Internist and Hospitalist Catriona Harrop, MD, was used to taking on challenges at Jefferson Health. As an associate chief medical officer at Jefferson Methodist Hospital in South Philadelphia, she took on a challenging population that had the highest percentage of COVID-19 cases of any hospital in the city.
Two years later, she got a new assignment: clinical lead at The Honickman Center, a state-of-the-art, 19-story ambulatory care building in the heart of Philadelphia. Dr. Harrop was tasked with bringing 23 disparate clinics into one location, standardizing their practices and ensuring the new center offered a satisfying experience for patients.
Creating a virtual checkout process was a key component of these deliverables, said Dr. Harrop, now an associate chief physician executive for Jefferson Health. Checkout occurs in the privacy of the patient exam room over a secure telehealth link through a "whiteboard,” which is a television screen that is in every exam room. It interacts directly with the patient, setting up follow-up radiological studies and appointments.
The first of its kind in the nation, the virtual check out process scores high for patient satisfaction, decreasing the lag time for follow-up visits and referrals to specialists and radiological studies. It also does not add significant time to the patient visit. It’s been so successful, Jefferson Health plans on deploying this technology in every new ambulatory care setting, Dr. Harrop noted during a presentation at the inaugural AMA Insight Network Summit in Chicago.
Jefferson Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Addresses space limitations
The $762 million Honickman Center opened in April 2024. Designed to maximize the clinical footprint and minimize administrative areas, it encompasses more than 300 exam rooms, 58 infusion chairs, 10 operating rooms and six endoscopy rooms, as well as imaging, lab and pharmacy. The facility combines the Sidney Kimmel Comprehensive Cancer Center, neurosurgery, neurology, otolaryngology, pulmonary and many other services in one space.
“It’s a busy, busy place,” noted Dr. Harrop.
With little room for admin space, the operations team faced a design limitation.
“When I inherited the project, one of the first questions was: What are we going to do with check in and check out?” she said.
Tackling the check-in process first, the operations team installed kiosks in the lobby, leveraging its Epic MyChart platform.
“When we started this process, many folks said: There's no way you're going to get people to check in online. You're going to have long lines in your lobby where you have kiosks,” said Dr. Harrop.
That turned out not to be the case. At least 25% of the patient population uses one of the 12 kiosks in the lobby and crowding hasn’t been an issue, she said.
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Versatile whiteboard assists checkout
Figuring out the check-out process took additional strategizing. Jefferson Health worked with its information systems team and a technology vendor to create an entirely new virtual checkout process.
Each exam room at the ambulatory care center has a whiteboard, which is a television screen, that physicians and other health professionals use to display X-rays, lab results and anything else that’s part of Epic.
Patients can also use it to include family members in their telehealth visits. And it is even used as a platform for multidisciplinary clinics, to play music and offers information on clinical trials that Jefferson Health is running.
“It’s a very interactive place within the room,” said Dr. Harrop.
The whiteboard has since adopted another function: a checkout platform for patients. Dr. Harrop expanded its use through the telehealth platform and added more staff to the facility’s centralized scheduling team for the virtual checkout process.
Physicians must close encounters
For checkout to occur, physicians must first close out the patient encounter. Wrapping things up in Epic signals to the virtual schedulers what to respond to. Does the patient need lab work? A chest X-ray?
This forced a change in workflow, which over time has improved efficiency with completing notes, said Dr. Harrop.
Medical assistants (MA) and physicians go through a “scripted” training where they’re taught how to wrap up the patient visit on Epic and guide the patient successfully through the virtual checkout process. Someone will also stay to help the patient if there are language barriers.
“The MA will stay in the room if it's an older patient or a patient where English is not their first language,” she said.
Checkouts reduce time to next appointment days
About 6,000 to 7,000 visits each month go through the checkout process, with more than 100,000 patients seen since December 2024. The facility has reduced its time to the next appointment from 17 to four days with virtual check out. Patients go through the system in a much timelier fashion, said Dr. Harrop. Much of that has to do with patients leaving with their appointment and not calling back several days later.
“It really had this unintended effect of shortening the time in which patients come in and get that follow up appointment,” she said.
There were bugs to work out. The operations team had to address privacy concerns related to the whiteboard camera. The workflow now includes a process for closing the camera after the patient leaves the room. Signage above the camera indicates that the camera is closed and is not open during the visit.
Additionally, many physicians and care team members were not happy at first. They thought the checkout process would prolong the visit. They’ve since changed their tune—the doctors love that patients get scheduled for their next appointment prior to departure.
Virtual checkout adds around three minutes and 40 seconds to the visit, said Dr. Harrop. But overall, the facility completes connection on the first try about 96% of the time.
“We feel like we've improved care coordination while servicing the patient in the room,” she said.
From AI implementation to EHR adoption and usability, the AMA is fighting to make technology work for physicians, ensuring that it is an asset to doctors—not a burden.
