The Doctor Will See You Now

Tomorrow’s waiting room: More automated, less icky

October 2021 – The Journal of Healthcare Contracting

For years, patients have accepted as necessary the crowded, stuffy waiting room at the doctor’s office. But due to the pandemic, the waiting room experience may be transformed into something much quicker, less icky, and, for the physician practice, less costly. Some observers even believe waiting rooms may be eliminated altogether, though that’s a long shot.

Three factors threaten the traditional waiting room and patient intake/checkout processes:

  • Post-pandemic, most people recognize that waiting rooms can be very unhealthy.
  • Consumers are less tolerant of people or businesses whom they believe are wasting their time.
  • Physician practices want and need to run their offices more efficiently, and traditional methods just aren’t doing it.

Some physician practices may find the solution in remodeling the office, while others may automate the intake and check-out processes. Then there’s the wild card – telemedicine – which, depending on how it catches on, could render moot much of the discussion.

“Pre-COVID waiting rooms were often crowded, sometimes cluttered with well-intentioned magazines, brochures, etc., to entertain patients while they waited,” says Adrienne Lloyd, MHA, FACHE, founder and CEO of coaching and consulting firm Optimize Healthcare. “In some offices and at some times of the day, patients might struggle to even find enough chairs for them and their family members,” says Lloyd, who is also a consultant for the Medical Group Management Association. “You would frequently see long check-in lines and frustrated patients. Sometimes, there was congestion as patients tried to use the same area for check-in and checkout. Patients could also wait for long periods for very short visits, such as lab draws, imaging or post-op visits. 

“Practices can minimize the crowding and still serve the same or expanded volume of patients by shifting not only total visits from in-person to virtual, but also evaluating which aspects of the patient visit, such as check-in, patient education, financial counseling, etc., can be moved to phone or video. We have to continue to innovate – both with technology and by rearranging services, types of patients and overall clinical flow.”

It’s not healthy

Tom Schwieterman, M.D., vice president of clinical affairs and chief medical officer for Midmark, says “proximity matters” when it comes to reducing aerosolized spread of disease. “The COVID-19 experience offers one important lesson: Placing mixed-disease persons in the same location, now more than ever, is understood to be highly risky. A simple stat tells the story.”

In 2019, between Sept. 29 and Dec. 28, the U.S. recorded over 65,000 influenza cases. During that same time period in 2020, the country recorded just over 1,000 cases of flu. “That is a 98.5% decrease, which is thought to be a direct result of social distancing, masking and hand hygiene. Traditional venues of care will see changes brought on by these incredible new realities to sustain something good that came out of a terrible pandemic.

“In addition, we now have a very well-educated populous that understands the importance of proper hygiene for prevention of contagious disease. It is likely that patients as consumers will demand changes and see a problem the moment a patient sitting next to them coughs and then holds onto the chair arm, a magazine or other publicly exposed surface.

“The waiting room may not go away completely, but it will most certainly change to reflect these newfound realities.”

Patient expectations

Patients’ desire for convenience and speed will probably play a role in bringing about change.

“The days of taking a clipboard from the check-in station and manually filling out pre-visit information are likely coming to an end,” says Schwieterman. “This is a time-consuming, inefficient activity in a high-risk environment for contagious diseases, and it can easily be transitioned to a non-manual digital process.

He envisions a check-in desk – virtually enabled – which allows for speedy access to the actual care environment once onsite. Pre- and post-visit virtual technologies will minimize onsite paperwork and documentation. “Finally, I imagine options allowing patients to receive a text to come inside, such as from their car, once their exam room is ready, similar to a restaurant texting diners when their table is ready.”

Lloyd’s vision for the post-COVID waiting room includes:

  • Check-in prior to arrival so patients do not have to stop at the front desk. Information updating, co-pay collection and many other things could be done electronically through patient portals or apps.
  • Patient education delivered electronically to prepare patients prior to visit and to communicate expectations around disease conditions, possible treatments, procedures, surgeries, and/or follow-ups after their visit.
  • Ideally, single-unit flow such that the waiting rooms remain welcoming, bright, and pristine, but do not require any patient to stay for long. Some practices have initiated “self-rooming” so the patient may know on an app which exam room they should proceed directly to.
  • Check-out completed before the patient leaves the exam room such that the next appointment is easily scheduled, perhaps with a tablet if there is a need for a staff member to be in the back roaming and assisting. 

She says that in addition to making waiting room changes, practices should consider moving some high-volume testing and imaging rooms/equipment toward the front of the practice, or perhaps even create external entrances directly off the lobby so that patients who are there for those tests only can come in and leave quickly without creating bottlenecks in the rest of the clinical flow.

Predictions such as these are already becoming reality. In May 2020, Phoenix-based Banner Health launched a “virtual waiting room” system across its network of 300 clinics in six Western states. Mobile chatbots from LifeLink Systems interact with patients to help them complete digitized intake forms, provide education, and enable remote check-in capabilities for telehealth and in-person physician office visits. The IDN reported that a prior intake automation initiative that focused on Medicare Annual Wellness Visits for seniors resulted in a 70% reduction in appointment cancellations.

Meanwhile, New York-based Yosi Health, provider of patient intake and management systems, reports that streamlining patient intake:

  • Eliminates 14 minutes of staff time spent printing, scanning, transcribing, etc.
  • Improves claim submission rates.
  • Reduces A/R cycle.
  • Enhances patient experience.

What’ll it take?

Visions aside, widespread change to the waiting room experience won’t happen easily.

Lloyd says that regardless of how frustrated patients are by crowded waiting rooms, many practices may trend back toward a pre-pandemic state due to a lack of funds to implement new technology or physically redesign their waiting rooms.

Making change will be difficult, says Schwieterman. “The waiting room is a longstanding and traditional norm for care delivery. Eliminating it requires a higher degree of order and efficiency for all aspects of the care chain. All other processes will need to be controlled first, since care teams will need to know with precision when a patient is ready to be seen. Invariably this will require new technologies for digital check-in, history taking, real-time locating and way-finding, as well as more efficient on-premises care methodologies.

“Variability and unpredictability will need to be significantly contained before the waiting room can be sacrificed. I don’t feel providers necessarily feel any affinity or loyalty to the waiting room, but we all do have resistance to changing how we work, and that may well be the primary barrier to this change.” The impact of telemedicine on in-person visits is unknown, he says. But COVID demonstrated that all or portions of the patient encounter can be done virtually, with intake in the clinic reserved for patients who truly need to be physically seen. “Virtual care need not be seen only as a replacemen

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