Improving clinic check in and other logistics....

[dieABRdie]

Our clinic is fairly rural and is still registering patients with pen, paper and then manually entering it into our EMR. Of course this means the patients sit in the lobby for 45 minutes trying to figure out what meds they are taking and what their insurance is. We've started mailing out the registration forms before the consult, but of course that doesn't work if they are being seen on short notice; and half the time they wouldn't do it anyway.

For those of you that are involved in the logistics... what have you done to facilitate this process? Its torture.

Electronic portal to fill things out? Kiosk? Tablet? Anything is better than what we are doing now.

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[elementaryschooleconomics]

Our clinic is fairly rural and is still registering patients with pen, paper and then manually entering it into our EMR. Of course this means the patients sit in the lobby for 45 minutes trying to figure out what meds they are taking and what their insurance is. We've started mailing out the registration forms before the consult, but of course that doesn't work if they are being seen on short notice; and half the time they wouldn't do it anyway.

For those of you that are involved in the logistics... what have you done to facilitate this process? Its torture.

Electronic portal to fill things out? Kiosk? Tablet? Anything is better than what we are doing now.

HAHAHAHAHA

I continue to come to SDN to verify my sanity.

I will yet again point out: in the next decade of the Silver Tsunami, many clinics that have been staffed by the same 1-2 RadOncs for the last 20-30 years will get a new grad/early career doc who came from a giant, complex, academic medical center.

Because every single RadOnc residency program, even the "small" ones, are still based in relatively massive hospitals - we don't actually get experience with "real" America.

@dieABRdie - what EMR system are you using? Epic and Cerner both have portals, but you can also get automated SMS/texting add-ons. Aria also has a patient portal. There are many SaaS solutions that are standalone.

But what you need is to find the solutions with the lowest activation energy, meaning, things your hospital has already bought and requires minimal learning from your staff.

I guess I'm making an assumption with that one - are you hospital outpatient or freestanding? Do you have an "Operations" crew in admin, and/or something like a Chief Medical Information Officer? Those are the people who would know if there are other solutions deployed in other clinics within your system, AKA you don't need to convince anyone to tap into the capital budget.

I can't tell from your question - are you building in that 45 minutes? Or are you running 45 minutes behind?

I recently took over a clinic in a very similar situation. I'm solo. My immediate solution (because the check-in crap is extremely important for billing/collections) is to build this into my schedule. Let's say they want to schedule me for a 2PM consult. When they go into the EMR to book it, the EMR knows to schedule the patient for 1:30PM, and it shows up as a "check-in/RN" appointment. So on the patient (and support staff) side, a consult is actually 90 minutes, and I've taken the guessing out of it. What was happening with the Boomers before me is every consult was a default 60 minute appointment, but then patients would show up precisely on time, they would spend 30 minutes on paperwork alone, people would freak out and run behind, blah blah.

I approached the executives to see what the hospital had already invested in, and SURPRISE, other clinics already had the automated texting, and SURPRISE, it was actually already in place for RadOnc...just no one used it. So I'm working on that now. Mailing the patients stuff beforehand is also good but - I would do both.

Mail. Text/phone call (depending on what your hospital has or is willing to buy). Make every consult a 90 minute block, with the first 30 minutes expressly dedicated to check-in.

 

[medgator]

We have patients arrive 30 mins earlier than scheduled consult time to do this. Forms are available for download from our website and that's communicated to them when we schedule the consult (or we offer to mail them paperwork)

 

[BobbyHeenan]

I assume your front desk staff gets a face sheet from the referring docs and has already entered some stuff in computer prior to arrival? That should get you address, phone numbers, DOB, insurance info, etc.

That would be the low hanging fruit if that's not already being done.

 

[ivybme]

We have patients arrive 30 mins earlier than scheduled consult time to do this

I’m just a resident, but the rad onc clinics I’ve seen that are the most efficient have this setup, although it’s more like 15 min.

 

[medgator]

I’m just a resident, but the rad onc clinics I’ve seen that are the most efficient have this setup, although it’s more like 15 min.

Yeah they put 30 but really 15-20 mins is all that is needed usually

 

[evilbooyaa]

I always wish that a 10am consult time meant that the patient was ready to be seen by the physician at 10am. Setting the patient with an 'arrive by' time that is at least 15, if not 45 minutes earlier would be ideal.

 

[dieABRdie]

HAHAHAHAHA

I continue to come to SDN to verify my sanity.

I will yet again point out: in the next decade of the Silver Tsunami, many clinics that have been staffed by the same 1-2 RadOncs for the last 20-30 years will get a new grad/early career doc who came from a giant, complex, academic medical center.

Because every single RadOnc residency program, even the "small" ones, are still based in relatively massive hospitals - we don't actually get experience with "real" America.

@dieABRdie - what EMR system are you using? Epic and Cerner both have portals, but you can also get automated SMS/texting add-ons. Aria also has a patient portal. There are many SaaS solutions that are standalone.

But what you need is to find the solutions with the lowest activation energy, meaning, things your hospital has already bought and requires minimal learning from your staff.

I guess I'm making an assumption with that one - are you hospital outpatient or freestanding? Do you have an "Operations" crew in admin, and/or something like a Chief Medical Information Officer? Those are the people who would know if there are other solutions deployed in other clinics within your system, AKA you don't need to convince anyone to tap into the capital budget.

I can't tell from your question - are you building in that 45 minutes? Or are you running 45 minutes behind?

I recently took over a clinic in a very similar situation. I'm solo. My immediate solution (because the check-in crap is extremely important for billing/collections) is to build this into my schedule. Let's say they want to schedule me for a 2PM consult. When they go into the EMR to book it, the EMR knows to schedule the patient for 1:30PM, and it shows up as a "check-in/RN" appointment. So on the patient (and support staff) side, a consult is actually 90 minutes, and I've taken the guessing out of it. What was happening with the Boomers before me is every consult was a default 60 minute appointment, but then patients would show up precisely on time, they would spend 30 minutes on paperwork alone, people would freak out and run behind, blah blah.

I approached the executives to see what the hospital had already invested in, and SURPRISE, other clinics already had the automated texting, and SURPRISE, it was actually already in place for RadOnc...just no one used it. So I'm working on that now. Mailing the patients stuff beforehand is also good but - I would do both.

Mail. Text/phone call (depending on what your hospital has or is willing to buy). Make every consult a 90 minute block, with the first 30 minutes expressly dedicated to check-in.

We try to build in the time by asking the patients to come in 30 minutes early; they just don't do it.

We are separate from the hospital which uses Cerner; but we use Aria since we have to use if for other rad onc specific things.

I did not know that Aria has a "portal". That would be the first place to start. Thank you!

 

[elementaryschooleconomics]

We try to build in the time by asking the patients to come in 30 minutes early; they just don't do it.

We are separate from the hospital which uses Cerner; but we use Aria since we have to use if for other rad onc specific things.

I did not know that Aria has a "portal". That would be the first place to start. Thank you!

Ah!

Ok - are you telling the patients "Your appointment is at 1PM, but please come at 12:30PM"

or

"Your appointment is at 12:30PM"?

It sounds like you're doing the former. The trick is to tell the patients the appointment is 12:30PM, period.

In Cerner I had the IT folks do this automatically. If anyone tries to book a consult for me, by default there is a 30 minute "RN" appointment that pops up in the system and that's what the patients see. On my end, with my schedule set to my name - I don't see it.

In Aria you can do something similar based on how you make schedule views but...you get the idea.

Now, if you're already doing this and patients are showing up on time...well, only God can help you.