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November 13, 2006
Banks do it. Airlines do it. Why not healthcare? Medical kiosks have the potential to make collecting patient data a whole lot easier. When a pre-op patient arrives at H. Lee Moffitt Cancer Center & Research Institute, the registration process begins in a somewhat traditional way—with a clipboard that contains all the documents the patient needs to complete to get checked in for surgery. The process is anything but traditional, however, because the clipboard is actually eClipboard, a wireless device that is part of Galvanon, Inc.’s MediKiosk system that electronically captures all the registration information. “In addition to basic demographic and insurance information, the kiosks also capture extensive patient history information. On paper, these forms fill 26 pages, but the process is greatly streamlined when completed electronically,” says Edward Martinez, vice president and chief information officer at Moffitt. “We also use the kiosks to capture electronic signatures on various consent and HIPAA forms, and the application suppresses any forms that have already been completed so that patients do not have to fill out the same forms multiple times. Finally, we are using the kiosks for a variety of patient surveys. Some questionnaires focus on research issues while others focus on patient satisfaction or clinical data.” Streamlining Through Self-Service To help manage growth and support its internal clinical research initiative called Total Cancer Care (TCC), the decision was made to deploy self-service technology throughout the facility to streamline and standardize patient data collection and increase the overall efficiency of the check-in process. Earlier this year, Moffitt went live with a combination of medical kiosk technologies from Galvanon, including the wireless devices as well as desktop and freestanding kiosks. In all, 20 eClipboards are in place in pre-op, head/neck, and Moffitt South where they are used for new patient registrations. The technology is also being deployed throughout Moffitt’s affiliate network, which is comprised of 15 hospitals and 300 community oncologists throughout Florida. Currently, 17 eClipboards are live at four of those organizations. According to Martinez, Moffitt’s goals for implementing medical kiosk technology were twofold. First was to support TCC, which provides patients with access to the latest discoveries in lifesaving research studies and is designed to provide personalized medical treatments to patients suffering from diseases such as cancer. “Specifically, we wanted to use the kiosks to standardize the collection of patient data at check-in,” he says. “By capturing this information as discrete data elements, we are able to improve the quality of data available for scientific research and analysis. In fact, Moffitt can now capture up to 800 different discrete data elements per patient, significantly increasing the amount of data available for future research. “Secondly, we wanted to increase the overall efficiency of the patient registration process,” Martinez adds. “With patient volume growing in our clinics, we wanted an effective way to reduce the amount of redundant paperwork gathered at check-in while ensuring we had the most up-to-date information available.” Less than one year after implementing the kiosk technology, Moffitt has realized significant return on investment (ROI) with self-service, beginning with increased patient satisfaction. Not only do patients appreciate the convenience of the kiosks, but because the data intake process is tailored to each patient’s stage within the treatment cycle, they need to provide information only once, according to Martinez. On the administrative side, using the self-service kiosks reduces the number of forms patients must complete at each visit, which in turn reduces congestion at the front desk and shortens wait times. It also has reduced printing and storage costs, improved patient flow, increased the accuracy of the information gathered at check-in, and reduced duplicate data entry for the staff. “We’ve also seen a boost in staff productivity,” says Martinez. “For example, staff no longer has to scan patient forms into the EMR [electronic medical record] system. In one month alone, more than 1,000 forms were interfaced directly to the EMR system, and we anticipate this will reduce the amount of time staff spend managing paper forms by 50%.” But the benefits realized from implementing kiosk technology go beyond administrative. Says Martinez: “Collecting patient information as discrete data elements speeds the process for bringing experimental therapeutics to market and expands our ability to expedite research that delivers new clinical trials and technologies to cancer patients in the state of Florida.” Fast-Track Technology Like Moffitt, healthcare facilities and group practices of all sizes are realizing the benefits of riding the self-service wave and are deploying kiosks to streamline a wide range of processes, including check-in, payment acceptance, information updates, and patient education. Medical kiosks aren’t cheap, but unlike many technologies, they offer a quick ROI and can be tailored to meet specific facility needs. “A medium-size clinic can expect to spend $200,000 to $300,000 for all the technology and the integration that need to happen, but the payback is very, very quick when you start talking about increased efficiencies, seeing more patients, increased accuracy because the patient is entering his own data, up-front validation of coverage for services, and less reliance on humans at the front desk,” says Charles Anastos, Jr, vice president of Beacon Partners, Inc., a healthcare management consulting service company. “For repeat patients, the time it takes to check in has been cut somewhere along the lines of 70% to 75% because they’re validating their own information. For new customers, because they’re entering it rather than telling someone who enters it, you’re saving about 25%.” For example, one Florida cardiologist has deployed wireless kiosk technology from Computerized Screening, Inc. (CSI) in his practice that allows patients to check in and even collect noninvasive vital signs such as blood pressure, weight, and pulse rate on the stand-alone machine. The information is collected and transmitted directly to the practice’s EMR system. “It’s a very efficient way for an office or very large clinic to get the patient involved, to let them do some of the work that a person, a nurse or technician, has been doing historically and it makes the office run more efficiently,” says Bob Sullivan, RPh, executive vice president of CSI. “The ROI is seen very quickly. The way this doctor explains it, it saves him at least 50% of a nurse, so it’s an efficiency play and it’s the use of technology.” Ensuring Patient Satisfaction “We’re seeing a very quick adoption,” says Nick Kennedy, vice president of sales for Galvanon, a wholly owned subsidiary of NCR Corporation. “It’s very common for us to see an 80% to 90% patient satisfaction ranking almost from day one because patients quite frankly are sick of filling out paper forms and they’ve been trained by other industries to use self-service.” The trick, he says, is to implement the kiosks in a way that won’t be overwhelming to the patients and to ensure human help is still available for those who are not comfortable with the self-service process. It’s also important to be aware of patient demographics because not everyone is comfortable with technology, adds Anastos. The older population is less accepting, as are lower-income and rural populations. “There is a mixed bag of how people will take to it, but that may change over time,” he says. The type of interface is also important, with touch-screen technology being the one patients most readily accept, says Sullivan. “I’ve seen many attempts that left a person feeling cold; it’s not a happy experience using the computer,” he says. “It’s important to keep in mind who the end user is, not just the client who’s going to pay for it.” Security Issues “There’s always a risk,” says Anastos. “Anytime you allow someone to access data, it automatically becomes insecure. It could be someone standing over your shoulder or a lot of other things. So you don’t get access to your entire medical record at the kiosk. You get access to a subset of things, but you’re not seeing your hardcore diagnosis or treatment plans.” In addition to limiting the amount of information patients can access through the kiosk, most vendors employ any of a number of security features to verify identities before a patient can begin inputting information. Most use some form of personal identification number code and identification verification, such as a credit card swipe and photo ID. Others are more advanced, using smart card technology and even biometrics such as thumb prints and facial scanning. “When we look at the check-in process, we look at three different areas, the first being authentication, the second being forms completion, and the third being the financial transactions, copay, or outstanding balances,” says Kennedy. “The authentication is separated out as the first and foremost because while it’s a very quick transaction, it needs to be very well thought out.… In our particular system, we continue asking questions until we get a 100% match. At no point in time do we say, ‘Which John Smith are you?’” In terms of validity of information, while kiosk technology does integrate directly with EMRs, most recommend employing some type of “gatekeeper” between what the patient enters and what is added to the record. Moffitt, for instance, has two validation processes in place. First, patients are prompted when invalid information is entered and are required to make corrections before they can proceed to the next question. Second, a patient service representative checks the accuracy of a patient’s changes prior to posting the records in the EMR system. “From a technical perspective, we can directly interface with the EMR. So in a theoretical way, the patient can update from the kiosk and push that back to the EMR or scheduling system,” says Kennedy. “What we recommend is that you manage that, though, because what happens when you push the data back is that it overwrites your native data.” Future Expansion Medical kiosks are also finding a place in the public health sector. The City of Long Beach Department of Health and Human Services, for instance, implemented a customized version of CSI’s Health Station in the South Bay region of Los Angeles County, Calif., to increase HIV awareness among high-risk populations and provide accessible health screening, education, and referral information to an estimated 60,786 individuals living with HIV/AIDS in those areas. The system also provides referral information for health and social services in any community and allows users to schedule medical or counseling appointments on the spot. The kiosks “get people into care, get them tested, and help them understand what is available,” says Sullivan. “Basically, it takes this terribly medically underserved situation and gives them a technological way to access care.” Medical kiosks have proven particularly effective for behavioral health screening, such as for teen depression and substance abuse. Because patients are interacting with a touch screen rather than a person, they feel more comfortable answering questions regarding their emotional state or drug use. “You get better answers because it’s more private,” notes Kennedy. “There are all these different areas, these different touch points where you can provide that patient with the ability to manage their care.” Adds Anastos: “There’s a ton of usage here and what we’re seeing is that healthcare is wanting to bring in the kiosk for the same full function capabilities as an ATM offers to banking.… The kiosks being utilized for education purposes are just a toe in the water.” — Elizabeth S. Roop is a Tampa, Fla.-based
freelance writer specializing in healthcare and HIT.
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