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 to use your kiosks?
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.
What’s next?
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.
How do we help orchestrate the data flow between the various physicians? The kiosk is one way. Allscripts Remote (for the Android, iPhone) is another.
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.
