Could your practice use a waiting room kiosk?

How to turn waiting time into learning time

Bryan P. Bergeron, MD

VOL 107 / NO 4 / APRIL 2000 / POSTGRADUATE MEDICINE

Waiting is an inescapable component of the doctor visit, given the variation in time needed by different patients. Fish tanks, dog-eared magazines, and elevator music can go only so far in placating waiting patients, but most of them grudgingly accept the delay. Many are probably more than a little anxious about whatever ails them and are hungry for knowledge about the condition and its cure. But it may not be until after the visit is over that they think of information they'd like to have or questions they didn't have time to ask.

This is where a waiting room kiosk can help. Why not transform your waiting room into an integral part of your practice and make time spent there something to look forward to? Properly implemented, a waiting room kiosk can both educate your patients, potentially increasing compliance with your recommendations, and allay their fears.

The investment
Hardware requirements for a waiting room kiosk are a computer with multimedia capabilities, a laser printer, and either a high-speed connection to the Internet or a few CD-ROMs. For about $2,000, you should be able to purchase a 300-MHz Pentium II, 64-MB RAM, 6-GB hard drive system with a 19-inch screen. You'll also need a small desk, a couple of chairs, and a mouse pad. If you don't have a spot in your waiting room that allows privacy, consider putting up a partition, because some patients might be embarrassed about the subject matter they want to look up.

The real issue in setting up a waiting room kiosk is the source of the educational materials. You can go with a totally open kiosk based on the Internet, a totally self-contained design based on CD-ROMs, or a hybrid that uses both. Factors to consider are initial and ongoing costs, comfort level with the information your patients will be receiving, and time needed to get the kiosk ready to use.

If you decide to use the Web as your main source of information, a high-speed cable modem or DSL connection is a must. Rates vary, but you can expect to pay about $50 per month for high-speed Internet access service. If you decide to go with a stand-alone, CD-ROM approach, your initial cost may be as much as $1,000 above the cost of the computer, but there won't be any monthly charges. However upgrades, when they become available, may cost a few hundred dollars over the course of a few years. A hybrid approach, with both a library of CD-ROMs and access to the Internet, is probably the most expensive approach. Opting for a 56-K, low-speed Internet connection can save some money, but you'll still have to pay for an additional telephone line.

The content
Regardless of the source of information, I think a waiting room kiosk should provide the following:

• A medical dictionary
• An anatomic atlas
• A drug reference
• A nutrition-analysis program
• A general medical reference resource

Of course, you can easily add to this core offering (eg, a tutorial on breast examination), depending on your patient demographics.

If you decide to go with a full or partial Internet kiosk design, you should encourage use of links that you have screened. Using Microsoft Word or another editor that saves results in HTML format, you can customize a home page for your browser that lists sites you've selected. You might want to add a note to your home page stating that you selected the links and believe them to reflect good medicine but that you cannot take responsibility for the content. Of course, a similar note, posted in the kiosk, is appropriate for CD-ROM software as well.

The following are Web sites worth considering for your kiosk:

• http://www.medicineNet.com has an easy-to-understand, comprehensive medical dictionary. In addition, the site covers medications, conditions, and medical tests. The advantage of this site for patients is that they choose terms by scrolling down an existing list, so they don't have to know how to correctly spell a word or phrase to find it.
• http://www.ncsu.edu/sciencejunction/terminal/imse/lowres/1/anatomy.shtml is an index of Web-based anatomy references. You'll probably want to examine each link in depth and provide direct links to the images that you feel are most appropriate to your patient population. For example, one of the links, "The Heart: An Online Exploration" (http://sln.fi.edu/biosci/heart.shtml), describes and shows the structure and function of the heart in patient-friendly terms.
• http://www.drkoop.com provides a comprehensive overview of general medical content, including drugs, exercise, nutrition, family health, and mental health. This popular site also has a variety of specialty-specific information "pockets," such as women's health, men's health, and parenting and children's health.
• http://www.nal.usda.gov/fnic/index.shtml is an impressive, comprehensive site for diet analysis, nutrition reference, and exercise planning. The US Department of Agriculture is a reputable source, and content (eg, an interactive nutrition-analysis program) is easy and fun to use.
• http://www.realage.com is based on internist Michael F. Roizen's book RealAge: Are You As Young As You Can Be? Patients can enter their risk factors and view their medical age. Included are a medical encyclopedia, drug reference, and behavior reference. This is a good site to help motivate patients to lose weight, quit smoking and, in general, adopt a healthier lifestyle.

If you don't have appropriate access to the Internet, don't want to be surprised by content downloaded and printed from your kiosk, or simply prefer a stand-alone system, you may want to opt for a CD-ROM design. A variety of CD-ROM offerings are available (unless otherwise noted, from Continuing Medical Education Associates at 800-447-4474 or http://www.medinfosource.com or from PC Connection at 888-213-0260 or http://www.pcconnection.com). Consider loading the CD-ROMs onto your hard drive so patients don't have to fumble with extra equipment. The following are titles that I've reviewed and recommend:

• Stedman's Medical Dictionary 4.0 ($80) contains more than 100,000 definitions and about 800 images. The only downside to this CD-ROM is that some of the definitions might be too complicated for some patients.
• Mosby's Medical Encyclopedia ($35) is a more approachable, but less complete, CD-ROM dictionary. It includes a drug guide, handbook of diseases, and reasonable human atlas and is worth considering. It is available from The Learning Company (617-761-3000).
• NutriBase Personal+ (available from http://www.dietsoftware.com) is probably the most comprehensive and easy to use of the inexpensive ($89.95) nutrition-analysis CD-ROM programs available. The food database, which can be modified, contains common fast foods as well as traditional foods. The professional version, NutriBase Clinical: Nutrition and Fitness Manager ($495), may be worthwhile if serious nutrition analysis is part of your practice. NutriBase Clinical is available from CyberSoft (800-959-4849) or at http://www.NutriBase.com.
• The Virtual Human ($99) is an affordable, interactive, engaging program that lets your patients view anatomic structures in 3-D.
• Netter's Interactive Atlas of Human Anatomy ($99) is a more traditional treatment of anatomy, but the more than 900 amazing illustrations by Frank Netter are hard to beat.
• Mayo Clinic Family Health ($40) provides a patient-oriented 3-D anatomy atlas in addition to a general medical reference.
• Mosby's Patient GenRx ($99) covers the 650 medications that are prescribed most often, providing 1- and 2-page sheets that are designed to be printed and carried home.
• The Mayo Clinic Family Pharmacist ($30) covers more than 9,000 drugs, including common side effects, potential drug-drug interactions, and the usual precautions. To purchase this CD-ROM, check with your local computer software retail outlet or IVI Publishing at http://www.ivi.com.
• The AAFP Patient Education Handout CD-ROM ($195) furnishes comprehensive, readable information on 300 of the most common medical conditions. The handouts are designed to be printed.

Too much of a good thing?

The downside of a waiting room kiosk is that it may become too popular. When patients see that they can obtain more free information about their particular illness than they ever imagined, they may be reluctant to give up the keyboard. You may have to limit use to 10 minutes per patient, use a sign-up sheet, or add a second computer to give everyone reasonable access. The idea is to provide something productive for patients to do in the waiting room, not to add another dimension to the wait.

Your comments and discoveries about using computers in practice and for fun are welcome and may be published in Digital Doc. Contact us

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Please send technical questions related to the Web site to Ann Harste