Premier Family Physicians, a nine-location group practice based in Austin, Texas, seeks to ensure its providers have the tools they need and processes in place to support patient care and get through each day as productively as possible. To that end, enhancing patient self-management and automating screeners and paper processes is a key goal.

THE PROBLEM

"We had significant staff retention issues at the front desk, along with issues related to missing registration information," said Rebecca King, vice president of operations. "We thought we could do a better job by automating the registration process, so implementing a self-check-in solution was a high priority for us.

"We switched to the athenahealth EHR about two years ago," she noted. "We consulted their marketplace in our search for a patient self-check-in vendor. That's where we discovered Qure4u."

PROPOSAL

What Premier Family liked about the Qure4u technology was that the digital health platform offered a self-check-in solution plus additional functionality the group practice could use down the road to incorporate electronic health screeners and mitigate other manual processes.

"The initial proposal was to implement patient self-check-in using either a mobile app before the patient visit or an intake tablet in each of our office locations upon arrival," King explained. "This would streamline the check-in process by eliminating paper documents and consent forms that then had to be scanned and manually entered in.

"Electronic self-check-in also would ensure that all pertinent patient information was captured through required fields."

Premier Family just acquired two new locations, so now it has an even broader spectrum of services, including surgery, allergy services, family medicine and pediatrics – all of which have vastly different information needs.

"For patients signing in on tablets, we went from capturing 88% of phone numbers to capturing 99%."

Rebecca King, Premier Family Physicians

"We have some internal medicine clinicians, as well, plus the need for Medicare-specific screeners," King said. "One of the best features about Qure4u's proposal was the customization it offered across locations. It also was clear the primary account manager we would be working with had experience in a clinical setting and was knowledgeable about common workflows and how the technology would better support those.

"We were in implementation planning stages for patient self-check-in when COVID-19 hit," she continued. "Although we never thought telehealth would be a core part of our business, the pandemic quickly upended that notion and shifted our priorities."

As a result of the pandemic, there was a stay-at-home order, so Premier Family had many calls coming in. It became important to roll telemedicine out as quickly as possible. Staff had daily huddles for two to three days ahead of rollout and testing. The vendor's ability to respond to that unexpected need so quickly was very important, King added.

MEETING THE CHALLENGE

Premier Family uses self-check-in on a mandatory intake tablet. The group practice had not adopted Qure4u when it initially transitioned onto athenahealth's EHR.

"We had a stack of paperwork that had to be scanned in," King recalled. "That produced issues where bad scans went into a bucket that someone had to electronically sort. Now, that data freely populates into the patient chart and the patient signs electronically. Our staff appreciates automation of the tasks they were previously having to field manual paperwork for.

"The platform has been great," she attested. "Patients appreciate they can also check in from home, which is especially helpful for moms and our pediatric patients. It's so easy for patients. They can update health and family history from home, instead of while they're wrangling kids in the office. All they have to do is confirm their name and date of birth when they arrive."

One of the pediatric offices is in a suburb with a high concentration of multi-child homes. That office also does family medicine, so many patients often show up all at once. Those patients appreciate that they can register via one main chart with each of their children integrated as sub-categories.

RESULTS

Premier Family has seen significant improvements in efficiency, staff and patient satisfaction, and data capture.

"One of the metrics we track is phone number capture rate," King noted. "For patients signing in on Qure4u tablets, we went from capturing 88% of phone numbers to capturing 99%. Our insurance card capture rate similarly went from the 80% range to the high 90% range. Patients often forget insurance cards in the office.

"Traditionally, if there was an issue, we would have to work it out with the patient at the window," she continued. "The platform also allows us to message the patient so we can get insurance card information the day before. That allows us to get eligibility done automatically the day prior to the next day's appointments."

That also supports co-pay and time-of-service payment collection rate improvement. Staff can have payment conversations ahead of time for things like outstanding balance.

"It's also impressive to note that we didn't offer virtual visits prior to COVID-19," she said. "Qure4u supported us, and we spun telehealth up in three days. Eighty percent of our business went virtual overnight, and it stayed that way for two to three months. We scrambled in survival mode initially, but now we're working to refine things.

"Virtual visits have yo-yoed from anywhere from 35% to 60% of total visits over the past year, averaging about 40%," she reported. "We're hovering at about 20% to 30% virtual so far this year. That has been pretty steady for a while now. Some providers are stronger adopters. Our two acquired locations are more remote, outside of Austin, so longer commutes amount to stronger virtual engagement there."

Premier Family also has been tracking the number of automated tasks completed through the new platform.

"We'd like to see how much work is being taken off of the front desk," she said. "For our 2020 report, 267,000 manual tasks were automated with Qure4u. We were able to decrease staff, too. One location sees 350 to 400 patients per day. We had a team of 14 front desk staff members, and we're now down to eight FTEs [full-time equivalents]."

At the biggest location, the group practice now is piloting a move to self-check-in kiosks.

ADVICE FOR OTHERS

"Initially, we tried to roll out electronic health screeners with patient self-check-in simultaneously," King recalled. "A lot of patients don't know things like diagnosis and medication names, which led to frequent front-desk interruptions, with patients asking questions. We found it was better to go through the screeners with them as a verification process once in the exam room.

"The functionality was great, but it was a new workflow for us, so we dialed back on screeners," she continued. "We want to eventually go across the board but appreciate that we can do so incrementally. My advice would be to identify a vendor that allows you to implement digital engagement solutions at a measured pace to ensure you build toward a sustainable long-term strategy."

It's also important to find vendors that are able to take feedback and customize different functionality based on workflow, she advised.

"We were excited about going all in and hadn't thought it through and had to roll some things back," she noted. "Finding a team that is responsive and hands-on, and understands your goals, is vital. Implementing tools that are easy to use and integrate into existing platforms also is key."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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