Customizable screens on the kiosks allow questions such as, “Do you need a wheelchair today?” and “Did you bring scans that your doctor needs to see?”
By the end of summer, the standard outpatient registration process, with its clipboards, paper forms, and waiting in line to interact with a registrar, will be a thing of the past for most clinics in the UAB Medicine system in Birmingham, Ala.
UAB Medicine’s orthopedic surgery clinic introduced check-in kiosks in 2016 with the goal of speeding the registration process. Surprise benefits, including greater patient satisfaction, increased patient payments, and more accurate data capture, quickly caught the attention of the health system’s revenue cycle leaders.
“Once we saw how much the patients enjoyed it, we decided that it was something that we wanted to implement in all of our clinics on the ambulatory side,” says Morgan Mansfield, ambulatory access manager at UAB Medicine.
The UAB’s orthopedics clinic, which serves some 4,000 patients each month, adopted check-in kiosks to reduce bottlenecks created by the standard registration process, says Rob Crabtree, executive administrator for the orthopedic surgery department. Patients needed to fill out several paper forms as well as give their insurance card and identification to the registrar to be copied. The process often involved multiple trips to the registration desk, and patients sometimes had to wait in line to be served.
“It's not desirable for orthopedic patients to have to walk back and forth to a desk, but it was pretty routine,” Crabtree says. “The patient leaves their purse or the wallet in the waiting room, they walk up to the desk, then have to go back and get their insurance card. It's just not efficient.”
The result: Surgeons were waiting for patients, sometimes becoming so frustrated that they went to the waiting room to see what the holdup was.
Kiosk check-in speeds the process dramatically. When patients arrive, they go directly to the kiosk rather than wait for a registrar to be available. The average check-in time for new patients fell from seven minutes to three minutes, and the average time for returning patients dropped to less than a minute and a half.
Patients use the kiosks to scan their drivers’ licenses or other identification cards, which links them to their appointments. Then patients advance through approximately 15 screens to confirm or change demographic information. That improves the accuracy of information captured. “It’s a hundred-fold better,” Crabtree says. “You're more likely to have mistakes when you fill out manual paperwork.”
In March 2017, check-in kiosks were only installed in a few UAB Medicine clinics, but they captured 3,000 driver’s license updates, 515 new e-mail addresses, 1,000 primary insurance updates, and 475 secondary phone numbers, he says.
At the orthopedics clinic, Crabtree seized the opportunity to customize a kiosk screen with two questions. The first is, “Do you need a wheelchair today?” If they patient says “yes,” a message is automatically sent to a medical assistant to bring a wheelchair immediately.
For the second question, “Did you bring any films today on a disc?” if the answer is “yes,” the patient is called to the front desk so the images can be scanned and transmitted to the clinical area. “The staff in the back can activate those images before the patient even gets into the doctor’s office,” Crabtree says. “That helps with patient satisfaction.”
Increasing Patient Payments
The kiosks also increase patient payments. Before the kiosks were installed in the orthopedic clinic, point-of-service collections averaged just more than $1,500 per day. In the first two months after the kiosk launch, the daily averages were about $2,400 and $2,070, respectively.
Similar results have been seen as the kiosks have been introduced in other clinics, Mansfield says. One reason, she says, is that registrars sometimes failed to notify patients that they would owe copayments for that day’s visit and alert them to balances from previous visits.
By contrast, the kiosk shows both numbers: copayments and, if applicable, deductibles for that day’s visit and patient-responsibility balances from previous visits. Seeing the information on the screen changes the psychology of patient payments, Crabtree says. While patients tend to delay payment when registrars mention copayments or other balances due, seeing the numbers on kiosks triggers the same behavior as seeing the numbers on acash registers: It’s time to pay.
The kiosks ask whether patients want to pay by credit card, cash, or check. Patients who wish to use cash or check go to the front desk to do so. Credit card swipes are handled at the kiosks. Patients can choose whether to pay the entire amount owed or pay part of it. Receipts are sent by e-mail.
Patient payments are posted immediately. “So, if the patient went to another floor for another appointment that day, no balance-owed will appear on that kiosk because the patient paid and, in real time, that information was entered into their record,” Mansfield says.
Introducing the kiosks in a single-specialty clinic was a good way to gain experience before starting a major rollout to all other clinics, Mansfield says. But the launch gets more complicated in bigger facilities.
Kirklin Clinic of UAB Hospital is considered one of the busiest outpatient centers in the country, housing hundreds of physicians in more than 30 specialties. “When there’s 40 clinics on a floor sharing 10 kiosks, you have to create processes that are going to work for everyone and get everyone as standardized as possible,” she says. “Be very mindful of what your workflows will need to be and plan that carefully in advance.”
Other tips from the front lines.
Notify your patients that the kiosks are coming. When UAB’s Kirklin Clinic and nearby Whitaker Clinic—which collectively serve more than 2,000 patients each day—introduced kiosks, a video was posted on the clinic website to walk patients step-by-step through the process.
“If your patients are positive about it and you feel their encouragement, it will be a successful project,” Mansfield says.
Assign registrars to hover near the kiosks, ready to help. The registrars rotate throughout the day so someone is always near the kiosks in case a patient has a question or needs help in some way.
Most patients do not need help and their feedback has been overwhelmingly positive, Mansfield says. Seniors have adapted easily. “We found it kind of funny that the age range where it may not have been as well-received was a younger generation—people between their 40s and 60s,” she says. “And the millennials who love technology get through the check-in in about one minute.”
Train all registrars. Before the systemwide implementation started, all registrars participated in a one-hour training module, Mansfield says. Then kiosk training was added to the new-hire training curriculum. Even though not every UAB outpatient clinic uses kiosk check-in, having all registrars trained means they will be ready if they are installed in their clinic.
Consider where kiosks will work well—and where they might not.Revenue cycle leaders reviewed the patient volume, spatial considerations, and workflows of each clinic to determine whether to install kiosks. The vast majority of clinics have moved to kiosk registration, but there is not a plan for universal adoption, Mansfield says.
Do not expect kiosks to reduce the number of registrars needed. Registrars’ job descriptions have changed a bit, but the overall workload did not decrease after kiosks were introduced.
The kiosk system has its own portal that sends information to the registrars as soon as patients finish check in. “That portal drives your front-end workflow to get the patient checked in and do some tasks within our other programs,” Mansfield says. “If anything, staff are busier because now they have this system that they have to work out of in addition to the systems they already had.
Registrars take turns on kiosk-user support. “That is a more hands-on position versus sitting at the front desk behind a computer,” Mansfield says. “I think they really enjoy that.”
Kiosk check-in has improved patient satisfaction, improved data capture, and increased point-of-service collections, in addition to the original goal of speeding patient registration.
Lola Butcher is a freelance writer and editor based in Missouri.
Interviewed for this article:
Rob Crabtree is executive administrator, Orthopaedic Surgery, UAB Medicine, Birmingham, Ala.
Morgan Mansfield is manager, Ambulatory Access, UAB Medicine, Birmingham, Ala.