You can skip the Vegas strip for finding the latest in health technology this year, as one of the coolest new technologies is right here in Boston. As reported in the Technology Review, an electronic "doctor kiosk" is under development at Massachusetts General Hospital (MGH).
The self-service kiosk promises to increase efficiency both inside and outside the physician office setting by gathering basic information from patients, such as the patient's medical history, weight, pulse, blood pressure, and blood tests for glucose and cholesterol, and directing that information to a physician prior to an office visit. It can also function as a virtual health concierge for managing chronic illness, prompting the patient to answer a series of important health questions, such as "did you take your meds today," a question many of us would like to ask our elected representatives these days.
The kiosk, a brainchild of Ronald Dixon, Director of the Virtual Practice Project, is part of the latest surge in health care technology aiming to increase efficiency in the health care system and the patient care process. Slated to pilot this coming June in supermarkets across Great Britain, the "Robodoc" has great potential in the telehealth market. Efforts at the Department of Veterans Affairs to bring essential primary care into the homes or rural towns of America's veterans could benefit from the kiosks.
Will patients really connect with Robodoc?
While gathering relatively mundane information that's zapped from a patient's finger tips to a doc's laptop screen sounds very cool and Jetsons, it must be matched with increased doctor-patient contact to make a material difference. After all, one of the primary problems with continuity of care to date has been the lack of resources and time that physicians (particularly primary care physicians) have with their patients. To put it bluntly, this country is woefully short on primary care doctors. And if you don't believe me, just try making an appointment with one. (I hope you like magazines.)
Clearly greater efficiency matters; cutting redundancies removes fat over muscle, and centralizing patient information for physicians can reduce errors. The use of electronic health records (EHRs) is also an important step in achieving these goals. Yet, we cannot discount the fear of technology among the public, particularly when it comes to our health.
For Robodoc to be seen affectionately by patients, it must make patients feel more connected to their health information - not less so. If patients feel the increased use of technology replaces physician-patient face time rather than supplementing it, they will reject it outright. Yet, while the importance of the buy-in is clear, any tool that will help physicians be more efficient in an era of rising patient rolls is at least worth consideration.
Robodoc, steer clear of the nurses!
Another challenge of the doctor kiosk is fitting into the clinical process without upsetting other stakeholders - namely nursing staff. Finding new places for technology demands a simultaneous shift in the clinical care process paradigm. If technology can rid the health care setting of some tasks that are routine and data collection driven, it presents the opportunity for more attention to complex, higher value patient-provider interactions.
At present, nursing staffs are overburdened, yet their valuable skills are underutilized. Nurse practitioners and physician assistants are wholly capable of providing non-urgent care that may clog a primary care physician's work pipeline. Relieving the nursing workforce of some aspects of care, such as data collection, may allow them more time to aid physicians with non-urgent care. This is particularly true with pediatric patients. The bottom line is that Robodoc may not be an alien intruder into one's workspace, but rather a useful colleague that can collect information without attitude, lip, and ideally, error.
Lessons Learned...
Experts note that past failures of kiosks were marked by their attempt to be all things to all people. For example, in the airline industry, kiosks work because "they are good for domestic flights and on-time flights only." Any hiccups in weather completely debunk the utility of the kiosk because passengers demand human interaction to solve their travel woes. While there are high hopes for the doctor kiosk, the temptation may be to allot the technology too much task control. Sticking to the data collection mission, whereby emphasizing the importance and preeminence of the human element will indeed secure it a more timeless place in the physician's office, instead of a passing cool toy that never was.
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