Simulation Modeling of a Check-in and Medication Reconciliation Ambulatory Clinic Kiosk

Lesselroth, Blake; Eisenhauer, William; Adams, Shawn; Dorr, David A.; Randall, Christine; Channon, Paulette; Adams, Kas; Church, Victoria; Felder, Robert; Douglas, David

doi:https://doi.org/10.1260/2040-2295.2.2.197

Journal of Healthcare Engineering

On this page

Abstract References Copyright Related Articles

Research Article | Open Access

Volume 2 | Article ID 967897 | https://doi.org/10.1260/2040-2295.2.2.197

Simulation Modeling of a Check-in and Medication Reconciliation Ambulatory Clinic Kiosk

Blake Lesselroth,^1,2William Eisenhauer,¹Shawn Adams,^1,2David A. Dorr,²Christine Randall,¹Paulette Channon,¹Kas Adams,¹Victoria Church,¹Robert Felder,¹and David Douglas¹

Received01 Aug 2010

Accepted01 Jan 2011

Abstract

Gaps in information about patient medication adherence may contribute to preventable adverse drug events and patient harm. Hence, health-quality advocacy groups, including the Joint Commission, have called for the implementation of standardized processes to collect and compare patient medication lists. This manuscript describes the implementation of a self-service patient kiosk intended to check in patients for a clinic appointment and collect a medication adherence history, which is then available through the electronic health record. We used business process engineering and simulation modeling to analyze existing workflow, evaluate technology impact on clinic throughput, and predict future infrastructure needs. Our empiric data indicated that a multi-function healthcare kiosk offers a feasible platform to collect medical history data. Furthermore, our simulation model showed a non-linear association between patient arrival rate, kiosk number, and estimated patient wait times. This study provides important data to help administrators and healthcare executives predict infrastructure needs when considering the use of self-service kiosks.

References

The Institute of Medicine, Preventing Medication Errors, National Academy of Sciences, Washington DC, 2006.
D. Bates, N. Spell, D. Cullen, E. Burdick, N. Laird, L. Petersen et al., “The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group,” Journal of the American Medical Association, vol. 277, no. 4, pp. 307–11, 1997.
View at: Google Scholar
S. Hasan, G. Duncan, D. Neill, and R. Padman, “Towards a collaborative filtering approach to medication reconciliation,” in AMIA Symposium Proceedings, pp. 288–92, 2008.
View at: Google Scholar
P. Pronovost, B. Weast, M. Schwarz, R. Wyskiel, D. Prow, S. Milanovich et al., “Medication reconciliation: A practical tool to reduce the risk of medication errors,” Journal of Critical Care, vol. 18, no. 4, pp. 201–5, 2003 December.
View at: Google Scholar
J. Pippins, T. Gandhi, C. Hamann, C. Ndumele, S. Labonville, E. Diedrichsen et al., “Classifying and predicting errors of inpatient medication reconciliation,” Journal of General Internal Medicine, vol. 23, no. 9, pp. 1414–22, 2008.
View at: Google Scholar
J. Santell, “Reconciliation failures lead to medication errors,” Joint Commission Journal on Quality and Patient Safety, vol. 32, no. 4, pp. 225–9, 2006.
View at: Google Scholar
T. Vira, M. Colquhoun, and E. Etchells, “Reconcilable differences: Correcting medication errors at hospital admission and discharge,” Quality and Safety in Health Care, vol. 15, pp. 122–6, 2006.
View at: Google Scholar
J. Schnipper, J. Kirwin, M. Cotugno, S. Wahlstrom, B. Brown, E. Tarvin et al., “Role of pharmacist counseling in preventing adverse drug events after hospitalization,” Archives of Internal Medicine, vol. 166, pp. 565–71, 2006 March 13.
View at: Google Scholar
S. Wortman, “Medication reconciliation in a community, nonteaching hospital,” American Journal of Health System Pharmacy, vol. 65, no. 1, pp. 2047–54, 2008.
View at: Google Scholar
M. Wagner and W. Hogan, “The accuracy of medication data in an outpatient electronic medical record,” Journal of the American Medical Informatics Association, vol. 3, no. 3, pp. 234–44, 1996.
View at: Google Scholar
P. Varkey and R. Resar, “Medication reconciliiation implementation in an academic center,” American Journal of Medical Quality, vol. 21, no. 5, pp. 293–5, 2006 September/October.
View at: Google Scholar
A. Makaryus and E. Friedman, “Patients' understanding of their treatment plans and diagnosis at discharge,” Mayo Clinic Proceedings, vol. 80, no. 8, pp. 001–994, 2005.
View at: Google Scholar
K. Orrico, “Sources and types of discrepancies between electronic medical records and actual outpatient medication use,” Journal of Managed Care Pharmacy, vol. 14, no. 7, pp. 626–31, 2008.
View at: Google Scholar
M. Staroselsky, L. Volk, R. Tsurikova, L. Newmark, M. Lippincott, I. Litvak et al., “An effort to improve electronic health record medication list accuracy between visits: Patients' and physicians' response,” International Journal of Medical Informatics, vol. 77, pp. 153–60, 2008.
View at: Google Scholar
A. Friedman, S. Georghegan, N. Sowers, S. Kulkarni, and R. Formica, “Medication errors in the outpatient setting,” Archives of Surgery, vol. 142, pp. 278–83, 2007 March.
View at: Google Scholar
A. Bergkvist, P. Midlov, P. Hoglund, L. Larsson, A. Bondesson, and T. Eriksson, “Improved quality in the hospital discharge summary reduces medication errors - LIMM: Landskrona Integrated Medicines Managment,” European Journal of Clinical Pharmacology, vol. 65, pp. 1037–46, 2009.
View at: Google Scholar
I. Bayoumi, M. Howard, A. Holbrook, and I. Schabort, “Interventions to improve medication reconciliation in primary care,” Annals of Pharmacotherapy, vol. 43(October), pp. 1667–75, 2009.
View at: Google Scholar
M. Manno and D. Hayes, “How medication reconciliation saves lives,” Nursing, vol. 36, no. 3, pp. 63–4, 2006.
View at: Google Scholar
G. Rogers, E. Alper, D. Brunelle, F. Federico, C. Fenn, L. Leape et al., “Reconciling medications at admission: safe practice recommendations and implementation strategies,” Joint Commission Journal on Quality and Patient Safety, vol. 32, no. 1, pp. 37–50, 2006.
View at: Google Scholar
B. Jack, V. Chetty, D. Anthony, J. Greenwald, G. Sanchez, A. Johnson et al., “A reengineered hospital dischage program to decrease rehospitalization,” Annals of Internal Medicine, vol. 150, no. 3, pp. 178–87, 2009.
View at: Google Scholar
D. Bails, K. Clayton, K. Roy, and M. Cantor, “Implementing online medication reconciliation at a large academic medical center,” Joint Commission Journal on Quality and Patient Safety, vol. 34, no. 9, pp. 499–508, 2008.
View at: Google Scholar
J. Rozich, R. Howard, J. Justeson, P. Macken, M. Lindsay, and R. Resar, “Standardization as a mechanism to improve safety in health care,” Joint Commission Journal on Quality and Patient Safety, vol. 30, no. 1, pp. 5–14, 2004 January.
View at: Google Scholar
J. Kramer, P. Hopkins, J. Rosendale, J. Garrelts, L. Hale, T. Nester et al., “Implementation of an electronic system for medication reconciliation,” American Journal of Health System Pharmacy, 2007 February 15, vol. 64, pp. 404–22, 2007.
View at: Google Scholar
K. Boockvar, S. Liu, N. Goldstein, J. Nebeker, A. Siu, and T. Fried, “Prescribing discrepancies llikely to cause adverse drug events after patient transfer,” Quality and Safety in Health Care, vol. 18, pp. 32–6, 2009.
View at: Google Scholar
S. Bedell, S. Jabbour, R. Goldberg, H. Glaser, S. Gobble, Y. Young-Xu et al., “Discrepancies in the use of medications,” Archives of Internal Medicine, vol. 160, pp. 2129–34, 2000 July 24.
View at: Google Scholar
Joint Commission on Accreditation of Healthcare Organizations, Hospitals’ National Patient Safety Goals. Washington DC2005; Available from: http://www.jcaho.org/accredited+organizations/patient+ safety/05+npsg/05_npsg_haphtm.
Institute of Healthcare Improvement, Protecting 5 Million Lives From Harm. Cambridge2007; Available from: http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm?TabId=1.
V. A. National Center for Patient Safety, NCPS TIPS - January/February 2006. Washington DC2007; Available from: http://www.va.gov/ncps/TIPS/Docs/TIPS_JanFeb06.doc.
The Massachusetts Coalition, Massachusetts Coalition for the Prevention of Medical Errors. [website] Burlington, Massachusetts2007 [cited 2007]; Available from: http://www.macoalition.org/index.shtml.
E. Poon, B. Blumenfeld, C. Hamann, A. Turchin, E. Graydon-Baker, P. McCarthy et al., “Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network,” Journal of the American Medical Informatics Association, vol. 13, no. 6, pp. 581–92, 2006 Nov/Dec.
View at: Google Scholar
J. Barnsteiner, “Medication reconciliation: Transfer of medication information across settings - keeping it free from error,” American Journal of Nursing, Supplement, pp. 31–6, March 2005.
View at: Google Scholar
B. Young, “Medication reconciliation matters,” MedSurg Nursing, vol. 17, no. 5, pp. 332–6, 2008.
View at: Google Scholar
B. Clay, L. Halasyamani, E. Stucky, J. Greewald, and M. Williams, “Results of a medication reconciliation survey from the 2006 Society of Hospital Medicine national meeting,” Journal of Hospital Medicine, vol. 3, no. 6, pp. 465–72, 2006.
View at: Google Scholar
J. King, J. Schommer, and R. Wirsching, “Patients' knowledge of medication care plans after hospital discharge,” American Journal of Health System Pharmacy, vol. 55, pp. 1389–93, 1998.
View at: Google Scholar
P. Cornish, S. Knowles, R. Marchesano, V. Tam, S. Shadowitz, D. Juurlink et al., “Unintended medication discrepancies at the time of hospital admission,” Archives of Internal Medicine, vol. 165(Feb 28), pp. 424–9, 2005.
View at: Google Scholar
P. Bridgeman and K. Rynn, “Medication reconciliation in the emergency department,” American Journal of Health System Pharmacy, vol. 65, pp. 2325–6, 2008 December 15.
View at: Google Scholar
K. Gleason, J. Groszek, C. Sulllivan, D. Rooney, C. Barnard, and G. Noskin, “Reconciliation of discrepancies in medication histories and admission order of newly hospitalized patients,” American Journal of Health System Pharmacy, vol. 61, pp. 1689–95, 2004 August 15.
View at: Google Scholar
T. Mersfelder and R. Bickel, “Inpatient medication history verification by pharmacy students,” American Journal of Health System Pharmacy, vol. 65, pp. 2273–5, 2008 December 1.
View at: Google Scholar
H. Vasileff, L. Whitten, J. Pink, S. Goldsworthy, and M. Angley, “The effect on medication errors of pharmacists charting medication in an emergency department,” Pharmacy World and Science, vol. 31, no. 3, pp. 373–9, 2009 June.
View at: Google Scholar
J. Millan, J. Rudolph, and M. Salow, “Pharmacologic Intervention in Late Life (PILL) Clinic: a geriatric model of care to optimize medication managment,” Journal of the American Geriatrics Society, vol. 55, no. s1:S100, 2007.
View at: Google Scholar
L. Bernstein, J. Framptom, N. Minkoff, S. Stepanian, L. Iapicca, J. Rollo et al., “Medication reconciliation: Harvard Pilgrim Health Care's approach to improving outpatient medication safety,” Journal of Healthcare Quality, vol. 29, no. 4, pp. 40–5, 2007.
View at: Google Scholar
R. Jones, “The role of health kiosks in 2009: Literature and informant review,” International Journal of Environmental Research and Public Health, vol. 6, pp. 1818–55, 2009.
View at: Google Scholar
B. Yackey, “Myth-busting - taking aim at seven common misconceptions,” Self Service World, pp. 17–20, 2007 July.
View at: Google Scholar
J. Rhoads and E. Drazen, Touchscreen check-in: kiosks speed hospital registration, California HealthCare Foundation, Oakland, 2009.
F. Bourgeois, S. Porter, C. Valim, T. Jackson, F. Cook, and K. Mandl, “The value of patient self-report for disease surveillance,” Journal of the American Medical Informatics Association, vol. 14, no. 6, pp. 765–71, 2007.
View at: Google Scholar
N. Wolcott, “Commentary: Self-service: Just what the doctor ordered,” Self Service World, pp. 1–3, 2009 March 4.
View at: Google Scholar
Anonymous, “Kiosks win patient kudos and speed registration,” Healthcare Benchmarks and Quality Improvement, vol. 12, no. 2, pp. 20–1, 2005 February.
View at: Google Scholar
Anonymous, “Sign-in kiosks shorten waiting room lines,” ED Management: The monthly update on emergency department management, vol. 19, no. 12, pp. 137–8, 2007 December.
View at: Google Scholar
D. Chisholm, R. Young, and A. McAlearney, “Implementation of a touch-screen new patient registration system: A case study,” The Journal of Medical Practice Management: MPM, vol. 21, no. 3, pp. 159–62, 2005.
View at: Google Scholar
F. Salaffi, S. Gasparini, and W. Grassi, “The use of computer touch-screen technology for the collection of pateint-reported outcome data in rheumatoid arthritis: comparison with standardized paper questionnaires,” Clinical and Experimental Rheumatology, vol. 27, pp. 459–68, 2009.
View at: Google Scholar
J. Fann, D. Berry, S. Wolpin, M. Austin-Seymour, N. Bush, B. Halpenny et al., “Depression screening using the Patient Health Questionnaire-9 administered on a touch screen computer,” Psycho-Oncology, vol. 18, pp. 14–22, 2008.
View at: Google Scholar
E. Aagaard, P. Nadler, J. Adler, J. Maselli, and R. Gonzales, “An interactive computer kiosk module for the treatment of recurrent uncomplicated cystitis in women,” Journal of General Internal Medicine, vol. 21, pp. 1156–9, 2006.
View at: Google Scholar
H. Bischoff-Ferrari, M. Vondechend, N. Bellamy, and R. Theiler, “Validation and patient acceptance of a computer touch screen version of the WOMAC 3.1 osteoarthritis index,” Annals of Rheumatoid Disease, vol. 64, pp. 80–4, 2005.
View at: Google Scholar
S. Porter, Z. Cai, W. Gribbons, D. Goldmann, and I. Kohane, “The Asthma Kiosk: A patient-centered technology for collaborative decision support in the emergency department,” Journal of the American Medical Informatics Association, vol. 11, pp. 458–67, 2004.
View at: Google Scholar
S. Dixon, T. Bunker, and D. Chan, “Outcome scores collected by touchscreen: medical audit as it should be in the 21st century?” Annals of the Royal College of Surgeons of England, vol. 89, pp. 689–91, 2007.
View at: Google Scholar
Z. Agha, R. Lofgren, J. VanRuiswyk, and P. Layde, “Are patients at Veterans Affaris medical centers sicker?” Archives of Internal Medicine, vol. 160, pp. 3252–7, 2000.
View at: Google Scholar
U. S. Census Bureau, Oregon Veteran Status: survey statistics. Washington, DC2008 [cited 2010 October 8].
Society HIaMS, “EMR Adoption Model. Chicago: HIMSS Analytics,” 2010 [cited 2010 February 1, 2010]; Available from: http://www.himssanalytics.org/hc_providers/emr_adoption.asp.
View at: Google Scholar
C. DesRoches, E. Campbell, S. Rao, K. Donelan, T. Ferris, A. Jha et al., “Electronic health records in ambulatory care: A national survey of physicians,” The New England Journal of Medicine, vol. 359, pp. 50–60, 2008.
View at: Google Scholar
V. Jylha and K. Saranto, “Electronic documnetation in medication reconciliation - a challenge for health care professionals,” Applied Nursing Research, vol. 21, pp. 237–9, 2008.
View at: Google Scholar
J. Schnipper, T. Gandhi, J. Wald, R. Grant, E. Poon, L. Volk et al., “Design and implementation of a webbased patient portal linked to an electronic health record designed to improve medication safety: the Patient Gateway medications module,” Informatics in Primary Care, vol. 16, pp. 147–55, 2008.
View at: Google Scholar
B. Lesselroth, S. Adams, J. Yang, K. Adams, V. Church, R. Felder et al., “The impact of an automated medication reconciliation kiosk on primary care compliance standards,” [Poster]. In press 2010.
View at: Google Scholar
K. Vergidis, A. tiwari, and B. Majeed, “Business process analysis and optimization: Beyond reengineering,” IEEE Transactions on Systems, Man, and Cybernetics - Part C: Applications and Reviews, vol. 38, no. 1, pp. 69–82, 2008.
View at: Google Scholar
D. Anthony, V. Chetty, A. Kartha, K. McKenna, M. Rizzo DePaoli, and B. Jack, “Re-engineering the hospital discharge: An example of a multifaceted process evaluation,” Advances in Patient Safety, vol. 2, pp. 379–94, 2005.
View at: Google Scholar
Q. Su, X. Yao, P. Su, Jinghua, Shi, Y. Zhu et al., “Hospital registration process reengineering using simulation method,” Journal of Healthcare Engineering, vol. 1, no. 1, pp. 67–82, 2010.
View at: Google Scholar
A. Kusiak, N. Larson, and J. Wang, “Reengineering of design and manufacturing processes,” Computer and Industrial Engineering, vol. 26, no. 3, pp. 521–36, 1994.
View at: Google Scholar
J. Perlin, R. Kolodner, and R. Roswell, “The Veterans Health Administration: Quality, value, accountability, and information as transforming stategies for patient-centered care,” American Journal of Managed Care, pp. 828–36, 2004.
View at: Google Scholar
B. Lesselroth, R. Felder, S. Adams, P. Cauthers, D. Dorr, G. Wong et al., “Design and implementation of a medication reconciliation kiosk: the Automated Patient History Intake Device (APHID),” Journal of the American Medical Informatics Association, vol. 16, pp. 300–4, 2009.
View at: Google Scholar
“Imagine That I. ExtendSim. 7 ed. San Jose, CA2002,” p. Process simulation software.
View at: Google Scholar
T. Cayirli and E. Veral, “Outpatient scheduling in health care: A review of literature,” Production and Operations Management, vol. 12, no. 4, pp. 519–49, 2003.
View at: Google Scholar
J. Jun, S. Jacobson, and J. Swisher, “Application of discrete-event simulation in health care clinics: a survey,” Journal of the Operational Research Society, vol. 50, no. 1, pp. 109–23, 1999 February 9.
View at: Google Scholar
D. Eitel, S. Rudkin, MA. Malvehy, J. Killeen, and J. Pines, “Improving service quality by understanding emergency department flow: A white paper and position statement prepared for the American Academy of Emergency Medicine,” The Journal of Emergency Medicine, vol. 38, no. 1, pp. 70–9, 2010.
View at: Google Scholar
B. Lesselroth, S. Adams, R. Felder, D. Dorr, P. Cauthers, V. Church et al., “Using consumer-based kiosk technology to improve and standardize medication reconciliation in a specialty care setting,” Joint Commission Journal on Quality and Patient Safety, vol. 35, no. 5:263, 2009.
View at: Google Scholar
S. L. Walston, R. B. Lawton, and J. Kimberly, “Does reengineering really work?” Health Services Research, vol. 34, no. 6, pp. 1363–88, 2000.
View at: Google Scholar
T. Nester and L. Hale, “Effectiveness of a pharmacist-acquired medication history in promoting patient safety,” American Journal of Health System Pharmacy, vol. 59(November), pp. 2221–5, 2002.
View at: Google Scholar

Copyright

Copyright © 2011 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

PDF Download Citation Order printed copies

Views

990

Downloads

2514

Citations