1. Best Practices in Patient Self
Service
Jennifer Andersson RN, BSN, MBA
Director, Admitting and Registration
Northwestern Memorial Healthcare

2. Northwestern Memorial Hospital
• NMH is affiliated with the Feinberg School of Medicine and is part of a 2-
hospital health system with over 1500 physicians on staff
• FY2013 Volume
 46,039 inpatient admissions
 14,759 observation stays
 84,909 ED visits
 603,235 outpatient registrations
 33,521 IP and OP surgical volume
 12,401 deliveries (largest birthing center in Illinois)
• Annual patient revenue: $1.2B
• Payor Mix (volume)
 29.1% Medicare (Government plan – over 65 and disabled)
 30.5% Blue Cross (Insurance)
 19.2% Managed Care (Insurance)
 13.2% Medicaid (Government plan – low income aged, blind, disabled)
 8.0% Self Pay (Uninsured)
2
Northwestern Memorial Hospital is a894bed hospital located in
downtownChicago,Illinois

3. Situation Statement – 2011
• 1.Approximately25% ofpatientsdidnotconfirmtheirinsuranceanddemographicinformationpriortothedateof
theirhospitalbasedservices.
 Forthe patient:
 Longregistration/check-inprocessonsite
 Servicedelays ifinsuranceauthorizationsare not obtained
 Unnecessaryselfpay billsifinformationisnot captured accurately
 Forthe hospital:
 Informationrequired to financiallysecure the servicepriortothe patient’s arrivalhas not been obtained
 Canresult inbilling incorrectpayor,delayedorno reimbursement,and re-work
• 2.Patientswerenotifiedoftheirestimatedout-of-pocketcostonthedateofservice,whichleadtosurprises.
 There isa 15%annual increase ofpatients withhigh deductible plans – higher out ofpocket costs
 Receivedover1,000 patient requests per monthforout-of-pocketcosts
 Patientswithhigher out ofpocket costsmay cancel their servicelastminute, resulting in‘coldtable time’ and
patient dissatisfaction
• 3.Clinicalandadministrativeformswerecompletedonthedateofservice,lengtheningtheregistrationandcheck-in
process.
 Formscaptured onpaper, and storageand retrieval weredifficult
 Questionsonformswereasked manytimes, whichgave the impressionthat we didn’t knowourpatients orretain
theirinformation

4. Call to Action – Patient Satisfaction Survey Comments
“Hate having to repeat all my info year after year… Should be able to just
make any changes year over year vs. having to complete the forms over and
over again…”
“Was called prior to visit to be "pre-registered" yet had to "register" again.
Waste of time on your end and mine. …”
“When asking how much the entire procedure will cost me I could not get an
answer.”
“I was surprised at the amount of paper/forms being filled out. Seems like
the process would be improved by computerizing and coordinating with my
physician who has my records electronically.! …”

5. Future State: Vision
ONE
One set of
demographic,
financial
information,
paperwork and
questionnaires
One point of
coordinated
scheduling
One clinical
history, meds,
problems,
allergies list
One
consolidated
bill/statement
One portal
5
Facilitate a seamless and consistent experience for patients across NM that
enables the highest quality care at the lowest possible cost

6. Proposed Solution
• Implementa patient portal that a patient can utilize to register for
upcomingNMH visits
 Provide pre-service viewing and updating of demographic and insurance
information and electronic completion and signature of forms
 Provide insurance eligibility and out-of-pocket estimates as a part of the
registration process
 Remember the answers to clinical questionnaires so that patients do
not have to complete the information from scratch every visit
 Eliminate paper
• Enable location-based, self-service check-in and registration Kiosks
for NMH

7. Vendor Selection – NMH Expectations v. “Competition”
Vecnawaschosen todevelop afirst inclass administrative patient portal
Competitive Analysis
Capability
Key:
• Have this functionality
О May have this functionality
NMHPatientConnectPortal
(FutureState)
NorthShore(Epic)
Advocate(Customer
PotentialManagement)
LurieChildren'sHospital
(Epic)
UW-Madison(Epic)
NewYorkPresbyterian
(HealthVault)
NMPGRelayHealth
Phase 1 Administrative Capabilities (delivered in FY12)
Appointment Requests / Referral Requests • • О •
Patient Visit Itineraries • • •
Online Pre-Registration • • • О О
View/Update demographics • • О О
View/Update insurance information • О
See insurance eligibility •
Electronic Forms and Signatures • О О
Upload scanned documents • О О • •
Clinical Questionnaires/Info based on Appointment Type • О • О
Online Check-In •
Online Bill Pay - prior balances • • • •
Estimate on future out of pocket costs •
Make payment on future balance •
Complete all of the above on a point of service device •

8. Patient Connect Project Organizational Structure
Theportal/kiosk project was managed within aseries ofpatient-
centered ITprojects called “Patient Connect”
Patient Connect
Steering
Committee
Director,
Admitting and
Registration
Director, Care
Coordination
Director,
Internet
Marketing
Manager,
Information
Services
Patient Connect
Project Director
Patient Connect
IT Director

9. Patient Feedback Incorporated into Portal
and Kiosk Design
Personas
Patient
Comments
Patients
Participate on
Workgroup
Analysis of
patient pain
points by
access point
Usertesting.
com
Patient
Advisory
Committee

10. High-Level Portal and Kiosk Process Flow
Patient
schedules
appt
<= 7 days
from DOS,
patient
receives
email
invitation to
join portal
Patient Pre-
Registers
using Portal
Patient
arrives for
visit
Staff views
on admin
tool
whether
patient has
pre-
registered
online
Patient checks
in using kiosk
with barcode
confirmation.
Staff use flags
for workflow
Hello Clover Zzzvecna,
Thank you for regis tering for your upcom ing MR Ankle Right appointm ent with Northwes tern Medicine
via Patient Connect.
Your appointme nt details:
Service: MR Ankle Right
Date: Monday, March 24, 2014
Time: 9:00 PM
Location:
NMIC MRI
676 N. Saint Clair St, Arkes Pavilion
3rd floor, Suite 300
Chicago, IL 60611
LOG ON at
PatientConn ect.n mh.org
CALL Northw estern
Medicine
at 312-926-5402
f or Assistance.
EMAIL us at
portalsupport@nmh.org.
LEARN more about
Northw estern Medicine
at w w w.nmh.org.
For fas t and eas y check-in, print this confirm ation page or us e your phone at one of our on -s ite
kios ks . To cancel or res chedule this appointment, contact us at 312 -926-6366.
Don't forget to:
 Bring a photo ID and your ins urance card(s )
 If you have an Order for your appointm ent, please bring it with you.
 Print this confirm ation and bring it to your appointm ent.

11. High-Level Process Flow
• Scan/upload insurance
card/ID/order
•Complete all
demographic and
insurance information
•Complete clinical
questionnaires
• Sign consent/HIPPA
•View/pay OOP estimate
for upcoming service
•View/pay outstanding
balances
• Request appt
•Print confirmation
barcode
• View map of facility
• Print directions
Patient Pre-Registers
using Portal

12. Best Practice: Pilot Large Organizational Changes First
Piloting helps ensure theproject will work ona small scale andallow the
teamtoidentify andresolve issues priorto them beingrolled out
hospital-wide. Ifsuccessful, theymay also help togain buy-infrom
stakeholders
A Pilot Should Be Used When
• Change covers a large scope
• Change is costly
• Change is difficult to reverse
• People are sensitive to the change
• Unintended consequences may result as part of the change
When Piloting Ensure
• The scope of the pilot is representative
• It can be reproduced on a larger scale
• It is measureable
• Effectively market pilot to key stakeholders – patients, physicians, staff

13. The Pilot
NMHpiloted theportal andkiosk first in theBreast Imaging Center, one
CT/MRIImaging location, and theInfectious Disease Cinic
Pilot Location Common Denominators
• Approximately 50-150 patients/day
• Patients pre-registered by Central Scheduling
• No walk-in patients – 100% scheduled

14. Results to Date (through 5/6/14)
• Portal and kiosks live in 6 different check-in locations, covering 17 different
medical services
• 15% of patients who receive portal invitations pre-register online
• 50% of patients who have pre-registered online check-in using kiosk
SinceNovember 2012,$130Kcollected onout-of-pocket estimates and
$1.3Mcollected onoutstanding balances ontheportal andkiosk

15. Patient Comments Post Go-Live
Overall, I'm satisfied with the ease of completing
online registration on Patient Connect.
I would use Patient Connect again for my next
appointment at Northwestern Memorial.
• “Made my appointment
online & did the online
registration. It was so simple
& fast. It would be great to
have this for doctor
appointments too”
• “I would use it again made
the check-in process a lot
faster”
Overall, I'm satisfied with the ease of
completing the steps on the Kiosk.
I would use the Kiosk again for my next
appointment at Northwestern
Memorial.
• “It didn't take a long time to
use. And I understood
everything good, no problems I
like it”
• “Piece of cake!”
• “I like the Kiosk. However, I
hope people will not be
replaced with the kiosk”
• “I think the system is very easy
and efficient for check-in. Just
please be aware of patient
privacy”

16. Lessons Learned
Whileweconsider ourportal andkiosk project successful, there were
lessons learned alongtheway….
• Involve the patient in the design of the portal and kiosk
• Involve the clinical teams in the design process – they are key stakeholders
• Preview the portal and kiosk for Senior Leadership and key Physician Leadership
• Thorough User Acceptance Testing is critical
• Portal adoption is KEY to a successful kiosk experience
• Kiosk location is KEY to kiosk adoption
• Patients do not want to spend a lot of time in front of a kiosk – barcode check in
is key
• Pilot thoroughly before further rollout

17. Lessons Learned
• Implement a ‘registration concierge’ model – instill confidence in patients that
they can use the kiosk – most patients are scared to use the kiosk until prompted or
told that they are easy to use
• SIGNAGE – patients should not have to wait in a line to be asked to use a kiosk for
check-in.
• LOCATION, LOCATION, LOCATION
Galter 8 NMIC 3

18. Lessons Learned
• Validate the process put in place pre-go-live is the correct process
post-go-live. Do not be afraid to make changes to the original plan if
it is not working as designed.
• Before investing in permanent kiosk structures, live with temporary
“bolt down” kiosks until you live with it for a few months and then
decide the best placement and construction needs for your location.
• Delay go-live if issues will negatively impact the patient experience.
One bad experience will prevent patients from wanting to use the
kiosk in the future.
• You cannot please everyone. Expect resistance.

19. Thank You