Death to the clipboard

  | June 1, 2016

It started with waiting. David Perez, a former stockbroker, was tapping on his iPad in a doctor's waiting room when he had an idea for a company: What if you could speed up the check-in process by moving it onto a tablet?

At a time when people are increasingly glued to screens, many medical offices hew to old-fashioned check-in tools. The clipboard. The pen. The handing over of insurance card to front-office worker.

Perez's company, Seamless Medical Systems, joins a growing number of tech start-ups that are creating digital devices — commonplace in airports and gas stations — designed specifically for the doctor's office. They range from hand-held tablets to stand-alone kiosks that can scan a driver's license and insurance card.

These devices can be costly to purchase and implement, and they require changes in workflow that are "always a downside for any large system," says Sumbul Desai, Associate Chief Medical Officer for Strategy and Innovation at Stanford Hospital and Clinics.

But Desai, whose work focuses on technology and the patient experience, says digital check-in has long-term advantages. It makes payment and insurance collection easier, smooths out administrative functions, and, yes, "can help eliminate wait time when the patient comes into the office."

Indeed, digital check-in vendors say their products streamline the claims process, unburden the front office staff, and boost a provider's bottom line.

More security, less shredding

Digital check-in tools allow patients to update their own insurance information and confirm demographic information. And when it comes to personal data, Desai notes, a digital screen is far more private than papers lying around the office, which can be seen by anyone, need to be transcribed into a digital system, and ultimately need to be shredded.

"Security is always a concern of every CIO," Desai says.

Most tablets and kiosks contain sophisticated encryption to ensure protection of patient data and HIPAA compliance. Perez says Seamless's level of encryption is three times stronger than current HIPAA rules require.

Some vendors say this added security can spur patients to give out personal information when they previously wouldn't.

When clients ask their patients to sign up for portals, "it's amazing how many patients will say 'yes' and give their correct email on the kiosk but won't on the clipboard," says Kelly Laughlin, vice president of Clearwave, which makes a self-service kiosk for doctors' offices.

Is that a 4 or a 9?

Patients using Clearwave's kiosk check in to their appointments by scanning their driver's licenses and insurance cards. That means there's no chance of sloppy handwriting getting in the way — and it's impossible for staff members to misread a birthday, an address, or an insurance ID number.

Errors are one of the biggest reasons claims don't get processed quickly; Laughlin points to a study that found that front desk employees can spend as much as 80 percent of their time correcting paperwork due to patient registration inaccuracies.

“Denied claims happen because the patient insurance information is incorrect or the patient demographic is incorrect," says Scott Freedman, chief operating officer of Epion, which makes a check-in tablet for patients. “And providers can't get paid if they don't have the correct information in the system."

Within eight months of implementing a check-in tablet from another company, Phreesia, Pennsylvania-based Keystone Orthopaedic Specialists' proportion of visits containing complete patient information rose to 53 percent from 17 percent.

Depending on the patient has its drawbacks, Desai notes: While digital check-ins are great for getting accurate information, there are always some users who will need a little extra help learning the ropes.

“Similar to airport check-in, most people have taken to it pretty well, but you're always going to have a few who need some navigation, and that's OK," she says.

Pay it now, not next time

Deductibles are rising, and patients are feeling the burden. For visits to providers in the athenahealth network, commercial patient obligations have risen 23 percent since 2010. For most medical offices, that means finding ways to increase point-of-service collections and devising strategies to collect large bills.

For now, this responsibility lies largely with front desk workers, who might be too swamped with paperwork to realize that a patient owes money — or who could feel uncomfortable asking patients for large balances. athenahealth data shows that point-of-service collection of outstanding balances begins to drop off significantly once the balance reaches $150, which suggests that the higher the balance, the less likely a staff member might feel comfortable asking for payment.
Digital check-in tools can change the equation, vendors say. Machines don't feel awkward asking patients to cough up a sizable balance. And they're programmed to prompt patients to submit their co-pays.
“You'd be shocked how many $20 or $30 co-pays go uncollected because the staff is uncomfortable or they say, 'Just pay it next time,'" Perez says. “It's a significant amount of revenue each year for practices."
Indeed, Keystone Orthopaedic Specialists was able to boost co-pay collection by 8 percent within eight months of implementing the Phreesia device — and its collections received through credit cards increased by 122 percent.

Service with speed

Back-end efficiency is important, but so is patient satisfaction. As Perez realized, no one likes waiting — and digital check-in tools can lead to a faster and easier door-to-door experience.

Clearwave's Laughlin says the average check-in time using his company's device is less than three minutes. One of Clearwave's orthopedic clients said the kiosk was especially popular with injured patients, who appreciated not having to hobble back and forth between the desk and their seats to file paperwork while on crutches.

And when digital devices do the check-in duties, Perez says, staff members should have more time to "focus on higher-value tasks, such as working closely with patients to answer individual questions."

Betsy Vereckey is a writer in New York.

Image credit: David McLain

Death to the clipboard