Active Forum Topics | Getting Started | Interviews | EMR Forum | Medical | Billings | Press & News | Voice Recognition | The Water Cooler
We have just recently interfaced with a Kiosk device that performs the following functions:
1. Patient Lookup
2. Appointment Lookup
3. Demographics Verification and Insurance Verification
4. Past due and Copay collection (credit card swiper)
5. Posts money into our billing system as a Prepayment so it can be distributed to invoices
6. Marks the patient as checked in on the schedule and places the patient in the "Waiting Room" for our workflow tool.
The solution was designed to make the check in experience as quick as possible while taking a bit of the load off of the person at the front desk. The solution works great for walk in appts like flu shots, allergy shots, cumadin checks, etc ...
When we demo the system, we typically walk through a typical checkin process and it takes less than 45 seconds to do it while talking all along the way. This includes scanning the insurance card and swiping the credit card. Most people are impressed.
The very next question that is asked is ... "Does it do intake forms?" Our answer is currently no, although there is work being done to integrate Instant Medical History.
I'm asking for advice, input, discussion on what people think about this. I have taken the KISS (keep it simple s....) approach to this. The selling point for me is that no one will be intimidated by this machine because it is really simple. I model it after the Airlines and their introduction of the Kiosk for checkin purposes. Our goal is to be able to handle 90% of the standard checkins, not 100%. The docs that I have spoken with are often very high on intake forms, which makes sense. However, this adds complexity to the solution and also takes a 45 second checkin process and could extend it to several minutes.
I think there is a place for intake forms. I often try to separate a checkin Kiosk from a Patient Portal. Combining both seems to lose the efficiencies of what they should be designed to do. Doctors always talk about having the patients do work for them, and this is a valid argument. The more time a doctor has to see patients, the more profitable the practice. However, I also consider patient satisfaction as part of the equation that needs to be considered. I have seen many frustrated patients standing in line at a doctors office waiting for someone to service them.
Thoughts?
Chuck.
Our goal is to be able to handle 90%
Haha. Sounds like a Winn(ing!) Theory.
Do any of your Kiosks have a keyboard ?
It'd be near impossible to "Do Medical Intake Forms" without a keyboard really.
A handy feature might be to verify the reason for the visit ...
Your appointment today was booked as ...
"Physical and pap smear" .. is this correct ? [ Y/ N ]
Anything else ? [ Y / N ]
How about an integrated camera .. .so new patient can take a picture of themselves for the EMR ? (Only when the staff allows it though, like first visit, you dont want them taking a new picture monthly).
Verify address .... any changes ?
I'll be needing some kiosks soon ... I'll probably make my own out of a touch screen monitor and Windows XP. I will either hack together a MS Access VB app to integrate with my Billing software.
I really don't buy it that you can do a meaningful Medical History in the Waiting Room with others waiting to use the Kiosk or someone else peering over your shoulder. Certainly the IMH Kiosk, if in every exam room, could be more "Clinical" than if they were in the waiting room, IMO.
Of course, you'd be able to sell more ... with one per exam room.
Gosh, I just increased your sales 500%, and giave you the sales pitch.
Feel free to send money for this free consult.
Is this the entire computer ? or does the CPU/box go und the table or something ?
Do you guys just do eMDs ? Send me up a demo unit and Graham will write the checkin software for Synapse and I'll write the stuff for my Billing software :)
email:
I don't know Chuck- I'd prefer one of these!
It'll see your patient for you too- now THAT's pretty nifty. It'll save you the cost of a PA or NP to boot!
URL: http://images.google.com/imgres?imgurl=http://www.wired.com/news/images/full/robot_f.jpg&imgrefurl=http://www.wired.com/medtech/health/news/2003/08/60017&h=500&w=375&sz=27&hl=en&start=5&um=1&tbnid=5b_YUIjgBc6xwM:&tbnh=130&tbnw=98&prev=/images%3Fq%3Djohn%2Bhopkins%2Burology%2Brobot%26um%3D1%26hl%3Den%26rls%3Dcom.microsoft:en-US%26sa%3DG
Actually, just giving you a hard time. I don't see how these guys can bill their insurance. I don't see any CPT codes for a "robovisit" (at least not yet).
Your kiosk idea sounds really good. Will it interface seamlessly with e-MDs?
Al Borges, M.D.
You know, Barbara Duck is quite the expert on kiosks, demonstrating them in trade shows and videos. I hope she will check in on this thread, as she just happens to be a consultant. Also, DigitalDoc is another good source of kiosk information, having pioneered some of the basic concepts. Kiosks are a great idea, and could give the patient a hand in his or her own EMR content entry.
Robert Gleeman, Medical Journalist for EMR Update.com Email: robert@emrupdate.com Tel: 1-650-968-6359 Skype and ooVoo user name: robertgleeman EMR progress is a matter of fact. EMR Update supports your right to know.
>>Thoughts?<<
>>"Does it do intake forms?" <<
What specifically do you mean by this? I assume you are talking about a custom form?
If your existing software (eMDS, etc.) has existing screens for the data you desire, then it might be easier to use those existing screens and pragmatically give patients data input access to ONLY specific screens in their chart. The trick is to make those data input screens friendly for patient and staff. (maybe even touch screen friendly).
Chris Wilkerson, D.C. Carson Doctors Group TabletPCs in Medicine Editor-in-Chief www.MedicalTabletPC.com Home: www.Digital-Doc.com
digital-doc: What specifically do you mean by this? I assume you are talking about a custom form?
There is a little bit of a philosophical debate that will go on here. With intake forms, I am talking mostly about the ability to capture ROS and HPI information. Being able to capture this information through a touchscreen interface and then properly placing it into templates within the EMR product.
I think this is a great feature that would enhance a practice, I just wonder if it goes against the concept of a quick simple check in process. If we have people lining up at a Kiosk with each user taking 5 to 10 minutes entering their data, does the Kiosk become the "unpleasant" experience at the office. The docs would love this because it is much easier to review the data then to collect it. One of things that impresses folks when we demo is how quick the checkin process becomes. Introducing ROS and HPI data collection would certainly change that.
Simplicity vs. Complexity and depth of data collection. I think both are valid. I just wonder if it should be the same box or separate boxes? Using the Airline model, I view the Patient Portal synonymous with a the Airlines Web Site. I can book reservations, manage frequent flyer miles, update my information, etc. However, when I show up at the airport and walk up to a Kiosk, I am looking for a quick simple way to say "I am here, give me what I need, take my money, etc ..."
A
alborg: don't know Chuck- I'd prefer one of these!
don't know Chuck- I'd prefer one of these!
Al,
Does this come in both a male and female model. Some patient might be intimidated by the gender of this beast!
Where do you find this stuff?
DrMurdoch: Is this the entire computer ? or does the CPU/box go und the table or something ? Do you guys just do eMDs ? Send me up a demo unit and Graham will write the checkin software for Synapse and I'll write the stuff for my Billing software :)
Dr. M,
That's the entire box, the CPU is embedded in the base. The only other hardware that is standard is a small insurance card scanner and a receipt printer (credit card type receipt). There is no keyboard and the interface is clean and simple.
I'm trying to be careful not to make this thread into an underhanded sales/promotional thread. The unit itself is developed by a third party company and interfaces with many PMS systems in the industry. I did the interface for my e-MDs customers and it took probably less than 40 hours to accomplish the basics. Graham, or anyone else, who deems the features as useful can feel free to contact me and I will gladly relay information.
My goal is to help define the role for this box. Most providers that I have spoken with want a box that will simply do everything ... kind of like Al's robot. My thinking is that if we look at the longterm picture and assume that Kiosks and Patient Portals are available for all, where should the lines of functionality be drawn?
I agree with the concept of having a CheckIn Kiosk in the waiting room and possibly a computer in each exam room that hooks into the Patient Portal. The patient portal could then present a interface (keyboard and mouse included) that could be used to collect PMH, HPI and ROS.
I'm looking forward to hearing how others invision this playing out. I often take a simplistic "building block" view of how to tackle to problems that exist in the office today. Sometimes we plug holes with technology that exists today, sometimes we need to wait for other vendors to step in. I always get a little nervous when people are promises a single solution that handles every possible variation of practice workflow and needs.
Also, I like the idea about the camera. This has come up before and we have passed it along as a request for future enhancement.
Cheers.
Personally, anything but a check box answer is too time consuming for a patient in the office.I've had patients take up to an hour to fill out forms! The patient was my auto insurance rep, from Farmers, so I let him go without helping him
Ideally, having the patient fill out custom screens online (before the first visit), that are downloaded to my server and imported into my EMR is the way to go. This way, I have the HPI, ROS etc., in my EMR before the patient is in my office.
Second approach is having staff assist the patient in filling out pertinent screens.
Third is load a Virtual Assistant where the software loads specific screens for the patient to fill out by themselves. I can do this in any of my treatment rooms with thin clients. I put them to work and I get an email when they are done.I use all three methods.
digital-doc: I've had patients take up to an hour to fill out forms! The patient was my auto insurance rep, from Farmers, so I let him go without helping him Ideally, having the patient fill out custom screens online (before the first visit), that are downloaded to my server and imported into my EMR is the way to go. This way, I have the HPI, ROS etc., in my EMR before the patient is in my office.
I've had patients take up to an hour to fill out forms! The patient was my auto insurance rep, from Farmers, so I let him go without helping him
I see the same thing. I believe that this is definitely a portal type of application. Have the patient go to the website in the comfort of their home and fill out all the information so that they don't need to do it when they get to the office.
The angle I am approaching with the CheckIn Kiosk is for a busy practice. One example is an 11 doc practice that schedules all their appointment slots in 15 minute intervals. They have a very active waiting room, not to mention the walkin appts for flu and allergy shots. We've been able to swing all the Flu/Allergy shot checkins to the Kiosk which checks the patient in and collects the payment. The patients are instructed to head directly to the lab upon completion of the checkin process. What we've accomplished is a less hectic waiting room and less lines at the front desk. Instead of a long line at the checkin desk, people are getting comfortable with doing a quick checkin at the Kiosk. During the first month of the implementation, they had staff waiting in the waiting area to assist the patients with their first Kiosk Checkin, so it does take some commitment on behalf of the practice to ensure its adoption.
The byproduct of this implementation is that collected money is up. The Kiosk is not bashful about asking for money, including past due balances. This appears to be a problem at many front desks ... from what I hear.
Much of what I am discussing with the Kiosk does not benefit the doctor directly, which is why many of the discussions lead to collecting HPI and ROS. This is the wrap against it. The benefits I see are more intangible ones. A cleaner more efficient check in process. A more satisfied patient base. A sign that the practice is committed to new technology as a way to better serve the patient. There is an ROI aspect to it, but that really only comes into play if your front desk is slammed and you are considered adding staff ...
>>The angle I am approaching with the CheckIn Kiosk is for a busy practice<<
Ah, a kind of sign in sheet with a chief complaint, etc., real simple and short. Perhaps a message on their balance, which if one exists, then triggers a speaker over the front door that sounds a large padlock closing or maybe prison doors slamming?
Actually, the Kiosk is there to help you make money if you depend on the likes of Medicare. If you wish to bill a 99214 (an "extended" visit), then you need to document as such:
From: http://www.medscape.com/viewarticle/512849_3 (see table 1)
History: CC History: HPI History: ROS History: PFSH Exam Medical decision making 99213 Required 1-3 elements Pertinent Not required 6-11 elements Low complexity 99214 Required 4+ elements (or 3+ chronic diseases) 2-9 systems 1 element 12 or more elements Moderate complexity Note: Two of the three key components - history, exam and medical decision making - are required. This means 2-9 ROS elements and a SH element- all of which can be completed by the patient as they are waiting and account for 1/3 of the needed requirements. Either they do it or YOU do it- but someone needs to do it to get paid well and appropriately.
Note: Two of the three key components - history, exam and medical decision making - are required.
This means 2-9 ROS elements and a SH element- all of which can be completed by the patient as they are waiting and account for 1/3 of the needed requirements. Either they do it or YOU do it- but someone needs to do it to get paid well and appropriately.
Your comments validate why it makes sense to collect HPI information, and why the patient should do it.
Now, let's think in terms of your office workflow. Would you want a patient to walk into your office, step up to a Kiosk, spend 5-10 minutes in front of this device checking in and answering HPI questions?
I am trying to position a Kiosk solution as a "Check In Kiosk", not a "Clinical Data Gatherer Kiosk". I see some value in this, but others seem to be seeking a more complete solution. I'm trying to understand the workflow that other envision for this process.
I am glad to entertain your thoughts because they are consistent with many that I have encountered. The docs mind immediately goes to towards ROS, HPI, reducing the docs workload and generating a higher E&M code. These are desirable things, but not necessarily something a Checkin Kiosk should be responsible for. The Checkin Kiosk will benefit your front office and possibly save you money on staff up front. I know the number one goal in an office should be to optimize the money makers time, but that doesn't mean we don't look to improve other areas within the practice that don't necessarily impact the docs busy schedule.
There are other ways to skin the clinical data collection and my personal belief is that this is best suited for a Patient Portal.
Tablet Kiosk had a set up similar in a way with a stand which was a touch screen tablet pc locked up in a cabinet with the wedge reader so the unit could be removed at any time as well. I might think the kiosk perhaps combined with some portable tablets might work well together, so you don't have one person at the front desk kiosk taking forever entering all the information desired. Perhaps the initial scheduling and check in with payment could be up front and then the patient could fill in additional information while waiting in the exam room, might as well be productive time instead of reading magazines.
After the information is filled in, as far as being able to populate a "chief complaint" area as an example with even a simple review of systems with multiple choices available (to make it easier for the patient) it could then be updated to the chart with via the data interface after a quick verbal verification process. Some places are doing something like this already. Main thing with portable tablets is you don't want the patients walking out with them and a kiosk settles that matter with being bolted down at the front office. Very good point too on the kiosk not being afraid to ask for money too, big help there.
Anyway just a few rambling thoughts on the process.
Barbara Duck Ducknet Services TabletKiosk Sales Information
Blog: http://ducknetweb.blogspot.com/
The Widget Blog Site: http://ducknet.net/default.aspx
Skype Address: Ducknetservices Phone: 714-898-1917 Email: barbaraduck@ducknet.net
The palest ink is better than the best memory. - Chinese Proverb
Ducknet:I might think the kiosk perhaps combined with some portable tablets might work well together, so you don't have one person at the front desk kiosk taking forever entering all the information desired.
That is my concern, as well as a patient being intimidated with having to answer all the questions and simply bypassing the Kiosk Checkin.
Let me expand upon my thoughts by pulling in workflow with regards to the direction e-MDs is heading. Their patient portal will soon incorporate Instant Medical History. The data collected via IMH will automatically flow into the patient's chart. The patient portal is a web application that is accessible via any internet connected device. The Checkin Kiosk is a physical piece of hardware that resides at the doctors office.
Upon entering the office, a patient walks up to a Kiosk, confirms address, insurance, appointment and makes a payment. The patient is now "in the system". At this point, a patient can gain access to a tablet or computer (whether in waiting room or exam room) and fill out HPI, PMH and ROS. This also can be done from home if the patient has internet access from home (not a given in many areas).
This method seems to satisfy both objectives. First, the checkin process is quick and simple. Second, we give the patients an opportunity to enter HPI, PMH and ROS information if they choose. The Kiosk is a more expensive piece of equipment because of the the touch screen, while the machines needed to access the Patient Portal are simple cheap computer, thin clients, etc. Since the clinical data gathering will take the longer amount of time, you will need more cheap computers, rather than more expensive ones.
Thanks for your input.