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Health kiosks are publicly accessible computing devices that provide access to services, including health information provision, clinical measurement collection, patient self–check-in, telemonitoring, and teleconsultation. Although the increase in internet access and ownership of smart personal devices could make kiosks redundant, recent reports have predicted that the market will continue to grow.
We seek to clarify the current and future roles of health kiosks by investigating the settings, roles, and clinical domains in which kiosks are used; whether usability evaluations of health kiosks are being reported, and if so, what methods are being used; and what the barriers and facilitators are for the deployment of kiosks.
We conducted a scoping review using a bibliographic search of Google Scholar, PubMed, and Web of Science databases for studies and other publications between January 2009 and June 2020. Eligible papers described the implementation as primary studies, systematic reviews, or news and feature articles. Additional reports were obtained by manual searching and querying the key informants. For each article, we abstracted settings, purposes, health domains, whether the kiosk was opportunistic or integrated with a clinical pathway, and whether the kiosk included usability testing. We then summarized the data in frequency tables.
A total of 141 articles were included, of which 134 (95%) were primary studies, and 7 (5%) were reviews. Approximately 47% (63/134) of the primary studies described kiosks in secondary care settings. Other settings included community (32/134, 23.9%), primary care (24/134, 17.9%), and pharmacies (8/134, 6%). The most common roles of the health kiosks were providing health information (47/134, 35.1%), taking clinical measurements (28/134, 20.9%), screening (17/134, 12.7%), telehealth (11/134, 8.2%), and patient registration (8/134, 6.0%). The 5 most frequent health domains were multiple conditions (33/134, 24.6%), HIV (10/134, 7.5%), hypertension (10/134, 7.5%), pediatric injuries (7/134, 5.2%), health and well-being (6/134, 4.5%), and drug monitoring (6/134, 4.5%). Kiosks were integrated into the clinical pathway in 70.1% (94/134) of studies, opportunistic kiosks accounted for 23.9% (32/134) of studies, and in 6% (8/134) of studies, kiosks were used in both. Usability evaluations of kiosks were reported in 20.1% (27/134) of papers. Barriers (e.g., use of expensive proprietary software) and enablers (e.g., handling of on-demand consultations) of deploying health kiosks were identified.
Health kiosks still play a vital role in the health care system, including collecting clinical measurements and providing access to web-based health services and information to those with little or no digital literacy skills and others without personal internet access. We identified research gaps, such as training needs for teleconsultations and scant reporting on usability evaluation methods.
Health kiosks are publicly accessible computing devices used to provide access to a variety of services in the health care system. In a 2009 review, Jones [
At that time, 65% of households in the United Kingdom had internet access. By 2020, internet access had increased to 96% of households, most (98%) with a fixed broadband connection and 64% of households having internet access through mobile devices [
Data from the International Telecommunication Union show that these trends are reflected worldwide:
The percentage of the world population with access to the internet increased from 26% (1.8 billion people) in 2009 to 51% (4 billion people) in 2019, broken down regionally as follows: 7% to 6% to 28.6% in Africa, 20.6% to 54.6% in the Arab States, 19% to 44.5% in Asia and the Pacific, 24.3% to 72.8% in the Commonwealth of Independent States, 59.6% to 82.5% in Europe, and 46.3% to 76.7% in the Americas.
The number of mobile phone subscriptions per 100 people worldwide increased from 68 in 2009 to 107.8 in 2019 (meaning that in 2019 some people had more than one subscription).
Fixed broadband connections per 100 people worldwide increased from 6.9 in 2009 to 14.8 in 2019. [
However, these developments do not make health kiosks redundant.
Despite these trends, various authors predict continued and even growing use of kiosks. Chen [
With the above in mind, we saw the need to investigate the evolution of the roles of health kiosks in the past decade and what possible roles they may play in the future. We were aware that there may have been reviews of health kiosks published since the work of Jones [
As mentioned previously, the roles played by kiosks a decade ago may now be performed by personal smart devices (smartphones and tablets), especially in the delivery of health information. In 2019, 79% of adults (aged ≥18 years) in the United Kingdom owned a smartphone, and tablet ownership was estimated at 58%. However, this is subject to age differences, as only 40% of adults aged ≥65 years own smartphones [
Even for smartphone and tablet owners, health information delivery via kiosks may still be useful as the information can be tailored, vetted, and delivered at the point of service. Although this may also be possible through smartphone apps, the app would need to be properly accredited and evaluated for accuracy, and the user would need to download it to their phone for it to be useful. However, tailored and vetted information delivered by a kiosk is already available without any further action on the part of the user.
The collection of clinical measurements is where health kiosks currently outperform personal smart devices. Although there are clinical measurement devices that can be connected to smartphones and tablets, such as blood pressure (BP) monitors, heart rate trackers, and glucose monitors, they have not yet become widespread in use. Health kiosks with linked measurement devices, such as stethoscopes, otoscopes, dermatoscopes, pulse oximeters, and BP monitors, can collect clinical data for telemonitoring or synchronous teleconsultations.
Teleconsultations are now also possible on smart devices or PCs without the need for a health kiosk. As reported in the news, during the lockdown period caused by the COVID-19 pandemic of 2020, only 7 of 100 general practitioner (GP) consultations were performed face to face, with the rest being done remotely. However, it is interesting to note that most of these consultations were still being conducted through telephone or text [
MedicSpot is a web-based GP service in the United Kingdom that allows patients to connect to a physician via kiosks placed in pharmacies. It is available at ≥300 locations across the United Kingdom. The kiosk is available for walk-in consultations without appointments and contains medical equipment for examinations. The service provides patients access to a connected stethoscope; pulse oximeter; BP monitor; contactless thermometer; and an inspection camera to check the ear, nose, and throat. This is a private service that charges £39 (US $51.70) per consultation. MedicSpot has recently partnered with the British supermarket chain Asda to offer in-store GP video consultations with diagnostics [
The kiosk line of Amwell, which is based in Massachusetts, United States, comprises a fully enclosed kiosk model, freestanding open console kiosk, and tabletop kiosk model. All models include a touchscreen interface, integrated camera, credit card reader, handset for private audio, and sanitation features. They can be equipped with biometric and clinical measurement devices that allow virtual monitoring of a patient’s vital signs in real time. These include stethoscopes, otoscopes, pulse oximeters, BP cuffs, dermatoscopes, and thermometers [
Meanwhile, H4D, a health technology start-up based in Paris, France, completed a €15 million (US$ 16.4 million) round of funding in June 2020. H4D developed a telemedicine platform centered on the Consult Station, which is a connected telemedicine booth. It comprises all the necessary instruments and sensors for physicians to consult with patients via videoconference. The Consult Station has been deployed to ensure continuity of care and treatment for patients who are chronically ill and cannot be safely treated in traditional health care facilities.
It is worth noting that the abovementioned implementations were all in the private health sectors of the United Kingdom, the United States, and France. The adoption of health kiosks for teleconsultation by government-run health systems has been slow because of the strict rules for suppliers of equipment. Publicly funded health systems require evidence from numerous trials before adopting new technologies.
Health authorities such as the World Health Organization and the Centers for Disease Control and Prevention have strongly urged ways of minimizing physical contact between patients and health care providers, otherwise known as
In response to the COVID-19 pandemic, Elephant Kiosks (Cornwall, United Kingdom) introduced the COVID-19 Reception Kiosk, which offers the first point of contact for visitors and staff in workplaces, care homes, schools, and other public places. It offers an integrated contactless temperature check, a COVID-19 questionnaire, and email alerts to managers or the reception. It meets the infection control guidance and can be used to support contact tracing [
The H4d Consult Station has also been used to support hospitals during the COVID-19 pandemic, notably the Ramsay Health Vert-Galant Hospital’s emergency department (ED). The station was used to provide an initial screen and detect suspected COVID-19 cases. Using the Consult Station, the hospital was able to substantially reduce nurses’ intake time and protect them from the virus [
One of the benefits of telehealth kiosks is making medical and specialist care available to remote places that medical professionals rarely visit. These places can be remote rural areas with poor infrastructure in countries such as India and Canada [
In their study, Nachum et al [
To clarify how the role of health kiosks has evolved in the past decade and what roles they may play in the future, we conducted a scoping review. The primary objectives of this review are to describe the scope of kiosk use in health care (by patients, health care providers, or the general public), examine the roles played by health kiosks in the health care system, and investigate the barriers to and facilitators of the deployment of kiosks. We have developed the following research questions to address these objectives:
What are the settings and health domains in which health kiosks are deployed, and what health services are they delivering?
Are health kiosk interventions evaluated for usability, which has been identified as being important for effective digital health [
Finally, what are the barriers to and facilitators of the deployment of kiosks, especially for teleconsultation (eg, resources, infrastructure, and training [
A scoping review is defined as a type of research synthesis that aims to “map the literature on a particular topic or research area” [
Computerized health kiosks have been defined as “freestanding units containing computer programs that provide users with information or services.” [
Articles were included if they met the following criteria:
Were about an actual implementation of a health kiosk and not a specification or nonfunctional prototype
Were published in peer-reviewed publications, trade publications, and web-based health information technology publications
Were published in the English language
Were published between January 1, 2009, and June 1, 2020; we chose this period to update the previous review by Jones [
Articles were excluded if they were design proposals for kiosks or nonfunctioning prototypes, if the device was a personal smart device rather than a publicly accessible device, or if they were in a language other than English.
The first source was published in the literature. We searched three electronic literature databases: Web of Science, PubMed (including MEDLINE), and Google Scholar.
The primary search term was
As used in previous reviews, this resulted in the inclusion of papers mostly about personal smart devices such as smartphones and tablets, which we did not classify as kiosks.
The final search terms were as follows:
PubMed:
((health[MeSH Terms] OR health[All Fields] OR health s[All Fields] OR “healthful”[All Fields] OR healthfulness[All Fields] OR healths[All Fields]) AND (kiosk[All Fields] OR kiosks[All Fields])) AND ((2009/1/1:2020/6/1[pdat]) AND (english[Filter]))
Web of Science (advanced search):
ALL=health AND ALL=kiosk
Google Scholar (advanced search): exact phrase
health kiosk
anywhere in the article between 2009 and 2020
Gray literature and social media were also searched using the Google search engine for reports and publications on relevant websites, as well as the search function on two social media websites: Facebook and Twitter. Key informants (kiosk manufacturers) were identified through a Google search and the contact database of the Ehealth Productivity and Innovation in Cornwall and the Isles of Scilly Project; they were contacted via email and video calls. We asked the manufacturers about the use cases of their kiosk offerings, training needs for kiosk use, barriers and facilitators for successful deployment, and any relevant publications. A total of 3 kiosk manufacturers from around the world responded to our inquiries.
We collated citations from the literature search using the Mendeley (Elsevier) reference management software, and duplicate citations were eliminated. Author IDM screened the titles and abstracts to determine whether the study met the inclusion criteria. The studies were classified as either included or excluded. All articles classified as
Diagram of articles reviewed for inclusion.
A data extraction form was created based on the table of published studies on health kiosks used in the paper by Jones [
We present the results of our literature search as follows: (1) settings, purposes, and conditions addressed by the kiosks in the included papers; (2) country of publication; (3) year of publication; (4) type of kiosk access; (5) patient self–check-in kiosks; (6) reporting on the usability evaluation of kiosks; (7) telemonitoring and teleconsultation kiosks, training needs, and barriers to and enablers of adoption.
We identified 141 publications (
In the 134 primary studies, the most frequent setting (n=61, 47%) was secondary care, which was subdivided into specialty and outpatient clinics (n=34, 54%), EDs (n=26, 43%), and inpatient settings (n=5, 8%). The most frequently cited purpose (45/134, 33.6%) was providing health information (
Summary of settings, purposes, and health domains for the primary studies (N=134).
Categories | Values, n (%) | ||
|
|||
|
|
63 (47) | |
|
|
Specialty clinic | 34 (54) |
|
|
Emergency department | 26 (41) |
|
|
Hospital inpatient | 5 (8) |
|
Community | 32 (23.9) | |
|
Primary care | 24 (17.9) | |
|
Pharmacy | 8 (6) | |
|
Multiple | 7 (5.2) | |
|
|||
|
Health information | 47 (35.1) | |
|
Clinical measurements | 28 (20.9) | |
|
Screening | 17 (12.7) | |
|
Telehealth | 11 (8.2) | |
|
Patient registration | 8 (6) | |
|
Patient feedback | 6 (4.5) | |
|
Medication adherence | 6 (4.5) | |
|
Patient outcomes data | 5 (3.7) | |
|
Other | 3 (2.2) | |
|
Patient triage | 3 (2.2) | |
|
|||
|
Multiple conditions | 33 (24.6) | |
|
HIV | 10 (7.5) | |
|
Hypertension | 10 (7.5) | |
|
Pediatric injuries | 7 (5.2) | |
|
Health and well-being | 6 (4.5) | |
|
Medication | 6 (4.5) | |
|
Cardiovascular disease | 5 (3.7) | |
|
Mental health | 4 (3) | |
|
Sexual health | 4 (3) | |
|
Acute care—emergency department | 3 (2.2) | |
|
Dementia | 3 (2.2) | |
|
Others | 43 (32.1) |
Purposes of the most frequent settings (N=134).
Purpose | Settings, n (%) | Total, n (%) | |||||
|
Secondary care (n=63) | Community (n=32) | Primary care (n=24) | Pharmacy (n=8) | Multiple (n=7) |
|
|
Health information | 23 (37) | 7 (22) | 12 (50) | 1 (13) | 4 (57) | 47 (35.1) | |
Clinical measurements | 3 (5) | 12 (28) | 7 (29) | 5 (63) | 1 (14) | 28 (20.9) | |
Screening | 12 (19) | 4 (13) | 1 (4) | 0 (0) | 0 (0) | 17 (12.7) | |
Telehealth | 0 (0) | 8 (25) | 0 (0) | 1 (13) | 2 (29) | 11 (8.2) | |
Patient registration | 7 (11) | 0 (0) | 1 (4) | 0 (0) | 0 (0) | 8 (6) | |
Patient feedback | 5 (8) | 0 (0) | 1 (4) | 0 (0) | 0 (0) | 6 (4.5) | |
Patient outcomes data | 6 (10) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 6 (4.5) | |
Medication reconciliation | 3 (5) | 0 (0) | 2 (8) | 0 (0) | 0 (0) | 5 (3) | |
Other | 1 (2) | 1 (3) | 0 (0) | 1 (13) | 0 (0) | 3 (2.2) | |
Patient triage | 3 (5) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 3 (2.2) |
For kiosks installed in community settings and retail pharmacies, the most frequent purpose was to collect clinical measurements.
For kiosks installed in specialty and outpatient clinics in secondary care, sexual health was the most frequent condition addressed by kiosks (4/134, 3%) [
In kiosks deployed in EDs, the most frequently encountered health domains were HIV, acute care, and asthma. The HIV screening process in the ED was streamlined using kiosks (7/134, 5.2%) [
Kiosks aided in the provision of acute care in the ED by performing patient triage, reliably collecting patient data, and significantly improving the time to identify new arrivals [
Primary care kiosks most frequently dealt with multiple conditions (7/134, 5.2%) [
We examined the papers to determine if multiple papers evaluated the same kiosk system. A careful examination of the papers by authorship and system description revealed that 20.9% (28/134) of the primary studies were about 9 distinct kiosk systems. The 28 papers covered the settings, purposes, and conditions described in
Thus, there were 115 distinct kiosk systems described in the 134 papers.
Conditions and settings (N=134).
Condition | Setting, n (%) | Total, n (%) | |||||
|
Secondary care (n=63) | Community (n=32) | Primary care (n=24) | Pharmacy (n=8) | Multiple (n=7) |
|
|
Multiple conditions | 5 (8) | 16 (50) | 7 (29) | 2 (25) | 3 (43) | 33 (24.6) | |
HIV | 10 (16) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 10 (7.5) | |
Hypertension | 1 (2) | 3 (9) | 2 (8) | 4 (50) | 0 (0) | 10 (7.5) | |
Pediatric injuries | 4 (6) | 1 (3) | 2 (8) | 0 (0) | 0 (0) | 7 (5.2) | |
Health and well-being | 0 (0) | 3 (9) | 2 (8) | 1 (13) | 0 (0) | 6 (4.5) | |
Medication | 4 (6) | 0 (0) | 2 (8) | 0 (0) | 0 (0) | 6 (4.5) | |
Cardiovascular disease | 1 (2) | 1 (3) | 2 (8) | 0 (0) | 1 (14) | 5 (3.7) | |
Mental health | 3 (5) | 0 (0) | 1 (4) | 0 (0) | 0 (0) | 4 (3) | |
Sexual health | 4 (6) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 4 (3) | |
Acute care—EDa | 3 (5) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 3 (2.2) | |
Breastfeeding | 3 (5) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 3 (2.2) | |
Cancer | 2 (3) | 0 () | 1 (4) | 0 (0) | 0 (0) | 3 (2.2) | |
Dementia | 0 (0) | 3 (9) | 0 (0) | 0 (0) | 0 (0) | 3 (2.2) | |
Pediatrics | 2 (3) | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 3 (2.2) | |
Smoking | 1 (2) | 0 (0) | 1 (4) | 0 (0) | 1 (14) | 3 (2.2) | |
Asthma | 2 (3) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (1.5) | |
Chronic kidney disease | 2 (3) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (1.5) | |
Diabetes | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (29) | 2 (1.5) | |
Domestic violence or home safety | 2 (3) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (1.5) | |
Obesity | 0 (0) | 0 (0) | 1 (4) | 1 (13) | 0 (0) | 2 (1.5) | |
Orthopedics | 2 (3) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (1.5) | |
Alcohol and drug use | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
Cervical cancer | 0 (0) | 0 (0) | 1 (4) | 0 (0) | 0 (0) | 1 (0.7) | |
Childhood obesity | 0 (0) | 0 (0) | 1 (4) | 0 (0) | 0 (0) | 1 (0.7) | |
Dental health | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
Dermatology | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
Dog bites | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
Environmental health | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
Food safety | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
General medicine | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
Genetic study | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
Health care environment | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
Infant mortality | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
Organ donation | 0 (0) | 0 (0) | 1 (4) | 0 (0) | 0 (0) | 1 (0.7) | |
Patient communication | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
Radiology | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
Rehabilitation | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
Social contact | 0 (0) | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) | |
UTIb | 1 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) |
aED: emergency department.
bUTI: urinary tract infection.
Kiosk systems described by multiple papers (N=28).
Kiosk system name | Country | Papers, n (%) | Settings | Purposes | Conditions |
Telehealth Wellness Kiosk [ |
Unites States | 2 (7) | Community | Telehealth | Multiple |
HPV Project Kiosk [ |
Unites States | 2 (7) | Secondary care | Health information | Sexual health |
HIV Screening Kiosk [ |
Unites States | 8 (29) | Secondary care | Screening | HIV |
APHID Kiosk [ |
Unites States | 4 (14) | Primary or secondary care | Medication adherence | Medication |
PEMT Kiosk [ |
Unites States | 3 (11) | Secondary care | Health information | Breastfeeding |
My Kidney Care Centre [ |
Canada | 2 (7) | Secondary care | Patient outcomes | Chronic kidney disease |
KIO kiosk [ |
Unites States | 3 (11) | Community | Screening or patient outcomes | Dementia |
e-KISS kiosk [ |
Unites States | 2 (7) | Secondary care | Health information | Sexual health |
Safety in Seconds kiosk [ |
Unites States | 2 (7) | Secondary care | Health information | Pediatric injuries |
The countries where the 115 kiosk systems were deployed and their corresponding settings are listed in
Countries and settings of included studies (N=134).
Country | Community (n=32), n (%) | Multiple (n=7), n (%) | Pharmacy (n=8), n (%) | Primary care (n=24), n (%) | Secondary care (n=63), n (%) | Total, n (%) |
United Statesa | 17 (53) | 6 (86) | 3 (38) | 15 (63) | 40 (63) | 81 (60.4) |
Canadaa | 0 (0) | 0 (0) | 2 (25) | 0 (0) | 3 (5) | 5 (3.7) |
United Kingdoma | 2 (6) | 0 (0) | 1 (13) | 2 (8) | 1 (2) | 6 (4.5) |
Germanya | 0 (0) | 0 (0) | 1 (13) | 0 (0) | 2 (3) | 3 (2.2) |
Indiab | 2 (6) | 0 (0) | 0 (0) | 0 (0) | 1 (2) | 3 (2.2) |
South Koreaa | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 2 (3) | 3 (2.2) |
New Zealanda | 2 (6) | 0 (0) | 0 (0) | 0 (0) | 1 (2) | 3 (2.2) |
Portugala | 0 (0) | 1 (14) | 0 (0) | 1 (4) | 0 (0) | 2 (1.5) |
Singaporea | 0 (0) | 0 (0) | 0 (0) | 2 (8) | 0 (0) | 2 (1.5) |
Australiaa | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) |
Brazilc and Portugala | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) |
Japana | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) |
Kenyab | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) |
The Philippinesb | 0 (0) | 0 (0) | 1 (13) | 0 (0) | 0 (0) | 1 (0.7) |
Swedena | 0 (0) | 0 (0) | 0 (0) | 1 (4) | 0 (0) | 1 (0.7) |
United States and Canadaa | 1 (3) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0.7) |
aHigh-income country.
bLower middle–income country.
cUpper middle–income country.
Most kiosk studies were conducted in the United States, accounting for 70.4% (81/115) of the installed kiosk systems. Of the 115 installed kiosk systems, Canada and the United Kingdom had 5 (4.3%) and 6 (5.2%) systems, respectively, and Germany, India, South Korea, and New Zealand contributed 3 (2.6%) systems each. The list includes 11 high-income countries (Australia, Canada, Germany, Japan, New Zealand, Portugal, Singapore, South Korea, Sweden, the United Kingdom, and the United States), 1 upper middle–income country (Brazil), and 3 lower middle–income countries (India, Kenya, and the Philippines), as classified by the World Bank [
The studies included in the review were published in the period covering 2009 to 2020 (
Number of primary studies published per year from 2009 to 2020 (N=134).
Year | Studies, n (%) |
2009 | 5 (3.7) |
2010 | 10 (7.5) |
2011 | 13 (9.7) |
2012 | 8 (6) |
2013 | 19 (14.2) |
2014 | 17 (12.7) |
2015 | 13 (9.7) |
2016 | 11 (8.2) |
2017 | 14 (10.4) |
2018 | 12 (9) |
2019 | 8 (6) |
2020 | 4 (3) |
Most (94/134, 70.1%) of the kiosks described in the included papers were integrated into clinical pathways (
Type of access to health kiosk (N=134).
Setting | Type of access, n (%) | Total, n (%) | |||
|
Integrated (n=94) | Opportunistic (n=32) | Both (n=8) |
|
|
Secondary care | 54 (57) | 9 (28) | 0 (0) | 63 (47) | |
Community | 16 (17) | 11 (34) | 5 (63) | 32 (23.9) | |
Primary care | 18 (19) | 5 (16) | 1 (13) | 24 (17.9) | |
Pharmacy | 3 (3) | 5 (16) | 0 (0) | 8 (6) | |
Multiple | 3 (3) | 2 (6) | 2 (25) | 7 (5.2) |
One type of kiosk that has been widely deployed over the past decade is the patient self–check-in kiosk in general practices, outpatient clinics, and hospitals. In the United Kingdom, the rise of the electronic patient self–check-in kiosk can be traced to a guide released by the National Health Service (NHS) in 2009, entitled
We found only a few studies in our literature search that evaluated patient self–check-in kiosks. These studies showed statistically significant reductions in waiting times for patients who checked in using the kiosks compared with those who did not [
Of the 7 reviews retrieved, 3 (43%) mentioned usability as one of the outcomes reported in their included studies [
The methods used for usability evaluation in 27 studies are listed in
Usability evaluations of health kiosks (N=27).
Methods | Values, n (%) |
Questionnaires | 13 (48) |
Validated questionnaires | 3 (11) |
Focus groups | 3 (11) |
Interviews | 7 (26) |
Completion rates | 4 (15) |
Error rates | 2 (7) |
Multiple methods | 10 (37) |
Heuristic evaluation | 3 (11) |
Think-aloud | 8 (22) |
Click recording | 2 (7) |
Visual observation | 5 (19) |
Although questionnaires were the most frequently used usability evaluation method, only 11% (3/27) of studies used validated questionnaires, namely the System Usability Scale, the Technology Acceptance Model, and the Perceived Usefulness/Perceived Ease of Use questionnaire. Validated questionnaires enable researchers to compare their results with those of other studies. Questionnaires are subjective and quantitative methods. Some of the studies used qualitative methods such as focus groups, interviews, behavioral observations, and think-aloud sessions (8/27, 22%). Qualitative methods are usually used during the developmental stages. Objective methods were also used, such as completion times, error rates, and click recordings. Heuristic evaluation, using a checklist of desired heuristic features, was used only in a small minority of the studies (3/27, 11%). Approximately half of the studies (10/27, 37%) used >1 method of usability evaluation. Approximately 37% (10/27) of usability evaluations of health kiosks were able to identify usability issues. Most (16/27, 59%) reported that the users found the health kiosks easy to use.
Approximately 7.5% (10/134) of papers described the use of kiosks to deliver some form of telemonitoring or teleconsultations between 2011 and 2014. Most papers (6/10, 60%) described kiosks implemented in retirement communities for the use of older adults. Approximately 30% (3/10) of papers related to the same kiosk for a residential community of older adults in New Zealand [
Approximately 80% (8/10) of papers described 5 different kiosks that provided telemonitoring services, including monitoring of vital signs such as BP and oximetry. These kiosks included a screen but did not allow for 2-way live communication with a health care provider. Telemonitoring kiosks aimed at older adults often also included measures of cognitive performance and the opportunity for residents to engage with educational videos and
Of the 20% (2/10) of papers that outlined kiosks that offered the opportunity for users to interact in a live 2-way consultation with a health care professional, one of them, HealthSpot, is no longer in operation. We will discuss the history of HealthSpot in greater detail in the following sections. The kiosk that is still in operation has been implemented in 7 urgent care pharmacies across New York City and included audiovisual equipment enabling a web-based consultation with an ED physician, a BP cuff, a pulse oximeter, and a thermometer [
Only 20% (2/10) of papers detailing kiosks providing telemonitoring or teleconsultation services described the training required to implement the kiosk. Wilamowska et al [
Resnick et al [
The experience of the telemedicine kiosk pioneer HealthSpot provides a good understanding of barriers to adoption. HealthSpot was founded in 2010 and raised approximately US $46.7 million in funding. It also attracted several big-name partners such as Xerox, MetroHealth, Mayo Health, Kaiser Permanente, the Cleveland Clinic, and Rite Aid (the third largest retail pharmacy chain in the United States). HealthSpot’s telemedicine kiosk was fully enclosed and used proprietary cloud-based software and was equipped with high-definition videoconferencing, a BP cuff, thermometer, stethoscope, otoscope, dermatoscope, and a built-in weighing scale [
Mudumba [
Too much time spent on the academic validation of kiosk functionality rather than vetting the business model in the market
Requires prescheduling appointments for HealthSpot kiosk users, which goes against the utility aspect of telehealth
No integration with mobile health platforms
Inadequate planning for scaling
The target market was too small
The HealthSpot kiosk used proprietary videoconferencing software, whose high cost weakened the HealthSpot business model. According to Chen [
Some other studies also mentioned barriers to and enablers of kiosk adoption. Venkatesh [
In this review, we sought to describe the current roles that health kiosks play in the health care system in terms of settings, purposes, health domains, and type of kiosk (opportunistic or integrated into a care pathway), as reported in the existing literature. We also investigated the use of kiosks for patient self–check-in, the extent of reporting of the usability evaluation of health kiosks, and the factors that affect the use of kiosks for remote consultations. We identified that clinical settings still comprised most (87/134, 64.9%) sites for health kiosks, and community settings accounted for some (32/134, 23.9%) of the kiosk installations in the included studies. Retail pharmacy settings comprised 5.9% (8/134) of the included studies. However, BP kiosks have long been deployed in pharmacies for quite some time. In 2012, Alpert [
When looking at the countries of installation, high-income countries dominate in the studies on health kiosks included in our review, accounting for 73% (11/15) of the countries where kiosks were installed. Regarding countries and settings, it can be noted that high-income countries have a larger proportion of kiosks in secondary care settings, whereas upper and lower middle–income countries tend to have their kiosks installed in community and primary care settings. This reflects the more advanced health infrastructure of high-income countries, which can afford to deploy information technology solutions in their health systems. A study on barriers to and facilitators of the deployment of health kiosks in Iran, an upper middle–income country, listed a lack of resources as one of the barriers [
Kiosks are more likely to be integrated into a clinical pathway (94/134, 70.1%), especially if they were in a clinical setting. Community kiosk installations were evenly divided between integrated access and opportunistic/dual access. In both clinical and community settings, health information and clinical measurements were the most frequent purposes for kiosks.
The 6-fold increase in publications on health kiosks is an indication of the growing use of computerized kiosks in health care. This also coincides with the increased growth of the computerized kiosk market in other sectors, such as retail, hospitality, and banking, during the same period [
The proportion of health kiosk studies that include a usability evaluation of the kiosk has not changed much since 2014 and is in the minority (<20%). This is consistent with the low rate of reporting on usability evaluations of digital health technologies in general [
This review has a few limitations. We were only able to search for papers published in English, which may have excluded several papers about health kiosks that were not published in English. This means that we were not able to include papers about kiosks installed in countries such as China, Japan, South Korea, and others if they were published in a language other than English. We were also constrained to reduce our search terms, as the use of the term
We were aware that there were existing reviews on health kiosks before we started this scoping review. Our search identified 7 prior reviews, the latest of which was published in 2013. It was our consensus that in the 7 years since the last review, there were sufficient technological advances to warrant a new review. In the process of writing the findings of this review, a new systematic review of integrated health kiosks was published [
A recent qualitative study of 20 experts in Iran investigated their perceptions of the barriers to and facilitators of health kiosk adoption [
The current success of MedicSpot in the United Kingdom contrasts greatly with the failure of HealthSpot in the United States. MedicSpot follows the points made by Chen [
This brings us to the need for training in using health kiosks for teleconsultation. Although most of the included papers about kiosks for telemonitoring and teleconsultations were aimed at older adults with less technical experience, it is surprising that end user training needs are not frequently described in more detail. It is possible that kiosk use with touch screens has been normalized in other areas of daily living (eg, banking and supermarket shopping), and thus, their use is seen to be intuitive. The lack of training may also reflect that, in some cases, a kiosk may be accompanied by a trained
The adoption of patient self–check-in kiosks has had its share of criticism and negative news reports. An opinion piece by Williamson [
In conclusion, this review characterizes the present roles that health kiosks play in the health care system based on the existing literature. We have established that despite the growth in erstwhile health kiosk replacements such as personal smart devices and their attendant apps, health kiosks still have a vital role to play in the health care system, such as in the collection of clinical measurements for teleconsultations, provision of access to eHealth for the older population without smartphones, and provision of tailored and vetted health information at the point of service. We also identified research gaps such as identifying training needs for using the kiosk/video call combination for teleconsultations; methods for usability testing of kiosks; barriers to and enablers of kiosk deployment; and the exact extent of kiosk use for patient self–check-in for primary, secondary, and tertiary care. We also recommend the implementation of programs that will increase the capability and capacity of kiosk developers to perform user experience evaluations, both during development and while in service.
Summary of included studies.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist.
blood pressure
emergency department
general practitioner
National Health Service
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Specific funding for this study was not acquired. The work of IDM, DA, and KE on digital health solutions is currently supported by the EHealth Productivity and Innovation in Cornwall (EPIC2) project, which is partly funded by the European Regional Development Fund. The funding body had no role in the design, execution, or analysis of this scoping review.
RJ conceived of the study. IDM, DA, and KE screened the studies and conducted the data extraction. IDM analyzed the extracted data. The review was written by IDM, DA, and KE, with revisions from RJ, AC, and EM. RJ, AC, and EM provided feedback on the draft text. The authors confirmed that they followed all appropriate research reporting guidelines. The checklist for scoping reviews was uploaded in
None declared.