Jennifer Andersson - Best practices in patient self service - e-health 6.6.14

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  • 1. Best Practices in Patient Self Service Jennifer Andersson RN, BSN, MBA Director, Admitting and Registration Northwestern Memorial Healthcare
  • 2. 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) 2 Northwestern Memorial Hospital is a894bed hospital located in downtownChicago,Illinois
  • 3. Situation Statement – 2011 • 1.Approximately25% ofpatientsdidnotconfirmtheirinsuranceanddemographicinformationpriortothedateof theirhospitalbasedservices.  Forthe patient:  Longregistration/check-inprocessonsite  Servicedelays ifinsuranceauthorizationsare not obtained  Unnecessaryselfpay billsifinformationisnot captured accurately  Forthe hospital:  Informationrequired to financiallysecure the servicepriortothe patient’s arrivalhas not been obtained  Canresult inbilling incorrectpayor,delayedorno reimbursement,and re-work • 2.Patientswerenotifiedoftheirestimatedout-of-pocketcostonthedateofservice,whichleadtosurprises.  There isa 15%annual increase ofpatients withhigh deductible plans – higher out ofpocket costs  Receivedover1,000 patient requests per monthforout-of-pocketcosts  Patientswithhigher out ofpocket costsmay cancel their servicelastminute, resulting in‘coldtable time’ and patient dissatisfaction • 3.Clinicalandadministrativeformswerecompletedonthedateofservice,lengtheningtheregistrationandcheck-in process.  Formscaptured onpaper, and storageand retrieval weredifficult  Questionsonformswereasked manytimes, whichgave the impressionthat we didn’t knowourpatients orretain theirinformation
  • 4. 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.! …”
  • 5. 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 5 Facilitate a seamless and consistent experience for patients across NM that enables the highest quality care at the lowest possible cost
  • 6. Proposed Solution • Implementa patient portal that a patient can utilize to register for upcomingNMH 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
  • 7. Vendor Selection – NMH Expectations v. “Competition” Vecnawaschosen todevelop afirst inclass administrative patient portal Competitive Analysis Capability Key: • Have this functionality О May have this functionality NMHPatientConnectPortal (FutureState) NorthShore(Epic) Advocate(Customer PotentialManagement) LurieChildren'sHospital (Epic) UW-Madison(Epic) NewYorkPresbyterian (HealthVault) NMPGRelayHealth 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 •
  • 8. Patient Connect Project Organizational Structure Theportal/kiosk project was managed within aseries ofpatient- centered ITprojects 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
  • 9. 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
  • 10. 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 regis tering for your upcom ing MR Ankle Right appointm ent with Northwes tern Medicine via Patient Connect. Your appointme nt 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 PatientConn ect.n CALL Northw estern Medicine at 312-926-5402 f or Assistance. EMAIL us at LEARN more about Northw estern Medicine at w w For fas t and eas y check-in, print this confirm ation page or us e your phone at one of our on -s ite kios ks . To cancel or res chedule this appointment, contact us at 312 -926-6366. Don't forget to:  Bring a photo ID and your ins urance card(s )  If you have an Order for your appointm ent, please bring it with you.  Print this confirm ation and bring it to your appointm ent.
  • 11. 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
  • 12. Best Practice: Pilot Large Organizational Changes First Piloting helps ensure theproject will work ona small scale andallow the teamtoidentify andresolve issues priorto them beingrolled out hospital-wide. Ifsuccessful, theymay also help togain buy-infrom 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
  • 13. The Pilot NMHpiloted theportal andkiosk first in theBreast Imaging Center, one CT/MRIImaging location, and theInfectious Disease Cinic Pilot Location Common Denominators • Approximately 50-150 patients/day • Patients pre-registered by Central Scheduling • No walk-in patients – 100% scheduled
  • 14. 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 SinceNovember 2012,$130Kcollected onout-of-pocket estimates and $1.3Mcollected onoutstanding balances ontheportal andkiosk
  • 15. 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”
  • 16. Lessons Learned Whileweconsider ourportal andkiosk project successful, there were lessons learned alongtheway…. • 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
  • 17. 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
  • 18. 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.
  • 19. Thank You