Sensing Intent: This is the starting point in any design innovation process. The intent here is to explore any potential opportunities to reduce patient wait times via the use of automation and thus enhance the overall patient experience.
Knowing the Context: The company studied the current environment to determine how innovation and automation could perhaps help in achieving the company vision. The processes outlined below:
• Paper-based records - Patients filled out multiple medical information forms and also signed multiple patient consent forms.
• Double data entry - The front desk personnel processed the paper forms by keying in all the information from the paper forms into the Medical Records System (EMR). They also scanned the paper forms and attached them to the patient medical records.
• Transcription errors - Transcription errors were not uncommon due to either not understanding the patient handwriting or inadvertently keying in the wrong information into the EMR. This resulted in some billing and claim submission issues.
Know your Consumer: This is a key step in the process. Consumers have adopted technology at a rapid pace whether it is the use of the Internet, mobile devices, social media or IoT (Internet of Things) powered devices. Today, technological solutions are ubiquitous at home, in the office or wherever the consumer travels, including airports, banks (ATMs), and even movie theaters, and since they have embraced paperless solutions everywhere else, consumers as patients now expect a similar experience from their healthcare providers.
The front desk personnel perform multiple functions, including greeting the patients, verifying insurance eligibility, entering data from paper forms, collecting co-pays, making specialist appointments for patients, and discharging them.
In order to provide excellent quality care, it is important to take a patient-centric approach in designing solutions
This staff would rather spend time performing the most important tasks and communicating with the patient than entering data from paper forms into the EMR.
Framing Insights: Based on what the company learned from mapping the current registration process and its inherent deficiencies, and what they read and observed about the consumers, the following insights were gained:
• Online Registration - Some healthcare practices allow the patient to register online in advance. While this solution works in most healthcare settings, since CityMD is an urgent care company, almost all patients just ‘walk-in’ to the facilities. Hence, online registration may not benefit urgent care patients.
• eSignature Pads for Patient Consents - While this will provide a paperless solution for recording consents, the patient would still have to fill out paperwork for everything else.
• Device-based check-in-front desk personnel can give the patient a device where they can enter and review all the information. Once completed, all the information is transmitted to the EMR.
Explore Concepts: CityMD decided to explore the device-based check-in alternative. There were a few choices that were considered for patients.
• The devices could be handheld and given to patients.
• The devices could be affixed to the front desk.
• A stand-alone kiosk could be used. The company selected this concept because consumers were more accustomed to kiosks at airports and banks. This option also supported the ability to easily scan driver’s licenses and insurance cards.
• The company also explored various screen sequences/flows on-screen instructions, to identify the optimal set of screens and sequences.
Realize Concept: The company decided to pilot the stand-alone kiosk. The solution was first deployed at one test site for one month. The willingness of the patients to use the solution, the time saved during the registration process, the reduction in the number of errors, and the overall patient experience were closely observed. The goal was to see if at least 40 percent of the patients checked in via the kiosk. During the month, about 65-70 percent of the patients used the kiosk. Based on the learnings from the pilot, the organization tweaked the screens, the locations of the kiosk, and made other adjustments. Currently, all urgent care sites have at least two kiosks. The patient feedback has been overwhelmingly positive.
• About 80 percent of the patients check-in via the kiosk.
• It takes less than a minute for a returning patient to check-in.
• It takes about two minutes for a new patient to register and check-in.
• All the data from the kiosks are automatically transferred into the EMR.
• Error rates and claims denials have reduced considerably.
• Paper consumption has gone down dramatically.
