Kiosks: Self-serve Patient Satisfaction

April 10, 2012

They’re not new. We see them everywhere – in airports, banks, hotels, etc. But how often do we see kiosks in our doctor’s office? Not as much. However, their usage in healthcare is on the uptick. One study predicted that kiosks are approximately two years away from mainstream adoption[i]. Why this drive toward adoption? A recent healthcare consumer survey [ii]found that:

• Consumers reported wanting more convenience and control

• 37% surveyed said they were “extremely” or “very” interested in using a self-service kiosk to help them check in for medical appointments more quickly

• More than 43% said they have chosen one medical provider over another because he/she offered self-service

These results suggest that consumers are not only comfortable with self-service kiosks, but also are using the availability of the technology as a differentiator when making decisions about healthcare services. Therefore, if you’re a healthcare organization providing kiosk technology now – before it becomes mainstream – you may have a distinct competitive advantage. In healthcare, there are basically three different types: self-service, pharmacy and health kiosks. Self-service kiosks provide consumer information and front/back office functionality by interfacing with registration, scheduling and financial systems. Pharmacy kiosks provide convenient services such as refill requests and after-hours prescription pickup.Health kiosks offer robust health-specific functionality and imbedded FDA-approved clinical devices that can be interfaced to a personal health record or an electronic medical record.

Self-service Kiosks

Wayfinding assistance is the most common self-service kiosk application offered in the healthcare environment.Busy consumers can access department/physician/provider directories, maps and directions to places within the facility. You find these in major entrances and lobbies, etc. Another common functionality in self-service kiosks is patient registration, patient information verification, preliminary triage in the emergency department, and patient check-in and queuing. In other words, once patients find their way to your office, they can quickly check themselves in and verify that their demographic and insurance information is correct. This is not just convenient for them – it’s a quality assurance process in the revenue cycle! One outdated policy number can hold up a reimbursement payment for weeks or months.

It’s no surprise that patients report being frustrated with long wait times associated with their healthcare appointment. Imagine how patient satisfaction would increase if a kiosk could help reduce wait times in half, as some organizations are finding. Some kiosks offer a feature that tracks the patient flow process from the time a patient arrives to the time they leave. These kiosks track wait times and other metrics, and the data is used by staff to identify bottlenecks, improve work flow, and maximize patient throughput – resulting in a better patient experience. Kiosks with this functionality are most commonly utilized in Emergency Departments, Laboratories, large clinics and outpatient areas.

Besides check-in and registration, there are countless other self-service kiosks features that can help improve patient satisfaction and give provider offices feedback for continuous improvement. These are not limited to:

• Appointment viewing and scheduling

• Access to personal health records

• Online statements and electronic payments

• Consumer satisfaction surveys

• Presentation of information in multiple languages

• Language translation services

• Access to education materials and healthcare websites

• Ability to electronically read and sign general consent consumer rights, HIPAA privacy notices and Medicare utilization forms.

Pharmacy Kiosks

Pharmacy kiosks are another offering that healthcare organizations should consider when trying to attract and retain consumers. In one market research survey, [iii] 72% of consumers said they are more likely to shop with a retailer that gives them the flexibility to interact easily via a kiosk self-service channel versus a retailer that does not.According to a 2008 study by pharmacy research firm Wilson Health Information, LLC, consumers cite convenience, price, and service as most important to pharmacy consumer satisfaction. Key contributors to this satisfaction are short lines, convenient pharmacy hours and after-hours prescription pickup.70 % were interested in the ability to pick up and drop off their prescriptions via a self-service kiosk.Survey participants reported these conveniences as key reasons to use one pharmacy over another.

There are two types of pharmacy self-service kiosks available: self-service and the prescription pick-up kiosk.The self-service kiosk provides services such as pharmacy refills, coupon printing, drug information and over-the-counter medication recommendations.Consumers report using this type of kiosk because it helps them avoid lines and it offers more privacy. The prescription pick-up kiosk allows consumers to pick up and pay for their prescriptions when the pharmacy is closed, or to avoid standing in line when the pharmacy is open. There are some limits with the prescription pick-up kiosks: They must be approved by the organization’s State Board of Pharmacy, the consumer must request the medication while a pharmacist is on duty, and some are unable to store oversized items and prescriptions that require refrigeration.

Health Kiosks

In addition to self-service kiosks, there are kiosks designed to help consumers monitor and improve their actual health. These health-related kiosks allow users to conveniently monitor their condition, set personal health goals, and measure and track their results. Clinics, physician practices and health centers that provide kiosks in locations convenient to the consumer see an increase in consumer satisfaction, as well as requests for additional services as the consumer becomes more informed about their health condition.

You are probably most familiar with the earliest and simplest form of a health kiosk – the one that can measure your blood pressure. Many of these kiosks can still be found in drugstores and grocery stores. The health kiosks of today are more technologically advanced. They are self-contained, internet-enabled units equipped with a touch screen, speakers and FDA-approved biometric devices such as a blood pressure cuff, EKG, scale, etc. They can measure temperature, pulse, blood pressure, weight, body composition, blood oxygen, glucose and other signs such as pulse oximetry and spirometry. Some provide eyesight and hearing screening, stress tests, diet plans, consumer education, phone and video enabled coaching, telemedicine, etc. Information about smoking, heart disease, diabetes, stroke, cancer, depression, asthma, exercise and weight management, domestic violence, HIV/AIDS, and sexually transmitted diseases are available by simply touching the screen. That’s a lot of staff time saved!

Many healthcare organizations encourage their patients to take an active part in their health by offering a rewards program. Patients who use the kiosks and meet their specific health goals earn points applicable to gift cards or other rewards. What consumer wouldn’t be satisfied with his/her healthcare provider after receiving a reward for health improvement?

Data collected can be maintained in a personal health record available to the consumer on demand. Results can be displayed or printed, or in some kiosks, downloaded via a USB port. The patient can then share the information with the provider during an office visit.

Healthcare organizations are using health kiosks to make their practice more efficient and to reduce input error. Kiosk data can be sent directly to the patient’s electronic health record for the physician or other care provider to access and verify during the office visit. Time saved by utilizing a kiosk for taking blood pressure and performing other activities means the physician can spend more time talking with the patient. Patient satisfaction becomes a byproduct of a well-functioning process.

Research shows that consumers enjoy the convenience of self-service and are more than likely to do business with companies that offer it. Although less than 10% of health delivery organizations have implemented patient kiosks, the experience of early adopters show that kiosks are an effective tool for improving service and efficiency while meeting rising consumer expectations. The result is a more satisfying healthcare experience for consumers and more efficient operations for organizations.

Important Considerations

While kiosks may perform some of the administrative duties of the front desk, it won’t eliminate the need for administrative staff. First, some administrative staff members will need to act as “kiosk ambassadors” to introduce and assist users with the technology. Second, some consumers may not be able or willing to use a kiosk. Third, kiosks are meant to supplement resources for a better consumer experience. There are situations which can only be addressed by knowledgeable, friendly staff. The human factor cannot be taken from the patient satisfaction equation.

Most benefits will only be realized if the kiosk is integrated with scheduling, registration and billing systems at a minimum, and with a fully functional EMR for the best outcome. Otherwise, the kiosk will force staff to deal with paperwork on the back end as opposed to the front end.

The kiosk applications need to be Health Insurance Portability and Accountability Act (HIPAA) compliant and contain safeguards that tracks who enters what data and when. It must also include programs that protect against identity theft. The healthcare industry has had a substantial increase in targeted theft of medical information, up 85% from January 2007 to January 2008[iv]. Theft of medical information has resulted in credit card fraud, and theft of credit card information has resulted in medical information mistakes. A company which processes credit card transactions, such as those using kiosks, has the responsibility to adhere to the standards described in the Payment Card Industry Data Security Specifications, otherwise known as the PCI DSS 1.1 standard. To demonstrate adherence, healthcare organizations must address its procedures, security policies, and technical infrastructure. Briefly, this means that an organization must use and update anti-virus software, install and maintain a firewall configuration to protect cardholder data, protect cardholder data using certified PIN entry devices and encrypting access to data stored on POS devices and servers, encrypt transmission of cardholder data across any open public networks, restrict access to cardholder data by business need-to-know basis, use unique user IDs and encrypted passwords, restrict and track physical access to card data and test all security systems and processes on a regular basis. Once an organization becomes compliant, there are ongoing requirements to maintain compliance. A kiosk vendor should be able to assist the healthcare organization in meeting these requirements.

Kiosk hardware must also meet Americans with Disabilities Act (ADA) Section 508 regulations which establishes requirements for electronic and information technology. ADA laws ensure that hearing and visually impaired individuals and persons with physical disabilities who may be confined to a wheelchair must have equal access in the same manner as an individual who has no physical disability. This means that an accessible kiosk is one that can be operated in a variety of ways and does not rely on a single sense or ability of the user. This applies to the kiosk, touch screen and other peripherals, such as a biometric devices, keyboard, bill acceptor, printer, etc. The ADA Accessibility Guidelines (ADAAG) is considered the best relevant guidance available.Here are some attributes that you should consider when selecting a kiosk:

• Meets all Health Insurance Portability and Accountability Act (HIPAA) and Americans with Disabilities Act (ADA) Section 508 regulations

• Is compliant with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) by providing and documenting consumer information

• Uses FDA-approved devices

• Supports branding and /or addition of logo

• Supports messaging/advertising display

• If a prescription pick-up kiosk, provides 24/7 pharmacist consultation

• Supports multiple kiosk platforms (tablet, wall-unit, sit down, etc.) to allow organizations to offer input alternatives to consumers

• Can withstand the environmental conditions such as dirt, vibrations, magnetic fields, power surges, high and low temperature and humidity, spills and rough handling

• An all-in-one integrated design, which avoids need to purchase separate pieces

• A presence sensor that activates the kiosk when user approaches

• Privacy panel

• Good screen size, quality graphics and audio

• Printer for receipts, medical information, coupons, etc.

• Magnetic stripe and/or barcode scanning for user authentication and payment entry

• Audio for users with visual impairments or literacy issues

• Instructions and education in multiple languages

• USB port for downloading personal health information

• Ethernet, wi-fi or wireless broadband connectivity

• Uses standard HL7 messages to interface with EMR and practice management applications.

Healthcare organizations are leveraging health kiosks to minimize errors, save provider time and improve efficiency. This not only leads to higher consumer satisfaction, but also to higher physician and staff satisfaction and a competitive advantage.

References - [i] Barry Runyon, Thomas J. Handler, M.D., Vi Shaffer, Barry R. Hieb, M.D., Jonathan Edwards, Wes., “Hype Cycle for Healthcare Provider Applications and Systems,” ID Number: G00159006. Gartner.com, June 27, 2008.[ii] “U.S. Consumer Research reveals that patients want self-service to manage healthcare interactions,”NCR White Paper, NCR Corporation, 2009.[iii] “U.S. Consumer Research reveals that patients want self-service to manage healthcare interactions,”NCR White Paper, NCR Corporation, 2009.[iv] SecureWorks Counter Threat Unit™. (2008, February 13). URL: http:// www.secureworks.com/research/threats/hackerattacks Copyright ©2010 Merion Publications2900 Horizon Drive, King of Prussia, PA 19406 • 800-355-5627Publishers of ADVANCE Newsmagazineswww.advanceweb.com

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