End of the line: Implementing patient registration kiosks

Implementing patient registration kiosks is a solid strategy to streamline the check-in process for patients, capture more accurate data during registration and increase patient satisfaction through a more expedient process in a high-volume practice.

Over the course of 19 years, a dermatology practice in Southwest Michigan grew from two full-time physicians to three full-time physicians, three full-time physician assistants (PAs) and one part-time PA. The practice is independent, part of a larger, physician-owned multispecialty group in the area, and this division was owned by three physician shareholders. The practice has been in its current location for four years, having constructed the building to the physicians’ specifications, and the three physicians own it in their separate, limited liability corporation.

The providers and clinical team see 250 to 280 patients a day at the main office. Two of the physicians treat patients three half-days a week in outlying turn-key clinics, as well.

As volume has increased, the line at the front desk for registration grew to a point in which patients were in line for up to 10 minutes to check in, often lined up into the foyer of the main lobby. 

The lengthy wait was especially bothersome for established patients who did not need to go through the rigorous process of initial registration, as well as patients arriving for ultraviolet phototherapy three times a week on a regular basis. If patients arrive at their exact appointment time, they are often late getting back to the providers due to the long line, putting the entire patient schedule behind.

Data entry mistakes increased as staff rushed to accommodate patients in line, which in turn caused patient dissatisfaction from claims denials. This wasted work affected the billing process, costing the practice money in delayed payments and re-work.

Adding staff to the front desk was not feasible, as there was not enough physical space at the check-in window, in addition to the significant cost of adding more staff and the added work for management of additional staff oversight.

Preregistration calls also were not viable: In addition to the daily patient volume, the practice received more than 300 incoming calls each day. Adding more staff and phone lines was not practical, as employee hours would shift to make calls outside of regular office hours.

Implementing an electronic solution addressed the long lines, increased patient satisfaction by making the registration process faster and improved data accuracy. This solution expedited patient throughput, increasing patient and clinical team satisfaction. Another benefit for providers is the added time to handle patients requiring more assistance during their visit.¹

Some practices have relied on Apple iPads and other tablet devices for electronic registration and check-in options, but the devices sometimes pose challenges in keeping track of them and ensuring they are charged and in working order; in a high-volume practice, many patients may still wait to receive a device from the front desk.

Free-standing kiosk technology avoids many of those issues when they are hard-wired to eliminate the need for charging. There’s less risk from patients damaging the equipment since they are not handheld. Furthermore, patients could approach kiosks without requiring any assistance of staff; if assistance was needed, a staff member could be assigned to the kiosk area, rather than circulating through the reception area where a patient might sit with a tablet.

Selecting a system

The first step to vetting a kiosk registration solution is finding out which kiosk offerings interface with the existing practice management software (PMS). The PMS developer recommended a high-end vendor offering a range of options beyond registration and check-in.

To get a broader picture of offerings, the practice issued an informal request for proposal, asking vendors the following questions:

1. How quickly can a patient register?
2. How user-friendly is the verbiage and directions on the kiosk?
3. What other tasks can the kiosk perform, besides registration and check-in?
4. What is the initial investment?
5. What are the ongoing costs?
6. How are software updates handled?
7. How often is the kiosk system down?
8. How well does the current PMS interface with the kiosk solution?
9. What is the best way to market to patients, to assure high compliance?
10. What challenges have other high-volume practices faced?
11. Are there practices we can contact that recently implemented the kiosk system?
12. Are there practices we can contact that have had the system for two years or more?

Other features presented during a demonstration call included:

• An immediate insurance verification for most payers when patient insurance information is entered during or before an appointment 
• Insurance verification two weeks before the patient’s appointment
• A third insurance verification at the time of kiosk check-in  
• An email confirmation of appointment time, date and provider sent to the patient if an address is on file, both the day of appointment and two weeks in advance
• A link to a secure portal connection in the patient’s two-week reminder email to pre-register or pre-verify basic demographics, insurance information and the ability to upload picture identification and insurance card(s).

 
The kiosk vendor, with direct pipelines to most payers, eliminated the use of outdated data from third-party vendors and made the billing process smoother due to accurate billing information.

Costs

After calculating one-time costs (including setup, configuration and training) and the first-year costs for maintenance and fees on five kiosks, it was determined there would be cost savings comparable to two full-time employees. Additional soft savings included the kiosks not calling off, not coming in late for work, nor taking vacation.

Pre-implementation

After presenting these figures to the physicians and obtaining approval, the practice administrator, along with the business office manager as the project’s technology champion, had weekly calls with the kiosk vendor trainer to do a host of pre-implementation tasks.

• The trainer needed information about the data the practice collects for demographics, HIPAA and guarantors through patient information form examples, including Spanish language forms.
• The trainer, practice administrator and business office manager reviewed verbiage to use on the kiosk to ensure it is clear, concise and at the appropriate reading level for all patient needs.
• The trainer, practice administrator and business office manager worked on the flow of information on the kiosk to ensure it is in logical order based on the practice’s current workflow.
• The trainer, practice administrator and business office manager used photos to determine the placement of kiosks in the lobby based on logistics for wiring for electrical and computer needs, and placement for maximum patient compliance.
• The practice administrator provided all clerical, clinical and business office team member names and emails to create logins and passwords for employees using the kiosk system.

The typical timeline for implementation was four months, but a more aggressive timeline was requested due to staffing challenges in the practice. From the initial exploratory call with the kiosk vendor to the implementation, the process took 15 weeks.

Implementation needs

For a successful implementation, a variety of contractors and practice staff were needed: 

• The business office manager, as technology champion, oversaw issues affecting the business office and front desk teams, keeping both teams upbeat and engaged about the coming changes. The business office manager also did testing for the interface between the kiosks and the PMS.
• An electrician was hired for the electrical and IT wire runs in the lobby. 
• The IT company completed the install of the kiosks after delivery to ensure connections were appropriate and the plugs for electrical and IT were secure from patients.
• The front desk and business office teams reviewed the workflow and verbiage, offering suggestions during the software build to make sure the kiosks were easy to use.
• The practice administrator worked with the practice’s marketing vendor to design and set up lobby signage to direct patients to the kiosks; worked with the practice’s website designer to post a video of the kiosk’s function and announce the new technology’s arrival; and reached out to the phone on-hold announcement vendor to add an outgoing announcement to the loop introducing the kiosk.
• The practice’s skin care manager used an email marketing service to send out emails to patients introducing the new kiosk technology.

Preparing patients

The kiosk vendor recommended a “greeter” in the lobby to welcome patients and to assist them through the check-in process. Lack of personal contact and help for confused patients was cited in conversations with individuals who used check-in kiosks at other facilities.

Another challenge was patients’ adverse reaction to change. To set expectations and to prepare patients before they arrive, the practice implemented several strategies: 

• Once the implementation date was chosen, the practice’s on-hold announcements touted the upcoming arrival of the kiosks. The practice updated the announcements to say the kiosks were operational after they went live.
• An instructional video was put on the website.
• Using a bulk email service, the practice sent an email introduction of the kiosks, with the instructional video, to all patients who were active in the past three years.
• The practice’s new patient packet letter advised patients of the kiosk check-in process and included brief instructions.
• The practice added a tall, stand-alone sign at the center of the tile walkway leading from the foyer to direct incoming patients to kiosks.
• The front desk staff politely directed patients to the kiosks if they circumvented them.

Updating new patient packets

With the implementation of the new kiosks, the new patient packet had to be updated. One of the items that takes considerable time at check-in is the HIPAA authorization for release of information. The determination was made to remove the patient demographic form from the packet and add the HIPAA form with a brief explanation in the packet letter. If the practice can secure this information at the initial appointment, it can be entered in the PMS, transferred to the kiosk system and annually trigger the patient to confirm the name of the person entered originally or to change it.

The workflow for collecting forms also changed as a result. Since every patient sees a member of the clinical team, the forms are collected by the nurse or medical assistant in the exam room.

Going live and beyond

After all the technical aspects of installing the kiosks were finished and the prep work complete, the kiosk implementation trainer was present for the go-live day to troubleshoot any issues and continue training and assisting the front desk team members.

During the first week after implementation, the practice administrator evaluated the progress by checking in with staff operating the system: greeters in the lobby, team members committing the information to the PMS and team members reviewing insurance verifications ahead of time. By touching base daily, any concerns with accuracy of information crossing over from the kiosk to the PMS were caught quickly and addressed.

Kiosk system report review was done regularly to determine the speed of the check-in process and monitor for improvement as weeks went by. It was determined that staff should keep an eye on how long it takes patients at the kiosk; how long staff spend addressing system information and committing the info to the PMS; and how long the overall process is from first reaching the kiosk to being called back with a provider.

After the first week, practice staff should listen and respond to feedback from patients. If tweaks are needed in the kiosk verbiage or workflow, they are relayed to the kiosk vendor for improvements.

Adding patient kiosks can be rewarding if key steps are followed, including assessing and selecting a quality vendor, building a team that’s engaged in the process of implementation and educating patients to embrace the technology.

Editor’s Note

This article was adapted from a paper submitted toward fulfillment of the requirements of Fellowship in the American College of Medical Practice Executives. Learn more about ACMPE certification: mgma.com/acmpe.

Notes

1. Dowling J. “A convenient truth: Self-service works in healthcare.” Healthcare IT News, Nov. 20, 2013. Available from: bit.ly/2sikngo.