RIGHT THIS WAY You can whisk healthy patients who've completed their health histories online right on back to pre-op.

When Tina Mentz, executive director of the Elmhurst (Ill.) Outpatient Surgery Center, considers the ways that technology might continue to improve her facility's pre-admissions process, her eyes widen. "The possibilities are endless," she says. "We have so many ideas and opportunities."

Ms. Mentz has already seen how she can turn patients into partners and make the entire admissions process run much more smoothly by bringing technology already being used in other industries to health care. The quest began a few years ago.

"Patients were telling us that they weren't being contacted in a timely manner by our pre-admission testing nurses and that the pre-admission tests that we required weren't being reimbursed by insurance carriers," says Ms. Mentz. "We decided to look into the whole process of how we interact with patients before admission."

A time-management study pulled back the curtain on a beleaguered staff that was spending far too much time on paperwork and being forced to rely on 11th-hour communication to get all needed information to and from patients.

"Our nursing staff was contacting patients only 1 or 2 days before scheduled procedures and administrative duties consumed almost 50% of their time," says Ms. Mentz.

The first step was to deploy an online pre-admission program, One Medical Passport. At first, the nurses at Elmhurst created passports for patients, but the more significant progress came when the facility started encouraging patients to complete the information themselves.

"We revised our patient brochure and began directing patients to go online and complete their medical history as one of the first steps for preparing for surgery," says Ms. Mentz. "Having patients involved resulted in more accurate and complete histories. Patients essentially create their own electronic health records that can then be updated anytime and shared with other providers."

And the staff that was having to spend so much time pushing paper? "They've been able to shift their focus," says Ms. Mentz. "Nurses now spend more than 90% of their time speaking to patients. They've shifted their focus from inputting patient information to conducting a more thorough review of medical histories, clarifying questions and providing pre-surgical instructions."

MOBILE MESSAGING Patients receive automated text messages.

Better information
Brooke Smith, administrator of the Maryland Surgery Center for Women, in Rockville, Md., has seen similar improvements since her facility began using Simple Admit, another online pre-admission program. "There's less paperwork, fewer missing items, fewer last-minute orders for additional testing and fewer cancellations," says Ms. Smith.

There was also the reduced embarrassment factor. Previously, if a self-conscious patient was at work when you called for information, he might have to run down a long list of meds and maladies within earshot of curious co-workers.

"Patients appreciate being able to answer questions about meds in the leisure of their own home, as opposed to being called at work and having to go through a list," says Ms. Smith. "Not only does that help them maintain their privacy, they're also able to look at the bottles of meds for exact information on what they're taking. That means we get more accurate information."

Fewer disruptions
Naturally, information that's more complete, more timely and more accurate is bound to have a positive effect on the bottom line.

"When we adopted Simple Admit, we did an ROI report that proved substantial savings," Ms. Smith recalls. "Of course the most significant was in staffing time, but there was also an improvement in cancellations caught in advance of the day of surgery. That not only saves the expense of the case being opened or the case being pre-op'd, but it also keeps the schedule open for another case to go in its place. Catching health conditions before the day of surgery has let us either have the physician re-schedule in the hospital or give us ample time to order proper pre-op testing or meet needed anesthesia criteria."

By adding a new element — mobile messaging — Ms. Mentz's Elmhurst facility has also reduced the number of patients who decide to grab a quick bite to eat on the day of their procedures. "NPO non-compliance used to cause a significant amount of disruption in our schedule," says Ms. Mentz. "Our mobile-first initiative has helped reduce confusion about when patients can eat and drink."

Elmhurst's mobile messaging service, CareWire, has become an integral part of interacting with patients. Texts serve to

• confirm the date and arrival time;
• direct patients to complete their online medical histories;
• remind them to bring along on the day of surgery a picture ID, an insurance card and a responsible adult driver;
• remind them about restrictions on eating and drinking; and
• provide special prep instructions for colonoscopies.

And when patients are back home, the facility texts them a brief satisfaction survey. Meanwhile, at the Maryland Surgery Center, Ms. Smith and staff are able to take advantage of a feature that provides automated patient notification via e-mail. "That saves more staffing hours because there are fewer reminder phone calls to make," she says.

REGISTERING ONLINE
One Way to Get Patients to Pre-Register Online: Pay 'Em

Besides the convenience, savings could be a reason for patients to take advantage of online pre-registration. We heard from one facility that gives patients who pre-register and pay up front a 10% discount on their co-pays and deductibles. "In today's world, with deductions and out-of-pocket expenses growing, it can be a pretty significant savings," says an official at the facility.

Half of the facility's patients currently take advantage, which has led to discussions about how to increase the percentage. "We know that offering a discount can really drive up the numbers," he says. "We have people lobbying for a 20% discount. Others say it should be a flat $25. Of course there are others who say there should be no discount. Maybe the best thing would be a gift card or a crisp $10 bill — just something that says: "Thank you. You have saved us time, and time is money."

— Jim Burger

The facilities are keeping an eye out for new ways to expand and improve the process.

"In 2012, we began asking patients to provide their demographic and insurance information, along with their medical history, so they can earn 'fast pass' status," says Ms. Mentz. "They can review our privacy policies, our policies on advance directives and patient rights, and a list of our physician investors."

Patients who do so are rewarded with expedited day-of-surgery registrations. Elmhurst staff can also track patient interactions on a dashboard developed by CareWire. "Our staff can easily see a patient's arrival time and confirm each mobile message transmission," Ms. Mentz marvels. "The dashboard also allows us to send courtesy messages when there are delays or changes, provide our address and parking instructions or request a call when we need additional information and dis-enroll patients who don't want to participate in the service.

"We also get to see patient interactions in real time and react when patients say we didn't meet their expectations," says Ms. Mentz.

The human element
All this technology can be a little daunting to a few patients, but most have embraced it as enthusiastically as the facilities.

"We've noticed that these days even our elderly patients are tech savvy enough to complete the pre-admission process," says Ms. Smith. "We say if you can send e-mail, you can navigate the online registration. We tell people it should take about 15 minutes, and for most, it does. Most say it's easy and effortless. For the few that struggle, they'll call and we'll complete the information with them over the phone."

"We promote the use of technology," says Ms. Mentz, "but it doesn't take the place of one-on-one discussions between a nurse and our patient. We still contact all patients to give them pre-surgical instructions and if they don't have access to the Internet, we complete their medical histories. If they can't get mobile messages, we call them the day before the procedure to tell them when they should arrive."

World of possibilities
As for the wide-open future of unlimited possibilities Ms. Mentz foresees?

"We hope to create interactive multimedia tools to educate patients and caregivers," she says. "Maybe we'll have electronic books that show younger patients what to expect on the day of surgery. They could include pictures and videos of our staff greeting patients, putting on their ID bands and giving them a stuffed teddy bear made by our volunteers. There would be images of where they'll wait with their families and how they'll be transported to the OR by one of our nurses in their own special red wagon! We want not only to educate, but also to decrease anxiety.

"We might also use mobile messaging to assist with post-surgical care," she adds. "By sending appropriately timed follow-up messages, we can improve compliance and cut down on the number of post-procedure phone calls placed to surgeons."