Contactless patient intake digitizes the workflow that enables patients to check in for scheduled and walk-in visits at veterinary ERs, urgent care clinics, and hospital emergency centers using their own device from their home, their car or any other location.

The COVID-19 pandemic changed patient check-in from a matter of convenience to one of safety.  Safety protocols combined with multiple surges in transmission rates have heightened the need to collect patients’ signatures, demographic information, ID and insurance images via digital devices instead of pre-pandemic norms that often relied on manual, in-person workflows.  In addition to reducing potential virus exposure for both patients and staff, staff need ways to quickly collect this information without relying on phone calls.

As provider settings and veterinary hospitals deal with a rapidly changing healthcare environment, here are three reasons to implement contactless patient intake:

1.     Reduce call volume
2.     See patients faster
3.     Focus staff on more valuable activities

First, what defines “intake?”

Intake encompasses everything that staff need to collect before the visit, including:

·       Appointment book / hold your place in line
·       Visit confirmation / reminders
·       Pre-visit registration
·       In office, lobby, or curbside check-in system
·       Chief complaint / visit reason
·       Demographic information
·       Consent forms
·       ID card capture
·       Insurance card capture
·       e-signature
·       Payment options
·       Payment collection
·       Review of systems

#1: Reduce call volume

Each time a community experiences a surge in COVID-19 rates, its on-demand healthcare settings also see a spike in patient visits.  Typically, call volume spikes as patients call for information about hours, appointment availability, test results and wait times.  However, the largest driver of call volume comes from the need to remotely collect intake information, via phone call.  Each patient typically triggers one to two inbound calls, plus two to three outbound calls.  Each of these calls last five to seven minutes on average, with some urgent care clinics receiving 30 inbound registration calls in the first 10 minutes of the day.

Digital contactless patient intake immediately reduces this call volume by enabling patients to submit all of their intake information from their mobile device or in-office tablet or kiosk.  Many clinics push this process further upstream to have patients complete their intake at home.

One animal hospital eliminated five phone calls per visit.

#2: See patients faster

Picture this: an urgent care clinic opens at 8:00 am and has twenty patients already at the door.  Signage directs them to call the front desk to register.  The clinic staffs two phone lines and can register a patient in five minutes on average.  Guess what time the 20^th patient gets registered?  Probably not until almost 9:00 am!  This phenomenon, sometimes dubbed “a line just to get in line,” can add 30% to the average length of staff.

However, contactless patient intake vastly reduces the intake time because it enables almost unlimited simultaneous, parallel registration.  Reimagine the above scenario: twenty patients all start filling in their intake information from their phones.  While some patients will complete it faster than others (depending on whether they have visited before, need to update their insurance, etc.), all 20 will get registered by 8:10 am.  Staff can review, triage, and prioritize all twenty patients.  They can spot the patient presenting with shortness of breath or the dog that ate chocolate immediately.

One urgent care clinic measured 30% shorter throughput times after it implemented contactless patient intake.

#3: Focus staff on more valuable activities

Manual intake consumes front office staff efforts on data entry related activities – verbally getting information from the patient, typing it into the practice management system, scanning insurance cards and then uploading those images, etc.  Additionally, they spend time answering the same set of questions related to managing patients’ expectations, most often around wait times.

By contrast, contactless patient intake removes 80-90% of the data entry.  Staff can re-allocate their time toward more valuable activities such as verifying eligibility insurance, collecting payment, or helping patients with unique circumstances (out-of-towners, out-of-network benefits, etc.).  In addition, contactless intake can include text message updates that give patients answers about why they can expect to wait longer than normal as well as how many patients have signed in ahead of them.

Virtual queuing and automated texts, as part of contactless patient intake, delivers all these benefits without the challenges of posting wait times.

Learn more about how ER Express supports contactless check-in workflows, including at-home and car check-in.

^{Kaufman Hall reports that the pandemic accelerated demand for more consumer-friendly healthcare services such as mobile check-in: https://www.healthcaredive.com/news/pandemic-spurs-consumer-friendly-healthcare-services/589023/}

A quick Google Search will show an overwhelming number of articles (“hospital wait times” showed 1.4 billion results) on healthcare wait times, how to reduce them, publish them, and/or use them as part of a marketing strategy. It’s no wonder then that as most emergency departments, urgent cares and other walk-in clinics see their competitors advertising their wait times via billboard, website or SMS message, they feel a strong impetus to follow suite.

This impetus assumes that by posting wait times, patients will choose the facility that offers this degree of transparency over another that does not. While this may be true, let’s take a step back and consider what posting wait times online really accomplishes.

Varying definitions of wait time rarely match what patients expect

First of all, what do patients think “wait time” means?  The definitions of wait time vary widely from one health system to another. Consider for example, these common definitions:

1. The time spent from arrival to triage
2. The total time spent from arrival to the exam room
3. The total time spent until the patient sees the doctor (including time spent waiting in the exam room)
4. The time from check-in to discharge

Definition #1 would likely result in very short wait times. Under this definition, staff immediately triage patients but send them back out to the waiting room again until a bed is available, making it look like the wait time is quite short but really, patients will still wait longer than they anticipated. On the extreme end, definition #4 most likely presents a much longer wait than what patients have in mind.

Wait times suffer from low accuracy

Many health systems use completely different methods for updating the wait times, such as taking an average over several hours and posting once every half hour or so, while another facility may just post yesterday’s average or a historical average. There are also plenty of health system websites that rely on staff updating the wait time – staff who are busy and are more likely to inflate the number to decrease their workload.

Wait times change rapidly

Consider that even real-time wait times posted online are not the same as the wait times a patient will experience once they arrive. A patient who sees a posted wait time of 15 minutes may head over straight away only to find out that by the time they get there the wait time has increased. The opposite situation may also be true. Patients may pass over the facility with a wait time they perceive as being too long, even though the busyness could clear up by the time they get there.

Wait times can make you look bad in comparison

On that note, in some cases patients will pass up the busiest location if you have more than one where wait times are posted and choose a location with more capacity to treat them. However, they may just decide to skip it altogether and pick a competitor with lower advertised wait times. That competitor may have a completely different definition of wait times that is more easily kept low, even if the actual throughput time is longer. Your posted wait times still can make you look bad in comparison.

A better alternative to posting wait times

What’s a better way to manage expectations while increasing transparency and patient satisfaction? Create a virtual queuing process. Allow patients to get in line ahead of time through your website using online check-in and wait from the comfort of home. Online check-in allows staff to offer up time slots during times of the day when they are historically less busy. If there is a sudden surge in volume, it’s easy to quickly turn it off or temper it down to fewer time slots.

In addition, all walk-in patients can sign-in via kiosk or their own mobile device, while a smart queuing algorithm automatically gives them an estimated treatment time slot that takes into account online time slots and the real-time volume. Both walk-in and online check-in patients can opt to wait from home, their car, or the lobby while staff have the ability to communicate with them via two-way text messaging to keep them informed while they wait.

To make the wait more transparent, virtual queuing has multiple tools that give patients a sense of their place in line – an API that can be added to the health system website that publishes the real-time number of patients already in line, an automated text sent upon sign-in that lets patients know what their place in line is, and the ability to text back a number to receive an update about the number of patients ahead of them.

Here’s what makes this a better solution than simply posting wait times online:

• Increases operational efficiency – Automating the check-in process reduces phone calls and paperwork and streamlines communication with patients.
• Optimizes throughput – The virtual queuing algorithm uses historical and real-time throughput to calculate and assign treatment times.
• Reduces staff workload – Allowing patients to essentially check themselves in and receive automated updates about the wait, reduces the amount of time your staff spends on the phone.
• Manages patient expectations – Patients are assigned treatment times instead of being told how long the wait may be based on an inaccurate average. Patients care more about their individual wait time than the average for all patients, so knowing what their specific wait time will be (or choosing their own treatment time via online check-in), while receiving updates on their phone, offers a much higher degree of transparency.
• Attracts new patients – Providing the convenience and transparency patients want turns first-time visitors into loyal patients. Providing the option to check in online and wait from home is a differentiator from the competition who still only post wait times.

While posting wait times online or through various marketing initiatives may seem compelling because everyone else is doing it, there is a better way to solve the issues that would make an urgent care or ED consider posting wait times in the first place. If you’re trying to increase patient satisfaction, then it makes more sense to give patients more control over their experience. If you need to increase efficiency, don’t stress your staff out by having to adhere to a posted wait time, automate the wait time process instead. If you want to better manage patient expectations, keep in touch with them without having to pick up a phone. Using these digital tools to your advantage checks off all the boxes that wait times do not and benefits both patients AND staff.

MedNow, a 7-location urgent care + primary care practice led by Mark Newton, M.D., deployed the MedChat triage bot combined with ER Express’ online scheduling solution to screen and book patients for telehealth visits and COVID-19 testing.

“We have long made it a top priority to deliver high-quality, timely, and efficient care. MedChat along with ER Express allows MedNow Urgent Care to stay at the forefront of respecting our patients’ valuable time,” said Newton, practicing ER physician and founder & CEO of MedNow.

“When the county asked us to provide COVID-19 testing, we needed a way to screen and prioritize patients,” said Newton. “Our scheduling partner ER Express brought the MedChat triage bot to our attention. In just a few hours, we launched the triage bot tailored to our telehealth workflow.”

The triage bot screens patients to determine their individual level of risk based on Centers for Disease Control criteria. Medium- and high-risk patients are routed to schedule a telehealth screening through ER Express’ queueing software and, if appropriate, prioritized for testing. Patients with severe symptoms are triaged to nearby emergency departments. All patients can opt for a telehealth visit no matter their risk.

“Members of our communities want a way to know if they should be concerned for their health,” added Dr. Newton. “Offering the triage bot assessment reassures low risk individuals. The full protocol of triage bot, telehealth encounter and in-person testing maximizes the number of patients we can serve. As the protocol evolves, MedChat’s platform makes it very easy to change the bot’s screening criteria. We can now better deliver care to the patients who most need to talk to a provider and get tested. Like almost all counties, the demand for testing exceeds our capacity to test them all at once.”

In the first week, more than 600 patients screened themselves – many during off-hours. In the first weekend, more than 60% of high-risk patients scheduled a telehealth consult.

MedChat helps physician practices and other providers screen and triage patients quickly. Prior to the COVID-19 outbreak, practices primarily deployed MedChat to improve call response times, simplify scheduling, respond to billing questions, and handle other common patient inquiries. The chatbot and live chat platform became immediately useful for COVID-19 response because screening criteria and triage rules can be quickly adjusted as clinical guidance changes.

“We were already working with MedChat to deploy Schedule Bots for urgent care and emergency departments,” said Sahil Patel, founder & CEO of ER Express. “When COVID-19 hit, our clients asked for ways to assess patients, facilitate telehealth workflows and handle growing call volume, we immediately thought of MedChat. We are now deploying MedChat with several clients to triage patients, enable staff to work from home and alleviate the flood of inbound phone calls.”

“Won’t patients in my lobby get mad when someone checks in at home and then shows up in the lobby?”

Many health systems face a psychological barrier to offering online check-in: “I know the patients who use it will love the convenience. But I’m afraid it will make all of my other patients mad because they think someone skipped the line.”

Our display board technology, which shows all patients in the lobby their place in line, now comes pre-loaded with a promotional ad that rotates in every 10 seconds.

This pre-installed ad:

• Explains the online check-in service
• Displays the health system’s URL for the landing page
• Reflects each health system’s brand identity
• Automatically displays as soon as you turn on the display board

This ad educates your patients on where they can find the online check-in option, helping to spread the word on its convenience. It also helps reduce the anxiety that walk-in patients may feel when they hear or see a patient enter the waiting room and announce “I made an online reservation.” It helps manage patient expectations and reduce the perception that other patients “skipped the line.”

Home page banner + fixed Save My Spot button

Missouri-based Freeman Health recently implemented online check-in and digital patient queuing in two of their urgent care clinics. Freeman’s ‘Save My Spot’ strategy aimed to reduce wait times and bring in new patient volume. The queuing system automates patient expectations and gives staff much better control over influencing patient arrival patterns by throttling down time slots during their busiest hours and opening up slots during typically slower parts of the day.

Delivering new patient volume

Freeman Urgent Care Director Kayla Martinez summarizes the appeal of Save My Spot for her patients as something akin to “…call ahead seating at a restaurant, you can get your name in line and then do your waiting at home or in your office.”*  Patients can plan out their visit at the time of day most convenient for them and avoid sitting in a waiting room when they’re not feeling well with other patients who may have contagious illnesses such as flu.

Patients immediately caught on to this idea. In the first two months:

• 9% of patients made an online reservation
• 15% of online reservation came from new patients
• 93% of patients surveyed said they were either ‘very likely’ or ‘likely’ to recommend Freeman Health to a friend/family member (n-219)

Doubling the % of 5-star Google reviews

Freeman has also seen an immediate uptick in positive Google reviews. Patients consistently praised the convenience of the service. ER Express’ reputation management feature elicits patient feedback via SMS text and then prompts the happiest patients to share their feedback on Google. Good reviews based on the convenience of the service, as well as the use of our built-in text survey which prompts the happiest patients to leave their feedback on the Google for the facility they visited, have started rolling in as well. Case in point, Freeman Urgent Care at Webb City received three new 5-star Google reviews in a 24-hour period following the online check-in go-live. Summary of the stats**:

• After go-live, 78% of Freeman’s Google reviews had 5-stars
• In the ten months prior to go-live, only 43% of Google reviews were 5 stars
• More than double the overall number of reviews

Here’s a preview of the good things patients had to say:

Save My Spot banner outside an urgent care

Getting the word out: digital marketing + local news + traditional signage

Freeman’s marketing team launched a very effective campaign to publicize Save My Spot in its community by combining digital promotion, local news reach and street side signage.

• They made the service exceptionally easy to locate on the home page of the health system
• They shared the launch with local media outlets such as KOAM News Now and The Joplin Globe
• The displayed a large, can’t-miss-it banner outside each urgent care advertising Save My Spot to help convert walk-in patients to using the online service for their next visit

The full embrace by Freeman’s operational and clinical leaders combined with a savvy marketing campaign points to future increases in new patient volume, 5-star Google reviews, and overall usage of the online check-in service.

*Source: https://www.koamnewsnow.com/freeman-launches-save-my-spot-program-for-urgent-care-patients/

**As of 2/19/2020; based n patient reviews posted for Freeman’s Webb City clinic