Virtual checkout at Jefferson’s Honickman Center lets patients skip the line

After the doctor says goodbye and closes the exam room door, an LCD screen on the wall flashes with instructions for the patient still inside: fully dress, flip open the camera lens, and press “continue” to call a checkout staffer.

Less than a minute passes before the camera light flashes and a Jefferson Health scheduling staff member appears on screen.

“Hi, I’m Tommy. I’ll be helping you with your virtual checkout,” Tommy Brown, a central scheduling representative, said during a recent demonstration of the health system’s new virtual checkout technology.

Jefferson Health wants to do away with the often tedious final step of a medical appointment: the checkout.

Patients normally queue up in line to check out at the office’s front desk. But at the Honickman Center, a remote staffer helps tie up loose ends and schedule follow-up visits virtually, before patients leave the exam room.

Jefferson debuted its virtual checkout process earlier this year when it opened the towering medical building with 300 exam rooms and 10 operating rooms. The new Honickman Center in Center City is where the largest nonprofit health system in the region sees patients for asthma, urology, rheumatology, and other services that don’t require hospitalization.

The approach is intended to make checkout faster and more private for patients, who now wait an average of 30 seconds before a remote patient support team member pops up on screen to greet them. Administrators say they have also reduced the number of patients who leave without follow-up appointments scheduled, but don’t yet have data to show.

Jefferson’s model is the first of its kind nationally, leaders say, as health systems in Philadelphia and beyond are increasingly looking for ways to use technology and artificial intelligence to improve daily operations.

Penn Medicine uses virtual monitors in its ICU to more closely watch complex surgeries and respond within seconds when a patient needs help. Lehigh Valley Health Network, recently acquired by Jefferson, uses monitors mounted in patient rooms to connect to doctors and nurses to discharge patients virtually, if they aren’t available for an in-person consultation.

But such innovation can create new challenges: Jefferson Abington Hospital was cited by the Pennsylvania Department of Health earlier this year after inspectors found that the virtual sitters the hospital had installed in behavioral health rooms to keep a closer watch on at-risk patients posed a safety risk. Inspectors said patients could strangle themselves with the eight-foot-long extension cord plugging in the machine to the wall.

With its virtual checkout, Jefferson must take extra precautions to secure private patient information now being communicated to a staff member working remotely in their own home. Administrators also had to convince doctors, who were skeptical that the approach would tie up exam rooms and slow them down. And while the technology is designed to be user-friendly, some patients may prefer in-person conversations or still need to follow up with a live staff member.

Still, they say the virtual approach has proven worthwhile. The health system plans to expand virtual checkout to more of its facilities within the next six months.

“It’s a much more personal interaction for the patient, rather than next…next…” said Catriona Harrop, senior vice president of Jefferson Medical Group.

The $762 million Honickman Center at 11th and Chestnut streets was designed to embrace new technology.

The lobby features self-check-in kiosks, much like those used to check in at the airport. The building’s walls are patterned with deep grooves designed to be touched to calm sensory overload.

Such features “represent the future of health care by blending physical and virtual care, while enhancing the human interaction between a patient and their care provider,” Jefferson Health President Baligh R. Yehia said when the center opened in April.

The 43-inch LCD screens mounted on each exam room wall were among the features administrators are most excited about. They can play music or breathing exercises to help soothe nerves before an appointment.

The screens can be used to virtually include in appointments a family member or other medical provider who can’t be there in person, and can help patients check out when the appointment is over.

When the doctor closes out of their notes on the computer, the system is prompted to show a screen with step-by-step instructions: fully dress and when you’re ready, flip open the camera lens (or opt to check out with the camera off), then press the “continue” button to call a checkout staffer.

Christiana Santiago, 35, said she appreciated being able to complete her appointment in a private room, where she doesn’t have to worry about other people overhearing her personal information.

The large screen and volume controls are thoughtful features for people who may be hard of hearing or seeing, said Santiago, who lives in Northeast Philadelphia.

“I think it’s wonderful,” said Michelle A. Freeman, 66, of Philadelphia. She’s been to the new building three times, but is still figuring out where everything is. Being able to check out in the exam rooms means a little less wandering around, she said.

Some patients aren’t as keen on the new technology.

“I like the old way better,” said Frank Buonadonna, 67, of Philadelphia. He thought it was “a little weird” to talk to a scheduling staffer through video, instead of in person.

A nurse helped him use the virtual checkout after his appointment Monday morning because he wasn’t sure what to do, he said.

Roughly 64% of patients — some 600 people a day — have used the virtual screens to check out of their appointments since the building opened in April.

The remaining 36% used a staffed checkout desk. That includes patients who needed multiple follow-up appointments or had more complex needs, and needed to coordinate with an in-house patient support staffer.

Some patients, like Buonadonna, still need assistance using the program. Others may be wary of sharing information virtually.

Brown, one of the scheduling representatives for Honickman’s virtual checkout, said that some people question whether he is a real person or an artificial intelligence creation.

He wears a Jefferson blue collared shirt and sits at a computer in front of a blue fabric backdrop in his spare bedroom at home in East Falls when he’s working with patients.

All virtual scheduling representatives wear headsets, so their conversations aren’t overheard. They use Jefferson-issued computers that are connected to the health system’s Epic electronic medical record system and heavily firewalled for security.

So far, the technology is only used at Honickman, where it was built into the building’s design.

But virtual checkout could also be done on tablets handed to patients at the end of the appointment, Harrop said.

She declined to say which Jefferson facilities will adopt the virtual checkout program next.