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Biomedicine

The Doctor Kiosk

An automated health-care interface aims to streamline preventative screening.

A computerized kiosk under development at Massachusetts General Hospital (MGH) can take a patient’s medical history, weight, pulse, blood pressure, and other vital signs, and even perform simple blood tests for glucose and cholesterol. Physicians hope that the device, slated to begin field testing in the United Kingdom in June, will one day bring relief to the overburdened healthcare system, and allow doctors to intervene earlier in chronic disease.

Doctors’ appointments in the United States often feel like more of an inconvenience than a help, both for patients, who can spend hours in waiting rooms, and doctors, who spend hours filling in charts and organizing patient information. Ronald Dixon, director of the Virtual Practice Project, imagines that his kiosk–a small, Windows-based desktop computer with just a few peripherals–could one day revolutionize doctors’ visits just as ATMs transformed banking. By removing the tellers from the interactions that could be easily automated, banks saved face-to-face contact for more complex transactions. Dixon, who’s also a primary-care physician at MGH, believes that the same could be done for doctors.

The kiosk consists of a tabletop computer and a number of peripherals–a blood-pressure cuff, a scale, a pulse oximeter to measure blood oxygen levels, and a peak-flow meter to determine whether someone’s airways are constricted–as well as a blood-testing device commonly used in emergency rooms that can measure cholesterol and glucose levels. (The current version requires a trained assistant to do the finger stick for blood collection, although future versions will be automated.)

Ideally, Dixon envisions his kiosks placed in supermarkets and big-box stores: customers could step up, key in their password-protected information, answer questions related to their personal health history, and then get their checkup. “The results would then go to your provider, and that provider sends a message back to you the way you want it–either through e-mail or texting–about what to do with that result,” he says. It could determine whether current medications are doing their job, whether a particular strategy is working or changes need to be made, and whether a more in-depth exam is necessary.

In June, the kiosk will get its first glimpse at prime time. A pilot version will be tested in stores and other public spaces in Britain as part of a newly established vascular screening program to prevent cardiovascular disease, stroke, and heart attack. The United Kingdom is an ideal testing ground because it has a nationalized health-care system: everyone has an assigned primary-care physician and electronic health records, so the infrastructure for sharing and responding to the results is already in place.

“They’re trying to catch people who typically don’t get screened, since a lot of the population doesn’t go to the doctor unless they’re sick,” Dixon says. “But everyone goes to the drugstore or grocery store once in a while.” A 10-minute interaction will include a blood-pressure check, combined with blood glucose and cholesterol screens. The information can then be sent off to a central database. Those residents at highest risk for disease will receive a phone call from their physician.

While some might worry that the kiosk will perform medical care best left in the hands of a doctor, Dixon notes that it’s not geared to diagnosis: the machine is designed to collect and relay test information in a much more streamlined fashion than that used today. And it is targeted, at least in part, to patients who might not otherwise visit a doctor’s office.

The ability to efficiently screen for and monitor chronic diseases, such as diabetes and hypertension, whose rates are predicted to rise over the next 10 to 20 years, will be especially important. “Treatment for these should be very streamlined to make sure that people are on the medicines they need to be,” says Kristian Olson, a pediatrician at MGH involved in global-health initiatives. “And all of that should be routinized as much as possible, or else you’re reinventing the wheel for each patient.”

Other physicians familiar with the project have created their own visions for how the kiosk might be used. “A trip to the doctor’s office is a fairly clunky process,” says David Howes, president, chief medical officer, and CEO of Martin’s Point Health Care, based in Maine and New Hampshire. “It takes a lot of effort, it takes a lot of time, and it doesn’t really use the time of high-paid specialized professionals in the best possible way.”

Howes believes that just placing versions of Dixon’s kiosk in doctors’ offices could streamline the process and completely change primary care for both patients and their physicians. “Think about your process of going to the doctor: you go in, the nurse sits down with you, takes a lot of history, takes vitals, and might even order some lab studies. And then the physician comes in and replicates a lot of that work,” he says.

But a kiosk would allow for much of that to be accomplished before a patient ever sits down in an exam room. “By the time you get in to see the physician, the information has been gathered and organized,” Howes says. A clinician can look at the information and determine what conversations she and the patient need to have. “We’ve daydreamed that a tool like this, in the intake process, would be very useful.”

An automated system like the health kiosk could also be used to extend health-care access to the poorest nations. “It’s clear that there’s a human-resource limitation overseas that’s far larger than what we have in this country,” says MGH’s Olson. The kiosks, in combination with just a single physician or nurse practitioner, “could provide common care to a huge percentage of people,” he says.

In developing nations, Olson views the kiosk as less of a preventative screening tool than one that could be used for vital follow-ups. “I could see it being incredibly useful for routine follow-up for patients with issues such as tuberculosis or HIV,” he says. “It’s a way to follow up with physicians, demonstrate side effects, talk about whether [patients are] taking their meds.”

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