Patients expect self-service — Give options: Register online, at kiosk
Executive Summary
A growing number of patient access areas offer "self-service" options with online registration or kiosks. Registration times decreased by almost 50% after kiosks were implemented at five of Integris Health’s hospitals. Patient access leaders should do the following:
• Use kiosks for pre-registered patients.
• Have support staff available to help patients.
• Commit to kiosks as the primary arrival mechanism for all scheduled patients.
Registration times decreased by nearly 50%
Patients accustomed to using self-service kiosks at airport check-in counters and placing online retail orders likely wonder why they have to stand in line to give demographic and insurance information to a registrar verbally.
"There are many self-service options available in patient access, and more are emerging. It’s an exciting time for patient access technology," says Amber J. Harris, administrative director of patient-centered access at Integris Health in Oklahoma City, OK.
Sandra J. Wolfskill, FHFMA, director of healthcare finance policy at the Healthcare Financial Management Association (HFMA), says self-service options "ease backlogs in the registration area, and in the case of online options, allow patients to interact with the hospital at their convenience." Wolfskill also is director of HFMA’s revenue cycle Measure Apply Perform (MAP) initiatives.
Wolfskill says that the options patients expect are "generational in nature. It varies from 20-somethings who expect mobile access and processing, to retirees with time to come in early and chat with the registration staff."
She estimates that about 20% of patient access departments offer some type of online pre-registration.
"This is a viable option for many patient access areas, as long as appropriate encryption and security are provided," says Wolfskill. "Some details may require staff intervention, such as electronic insurance verification or billing codes that are captured during registration."
Kiosks are especially useful for patients who have been pre-registered for services, according to Wolfskill. Payments are processed electronically from the kiosk and applied to the account, the patient’s armband and arrival paperwork are printed, a staff member bands the patient, and the patient is directed to the service area.
"Since the patient’s information has already been validated and updated, the arrival process involves simply checking in, confirming identity, and paying any agreed-upon amount," Wolfskill explains.
Registration time cut almost 50%
Registration times decreased by almost 50% after kiosks were implemented in the main registration area and surgery centers at five of Integris Health’s hospitals.
"We are building a new registration area at Integris Baptist Medical Center, and it fully incorporates kiosk into the registration experience," reports Harris.
"We use them as an express registration option for pre-registered patients," says Harris. Integris Health plans to implement an online patient portal for registration once the hospital converts to a new Epic system, she reports.
Patients adjusted quickly to the kiosks. "They are exposed to increasing self-service technology in other industries," notes Harris. "We asked patients if they wanted to try our kiosks. We didn’t force anyone to use them and still don’t."
Every patient using the kiosk is presented with a quick survey at the end about their registration experience. "Of patients surveyed, 96% said they liked the kiosks, and 87% said the process was easier than a traditional registration," reports Harris.
Harris says that she would like to see the kiosks used in the emergency room (ER), but that this setting presents some unique challenges.
"The challenge in the ER is integrating fully into your Master Patient Index, just as expected’ patients for the day are," she explains. "It’s a completely different work flow. But other hospitals successfully do it, and I am sure we could, too."
Do this before implementation
Before implementing kiosks in registration areas, Wolfskill says to take these steps:
• Define when self-registration is appropriate.
"Self-service options are not appropriate for the emergency department, walk-ins, or unscheduled outpatients," says Wolfskill.
• Have support personnel available to help patients use the kiosks.
Without appropriate support, some patients will become frustrated or unable to complete the process.
"Even the airlines, who pioneered the extensive use of kiosks, have personnel standing by to help the moment a passenger looks lost or confused," says Wolfskill.
• Commit to kiosks as the primary arrival mechanism for all scheduled patients.
Patient access leaders can provide information on kiosks to patients during the pre-registration process, make announcements to the community, post signs about the kiosks, and provide handouts on the kiosks in registration areas.
"Otherwise, the unscheduled arrival area becomes backlogged with people who do not want to use the kiosks," Wolfskill says.
Moving toward self-service
At Emory University Hospital in Atlanta, the Information Services Department is working on ways to use technology to add self-service options to patient access areas. A related goal is to minimize the need for patient contact with patient access employees at time of service, says Pete Kraus, CHAM, CPAR, FHAM, business analyst for patient financial services.
"With respect to elective services, it all begins at scheduling," he says.
This process involves the gathering of data needed to pre-register, pre-certify, determine medical necessity, determine whether the patient’s status is inpatient or outpatient, and determine financial need and the patient’s ability to pay. All these items must be completed as a prerequisite to scheduling, says Kraus.
Kraus recently discussed the feasibility of patients completing the Medicare Secondary Payer Questionnaire using a kiosk or as part of online registration. "Given current complexities, we’re not sure it will ever be doable, but we can and do collect the information during preadmission calls," says Kraus.
In coming years, once the patient presents, there could be little left for patient access to do except obtain signatures.
"Perhaps we’ll eventually embrace technology to have consent obtained in advance," says Kraus. "Very little of this is current reality. But each step we take is designed to move us in that direction."
- Amber J. Harris, Administrative Director, Patient Centered Access, Integris Health, Oklahoma City, OK. Phone: (405) 713-5547. Email: [email protected].
- Pete Kraus, CHAM, CPAR, FHAM, Business Analyst, Patient Financial Services, Emory University Hospital, Atlanta. Phone: (404) 712-4399. Fax: (404) 712-1316. Email: [email protected].
- Sandra J. Wolfskill, FHFMA, Director, Healthcare Finance Policy, Revenue Cycle MAP, Healthcare Financial Management Association, Westchester, IL. Phone: (708) 492-3419. Email: [email protected].
