Patient check-in is the process where patients begin their registration with the healthcare facility topically using a clipboard, electronic tablet, touch screen, kiosk, or by other method, sometimes self-service. Patient check-ins start as far back as the Roman times when patients would wait for special services in purpose-built hospitals. As patient services were made more available, so was the need to have some method of tracking patients as they arrived.[1]
For many years, patient check-in and registration was done primarily through paper, clipboard, and pencil. Then, on August 21, 1996, President Clinton signed HIPAA into law, which included a Privacy Rule designed to protect patient's privacy. The privacy rule took effect on April 14, 2003, and changed the way hospitals, doctor's offices, outpatient ambulatory care centers, clinics, and surgery centers thought about collecting, sharing, and knowingly exposing Protected Health Information (PHI). In addition, the evolution of computers made it more affordable for institutions to transition to an electronic check-in system, replacing traditional paper sign-in sheets. In later years, tablets and touch screen devices continued to increase in functionality while becoming more readily available and affordable.
Technology today
Healthcare facilities are realizing that HIPAA compliance and efficiency are no longer optional if they want to provide quality healthcare and avoid hefty fees and penalties. Patient Check-in is one of these areas of improvement for healthcare organizations motivated by HIPAA, Meaningful Use, and Lean/Six Sigma projects. Healthcare is finally starting to adopt technologies that other industries have implemented and relied on for many years now. Just as airlines, hotels, movie theaters, movie rentals, and grocery stores have discovered, self-service options provide higher throughput, reduce errors, and improve customer satisfaction. Bottom line, they make the organization more efficient and thus more profitable. Hospitals and clinics are realizing they can simply replace their paper sign-in sheets with a tablet or a wall-mounted or floor stand kiosk to realize a huge efficiency gain.
Concerns
Loss of personal touch – by implementing a self-service check-in process, one misconception is the risk of losing personal touch with the patient. The truth is the check-in system separates people signing in from the HIPAA protected conversations between the office staff and patients at the window. Also, the patient gets to sign in faster due to the system being closer to the door. Although defeating the purposes of the check-in, some organizations mitigate this by providing concierge greeters to welcome and assist patients. Obviously this is additional cost to the office. Others make it completely optional, so those patients that like an experience with a live person or who feel intimidated by technology, still can have the option to use the traditional face-to-face or paper process. By using a welcoming concierge or by making electronic check-in optional, the organization can still benefit from an improved workflow, cater to those who cannot use technology, while keeping a personal touch and a high level of patient service.
Theft – tablets and pagers that walk off are a big concern to many organizations investing in hardware. The best way to mitigate that is through properly mounting hardware by using table-top mounted, wall-mounted, or floor-mounted kiosks with security fasteners (star screws and key locks). If a non-mounted table-top tablet or kiosk is used, theft can be eliminated by putting the devices in close proximity to staff – ideally on the same countertop where the paper sign-in sheet was previously located. If tablets, pagers, or devices are given out to patients to read and collect a variety of data, a good practice may be to collect minimal data such as name, date of birth, and picture to provide accountability, then assign the asset to the person so it can be tracked. Another added benefit to many newer tablets is the ability to go into lockdown mode, even going as far as capturing GPS info, then reporting that when a connection is available. These systems provide an affordable way to protect your investment if theft is still a concern.
Patient Acceptance – many organizations feel that elderly or those uncomfortable with technology may will have a difficult time using electronic patient check-in. However, a properly-sized screen paired with wizard style check-in requiring minimal typing can highly improve the patient acceptance rate. In addition, offering prompts and questions in multiple languages can further improve user acceptance. Another method that may improve patient acceptance is pairing kiosks with welcoming or concierge staff who can assist patients through the process, explain the process, help them check-in, offer them a beverage, and show them to their seat. This service can often be offered by volunteer staff.
Complexity - The first thought is to have a kiosk that will make patients verify their personal information, update their medical history, check their insurance, take their co-pay, print a receipt. sign a waiver and then ask what symptoms they are having. All before they get to see anyone in the office. While these are great ideas consider the downsides of a complicated kiosk. Integration with other systems means cost and tech staff. How long will it take for a patient who has never seen the system? Since it takes longer, how many kiosks will you need? Does every patient have to go through the same process? What happens when the patient doesn't care about accuracy?
On the other side, some patient check in systems are simple, fast and more cost effective. Instead of trying to replace the office staff, simple systems complement the existing EMR and give the staff a tool for organizing the patients. Simple systems generally only collect the name, reason for visit and a timestamp. The advantage they provide is organization and privacy.
Operations and uses
Simple systems are usually lower cost and easier for the patient. Many of these systems are tablet based and use inexpensive hardware such as the Apple iPad or an Android tablet. Medical Check In is one of the least expensive on the market and uses the iPad. It asks for the patient name and reason for visit, then passes the information to the computers in the office. The system is not integrated and is not designed as a data acquisition type.
In additional to the on-site kiosk, the patient documentation can be completed remotely before the patient visit reducing the patient wait time, one of the major advantage of using paperless system at the front office. With introduction of cloud technology in recent years, healthcare offices are now able to easily manage the patient documentation without need to spend hours in manually scanning the forms and duplicate entries in the system.
Beyond simply asking for a patient's name like paper sign-in sheets traditionally did, the self-service kiosks can gather much more info to facilitate registration. Savance Health's solution offers integration with license, ID, credit card, and insurance card scanning devices, allowing the patient to identify themselves quickly and accurately with little to no keyboard input. By using a duplex ID/insurance card scanner with a magnetic strip reader, healthcare organizations can acquire a digitally scanned image of the front and back of the patient's license and insurance card to automatically keep it on file (in PDF format for example). In addition, a magnetic card swipe (MSR) credit card reader can be connected so co-pays or open balances can be collected and processed before services are offered. Eligibility checking can also be offered automatically through services like eligibilityapi.com for small transactional fees. Another common function during check-in is for patient's to verify their insurance and address info that is on file. Changes can be made and verified by the patient rather than staff eliminating common mistakes from typos that ultimately lead to inaccurate data.
In addition to verifying data, focusing on patient safety and infection control can also be managed by asking simple questions like, “Are you a fall risk?” and “Do you have or have you recently had a cough, temperature, or flu-like symptoms?”. Based on their answers, staff can properly handle the patient or the kiosk can instruct the patient to wear a mask. Another common question is, “Do you require an interpreter?” allowing the appropriate staff from interpreter services or similar to automatically be dispatched.
Virtually any question or data that organizations may collect now can be collected in a self-service check-in kiosk. By coupling this with pagers, text alerting, and waiting room displays, patient satisfaction and Hcap scores can have a big impact.
Related services
Patient Tracking – the movement of the patient through an ER, surgery center, outpatient facility, ambulatory care facility, or throughout the entire hospital is often plagued with bottlenecks, inefficiencies, and poor handoff. The patient is often the one that suffers. When an electronic patient check-in process is implemented, patient tracking can start immediately when the patient enters the building. From there, the right staff can properly be contacted. As the patient progresses along their care path, say in a surgery center, patients can be assured the most prompt service when staff communicate effectively. In addition, patient tracking provides constant measuring using electronic time stamps allowing automatic, accurate, and constant feedback on performance.
Waiting Room Optimization – since patient check-in typically starts the process for a customer, optimizing the waiting room experience significantly can improve customer satisfaction scores. For example, using pagers similar to those used in the restaurant business can allow patients to freely roam the hospital and stay in constant communications with the front desk.
Time Use Study Data – this kind of data is traditionally gathered manually through spot checks. Staff typically have to document times for every step of the process for a given set of patients or all patients on a given day. Then this data is manually tabulated in order to identify bottlenecks. Improvements can then be identified and an action plan can be created. After implementing the action plan, staff then repeat the process over again to measure and gauge improvement.
Co-Pay and Open Balance Collections – the movement to private insurance and the increase in co-pays has many patients carrying a balance. In addition, co-pays account for a higher percentage of the overall compensation than they once did making co-pay collection a more important part of the healthcare process.
Electronic Forms and Signature Capture – patient intake forms, new patient forms, consent forms, health history forms, HIPAA portability forms, and other data-driven or signature captured forms are prevalent in today's healthcare organizations. Unfortunately, the majority of them are paper-based as of the time this article was written. Patient check-in can give healthcare organizations a chance to feed electronic data into their operations with or without a newer EMR.
Eligibility Verification – to ensure that a healthcare organization gets paid for its provided services, it is common for staff to do eligibility verification via telephone or through an interactive website. This can provide the most up-to-date verification to ensure the healthcare organization will get paid by the carrier such as Medicaid, Medicare, or the insurance provider for the services scheduled for the day.
Integration with EMR – reading demographic, appointment, order and billing data from the EMR can help improve overall workflow around patient check-in systems by reducing time spent charting any data entered into the patient check-in system. HL7 is the primary method used to integrate with EMR systems.
Communications – several communication enhancements can be realized through an electronic patient check-in system.[2] For example, in a dentistry, if a patient shows up for their cleaning and the hygienist is waiting for them, immediately upon arrival the hygienist can be alerted via e-mail, text, as well as a popup on the PC. This provides the fastest service possible while allowing other staff members to optimize their time while waiting for patients to arrive. In this example, that includes an office manager as well as the hygienist. The same goes for a larger organization such as a hospital. When the patient walks into the main entrance of the hospital, a greeter can assist them during the check-in process, at that point, the system can automatically know the services they are here for or the kiosk/staff can gather that info. The system can then alert the department that their patient is on their way up so they are fully prepared when the patient arrives. Similarly, if the patient needs to flow from medical imaging to labs, electronic communications, tracking, and alerting can help hand off a patient further allowing staff to prepare for the arriving patient.
Related Research Articles
Medical privacy, or health privacy, is the practice of maintaining the security and confidentiality of patient records. It involves both the conversational discretion of health care providers and the security of medical records. The terms can also refer to the physical privacy of patients from other patients and providers while in a medical facility, and to modesty in medical settings. Modern concerns include the degree of disclosure to insurance companies, employers, and other third parties. The advent of electronic medical records (EMR) and patient care management systems (PCMS) have raised new concerns about privacy, balanced with efforts to reduce duplication of services and medical errors.
The Health Insurance Portability and Accountability Act of 1996 is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996. It aimed to alter the transfer of healthcare information, stipulated the guidelines by which personally identifiable information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and addressed some limitations on healthcare insurance coverage. It generally prohibits healthcare providers and businesses called covered entities from disclosing protected information to anyone other than a patient and the patient's authorized representatives without their consent. The bill does not restrict patients from receiving information about themselves. Furthermore, it does not prohibit patients from voluntarily sharing their health information however they choose, nor does it require confidentiality where a patient discloses medical information to family members, friends or other individuals not employees of a covered entity.
Medical billing is a payment practice within the United States healthcare system. The process involves the systematic submission and processing of healthcare claims for reimbursement. Once the services are provided, the healthcare provider creates a detailed record of the patient's visit, including the diagnoses, procedures performed, and any medications prescribed. This information is translated into standardized codes using the appropriate coding system, such as ICD-10-CM or Current Procedural Terminology codes—this part of the process is known as medical coding. These coded records are submitted by medical billing to the health insurance company or the payer, along with the patient's demographic and insurance information. Most insurance companies use a similar process, whether they are private companies or government sponsored programs. The insurance company reviews the claim, verifying the medical necessity and coverage eligibility based on the patient's insurance plan. If the claim is approved, the insurance company processes the payment, either directly to the healthcare provider or as a reimbursement to the patient. The healthcare provider may need to following up on and appealing claims.
The terms medical record, health record and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdiction. A medical record includes a variety of types of "notes" entered over time by healthcare professionals, recording observations and administration of drugs and therapies, orders for the administration of drugs and therapies, test results, X-rays, reports, etc. The maintenance of complete and accurate medical records is a requirement of health care providers and is generally enforced as a licensing or certification prerequisite.
An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.
An interactive kiosk is a computer terminal featuring specialized hardware and software that provides access to information and applications for communication, commerce, entertainment, or education.
Medical practice management software (PMS) is a category of healthcare software that deals with the day-to-day operations of a medical practice including veterinarians. Such software frequently allows users to capture patient demographics, schedule appointments, maintain lists of insurance payors, perform billing tasks, and generate reports.
A personal health record (PHR) is a health record where health data and other information related to the care of a patient is maintained by the patient. This stands in contrast to the more widely used electronic medical record, which is operated by institutions and contains data entered by clinicians to support insurance claims. The intention of a PHR is to provide a complete and accurate summary of an individual's medical history which is accessible online. The health data on a PHR might include patient-reported outcome data, lab results, and data from devices such as wireless electronic weighing scales or from a smartphone.
Continuity of Care Record (CCR) is a health record standard specification developed jointly by ASTM International, the Massachusetts Medical Society (MMS), the Healthcare Information and Management Systems Society (HIMSS), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and other health informatics vendors.
Health technology is defined by the World Health Organization as the "application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of lives". This includes pharmaceuticals, devices, procedures, and organizational systems used in the healthcare industry, as well as computer-supported information systems. In the United States, these technologies involve standardized physical objects, as well as traditional and designed social means and methods to treat or care for patients.
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers, including commercial healthcare insurers. The transition to the NPI was mandated as part of the Administrative Simplifications portion of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Patient portals are healthcare-related online applications that allow patients to interact and communicate with their healthcare providers, such as physicians and hospitals. Typically, portal services are available on the Internet at all hours of the day and night. Some patient portal applications exist as stand-alone web sites and sell their services to healthcare providers. Other portal applications are integrated into the existing web site of a healthcare provider. Still others are modules added onto an existing electronic medical record (EMR) system. What all of these services share is the ability of patients to interact with their medical information via the Internet. Currently, the lines between an EMR, a personal health record, and a patient portal are blurring. For example, Intuit Health and Microsoft HealthVault describe themselves as personal health records (PHRs), but they can interface with EMRs and communicate through the Continuity of Care Record standard, displaying patient data on the Internet so it can be viewed through a patient portal.
Electronic prescription is the computer-based electronic generation, transmission, and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, physician assistant, pharmacist, or nurse practitioner to use digital prescription software to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient's team of healthcare providers to facilitate knowledgeable decision making.
The nation of Austria has a two-tier health care system in which virtually all individuals receive publicly funded care, but they also have the option to purchase supplementary private health insurance. Care involving private insurance plans can include more flexible visiting hours and private rooms and doctors. Some individuals choose to completely pay for their care privately.
Clinical point of care (POC) is the point in time when clinicians deliver healthcare products and services to patients at the time of care.
The Health Information Technology for Economic and Clinical Health Act, abbreviated the HITECH Act, was enacted under Title XIII of the American Recovery and Reinvestment Act of 2009. Under the HITECH Act, the United States Department of Health and Human Services resolved to spend $25.9 billion to promote and expand the adoption of health information technology. The Washington Post reported the inclusion of "as much as $36.5 billion in spending to create a nationwide network of electronic health records." At the time it was enacted, it was considered "the most important piece of health care legislation to be passed in the last 20 to 30 years" and the "foundation for health care reform."
Digital health is a discipline that includes digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise. It uses information and communication technologies to facilitate understanding of health problems and challenges faced by people receiving medical treatment and social prescribing in more personalised and precise ways. The definitions of digital health and its remits overlap in many ways with those of health and medical informatics.
Medical image sharing is the electronic exchange of medical images between hospitals, physicians and patients. Rather than using traditional media, such as a CD or DVD, and either shipping it out or having patients carry it with them, technology now allows for the sharing of these images using the cloud. The primary format for images is DICOM. Typically, non-image data such as reports may be attached in standard formats like PDF during the sending process. Additionally, there are standards in the industry, such as IHE Cross Enterprise Document Sharing for Imaging (XDS-I), for managing the sharing of documents between healthcare enterprises. A typical architecture involved in setup is a locally installed server, which sits behind the firewall, allowing secure transmissions with outside facilities. In 2009, the Radiological Society of North America launched the "Image Share" project, with the goal of giving patients control of their imaging histories by allowing them to manage these records as they would online banking or shopping.
Federal and state governments, insurance companies and other large medical institutions are heavily promoting the adoption of electronic health records. The US Congress included a formula of both incentives and penalties for EMR/EHR adoption versus continued use of paper records as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the, American Recovery and Reinvestment Act of 2009.
Project Nightingale is a data storage and processing project by Google Cloud and Ascension, a Catholic health care system comprising a chain of 2,600 hospitals, doctors' offices and other related facilities, in 21 states, with tens of millions of patient records available for processing health care data. Ascension is one of the largest health-care systems in the United States with comprehensive and specific health care information of millions who are part of its system. The project is Google's attempt to gain a foothold into the healthcare industry on a large scale. Amazon, Microsoft and Apple Inc. are also actively advancing into health care, but none of their business arrangements are equal in scope to Project Nightingale.
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