Baylor spreads automated check-in throughout system, installs MediKiosk
Newest E-clipboards are being used to process payments
Baylor Health Care — which began automating the check-in process at its Sammons Breast Imaging Center in Dallas more than a year ago — is now extending the concept throughout the health system.
"We will be installing 15 MediKiosk locations in the next three years," says Jason Whiteside, corporate director for solutions management, adding that his goal is to have automated check-in systems "of every form and factor" distributed among those locations.
The three versions of the MediKiosk, he adds, include the following:
1. E-clipboards. These electronic tablets, already in place at the Sammons Center, are handed to arriving patients by a receptionist or registrar, notes Scott Schoenvogel, Baylor's assistant vice president of revenue cycle. "The registrar says, 'Press here to start, and this is how you will check in.'"
The patient takes the device back to his or her seat and, using a stylus, signs the forms that are displayed on the wireless touch screen, and enters any necessary information, he explains. "If a form needs to be printed, [the system] can convert back to the paper format."
Ultimately, "we're looking to take the forms signed electronically, convert them to PDF format, and then electronically transmit them to the patient's medical record," Schoenvogel says.
"Some of our facilities have electronic medical record storage and some do not," he adds. "In phase two, we will coordinate [that piece of the process] with those who do."
When E-clipboards were recently installed at Baylor Sammons Breast Imaging — North Dallas, Whiteside notes, Baylor took the opportunity to also upgrade the system at the original Sammons location to the latest version.
Those changes, he says, "were the product of a lot of different things we've learned — changes in the work flow. We added logic that reveals/conceals certain consent forms — release of original mammograms being one example — based on information provided in the health history and demographic screens."
Another change is that — unlike the two Sammons Center locations — when Baylor goes live with the MediKiosk at Irving (TX) Women's Imaging Center, the kiosk will be used to process payments, Whiteside points out, "so we built an interface to patient accounting."
"We get a nightly feed from our patient accounting system, so for scheduled patients we will know how much the expected payment is for that visit and offer the ability to make the payment on the kiosk," he says.
At the Sammons locations, patients depend on the registrar to complete and activate their visit, Whiteside notes, adding that at Irving "patients will still speak with a registrar but we'll be using fewer registrars to accomplish the job."
2. Desktop model. This version has a touch screen as well, but looks like a PC, sits on a desk, and has a keyboard and a mouse, Whiteside says. The desktop model is perhaps best suited for places that already are set up with traditional registration cubicles, he adds. "Instead of having a registrar at each desk, there will be a registrar who floats from cube to cube."
3. Freestanding kiosk. The ideal setting for this model, which is much like the kiosks used for check-in at airports, might be a place that is not on a wireless network, Whiteside says, although that is not an issue for Baylor.
It is also well suited for a location where loss prevention is a concern and "you want something you can bolt down," he adds. "You're not going to give a $2,500 [handheld device] to someone in the emergency department [ED] who could walk out the door with it.
"We're looking at this possibility in the ED," Whiteside says, noting that it obviously would be used only in non-emergency cases. "The patient would use the kiosk to provide us with demographic information, indicate the primary complaint, and sign consent forms — so it's a patient intake and forms management process."
The process would be overseen by a registrar — much like airline employees monitor the use of airport kiosks — to make sure all the necessary information is obtained, he adds.
It's more than data capture
With the use of the MediKiosks, which were designed by Maitland, FL-based Galvanon Inc., Baylor is doing more than capturing specific data fields from the patient, Schoenvogel points out.
"We're [implementing] a lot more powerful access solution," he says. "We present previously stored information, customize forms, and generate them automatically based on payer or patient status. All that is dynamic within the tool itself, and it takes away from the paper shuffling.
"One of the biggest benefits for us has been the ability to provide back to the patients all the information they have given us [in the past], to show that we remember their information," Schoenvogel adds.
While he has gotten a lot of questions about whether the automated check-in tool will help manage verification activities — and Galvanon says it can be interfaced with eligibility systems when there are good processes around the validation of information — that was not really the point as far as Baylor was concerned, he says.
"Baylor is looking to use it to create the ideal patient experience, for electronic record management and to standardize copay and deductible collection," Schoenvogel notes. Although there is potential for reduction in administrative costs, he adds, "we're not looking to shrink registration departments, but to free up capacity to do more customer service."
In fact, what led the organization toward an automated check-in solution, says Randy Fusco, director of Internet development services, was an enterprise-wide initiative aimed at making it easy to provide and receive care at Baylor. One track within that initiative, he adds, is about creating the ideal patient experience.
With that goal in mind, Fusco notes, "I started looking at improving patient satisfaction by streamlining manual and paper-driven processes." The check-in process — riddled with problems, associated with a high level of patient dissatisfaction, and far from automated — was an easy target, he says.
After a conversation with Galvanon representatives about the concept of automated check-in and a presentation to senior management, Fusco explains, Baylor became the first health care system to implement the MediKiosk, and to show a return on investment.
As an early adopter of the MediKiosk, he says, Baylor gave immediate feedback on the product, and Galvanon was able to make quick adjustments.
When the E-clipboard was first rolled out, for example, patients had to key in their information on the forms, which was difficult for some because of the touch screen, Fusco says.
The next day, the process was changed so that the forms repopulated with previously obtained information that patients could review and update if necessary, he adds. "They were just looking for what had changed. That allowed adoption to skyrocket."
Patient reaction to the new technology has been "very surprising, very positive," Fusco says. "We had more than a 95% acceptance rate with the 7,000 patients [involved in the Sammons pilot]. The 5% that didn't respond favorably were those who showed up without any form of identification and a couple of people who were having a bad day."
By late October, Whiteside notes, more than 11,500 had checked in on the kiosk, and the patient satisfaction rate continues to be "overwhelmingly positive."
Fusco's advice for organizations contemplating a similar implementation is to fully engage both pertinent groups — information technology (IT) and access services — in the planning process.
"If you just look at it as an IT process, you won't get the efficiencies around work flow," he says. "And if it's just access without IT, you have less chance of getting it implemented successfully."
[Editor's note: Jason Whiteside can be reached at [email protected].]
Baylor Health Care - which began automating the check-in process at its Sammons Breast Imaging Center in Dallas more than a year ago - is now extending the concept throughout the health system.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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