From typewriters to high technology

Registrars had no computers

The "technology" utilized by registrars 30 years ago at Tufts Medical Center in Boston consisted of a typewriter, multi-part forms, a copy machine, and a manual embossing machine to print patient identification cards.

"How did we ever get the job done?" asks Mary Jo Brown, the hospital's director of admitting and patient registration. "We had no computers, so patient scheduling was done in a book."

There was no advance insurance eligibility checking, as health maintenance organizations didn't emerge in Massachusetts until the mid-1980s, says Brown, and most of the population was covered by Medicare, Medicaid, Blue Cross, and a few commercial insurance companies.

Patient's registration data was handwritten on multi-part forms, says Brown, so it was sometimes illegible with inconsistently used abbreviations. "If the paper was misplaced, so was all of the patient demographic and insurance information," she says.

The patient billing department was the only area with a computer, she reports, with staff using a "keypunch" system to enter billing information. "Daily admission and discharge reports were typewritten, and many copies were made in order to distribute the information," she says.

Daily statistical reports were completed manually utilizing a calculator, says Brown, with the first automated registration database installed at Tufts Medical Center in 1984. "A whirlwind of exciting technology has continued to become part of our work life ever since," says Brown. "We have converted our registration system twice since the original was installed, and we are preparing for a third conversion." Here are some technology changes the department has seen:

• Automated insurance eligibility verification systems give staff up-to-date information at each patient encounter.

"Automatic posting programs help us to save the eligibility data by posting the automated responses right to the patient's account number," adds Brown.

• Electronic bed board systems make the status of each bed "visible" on a computer screen.

"The bed coordinators know just by a glance at the screens which beds are occupied, vacant, dirty, or have a discharge pending," says Brown. "Planning for bed placement becomes much smoother."

• Patient identification bands are placed on the patient's wrist during the registration process, and they are scanned by the bedside nurse prior to administering medications.

"This process provides a direct support to improving patient safety by eliminating medication errors," says Brown. "Upcoming technological advances for patient access will certainly be exciting. I can't wait to see what the next decade brings!"


For more information on technology used by patient access departments, contact:

• Mary Jo Brown, Director, Admitting and Patient Registration, Tufts Medical Center, Boston. Phone: (617) 636-4746. Fax: (617) 636-8803. E-mail:

• Michelle M. Mohrbach, CHAM, Manager Patient Access/Central Scheduling, Blanchard Valley Health System, Findlay, OH. Telephone: (419) 429-7655. Fax: (419) 424-1864. E-mail:

• John Woerly, RHIA, CHAM, FHAM, Senior Manager, Accenture, Indianapolis. Phone: (317)590-3067. E-mail: