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
Capability Key: • Have this functionality О May have this functionality N
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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
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
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