Introducing the Automated Registration System as a means to improve patient access and convenience for GOPD services

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1 Introducing the Automated Registration System as a means to improve patient access and convenience for GOPD services Mr. Steve CHAN Chi Keung Kwong Wah Hospital Hong Kong Introduction Information technology is not a new topic in nowadays world. We have advance computer system for diagnosis purposes as well as for treatment purposes. As a layman of advance technology, I am not going to discuss about the technical advancement of information technology. Instead, I will demonstrate how technology could facilitate process re-engineering exercise which could improve patient access and convenience for General Outpatient services. The Environment Kwong Wah Hospital is one of the acute general hospitals of Hospital Authority serving Kowloon West Region. Hospital Authority is a statutory body established on 1 December 1990 under the Hospital Authority Ordinance to manage all public hospitals in Hong Kong. It is an independent organization which is accountable to the Government through the Secretary for Health and Welfare, who is responsible for the formulation of health policies and monitoring the performance of Hospital Authority. The Tung Wah Group of Hospitals founded Kwong Wah Hospital in It came under the management of the Hospital Authority since The hospital operates 24-hour Accident and Emergency services, and provides a full range of general, specialist and allied health services to the population of the Mongkok and Wong Tai Sin areas. Kwong Wah Hospital is the major acute hospital in the Hospital Authority s Kowloon West Hospital Cluster which also comprises Wong Tai Sin Hospital and Our Lady of Maryknoll Hospital. The serving population of Kwong Wah Hospital is around to 630,000. The Kwong Wah Hospital General Outpatient Department (GOPD) is located at the ground floor and first floor of Tsui Tsin Tong Outpatient Building. As of 1999/2000, the total number of patient attendance is 203,776. It is the largest General Outpatient Clinic in Hospital Authority and represents 26% of Hospital Authority total General Outpatient attendance. Prior to the introduction of Automatic Registration System, patient registration was done manually.

2 The Problems With over 800 patient attendances, the manual registration process has many problems. First of all, the queuing time for quota is long. Patients would have to queue up for General Outpatient registration done by counter staff. For registration, patients would submit their identification documents and counter staff would then complete the registration procedures by writing down their names, General Outpatient numbers in a form. Then, the counter staff will assign consultation rooms and queue numbers accordingly and all these information will be put down in a queue ticket. Since the manual registration is not efficient and the patient load is high, especially in the morning, the queuing time may take as long as 4 hours. Secondly, patient is unclear about the quota status and queue status in consultation room. Since the quota is limited for both the morning and afternoon sessions, patients at the waiting hall and at the end of the queue would not know the quota situation. They could only line up to see if they could obtain a queue ticket. Moreover, after receiving the queue ticket, patients did not know the serving number at consultation room. As such, patients are crowded in the waiting area waiting for the nurses to call them. Thirdly, the patient list is required to send by facsimile to the medical record store located at another floor for records retrieval. As the patient volume is as much as 800 per day, the counter staff member has to repeat the facsimile process frequently. Fourthly, there is lack of management information for service monitoring and review. Since registration was done manually, it was not easy to obtain patients attendance records. As such, it was difficult to conduct utilization review. Furthermore, queuing time information was not available for future planning of services. The Solution Taking into consideration of the above problems, we analyzed the workflow of GOPD registration. After the study, we found that the registration process can be re-engineered in such a way that application of computer can replace manual work (Appendix I). After re-engineering the registration process, we introduce a simple barcoding technology so that patients can make registrations by themselves. In order to cope with the functional need for the benefits of patients, the Automated Registration System is designed to streamline the registration process, provide more user-friendly information to patients both waiting for the quota and waiting outside the consultation rooms, and finally, to provide management information for service review. The logical connection diagram is showed below: -

3 Automated Registration System Registration Processing PC OPAS Remote Counter Waiting area Plasma Display Panel Registration area Control PC Data Capture Terminals (room no.) Kiosk First Floor Local Area Ground Floor Network Logical Connection Diagram of Automated Registration System (ARS) Implementation After the re-engineering process, we designed the Automated Registration System consisted of 4 major components. 1) Patient Registration Card All existing and new patients will be issued new patient registration card containing barcode, patient name and GOPD number. All patients can then register for General Outpatient services simply by placing the cards into the slot of Ticketing Printing Kiosk. This streamlined the manual registration process by counter staff with a new do-it-yourself automated process. Queue Ticket and Patient Registration Card

4 2) Ticket Printing Kiosk and Queue Ticket The Ticket Printing Kiosks interface with the Outpatient Appointment System (OPAS) that is a database containing patients demographic data and attendance records. For the registration, a patient could simply place the patient card at a slot where the barcode would be scanned. After that, a queue ticket will be issued which contains the patient s name, consultation room number, queue number and the appointed time slot. At the same time, the registered patient information will send through network to record store for record retrieval and to the display panels located at the first floor which display the on-line queue status. Ticket Printing Kiosk 3) Display Panel 1 display panel is designated just outside the registration counter at ground floor of GOPD in front of the waiting area for showing the quota remaining. 2 Central Display Panels are fixed at the first floor waiting area of GOPD displaying upcoming queue numbers of all consultation rooms. Each consultation room is also equipped with 1 small display panel displaying current serving queue number. Patients could obtain the information just at the doorstep of the GOPD and consultation rooms.

5 Central Display Panel 4) Management Information The ARS interface with OPAS that supports provision of valuable information for services review and future planning purpose. Registration time and queuing time figures could be easily retrieved. Results and Achievements With a view to automate the registration system so as to benefit patients, the ARS was implemented in August 2000 and the following results are achieved. 1) Speed Up Registration Process After ARS's implementation, registration could be completed in 10 seconds compared to 20 seconds during the time of manual registration. It is a 50% reduction in the registration processing time. In return, the queue could be clear in a faster pace and the queuing time could be shortened significantly. 2) Accurate and Timely Information for Patients The quota status display provides clear indication for patients. For the Central Display Panel and Displays outside the consultation rooms, patients are able to know their turns for consultation. Moreover, nurse s effort in calling patients is streamlined.

6 3) Instant Retrieval of Medical Records The whole registration process is built on a local area network (LAN). Therefore, upon registration, the information could be sent to our medical record store instantly. Medical records could be retrieved efficiently for consultation. 4) Provision of Management Information The ARS is able to capture essential information previously not available. Management reports regarding quota utilization, processing time and waiting time could be prepared to further improve the services. The Way Forward I have described how technology could facilitate process re-engineering exercise which could improve patient access and convenience for General Outpatient services. In fact, what is using now is just a simple technology of barcoding. It is only the first step to demonstrate that technology, with innovation, can help to improve patient services. With effective application of the simple technology in daily operation, we can improve the services to patient directly. The Automated Registration System is a break through in the re-engineering of General Outpatient registration process. Kwong Wah Hospital is the first among all HA hospitals to introduce Automated Registration System in General Outpatient Clinic and it is a new milestone in patient registration process. Looking forward, if we are able to apply a more advanced technology on patient access to services, the improvement will be more significant. In fact, the feasibility to implement the Automated Registration System to Specialist Outpatient Clinics and Accident and Emergency services is under studied for the benefit of patients. Acknowledgement: The author is indebted to the following person for their dedication and support throughout the whole project: Dr William Ho, Mr. T. K. To, Mr. K Y Cheng and Miss Winnie Kan.

7 References Andersen, B. (1999) Business process improvement toolbox. Milwaukee, ASQ Quality Press. Gilpatrick, E. G. (1999) Quality improvement projects in health care : problem solving in the workplace. California, Sage Publications. Government Center on Information Systems (1994) BPR in the public sector: an overview of business process re-engineering. London, HMSO. Hammer, M. (1996) Beyond reengineering: how the process-centered organization is changing our work and our lives, 1st ed. New York : Harper Business. LaMoreaux, R. D. (1995) Barcodes and other automatic identification systems. England, Pira International. Lientz, B. P. (2000) Business process improvement: planning and implementation. San Diego, Harcourt Brace Professional Pub. Tenner, A. R. (1997) Process redesign: the implementation guide for managers. Reading, Mass.: Addison-Wesley.

8 Appendix I Workflow of Automated Registration Process Patient at GOPD for consultation services New patient yes Approach counter issuing for registration and New card with barcode No Barcode information will interface with OPAS* for appointment booking and record retrieval list Place the card at Ticketing Printing Kiosk for scanning of the barcode Collect queue ticket with patient name, consultation room number, queue number and time block Retrieval of record Display at the Central Display Panel which indicates the upcoming queue number and consultation room in the appointed time block Consultation Room * OPAS : Out-patient Appointment System provided by Hospital Authority Wk12-ARS at GOP