Do kiosks deliver what they promise?

Do they impact satisfaction, delay reduction?

If you want to know if computer kiosks deliver results when they are used to register patients, the answer depends on what results you're looking for. John Woerly, RHIA, CHAM, a senior manager at Accenture in Indianapolis, says that in some cases, patient access departments were disappointed with the results they saw after implementing registration kiosks. "This may be due to patients tending to still want face-to-face 'people' service," says Woerly.

According to Beth Keith, manager of ACS Healthcare Solutions, one of the biggest issues with implementation of kiosks has been that the cost savings in terms of staff have not been as significant as originally projected. 

"The places that appear to be the most successful using the kiosks are those that see it strictly as a customer satisfaction feature. It allows people who are computer-savvy to register themselves rather than wait for someone," says Keith. "From my research, those facilities that have expected huge personnel savings have not been as happy, because the need for assistance has not gone away."

Typically, the patient has to be preregistered so that the appropriate insurance selections are made. "For a patient to move through the sophisticated registration systems to select the right choices for data that are needed for billing would not be a simple task," says Keith. "Some facilities use it to register that the patient has arrived." Patients select themselves from a list matching their name, sex, and birth date and then add some limited data, but are ultimately registered by a facility employee. "Those organizations have not reduced staff, but merely used the kiosk to enhance customer satisfaction," says Keith.

At Hackensack (NJ) University Medical Center, the decision to implement computerized kiosks was driven by the need to improve customer satisfaction, reduce delays associated with registration, and to improve the operational flow of arriving patients. The kiosks were implemented in two high-volume areas — physical medicine and rehabilitation and the Institute for Child Development. "Patients do like utilizing the kiosks," says Alan N. Leipsner, MPH, MBA, FACHE, the hospital's administrative director of urology. "The development of proper interfaces is key to achieving optimum success with the kiosks."

One challenge in physical medicine is the use of kiosks by patients with injuries requiring braces and crutches. "This has been addressed through the utilization of staff to assist in the use of the kiosks," says Leipsner. "Additionally, we were faced with the issue of privacy, which has been addressed by side panels and putting one kiosk in a small office."

Fears were unfounded

Two big challenges patient access was facing in 2007 at the Medical College of Central Georgia in Macon were getting clean claims so they are paid as quickly as possible, and dealing with understaffing due to vacancies and people being out on leave. "We had lots of decentralized registration areas, and we were really, really struggling with how in the world to continue to staff these areas," says Kim Whitley, director, patient access and clinical intake management.

Kiosks were seen as a way to relieve these staffing issues. "As we look forward to the shrinking dollar of health care, we were looking to reduce overtime and FTE needs while maintaining a high level of customer services," says Whitley.

At that point, kiosks were being used in other markets but were not utilized in health care. "We had a really hard time finding a vendor, but we kept looking. It also took us a little bit longer than we hoped to get our project approved," says Whitley.

One reason for this was that higher-ups were worried that patients would not want to register themselves using kiosks. "There were some concerns that there would be issues with that. Once we convinced everyone that this would be fine, we were able to move forward," says Whitley. Two years ago, kiosks were implemented at the hospital's Georgia Heart Center, and patients began checking themselves in for medical appointments.

The fears about resistance from patients turned out to be unfounded, and the department boasts 96% to 98% satisfaction rates.

"The reason we know this is because at the end of every kiosk check-in, we have an automatic customer service survey," says Whitley. "We know in real time how our patients feel about the check-in process with the kiosk. We have a grid that we use to assess the area. This included the presence of preregistration, because obviously if you have a strong preregistration component then your patient will spend less time at the kiosk."

As for the rollout of the kiosks, Whitley says "we were looking at those areas we would get the best use out of it. We decided to roll this out in the procedural areas first. Once we got it under our belt and working, then we'd move on to other areas."

Although administrators were most concerned about the older patient population being dissatisfied with the kiosks, the elderly patients turned out to be more computer-savvy than expected. "And for those that may not be, they very rarely come by themselves," says Whitley. "So we really didn't have the obstacle that we had anticipated."

In addition, registration staff are always present to help patients, should they need assistance to get through the check-in process.

Kiosks were just implemented at a second registration site, and customer satisfaction is being measured using the same real-time survey. Patients are asked whether the registration process was easy, moderate, or difficult. Out of about 100 to 150 registrations, only about three patients check "difficult."

If patients answer "difficult," then they are asked a series of additional questions: Were you uncomfortable with self-service check-in? Did the screens move the way you wanted them to? Was your registration staff member courteous to you during the process? Would you like to be contacted?

"If we have any issues, we can address them right then and there. We don't have to wait until we get a survey back later on," says Whitley.

Delays dramatically reduced

Since patient satisfaction with registration was already measured before the kiosks were implemented, the department had a baseline to work with. "Most of our registration issues, when we didn't score well, were due to wait time," says Whitley. "It wasn't so much the actual registration process but how long it took to see a registration person and the time it took us to register them."

Previously, average wait times from the time patients walked in the door until they finished registration, including the time they waited for a registration person, were at around 32 minutes. "Now, in our heart services site, from the time the patient signs in until they finish checking in is six-and-a-half minutes," says Whitley. "So we are carving about 20 to 25 minutes off the registration time. It's been very successful for us."

For this reason, Whitley recommends working closely with clinical staff during the rollout of kiosks. Kiosks were rolled out in the heart services area first, which had only two registration staff members. This meant that if 10 patients walked in at the same time, they could only be registered two at a time.

When the department went live with kiosk registration, suddenly all 10 patients could be registered at once. "This meant that patients were processed five times faster, so we had more patients going to the clinical area in a faster manner," says Whitley. "In order to be ready to accept them, the clinical areas had to adjust their scheduling."

Previously, the clinical areas had based their operations on a 30 to 45 minute wait time for registration. Since that wait time decreased significantly, more appointments could be booked, for example, in the imaging area. "They were able to go from 30-minute slots to 15-minute slots and increase the number of appointments, because people weren't being held in registration," says Whitley.

Staff are ambassadors

In the past year, kiosks were implemented in two of the hospital's freestanding imaging centers, a multiphysician clinic, and a family health center. "We have four registration areas in our main hospital that we have now consolidated to one area," says Whitley. Currently, the organization is in the process of rolling out kiosks in all of its surgical services and plans to add kiosks to its urgent care center, ED, and wound care and rehabilitation center.

Whitley says that "one of the most important aspects of success with kiosks is your staff. The kiosk technology works, but the presentation of the technology in a positive manner is what makes it successful. Your employees can definitely make or break the success of the project."

In other words, your staff have to act as "ambassadors," says Whitley. "Staff move from being the interrogators asking questions behind the desk, to moving next to the patient and assisting them with any of their needs. This changes the dynamics of the registration staff."

As a side benefit of kiosk registration, you can learn a great deal of information. "The computer tells you everything that's going on with your patient. It tells you who is scheduled, what time they are scheduled, who is checking in, who has completed the check-in, whether this is a Medicare patient, and many other aspects," says Whitley. "The person who monitors the activity of all of the kiosks has to be a highly functioning, multitasking employee."

[For more information, contact:

• Beth Keith, Manager, ACS Healthcare Solutions. Phone: (985) 845-1559. E-mail: beth.keith@acs-hcs.com.

• Alan N. Leipsner, MPH, MBA, FACHE, Administrative Director of Urology, Hackensack University Medical Center. E-mail: ALeipsner@humed.com.

• Kim Whitley, Director, Patient Access and Clinical Intake Management, Medical Center of Central Georgia, Macon. E-mail: Whitley.Kim@mccg.org.

• John Woerly, RHIA, CHAM, Senior Manager, Accenture, Indianapolis. Phone: (317)590-3067. E-mail: john.woerly@accenture.com.]