How Ochsner Health System Uses E-Signatures and Self Check-In to Drive Patient Satisfaction

Today’s healthcare consumers gauge value based not only on the quality of the care but also on the innovation and expediency of that care.

A desire to enhance the patient experience is what ultimately drove hospital executives at Ochsner Health System to explore how technology could improve patient registration and check-in.

“Patients are consumers of healthcare. They’re shopping around looking for the best value,” says Melissa Landry, assistant vice president of health information management (HIM) at Ochsner Health System, southeast Louisiana’s largest non-profit academic and multi-specialty healthcare delivery system.

Today’s healthcare consumers gauge value based not only on the quality of the care they receive but also on the innovation and expediency of that care, says Vicki Kaplan, vice president of health information management.

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That’s where technology comes into play.

“Our patients use technology every day, and we wanted to offer them that experience here as well,” she adds. “Not only does technology now expedite our registration process, but it also allows for the seamless integration of our patients’ medical records.”

In 2011, Ochsner began its journey toward a systemwide electronic health record (EHR), presenting the health system with the opportunity to offer a patient portal that includes shared notes, online appointment scheduling, and online bill pay. The health system was also able to digitize its signatures and eventually deploy self-check-in kiosks.

By venturing into a more digital world, Ochsner was able to engage patients on a level that simply wasn’t possible previously, says Kaplan. That’s because the health system is now offering tools and technology that allow patients and providers to work together in partnership, thus making patients feel more empowered in their own healthcare decisions. By capitalizing on technological efficiency, the hospital has also improved patient satisfaction by making the check-in process more efficient.

By using electronic signatures and kiosks, the health system accomplished the following goals.

Provide a faster check-in process. With electronic signatures, registrars don’t have to manually scan signed paper consent forms into each patient’s electronic record. Patients using self-check-in kiosks can check themselves in quickly and pay any balances that are due.

Avoid re-signing forms. If forms are lost or misplaced when using a paper workflow, patients have to re-sign them. However, electronic signatures offer efficiency because signatures are mapped directly to each patient’s electronic record where they are stored in the digital file. This method of documentation also ensures a smoother process for billing, release of information, disability verification, and other tasks.

Satiate patients’ demand for technological integration. Airports, grocery stores, and other retail outlets have used electronic signatures and kiosks for quite some time, says Dale Beler, assistant vice president of patient access at Ochsner. “I think there’s an expectation that we continue to develop the use of electronics in healthcare,” she adds.

Phase One: Forms Management

Before Ochsner deployed e-signatures, it needed to centralize and consolidate its forms management process. This meant creating a systemwide council that developed a process to establish a single electronic forms repository. Registration and clinical employees at each of its eight hospitals and more than 60 health centers would subsequently be able to access this repository. The council included representatives from HIM, nursing, performance improvement, case management, patient access, and its legal team.

“This was a huge opportunity as well as a challenge for us,” says Landry. “Each facility had to learn to trust that it was ok to lose some autonomy and control.”

The good news is that by consolidating its consent forms, many of which included slight variations for the same clinical procedure, Ochsner reduced its volume of these forms by 50 percent from more than 1,000 to approximately 500.

Phase Two: E-Signatures

As the health system deployed the EHR in each of its various hospitals and clinics, registrars in all patient access areas—including outpatient, inpatient, and the emergency department—also began to take advantage of the electronic signature pad for each of the newly consolidated forms.

Registrars currently use the signature pad to obtain electronic patient signatures for the following forms.

Consent for treatment. Clinic/hospital authorization form that details patients’ rights and authorizes treatment and billing.

Notice of Privacy Practices acknowledgment. Form that acknowledges patient receipt of the HIPAA booklet that explains the hospital’s privacy policy and how protected health information is used.

Important Message from Medicare. Form that explains Medicare patients’ rights to receive covered services and be involved in decisions regarding their hospital stay.

Provider-based acknowledgments. Form that acknowledges that patients understand that they are receiving services in an outpatient facility of the hospital and that services will be billed as outpatient services.

Here’s how it works:

1. Patients check in for clinical services.
2. Registrar receives an alert regarding what specific forms patients must sign. If Ochsner updates a particular form, the registrar receives an alert that patients must re-sign the most updated version.
3. Registrar provides patients with laminated copies of forms to read before signing. Ochsner is currently working with information services to load these forms electronically so that a laminated copy won’t be necessary.
4. Patients use an electronic signature pad to sign the form.
5. Signatures submitted on pads are automatically linked with patients’ electronic records and stored there for easy reference.
6. Registrar asks patients if they would like a signed copy of paper forms for their records.

In looking ahead, Ochsner hopes to eventually integrate EHR data into its electronic forms, offering patients even more efficient and customized experiences. “This is the future of where we want to go,” says Landry.

Landry provides the following tips for organizations seeking to accomplish similar goals:

Obtain executive buy in to drive cultural change. Landry’s division participates in operational reviews and shares potential cost savings related to paper reduction.

Create a systemwide forms council. Appoint someone as a project coordinator who can focus on building electronic workflows and converting paper forms into digital formats.

Take an inventory of forms. Update, consolidate, and identify/delete rogue forms.

Identify your top 10 ‘focus documents.’ These are your top documents by volume of scanned images. Use this as a priority list for a forms digitization project.

Phase Three: Self-Check-In Kiosks

Ochsner deployed its first kiosk in its Center for Primary Care and Wellness at its Jefferson Highway location. Kiosks are also used in its Covington clinic as well as its Ochsner Health Center—Elmwood clinic. Other areas are under consideration as potential sites for additional kiosk pilots.

Here’s how it works.

1. Patients enter clinical settings and are prompted to check in at kiosks.
2. If patients have questions, they can ask nearby patient access representatives.
3. Patients then move to waiting areas until they are called into exam rooms for their appointments.

Stacy Collins, assistant vice president of patient access, provides the following tips for organizations seeking to explore kiosk options.

Conduct a pilot program in each specific setting. Keep in mind that a kiosk may be suitable for one setting and not another.

Choose strategic locations. “If a patient walks in the door and sees a registrar, they’re going to go to the registrar,” says Beler. At Ochsner, kiosks are located at the entrance so patients are encouraged to check in before moving forward.

Plan to place greeters near kiosks. Greeters direct patients to kiosks, answer questions, and perform troubleshooting. At Ochsner, patient access representatives take turns working the kiosk. 

Identify a back-up plan. Equip greeters with laptops so they can provide alternative check-in options if kiosks malfunction or if there is a line of patients waiting to use the kiosk.

Measuring Success

It’s difficult to measure the specific impact of the electronic signature process on patient satisfaction. However, anecdotal feedback suggests that patients like the technology, says Collins. “We get a lot of positive feedback because patients like not having to flip through papers,” she adds.

Although the cost per page to process a paper document has remained the same―$.15 per page due to scanning and courier fees―the volume of “focus documents” is projected to decrease by 15 percent by the end of 2016, yielding a cost savings of approximately $48,000. Ochsner has seen the greatest savings in less time spent scanning progress notes, forms generated in the skilled nursing unit, and patient education and teaching forms. 

See related tool: Quarterly Dashboard: Scanning Reduction Efforts by Document Type, 2016

While patients have responded favorably to the kiosks, Ochsner continues to work through its challenges related to care settings in which the kiosk isn’t ideal. This includes care settings in which armbands are needed, settings in which patients continue to pay by personal checks or cash, and settings in which there are high volumes of new patient appointments. In these scenarios, patients have access to face-to-face check-in with registrars, says Landry.

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Lisa Eramo is a freelance writer based in Rhode Island. 

Interviewed for this article: Melissa Landry is assistant vice president of health information management, Ochsner Health System.

Vicki Kaplanis vice president of HIM, Ochsner Health System and is a member of HFMA’s Louisiana Chapter.

Dale Beleris assistant vice president of patient access, Ochsner Health System and is a member of HFMA’s Louisiana Chapter.

Stacy Collins is assistant vice president of patient access, Ochsner Health System.

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Discussion Starters:

Forum members: What do you think? Please share your thoughts in the comments section below.

• Please share any patient access strategies that you have implemented that have had a positive impact on patient satisfaction.

• If you have implemented new technologies, how have you introduced those to patients to ensure they are comfortable with the process?