Author Archives: Jeremy

Proper placement of a patient check-in kiosk

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Here are just a few things to consider when deciding where to place patient check-in kiosk.  Chosing the right location is often overlooked and unfortunately one of the most important factors affecting usage and adoption. 

Privacy – Despite the inclusion of integrated privacy filters which restrict viewing to those standing directly in front of the kiosk, consideration should be given to patient privacy at the kiosk.  When considering placement it is beneficial to select a location that offers the patient a sense of privacy, this location should be one that does not have patients standing or walking directly behind and in close proximity to the user at the kiosk.  Proper placement facilitates usage, patients who do not feel a sense of privacy are far less likely to use the kiosk.   Consider a “Please wait here” line/sign similar to those present at the registration counter if necessary.

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The benefits of thermal printers in your kiosk

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Thermal printers come in many different shapes and sizes, the ones I am going to focus on here are the large format 8.5″ thermal printers that I would typically propose instead of a standard black & white laser printer.  If color is an absolute requirement then these 8.5″ thermal printers will not be practical, but if it is not necessary then there is always a case to be made for thermal.  The theme below is that thermal printers are designed for unattended environments, this is an important point of differentiation between the two.

The most common question or concern that I hear is often about the higher initial cost of a thermal printer compared to laser.  True, the upfront cost is higher, but when you consider the cost of consumables (recurring) and the shorter lifespan of lasers you will see that thermal printers can pay dividends very quickly.

No ink/toner/drums/fusers

As mentioned above, thermal printers do not have ink, toner, drums, or fusers.  Depending on the type of printer purchased the cost of maintenance can be significant, thermal printers have one consumable, the paper.

Thermal Paper

Thermal printers only have one consumable, the paper itself.  Unlike traditional laser printers with 100/150/250+ sheet paper drawers thermal printers have a roll of thermal paper, the size of the role varies but common rolls are 6 – 10″ in diameter.  The yield from one of these rolls is primarily dependant on the size of the printout, which can be setup to end (cut) the page at the printable area, eliminating waste.  The benefit here is that you can print at 8.5″ wide but the length of the paper may only be half of that, depending on what you are printing.  For instance, if you were printing a wayfinding map then the page may be full length (8.5″ x 11″) but a co-pay receipt may only be 4″ long.  The size of the roll, length of the printouts, and usage of the kiosk ultimately determine how long a roll will last but in my experience this may get changed once per quarter.  Users are often not required to print if they chose not to, extending the life of the paper roll.

Paper Retraction

An important feature of thermal printers and especially patient check-in kiosk is the ability for the printer to be able to retract pages that may be left behind by the user. These pages could include items like appointment slips, future appointments and co-pay receipts, so it is important that if they are not taken they can be retained by the kiosk.

Monitoring

Monitoring is critical for kiosk and a large part of that monitoring is the printer.  Ideally thermal printers should be able to report on the following variables at a minimum:

  • Paper Jam – Arguably the most important thing to monitor, paper jams need to be addressed in a timely fashion when they arise so it is  important that appropriate personnel receive alerts when the paper reports a jam
  • Heartbeat – Heartbeats ensure that the printer is online and available to the kiosk/CPU.
  • Cutter Error – The cutter handles the cutting of the paper as such it is a critical function and needs to be monitored
  • Low Paper/ No Paper – Thermal printers have sensors to inform you when the roll has reached a certain threshold, for example 1″ of paper left. These alerts allow you to be pro-active in replacing paper rolls, they can also send alerts when the paper is out.
  • Many more – There are dozens more alerts like (power on, page printed, page retracted, voltage, etc..)

The large format thermal printers used in kiosks typically have a cutter with a mean time between failure (MTBF) of greater than 1 million cuts, testament to their intended longevity.  In any deployment where large format (8.5″ x 11″) printing is required it is always worth taking a look at thermal.

Patient Check-in Kiosk

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CTS Patient check-in kiosk

My first experience with Patient check-in kiosk was in 2008, we haven’t stopped moving since then.  The kiosk themselves have gone through multiple changes, some small, some big.  The functionality has been constantly improved to include a wider range of available peripherals and features.

I should elaborate on the word kiosk so we are on the same page, there are providers in the industry who offer patient check-in “kiosk” that entail a touchscreen and a card reader, mounted on a wall or setup on a desk.  I cannot deny that those are elements of a kiosk, but I would like to define what I consider to be a complete kiosk solution, the point of differentiation.

A complete kiosk solution can take full advantage of every feature the software has been developed to support.  This is the critical difference between the kiosk vendors, some tell you what you can have, others offer you everything that is supported.  Why, you ask? The reason that kiosk manufactures don’t like to support new peripherals is because it takes time and engineering dollars to accommodate new equipment. So when you look for a kiosk vendor because you are considering patient check-in, have a look at all the of the peripherals offered, and consider getting a fully loaded demo unit for evaluation.

Patient check-in kiosk gained quantifiable traction in or around 2007 and the concept took off, particularly with the development of Epic’s Welcome application, their homegrown software for patient check-in.  Having been involved in deploying kiosk that run Epic’s Welcome from the near start, they took the somewhat unusual step of developing this application themselves, rather than allow middleware providers to interface with their backend.  This move, in my opinion, is why Epic (Welcome) leads the way for Patient check-in software.

Other Electronic Health Record (EHR) companies (GE, Cerner, McKesson, Meditech, AllScripts, and hundreds more) either due not have their own patient check-in application, are in-development, rely on middleware providers like EncounterPointe, which provide a middleware or standalone application for patient check-in, or I just haven’t heard/seen them yet.  This is not to say that there are no other kiosk deployments than those I was involved in, I have seen other kiosk at shows, and from time to time when competing for a customer, it would be naive to assume they never sold one, wishful thinking I guess.

There is a laundry list of reasons why Epic Welcome is a leading patient check-in software, and an equally long list why CTS’ kiosks have been the preferred choice of some of the leading clinics in the country. A simple Google search for Patient check-in kiosk will produce a multitude of vendors with, dare I say, erroneous claims of the “best” check-in kiosk, with the largest deployments, most functionality, etc.., etc… The truth is, with a few exceptions, large scale patient check-in deployments are still in the works, this is not the airline industry……yet! With that being said, there have been large deployments, ask me and I can direct you.

What can patient check-in kiosk do:

  • Patient identification (can be by answering questions or via credit card and/or biometrics)
  • Schedule & print future appointments
  • Co-pay collection (Credit/Debit)
  • Pay outstanding balances
  • Forms/document signing
  • Image capture (drivers license, insurance card, etc.)
  • Receipt printing
  • Print wayfinding maps and appointment slips
  • Update/verify demographics
  • Sky is the limit…..

Not all EHR’s are created equal and for that matter, patient check-in software varies from provider to provider, but the core features remain similar.  The noticeable difference is in the kiosk enclosure itself.

Some kiosk look the same as every other one, like the golden arches.  When you start getting into healthcare registration kiosk though the designs and equipment options do vary.  Some of the more serious consideration outside of the hardware and software revolve around ADA considerations.  Side access (wheelchair) is not the way of the future, and with this in mind CTS designed and deployed the first Adjustable Patient check-in kiosk that includes a 40″ range of motion to provide equal access to as many patients possible, needless to say, it has been a phenomenal success.  This kiosk is aesthetically one of the most modern, pleasing designs, have a look at the CTS Patient check-in kiosk here.

When selecting a kiosk, here are some things to look for:

  • Kiosk manufacturer – Do they have relevant and successful past deployment experience?  Can they provide proven deployments with various EHR’s (i.e don’t deploy an Epic Welcome kiosk with a vendor who has never deployed a kiosk that runs Epic Welcome).
  • Quality – Recouping the upfront capital expenditure in part involves the kiosk performing for an extended period of time.  Quality enclosures with appropriate equipment should operate no less than 5 years.  Check out the mean time between failure (MTBF) ratings for applicable equipment, although not always the most reliable source, it provides a baseline of information.
  • Support – Having a place to call should something not work is important.  Are you calling to a helpdesk based in the U.S or abroad? What levels of service can they provide?  What are the replacement procedures?  Call the helpdesk line, maybe before you even make a decision.
  • KLAS Performance Report – If you are reading this, and in the healthcare field their is a good chance you know what a KLAS report is, check out kiosk vendors and products here to get a good idea of what other organizations are saying.

Patient registration kiosk have a quantifiable hard ROI, as well as not so easy to to measure soft ones.  Each organization has different goals, they measure success with varying metrics, have different requirements and deployment plans. I’ve seen usage numbers as higher than 80% when patients are required to use the kiosk and i’ve seen them hover around 25-50% elsewhere.  Depending on an organizations workflow, certain patients won’t be able to use the kiosk, this is necessary when additional information is needed.  Working with your EHR company and kiosk vendor is critical to a successful deployment

I could talk for hours about patient check-in, and subsequently it will take be weeks/months/years to complete this post so in the meantime here are additional useful links.

Links:

A Forbes interview on patient check-in kiosk

A co-worker demonstrating the newest patient check-in kiosk