Connected Health (CH) is about extending the reach of the health care system beyond the traditional brick and mortar walls and empowering patients to assume a greater role for managing their own health. Access to care and an exceptional Veteran experience are listed as the Department of Veterans Affairs (VA) Veterans Health Administration’s (VHA) top priorities. VA CH initiative is aligning virtual care technologies to create a seamless, unified experience for Veterans by:
• Identifying patient needs to drive the next generation of tools. • Translating Veteran needs to information and services. • Developing Health Information Technology (IT) solutions to meet Veteran needs (e.g. reminders, secure email, and video visits) • Tailoring across platforms to optimize reach (e.g. smart phone, feature phone, web and Veterans Point of Service Kiosk Tablets)
The Veterans Point of Service (VPS) program office is responsible for managing the current VA Point of Service Initiative, known as VetLink, and the future replacement patient kiosk Commercial-off-the-shelf (COTS) solution. VPS under the Office of Veterans Access to Care completed national deployment of ≈ 6,300 vKiosk devices to approximately 161 VA Medical Centers (VAMC) and their Community Based Outpatient Clinics (CBOC) nationwide in 2014. The legacy vKiosk devices have met the end of their device life-cycle. This effort is not a 1:1 refresh of all the currently deployed vKiosk devices, only 4,200 patient tablet kiosk units tablets will be purchased. Currently branded vKiosks and the Government- off-the-shelf (GOTS) VetLink proprietary software are provided by Vecna Technologies, Inc.
VA strives to provide high quality, effective, and efficient clinical and business capabilities, along with IT services to those persons who are responsible for providing care to the Veterans at the point-of-care. In addition, VA strives to provide high quality health care to Veterans throughout all points of their experience in an effective, timely, and compassionate manner. VA depends on a strong business backing, information management and IT systems to meet mission goals
In 2020 VA is seeking a Contractor to demonstrate feasibility of a replacement self- service tablet patient check-in solution designed especially for the healthcare industry. VHA is seeking a viable solution that can be easily transferred from one commercial vendor to another.
Subsequent, national roll-out to all VA health care facilities will only occur following the acceptable completion of Pilot 1 at Spokane, Washington (henceforth referred to as Spokane) and Pilot 2 at Columbus, Ohio (henceforth referred to as Columbus) followed by the completion of two acceptable small phased approach deployments in VISN 20 and in VISN 10. While the national deployment schedule isn’t defined, it is expected that national deployments will move through a phased roll-out, VISN by VISN over an estimated 12 to 18-month period.
VHA envisions an advanced level of interoperability with tablets and/or mobile apps that will allow Veterans to conveniently transact with the Federal Government.
Account representatives from Epic Systems, one of the largest providers of medical record systems, have started calling customers with a clear message: We will not be pursuing further integrations with Google Cloud.
Epic’s reps told customers the company would instead focus its energies on Amazon Web Services and Microsoft Azure. They said the company decided to halt development with Google Cloud because it wasn’t seeing sufficient interest among its health system customers to warrant the investment.
The calls have come in the past few weeks, said three people with knowledge of the matter, and were directed to Epic’s hospital customers that use Google’s cloud-based technology either for medical research, data storage or for their basic IT operations, including file-sharing. These people declined to be named because they were not authorized to speak for their organizations on the matter.
Nearly a decade ago, many states failed to create their own independent state-based health insurance marketplaces. Today, they are ready to try again.
When President Barack Obama’s Affordable Care Act (ACA, or “Obamacare”) was passed nearly a decade ago, the goal was for states to launch their own certified health insurance exchanges. These exchanges were intended to offer individuals and small businesses the opportunity to compare policies and choose from a range of affordable plans. They were supposed to be easily navigable and simplify enrollment. On top of the generous federal financial support that states received to build their exchanges, federal subsidies were also promised to those looking to enroll.
Nearly ten years later, there are only 13 state-based marketplaces in operation, according to a surveyby Kaiser Family Foundation. When states attempted to launch their marketplaces in 2013, they did not work out as intended. Websites did not work, data could not be accessed, and call centers were overwhelmed. Furthermore, states spent millions of dollars on quick fixes that were ultimately unsuccessful. As a result, most states abandoned their plans to build independent exchanges and adopted the federal marketplace, Healthcare.gov. Today, 32 states rely on this federal platform, while six use a federal-state partnership.
However, at least six states – Maine, New Mexico, New Jersey, Nevada, Oregon and Pennsylvania – are ready to try again. These states are either creating their own marketplaces or seriously considering doing so. Officials in these states are confident that they will be successful the second time around, as they are equipped with better knowledge of the process than before. In recent years, vendors have also developed better software and other technology to support health insurance exchanges.
“A lot of kinks have been worked out, and the ability to set up marketplaces that run effectively and efficiently has gone up,” said Jeanne Lambrew, commissioner of the Department of Health and Human Services in Maine. Lambrew and other state officials are hoping to launch an independent exchange in Maine by 2021.
Pennsylvania also hopes to launch its own marketplace in 2021. “We know our markets and our consumer and our carriers best,” said Jessica Altman, the state’s insurance commissioner. “We believe we can leverage that information to make the experience of seeking health insurance more consumer-friendly and provide plans that are more affordable.”
States like Maine and Pennsylvania that are still in the planning process can follow Nevada’s example. Nevada’s independent marketplace – Silver State Health Insurance Exchange – launched in September 2019. “Nevada spent two years working with our colleagues in other state-based exchanges,” said Janel Davis, spokesperson for the state exchange, “looking at the mechanics of their operations to understand not only what would be required for Nevada’s own implementation, but also to understand what efficiencies could be achieved.”
Indeed, as states move towards creating their own marketplaces, interested vendors should expect solicitations for system development, as well as for operations and maintenance. GovWin is currently tracking over 20 upcoming opportunities related to health insurance exchanges. The complete list of these opportunities can be found here.
Amazon has begun offering Transcribe Medical to Amazon Web Services customers, and the company says the virtual medical scribe will allow health care providers to devote more time to patients. The software transcribes conversations between health care providers and patients and inputs the information into EHRs, and it is compatible with Amazon’s Comprehend Medical language processing program.
Kaiser Permanente CEO and Chairman Bernard Tyson died unexpectedly in his sleep at the age of 60, the Oakland, California-based health system said Sunday.
Tyson was named CEO in 2013 after serving in a number of roles throughout Kaiser, including hospital administrator and chief operating officer. His career at Kaiser spanned more than 30 years.
Gregory Adams was named interim chairman and CEO by the board. Adams most recently served as executive vice president and group president for the integrated health system.
Tyson was an influential figure in the healthcare industry. The 60-year-old was Kaiser Permanente’s first black CEO, and also one of the few black CEOs in healthcare and corporate America as a whole.
In a 2014 essay, he wrote about race in this country following the death of Michael Brown by a white police officer and the unrest that ensued. “Even as a CEO, the black male experience is my reality,” he said in the post.
Many have turned to social media to the mourn the loss of Tyson, including California Governor Gavin Newsom, who said on Twitter he and his wife were “deeply saddened to learn of the passing of our dear friend and healthcare pioneer, Bernard Tyson.”
Nancy Brown, CEO of the American Heart Association, said Tyson “transformed the healthcare landscape in this country and around the world, allowing people to live longer, healthier lives. I will miss him greatly.” Tyson served on the heart association’s board.
Magic Johnson, the former basketball legend turned business titan, called Tyson “a great man, visionary, and an inspiration to African-Americans in our country.”
Tyson lead one of the nation’s largest nonprofit health systems and health plans serving 12.3 million members and operating 39 hospitals and more than 700 medical offices. Kaiser generated operating revenue of nearly $80 billion in 2018.
Bernard, a San Francisco area native, is survived by his wife, Denise Bradley-Tyson, and his sons, Bernard Tyson Jr., Alexander and Charles.
Cleveland Clinic and telehealth company American Well are launching a joint venture to provide broad access to comprehensive and high-acuity care services via telehealth, the organizations announced Monday.
Named The Clinic, the Cleveland-based joint venture will provide virtual care from Cleveland Clinic’s staff through Boston-based American Well’s digital health technology platform, according to a news release. Through the new joint venture, patients across the globe will be able to connect to Clinic specialists for treatment for a number of conditions.
The Clinic will offer online access to expert care across a wide array of specialties. Cleveland Clinic executives did not specify what medical specialties would be available through the joint venture company’s telehealth services.
It’s Epic’s 40th birthday this year, and they’re celebrating with another exciting year of Epic UGM.
The conference begins on Monday, August 26th, and concludes on Thursday, August 29th. Just like previous years, the conference is taking place in Verona, Wisconsin at Epic’s campus.
This year’s theme is “Summer of ‘79”, a marker of Epic’s first year of service, exactly 40 years ago. Attendees will blast into the past with the theme and decor of the conference but will look to the future to learn about the changes coming to the healthcare technology industry.
Important Registration Dates:
Currently – Registration is open!
July 18th – Early bird registration ends
August 23rd – Standard registration ends
Epic UGM Schedule:
Sunday, August 25th – Taste of Epic and First-Time UGM Orientation
Monday, August 26th – Advisory Councils, CIO Morning Breakouts, CIO Roundtables, Legal Council, International Meetup, CEO Council Welcome Dinner, Legal Council Reception
Tuesday, August 27th – Executive Address & Cool Stuff Ahead, CEO Council, Executive Breakouts, Safety Forum, Peer to Peer Sessions, Cool Stuff Breakouts, Dinner & Celebration
Wednesday, August 28th – CEO Council, Peer to Peer Sessions, Cool Stuff Breakouts
Thursday, August 29th – Forums
Tips On Having An Epic Time As An Attendee:
Plan your agenda in advance to save yourself time (and from logistical headaches) during the week of the conference. And you find yourself packed with a back-to-back schedule, carve out time for networking and exploring the stunning Epic Campus.
Download the mobile app on Apple or Android to stay up-to-date on conference sessions and to save time finding colleagues onsite.
Make a point to strike up conversations with the presenters of presentations you found most compelling. This is a great way to network and to further absorb content!
The Sunday orientation session is a valuable time to gain information and tips for the upcoming days.
If you’re a physician or pharmacist in need of continuing education credits, don’t forget that many UGM sessions qualify for CME, CNE, and CPE credits.
Is it your first year attending Epic UGM? Coordinate your travel schedule so you can attend the First-Time UGM orientation session happening on Sunday, August 25, 2019.
Excerpts from the California Health Foundation paper on check-in kiosk benefits. A PDF is included at the end for download.
For this research, interviews were conducted with several health delivery organizations that are leading the way on the implementation and use of kiosks. The following case summaries demonstrate the wide variety of uses and benefits available to organizations that employ this technology.
CASE STUDY #1
Basic Check-In and Payments
Kaiser Permanente (KP) is a large, nonprofit, integrated health plan based in Oakland, California. Through its Kaiser Foundation Hospitals and their subsidiaries, KP serves about 8.7 million members in nine states and the District of Columbia, including a sizable presence in the Southern California (SCAL) region . Two years ago, as part of an initiative to design the “Front Office of the Future,” KP SCAL began looking at kiosks as a way to enhance ambulatory services. They developed a vision that would use kiosk-based self-service as a complement to KP HealthConnect, the name of the organization’s electronic health record system.
Prior to rolling out kiosks at a number of their SCAL facilities, KP offered a traditional check-in experience in which members lined up at the receptionist’s desk to check in. Changes to demographic information were communicated verbally, and co-pays were collected at the window. The process was not marked by any major breakdowns, but occasionally long lines would form during peak hours of operation, or if one member required special attention for questions or complex transactions. The verbal communications sometimes led to misspellings or other data entry errors, and co-pays were not always collected reliably.Also, traditional face-to-face check-ins did not always work well for members who spoke little or no English.
In 2007, KP tested the available technologies and surveyed members on their willingness to use a kiosk. The organization worked extensively with hardware vendors to select the right enclosure and technical components, as well as with its own clinical software system vendor to ensure back-end integration with the registration, scheduling, billing, and reporting tools.
Positive feedback from members led to an expanded pilot project in June 2008.By the end of the year, about 100 self-service kiosks were deployed in 60 medical clinics, making Kaiser the largest user of health care check-in kiosks in the country.Kaiser has plans to roll out an additional 200 kiosks in 2009.
The kiosks are used by members to:
Check-in for scheduled appointments;
Update demographic information;
Pay copay and deductible with a credit or debit card; and
Receive wayfinding assistance for directions to their appointment.
These functions account for the bulk of tasks and transactions that are typically performed through staff at the check-in counter. All of the tasks can be performed with the aid of language translation. Members can choose from one of six languages: English, Spanish, Chinese, Tagalog, Armenian, and Vietnamese.
In 2007, a patient satisfaction survey was conducted. Patients who checked in with receptionists were interviewed to learn about their awareness level of the new self-service check-in option. Patients who checked in with a kiosk were asked about their experience using this tool. Member reactions to the KP Self-Service Kiosks were very positive. The vast majority of members who checked in using the kiosk had a successful experience, with over 75 percent of members feeling that checking in through the kiosk is faster than checking in through a receptionist.
About 60 percent of members report that the reason that they used the kiosk was because the line was shorter.More than 90 percent of members who used a kiosk to check in are able to do so successfully without needing any assistance, and the same number also report that they felt comfortable with the level of privacy offered by the kiosk.
Kiosk utilization numbers have not yet been baselined, as the focus in 2008 was to learn how to deploy and support kiosks across the KP Southern California region. Utilization is noticeably higher during peak hours, though, suggesting that the kiosks are fulfilling their role of providing additional capacity as needed.
Department administrators are also pleased with the kiosks. Before the introduction of the kiosks, members requiring special attention may not have received all the assistance they needed, as staff tried to check in members as quickly as possible in order
CASE STUDY #2
Check-In and Payments, Forms,and Basic Scheduling
Vanderbilt University Medical Center
Vanderbilt University Medical Center (VUMC) is a comprehensive health care system, with dozens of hospitals and clinics, as well as schools of medicine and nursing. Vanderbilt clinics see more than 1.2 million patients per year across a full range of specialties, including: cancer; ear, nose and throat; gynecology; kidney disease; pulmonary disease; and urology.
In 2008, VUMC became interested in kiosks as a way to improve operations in three key areas: patient satisfaction, patient flow, and the satisfaction of patient service representatives (PSRs). During VUMC’s expansion to new buildings in the Nashville area, officials sought technologies to maintain a high level of patient service and ensure that bottlenecks would not occur in the waiting rooms of new clinics.
First, VUMC worked with a kiosk hardware vendor to select the right enclosure and components. The vendor custom-designed the enclosures, installed the internal computers and external user interface components, and configured the drivers to ensure that everything within the kiosks worked properly.
Then VUMC worked with a software integrator to enable the kiosks to communicate with the clinics’ systems. An interface was built to connect to VUMC’s in house electronic medical record system (called StarPanel). Another interface was built to enable credit card processing through Vanderbilt’s existing financial system.
In May 2008, VUMC began its pilot by installing kiosks in three areas that do not collect co-pays:
the preoperative evaluation clinic, the pediatric rehabilitation unit, and radiology.Initially, patients were able to use the kiosks only to check in.Staff greeters encouraged patients to try the kiosks and answered questions. After this rollout was deemed successful, VUMC expanded the scope and functionality of the pilot, deploying the kiosks to 11 more areas and permitting patients to use credit and debit cards to make payments for co-pays.
The initial reaction of patients and PSRs to the kiosks was so positive that the wider second-phase deployment was started just five months later, in October 2008. VUMC is deploying kiosks to 20 of its ambulatory settings, including clinics in dermatology, surgical weight loss, and women’s health, among others. Patients can check in and make payments via credit card and debit card, or they can select the “cash/check” button and pay at the receptionist’s window after they have checked in.
Patients can also use the kiosks to read and sign forms, such as the HIPAA consent form and VUMC’s standard consent-to-treatment form.
Patients simply review the form as they would on paper, and then use the electronic signature pad to give their signature (paper versions are always on hand if patients prefer not to use the kiosk) .
Additionally, patients can access their schedule of appointments, and view or print a summary of all of their future appointments. VUMC requires that the user answer a security question- birth date-in order to perform these transactions.
VUMC’s own informal study of patient feedback indicates that kiosks reduce lines and decrease the perceived. waiting time. In a sample of 465 timed kiosk check-ins, VUMC measured the average check-in time at two minutes, which staff members believe is at least as good as the total time waiting in line for a receptionist and then checking in with the receptionist. Utilization rose to 35 percent of check ins. In addition, staff members reported feeling better about spending more time with patients who have complicated questions or additional needs.
As VUMC continues to expand its ambulatory clinics, patient kiosks will be deployed to more locations and specialties. Additional functions are also being discussed, such as identifying a patient who is part of a research study, and the ability to handle Medicare secondary-payer claims more easily. VUMC has also explored the idea of introducing mobile kiosks to enable new patients to register and provide their full medical histories.
CASE STUDY #3
Check-In and Payments, Patient Feedback,and Reporting
Scott & White Hospital and Clinic
Scott & White Clinic (S&W) is the largest multi specialty medical practice in Texas, and one of the largest in the United States. It has approximately 700 physicians spread over 30 locations in central Texas.
After changing its model from a “closed system” to accept a wider range of insurers, S&W found that it needed to perform far more eligibility checking and verification tasks than before. These additional processes increased the check-in time, causing patient queues to build up, occasionally even stretching out the door. In order to maintain its reputation for operating efficiency and community responsiveness, S&W began to look at solutions to increase patient satisfaction.
Option #1 – overhaul the entire computer system, but this approach would take too long to implement.
Option #2 – redesign workflows, but administrators were not confident that this approach would provide enough of a benefit. A third option-to redesign the physical architecture of the clinics or construct a new building- was also briefly considered but dismissed due to cost.
Solution and Results
S&W ultimately turned to self-service kiosks as a means of improving patient check-in. They worked with a hardware vendor to supply a streamlined countertop kiosk outfitted with a mag-stripe reader, electronic signature pad, and integrated receipt printer.Then they worked with the vendor to integrate the kiosk with their practice management system.
S&W started with three kiosks to test user acceptance, and shortly thereafter deployed three more. Patient feedback during this period was 95 percent positive. Today, about ten kiosks are in use across three sites. More may be added, depending on capacity and demand patterns.
Using the kiosks, patients can check in by swiping a driver’s license or entering their social security number. Then they verify their insurance information, and make a co-payment with a credit card or debit card. The system is custom-configured to print off arrival notices at the nurse’s station automatically.Patients can also indicate whether they need any other printouts, such as a doctor’s note.
These instructions are captured in the scheduling system and passed along to the appropriate caregiver.
S&W also takes advantage of the opportunity that kiosks provide to conduct real-time patient satisfaction surveys. Depending on patient volume, the system can be configured to prompt users to answer a few brief questions about their experience, such as “Was parking adequate for you today?” and “Is the building clean?” Questionnaires are kept very short in order to allow people to conduct their business and move on, but nevertheless the feedback provided is valuable to S&W and can be reviewed as often as desired.
S&W also makes use of a number of metrics and reporting capabilities, including daily and monthly counters for check-ins, co-payment tallies, time-to check-in, and percentage of successful check-ins. For example, early in the deployment, the organization found that two kiosks in one location logged 1,872 check-ins over a two-month period (about 20 check ins per kiosk per day). Currently, each kiosk handles between 50 and 110 patients per day. Average check in times range from one to two minutes, depending on the location and configuration. By comparing the number of kiosk check-ins to traditional check-ins, S&W estimated that about 25 percent of visiting patients use a kiosk. Patients report liking the kiosks for two reasons: (1) faster check-in/no waiting in lines; and (2) enhanced privacy and confidentiality.
Each kiosk handles between 50 and 110 patients per day. Average check-in time ranges from one to two minutes.
Although the purpose of the kiosks is not to eliminate staff, S&W estimates that one kiosk can handle approximately one-half of a receptionist FTE (in terms of check-ins). In effect, each two kiosks that are deployed free up a person to resolve more complex issues relating to check-ins and insurance questions, or to spend more time with patients as they check in-particularly if they require referrals or would like to set up future appointments.
With an acquisition cost of about $12,000 per kiosk, plus $350 for annual maintenance, S&W’s total five-year cost of ownership has been under $15,000 per kiosk. A basic cost-benefit analysis estimated that the average cost of a check-in with a kiosk is between $0.74 and $1.12, compared to $8.12 per check-in through an office clerk. In addition, although the kiosks cannot perform all of the duties of an office clerk, the kiosks have been shown to collect more co-pays than the average clerk.
Finally, S&W has found that the kiosks have essentially no impact on the information technology department, once the initial setup and configuration is complete. As is the case with most kiosk vendors, the annual maintenance fee paid by S&W covers all of the routine issues that arise.
CASE STUDY #4
Kiosks for Check-In and Triage in the ED Setting
Newark Beth Israel Medical Center (NEWARK, NJ)
Newark Beth Israel Medical Center (NBIMC) is a 673-bed regional teaching hospital and affiliate of the Saint Barnabas Health Care System. With more than 100,000 patients per year, NBIMC is a major referral and treatment center for the northern New Jersey metropolitan area.
In 2005, Newark Beth Israel became an early adopter of patient self-service kiosks, deploying several units across selected hospital departments, including oncology, pre-admission testing, same-day surgery, and the adult and pediatric clinics. Patients and staff reacted so positively to the convenience and efficiency offered by the kiosks, that the organization began to look for new opportunities to use the technology.
After two years of experience with the kiosks for basic check-in and wayfinding, NBIMC expanded the program to the emergency department, which had been using an inefficient pen-and-paper system that was slow and led to long lines. In an urban setting with many patients dependent on public transportation, it was not uncommon, for instance, for the 11:30 a.m. bus to drop off 15 patients at once, creating an instant backlog. Sometimes waiting times for check-in stretched to nearly an hour and a half, contributing significantly to low patient satisfaction ratings and low Press Ganey scores.
NBIMC worked with an established kiosk vendor to select components- three wall mounted kiosks-which were installed in the ED in November 2007. The units have a 15-inch touchscreen display and are placed inside wooden carrels to provide privacy for patients. Three mobile kiosks are also kept on hand for use by the ED hospitality officer or waiting room technician, or to hand to patients who arrive in a wheelchair. (For emergency department settings, NBIMC’s vendor recommends approximately one kiosk per 25,000 patients per year. Between the wall-mounted kiosks and the less-used mobile ones, NBIMC meets this ratio.)
Prominent signage helps guide patients to the registration kiosks as they arrive at the ED. Patients with serious emergencies are rushed to treatment areas, but other patients may use one of the kiosks as an alternative to waiting in line to check in with a staff member. The kiosks are configured to perform “registration lite,” meaning that patients answer a few basic demographic and health questions, but are not required to enter a detailed medical history. Repeat visitors can swipe a credit card to populate the standard fields such as first name, last name, date of birth, sex, and zip code.New patients simply type in this information using the onscreen keyboard.
The screening questions that appear arc adaptable based on the answers provided .For example, a female patient between the ages of 12 and 55 would be asked if she is pregnant . If she answers yes, the kiosk asks if she is less than 20 weeks into her pregnancy, more than 20 weeks, or in active labor. Other screening questions ask about diabetes and allergies to medications. The final screening question is an all-purpose “complaint field” composed of a grid of 18 different conditions. Eight of these are red-flag indicators, including chest pain, shortness of breath, blood-borne exposure, fever and/or chills, and homicidal ideation.
The kiosks are configured to perform “registration lite” meaning that patients answer a few basic questions, but are not required to enter a detailed medical history.
After the information is collected at the kiosk, it is sent to a back-end system monitored by the triage nurse. As yet, NBIMC has not implemented a direct interface between the ED registration kiosks and the documentation system. Therefore, the nurse manually re-enters the data along with his or her evaluation. Since both systems can be accessed via the same computer, transposing the information is usually only a matter of copying it from one window to another- a process that is at least more efficient than traditional pen and paper.
Nurses can now perform triage more quickly than before, allowing caregivers to provide patients with faster treatment based on medical need. Once the information is in the system, the nurse can print out a face sheet with demographic information , and can look up medical record numbers and patient numbers. Within the first day of implementation , the number of triaged patients seen rose from six to ten patients per hour.
Patient feedback has been almost entirely positive.
Waiting lines to check in at the ED have essentially disappeared, and some patients commented that the kiosks also make the ED experience less stressful. The average waiting time has been reduced by one hour. The department saw an immediate increase in Press Ganey patient satisfaction ratings from 74 percent to 77 percent. Perhaps most revealing, the number of patients who left the ED without being seen dropped 13 percent despite an overall increase in volume of 8 percent.For a total investment of under $100,000 for six devices and all the necessary software and integration, NBIMC is now able to serve more ED patients at a higher level of service than before.
As ED utilization continues to rise, NBIMC plans to refine its triage kiosks program and make use of new features as they become available from the software vendor. Reporting capabilities, for instance, currently include average check-in time, wait time to be seen, and average triage time. New functionality will continue to be introduced as more hospitals express interest in kiosks and vendors catch up with the needs of leading organizations.
CHF Case Study Patient Check-in CONCLUSIONS:
Kiosks are a relatively simple and inexpensive way to introduce the patient self-service concept to the ambulatory office or emergency department. Patients benefit from enhanced convenience and shoner waiting lines, and staff members benefit from spending less time on routine administrative tasks and more time with patients who need their assistance. Kiosks benefit the organization as a whole through improved patient satisfaction scores and greater operational efficiency.Moreover, these enhancements frequently have a “halo effect,” helping to create a positive atmosphere for patients, staff, and providers.
Adoption of patient kiosks will continue to increase until kiosks become a mainstream technology. The physical design of kiosks has reached maturity and is not likely to change significantly.The originally segmented vendor landscape may continue to blend together as hardware specialists accumulate expense in software integration, and as combination hardware/software vendors reach out to more customers through competitive pricing.
The growth of check-in kiosks could also spur hospital interest in other self-service technologies. For example, there are kiosks that dispense medications to patients, which increases patient access and convenience. At Owatonna Hospital (Owatonna, MN) patients can get their emergency prescriptions filled without making a trip to the pharmacy.The kiosk is stocked with 40 to 60 of the most common acute-care drugs (no narcotics) and is accessible 24 hours a day, 365 days a year.
Kiosks can also be used as diagnostic health stations, where patients can get readings taken using the blood pressure cuff, pulse oximeter, weight scale, and body composition analyzer; they can then learn more about their health and what risk factors they might have. One cancer research program, run by the University of Georgia College of Pharmacy in conjunction with the American Cancer Society (ACS), placed several of these kiosks in local pharmacies and grocery stores in Georgia for use by the general public.
Kiosks should be thought of as an express option for those who are comfortable with selfservice technologies and desire the convenience and/or privacy.
Compared to other key hospital technologies such as electronic medical records, computerized physician order entry (CPOE), and eprescribing, patient kiosks are relatively easy and inexpensive to implement.
Kiosks in ambulatory settings and emergency departments complement staff resources by enabling patient selfservice. Their purpose is not to replace existing staff.
Several best practices for successful implementation emerged from the research. They are based on the experiences of numerous organizations that have led the way in introducing kiosks into health care delivery.
• Select a kiosk with the physical location in mind. Countertop and wallmount kiosks may appear to take up less space than freestanding models, but can require just as much space if a carrel will be used for privacy. • Consider purchasing more than one kiosk per area/department. While an incremental approach to deployment is wise, kiosks should not be underallocated in the piloting phase. Vendors can supply a rule of thumb. For ambulatory settings, two kiosks equal about one FTE receptionist. For the ED, one kiosk per 25,000 patients seen per year is suggested. • Take advantage of branding opportunities.Clear and consistent colors, design, and logos should be used on large enclosures and freestanding kiosks. This signals to patients that the kiosk is intended for their use. It gives users confidence that the kiosk is safe and secure, and reinforces the idea of a consistent patient experience. Ultimately, branding also increases use. Branding has less usefulness in countertop and mobile kiosks, which have far less surface area to work with.
For these kiosks, clear and consistent print signage surrounding the kiosk will suffice.
• Start in areas with high numbers of frequently returning patients. Patients who come for regular visits will be most attracted to the speed and convenience that kiosks offer. Departments like oncology, physical therapy, and rehabilitation are excellent places to start because the benefit is likely to be the greatest and the learning curve the shortest. • Start with check-in and payments. Although some hospitals enable consent forms and scheduling immediately, most organizations start with a basic set of transactions and add functionality later on. Kaiser Permanente, for example, started with basic checkin and copayments, and now has plans to enable patients to schedule future appointments. • Use a greeter during the initial rollout. Even with signage, it is highly likely that patients will fail to notice the kiosks or will not understand that the kiosks are intended for checkin. Allocate a staff member for at least one or two weeks to greet patients, encourage them to use the kiosk, and to answer questions. • Choose an obvious and convenient location. Patients who do not use a kiosk often state that they did not notice the kiosk, or did not understand that it was intended for their use. Locate the kiosks near the place where the patient would normally go to check in. Additional signage can be used to invite patients to try the kiosk. • Enable as many languages as you reasonably expect to use. Support of foreign languages is a major benefit for patients who do not speak English. Most kiosks can support at least three languages, and some offer many more. Usually, there is minimal cost associated with offering additional languages. Organizations may be required by law to offer particular language options if a certain percentage of its clientele speaks that language. Back translations of all scripts must be done so that staff members receive arrival notes in English, regardless of what language the patient uses at the kiosk.
Patient Kiosk Check-in Best Practice Processes
• Make use of the patient kiosk optional. Making the kiosk mandatory will inflate use statistics, but it will not necessarily increase patient satisfaction. Patients with complex questions still need a receptionist to resolve their issues. Kiosks should be thought of as an express option for those who are comfortable with selfservice technologies and desire the convenience and/or privacy.
Assign basic oversight responsibilities. Although patient kiosks do not need to be fully attended, departments should still designate a staff member to periodically check the kiosks to ensure that they are clean and in proper working order. At Newark Beth Israel Medical Center in New Jersey, the hospitality officer wipes the kiosks with a disinfectant about once an hour, and hand sanitizer is kept nearby for use by patients. Following the vendor’s recommendation, the hospital reboots the kiosks once every 24 to 48 hours to maintain optimal hardware performance.
Before installing kiosks, organizations should record their baseline service levels to enable a clear before and after comparison. Some statistics, such as average time in line, may need to be collected by hand. This is well worth the effort, as it helps demonstrate the service level improvement and can be used to help other departments prepare their business cases for implementing kiosks.
Although many kiosk implementations meet and exceed their objectives, some deployments have not been successful. For example, Parkland Memorial Hospital (Dallas, TX) deployed registration kiosks in its emergency department using funds that were donated to the organization’s affiliated medical school. Some patients found the kiosks very efficient and appreciated the reduction in wait time and increased privacy, but others found the touchscreens difficult to use. Many did not notice or did not want to try the kiosks, forcing the department to staff them with greeters at all times. This became inefficient, and the program was discontinued. Another organization tried using mobile kiosks in its cancer center, where new patients were given tablet PCs to complete an initial patient profile.The electronic answer sheet improved legibility for staff, but the tablets were not integrated with the patient registration system, which forced staff to rekey the information into the system. The benefit of enhanced legibility was too small to justify continuing the program.
Healthcare Kiosks Providing Benefits to Facilities and Patients
Patient check-in kiosks are proving to be very valuable in helping clinics to run more efficiently. According to a recent internal study conducted by a healthcare facility in Idaho, check-in kiosks have shaved two minutes off of the average check-in time and over 50% off of the time it takes for new patients to fill out forms. The result: customer satisfaction has risen and the facility is able to see one to two more patients per day!
By treating just one to two more patients per day, the typical provider could accommodate up to as many as 500 additional appointments in one year’s time. Healthcare check-in kiosks such are effectively streamlining the administrative aspects of running a healthcare facility, and this is allowing them to run with a streamlined staff while still providing for high patient satisfaction.
The Verona Healthcare Kiosk
Olea Kiosks has been developing innovative cutting-edge interactive healthcare kiosks for many years. Our healthcare kiosks are designed to provide a high level of convenience and ease-of-use for the end user while being compatible with all major healthcare software solutions. This results in better customer service and happier patients while also streamlining administrative tasks for the clinic.
The Verona Healthcare Kiosk, which is the latest product in Olea’s line of healthcare kiosks is the most innovative yet. This fully ADA-compliant kiosk has an adjustable screen height that can raise and lower over a 10-inch range at a touch of the button. This functionality makes the kiosk interface easy-to-use for all users – whether seated in a wheelchair or standing. In addition, because Olea’s engineers are always looking to build kiosks that can stand the test of time, this kiosk has a hardware system that incorporates Olea’s “toolless” design concept.
Contact Olea Kiosks Today
Olea has been designing and manufacturing cutting-edge kiosks for over 40 years. Made in America, our kiosk engineers pride themselves on quality craftsmanship, the highest quality materials, and the most up-to-date technologies. Contact Olea today to find out how our healthcare kiosks can help to streamline your organization while increasing customer satisfaction.