Creating a Diabetes Technology Kiosk in the Clinic

If there’s one thing you can say about interactive kiosks, it’s that they are impossible to ignore, even in the outpatient endocrinology office. This technology has been front and center at some of the largest and most successful retail, food, hotel and transportation businesses for quite some time. Less known, however, is the reason for their recent proliferation in medicine and diabetes.

Currently, there is a lot of conversation about the rise of the “consumer” as a newly empowered stakeholder in our country’s health-care system. It’s admirable to do whatever we can to make health care more accessible and transparent to the people who need it and to help patients become active participants in their own care. Giving patients a voice—and listening closely to that voice—is the single most important driver to a better health-care system. Compared to a decade ago, we now have a system in which patients feel they have more information and more choice. Health reforms and new technologies are, to some degree, starting to put the patient in the driver’s seat.

As medicine shifts from viewing people as patients to consumers, expect to see changes such as kiosks in offices. While it’s easy for the casual observer to dismiss them as a novelty or cost-cutting measure, major players in this technology space understand that kiosks can play a critical role in the way they engage customers, promote new products and improve operational efficiencies.

The birth of interactive kiosks

The first self-service interactive kiosk was developed in 1977 at the University of Illinois at Urbana-Champaign by premed student Murray Lappe. The content was created on the PLATO computer system and was accessible by plasma touch screen interface. The plasma display panel was also invented at the University of Illinois at Urbana-Champaign, by Donald Bitzer. Lappe’s kiosk, called The Plato Hotline, allowed students and visitors to find movies, maps, directories, bus schedules, extracurricular activities and courses. When it debuted in the University of Illinois student union in 1977, more than 30,000 students, teachers and visitors stood in line during its first six weeks to try their hand at a “personal computer” for the first time. The first successful network of interactive kiosks used for commercial purposes was developed by the Florsheim Shoe Company in 1985. The network of more than 600 kiosks provided images and video promotion for customers who wished to purchase shoes that were not available in the retail location. Style, size and color could be selected, and the product paid for on the kiosk itself. The transaction was sent to the Florsheim mainframe in St. Louis, Missouri, via dial-up lines for next-day delivery. This kiosk network operated for six years in Florsheim retail locations.

In 1991, the first commercial kiosk with Internet connection was displayed at the Comdex computer expo to locate missing children.

Kiosks today

Kiosks now combine the classic vending machine with high-tech communications and complex robotic and mechanical internals. Such interactive kiosks can include self-checkout lanes, e-ticketing, hospital check-ins, medical device downloads and viewing, and vending. Interactive kiosks have become a larger part of the retail and medical landscape as customers embrace technology in their daily lives.

It is often said that “the language of the millennials is digital.” It’s not surprising that this generation raised by technology would prefer a kiosk type of digital, customizable consumer experience in health care. Therefore, the use of a diabetes kiosk for medical devices within our pediatric endocrinology office in Columbus, Ohio, has been successful.

Pediatric endocrinology office kiosk case example

Patients begin their appointment experience by sitting down at a public computer, or kiosk.

They are greeted by a friendly medical assistant and a set of instructions detailing which software programs they will need to open on the kiosk desktop. The software program is determined by each patient’s glucose meter, insulin pump or continuous glucose monitoring device. Current diabetes device software programs used on the kiosk include Diasend, Glooko, Carelink and Dexcom.

The patient then uses the designated device connection cord provided by the medical device company to access the kiosk and software. The cords hang next to the kiosk and are a visible reminder of the lack of interoperability between medical devices.

Once the devices are connected to the software programs, the patient’s device data from the past two weeks are downloaded and printed out by a printer at the kiosk station so that the data can be quantified and visualized. Total daily insulin doses, number of daily boluses, average blood glucoses, percent time in range, percentage of time below target, and amount of time between infusion set changes are just a few of the summary data points that quantify each patient’s diabetes experience and are then discussed during the clinic visit. Having patients successfully use the software programs with their devices allows them to confidently communicate with the office between visits if they need assistance with their data interpretation or pattern management.

In our experience, these kiosks in the outpatient endocrinology clinic have provided benefits in patient empowerment, patient engagement, patient support, communication and office visit efficiency.

Patient empowerment

People want to feel empowered. The elements for empowerment most often requested by our patients are continuity and connectedness. Kiosks allow for data visualization that makes comparisons of information collected over time easy. This continuity allows the eye to visualize differences within the same landscape. In other words, the continuity turns the numbers into pictures and then stories that clarify the diabetes experience. Once the diabetes experience is clarified, it can be better understood and consumed. This allows for a common shared connectedness among the patient and the care team (providers, caregivers, parents, spouses, babysitters, school nurses), which eventually leads to empowerment. Once these elements exist, the next logical step of empowerment is engagement.

Patient engagement

Engagement, non-hurried and enabled by interactive kiosk software, is the medical experience all people desire. As noted, sharing a complete quantified diabetes experience aided by the kiosk with the patients themselves and their care team allows for empowerment. The empowerment is often directly related to finding actionable data patterns that relate to each patient’s current diabetes experience. Sometimes the patient or family cannot find that pattern unless the provider points it out during the clinic visit. However, once that pattern is revealed, it is more likely that a patient can understand what behaviors will help to change that pattern. Nonetheless, behavior change can only happen when a patient is ready.

Patient support

Encouraging families to download data from their child’s medical devices on a weekly basis has allowed parents to reduce the burden of diabetes on their children by helping directly with pattern management and problem-solving. This has been especially true for our teenage patients, who often operate their devices independently of their parents. However, teens can easily become overwhelmed, which leads to compensatory behaviors such as lying about blood sugars to their parents and ignoring their diabetes all together. Weekly downloads allow parents to be more informed about their teen’s diabetes habits and offer support early and often when a problem first develops.

Communication

Kiosk downloads have allowed for streamlined communication between visits when families need extra assistance in pattern management, a core principle for successful diabetes management. When the provider is able to review the data within the full picture of total daily insulin dosing as well as past and present continuous glucose trends, a precise dosing recommendation can be made. Furthermore, discussion of the data visualization and the diabetes experience can be used to teach the principles of pattern management to better empower each patient and their families between visits. Communication about device settings (which is noted in the kiosk downloads) has been very helpful for families that have children with multiple caregivers: daycare, school nurses, teachers, coaches, babysitters, grandparents. Families are able to access the data easily from home to share with these caregivers. The consistent data presentation of device settings from the downloads has allowed each of these stakeholders to clearly see how each device should be set, thereby minimizing dosing errors while the child is in their care.

Office visit efficiency

Having patients download their own data at the office kiosk has also improved operational efficiencies within the office. Prior to the kiosk, the downloading process by the medical assistants was slowed by the need to perform multiple tasks by one person: vitals, urine checks, in-office A1C checks, device downloads. Having a patient and/or their family member download the device’s data allows the medical assistant to measure the patient’s A1C and check vitals while someone else downloads the information. Furthermore, when there is a line to check into the office, a patient can begin the downloading process at the kiosk, thereby better utilizing the wait time. The downloading time was a bit slower while patients and families initially learned the kiosk process, but after only one or two more visits, patients and families were able to quickly access their data and subsequently were escorted into the exam room. This improved efficiency has allowed for more time to be spent with the provider than on administrative tasks during each office visit.

In conclusion, kiosks have become a tool for patient empowerment, engagement, communication and efficiency within the pediatric endocrinology office. Despite the fact that technology can often be impersonal, kiosks can aid in personalization for the diabetes consumer…and just make life with diabetes a little bit easier and quicker.

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Kiosk checklist

• Computer
• Printer
• Software programs that coordinate with glucose monitoring devices, i.e., Diasend, Glooko, Carelink and Dexcom
• Cords for connecting devices to the kiosk computer and software
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Access additional resources and practical information to enhance the care and treatment of your diabetes patients.

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About our expert: Jennifer Shine Dyer, MD, MPH, Central Ohio Pediatric Endocrinology and Diabetes Services Columbus, Ohio