Article

Kiosk developers target doctors' concerns

Kiosk developers seize opportunities as doctors search for solutions to practice management.

July 16, 2006

The author is also editor of selfservice.org.

Dr. Jack Goldstein could have just stepped out of a Norman Rockwell painting. The Pawtucket, R.I., orthopedic surgeon has gray hair, suspenders and black plastic glasses with circular frames. And while he has an old-time doctor's demeanor, he has 21st century challenges: rising insurance costs, declining Medicare payments and ever-increasing demands for accurate treatment tracking.

He turned to self-service for help.

Goldstein collaborated with a former patient, a kiosk software developer, and his resulting company, AutomationMed, is an example of how many kiosk companies try to find opportunities while doctors struggle to manage their practices.

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With Medicare and Medicaid considering pay-for-performance programs for reimbursing doctors and medical institutions, and some insurance companies already instituting them, Goldstein believes demand will soon grow for a system that tracks the success or failure of medical treatments, patient-by-patient.

"The Orthopedic Academy wanted to do outcomes data collections in the mid 90s," Goldstein said. "You want to know how someone's doing before and after you work on them, so you need a statistically validated measure."

AutomationMed lets patients check in for their appointments using the lobby-side. They enter their symptoms on an interactive chart of the body and complete a standard SF-36 medical questionnaire at a touchscreen connected to a Windows PC. All that data is saved as XML in a MySQL database so the patient information can be communicated to other healthcare providers.

The next kiosk patients see is in the examination room, where Goldstein keys in his diagnoses and prescribed treatments as he examines patients. In subsequent visits, as Goldstein monitors their progress, patients retake the questionnaires. The differences in their answers allow him to electronically compare rates of improvement by condition and treatment.

The conditions and treatments are compared to his purchasing and billing data. For example, he can compare the payment he receives for a patient to the cost of the treatment, thereby learning which treatments are most profitable.

Dr. Jack Goldstein

"One, you can save money," Goldstein said. "Two, it's the right thing to do. You can see what works and what doesn't to make people better."

Like AutomationMed, Otech is a start-up software developer in the medical kiosk market. The company targets clinics like Goldstein's, where the doctor and his staff need less paperwork but at least as much patient time.

Whereas AutomationMed kiosks use an all-in-one approach, Otech focuses on check-in, including co-pay collection. And, for now, the company is not specifically targeting pay-for-performance needs – though it does have an agreement with another vendor that can track patient histories, which it has not yet implemented.

"(Pay for performance is) a buzzword but it's not anywhere near being implemented, except for a few HMOs," Otech President Bruce Steinhardt said. "It's going to be a long road before you get somebody comfortable to think that data's accurate enough that they will change something so that they get paid based on it. It's going to take either a real large institution and has the money to burn, or some really major payers to institute payment based on outcomes."

Galvanon, an early entrant in the market, opened for business in 2002. NCR purchased the firm in 2005. Galvanon's software offerings include patient-history tracking, and options for large operations, like wayfinding. The company also offers advanced hardware features, like a branded eClipboard and electronic-signature capture with consent forms. The Galvanon MediKiosk can also be equipped for biometric security.

Galvanon also tracks patient histories in an analytical data warehouse as well as a relational database. It also includes a clinical trials module.

"This module allows research facilities to tailor the clinical intake process for each patient, increase the quality of data collected for use in clinical trials and minimize the need for costly, time-consuming paper forms," Galvanon spokeswoman Cathi Hilpert said.

While different companies have different concentrations, they all agree the market for medical kiosks is expanding, and reducing paperwork is a key attraction.

"Physicians offices in particular, they've struggled with revenues being flat or down on a per-unit basis," Steinhardt said. "It truly has come to a point where they're saying, ‘What area can we automate? And, if we can, we have to save money where we have to.'"