Self-Service Patient Kiosks A Briefing for Providers

1. 1 Self-Service Patient KiosksA Briefing for Providers VeHU Providers Track Class #168 Lynne Harbin, Director, Systems Management, Chief Business Office Scott Finley, MD, MPH, Informatician, OHI ESM Blake Lesselroth, MD, MBI, Informatician, Portland VAMC

2. 2 Session Overview Kiosk Technology Background (L. Harbin) VPS Program Mission and Goals (L. Harbin) VPS Project Overview and Current Status (L. Harbin) Description of VPS Functionality (S. Finley) Overview of the Portland pilot installation (B. Lesselroth)� Data gathered during regional piloting (B. Lesselroth)� Organizational change best-practices (B. Lesselroth)

3. 3 Presentation Overview and Goals Detailed description of first phase timeline and expectations CBO, OHI, OIT expectations (estimated 1 slides) High level overview of project timeline with milestones (estimated 1 slide) Subject matter expert participation (estimated 1 slide) Requirements assembly process (estimated 2 slides) Review of requirements and specification documentation Listing of business requirements (estimated 1 slide) Listing of cross cutting requirements (estimated 1 slide) Discussion of near-term and long-term clinical capabilities (estimated 2 slide) Expected alignment with other programs (estimated 1 slide)

4. 4 Growth of Self Service Point of Service Devices are used in industry to provide information and services on a computer screen and allow consumers to perform tasks Since ATMs were introduced in the 1970s, self-service has permeated our lives

5. 5 Kiosk Use in Healthcare Hospitals and clinics leverage self-service kiosks for: Complete registration/update demographics Real-time validation of health insurance coverage Schedule appointments Pay medical bills Complete satisfaction surveys Complete medical questionnaires Complete administrative forms

6. 6 Kiosks Empower Patients Kiosks can be effective tools for meeting rising consumer expectations for speed and convenience

7. 7 Current State of Kiosks in VHA Kiosks have been piloted in VAMCs and are used to provide streamlined approaches for veterans to transact business. enable VAMCs to enhance services to Veterans improve efficiency of operations Pilots have taken diverse approaches Locally developed, as in Portland Vendor based, as in Pittsburgh, Martinsburg and other VAMCs In 2008, VHA�s Chief Business Office, collaborating with VHA field representatives, VHA ESM office and VA OI&T, was assigned responsibility to coordinate the development and management of the requirements IT issued a moratorium on local acquisition of Kiosks

8. 8 Pittsburgh VAMC

9. 9 VPS Program Mission

10. 10 VPS Vision

11. 11 VPS Solicitation

12. 12 Pilot/Deployment Phases

13. 13 CBO, OHI, OIT expectations Improve patient check-in experience Improve information flow at check-in Flexible, extensible systems Commercial solution COTS or largely COTS Integrated with VistA data Effective CPRS interface Leverage existing pilots in Portland, Pittsburgh, �

14. 14 What functions to prioritize?

15. 15 Requirements assembly process (1) Three overlapping teams Administrative Clinical Cross-cutting Environmental scan Open-ended requirements development (�blue sky,� �brainstorming�) � LiveMeeting RFI followed by RFQ

16. 16 Subject matter expert participation Frequent, facilitated meetings Administrative Chair: Anne Dow Clinical Chairs: Blake Lesselroth, Jasbir (Jay) Mavi Cross-cutting Chair: Gerard (Jerry) Roy

17. 17 Requirements assembly process (2) �De-scoping� � key subset of requirements for initial phases Formal requirements: Business Architecture Document (�BAD�) Balancing functionality vs. development time

18. 18 Potential Administrative Capabilities Check-in / check-out Account review and payment Accessing consent and HIPAA forms Appointment scheduling Patient surveys �Wayfinding� Parking coupons

19. 19 Near-term Administrative Functions Appointment check-in and view future appointments View/update demographic/insurance information Access/print basic facility information Print forms

20. 20 Later Administrative Functions Request future appointment cancellation View/update full demographic information View and update eligibility/enrollment information View account balance Complete basic and post clinic visit patient surveys

21. 21 Cross-cutting Functions Hardware Communications & interfaces (VistA; Registration, Scheduling, Insurance, Pharmacy) Standards Architectural framework Support and Maintenance standards Security, authentication and authorization Integration with VA Identification Card Login/Log out

22. 22 Near-term clinical capabilities Allergy review (first) Medication review / �reconciliation� (subsequent functionality) �Clinical check-in�

23. 23 Long-term clinical capabilities Biophysiological Data HPI Data Chief Complaint PMH Allergy History Social History Preventative History Preventative Hx � advice � suggestion - health maint. needs Survey data (disease/domain specific) Medication use History Patient Education (clinic/disease specific) Non-VA Caregiver data - coordination of care Support Programs Patient Decision Support MyHealtheVet functions/access Print functions Clinician tools: reconcile/record patient entered information Clinical flow tools (patient tracking/info tracking) Messaging - clinical reminders & admin notes (e.g. - shuttle schedule) Twitter/Instant Message

24. 24 Alignment with other programs MyHealtheVet Medication Reconciliation Medical Home Innovations Projects Pharmacy Reengineering

25. 25 Portland VAMC Prototype Automated Patient History Intake Device (APHID) Point of service consumer software with CPRS/VistA interface Developed by PVAMC and the National Center for Patient Safety (NCPS) Used in production at PVAMC since June 2007

26. 26 Functional Capabilities Configurable logic supports variety of local check-in processes Permits demographic and insurance verification and update Automates information routing within VistA Supports abbreviated medical history collection

27. 27 Medication Reconciliation Supports medication adherance history and allergy history capture Displays all active, remote, non-VA, discontinued, and expired medications (configurable) Images are matched with dispense data and National Drug Code numbers Data available in CPRS notes as free text data objects

28. 28

29. 29 Durability and Sustainability Over 140,000 encounters checked in using APHID since 2007 Voluntary use averages 48% Facilitated use averages 85% Use is a function of stakeholders and built environment

30. Patient-Facing Usability Assessment

31. 31 Performance Measures Data collected from September 2009 through February 2010 Staff imported history in 37% of all encounters and 76% of APHID check-in encounters APHID clinics were 97% compliant; usual care clinics were 72% compliant Average of 4.4 discrepancies per case in APHID; 2.2 discrepancies in usual care

32. 32 Sensitivity and Accuracy Randomized controlled trial studying accuracy of medication identification process Comparative analysis incomplete 100% of subjects have 1 or more discrepancies when compared to VistA; 483 discrepancies out of 1245 medications reviewed (38.7%) An estimated 50% of discrepancies have a system-based root cause

33. 33 Myth Busting Kiosks cannot replace customer service personnel; kiosks augment staffing Kiosks can be used by most veterans, including the elderly Kiosks with multiple applications are rarely successful; less is better Kiosks will not solve fundamental business problems without attention to organization Patients do not automatically gravitate to kiosks Kiosks are not plug and play and forget

34. 34 Organizational Change Have a change management plan with clear expectations Identify clinical and administrative champions Carefully consider the built environment and think like a customer Consider heurisitics and support systems to accommodate new work

35. 35 Resources and Questions