High-tech Check-ins

Just three years ago, at a time many of its neighboring practices still used paper charts, Gwinnett Center Medical Associates in Lawrenceville, Ga., started using an EHR. But even though the EHR made life more organized for the small internal medicine practice's clinicians, its front-desk staff didn't enjoy the benefits of the new technology.

"We were still copying hundreds of pages of paper from patients in the waiting room," recalls administrator Shari Crooker. "I thought that was a little ridiculous."

Within two months of getting her practice's EHR fully implemented, Crooker decided to try out a hard-cased media tablet - a portable touch-screen computer check-in device with a built-in card-swipe. The goal: to help front-office staff avoid some of the paper-based headaches they'd been experiencing in the otherwise tech-friendly environment.

More than two years later, Crooker says she can't imagine life without the tablet.

"I don't have to have someone constantly copying paper, I don't have to struggle reading anything, and patients don't have to sit there writing things out," says Crooker.

Thanks to the availability of newer, lower-priced technology - along with the national push for practices to use EHRs in lieu of paper - the desire for, and practice of using an electronic device in the reception room is gaining traction.

Using front-office technology has loads of benefits too, including and beyond the time it saves front-office staff.

Immediate benefits of ditching paper

Not so long ago, the main market for patient check-in technology resided in large kiosks - those big freestanding computers that look like small ATM machines - which were too cumbersome for small- or midsize practices. Today, an increasing number of smaller and more affordable kiosks and portable check-in devices are available for the private-practice setting. Some of the smaller high-tech options - often referred to as tablet kiosks, or wireless clipboards - take up the dimensional space of a laptop screen.

Whether freestanding machines (like the traditional kiosk), or smaller portable devices, like the tablet or wireless clipboard, high-tech check-in devices bring practices several advantages, the first of which is time savings - the front-staff no longer have to input the patient data, because the patient inputs the data herself. With the trend toward lower government reimbursements putting pressure on practices to cram as many visits into a day as possible, every extra minute adds up; freeing front-desk staff and clinicians to do something else.

"It [check-in technology] saves five to 10 minutes per patient," says MGMA consultant Rosemarie Nelson. "And if you're seeing 10 patients, that's a lot more nursing time."

Computerized check-in can also reduce your employees' stress levels in other ways. Because the patient inputs his information electronically, it is easy to verify insurance eligibility quickly.

At Beaumont, Texas-based Calder Place Family Practice, using electronic check-ins helps patients save time, and it is improving their satisfaction levels, says Francis Mijares, family medicine nurse practitioner at Beaumont, Texas-based Calder Place Family Practice.

"When you go into a medical office, the wait time is about two hours when you're a new patient," says Mijares. "We have to call your insurance company to see if you're eligible, and it's an automated system, 'please press this, please press that.' You know how long that takes? You never get your answer, so you have to talk to another person to find out what their deductable is."

Since Mijares' practice has been using a wireless tablet in the waiting room, patients are spending less time there. Today, the average wait time for new patients is 30 minutes.

Another similar way electronic check-ins ease stress is with fewer missed insurance copays, which, in turn, means more money toward the bottom line.

"In the medical practice, we can't seem to train receptionists to ask for money enough," says Nelson. "Less than 60 percent of practices collect even three-quarters of the co-pay. The kiosk always asks."

At Gwinnett Center Medical Associates, Crooker concurs that her media tablet makes the payment-collection process streamlined and user-friendly.

"The best thing about [our] media tablet is patients can pay their copay right there," says Crooker. "They can pay their balance and there's instant [eligibility and benefits] checks."

Checking in and meaningful use

EHRs are making information -gathering more efficient and easier for many physicians. But for practices that use paper-based forms in the front office and EHRs in the exam room, there is a greater chance of wasting time gathering the same information twice.

For practices considering a paperless reception area, it should be noted that most EHRs available today can integrate with the kiosks or tablet-based systems used when checking in. As soon as patients hit "done" or "submit," information translates into the practice's EHR. Plus, if a practice has a Web portal, information recorded at check-in can be automatically transmitted to the portal so patients can access their health information anytime.

"Demographic Information" is a Stage 1 meaningful use measure that can be met easily at intake. To fulfill meaningful use requirements, CMS requires a practice to record (for at least 50 percent of patients within the 90-day demonstration period) all of the following demographics: preferred language, gender, race, ethnicity, and date of birth. What easier way to do that, than when patients come in for their first visit?

Another measure that may be assessed in the reception area (so physicians don't have to remember if they asked) is smoking status, which must be recorded for all patients ages 13 and older.

By having front-desk staff gather information during check-in, practices save money, too, because reception staff compensation is less than that of nurses or physicians, says Nelson. "Also, if it is done at intake by the patient, via kiosk, tablet, or notebook PC, then it costs the practice zero dollars because the patient is doing the data entry," she adds.

Is there a catch?

Adding high-tech check-in technology to your waiting room isn't without its drawbacks.

Perhaps the biggest is the upfront cost: Full-size kiosks can run several thousands of dollars; even smaller tablets can cost several hundred. And that doesn't even include a possible monthly user fee, or the replacement costs for routine wear and tear.

One solution to help avoid these expenses is renting a portable computer or wireless tablet that charges only a monthly user fee, with no upfront device costs, like Mijares and Crooker do.

Or, your practice can try to put these costs into perspective in terms of saving money in the long run.

"What's the cost of that nurse spending 10 minutes on data entry time?" says Nelson. "Instead of thinking about it as 'oh, I'm going to write another check to a company,' think of it as, 'oh, I'm going to get a better utilization out of our staff."

The second biggest challenge is getting patients adjusted to the learning curve, especially senior citizens or other low-income patients who might not be familiar with computers.

The best way to deal with that is to allow for extra time in the first few months of use while patients get used to filling out forms electronically, and be ready to help less-computer-literate patients. As time goes on, the number of patients who are uneasy with technology will likely decrease, says Mijares.

"The older patients were reluctant to have it, because they were intimidated by the interface," says Mijares. "But once we show them, it only takes once or twice to help them, and after that it's easy."

Marisa Torrieri is an associate editor at Physicians Practice. She can be reached at marisa.torrieri@ubm.com.

This article originally appeared in the September 2011 issue of Physicians Practice.