While telehealth technology has already extended the reach and availability of several types of behavioral health services - psychiatry, psychotherapy, or counseling, to name a few - patients who require a more “hands on” approach to diagnosis and treatment must still call ahead to schedule an office visit, or wait their turn at a more costly urgent care site or hospital emergency department.
But this limited paradigm of telehealthcare might well change soon thanks to private, walk-in medical kiosks that combine conventional provider-to-patient telecommunications with an array of medical and diagnostic tools as well as a digital record of care. Two companies, HealthSpot (Columbus, Ohio) and Computerized Screening, Inc. (CSI - Reno, Nev.), are emblematic of this trend, which offers the promise of expanded and better integrated medical and behavioral health service access in a variety of locations.
The goal of these compact, ADA- and HIPAA-compliant telehealth kiosks is to deliver care more quickly, conveniently, and cost-effectively to those patients who “have a cold or a sore throat, a behavioral health concern, a chronic health problem, or maybe a question about medications,” says Steve Cashman, CEO of HealthSpot.
Many such interactions can now be handled using kiosks, which can be located in hospitals, behavioral healthcare facilities, long-term care facilities, corporate offices, or even retail sites such as pharmacies. The health professional who appears on the other side of the screen in could be any kind of specialist—a dermatologist, ENT physician, primary care doctor, or a behavioral health provider.
How it works
According to Cashman, there are multiple ways for an individual to set up a visit to a HealthSpot kiosk. Patients may call ahead, go online, or simply walk in to a location and meet with a trained attendant to begin. The medical attendant then collects the co-pay, directs the patient into the unit, and launches the session. Patients can create and access their own personal health record by logging in using a PIN, a phone number, a fingerprint scan, or other means of personal identification. For both HealthSpot and CSI kiosks, the visit begins with questions about the patient’s symptoms, a determination about the professional or specialist required, and insurance or payment requirements. HealthSpot allows individuals to choose the first available provider, or to scan all available providers and choose a particular one.
Patients are asked to take their own vital signs, using a range of medical instruments in the kiosk and their data is uploaded to the cloud. If a physician visit is requested, the doctor or clinician appears on the screen, accesses the patient’s available records and vital signs, and proceeds with the patient’s assessment, care, or therapy.
The medical instruments available in kiosks may be customized based on the needs of the location, and are generally used by the patient according to on-screen instructions. These may include:
- Automatic weight and height measurement
- An otoscope for observation of ears, nose, or throat, with images provided to the provider, who can capture, annotate, and display the images to the patient.
- A dermascope for close examination of skin or skin conditions.
- An automatic blood pressure cuff
- A pulse oximeter that allows examination of pulse rate, heartbeat, and blood oxygen level.
- An electronic stethoscope
- An alcohol breathalyzer
In addition, kiosks can be equipped with a range of safety and security features, including electronic signature pads, fingerprint scans, and even self-sanitizing UV lighting systems.
Typically, walk-in kiosks are staffed by a trained and certified attendant who is employed by the facility where the kiosk is located. Because of capabilities of the kiosk to link with a range of specialty providers, HealthSpot attendants need not be staffed by nurses or other highly trained medical personnel. However, the CSI kiosk requires an assistant to perform with the dermascope, stethoscope, otoscope and the cholesterol with glucose test, and this person can be a pharmacist (if at a retail setting) or a nurse (if at an employer site). A network of kiosks can be “staffed” by providers with a range of specialties who are available on an “on call” basis.
While a kiosk cannot replace well-equipped medical professionals in delivering emergency care, conducting diagnostic tests, performing blood draws, or treating lacerations or fractures, Cashman believes that they have a role to play. “If you walked into a CVS that has a kiosk, you could use it to see a behavioral health specialist, a dermatologist, or have a follow-up visit with another specialty. You could get many more services than a drug store offers today.”
Even well-equipped telehealth kiosks like these are not meant to replace doctors or behavioral health professionals, but rather to create efficiencies. Emergency medical cases or behavioral health crisis cases require specialized intervention, but for many more routine health concerns or for chronic condition monitoring, kiosk technology can improve access, speed up office check-ins, and reduce the use of high-cost emergency resources.
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