Over the last two months, I witnessed my neighborhood grocery store install self-service checkout stations. Many fast food restaurants have kiosks or electronic order stations. The laboratory I use to have my blood drawn for my yearly checkup has a kiosk where I check in for my appointment, have my ID and insurance card copied, and pay my copay or deductible. Even the hospitals where I perform surgery have kiosk check-ins in the surgery lobby.
Is this the way of the future? Technology in health care is moving at a quick pace with robotics for some surgical procedures and telemedicine, which allows patients to interact with their physician remotely for quick checkups or discussions of lab results. Regardless of the technology, the check-in process will always be a necessary evil for a new patient and to update information on patients who have not been seen for some time.
Most patients seeing a physician for the first time have to arrive at the office at least one hour earlier than their scheduled appointment. This is rather standard in our area as this time is allocated for patients to complete their registration, insurance verification and relevant medical history. If one was to do this in a paper format, this hour is also dedicated to allow the medical staff to enter all of this new information into the electronic medical record (EMR). In my office, a new patient completes four to five pages of documents before seeing the doctor. I must say that a general surgeon’s office astounded me as the office requires patient paperwork that includes seven pages for demographics, HIPAA, the financial policy and then 30 pages for medical history information.
In the future, these repetitive tasks can and are likely to be automated with the aid of a self–service patient check-in kiosk like the one I mentioned at the lab. These systems are quickly emerging as efficient unattended or mostly unattended solutions. What are the benefits of this increased automation?
Increased efficiency. Using an automated process, whether a patient accesses it from home or performs it once in the office, can reduce wait times for patients. Patients would not need to arrive one hour before their scheduled visit if they complete required patient info forms from the leisure of home. Then the information can be directly imported into the EMR with a click of a button. Upon arrival at the office, patients can be directed to the treatment room within five minutes if all the documentation is complete.
Medical assistants are still available to answer questions and help with the electronic process. However, they should be able to redirect their time and attention to other tasks. This should effectively improve overall facility efficiency and patient satisfaction.
Secure access. All of this, of course, is on a secure platform where patients can update personal information, access health records, review instructions from their provider and make note of any future follow-up appointments. Our EMR even allows us to upload short video clips of instructions or patient discussions into the patient’s education file for later review. For quick questions, patients can also send secure emails to the office. However, this cannot be a substitute for a more in-depth office visit. The same is also true for the video chats.
Improving the patient experience. By utilizing patient check-in kiosks or patient portals, we can reduce the amount of time and focus spent on administrative tasks. We can direct staff to focus more attention on other functions such as prior authorizations or have them focus more on patients and their unique health needs, thus improving the patient experience.
When speaking with healthcare providers regarding the use of technology, many express concerns that older individuals will not be able to use this technology. I say they underestimate our older population. Older patients are used to buying airline tickets online along with checking in at the airport kiosk, albeit some may require a little assistance. I notice that many elderly patients use their cell phones to talk to their grandchildren all the time.
I am not skeptical that our patient population will revolt if we had this automated system in our office. The younger population loves this easy access as they are always on their cell phones. Checking oneself in or completing medical information from one’s phone, laptop or on an office kiosk is a welcome alternative for those who do not have the patience to do so on paper, or arrive for an appointment more than five minutes early.
Potentially decreased labor costs? There is also the debate regarding if these methods can save on labor costs. As minimum wage creeps up to $15 an hour, there has been discussion that fast food restaurants can reduce staff due to automated systems. This may turn out to be the case. Even Amazon is reportedly automating jobs held by workers who box up customer orders and this automation may lead to the elimination of more than 1,300 jobs at fulfillment centers.1
Can this idea work in medicine? Can we reduce staffing costs, and regain or increase profits? Increasing profits is more difficult in years of Medicare reimbursement reductions (or stabilization) with private payers not far behind. Patients are truly unaware that reimbursements to doctors have not risen in the 29 years I have been in practice, or that Medicare has a payment system that is budget-neutral. Instead, patients hear that doctors are getting bonuses for performance and outcomes. Well, I recently received a Medicaid bonus check of $0.23. The check likely cost them more money to print and mail than the “bonus” itself. I guess it was better that I got a bonus and not a reduction. I will leave that discussion for another day.
Dr. Aung is Chief of the Podiatry Section of the Tenet Health System/St. Joseph’s Hospital and a Panel Physician at Tenet Health System/St. Mary’s Hospital Outpatient Wound and Hyperbaric Center in Tucson, Ariz. She is a member of the APMA Coding Committee, the APMA MACRA/MIPS Task Force and is on the Exam Committee of the American Board of Wound Management. Her website is www.healthy-feet.com.
- Dastin J. Amazon rolls out machines that pack orders and replace jobs. Available at: https://www.reuters.com/article/us-amazon-com-automation-exclusive/exclusive-amazon-rolls-out-machines-that-pack-orders-and-replace-jobs-idUSKCN1SJ0X1. Published May 13, 2019. Accessed January 21, 2020.