Posting in Finance
Palm-reading kiosks lead to faster and smarter check-ins at the doctor's office -- not to mention better treatment. SmartPlanet talks to the man behind the innovation.
Last month I went to a doctor’s appointment at George Washington Medical Faculty Associates (MFA) here in D.C. I stepped off the elevator, had my palm scanned at a kiosk, answered a few questions on a touch screen about my insurance and emergency contacts, selected my appointment for the day, paid my co-pay, took my receipt and sat down with a crossword puzzle in the waiting room. How great is that?
I’ve now used the kiosk four times at MFA, a facility that treats about 4,600 patients daily. Most recently, there was a longer line at the kiosk than at the check-in desk, where the receptionists looked bored.
To learn more about these kiosks and the direction we are headed with electronic health, I called Chicago-based Allscripts, which makes the machines, and talked Chief Innovation Officer Stanley Crane. As Crane told me, imagine if our banks operated in the low-tech and arcane way that our health providers do—entering data manually, shying away from computers and never having the right records available. That’s only money, he said. "This is life and death."
I’ve loved using the kiosks.
That’s a common experience. You get to the airport, you need to check in, and you don’t have any bags to check. Do you want to talk to the agent? Do you want to talk to the teller or just get your money at the ATM? I think we’ve all gotten used to talking to the electronics, and the computer is faster than the human.
Also smarter. It always knows my co-pay, whereas the people behind the desk never seem to know, so they ask me, and I don’t know either. It happens every time.
When I get that question, I like to tell them that they owe me money.
Were these modeled after airport or ATM kiosks, or was this different enough that it had to be built from the ground up?
When we started the project, we had a client from New York who was very concerned about Medicare fraud—patients using one card and passing it around. So they wanted to know what could we do to help them with Medicare fraud.
So it’s a blend of a few things. The first time you sign in, you authenticate yourself. We were thinking about fingerprint readers, but they were not reliable enough when you change devices--from one fingerprint reader to another, we couldn’t tell you were the same person. The palm scan--the vein-reading technology--we see that at about a 10,000-to-one failure rate. It has a much higher rate of detecting the person you are.
The kiosk has a series of questions to ask. Once a year, for example, I want to ask you in the October through December time frame, “Do you want a flu shot?” The kiosk has the capability to ask a series of targeted questions. If you’re male, these questions, if you’re female, other questions. Same with patients of different ages. After the first time you use it, there are fewer questions. Usually if we ask them more than about five questions they have a tendency to drop off.
We want to make it a little easier for you to see the doc and to provide more information to the nurse and the doc so they understand more about your situation before they see you. It puts us in a better position to collect your data if we start collecting it electronically. Also, we find people are more likely to be honest with the machine than with a person. I just went to the doctor, and I had to tell the security guard where I was going. It was just for a cold, but what if I was going to the place for sexual dysfunction or drug rehab?
GW was one of the first. GW has been an excellent partner-- collaborative, opinionated and negotiable.
Who controls the kiosks now—like programming certain questions—them or you?
They do. So if they want to take a question out or add a question, they do it. They could ask, “Have you been exposed to swine flu?” The machines are all the same, but the questions are tailored by the client.
What’s the smart technology that’s used?
It’s a tablet PC, a classic Microsoft windows application, custom built for Allscripts.
The staff told me that they clock in with a fingerprint reader. Is that your system?
You can sign into our applications with a fingerprint reader, but clocking in—that’s not ours.
We’ve enabled biometrics, but the one we haven’t done is the iris reader. I know it, I get it, and I still felt uncomfortable with it: Let me shine this laser in your eye…
Tell me about how the palm reader works.
It’s built by Fujitsu. The PalmSecure technology reads the veins [with a near infrared light]. And the thing about a palm reader versus a fingerprint reader is that someone can cut your hand off, and they can’t use it and pretend to be you. The palm reading won’t work, because the veins aren’t working anymore. It’s a thermal reading of the veins in your hand.
You thought about this?
I did ask that question.
There’s a theme in a lot of what we’re doing. When you think about EHR (electronic health records), you think about a doctor or nurse talking to a computer or tablet. We’re extending the edges of where the EHR reaches: We’re extending it to the waiting room, and we’re extending the boundaries of where that information is available.
It used to be a really hard boundary—you had to be in the clinic or connect VPN (virtual private network) to the clinic. So how do we make it easier ? We’re trying to make sure wherever that point of care is, the information is, and make it easy for the patient to have access to his information.
And for doctors, we should make it electronically easy for them to pick up their smart phone, access your records and know how to treat you. Knowing, for example, when your last tetanus shot was, so [the shot] is not wasted if your shot is current. We give you the tetanus shot if you need it, but we don’t depend on you to remember when your last one was.
It’s breaking down the geographic barrier of where the information is and where it needs to be.
What’s the biggest challenge in moving forward with all this?
I’ll tell you what I think challenges are. In health care in general, I think training is always an issue--helping doctors, nurses, patients do things in a new way.
I think managing is always a challenge.
I think with the new wave of devices like iPads and digital pens, a challenge is figuring out what to do. Given the amazing capabilities of an iPad, what should do to have the biggest impact on health care? Assume we can do anything, what should we do?
I am at Allscripts because I love what we do. We get to be part of creating the type of health care we want.
And what is that?
We need to come up with ways we can use information technology as every other industry uses it today. Borrowing the kiosk to create the same type of efficiency the airlines and banking industries use. And with that, we save healthcare resources.
Allscripts Referral Network is another way. Our CEO is impatient; he wants to change health care, and wants to change it now. Rather than waiting for a national clearinghouse to exist, how about just connecting the 180,000 physicians who use Allscripts software? We started about a year, ago and it’s coming to fruition now. It’s about moving data around.
So in this respect, health care is far behind other industries.
I joke a lot and draw parallels between finance and health care. Let’s say you move to Chicago and want to open a bank account. You see file folders, they manually create statements, steer away from the Internet and send you a hand-written statement every month. What’s your next move?
I run out of there as fast as I can.
How many doctors’ offices are like that? And that’s only money. This is life and death.
I believe so much in the problem-solving ability of our physicians that if we prime that pump with information, they will find solutions. How do we help that doctor practice medicine more efficiently and effectively? We're not the magic part; the physician is the magic part.
Jan 4, 2011
Sorry to inform you but patient kiosks were not invented nor revolutionized by Allscripts. In fact many people have been using third party kiosks years before Allscripts decided to copy the inventors. Yes, there are more affordable solutions that have been in use for at least 7 years.
As a wounded warrior (traumatic brain injury), I would point out that "passive" kiosks (such as the palm-reader) can simplify some everyday tasks that are challenging to people with neurological damage. "Active" kiosks (like the airport check-in), however, can make life MUCH more difficult for the same people. Most of them cannot sense that someone may need more time, or additional help, to accomplish a transaction.
Additionally as to support ncberns@ point about co-pays etc. I am not sure why people think this will be a more effective method of determining that information. I would assume that the kiosk is pulling a person's insurance coverage information from the same systems the folks behind the desk are using. You just have a kiosk saying "We know your co-pay is $15" instead of a person. The information is coming from the same source.
IMWeira is right on target as is ncberns@ This kiosk concept arrogantly assumes that all people are technically savvy, literate and well educated health care consumers. It also assumes that people want to interact with a machine rather than a person. What if you are illiterate? Someone directs you to this registration kiosk where you are not able to read the directions. At this point you have to hunt down assistance that may or may not be available. Will you ask a stranger for assistance who may not have your best interest in mind? Will there be a staff member to assist you or take your information manually? What if you have a language barrier? A physical barrier? A mental impairment? The reality is this kiosk can actually create boundaries for access to health care. I see no measures for privacy on the kiosk in the photo. Can anyone within a short distance see your information you are entering? Is this like an ATM where someone is standing behind you waiting? I don't feel it is appropriate to be answering questions about my health in plain sight. I also do not wish to display my demographic information on a screen where others may see it. Identity theft is rampant in this country. Healthcare Identify theft is on the rise. In years past people were encouraged to cover the keypad while typing in their calling card numbers in public settings on pay phones. Is a calling card number more precious than personal and healthcare information? Additionally there are those of us who are not comfortable with using biometric validation of our identity. What if someone does not understand some of the questions they are being asked? Many consumers are intimidated by doctors. Who is to say that giving them a kiosk that is even less interactive is going to be well received? This kiosk may be well received by those who love technology, gadgets and want "an app for that." This is my health. My life. I do not want it to be treated like an encounter at the Red Box rental machine.
I was a critical care nurse for 43 years. I worked from ER's to Burn Units to Neonate Open Heart Surgery. I suspect that if you are not sick, not elderly, not impaired visually or mentally, not having arthritic hands, et al, then this type of thing might work well. While waiting on a script I saw an older couple trying to access the computer for their entry into the system for a flu shot. I got my RX and because I can't stop being a nurse, offerred to help them. They were naturally suspicious of a stranger wanting to know their medicare numbers, etc. I tried to enlist other employees to help them but it was not their job and they insisted the couple must do it themselves or it was "illegal." The couple gave up and left the area. At this point the Nurse Practitioner came out to see where the patients were. Too little care too late to save the loss of clients and too late for the patients to get their flu shots.
Your source for great games and books for any occasion.?We don?t sell everything out there, just the best:?books that will feed the thirst for knowledge, and?games that will get your neurons humming?and provide plenty of family fun.? http://www.skymindgames.com
Am I the only one who's terrified by this...? Folks, we're not talking about an assembly line here - this is my life you're playing with. My doc has been struggling for years to get all my files online. In that time, we've found other patients records mixed into mine, missing information, disappearing test results. Long list. "We know your co-pay" is a marketing myth - too many medical offices I see have gotten it wrong time after time after time (thanks to the help of their computers) Yeah, I suppose this might eventually be slightly more efficient (and terrific at eliminating jobs), but will it be better for my health or for the health of the corporation behind it.
The only issue I see with this is who cleans the germs off the screen between patients? Especially during flu season!
I find it interesting that everyone thinks about the germs on a touch screen but never thinks about the pen used on a sign in sheet. The same pen that hits the floor, gets stuffed in drawers, and is often in the mouth. The answer to "who cleans the touch screen?" - The same person that cleans the pen that you use to sign in on a sign in sheet.