Patients give hospital heads-up: It’s time for on-line registration

Screen flow, ‘guided accuracy’ important

It became very clear that customers of Dayton, OH-based Kettering Medical Center Network (KMCN) were ready for on-line registration soon after the hospital network began testing the process in August 2004, says Grace Curtis, MBA, director of patient registration and central scheduling.

“We started looking at [on-line registration] at the beginning of 2004, and by August, had developed some screens and were pretty far along,” she notes. “We did two months of testing and then found we had to go ahead and roll it out in January 2005.”

What happened was that although there was no direct link, people using the search box on the KMCN web site found the test version of the on-line registration form and began filling it out and sending it in, even though the service hadn’t yet been offered to the public, Curtis explains. “We realized that there was an expectation on the part of consumers that you do business electronically,” she says. KMCN still hasn’t promoted the service and is averaging 2.5 on-line registrations a day.

“We had some coverage from local news journals,” Curtis adds, and the central scheduling department includes information on on-line registration in the packets that it sends out to patients. To further spread the word, she says, brochures describing the on-line registration option will be placed in physician waiting rooms.

Although on-line forms, at present, represent only a small fraction of the 500,000 registrations done annually by KMCN’s four hospitals and numerous clinic sites, Curtis says, the organization sees the potential for much more business being done that way. “I think our next route is that we want to set up secured accounts with people, so they can go in, review the [registration] information, and eventually begin to look at their account information,” she says.

Curtis’ advice to those toying with the idea of on-line registration is “to just begin to do it, to take the step. It’s a much easier process than one would think.”

At present, the KMCN registrations received on-line are not directed straight to the admission/discharge/transfer (ADT) system, she explains. “They’re printed off, and a designated registrar creates all of those registrations for the entire network.

“The real problem is that if you drive them directly into the [ADT] system, you have no human intervention to let you know if you’re creating a duplicate account,” Curtis says. (See K-eReg flowchart [click here] and subroutine [below].)

KMCN is transitioning to a new version of its ADT system and as part of that process may — somewhere down the line — work with the information technology department to create a temporary account whereby on-line registrations could be received and verified, Curtis notes. They might be automatically matched against a master person index, for example, without having to be manually entered into the system, she adds. “If we go to a secure account where we really know who we’re dealing with, we’ll be a lot more competent in creating an account from the on-line system,” Curtis says.

That process would require that consumers use a password to log in and create an account for themselves, or perhaps verify the information the system already has for them, she explains. “The person might look at the information and say, ‘Oh, I have a new phone number,’ and make that change.”

Still, Curtis recommends that whatever the ultimate technology plan, hospitals take the interim step of having the on-line registrations go into a temporary holding pattern. “You will learn a lot about it. It’s well worth it, even if you are re-keying the data.”

The advantage there, adds Jana Mixon, patient access manager for Kettering Memorial and Syca-more, two KMCN hospitals, “is the ability to control the information that is being entered. It won’t be compromised by a patient not understanding what we’re looking for or by putting in a wrong number.”

Getting the bugs out

KMCN continues to tweak the on-line registration process, Curtis notes. “We learn along the way and make changes constantly. One [enhancement] is that we just got the system to send [the person registering] an automatic confirmation that the information was received. That cut down on the number of people calling to check.”

A toll-free number is available 24/7 for those who have questions, she adds.

Screen flow was an important consideration in the design of the on-line registration process, Mixon adds. “I went through the registration process as it stands in the [ADT] system and laid out the [on-line] screen flows to exactly match the order and the information we’re asking for,” she says. “It’s really important to follow that flow. By doing that, when we get the information out of the server, it’s easy to go right down the line and key in the information.”

Because the on-line screen flow matches that of the face-to-face registration process, it takes just a few minutes for the designated registrar to enter the data, “and if the patient has been here before, it’s just a matter of verification,” Curtis explains.

To further smooth the on-line registration process, KMCN uses something known in the industry, creating on-line forms as “guided accuracy,” she says. That means, for example, that if a person answers yes to the question of whether he or she is married, the next question will be about the person’s spouse, Curtis notes.

If the answer to the marriage question is no, “that next question doesn’t even come up,” she adds. “We looked at a lot of on-line registration systems that go straight down a page, but with ours, each page is customized depending on how you answered on the previous page.”

In addition to emphasizing the effectiveness of guided accuracy, Curtis cautions those involved in creating on-line forms against using health care jargon. The word “guarantor,” for example — meaning the person who will be responsible for the bill after insurance has paid its share — is a term the typical consumer doesn’t really understand, she says, so it isn’t used anywhere on the form.

The KMCN system uses what she calls “fly-by” help to define other words or phrases the person may not be familiar with. “If you run a cursor over the word, the system will define it for you. The more you can do that, the better off you will be in terms of people not calling you with questions,” Curtis adds.

While the on-line registration service has the potential to create financial savings and reduce staff workload at the KMCN hospitals, Curtis emphasizes that the process was not set up for that reason. “The rationale is you want to give your patients as many access points as possible.”

Another benefit she cites is that patients are more likely to provide complete and accurate information at home than at the hospital. “When we send out packets with preregistration forms for patients who are scheduled for surgery, those forms come back with data that are very clear,” Curtis points out. “We thought we’d get some of that same advantage with on-line registration.” Also, when patients provide information in advance — in any setting, including via on-line registration — KMCN uses an on-line verification tool, notes Mixon. “We are able to know very quickly, nine times out of 10, whether their insurance is valid.”

In some cases, that tool also provides the person’s out-of-pocket financial responsibility, she adds. “We have not yet started asking for copays upfront, but that is a long-term goal. (For more goals, see box, below.)

“Anything we can get done in advance is a help,” Mixon says, noting that offering the on-line registration option “has been a greater advantage than I thought it would be. It’s made a difference with a lot of patients out there who are computer-savvy and who can do this rather than have to come in and sit and wait.”

[Editor’s note: Grace Curtis can be reached at (937) 298-4331.]