George Washington University Medical Faculty Associates

MATCHING STAFFING TO PATIENT VOLUME

Like many practices, the demands on MFA’s administrative staff varied greatly depending upon patient volumes. “There were long lines of patients waiting to check in during our busy periods because we couldn’t get enough staff to handle the volume, and then we were overstaffed during the slow periods,” said Vandana Toteja, director of healthcare informatics for MFA.

In addition to the long lines, the process of entering and modifying patient demographic and insurance information at the time of check in was inherently error prone and negatively affected billing.

In 2005, MFA started to evaluate a solution to automate this process and get patients directly involved with verifying and changing their information. MFA’s goal was to have a sleek and interactive patient (patient empowerment) check-in device that would leverage the self-service technology that other industries were using, such as automated teller machines and self-checkout kiosks at retail stores. However, after several years of investing money and time in a solution with its PM provider that did not meet their goals, MFA turned to Allscripts....

“In addition to offering check-in capabilities, the Allscripts kiosk solution had the ability to seamlessly tie in to our Allscripts electronic health record,” said Vandana Toteja.

ALLSCRIPTS PATIENT KIOSK BRINGS SELF-SERVICE CAPABILITIES TO PATIENTS

The Allscripts Patient Kiosk is a freestanding, interactive system that streamlines the patient registration process from check-in to payment. In addition to using the Patient Kiosk to check in for appointments, patients can use the Kiosk to update their information, such as home address, marital status, insurance information, and more. Also, the Patient Kiosk handles the processing of patient co-payments during the appointment check-in process.

"The decision to go with Allscripts happened quickly," Vandana Toteja said. "We made our decision in April of 2009, and had 20 of the kiosks rolled out in multiple clinical areas by December."

MFA’s quick purchasing decision was driven by the solution’s capabilities. Perhaps most surprising is that the Allscripts Patient Kiosk operated much differently than the kiosk solution that MFA was developing. "Our thought process was much different when we were developing our own solution vs. when we found the Allscripts solution," said Praveen Toteja, chief information officer of MFA. "The Allscripts Patient Kiosk asks the patient simple questions, such as ‘has your insurance changed?’ The solution we were designing tended to confuse patients by asking them detailed questions, such as ‘what is your group ID number?’"

"With the Allscripts Patient Kiosk, we can control the type of information that the patient can change, such as their e-mail address and phone numbers. But for information that affects billing, such as their date of birth or demographic data, we let them indicate on the kiosk that they have a change. We then have someone on our staff verify the information," said Praveen Toteja. "That allows our staff to act as gatekeepers on the important information changes, rather than having them handle the entire check-in process."

PALM SCANNING BIOMETRICS

The hardware for the kiosk was developed by Fujitsu, a leading US and Japanese IT solutions provider, and uses Fujitsu Palm Secure technology so pre-registered patients can be safely and positively identified by a palm scan. Other methods of patient identification include entering last name and date of birth, or sliding the patient’s credit card through the kiosk’s reader.

KIOSK INTERFACES WITH PM AND EHR SOLUTIONS

The Allscripts Patient Kiosk interfaces with MFA’s practice management system and their Allscripts Enterprise EHR. Patient demographic and insurance information that is entered by the patient is sent into a queue to be verified by an MFA staff member. Once verified, the practice management system is automatically updated with the new information. The interface with the Enterprise EHR allows the kiosk to notify patients when upcoming tests or procedures need to be performed, or the date of their next appointment. Patients are also given the option to use the kiosk’s camera to take their picture, which is then inserted into the patient’s electronic record.

The first area to go live on the kiosk was the OB/GYN department. It was selected for the first deployment because patients often visit their OB/GYN frequently during pregnancy, which made it an ideal test to see if the kiosk could streamline the check-in process. After their initial registration and check in, patients have less information to enter, so MFA found that the kiosk greatly reduced wait times. MFA now has kiosks deployed in eight other specialty departments.

The kiosk is designed to re-verify information following customer-defined time periods. For example, a practice can configure the kiosk to re-verify patient employment or address information if a check-in hasn’t occurred in 60 days. For OB/GYN patients who visit their physicians frequently, this feature decreases the amount of information that patients need to verify at check-in, and expedites the process.

Following the successful deployment of the kiosk in the OB/GYN department, MFA deployed an additional kiosk every three weeks. Typically, deployments occurred by floor, so that all specialties on that floor would incrementally go live with a kiosk. Multiple kiosks were deployed in clinical areas with several specialties or in areas with exceedingly high patient volumes. By December, a total of 20 kiosks were deployed. MFA’s information technology staff managed the entire implementation process.

KIOSK FREES UP STAFF TIME SO THEY CAN HANDLE OTHER DUTIES

The biggest benefit that MFA has realized by using the Patient Kiosk is a substantial reduction in the workload on its staff. “The kiosk has taken a lot of weight off of them in terms of workload,” Praveen Toteja said. “Now they’re freed up to do other tasks, such as call patients with reminders, handle referrals, check eligibility, etc. We’ve gone from an overworked staff to a staff that has a manageable workload. They’re now able to finish up all of their work by the end of the day, and that was difficult to do before we had the kiosk solution.”

Another benefit is that accurate information is entered into the kiosk, which helps MFA avoid billing problems due to legibility and other errors. “The business office says that there are fewer claims denials since we began using the kiosks, and we’re now working on quantifying if there has been a change,” Praveen Toteja said.

MFA is currently conducting a study of how the kiosks improve registration and check in efficiency, and expects to complete the study by summer 2010. Patients have commented that the kiosks reduce waiting times and that they’re easy to use. “We worked with Allscripts to make sure that the letters on the screen were big enough for nearly everyone to see, and that the process of using the kiosks was simple and quick,” Praveen Toteja said. “We haven’t mandated that patients use the kiosks, but most choose to use them and say that they enjoy the process.”

“We think that more practices will begin kiosks in the near future and patients will come to expect them when they visit a physician’s office,” Praveen Toteja said.