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'eClipboards' smooth check-in for outpatients
'Patients love it,' director says
Having patients use "eClipboards" to review and update their own information during check-in at the Breast Health Center at University Medical Center of Princeton (NJ) is increasing registration accuracy and streamlining work flow, says Laurie Grey, director of revenue cycle management.
Patient satisfaction surveys at the center — which opened in December 2006 — are eliciting "nothing but wonderful comments" regarding the check-in process, Grey adds. "Patients love it."
Individuals arriving for a service at the Breast Health Center, she explains, are met by a greeter, who hands them an eClipboard, one of three MediKiosk models created by Maitland, FL-based Galvanon. There are plans to use desktop and freestanding models in future implementations, Grey notes.
Patients take the eClipboard to a seat and use the stylus to go through the registration steps after typing in their last name, date of birth, and zip code to access the proper account.
Typically, access would be gained by swiping a driver's license, Grey says, but in New Jersey driver's licenses do not have magnetic strips.
When the account is accessed, she says, a message comes up, welcoming the patient and asking, for example, if today's visit is for a mammogram. After the patient checks "yes," there is a series of screens asking the person to confirm demographic, physician, insurance, and other information.
"If it all looks OK, the patient just hits 'next,'" Grey adds. "If at any point the patient needs help, is confused, or has a question, [he or she] clicks on the 'help' button."
There is a monitoring tool, she says, whereby the access associate is able — behind the scenes — to see where the patient is in the process.
"When they say they need help, whatever screen they're on changes to a different color," Grey explains. "[The associate] can say, 'I see you're having trouble with your insurance information. How can we help you?'"
If the insurance information needs to be changed, she notes, hospital management may or may not want the patient to be able to update those changes in the system. Either way, the software can be programmed accordingly, Grey says. "We, the facility, have the option to see if we want the change made by the patient to automatically update or to be reviewed by the patient access associate before updating."
If there is an insurance change, access associates are prompted — also by a color change — to ask for a copy of the insurance card when the patient brings back the eClipboard, she adds.
Putting patients in control
The MediKiosk process — enabled by a Quadramed ADT (admission/discharge/transfer) system and Affinity software — is "very flexible, very user-friendly, and seamless for the patient," Grey says. "There is a minimal learning curve. Ninety-nine percent of the patients totally embraced this. It's such a success, we plan to implement it throughout the organization."
Patients like using the eClipboard, she says, because they enjoy being in control, and recognize the efficiency it adds to the registration process. For staff, Grey says, it has meant less labor at the data entry point, as well as reduced paper costs and management of paper.
With the eClipboard being introduced in a new facility, there is no hard data with which to make comparisons, but it is clear that patient wait times also have been dramatically reduced, she notes. "We can tell by how quickly patients are going through the process. We know that is going to be one of the benefits."
In addition to patient check-in, she points out, the MediKiosk offers other functionalities, such as point-of-service collections and way finding, that the medical center will make use of in the future.
As for how implementation will proceed, Grey says, "we're toying with continuing with patients who are preregistered — in areas such as endoscopy, same-day surgery, interventional radiology and cardiology procedures — and at the same time, looking at walk-in patients, like those who come in for lab draws or chest X-rays."
Which model — eClipboard, desktop or freestanding — is chosen for particular areas, she says, "will be totally dependent on the throughput in [those] departments."
A freestanding MediKiosk, for example, or perhaps a desktop model, might be best for walk-in patients, Grey adds, "because they don't need to see [a staff member] at that point in time. With an eClipboard, somebody still has to hand it out."
As for care and maintenance of the eClipboards, notes Kathleen Donnelly, patient access manager, they are housed in rubberized brackets to prevent damage in case they are dropped and are cleaned between customers with sanitary wipes such as those used in patient rooms.
The eClipboard is docked and recharged at night, as well as between patients during the course of the day, Donnelly adds.
Patient flow charted
One of the things the team did in preparation for the eClipboard implementation was to chart the patient flow in the breast health area, Grey says. "We looked at the current process and the new kiosk process to see how things would change. We take so many things for granted — this forced us to take a look at each step and flesh it out."
That exercise helped improve communications between patient access employees and clinicians, adds Donnelly.
"Patient access [staff] knew what we did, and clinical [staff] knew what they did," she explains. The new focus prompted questions such as, "After we give you a call, what do you do?"
What happens now, Grey says, is that clinicians, as well as access employees, are able to monitor the process in the background. When the patient has checked in and is ready for the service, she adds, a technician can take note of that and go out to take the person back to the treatment area.
From the patient's perspective, notes Donnelly, these steps take place seamlessly. Their experience, she says, is, "'I didn't see anybody talking to anybody, but the technician knows I'm ready.'"
"We are really very, very excited about implementing [the kiosk]," adds Grey. "It's becoming more and more acceptable to have this type of process, where the patient is more in control."