Patients want self-service, but they aren't finding it in access areas

Online options are 'severely lacking'

Customers can obtain self-service at gas stations, airports, supermarkets, libraries, and retail stores, but not at the vast majority of hospital registration areas.

"Patients are getting used to having access to all sorts of things online in other areas. To date, healthcare facilities are being given a free pass," says Mitch Mitchell, president of T.T. Mitchell Consulting, a Liverpool, NY-based consulting firm specializing in revenue cycle and technology.

Self-service registration options "are increasing for sure, but not as much as you might think," says Mitchell. "Hospitals are missing out on another way of promoting great customer service, by not opening up more ways for their consumer base to interact with them."

There is clear demand for alternative options to schedule and pre-register for medical tests, says Daniel Thiry, managing principal of Revenue Cycle Solutions in Pittsburgh, PA. This demand is especially seen at facilities where most patients schedule tests themselves instead of going through referring physician offices and where the patient population includes a younger, more computer-savvy group, he says.

While some patient access departments do allow patients to pay account balances online and send feedback by email, "there's still a lot missing," says Mitchell. "Most hospitals have a web presence because they feel the need to be online. But after that, they're severely lacking in so many areas."

"Online scheduling would be great. Patients could select their own times for certain types of procedures based on what's available, especially since often they can't get to a phone during the day to make appointments," says Mitchell, who adds that this service rarely is offered.

At Ochsner Medical Center in New Orleans, the previous system used by the patient access department allowed patients to do some online scheduling, but the recent implementation of a new electronic medical record gives patients more access to the providers' schedules. "Our first facility went live on Epic in November 2011, and as we bring our other facilities live on the system, we encourage all of our patients to sign up for the online services," says Beler.

When a patient attempts to make an appointment through Ochsner's Patient Portal, he or she is asked to enter demographics and insurance information. "Once this information is entered, insurance verification can be started," says Dale Beler, director of patient access. "Completing authorizations and collection of pre-payments prior to arrival guarantees a quick and efficient registration."

If this information already has been entered, the patient can verify that it is correct and confirm it. Patients appreciate spending less time on hold waiting to speak to a representative, Beler says. "However, not all of our providers have open schedules, so some types of appointments cannot be scheduled through the portal," she adds.

Obstacles are many

Mitchell notes his own frustration with patient access areas using traditional mail instead of giving the option to respond online to requests for demographic and medical information.

"Sometimes the option is there to respond that everything they show me is correct," he says. "Other times, I have to fill everything in, including insurance information and medical history."

Also, Mitchell points to post-service surveys sent through the mail asking patients how the hospital experience went, not only with the department visited by the patient, but also the admissions process. "Truth be told, I don't always respond to those things, but I might be more encouraged if I could do it online and still maintain confidentiality," he says.

Concerns about violating patient privacy regulations are one obstacle for patient access areas asking for information via email, acknowledges Mitchell. "Hospitals need to guarantee protection of information they're given online, while still keeping up with the patients coming into the hospital," he says.

Other obstacles to "self-service" registration are lack of comprehensive staff training and the need to update financial clearance policies, says Thiry. "In our experience, cost is rarely a factor, if the health system has first taken the time to develop a comprehensive and robust patient intake process which meets all of the organization's customer service and reimbursement needs," he says.

If self-service options are offered to patients when current patient access processes are disjointed and lack a defined flow, this offer often exacerbates problems, warns Thiry. It is critical patient access areas first develop their desired intake process, and then select the best tools to support it, he says.

"An operational assessment is usually the best place to start," says Thiry. "This is the single best way to document current practices and identify ways to reduce expenses, increase revenue, and give better service."

A safe first step

Patient access departments should start asking for email addresses if they don't already, Mitchell says. The next step might be to send emails to those patients who have to book appointments, with a link they can use to confirm their appointments and verify that all information is correct.

"There's no real medical information that would be revealed, other than the department the person should be going to," he says. "It's a way to see how the community responds. If it turns out to be a big hit, then maybe administration would be convinced to look deeper into new technologies."

With Ochsner Medical Center's new electronic medical record system, email address is a suggested field for registrars. "This reminds all registrars to discuss with our patients the option of receiving information electronically," says Beler.

Kiosks are being considered by the department, but cost is an issue, she explains. "We are still reviewing the feasibility of this equipment," says Beler. "While I think everyone agrees that this will be the future state, we hope to help pave a path [to kiosks] by getting patients to utilize the patient portal."

Thirty says, "A very small percentage of our clients are utilizing the registration kiosks at this time. However, more are inquiring regarding the potential benefits. Use has been limited, but is steadily growing."

Kiosks would give patients a quick way to check in, verify their information, pay any balances due, and sign all necessary forms without intervention from a registrar, but some patients prefer to have human interaction, says Beler.

"There has to be a balance between new technology and good, friendly customer service," she says.


For more information on self-service options for patients in registration areas, contact:

• Dale Beler, Director, Patient Access, Ochsner Medical Center, New Orleans, LA. Phone: (504) 842-0352. Email:

• Kathleen Mandato, MBA, PhD, Director, Vanderbilt Medical Group Systems & Service Education Department, Vanderbilt University Medical Center, Nashville, TN. Phone: (615) 936-6878. Email:

• T.T. "Mitch" Mitchell, President, T.T. Mitchell Consulting, Liverpool, NY. Phone: (315) 622-5922. Email:

• Geralyn K. Murphy, MHA, Director, Access Services, University of Wisconsin Hospital, Madison. Phone: (608) 263-9229. Fax: (608) 265-5814. Email:

• Daniel Thiry, Managing Principal, Revenue Cycle Solutions, Pittsburgh, PA. Phone: (412) 224-4835. Fax: (412) 322-8100. Email: