Telehealth Kiosks: The Next Step In Employee Health?

The Mayo Clinic is experimenting with an intriguing new way of delivering health care to employees--via a kiosk that connects the patient to a physician by video conference, over a secure, online link.

The Mayo Clinic Health System's clinic in Austin, Minnesota, is piloting the new program, called Health Connection. The kiosks were developed by HealthSpot, a health technology company based in Dublin, Ohio.

"This concept of a kiosk is fairly new," says Gary Capistrant, senior director of public policy for the American Telemedicine Association. "The advantage of telehealth is the convenience. An advantage to an employer is reduced absenteeism for workers."

"STEP INTO THE KIOSK."

The walk-in kiosks can take blood pressure readings, record the patient's height and weight, and feature a stethoscope, along with a device to look inside a patient's ears, nose, throat and eyes.

Officials say the system allows employees to see a provider quickly and conveniently, without an appointment. During the visit, the patient will talk with a Mayo Clinic Health System primary care provider, such as a physician, a nurse practitioner or a physician assistant.

The provider can discuss the employee's symptoms and make a diagnosis and treatment plan, which is then integrated into the patient's medical record. Conditions that can be seen at the kiosks include earaches, sore throats, sinus infections or skin conditions.

According to Steve Cashman, CEO of HealthSpot, the Mayo Clinic is one of a handful of employers that are experimenting with the kiosk system. Others include the Kaiser Permanente health system in San Diego, and the Cuyahoga County Justice center in Cleveland, Ohio. The company is developing provider relationships with health systems across the country, including Mayo Clinic, Kaiser Permanente, Miami Children's Hospital and Cleveland Clinic.

Cashman says the kiosk technology expands the reach of providers while managing resources effectively, allowing health care to remain affordable.

"Employers are looking to low-cost alternatives for emergency room or physician office visits for nonemergency health issues that their employees may have," he says. "Employees can find superior patient experiences right in their place of work, where they spend most of their day. This decreases absenteeism, lowers costs and increases wellness."

Capistrant agrees that businesses will benefit from having employees who are able to access health care without leaving work. "This greatly reduces the amount of time the employee has to be away, and it's convenient--the employees love it," he says. "The notion of getting the right care at the right time can end up reducing cost."

Matt Bernard, MD, chair of Family Medicine at Mayo Clinic, says the kiosks could be the next step after retail clinic-type sites, which many employers use to give employees convenient care options.

"This is taking that same idea but putting in the technology and encompassing the visits in a different way," he says. "This is an exciting step for us--it gets us further down the road in trying to identify ways to care for patients in a less costly, but ultimately higher-quality way."

HANDS-OFF CARE?

A number of physicians have questioned whether a remote physician can deliver the best quality of care, but Bernard says that despite skepticism, physicians will eventually adapt, because patients are embracing new technological solutions.

"We were all trained to practice medicine a certain way," he says. "But we are in some ways failing to provide the type of services our patients need when they need it and where they need it. I look at it as listening to the voice of the patient. This might be an opportunity to give them what they want instead of what we've always thought they should have."

Bernard notes the experience of the retail clinics, which raised similar concerns from physicians. "They got busy pretty quick," he says. "You can fight that, but the reality is that it's providing a service that patients want."

Cashman says that the remote sensors will give physicians data similar to what they would get in person.

"The HealthSpot platform is more than just a virtual face-to-face visit. It has been recognized by medical boards and health systems as being truly equivalent to an in-person visit, including the ability to have a remote physical exam," he says. "HealthSpot's platform establishes face-to-face dialogue, sets a path to follow-up treatment, maintains a readily available medical record, and documents electronic prescription information as part of the patient medical record."

Finally, Cashman says, the HealthSpot visit is an interactive experience for patients.

"Patients are empowered by seeing what the doctor sees during the visit," Cashman says. "[It] gets people excited about their own health care."

AN EMERGING TECH

In general, experts describe the telehealth kiosks as a technology that's still evolving. Cashman says developing new health delivery solutions can be a "long road."

"There are many stakeholders," he says. "Policy regulation lags behind technological innovation, and changing insurance policies have created confusion." He notes that his company is working with lawmakers in Ohio on legislation to require telehealth visits to be reimbursed by insurance plans.

"Our goal is to make the patient insurance piece work the same way a regular in-office visit would work," Cashman says, adding that in many cases, carriers already do cover telehealth.

The practical economics of the system also need to worked out between employers and technology companies, as well as health systems. HealthSpot charges a one-time implementation fee, but there are also maintenance and licensing costs.

Capistrant says one of the attractive features of the kiosk approach is that it doesn't require an employer to create a new clinic in a facility--the kiosk is a self-contained unit, "ft can be dropped on the site and be up and running quickly," he says. "One of the selling features is the ease of setup."

Bernard says Mayo Health System sites currently have retail clinic-type sites for employees, but a kiosk site could be another tool to help find the best fit for employee health. The new kiosk site in Austin allows the clinic to "kick the tires, work out the bugs, and partner with local organizations to see where it's a good fit," he says.

"It might not work, but it takes us a step in a direction we want to go," Bernard adds. "And it helps us educate our patients; to start to change the dynamics of always having to come in [to a clinic] for everything."

So could delivery of primary health care services continue to evolve, from clinic appointments, to retail sites, to kiosks, and even beyond?

"I can envision a time where you don't even have to leave your home to have a visit. As long as the technology is good, you could be on your smart phone and have an office visit," Bernard says. "I think the opportunities are unlimited."