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    Ava Treon
    Ava Treon
    Leslie R. Jebson
    Leslie R. Jebson, MHA, FACMPE, FACHE

    The Great Resignation in healthcare has been deemed one of the largest voluntary exits in the history of the U.S. workforce. According to some reports, the industry has lost an estimated 20% of its workforce.1 The COVID-19 pandemic placed unparalleled strains on healthcare workers with long hours, regulations, and overwhelming staffing ratios. Many in the healthcare workforce opted for early retirements while clinical staff traded in their access badges for travel badges, driving cost and staffing challenges. Three years after the pandemic began, the industry continues to feel the repercussions. The lack of staff in hospitals and outpatient clinics continues to affect how and where healthcare services are optimally provided. 

    Other industries — from airlines to fast-food restaurants — continue to deploy and improve self-service kiosks to shorten check-in times and save millions of dollars in labor costs. When Continental Airlines installed the first self-service kiosks in 1995 at Newark International Airport in New Jersey, it cost the airline 16 cents per passenger, compared to $3.68 using ticket-counter agents.2 Convenience and quick access to boarding passes helped entice traveler adoption. Today, kiosks are universally adopted in all major airports for all major airlines. In 2003, McDonald’s introduced a self-service kiosk pilot. Key statistics favored customer access to fast order processing and customizable menus. Since its introduction, McDonald’s has reported a 6% increase in overall sales.3

    The presence of kiosk stations in healthcare settings is far from new. For more than a decade, kiosks have been used for wayfinding, marketing, patient education and appointment intake. In the past several years, kiosks are complemented by the promotion of smartphone apps and online portals, yet broad adoption and utilization has been less than optimal. Efforts are underway to develop more robust online patient portals and implement more kiosk stations, while aiming to keep patient penchants a top priority. Labor shortages, particularly in high-volume ambulatory care settings, are driving the need for greater promotion and patient adoption.

    A slew of portals and applications exist to complement EHRs. Two of the more broadly adopted solutions — Epic MyChart and eClinicalWorks (eCW) healow — were developed to allow patients to freely access their EHRs, providing the opportunity to confirm appointments, update demographic and health insurance information, and electronically check in for appointments.

    Quest Diagnostics labs’ broad deployment of electronic engagement includes using the website for patients to enter their information and self-schedule an appointment. Upon arrival at Quest Diagnostics, patients check in at one of the clinic kiosks. When a patient finishes the registration process, the status on the schedule changes to signal that the patient is ready to be brought back for the appointment. This practice has saved Quest Diagnostics between 15% to 30% of its expenses by utilizing digital solutions in lieu of employee positions.4

    McKinsey Consulting published a research survey in 2022 ranking the top six industry sectors for digital optimization. According to the survey, healthcare ranked second in data optimization but last in self-service and ability to adapt to new business models. According to the report, the healthcare industry’s highly regulated market places security over patient interaction. Making their technology investments centered more on business operations and record-keeping instead of investments that tie directly to patient engagement.5

    The hybrid method of patient check-in is the adoption of online portals and kiosks while also keeping staff available for face-to-face check-in. The hybrid method presents opportunities for operational and fiscal cost savings, while serving multi-generational patient viewpoints. The Medicare population — the Silent Generation (1928-1945) and Baby Boomers (1946-1964) — tend to be the largest consumers of healthcare. As such, this population generally continues to prefer a traditional healthcare setting, with human interaction. Aggressive promotion of digital solutions may frustrate and even discourage access to healthcare services in some cases.

    Generation X (1965-1980) patient populations tend to lean toward greater convenience and ease, seeking healthcare services as they would when making retail decisions by analyzing multiple sources before choosing to pursue treatment options. Millennial (1981-1996) patient populations utilize digital solutions to examine cost, seeking price transparency and digital options before making healthcare decisions. Finally, Generation Z (1997-2012) patient populations seek convenience more than other factors, preferring to use a digital platform over in-person interactions, particularly in the utilization of preventative care services. With each generation having vastly different viewpoints on healthcare services, implementing a hybrid method with kiosks and online solutions creates a consumer middle ground.

    Healthcare administrators can further implement the hybrid method using eCheck-in and traditional in-person check-in. The hybrid method allows healthcare organizations to take advantage of the convenience of patient portal apps and processes, while alleviating some labor constraints. Patients directed to online solutions can reduce the need for call center and support staffing through provider messaging, scheduling appointments, requesting prescription refills, and paying copays and outstanding balances. Further advancement of this model may improve employee satisfaction, while reducing burnout and critical staff vacancies. 

    In addition, information security management is an essential component of broad deployment of portals and next generation kiosks, especially as security breaches at hospitals and clinics throughout the country continue to increase. As EHRs have developed, so have rules and regulations to protect patients’ rights. Since 1996, the Health Insurance Portability and Accountability Act (HIPAA) requires all health organizations to implement sufficient security measures for health data access and privacy. In 2004, the Office of the National Coordinator for Health Information Technology was established with the goal of making electronic records broadly available. The ONC created rules and guidelines for providers to follow when managing patient records.

    As such, for medical practices to remain HIPAA compliant when enlisting the help of self-service kiosks, they must provide encrypted communication channels protecting the integrity of the organization’s EHR.

    An organizational shift toward an entirely digital intake process may affect patient satisfaction, but consideration should also be given to cybersecurity and potential system crashes. Likewise, generational and organizational users must be considered when developing new eCheck-in processes. While digitization of healthcare services continues forward at a brisk pace, for the remainder of this decade the optimal patient management digital model is one that leverages online solutions and apps. Congruently, however, the physical clinic setting will continue to shift more toward other industry sectors. This path of adoption will continue to accelerate with the advent of digital humans akin to Alexa and Siri. Others may contend that based on their competitive market or the patient population they serve human interactions in clinic or by phone are a necessity and the current labor challenges only temporary.

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    Notes:

    1. Weldon D. “The Great Resignation’s toll on healthcare.” HealthLeaders. March 16, 2022. Available from: bit.ly/3FLsn0c.
    2. Jones D. “Speeding flight check-in at self-service kiosks.” The New York Times. Feb. 3, 2004. Available from: bit.ly/3FJgIyN.
    3. Tsernov, K. “How McDonald’s Self-Service Kiosks Changed the Customer Experience Game.” Qminder. Aug. 16, 2021. Available from: bit.ly/3Ev7u8v.
    4. Muoio D. “Wasteful administrative spending costs US healthcare up to $570B a year, research finds.” Fierce Healthcare. Oct. 7, 2022. Available from: bit.ly/3HrjqtU.
    5. Khan Y. “Digital maturity in health: Comparison with other industries.” Oracle Center Blog. July 18, 2022. Available from: bit.ly/3S0Pw34.
    Ava Treon

    Written By

    Ava Treon

    treonar@tamu.edu

    Leslie R. Jebson

    Written By

    Leslie R. Jebson, MHA, FACMPE, FACHE

    Email: jebson@tamhsc.edu


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