Patient check-in is the process where patients begin their registration with the healthcare facility topically using a clipboard, electronic tablet, touch screen, kiosk, or by other method, sometimes self-service. Patient check-in start as far back as the Roman times when patients would wait for special services in purpose-built hospitals. As patient services were made more available, so was the need to have some method of tracking patients as they arrived.
History For many years, patient check-in and registration was done primarily through paper, clipboard, and pencil. Then, on August 21, 1996, President Clinton signed HIPAA into law, which included a Privacy Rule designed to protect patient's privacy. The privacy rule took effect on April 14, 2003, and changed the way hospitals, doctor's offices, outpatient ambulatory care centers, clinics, and surgery centers thought about collecting, sharing, and knowingly exposing Protected Health Information (PHI). In addition, the evolution of computers made it more affordable for institutions to transition to an electronic check-in system, replacing traditional paper sign-in sheets. In later years, tablets and touch screen devices continued to increase in functionality while becoming more readily available and affordable.
Technology today Healthcare facilities are realizing that HIPAA compliance and efficiency are no longer optional if they want to provide quality healthcare and avoid hefty fees and penalties. Patient Check-in is one of these areas of improvement for healthcare organizations motivated by HIPAA, Meaningful Use, and Lean/Six Sigma projects. Healthcare is finally starting to adopt technologies that other industries have implemented and relied on for many years now. Just as airlines, hotels, movie theaters, movie rentals, and grocery stores have discovered, self-service options provide higher throughput, reduce errors, and improve customer satisfaction. Bottom line, they make the organization more efficient and thus more profitable. Hospitals and clinics are realizing they can simply replace their paper sign-in sheets with a tablet or a wall-mounted or floor stand kiosk to realize a huge efficiency gain.
Concerns Loss of personal touch – by implementing a self-service check-in process, one misconception is the risk of losing personal touch with the patient. The truth is the check-in system separates people signing in from the HIPAA protected conversations between the office staff and patients at the window. Also, the patient gets to sign in faster due to the system being closer to the door. Although defeating the purposes of the check-in, some organizations mitigate this by providing concierge greeters to welcome and assist patients. Obviously this is additional cost to the office. Others make it completely optional, so those patients that like an experience with a live person or who feel intimidated by technology, still can have the option to use the traditional face-to-face or paper process. By using a welcoming concierge or by making electronic check-in optional, the organization can still benefit from an improved workflow, cater to those who cannot use technology, while keeping a personal touch and a high level of patient service. Theft – tablets and pagers that walk off are a big concern to many organizations investing in hardware. The best way to mitigate that is through properly mounting hardware by using table-top mounted, wall-mounted, or floor-mounted kiosks with security fasteners (star screws and key locks). If a non-mounted table-top tablet or kiosk is used, theft can be eliminated by putting the devices in close proximity to staff – ideally on the same countertop where the paper sign-in sheet was previously located. If tablets, pagers, or devices are given out to patients to read and collect a variety of data, a good practice may be to collect minimal data such as name, date of birth, and picture to provide accountability, then assign the asset to the person so it can be tracked. Another added benefit to many newer tablets is the ability to go into lockdown mode, even going as far as capturing GPS info, then reporting that when a connection is available. These systems provide an affordable way to protect your investment if theft is still a concern. Patient Acceptance – many organizations feel that elderly or those uncomfortable with technology may will have a difficult time using electronic patient check-in. However, a properly-sized screen paired with wizard style check-in requiring minimal typing can highly improve the patient acceptance rate. In addition, offering prompts and questions in multiple languages can further improve user acceptance. Another method that may improve patient acceptance is pairing kiosks with welcoming or concierge staff who can assist patients through the process, explain the process, help them check-in, offer them a beverage, and show them to their seat. This service can often be offered by volunteer staff. Complexity - The first thought is to have a kiosk that will make patients verify their personal information, update their medical history, check their insurance, take their co-pay, print a receipt. sign a waiver and then ask what symptoms they are having. All before they get to see anyone in the office. While these are great ideas consider the downsides of a complicated kiosk. Integration with other systems means cost and tech staff. How long will it take for a patient who has never seen the system? Since it takes longer, how many kiosks will you need? Does every patient have to go through the same process? What happens when the patient doesn't care about accuracy? On the other side, some patient check in systems are simple, fast and more cost effective. Instead of trying to replace the office staff, simple systems complement the existing EMR and give the staff a tool for organizing the patients. Simple systems generally only collect the name, reason for visit and a timestamp. The advantage they provide is organization and privacy.
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