From Retail Clinic to the Cloud: The Rise of Medical Kiosks

You’ve probably noticed the do-it-yourself blood pressure monitor installed in your local pharmacy, in the back with the pharmacist. You may have also noticed or even used the services of a walk-in mini-clinic, also common in pharmacy chains, for minor illnesses, screens or physicals. They’re convenient, covered by insurance plans, and typically staffed by nurse practitioners or physician assistants. Often, the treatment you receive there is overseen by physicians at local brick-and-mortar healthcare centers.

What you may not have seen yet adds a thermometer, scale, spirometer, otoscope, stethoscope, dermatoscope, pulse oximeter and perhaps other diagnostic devices to that DIY blood pressure cuff.  Applied to forehead, chest, ear, skin, etc. by the patient herself, these instruments wirelessly transmit their images or readings through an encrypted IP connection to the physician on the other end of a videoconferencing session. They ultimately send this data, with patient permission, to the electronic health record system of the affiliated healthcare organization. There’s still a clinician — or perhaps just a trained pharmacy employee — on site to help the walk-in patient. There are also walls that wrap the whole array into a sound-proof mini-room for HIPAA-compliant privacy.

These are medical kiosks, and an increasing number of companies are programming and assembling the hardware, software, physician networks and telecom infrastructure to install these in retail outlets, corporate workplaces, schools, malls, and anywhere else where traditional examination rooms and clinicians may be scarce. In 22 “parity” states and the District of Columbia, legislators have ruled that telehealth clinics should be reimbursed by payers “at parity” — under the same copay and deductible terms as those of on-site providers.

With the ACA, doctors are rewarded for avoiding hospitalizations and emergency room visits.

Credit (or blame) the Affordable Care Act for the business case. In an age in which fee-for-service medical practices are giving way to ACOs, (cost-accountable care organizations), doctors are rewarded for avoiding hospitalizations and emergency room visits. Kiosks take a step in that direction by making patient access easier, less expensive and more convenient.

Registering patients via on-screen directions and keyboard, kiosks automate the paperwork formerly requiring desk staff, copiers and clipboards. They can guide the patient through the preliminaries that nurses often perform: weight, height, blood pressure, pulse, body mass index. Scanning insurance and credit cards, they automate payment. They also make it possible to serve many patients on demand by pooling a network of general practitioners and even specialists on a next-available-doctor basis. In doing so, they make use of virtual call center technology, which routes audio, video, and data over IP among “agents” who are physically dispersed. And as in other call center systems, they efficiently grow or shrink the pool as traffic demands. Doctors tapped for tele-visits may work in in-person practices most of the time.

Medpod, a new entrant in this space, is launching April 15. CEO Jack Tawil has a background in Walmart retail clinics. “The break-even point for these clinics was 22 to 25 patients per day at around $79 per visit,” he says. Unfortunately, that number went down by half in the summer. Tawil’s goal is profitability with as few as 10 patients per day.

The other driver behind these kiosks is the shortage of providers in rural areas. “Walmart’s had up to 10,000 people a day coming into their stores from up to a 45-mile radius,” says Tawil, “but we couldn’t find the nurse practitioners registered in the region to staff their clinics.”  For a while, he recruited them to stay in local hotels on a rotating basis and work 12-hour shifts.

The other driver behind these kiosks is the shortage of providers in rural areas.

Tawil’s new business model taps clinicians remotely, in tandem with an on-site staffer who, depending on the range of tests offered, can be an RN or even a medical assistant (MA) with phlebotomy skills. At 220 square feet, a Medpod structure offers a large array of Welch Allyn diagnostic devices and services; Tawil goes so far as to call it a full-service medical facility. A Medpod has its own bathroom, labs, as well as options for ECG and X-ray. A mobile version, with two examination rooms and a waiting area, is trailered in and usable within half an hour, according to Tawil.

Medpod, which is backed by a major name in medical supplies, is currently in pilots with hospital outpatient departments, and as an adjunct to urgent care facilities.

The live doctor on Medpod’s screen may be associated with a specific healthcare system or part of a third-party, all-telehealth network of providers; several of these already exist. He or she can conference in, power and read instruments through a browser-based application that uses WebRTC for voice and video, and an HTML5 container. My Cloud communications platform is provided by Meditel360, a startup with roots in virtual call centers.

A similar call-center platform underpins the kiosks of Computer Screening, Inc., a firm with a 37-year history that goes back to those early DIY blood pressure cuffs. CEO Charles Bluth’s early deployments centered around corporate customers with self-funded health plans. Today, he’s working with prisons: “The prison industry spends $300 million a year transporting prisoners to emergency rooms,” says Bluth.  “In 70 percent of the cases, they don’t need to be.”

Fortunately, these are just a handful of examples showing the healthcare industry’s transformation to a modern digital (and mobile) era, but it’s been — and continues to be — done at a rather slow pace. “It’s one of the last industries that has moved from a pure paper-based system to an all-digital system,” said Frank Nydam, VMware senior director, Healthcare Solutions. As the aforementioned trends continue to accelerate in popularity, however, the rest of the industry will follow.