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Check-in kiosks keep expansion 'FTE neutral'
Patients say they're 'easy to use'
The biggest challenge regarding the implementation of registration kiosks at the Medical Center of Central Georgia (MCCG) in Macon was "just trying to arrive at the place where our organization was ready to present self-service," says Jane Gray, CPA, CHE, FABC, assistant vice president of patient business services.
"We are very focused on the patient experience and wanted to be able to prove that this would accentuate it," she adds.
So far, the feedback from a brief survey embedded at the conclusion of the kiosk process — now in place in the cardiac catheterization lab — indicates that MCCG made the right decision, Gray says. "The surveys are coming back very positive. [Patients] feel it is easy to use."
A 92-year-old woman successfully used the kiosk during the first week of operation, she notes. Patients who are apprehensive at first become comfortable with the process with a little guidance from an access representative, adds Gray, who says staff have heard comments such as, "Who would have thought I'd be able to use a computer?"
One of the few negative comments came from an Air Force pilot who said the system didn't move through the process fast enough, she notes.
"Overall, everything has been great," Gray says. "As with any new system, there are kinks to work out, but we've been able to do that successfully."
In a pilot project done in preparation for moving its cardiac services to a new "Heart Tower" in December 2007, MCCG set up kiosks in two different locations, she explains. "Because of space constraints, we have [cardiac services] on two different floors, which is part of the impetus to move.
"Our objective is to move to our big new building and remain FTE [full-time equivalent] neutral, using technology to keep staff size the same," Gray adds. MCCG is using three versions of the kiosk — wireless tablets, desktops, and one freestanding model, she says.
While the hospital's information technology staff were initially concerned about a possible hardware burden associated with the kiosks, that has been pretty much a non-issue, Gray says.
The hospital's decision to have all the devices be wireless — "so we wouldn't have to run cable" — led to the need for an adjustment with the wireless network, she notes. "On one of the floors, the wireless antenna was very close to radiology, which has lead walls, so we had to move it to get a better signal."
Keeping the kiosk neat and clean also has not been a problem, she adds. "So far, so good. This is not a trauma population. All of these patients are scheduled, and a high percentage are preregistered."
Registrars periodically clean the kiosk with sanitary wipes, Gray says.
Patients may access the kiosk with any card that has a magnetic stripe, she notes. Even a grocery store card or employee badge can be used to locate the person's name, which is then verified with a more precise identifier such as the last four digits of the Social Security number, Gray says.
One of the kiosk's biggest pluses is that it eliminates much of the redundancy of the traditional registration process, she says. Instead of verbally responding to a lengthy series of questions — aimed at ensuring the accuracy of existing data — that make up the face-to-face or telephone encounter, Gray adds, customers can review their information easily and, if they need to make a change, do it quickly.
If there are no changes to be made, she says, patients can complete the process in two or three minutes.
"Another benefit is the availability of electronic forms," Gray says. "In the past, we had to have a packet of forms ready, and there are costs associated with that. Now, we present them electronically; the patient can deploy an electronic signature, and it is stored in our imaging system."
The MCCG kiosk has "one of the most complex scripting interfaces" that the vendor — Maitland, FL-based Galvanon — has worked on, she notes. "We are still fine-tuning, but everything we've done has led to a minimum of duplicate entries, and we can update fields automatically, rather than having to key in information.
"There are a lot of different decision points that we've built in, where other hospitals might just take traditional demographic updates," Gray adds. "We're taking it to the next level as to what data are presented and what we're feeding back."
An added plus is that there is a work flow that presents in Spanish, she says. "We could build in any other language, so there is greater flexibility there."
MCCG leadership is particularly pleased that not only patients like the MediKiosk, as the Galvanon product is called, but registration employees also have demonstrated a high level of satisfaction with it, Gray says.
"It relieves some of the stresses on them," she adds. "For our heart services, we might have 10 people showing up at 7 a.m. for appointments in an environment where there are only two [registrars], so eight people are having to wait for their turn."
With the kiosk, the majority of patients can be served fairly quickly, Gray says, so there is less waiting and employees don't feel the pressure of a line forming.
Clinical staff, meanwhile, are commenting that patients are getting back to them more quickly, she notes. "As we get deeper into this, registration will no longer be a delay in the process. We hope to gain more efficiencies in clinical scheduling to take on more cases, and to be able to take patients in real-time with limited waiting."
To allay the concerns of hospital leadership about whether patients would accept the new technology, MCCG representatives visited Newark Beth Israel Medical Center in New Jersey, where MediKiosks were already being used, Gray says. "We were very impressed with the usability of the product.
"This is really a technology that we envisioned and wanted before it existed in the marketplace," she adds, "so when we came across it we were very excited."
Consumers looking for flexibility
Enabling access at multiple touchpoints — not just at the point of service — is the next big focus for the kiosk technology, says Chakri Toleti, vice president, operations for Galvanon, which recently became part of NCR Corp.'s health care division.
Consumers will be looking for that flexibility in health care interactions, he says, as it increasingly is offered in other facets of their daily lives. Toleti mentions such examples as "Minute Clinics" and "Take Care" clinics in retail settings like Walgreen's, Wal-Mart, and Target, where people receive routine health care services.
These clinics typically offer services such as flu shots, school physicals, and strep tests, with costs in the $25 range.
"Hospitals will have to compete with local retailers for that level of service," he says. "Technology like this enhances the customer experience and brings down the cost of delivering care."
Ultimately, customers will routinely make arrangements for their health care service on-line from home — just as they do for air travel — and then report to the hospital or clinic with 90% of the work done, Toleti adds.
"They will just sign forms and pay the co-pay," he says. "We can even enable payment on-line."
One of the key functionalities his clients want, Toleti notes, is the ability to handle up-front collections via the kiosk. Westchester Medical Group, a 100-physician organization in White Plains, NY, he points out, experienced significant savings by collecting payments in this manner.
According to Simeon Schwartz, president of the group, the kiosks have driven a 50% reduction in the transaction costs associated with co-payments and have reduced the staff time necessary to collect and post payments by about 90%.
With a focus on streamlining patient registration, the team at Westchester had very specific criteria in mind to make the project a success, Toleti adds. Those requirements included:
Using the MediKiosk, Toleti explains, customers can type in their check number and have their bank account debited immediately for the amount owed. By the time the check-in process is completed, he adds, the hospital knows that the check has been paid or if it is a bad check.
Through an interaction with the health care organization's billing system, Toleti says, the kiosk technology also can trigger a message to financial counselors, saying, "Mrs. Smith is checking in, and she owes $1,000 from a previous visit."
"Most ADT [admission/discharge/transfer] systems don't have a way of accessing outstanding balances," he says.
Rather than charging a percentage of the monies collected, as credit card companies do, Galvanon charges a flat fee per transaction, Toleti notes.
Through its association with NCR, Toleti says, Galvanon has been able to leverage a great deal of knowledge from other industries to improve the design of its three types of kiosks.
Work flows and user interfaces have been enhanced, he adds. "We have made improvements in things like the way the buttons are positioned and how forms are presented. [The kiosks] are a lot more user-friendly."
While the kiosk technology offers a fundamental paradigm shift in how the registration function is performed, Toleti says, it is an example of automation, not invention.
"We're not really reinventing," he adds. "We're taking existing processes — the piece of paper, the clipboard — and automating them. Multiple check-ins can be done at the same time, and [the registrar] doesn't have to remember to ask for the next step. It makes life a lot easier to streamline the process."
Toleti emphasizes that there will always be a certain section of the population that will need some level of assistance in using the kiosk. You still want to have 'touch' with the person who is there, but it's at a different level."
More than 100 hospitals are either using Galvanon's kiosks or in the implementation phase, he says.