Research Utilization Proposal

Efficacy of Kiosk Technology in Clinical EnvironmentsANALYZING ITS EFFECTIVENESS THROUGH INFLUENCE AND BEHAVIOR

The Central Aims of R01

Improving customer satisfaction through performance measures.

Identifying opportunity for technological breakthroughs from device metrics.

Demonstrating effective decisions made using the technology.

Using analytical data to fulfill Meaningful use measures.

Key Stakeholders

Chief Information Officer

Chief Technology Officer

Principal, Clinical Measures

Principal, Health Informatics

Principal, Public Health Analytics

Systems Architect

Unit Clinicians

Proposal Objective

Gather and share data on the efficiency of kiosk Using Inferential Statistical to compare comparable medical technologies.

To analyze the comparable services of the kiosk and the services of the clinician.

To test possibility of technology evolving to desired full automation.

Background Kiosk are self-service touch screen device that allow customers to access their information, receive rudimentary medical diagnoses, and update their personal health information.

The purpose for installing medical kiosk was to expedite appointment check-in, review scheduled appointments, manage account balance, apply for travel reimbursement payment, and future application of being able to pay copay bills (VA.gov, 2015).

The benefits of the technology are to improve customer satisfaction, promote workflow efficiency, enhance data quality, reduce wait-time at check-in, and future application of automating certain administrative processes like generating forms, wristbands, and labels (VA.gov, 2015).

As an addition to clinics to alleviate traffic at check-in areas, its potential can be supplanted by lack of acceptance from clinic staff and under-utilization from customers.

Success of electronic device useKey findings

In 2011 84% of emergency departments (ED) use an electronic health record (EHR) system.

Adoption of basic EHR system in ED increase from 19% in 2007 to 54% in 2011.

From 2007 to 2011, stage 1 Meaningful Use objective increased by ED.

In 2011 14% ED had EHR technology able to support 9 Meaningful use objectives (Jamoom & Hing, 2015).

Figure 1 Reprinted from NCHS Data brief, No.187, Feb. 2015

Outpatient Department (OPD)In 2011 73% of OPD used EHR, up from 29% in 2009.

Adoption of EHR system increased from 9% in 2009 to 54% in 2011 by OPD.

Figure 2 Reprinted from NCHS Data brief, No.187, Feb. 2015

Informaticist Change Management ModelDemonstrative change is required by the informaticists in organizational, analytical, problem solving, and strong communications. Due diligence in efforts of leaders, to include the informaticists, are by example in the way of Lewin’s Change Model. Which is a steady deliverable when considering organizational behavior, business economics, and system thinking.

Figure 3 Source http://www.google.com/search?q=operational+change+model&tbm=

Relationship ScorecardKey Performance Indicators (KPI)

Financial• ROI• Cost Savings• Forecast

Customer Survey• Product/Services Attributes• Customer Satisfaction Index• Staff Performance

Technology• Ease of use• Device Performance• Scalability

Vendor Performance• Cost• Quality-customer satisfaction• Trend Analysis-customer driven

analysis • Relationship-service level agreement

i.e., maintenance, support, upgrades, etc..

Literature Review

The comparative aspect to my research is that patient preferences is a focal point and innovation use was studied for measurable indicators in quality care. The purpose of this study was to see whether a cross section of ≥18-year-old patients were likely to disclose at-risk alcohol and substance use to computers than to an interviewer

A convenience sample of (n=1207) participants was used for the screening using both modalities, (n=229) were in person, (n=824) use the kiosk, and (n=154) used both. Single modality participants were more likely to reveal high risk alcohol and substance abuse (SA) use to kiosk. Patients using both modalities were more likely to reveal high-risk alcohol and substance abuse use to kiosk.

Paradoxically, 76.3% stated when asked that they prefer in-person interview as they rated it highest in safety and privacy concluding that in-person is preferred despite the reluctance to disclose substance abuse (Hankin, Haley, Baugher, Colbert, & Houry, 2015). The article’s relevance is key to indicate an innovation’s role as a metric sensor to reduce treatable turnaround in the emergency department for SA and offer intervention therapy and treatment program. This trend spotting is a key component in the affordance of better care.

Cont.

Data Sharing and Open Access Limitations

The Healthcare Information and Management Systems Society (HIMSS, 2009), outlined the Health Information Exchanges (HIE) architectural models used to share data across multiple platforms consisting of:

Decentralized (federated) Model

Centralized Model

Ethical ConsiderationsIRB and HIPAAApplicable Institutional Review Board (IRB) rules and security and privacy under the Health Insurance Protection Accountability Act (HIPAA). With the assumption of IRB application approval and policies in possession adapted from the Department of Health and Human Services site. IAW Federal Regulations Title 45. 45 CFR Part 46, subpart A: Basic HHS Policy for Protection of Human Research SubjectsSection 46.114 Cooperative Research.Section 46.116 General requirement for informed consent.Section 46.117 Documentation of informed consent.Section 46.118 Applications and proposals lacking definite plans for involvement of human subjects. Section 46.119 Research undertaken without the intention of involving human subjects

cont. • HIPAA Privacy Rule and Sharing Information Related to Mental

Health• The HIPAA rule provides consumers with important privacy rights

and protection including their health information and controls in how that information is to be use by health plans and healthcare providers under 45 CFR 160 and 164 Part A, Part E. Using the kiosk for alcohol and substance use review as a control to the rights of the patient when under duress of a substance is as follows:

• Communicate with family as long as the patient consents. 45 CFR 164.510(b)

• Consider the patient’s capacity to agree or object to sharing their information.

• Communicate with family members, law enforcement, or others when the patient presents a serious and imminent threat to others or self.

Operational Measures

Financial Change ModelAn efficient practice operation will display how much of organization cost is covered by service revenue.

Figure 4 Reprinted from CTS Medical Kiosk & Retail Kiosk, 2015,

http://www.kioskcts.com/category/healthcare/whitepapers/

American Recovery and Reinvestment Act (ARRA)

Page Title Topic Legislative Intent Impact

271 III various Part III - Encouraging Development of New Patient-Care Models. Section 3021, Establishment of Center for Medicare Medicaid Innovation within CMS. Sec. 115A. (a) Center for Medicare and Medicaid Innovation Established Created within CMS to test payment and service delivery models to reduce program expenditures under the applicable titles while preserving or enhancing the quality of care furnished to individuals under such titles. The Secretary shall give preference to models that also improve the coordination, quality, and efficiency of healthcare services furnished to applicable individuals...Models to be tested include a wide range of areas including patient-centered medical home models and a range of others.

Exchange of data among healthcare providers will mean a much more current and accurate record at discharge or transfer.

277 III Medicare savings

Sec. 3022 Medicare Shared Savings Program Sec. 1899. Establishment –

By January 1, 2012, the Secretary shall establish a shared savings program that promotes accountability for a patient population and coordinated items and services under Parts A and B, and encourages investment in infrastructure and redesign care processes for high quality and efficient service delivery.

o ACOs that meet the quality performance standards established by the Secretary are eligible to receive shared savings payments...

o The Secretary may require quality reporting, e-prescribing, and the use of electronic health records.

Additional reporting which could have an impact on reimbursement.

To offer proof of funding eligibility look under Legislative intent of PL 111-148, Patient Protection and Affordable Care Act, 2010:

Sample Budget Table for Research request.

Budget Period: 7/1/05--6/30/06

Annual Cost

Effort Sponsor

Effort University

Sponsor Amount

University Amount

Total Amount

Faculty Salaries

Principal Investigator 78,719 30% 20% 23,616 15,744 39,360 Co-investigator 57,881 50% -- 28,941 0 28,941

Staff Salaries Research Associate 40,517 60% 40% 24,310 16,207 40,517

Lab Technician 32,414 75% -- 24,311 0 24,311 Data Entry Clerk 23,037 50% -- 11,519 0 11,519

Graduate Assistantships (50%) 18,010 5 -- 90,050 0 90,050 Student Wages -- -- -- -- -- 0

Other Wages -- -- -- 10,000 0 10,000 Total Salaries and Wages -- -- 212,745 31,951 244,696

Faculty and Staff Benefits @30% -- -- -- 33,809 9,595 43,394 Wage Benefits @7.65% -- -- -- 765 0 765

GSRA Benefits @$485/mon. 5,820 5 -- 29,100 0 29,100 Total Benefits -- -- -- 57,074 9,585 66,659

Consumable supplies & materials -- -- -- 13,000 9,000 22,000 Travel -- -- -- 28,000 0 28,000

Other operating costs -- -- -- 5,700 0 5,700 Tuition Remission 11,920 5 -- 29,204 30,396 59,600

Fellowships/Traineeships -- -- -- 0 0 0 Space rental fees -- -- -- 0 0 0

Consultants -- -- -- 0 0 0 Subcontracts -- -- -- 35,000 0 35,000

Patient Care Costs -- -- -- 33,280 -- 33,280 Total Operating Costs -- -- -- 144,992 40,588 183,580

Equipment -- -- -- 12,700 0 12,700 Other Service Facilities -- -- -- 0 0 0

TOTAL DIRECT COST 425,511 82,124 507,635

INDIRECT COST MTDC 53% -- 167,755 26,784 194,539

Subcontractors -- -- -- 0 -- 0 TOTAL INDIRECT COST 167,755 26,784 194,539 GRAND TOTAL 599,866 108,908 708,774

A budget table will display cost as it occurs and who is accountable for the incurring cost. There is a provision for ARRA sponsorship should it be need and/or approved. A sample budget table would be as such.

Evolution of Technology through Research

From its initial intent to the fulfillment of full automation of routine, minimum human interactivity services.

The evolution can culminate into wearable tech that direct patients to appointments via LED panels on hospital walls or smartphone GPS-based audio streaming guiding patients through crowded hallways to the providers’ office.

This type of change can only happen with cooperation from elicited study participants and change oriented researchers willing to take extra efforts in realizing the value of consumer knowledge and beliefs of what they want.

The culture of Big Data is not so big when the details enlighten us all on how the next degree of patient satisfaction is achieved and stage 3 Meaningful Use is no longer perceived as the restrictive mold to fit into but the catalyst to explore and expand the boundaries of medical technology.

Conclusion The goal is to measure the “why” in creating a push to increase the momentum into new realities of technological innovations to match the enthusiasm of delivering better services for no additional or lower cost. To do this we need smart communications with appliance help from learning machines and more assistance from learned individuals. Connected Technology Solutions - CTS is a company that provide interactive kiosk to a variety of industries exact to the customers’ requirements. Their project management team is qualified to work with clients’ staff and assist in training while building systems suited to the organizations’ aesthetics. Their involvement in this proposal is to clarify the feasibility of full automation in many workaround practices and the interconnectedness of stress in patient intake to their feelings of gratification after the provider interaction. Adams et al., (2015) authored a paper about transforming healthcare requires a corresponding transformation in understanding the value that care providers deliver.

CONT. Healthcare system must address the root cause of their predicaments – rising cost, poor or inconsistent quality of care, changing demographics, and inaccessibility to timely care. Coupled with the underlying drivers of globalization, consumerism, and lifestyles are impacting healthcare providers in these areas: a) greater focus on healthcare in all areas, b) growing resource challenges, c) activate responsible citizens, and d) new approaches to promoting health and delivery care (Adams et al., 2015).

This type of change can only happen with cooperation from elicited study participants and change oriented researchers willing to take extra efforts in realizing the value of consumer knowledge and beliefs of what they want. The culture of Big Data is not so big when the details enlighten us all on how the next degree of patient satisfaction is achieved and stage 3 Meaningful Use is no longer perceived as the restrictive mold to fit into but the catalyst to explore and expand the boundaries of medical technology.

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Cont.

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