Air travelers are so accustomed to using kiosks to check bags and print boarding passes that most do not think twice about it. However, the same is not true of kiosks in healthcare registration areas.
Kiosks are expensive investments that do not always pay off for hospitals. For patient access, kiosks face two big obstacles, according to David Kelly, CHFP, MSHA: “The first is that kiosks have to benefit the patient. Often, they don’t.”
Many kiosks are put in place just for the purpose of “lobby management,” which helps the hospital, but does nothing for the patient.
“Put the patient first and make sure they are getting the most benefit. Then, look at the benefit to the organization,” advises Kelly, director of revenue cycle and managed care at Mary Rutan Hospital in Bellefontaine, OH. This means investing in a kiosk that can actually do what people expect: check in and registration. This way, the kiosk allows a person to bypass the usual registration process.
“The second obstacle I’ve seen is the type of patient,” Kelly says. Walk-in patients are bad candidates for kiosks. That is because registration takes longer for these patients due to the need to collect all kinds of demographic information. Patients expect the kiosk to speed the process, not force them to stand there typing in insurance, addresses, and Social Security numbers. Better candidates for kiosks? Scheduled, recurrent patients. “They come back time and again with very few changes,” Kelly explains.
Kiosks can be offered to walk-ins, but patient access should be realistic. Expect more complaints, lower use rates, and many requests for assistance from staff. “Start other places first,” Kelly recommends.
Regardless of who is standing at the kiosk, he or she should not have to go it alone. Staff should be ready to step in when inevitable glitches arise.
“If you have staff to help, if the system has a high up-time ratio, and it allows patients to skip steps, then satisfaction will come,” Kelly offers.
At Mary Rutan Hospital, kiosks are used in urgent care for walk-in patients, with a roughly 12% use rate. “We are looking to repurpose them elsewhere because of the troubles with walk-ins,” Kelly reports.
In contrast, more than 200 patients a day use kiosks to check in at the hospital’s rehabilitation service line. This equates to a use rate of about 98%, according to Kelly. “We are seeing very positive results there.”
Focus on Self-Arrival
At the University of Pittsburgh Medical Center (UPMC), self-arrival technology has been a focus for two years. An executive steering committee was formed to make this a top priority, including hospital administrators, marketing, physician practices (both hospital-owned and within the community), and revenue cycle leaders.
“There was a lot of great buy-in early,” reports Daniel J. McCann, MBA, director of revenue cycle business operations at UPMC.
Smaller groups were formed to target each area the kiosks were planned for: point of service, the day of arrival, hospital ancillary services, and the ED.
“Our team developed a rollout plan, campus by campus,” McCann says. The goal was to supplement front-end staff with kiosks, yet still give patients a great experience. “After the initial kickoff, we brought in all the localized practice managers,” McCann says. All employees were brought in for a training session on kiosks.
Concerns about job security were assuaged. “We explained that we are not going to displace staff, we are just shifting their focus,” explains McCann. Patients handle simple tasks, such as updating or confirming demographic information. This allows staff to collect copays or enroll patients in a mobile app for scheduling. The department set a kiosk use rate goal of 40%, based on industry standards.
“We now have 63% of arrivals checking in with no-touch registration, which is great,” McCann reports. More than 200,000 appointments each month are checked in at kiosks. “We offer the choice, but we are glad patients are choosing the kiosk,” McCann says. “It’s become an expectation.”
Patients are not robotically pointed to a kiosk. Registrars give patients a warm verbal greeting and encourage them to use kiosks while making it clear staff are ready to assist at the first sign of difficulty. “If the patient just wants to be checked in by someone instead, we can do that,” McCann says.
Consistent signage and kiosk placement are used for every registration area. This way, the patient’s eyes go straight to the kiosk and it is very clear what the kiosk is intended to do.
“The numbers have been very consistent for a long period of time now,” McCann says.
The People Aspect
Five optimization specialists visit more than 600 UPMC locations with kiosks to assess how they are used. Mainly, they want to see that the arrival experience for patients is not just average, but excellent. “We’re not selling iPhones. We’re greeting people who don’t want to be there,” says McCann.
Biometric recognition is used in tandem with kiosks, with about 500,000 patients in the organization’s database. Patients enroll at any UPMC location after their ID is validated. At some hospitals and surgery centers, kiosk users no longer type in their names. Instead, they place an index finger and enter a date of birth, thereby expediting the process.
The team expected low use rates in geriatric locations. “But it’s turned out to be one of the highest-utilizing areas,” McCann says, attributing this to widespread use of biometrics in other industries, which many people use to access their smartphones. “We can see utilization in real time.” Office managers can pull up the daily schedule and see that of 12 patients who checked in, eight used the kiosk. Frequent patients appreciate not having to validate information each visit, since demographic information only appears every 90 days.
On the employee side, they gave up their titles of patient information coordinators. They are now patient services representatives, an indication that the emphasis is on customer service as opposed to just providing information. “Kiosks can do a lot of that,” McCann notes. “Who wants to ask people over and over if their phone number is still the same?”
Staffing has decreased, but only through attrition. “We’ve got to be efficient with our resources,” McCann says. “Now that we have 65% of patients coming in through the kiosk, it made sense to adjust staffing.”
Employees have turned to more complex tasks, such as explaining why the patient has a copay, scheduling a radiology appointment for a patient leaving the physician’s office, or helping people apply for financial assistance. “Our workforce is there to be the ultimate concierge,” McCann says. “If we have highly engaged staff, we have highly engaged patients as well.”