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Interactive kiosks expanding beyond patient check-ins

A practical look at information technology issues and usage

By — Posted March 30, 2009.

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Adoption of patient kiosks, simply defined as an interactive computerized system designed for self-service tasks, are on the rise, according to a study released earlier this month by the California HealthCare Foundation.

While hospitals have been among the first to adopt the systems in outpatient and emergency departments, the study indicates patient kiosks could soon be a common sight in other ambulatory settings as well.

Several physician practices are using the systems to expedite the check-in process. But kiosks also can enable automation of many routine tasks, including insurance verification and billing, and patient education. They also can be used to elicit answers to routine questions typically asked at the start of each clinical visit or patient satisfaction questions at the end of a visit. A system under development at Massachusetts General Hospital has the capability of recording a patient's medical history, obtaining vitals and even performing simple blood tests, such as those measuring glucose or cholesterol levels.

What your patient kiosk can do will not only depend on how much you want to spend, but also on what other technologies your practice has or is willing to adopt.

Gary Grandovic, director of the West Boca Diagnostic Imaging Center in Boca Raton, Fla., said his organization adopted the technology about a year ago as a beta test site for its parent company, Tenet Healthcare Corp. As part of the pilot program, the center adopted the kiosks as a way of speeding up the check-in process.

The technology has allowed the center to see about 15 to 20 additional patients per day by reducing the check-in time from about 10 minutes per patient to two minutes. It has not, however, eliminated the need for front desk help.

Experts say no kiosk deployment should ever completely eliminate administrative staff. Not every patient will want to use a kiosk, and use by some patients would not benefit the practice.

Grandovic said at his facility, patients with outstanding issues, such as co-pays that are due or personal information that needs updating, go entirely through the administrative staff. And while other patients perform most of their check-in procedures at the kiosks, patients still must be met by staff members upon entering the office.

"We still need to check ID and make sure the patient is who they say they are." Grandovic said the amount of staff has not been reduced, but some staff time has been opened up for other tasks.

Because West Boca's pilot program was a success, the center is adding a payment function to its kiosks, which it hopes will prompt more people to pay at the time of service. Grandovic said the machines already have a card swiper. But they will need to be programmed to operate with the facility's practice-management and billing system.

Experts say there are other financial benefits to be gained from the use of kiosks, including reduced paper costs and reduced staff time for chart filing.

But those benefits will only be realized if the kiosks are part of a wired practice with a fully functional EMR. Otherwise, the kiosks will only be forcing administrative staff to deal with the paperwork on the back end as opposed to the front end.

David Gulian, president and CEO of InfoLogix, a Hatboro, Pa.-based health technology company, argues that even then, the kiosks should have more functionalities than simply checking patients in.

"I don't know of anyone that can come up with [a return on investment] and why you should put a kiosk in versus signing on a piece of paper saying 'I'm here,' " he said. A kiosk that has the ability to ask the questions a doctor would normally ask in the first few minutes of a visit would not only save check-in time, but also reduce the time the doctor spends in the exam room.

Beyond the financial benefits, Virginia Cardin, DrPH, senior research health care consultant for the market research firm Frost & Sullivan, said patient kiosks hold enormous potential for patient education and prevention. Cardin has consulted with several practices that are placing kiosks or handheld devices in reception areas to serve only an educational purpose. She said the kiosks are interactive and have a variety of programs on various health concerns that patients might be too embarrassed to talk about with their physicians. The kiosks can also prompt a patient to ask questions about lingering problems that they may have otherwise brushed off.

Cardin said she sees the potential for practices to become so wired that the patient kiosks could not only check patients in, but provide interactive programming based on the patient's medical history.

Depending on the functionality of the systems, kiosks could cost anywhere from a few hundred to a few thousand dollars to implement. Grandovic said the West Boca facility spent about $14,000 to build its kiosk areas, not including the hardware and software, which its parent company supplied. Gulian said the technology his company uses, which includes not only the kiosks but the EMR, practice-management system and ongoing IT support, costs between $3,000 and $7,000 per month, per practice, to operate.

According to Cardin, many kiosks, especially those used for patient education, contain advertisements throughout the programming that can help practices defray the cost. But "the best ones I have seen do not have advertising," she said.

Elizabeth Warren, a health care attorney for Nashville, Tenn.-based Bass Berry & Sims, says that regardless of the purpose the kiosk will serve, practices need to be aware of potential legal ramifications. Not only do the systems need to be HIPAA-compliant and contain such safeguards as metadata tracking who entered what data and when, but practices need to include the kiosks in programs to protect against identity theft.

Warren said practices need to be aware of the potential violation of anti-kickback and Stark rules in situations where outside companies provide sponsorship of kiosks. She referred to a February 2008 ruling by the Office of Inspector General that allowed a pharmaceutical company to sponsor kiosks that provided patient education.

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