User Guide — Enhanced Patient Self Check-In

 

If your practice is using Enhanced Self Check-In, this feature is automatically turned on.

 

You can control the ability for staff to initiate self check-in—including whether it's enabled for all departments or for specific departments—from the Self Check-in Settings page.

 

This feature is set to on by default, as indicated by the toggle shown here:

 

When this toggle is on, you can designate whether the feature is enabled for all departments (default setting) or for specific departments:

The Departments filter offers the ability to either select all or to select individual departments. The example below shows the Departments filter with All selected:

Clicking Selected opens a menu showing a list of available departments:

You can search departments using the Find department field, and you can manually select departments, which then appear in the selected pane on the right. This menu also features the option to Clear all, or to remove individual selections (x). You can also cancel to close this menu without saving changes, or you can click Save.

Important: For clients where Enhanced Self Check-in is turned ON only for specific departments, this feature is only available for those departments that are currently configured to Enhanced Self Check-in.

 

While admin has the ability to enable or disable Enhanced Self Check-in for all departments in the tablespace from the SCI Settings page, it will only take effect for the specific departments that are on Enhanced Self Check-in.

 

 

Front desk staff can confirm the status of a patient's self check-in from the Appointment page. In the example below, the status shows as "Not started." Your staff can then send the patient an SMS link to self check-in six hours before the appointment by clicking Send Link to Patient.

 

Note: The self check-in SMS message is not configurable and is separate from the text message that can be configured via ReminderCall.

 

A pop-up opens, allowing staff to enter a mobile phone number. This field is prepopulated with the patient's mobile number on record. If the patient does not have a mobile number on record, this field is blank.

 

Your staff has the ability to save the mobile number to the patient's record. This is useful in cases where a patient does not yet have mobile number on file, but has provided a number for check-in purposes. In this case, your staff does not need to manually save this number in the patient's chart. They can simply check Change the phone number on file in the patient's record (shown below).

After the SMS link is sent, the Appointment page displays a message noting the expected delivery time of the SMS. Your staff has the option to send another link at this time by clicking Send Link to Patient.

Note: Actual message delivery times are dependent on the patient's mobile carrier. The message above indicates a general delivery time.

 

The patient receives an SMS that includes a link to self check-in. An example of this SMS is shown below:

After clicking the link, the patient is asked to verify their identity by providing their last name and date of birth:

Note: If the patient opts to log in with athenahealth, they are taken to the same verification method used when logging in to their Patient Portal. After verifying, they are taken to the self check-in workflow.

 

Then, the patient is asked if they are checking in for themselves or for another person. The patient clicks Begin Check-in after making this designation:

The patient is then taken to the self check-in landing page.

 

While the patient completes self check-in, the Appointment page shows a status of "In progress." While check-in is in progress, your staff can still send an SMS link if needed.

After self check-in is complete, the Appointment page shows a status of "Complete." The option to send an SMS link no longer exists.

 

There are several options for how frequently the Medications section will be shown to patients during self check-in:

• every time
• after 1 week
• after 1 month
• after 6 months
• after 1 year

It's also possible to configure Medication Review for either all appointments, or for specific appointments. When specific appointments is selected (as shown below), filter options appear:

These filter options are as follows:

• Departments

• Providers

• Specialties

• Appointment Type

• Age

• Sex

Each filter offers the ability to either select all, or to select individual options. The example below shows the Departments filter with All selected:

Clicking Selected opens a menu showing a list of available departments:

You can search departments using the Find department field, and you can manually select departments, which then appear in the selected pane on the right. This menu also features the option to Clear all, or to remove individual selections (x). You can also cancel to close this menu without saving changes, or you can click Save.

 

The other filter options feature similar menus. These filter options are as follows:

• Providers

• Specialties (Important: The Specialties filter only appears if you have the Clinicals – Multispecialty Filtering implementation setting enabled.)

• Appointment Type

• Age

• Sex

The Pharmacies section is shown during self check-in on a department basis - either all departments, or specific departments. You can select specific departments from this page.

• Ensure that your forms match the patient's preferred language.
• Check that the text is clear and readable.
• Do not include forms that require more than just one signature. In a future release, we will add the ability to include multi-field, customizable forms.

 

 

For a full patient workflow example, refer to the enhanced self check-in release note included in our Fall 2022 release.

 

Your practice can upload an image file for each form that needs to be signed. Patients click the + button to increase the size of the form. They can also click the download button to download the form in a new tab.

Both buttons are at the top right corner of the form, shown here. The white circles under Forms indicate the number of forms that need to be signed.

 

Patients or caretakers enter their first and last name in the Your Signature (Full Name)* field and click Sign & Next.

 

 

You can view a patient’s signed or unsigned forms within athenaOne from the check-in status page for the associated appointment. Unsigned forms can be printed for the patient to sign in office.

 

Printing isn’t helpful in a telehealth context, but you can still confirm whether or not required forms have been signed.

 

 

If a patient wants more information about a specific bill, they can click View breakdown from the main Payments page.

 

From this breakdown view, a patient can see what they owe, as well as any insurance coverage, past payments they made, and the total amount due. This view also shows the individual services included in this bill.

 

If a patient wants to see this same breakdown for a different bill, they can use the arrows at the bottom of the page to scroll through their bills.

If a patient wants some more information about a specific service in a bill breakdown, they click the Details drop-down menu.

 

This detail view shows the patient exactly what their insurance paid, as well as the dates of their last online payments.

To view a payment receipt, a patient clicks View receipt. This receipt shows the date and time of the payment, the card used to make the payment, the payment total, and some confirmation details.

 

 

When a patient chooses their payment method, they can also choose to delete a stored card. A patient may choose to delete a card if it is expired, which is noted next to their stored card as shown here:

If a patient deletes a card, a pop-up message displays asking them to confirm the deletion.

 

 

A patient may see a variation of the Payments option, depending on a previous action they took when paying a bill.

 

Here are some examples of what patients might see for a few different scenarios:

• If a partial payment was made previously, patients see the following:
  
• If the outstanding balance was reviewed but not paid, patients see the following:
  
• If one or more bills are not payable online, patients see the following:
  
  If a patient has a bill that is not payable online, this version of the Payments option will appear to the patient taking any action towards paying a bill. A bill may not be payable online if it is in collections, or if your practice does not have the epayments setting on.
  
  
• If the outstanding balance is paid in full, patients see the following:
  

 

 

• Patients can complete screening questionnaires up to 10 days before their appointment, saving time when they arrive at your practice. By default, patients can use check-in seven days before their appointment. Contact the CSC to adjust this setting to anywhere from two to 10 days.
  
• As a practice user, you have access to our an extensive library of questionnaires for use in self check-in, allowing a high level of configurability and insight into the health status of your patients.
• You can easily identify if a screening questionnaire was completed by the patient during self check-in by viewing an attribution at the top of the screener. This makes it whether the questionnaire was completed by the patient during self check-in, or completed in-office by a clinician. You can also see if a questionnaire is incomplete.

 

 

For a full patient workflow example, refer to the enhanced self check-in release note included in our Fall 2022 release.

If a patient partially answers a questionnaire and then clicks Previous, their answers are “soft saved.” This means that, if a patient returns to the questionnaire within the same session (without first logging out and then re-authenticating to log back in), their answers are saved but not submitted to the provider. If a patient logs out before returning to the screening questionnaire, they must start the questionnaire over.

 

 

Clinicians are responsible for reviewing a patient’s screening questionnaires, historically completed by the patient during in-office check-in. Screeners are often reviewed during the intake stage of a patient encounter.

 

There is an attribution at the top of the questionnaires, making it apparent to clinicians when a screening questionnaire is completed via enhanced self check-in.

 

In this example, a clinician is reviewing screening questionnaires during the intake stage of a patient encounter. The highlighted part of the example shows the attribution language and location:

The attribution makes it clear that the screener was completed during self check-in, and when the questionnaire was received.

 

If, during an encounter, a clinician changes an answer in the screening questionnaire, this attribution moves to a different location in the screener.

 

This example shows a changed answer (highlighted) and the lack of attribution next to the screener name:

Because the completion information changed for this screener, the attribution moves to the bottom of the expanded view. The user name, date, and time information are also included.

If a patient submits an incomplete screening questionnaire, this status is reflected in the new attribution (shown below):

The incomplete answer (highlighted above) will likely be completed by the clinician while speaking with the patient during intake.

 

If a clinician changes an answer that is part of a screening questionnaire completed by the patient via enhanced self check-in, the self check-in attribution is not shown:

Because a clinician completed part of this questionnaire, the attribution at the bottom of the screener changes to include the user name, date, and time information reflective of the person making the change.

 

 

View all available screeners.

 

 

To get started follow the steps outlined in the To configure patient health forms quick reference in O-help.

 

Important: Only the Medications section is available. You can see the other section types—such as Social History, Immunizations, and so on—from the older portal self check-in on the settings page. However, if you configure these other sections, they won’t appear in the enhanced self check-in workflow.

 

 

For a full patient workflow example, refer to the enhanced self check-in release note included in our Fall 2022 release.

 

Patients can perform the following medication-related tasks with enhanced self check-in:

• Review current medications

• Add medications

• Delete medications

• Edit existing medications

   

 

• When a patient makes changes to their medications from self check-in, this change enters Data Reconciliation.
  
  In this example shown below, two medications changes are shown:
  • A patient added a medication (Zyrtec), shown as Incoming Only.
  • A patient modified the frequency of another medication (isotretinoin), shown as a Conflict.
    
    
    
    
• Refer to the Patient Portal Health Forms O-help article for more information on configuring health forms (specifically the Medications section). Important: Currently, the medications form is the only health form supported by enhanced self check-in.
  
  
• When medication information is downloaded from Surescripts, the information becomes part of the chart and is treated the same as any other provider-inputted information is treated. The interface with Surescripts is uni-directional. Changes made to the medication history—whether by a practice user or by the patient via self check-in—are not communicated back to Surescripts.
  
  
• The medications that appear in the patient's chart from the Medication History Download feature are also shown in the medication review portion of the enhanced self check-in workflow.
  
  Surescripts imports medication information into patient charts via our Medication History Download feature. This feature is on by default, but can be turned off for an entire practice by contacting the CSC. Alternatively, individual patients can deny consent to download their medication history. Review the Medication History Download article in O-help for additional information.
  
  
• Prescribed medications cannot be modified by patients during self check-in.
  
  

• Medications added to the chart by practice users can be updated by patients.Use of the medications accelerator function on reconciled medications adds the reconciled dosage to the D&O section of the exam. It is recommended that the provider verifies the dosage before placing the order.

   

  Compound medications and unlisted medications are considered read-only. They cannot be updated or removed. An unlisted medication refers to a medication that cannot be found in our medication library.

   

 

To ensure all users have access to view insurance card images uploaded by patients during self check-in, take the following actions:

• If your organization uses domain-based whitelisting, whitelist "patient-insurance.api.athena.io."
• If your organization uses IP-based whitelisting, whitelist the following IPs:
  • 99.83.222.76
  • 75.2.108.241

athenahealth strongly recommends using domain-based whitelisting because it is less likely to change and requires fewer future updates.

 

See the athenaOne Technical Requirements for more information on whitelisting for athenaOne.

 

 

For a full patient workflow example, refer to the enhanced self check-in release note included in our Fall 2022 release.

 

If a patient has not added any insurance information during self check-in, they are prompted to do so from the main self check-in page:

Patients can add information and card images for up to two difference insurances by taking pictures of the front and back of their insurance cards. They may also indicate if an existing insurance is no longer valid.

 

Once the patient has submitted their insurance card images, the information is ready for review by the front desk staff.

 

 

 

Click Create at the top of the page to create a new form:

The following page displays:

Configuring form content

A number of default templates display on the right side of the page. From here, you can toggle certain form content on. This determines what appears for patients during self check-in.

You can also configure what content from each template actually appears in your social history form. Click the pencil icon to edit:

Here is an example of the edit page for the Home and Environment template:

A number of features are included when editing a default template:

• You can click Back to Templates at any time to return to the full list of default templates.

• You can click Clinicals Admin: Social History Global Templates to go directly to that page in athenaOne.

  Note: It's important to remember that certain questions and filters within a template may be turned off on the Social History Global Templates page.

   

  When editing a template, a note appears at the top of the page (highlighted below), and a tooltip appears when hovering over a disabled toggle or field:
  
  
  
  
  
  

• A count of the currently enabled questions is kept at the top of the page:
  
  

• You can designate if certain fields are required using the checkboxes under the Required column.

Any changes made on the edit page are saved when you click Back to Templates. Ensure that the template itself is enabled from the Create Form page, otherwise the configured content won't appear when your new form is published to self check-in.

Form Settings

You must determine a few settings categories to complete your new form:

• Departments

• Providers

• Specialties

• Appointment Types

• Ages

• Sexes (Male, Female, or All)

For all categories except Sexes, you can designate whether the setting applies to All or to Selected options.

 

Here is an example of the Departments settings after clicking Selected:

You can expand each brand to display specific practices, and then choose from the list. Any selections appear in the Selected menu to the right"

For the Ages setting, you must provide a minimum and maximum age, in either months or years:

After completing any required forms, you can click Create to save your form. There is no requirement to check Publish to Self Check-in; your completed form will still appear on the Social History Forms landing page, and you can edit and/or publish the form at any time. Clicking Publish to Self Check-in ensures the form appears in patient self check-in.

 

What the patient sees during self check-in depends on the configurations made on the Self Check-in Settings page. Here is an example of the Social History section requiring patient input:

Here is what the patient Quickview shows:

Patients can view and complete the forms you configure from the Self Check-in Settings page:

 

There is no change to our current data reconciliation feature.

 

After the patient submits their responses via self check-in, their responses get saved in the patient chart and the clinical team can review patient responses, especially if the responses are brand new and/or different from what's saved in their chart.

 

 

To create a new form, click Create at the top of the Manage Digital Patient Forms page.

You are brought to the Create Form page. Here is an overview of the page:

Tip: Hover over the image to expand.

 

Blue borders denote required fields:

The following sections detail each part of the create form workflow.

Acknowledgments & Consent

The acknowledgments and consents included in this element reflect the checkboxes (acknowledgments) and yes/no radio buttons (consents) found on the patient's Quickview and full registration page.

 

Consents include, for example, medication history authority (reflected by the radio buttons on the patient's Quickview) and any data/health sharing consents that have been set up for the practice. These data/health sharing consents are typically set up via interface. For example, practices in the state of New Jersey may have consents set up for the New Jersey Immunization Information System (NJIIS).

 

Consents have two patient-facing options: I consent and I do not consent.

 

You can select multiple acknowledgments and/or consents, then click Add to add them to the form preview.

 

Here is an example of an acknowledgment preview after it has been added:

For acknowledgments, there is no option for the patient to decline.

 

Here is an example of a consent preview after it has been added:

 

Registration questions

Registration questions are sourced from the patient Quickview and the full registration pages.

From the view shown above, you can search for available fields. You can also use the check boxes to select which questions to add prior to clicking the Add Questions button, which includes your selected question count in parentheses.

 

The column headings display the front desk name of a particular field, the patient-facing label, and the answer type. Answer type refers to the format in which the patient answers the question (via drop-down, entering a phone number, entering a date, and so on).

 

The following information appears at the bottom of this menu:

 

"If the option you are looking for is not available, you can add it to the Additional Information section of your Quickview via the Custom Fields admin page, or use this link to request we add support for an existing Quickview or Full Registration page field."

 

Any questions already created by your practice via the custom fields admin page will also appear in this list.

 

 

Here is an example of multiple registration questions after they have been added:

From here, you have the option to require an answer for each question. If an answer is required, the patient is not able to submit the form until a value is present in the patient-facing field.

 

The presence of a signature is driven by the Require a digital signature toggle under Form Settings:

However, if you add a consent or an acknowledgment field, this toggle automatically turns on and is locked.

 

Form Name is a required field near the top left of the Create Form page. Enter an internal-facing form name. This name appears on the Manage Digital Patient forms landing page:

 

Under the Document Classification heading, you can toggle whether or not a PDF is generated when a form is completed. By default, this is toggled on (as shown in the image below).

The document class is set to ADMIN and is not configurable. However, the document subclass can be selected from a short list of options in the Document subclass drop-down.

 

You can also add a label to the form using the Document label drop-down.

 

You can set the incoming status of the form to either Closed or In Review. The default status is Closed, meaning the form is not assigned to any internal user.

 

If you select a status of In Review, the document is automatically assigned to either the department staff bucket or the provider staff bucket, depending on how your practice is configured.

In addition to the digital signature toggle, Form Settings includes a Frequency drop-down, as well as selectors for departments, providers, specialties, appointment types, sex, and age.

The frequency options are every time, once a week, once a month, once every six months, or once a year. The default frequency value is "every time."

 

If the form includes at least one field with an expiration date, the selected frequency is compared against the expiration date of the completed field and a determination is made regarding whether or not to display the form to the patient.

 

For example, when the frequency is configured for once a year, when the form is signed, the expiration date is the day of signing plus 365 days.

 

Click Cancel to discard any changes made while creating your new form. Create saves your changes, but the Publish to Self Check-in box must be checked for the patient to be able to see the new form in the self check-in workflow.

When you save a new form, it appears on the forms list on the Manage Digital Patient Forms landing page.

 

On form completion, we'll generate a PDF that serves as a record of what the patient saw and how they responded. That PDF is stored in the Find tab in the patient's chart. For both drop-down and radio button fields, completed PDFs only display the answer provided by the patient, not the full array of options presented.

 

Note: PDF generation only occurs when the document generation toggle (located under Document Classifcation) is in the ON position.

 

If your practice features multiple locations (contexts), you can push out patient form configurations to member contexts using the Cross-Context Configuration Management tool.

To access this page,

1. On the Main Menu, click Settings > Implementation.

2. In the left menu, under Practice Links - Tablespace Data Transfer, click Cross-Context Configuration Management.
   
   Tip: Alternatively, enter text in the search box.

Context-specific aspects of your forms, such as custom questions and department, provider, and appointment type filters, do not copy over. Configure these form aspects within the destination tablespace(s) after the copy process is complete and prior to form publication.

When a patient completes a form, we will do the following:

• Generate a PDF of the completed form and attach it to the chart as an ADMIN document (unless PDF generation is toggled off).

• Update structured data fields with the patient-submitted responses. For example:
  
  
  
  The patient fills out an emergency contact name field. After submitting the form, this information is also updated in the patient Quickview.

Is Enhanced Self Check-in compatible with client devices (for example, in-office iPads).

No, not currently.

Is Enhanced Self Check-in available in multiple languages?

Enhanced Self Check-in is currently available in English and Spanish only.

Can digital patient forms be created using HTML?

No, digital patient forms do not use HTML. Users have the ability to format their templates as desired using the template builder.

Is there be a preview option to preview the digital patient form?

No, not currently.

Can I configure certain questions based on age?

You can use the age filter at the form level to make sure a given form only appears for certain patient ages.

Can I create a custom screening questionnaire?

No, digital patient forms are for administrative purposes only.

Can digital patient forms be pushed to the Patient Portal?

The forms are only available via the Enhanced Self Check-In Workflow.

Can I add letterhead to the forms?

No, not currently. If this is an enhancement of interest, please add an idea to the Success Community.

Can you build drop-downs and/or radio buttons in digital patient forms?

We can add custom fields to digital patient forms with drop-downs but not radio buttons.

If the patient completes the digital patient form and then reschedules the appointment, is the data lost or does it apply to the new appointment?

After a digital patient form is submitted by the patient, it automatically saves in athenaOne.

Are digital patient forms logged in the "portal e-signature history" under Manage Privacy (as clinical paper forms were)?

Signed digital patient forms are not logged under the "portal e-signature history." Digital patient forms generate the PDF to the patient’s chart. The

Acknowledgment checkboxes on the Quickview and Managed Privacy do get checked off and associated effective and expiration dates are updated appropriately.

If a patient does not complete the entire digital patient form during self check-In, does the practice see the completed portion?

If the patient does not click Submit, the practice does not see the completed portion. If the patient clicks Submit and does not answer non-required questions, the practice sees the completed portion.

Is there an expiration date associated with the consent forms and, if so, is the practice prompted when the patient needs to re-sign?

The Frequency filter determines when forms need to be signed. For example, if a form is signed on August 1, 2024, with the Frequency filter set for one time per year, the expiration date is written automatically as August 1, 2025. Even if forms do not contain an expiration date, if the Frequency is defined, the system defaults to the timeline that was defined.

What happens when a patient completes a form?

The digital patient form generates a PDF and updates any structured data fields with the patient-submitted responses.

How do you know if you are enabled for enhanced self check-in?

If you are not sure whether you have Enhanced Self Check-in enabled, please submit a case to the CSC.

Is enhanced self check-in an out-of-office workflow only or can enhanced self check-in and the new digital forms function be used for in-office check-in?

Enhanced Self Check-in (ESCI) can be completed via both out-of-office and in-office points of entry. To use the in-office workflow, first ensure In-Office is enabled (via the Gear > Communicator > Self Check-in Settings admin page). Then, on the pre-check-in page, practice staff can choose to send a check-in link to the patient via text message any time within 6-hours of the appointment start time.

Will there be "standard forms" already created?

There are no standard forms at present, though we are exploring this as a potential future enhancement. All digital patient forms must be created by a client.

Where do we make custom acknowledgements?

Custom Acknowledgements can be created via Gear > Practice Manager Admin > Custom Fields, and choosing the field type "Privacy Checkbox."

If patient consents to medication authority will it auto select in the patient chart?

Yes.

Will the patient information automatically default on the forms, or would we have to annotate or manually put their information on the form?

Any existing values already on file will auto-populate into a form when it is displayed to a patient in the Enhanced Self Check-in workflow. This saves patients time by allowing them to just review for accuracy and make edits as necessary, rather than having to answer every question from scratch.

How is pre-visit sent to the patient? Via email and text?

If your practice has ReminderCall emails and text messages enabled, pre-visit check-in links will be included in ReminderCall confirmation emails, ReminderCall reminder emails, in a ReminderCall Check-in SMS (sent one day before the visit), and in the "Last Moment Reminder" message sent 4 hours before the appointment.

Can you make some questions mandatory?

Yes.

How do you remove previous forms so that they are not duplicated?

To unmap the older Clinical Paper Form version from Enhanced Self Check-in to prevent the patient from seeing redundant forms please follow this pathway: Gear> Clinical>Clinical Paper Forms> update> uncheck "Enable for Digital Signature" checkbox.