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A health kiosk-decision support system may be a novel and important approach to improve provider prescription patterns.
Veterans Administration (VA) Palo Alto Healthcare System, through collaboration with Stanford University and the University of California, San Francisco, is having great success with self-serve kiosks to screen and reduce antibiotic use in its patient population of 10,000.
“A health kiosk decision-support system may be a novel and important approach to improve provider prescription patterns,” says Rona Margaret Relova, MD, a research health scientist with the VA Palo Alto Healthcare System. “An interactive, self-service kiosk allows patients to input information about their illness. Utilizing patient provided data, the decision-support system then generates customized recommendations for healthcare providers.”
To determine just how effective the kiosks could be in reducing antibiotic use, Leonard Goldschmidt, MD; Mitchell Wong, MD; Rona Relova, MD; Ralph Gonzales, MD; and Don Collado of the VA Palo Alto Institute for Research and Education, conducted a study on the administration of electronic clinical screenings via the kiosks during flu season.
Vecna, a patient solutions company based in Cambridge, Massachusetts, provided the Patient Information Exchange platform that pulls from siloed health information systems and gives VA Palo Alto patients the ability to update their demographics and insurance information, and to register using onsite kiosks.
The kiosk platform comprises six modules: pre-registration, onsite registration, patient queuing, surveys and forms, clinical messaging, and a business intelligence data warehouse. The study researchers used the survey and forms module to conduct clinical screenings on acute respiratory tract infections.
In addition, researchers used a system application to assess the utility of the decision-support algorithm to guide antibiotic treatment of acute respiratory tract infections (ARIs). Microbial antibiotic resistance is linked to delays in appropriate care, increased costs of inpatient care, and excess mortality. A root cause of this public health problem is non-selective use of antibiotics.
“Overuse of antibiotics may be the reason for the continued proliferation of germs because inadequate antibiotic treatments result in a strengthening of germ populations,” Relova states.
Efforts to reduce unnecessary antibiotic use have focused on the outpatient management of ARIs, since these conditions account for 75% of ambulatory antibiotic prescriptions.
The study results suggest that a paper-based, decision-support algorithm may result in a reduction of 30% in unnecessary antibiotic use for ARIs.
“Results also showed that veterans were very engaged,” says Leonard Goldschmidt, MD, one of the principal investigators involved in the pilot study. “They actually took the screening surveys on their own and 100% of patients who started the survey answered all of the questions. In fact, many wanted to learn more about their symptoms and chief complaints.”
“Aside from the benefits to the veterans, this method of clinical screening is helpful to physicians as it serves as a way for providers to align patient attitudes and expectations with their prescribing behaviors,” adds Ralph Gonzales, MD, chief innovation officer, University of California, San Francisco, another lead on the project.
The kiosks, part of the nationwide implementation, include business functions (e.g., check patient eligibility, update personal information) and interface directly with the VA computerized patient record system, thus allowing systems to share data.