Best Practices in Patient Self Service Jennifer Andersson RN, BSN, MBA Director, Admitting and Registration Northwestern Memorial Healthcare

Northwestern Memorial Hospital

• NMH is affiliated with the Feinberg School of Medicine and is part of a 2-hospital health system with over 1500 physicians on staff • FY2013 Volume 46,039 inpatient admissions 14,759 observation stays 84,909 ED visits 603,235 outpatient registrations 33,521 IP and OP surgical volume 12,401 deliveries (largest birthing center in Illinois)

• Annual patient revenue: $1.2B

• Payor Mix (volume) 29.1% Medicare (Government plan – over 65 and disabled) 30.5% Blue Cross (Insurance) 19.2% Managed Care (Insurance) 13.2% Medicaid (Government plan – low income aged, blind, disabled) 8.0% Self Pay (Uninsured)

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Northwestern Memorial Hospital is a 894 bed hospital located in downtown Chicago, Illinois

Situation Statement – 2011

• 1. Approximately 25% of patients did not confirm their insurance and demographic information prior to the date of their hospital based services.

For the patient:

Long registration/check-in process onsite

Service delays if insurance authorizations are not obtained

Unnecessary self pay bills if information is not captured accurately

For the hospital:

Information required to financially secure the service prior to the patient’s arrival has not been obtained

Can result in billing incorrect payor, delayed or no reimbursement, and re-work

• 2. Patients were notified of their estimated out-of-pocket cost on the date of service, which lead to surprises.

There is a 15% annual increase of patients with high deductible plans – higher out of pocket costs

Received over 1,000 patient requests per month for out-of-pocket costs

Patients with higher out of pocket costs may cancel their service last minute, resulting in ‘cold table time’ and patient dissatisfaction

• 3. Clinical and administrative forms were completed on the date of service, lengthening the registration and check-in process.

Forms captured on paper, and storage and retrieval were difficult

Questions on forms were asked many times, which gave the impression that we didn’t know our patients or retain their information

Call to Action – Patient Satisfaction Survey Comments

“Hate having to repeat all my info year after year… Should be able to just make any changes year over year vs. having to complete the forms over and

over again…”

“Was called prior to visit to be "pre-registered" yet had to "register" again. Waste of time on your end and mine. …”

“When asking how much the entire procedure will cost me I could not get an answer.”

“I was surprised at the amount of paper/forms being filled out. Seems like the process would be improved by computerizing and coordinating with my

physician who has my records electronically.! …”

Future State: Vision

ONE

One set of demographic,

financial information,

paperwork and questionnaires

One point of coordinated scheduling

One clinical history, meds,

problems, allergies list

One consolidated

bill/statement

One portal

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Facilitate a seamless and consistent experience for patients across NM that enables the highest quality care at the lowest possible cost

Proposed Solution

• Implement a patient portal that a patient can utilize to register for upcoming NMH visits

Provide pre-service viewing and updating of demographic and insurance information and electronic completion and signature of forms

Provide insurance eligibility and out-of-pocket estimates as a part of the registration process

Remember the answers to clinical questionnaires so that patients do not have to complete the information from scratch every visit

Eliminate paper

• Enable location-based, self-service check-in and registration Kiosks for NMH

Vendor Selection – NMH Expectations v. “Competition” Vecna was chosen to develop a first in class administrative patient portal

Competitive Analysis

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Phase 1 Administrative Capabilities (delivered in FY12)

Appointment Requests / Referral Requests • • О •

Patient Visit Itineraries • • •

Online Pre-Registration • • • О О

View/Update demographics • • О О View/Update insurance information • О See insurance eligibility •

Electronic Forms and Signatures • О О

Upload scanned documents • О О • •

Clinical Questionnaires/Info based on Appointment Type • О • О

Online Check-In •

Online Bill Pay - prior balances • • • • Estimate on future out of pocket costs • Make payment on future balance • Complete all of the above on a point of service device •

Patient Connect Project Organizational Structure The portal/kiosk project was managed within a series of patient-centered IT projects called “Patient Connect”

Patient Connect Steering

Committee

Director, Admitting and

Registration

Director, Care Coordination

Director, Internet

Marketing

Manager, Information

Services

Patient Connect Project Director

Patient Connect IT Director

Patient Feedback Incorporated into Portal and Kiosk Design

Personas

Patient Comments

Patients Participate on

Workgroup

Analysis of patient pain

points by access point

Usertesting. com

Patient Advisory

Committee

High-Level Portal and Kiosk Process Flow

Patient schedules

appt

<= 7 days from DOS,

patient receives

email invitation to join portal

Patient Pre-Registers

using Portal

Patient arrives for

visit

Staff views on admin tool whether patient has pre-registered online

Patient checks in using kiosk with barcode confirmation. Staff use flags for workflow

Hello Clover Zzzvecna,

Thank you for registering for your upcoming MR Ankle Right appointment with Northwestern Medicine via Patient Connect.

Your appointment details:

Service: MR Ankle Right

Date: Monday, March 24, 2014

Time: 9:00 PM

Location:

NMIC MRI

676 N. Saint Clair St, Arkes Pavilion

3rd floor, Suite 300

Chicago, IL 60611

LOG ON at

PatientConnect.nmh.org

CALL Northw estern

Medicine

at 312-926-5402

for Assistance.

EMAIL us at

portalsupport@nmh.org.

LEARN more about

Northw estern Medicine

at w ww.nmh.org.

For fast and easy check-in, print this confirmation page or use your phone at one of our on-site

kiosks. To cancel or reschedule this appointment, contact us at 312-926-6366.

Don't forget to:

Bring a photo ID and your insurance card(s)

If you have an Order for your appointment, please bring it with you.

Print this confirmation and bring it to your appointment.

High-Level Process Flow

• Scan/upload insurance card/ID/order

• Complete all demographic and insurance information

• Complete clinical questionnaires

• Sign consent/HIPPA

• View/pay OOP estimate for upcoming service

• View/pay outstanding balances

• Request appt

• Print confirmation barcode

• View map of facility

• Print directions

Patient Pre-Registers using Portal

Best Practice: Pilot Large Organizational Changes First Piloting helps ensure the project will work on a small scale and allow the team to identify and resolve issues prior to them being rolled out hospital-wide. If successful, they may also help to gain buy-in from stakeholders

A Pilot Should Be Used When • Change covers a large scope • Change is costly • Change is difficult to reverse • People are sensitive to the change • Unintended consequences may result as part of the change

When Piloting Ensure • The scope of the pilot is representative • It can be reproduced on a larger scale • It is measureable • Effectively market pilot to key stakeholders – patients, physicians, staff

The Pilot NMH piloted the portal and kiosk first in the Breast Imaging Center, one CT/MRI Imaging location, and the Infectious Disease Cinic

Pilot Location Common Denominators • Approximately 50-150 patients/day • Patients pre-registered by Central Scheduling • No walk-in patients – 100% scheduled

Results to Date (through 5/6/14)

• Portal and kiosks live in 6 different check-in locations, covering 17 different medical services

• 15% of patients who receive portal invitations pre-register online

• 50% of patients who have pre-registered online check-in using kiosk

Since November 2012, $130K collected on out-of-pocket estimates and $1.3M collected on outstanding balances on the portal and kiosk

Patient Comments Post Go-Live

Overall, I'm satisfied with the ease of completing online registration on Patient Connect.

I would use Patient Connect again for my next appointment at Northwestern Memorial.

• “Made my appointment online & did the online registration. It was so simple & fast. It would be great to have this for doctor appointments too” • “I would use it again made the check-in process a lot faster”

Overall, I'm satisfied with the ease of completing the steps on the Kiosk.

I would use the Kiosk again for my next appointment at Northwestern Memorial.

• “It didn't take a long time to use. And I understood everything good, no problems I like it” • “Piece of cake!” • “I like the Kiosk. However, I hope people will not be replaced with the kiosk” • “I think the system is very easy and efficient for check-in. Just please be aware of patient privacy”

Lessons Learned While we consider our portal and kiosk project successful, there were lessons learned along the way….

• Involve the patient in the design of the portal and kiosk • Involve the clinical teams in the design process – they are key stakeholders • Preview the portal and kiosk for Senior Leadership and key Physician Leadership • Thorough User Acceptance Testing is critical • Portal adoption is KEY to a successful kiosk experience • Kiosk location is KEY to kiosk adoption • Patients do not want to spend a lot of time in front of a kiosk – barcode check in is key • Pilot thoroughly before further rollout

Lessons Learned

• Implement a ‘registration concierge’ model – instill confidence in patients that they can use the kiosk – most patients are scared to use the kiosk until prompted or told that they are easy to use • SIGNAGE – patients should not have to wait in a line to be asked to use a kiosk for check-in. • LOCATION, LOCATION, LOCATION

Galter 8 NMIC 3

Lessons Learned

• Validate the process put in place pre-go-live is the correct process post-go-live. Do not be afraid to make changes to the original plan if it is not working as designed. • Before investing in permanent kiosk structures, live with temporary “bolt down” kiosks until you live with it for a few months and then decide the best placement and construction needs for your location. • Delay go-live if issues will negatively impact the patient experience. One bad experience will prevent patients from wanting to use the kiosk in the future. • You cannot please everyone. Expect resistance.

Thank You