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 1911. It
came under the management of the Hospital Authority since 1991. 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.
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: -
Automated Registration System

OPAS
Registration Processing PC Remote

Counter Plasma Display Panel Registration area

Waiting area

Control PC
Kiosk
Data Capture
Terminals
(room no.)

First Floor Ground Floor

Local Area
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

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.
 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.
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.
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.
 Appendix I

Workflow of Automated Registration Process

Patient at GOPD for

consultation services

Approach counter
yes issuing for
New patient registration and
New card with
barcode

No

Barcode information Place the card at

will interface with Ticketing Printing Kiosk
OPAS* for appointment for scanning of
booking and record the barcode
retrieval list

Collect queue ticket with patient

name, consultation room number,
queue number and time block

Retrieval of Display at the Central Display Panel

record 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