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Research ArticleOriginal Research

Implementation of a New Kiosk Technology for Blood Pressure Management in a Family Medicine Clinic: from the WWAMI Region Practice and Research Network

Chia-Fang Chung, Sean A. Munson, Matthew J. Thompson, Laura-Mae Baldwin, Jeffrey Kaplan, Randall Cline and Beverly B. Green
The Journal of the American Board of Family Medicine September 2016, 29 (5) 620-629; DOI: https://doi.org/10.3122/jabfm.2016.05.160096
Chia-Fang Chung
From the Department of Human Centered Design & Engineering, University of Washington, Seattle (C-FC, SAM); Department of Family Medicine, University of Washington, Seattle (MJT, L-MB); the Memorial Physicians/Yakima Valley Memorial Hospital, Yakima, WA (JK, RC); and the Group Health Research Institute, Seattle (BBG).
MBA
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Sean A. Munson
From the Department of Human Centered Design & Engineering, University of Washington, Seattle (C-FC, SAM); Department of Family Medicine, University of Washington, Seattle (MJT, L-MB); the Memorial Physicians/Yakima Valley Memorial Hospital, Yakima, WA (JK, RC); and the Group Health Research Institute, Seattle (BBG).
PhD
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Matthew J. Thompson
From the Department of Human Centered Design & Engineering, University of Washington, Seattle (C-FC, SAM); Department of Family Medicine, University of Washington, Seattle (MJT, L-MB); the Memorial Physicians/Yakima Valley Memorial Hospital, Yakima, WA (JK, RC); and the Group Health Research Institute, Seattle (BBG).
MBChB, MPH, DPhil
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Laura-Mae Baldwin
From the Department of Human Centered Design & Engineering, University of Washington, Seattle (C-FC, SAM); Department of Family Medicine, University of Washington, Seattle (MJT, L-MB); the Memorial Physicians/Yakima Valley Memorial Hospital, Yakima, WA (JK, RC); and the Group Health Research Institute, Seattle (BBG).
MD, MPH
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Jeffrey Kaplan
From the Department of Human Centered Design & Engineering, University of Washington, Seattle (C-FC, SAM); Department of Family Medicine, University of Washington, Seattle (MJT, L-MB); the Memorial Physicians/Yakima Valley Memorial Hospital, Yakima, WA (JK, RC); and the Group Health Research Institute, Seattle (BBG).
MD
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Randall Cline
From the Department of Human Centered Design & Engineering, University of Washington, Seattle (C-FC, SAM); Department of Family Medicine, University of Washington, Seattle (MJT, L-MB); the Memorial Physicians/Yakima Valley Memorial Hospital, Yakima, WA (JK, RC); and the Group Health Research Institute, Seattle (BBG).
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Beverly B. Green
From the Department of Human Centered Design & Engineering, University of Washington, Seattle (C-FC, SAM); Department of Family Medicine, University of Washington, Seattle (MJT, L-MB); the Memorial Physicians/Yakima Valley Memorial Hospital, Yakima, WA (JK, RC); and the Group Health Research Institute, Seattle (BBG).
MD, MPH
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  • Article
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Article Figures & Data

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    Figure 1.

    Typical workflow after kiosk implementation. BP, blood pressure; MA, medical assistant.

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    Figure 2.

    Blood pressure (BP) kiosk print-out with BP classification.

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Tables

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    Table 1.

    Timeline of Data Collection throughout Blood Pressure (BP) Kiosk Adoption

    Data CollectionKiosk Adoption Process
    Planning (6 Months)Deployment (Months)
    12345678
    Provider, staff, and clinic leader perspectives
        Planning meeting observationX
        Lean Six Sigma team status updateXXXX
        Focus group sessionsXX
    Patient perspectives
        Clinic observationsXX
        Patient surveysXX
    Patient rooming time
        Lean Six Sigma team observationsXX
    BP data
        Vendor ReportsXXXXXXXX
    • View popup
    Table 2.

    Focus Group Quotes and their Relationship to Study Themes and the Consolidated Framework of Implementation Research Constructs

    QuotesCFIR Constructs
    Clinic perspective
        Benefits
            Saves time“Yeah, it does [save time]. You know, you call them back, they hand you their blood pressure slip, all you have to do is weight, height… . Just by that piece of paper, it saves quite a bit of time with blood pressure and pulse.” (MA, month 8)Intervention characteristics (relative advantage)
            Provider awareness“I am much more likely to notice a little slip of paper laying on the top of the counter top than the one that's in the vital signs on the chart.” (Provider, month 8)Intervention characteristics (relative advantage)
            Patient awareness“It is real positive that the patients now are thinking about their BP as they're seeing the numbers. In the past, they never really saw the numbers so it was something that was told to them which may or may not have been received.” (Provider, month 8)Intervention characteristics (relative advantage)
        Challenges
            Perceptions of accuracyClinic leaders addressed the initial accuracy concern by asking providers and staff to compare average BPs taken by the kiosks with those taken by MAs. When asked about the comparison experience, one MA responded: “Most of the ones that I've had to re-check are pretty close, within 5 points of that.” (MA, month 2)Inner setting (implementation climate: compatibility)
    “The main problem I think is it's off quite a bit and so then I get questioned so I have to retake it in the room or if I notice it's high, I will always recheck it. About 90% of the time, I recheck it” (MA, month 2).Characteristics of individuals (knowledge and beliefs about the intervention)
            Workflow“[Whether the kiosk saves time] just depends on how many [patients] you have in a day that either won't use it, don't like it, want it rechecked. Then, it takes more time than if you were just checking it yourself.” (MA, month 8)Characteristics of individuals (knowledge and beliefs about the intervention)
            Job security“It could be like the airport, … they just walk in the door and you go over to the kiosk.” (Receptionist, month 2, commenting about job security concern)Inner setting (implementation climate: compatibility)
    Patient perspective
        Benefits
            Patient comfort“Some patients now have had enough experience with it where they'll just go straight to it, and they know.” (Receptionist, month 8)Characteristics of individuals (self-efficacy)
            More self-service“Instead of doing nurse visits, [patients] just come, check it, give it to [the receptionists] and they write their name on it and then they bring it back to us, or some leave it on the counter … .” (MA, month 2).Intervention characteristics (adaptability)
    “If they come in with their blood pressure machine and they say, ‘I need to check my blood pressure, check it [using the kiosk] against my own,’ I say go right ahead.” (Receptionist, month 8)Intervention characteristics (adaptability)
        Challenges
            Resting before BP measurement“I think that we would get better readings if the kiosks were located in a different spot, not in the waiting room. If the patient had a chance to sit for a few minutes before they took their blood pressure, be all done with Phreesia pad so that it was not causing them anxiety.” (Provider, month 8)Characteristics of individuals (knowledge and beliefs about the intervention)
            Prehypertension“It's [the prehypertension notation] an opportunity to enhance some discussion between us and the patient on what that means and what steps they can take.” (Provider, month 2)Inner setting (implementation climate: relative priority)
    “It's not that we don't believe that their blood pressure should be better, it's just we have so much competing for our time.” (Provider, month 8).Inner setting (implementation climate: relative priority)
            Preferred not to use“We do have people that refuse to use it, because of so many people, bacteria, germs.” (MA, month 2).Characteristics of individuals (knowledge and beliefs about the intervention)
    “A lot of them [patients] just want to stand up there and talk… . Before, you know, while we were checking them in, we could talk to them, but now we just tell them, you got to go do this and, I think it's kind of taken away their social hour.” (Receptionist, month 2).Characteristics of individuals (knowledge and beliefs about the intervention)
    • BP, blood pressure; CFIR, consolidated framework for implementation research; MA, medical assistant.

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The Journal of the American Board of Family     Medicine: 29 (5)
The Journal of the American Board of Family Medicine
Vol. 29, Issue 5
September-October 2016
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Implementation of a New Kiosk Technology for Blood Pressure Management in a Family Medicine Clinic: from the WWAMI Region Practice and Research Network
Chia-Fang Chung, Sean A. Munson, Matthew J. Thompson, Laura-Mae Baldwin, Jeffrey Kaplan, Randall Cline, Beverly B. Green
The Journal of the American Board of Family Medicine Sep 2016, 29 (5) 620-629; DOI: 10.3122/jabfm.2016.05.160096

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Implementation of a New Kiosk Technology for Blood Pressure Management in a Family Medicine Clinic: from the WWAMI Region Practice and Research Network
Chia-Fang Chung, Sean A. Munson, Matthew J. Thompson, Laura-Mae Baldwin, Jeffrey Kaplan, Randall Cline, Beverly B. Green
The Journal of the American Board of Family Medicine Sep 2016, 29 (5) 620-629; DOI: 10.3122/jabfm.2016.05.160096
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