that the cost of inefficiencies would increase exponentially when multiplied by the total registration locations.
The pilot program. The health system then launched a pilot in 28 clinics across four hospitals within the same suburban area. Working with a cross-functional team, it was able to map current workflow and electronic health record (EHR) solutions that would be linked to the tablet-based registration process. Once that process was finalized, 102 tablets were deployed, and staff was trained on the workflow and supporting cloud-based administration tools. The pilot included variety of departments including all emergency, women’s health, wound care, physical therapy, surgery, oncology, and pediatrics departments. The mix of departments would allow a comparison of usage across distinct patient populations.
Digitized forms. The organization digitized eight paper-based documents—administrative forms, registration forms, demographic updates, insurance verifications, identification verifications, collections documents, and wait-time management forms—across six modalities, including preregistration, e-signature, registration for scheduled and walk-in appointments, bedside registration, and queuing.
Platform design. The tablet-based platform was designed with three primary value requirements: demographics updates, insurance updates, and questionnaire form completion. Demographics verification offered an opportunity to capture additional information not previously on file. All fields marked as “required” were modeled after the fields already required in the billing and accounts receivable system, ensuring the consistent use of accurate information for billing and care purposes across the enterprise.
The platform is designed to send information to the financial system only after performing insurance eligibility checks, thereby ensuring that patients receive the correct billing information up front and reducing denials on the back end.
Because the reason for adopting a tablet-based approach is to run a paperless registration operation, primary area of focus in designing the system was on the forms themselves and their content. The forms display in either English or Spanish, in Section 508-compliant font sizes, and are triggered based on unique account numbers, location of services (e.g., clinic), and financial classes, (e.g., Medicare and Tricare). The system captures the patient’s e-signature only if the patient selects “Agree.” In addition, each form must be stamped with patient and location identifiers.
Security and usability. Each department received tablets in secure, locked cases that mount to the registration counter and are removable only with a special key tool. Mobile tablets also were deployed for staff-assisted registration where patients are unable either to complete the forms themselves or to stand at the registration counter.
Each tablet is specially configured to prevent access to anything except the registration workflow. Tablets feature high levels of security safeguards protecting the devices and the data they collect. For example, tablet settings make it mandatory for end users to sign on, thereby ensuring that the devices are used only for business needs. Even if devices get lost or stolen, the settings can’t be modified.
For added security, each tablet is accounted for in the health system’s radiofrequency identification system, which tracks the tablet’s movements throughout the facility and information about when tablets are checked out or in and by which staff members.
An important consideration for health systems in adopting tablet technology is to ensure the tablets are appropriately connected. Many hospitals experience wireless connectivity issues, particularly around imaging centers where interference interrupts and slows down connectivity. It’s imperative that a provider implementing this technology ensure strong wireless signals. Staff is more inclined to adopt technology if they are confident that they can rely on it and that the wireless signals will not be interrupted.
Tablet-based registration workflow is designed to promote operational staff efficiency and enhance the patient experience. At the case study health system, on-site workflow options include a self-guided registration workflow for both scheduled and walk-in patients.
Scheduled patients use an affixed tablet at registration and are asked to authenticate their identities using multiple identifiers, including name and date of birth. This authentication process enables the integrated solution to securely access the patient’s record from the health system’s EHR. Patients can confirm or edit demographics, confirm or add insurance, and sign forms electronically. Patients also can request assistance from staff at this point to guide them through the process. In addition, before a patient can complete the tablet registration, an employee must physically verify the patient’s insurance and government-issued ID.
Once demographic information has been reviewed, patients work with staff to make payments on the tablets. If the patient’s payment information for a health savings account or credit card is stored in the system, the tablet offers a one-click payment option. If not, the patient may enter the information manually, as most online retail consumers do.
The tablet workflow is the same for staff-assisted and walk-in workflows, with some minor differences. Staff-assisted workflows require initiation by staff, and may also be configured on the spot if certain information is not necessary (like demographics capture, for instance). Walk-in workflows merely require that staff perform a medical screening exam to ensure and the patient does not need emergency care and that the patient account has been created accurately.
For all workflows, staff receive notifications for follow-up activities if a patient declines a form (such as a financial services request for assistance), and for clinical precautions.
The tablet registration platform at the health system works within an existing enterprise IT ecosystem and is designed to require minimal support from health system IT staff. Bidirectional interfaces connect the solution to current systems, allowing information such as patient data, appointments, forms, and demographics to flow seamlessly and securely among the EHR, billing, and document management systems in real time.
The ROI from adoption of tablet technology is realized in six major categories.
Paper and materials. Typically, health systems require 10 pages of forms per patient per visit. For the case study health system, digitizing forms accounted for $40,000 of first-year savings on paper alone, plus additional savings on the cost of toner, ink, pens, clipboards, scanners, printers, and storage/archival space.
Labor handling forms savings. Under a paper-based registration process, a health system’s patient forms must be printed, handed out, and received after they’re filled out. The staff member receiving the completed paperwork must then carefully review each form to make sure it is complete. At the end of the day, another member of the team scans the forms, files them electronically, and then archives them physically. The use of tablets eliminates much of this administrative work—with the amount varying based on the health system’s manual process—thereby improving operational efficiency and allowing the provider to reallocate resources to value-added tasks.
Self-service adoption. One advantage of using a tablet at registration is that patients can review and edit the basic demographic information their provider has on record in the EHR. In the case of changes, staff can update the patient record at the click of a button rather than that having to manually submit the change in writing. Patient demographic information tends to be wrong more than 30 percent of the time, and the simple act of ensuring patient information on file is correct can reduce bad debt by over 4 percent. a In addition, eliminating paperwork improves patient satisfaction and staff morale by offloading the most tedious part of the process. The case study health system saw a 15 percent increase in staff efficiency.
Point-of-service collections. Tablets can be integrated with the finance and billing systems, making a payment at the point of service is easy for both patients and staff. The workflow can be configured to accept payments for past due balances, copays, and display cost of care estimates. Analyses have shown that presenting patients with outstanding bills at the point of service increases the chances of collecting payment by 62 percent. b For the consumer, this approach removes the transaction cost of having to think about finding the credit card or writing the check and quickly moves bill payment off a patient’s to-do list.
Reduced denials amount. Verifying that the right insurance is on file increases billing clean claim rates by 22 percent. c Eligibility gives patients and staff the necessary benefits coverage information for an upcoming service. By presenting patients with this information before service, providers give the patients the opportunity to make better decisions about their treatment. Determining eligibility also can help healthcare organizations reduce claims denials and put the proper safeguards in place to ensure patients have the support structure they need, such as financial assistance or payment plans.
Improved patient satisfaction. The greater efficiencies that can be realized through tablet-enabled registration contribute to improved satisfaction among patients. After implementing tablets for forms management, for example, the case study health system reduced check-in time from 12 to 4 minutes. And it stands to reason that reducing wait times will invariably have a positive effect on patient satisfaction.
In addition to the gains mentioned above, tablet technology can provide the following benefits.
Standardized workflow. Eliminating paper forms using a mobile, tablet-based registration platform makes standardization across the organization much more easily achievable. What often has been left up to local staff can now be quickly disseminated through on-line processes across a health system. Standardized forms and technology platforms lower training and compliance costs and provide patients with a consistent experience across the health system.
Reporting. Aside from conducting a manual time study, health systems have no way to collect data about the time it takes to complete a manual check-in process, or to get data on wait times, staff, or throughput. With a patient check-in platform, metrics are collected by location and clinic. Administration gains an aggregated view of daily operations and can make decisions on, for example, whether to staff up or down depending on the varying volume trends.
Clinical intake questionnaires. Tablets afford staff the opportunity to modify the digital workflow on the fly and gather appointment-specific information. Being able to quickly address even the most basic questions—whether a patient has a scheduled appointment or is a walk-in, for example—can help healthcare facilities to optimize their patient flow. Expanding these queries to include information about symptoms, pain level, or risk factors like recent travel abroad can give healthcare facilities the opportunity to prioritize patients correctly and discreetly. Dynamic electronic form design allows health systems to tailor forms to meet the clinical requirements of the patient population.
Scaling for Greater ROI
Simply by removing paper from the equation and digitizing forms, health systems are realizing major, immediate cost savings, relieving staff of manual tasks, and giving patients a more modern, faster registration process. But perhaps what’s most compelling is the greater advantage of adopting a culture of efficiency by technology.
Online patient portals allow patients to complete many of the same tasks at home before arriving for an appointment, reducing wait times and streamlining staff workflow even further. Kiosks also can be used for quick, on-site check-in in main lobbies, and digital queuing screens provide patients visibility in their wait times. These additional onsite modalities give staff a consolidated view of patient information, billing, flags, and alerts, as well as the ability to prioritize patients in their waiting room from the same dashboard.
Portals, kiosks, tablets, and queuing platform offer the ability to connect and digitize across the entire patient experience. Removing paper opens the doors for major savings along the whole continuum—and more important, it represents an inevitable step in the ultimate transformation of health care.
a. Based on 2016-2017 Vecna Technologies analysis of current provider client performance
b. Based on Vecna customer analysis, 2016-2017
c. Based on enterprise health system/Vecna data analysis, 2017