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Sunday, May 19, 2013

Healthcare via Kiosk. Boone or Bane?

The American Optometric Society and I do not often see eye to eye on various topics...on this subject we are in complete agreement. They posted this article on their website. I have edited the article and offered editorial opinion as well. If you wish to read the whole article in its unedited form, see the link at the end of this blog post. DM

Are you being replaced by a kiosk?
By Katie Ulrich, Williams Group

....... A bill being drafted for introduction to the state legislature in Utah, H.B. 408, would apparently allow a company like 1800Contacts (interestingly, the bill's sponsor is Greg Hughs of Draper, UT, home of 1800Contacts) to set up kiosks in stores like Walmart and dispense prescriptions for glasses. No waiting room, receptionist or optometrist needed; just put your head in the machine, select your frames and lenses, swipe your credit card, and wait for your new glasses to arrive in the mail......

..., the kiosks being proposed in Utah's H.B. 408 are clearly a threat. ... these kiosks would pose new risks for consumers. Any legalization of a self-service option like this could easily be perceived as an official "okay" for many to put off or completely forgo their next in-depth eye exam, opening the door to a range of unexpected eye health issues.

In a span of a few weeks back in 2008, over 6,000 people used one of the free vision screening kiosks located inside a Georgia Walmart store. Imagine if that same kiosk had given out prescriptions as well. A slight inaccuracy with the built-in autorefractor of just one kiosk could be responsible for thousands of people walking around with eye strain or headaches.

The idea of self-serve eyewear becomes even more of an issue when it comes to providing comfortable, properly-adjusted frames. Most consumers have no idea how much their level of vision and comfort is improved by a skilled optician. Even in the frame selection process,... Without involving a good optician, the overall comfort and enjoyment of your new eyewear is going to be greatly compromised. Additionally, many of today's self-serve consumers would be likely to attempt their own eyewear adjustments when their frames arrive, resulting in an even greater loss of quality vision and comfort.

The most significant threat from this type of legislation, however, is that it would allow self-serve technology to basically "perform medicine", diagnosing and prescribing without the direction of a doctor. Logically, if we replace a trained medical professional with a kiosk in this arena, we can expect to begin doing so in other arenas as well.

Will the kiosks (or their owners) actually care about each kiosk user individually like you care about each of your patients? It's easy to assume that those interested in legalizing these kiosks are more interested in what they have to gain financially than they are in advancing the overall vision and health each individual these kiosks would service.

As an eyecare provider, you are well-trained in eye health-related conditions that can threaten one's vision; and you have taken an oath to "faithfully and conscientiously practice the art and science of optometry with concern and compassion." Your mission is to help your patients restore, maintain and enhance their vision and general health. In conducting a complete eye exam, you not only provide your patients with a prescription for eyeglasses, you identify other risks to their health and diagnose conditions that can be both vision- and life-threatening.

....  if we cross the line into letting kiosks or other self-serve solutions perform functions that have been – and should continue to be – reserved for trained members of the medical profession, we open ourselves up to a world where convenience and price not only trump good customer service, but also the future of our overall health, well-being and quality of life.

Comments: I am a very strong proponent for the use of disruptive technology.This is a form of technology that  "has a serious impact on the status quo and changes the way people have been dealing with something, perhaps for decades. Music CDs all but wiped out the phonograph industry within a few years, and digital cameras are destined to eliminate the film industry. The most disruptive technologies in history have been the telephone, the computer (and all of its offshoots) and the Internet (1)." This technology should always be for good and NOT evil. (Yes, I actually said that!). 

In several conversations with Vitor Pamplona PhD ***, where we discussed disruptive technology in health care, he noted that in a relatively short amount of time, we will be conducting our own specialized health care testing at home. We will be using instrumentation that previously was only available in a hospital or doctor's office and printing our own glasses after using a deice like his NetraG to obtain a refraction. This "disruptive technology" has the potential to place an individuals'  health care squarely within his or her own domain. Scary? Yes. Empowering? Also yes. Dangerous? Definitely.

If this technology is driven by companies whose only concern is profit and not patient welfare, we all loose. If this technology does not include the didactic and clinical knowledge and skill of the health care practitioner, it does not serve the patient well and could result in poor health care outcomes. Our patients are smarter than ever before. They have a tremendous amount of resources available when it comes to health care. Oftentimes however, this information can be contradictory, confusing, misleading or just plain wrong.

With the use of any technology, we often need a trusted guide. Your primary care doctor, such as your family optometrist, is the individual you can always go to for the most up to date information. Great health care, with outstanding outcomes depends upon the human factor as much as it does the technology involved.

In the not too distant future, I (like Vitor) believe that disruptive technology will significantly affect healthcare delivery and outcomes. The doctors of today must be ready to assist that self-serve patient of tomorrow for the benefit of all.

*** (Vitor is a MIT researcher who helped to developed of the Netra and NetraG cell phone-based autorefractor. He was a source for a past technology column in the AOANews (DIY Refractions). He will be a resource for a future AOANews column tentative titled "Dr. could you please print my new pair of glasses?" concerning the use of 3D printers.)

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