title: Streamlining HIV testing in the emergency department-leveraging kiosks to provide true universal screening: a usability study.
abstract: BACKGROUND
  Emergency department (ED) human immunodeficiency virus (HIV) screening programs are challenged by the unsustainable cost of exogenous staff and the relatively low penetration rates. Kiosk systems have increased registration efficiency in various clinical settings and have shown promising results for advancing various public health initiatives. This study evaluated the usability of kiosks within the existing HIV testing program and assessed patients' perceived acceptability of kiosk-based screening in the ED.
  
  
  METHODS
  ED patients (n=88) were asked to complete both a Registration Module (intended to integrate into the ED's pending kiosk registration system) and a Risk Assessment Module using a pen-based touchscreen tablet platform. Participants provided feedback upon program completion. All comments, questions, and errors were documented. Kiosk programs tracked time spent on each screen. Quantitative (chi-squared test or t test) and qualitative data analyses were performed.
  
  
  RESULTS
  Consented subjects (n=62) were 60% female, 69% were black, the mean ± standard deviation age was 37.8 ± 11.4 years, 52% had a high school degree or less, and 50% reported no prior kiosk experience. Mean time spent on the Registration and Risk Assessment Modules was 2:35 ± 1:24 min and 5:09 ± 1:58 min, respectively. The leading technical challenge identified was login: 84% of patients required assistance. Removal of the login screen reduced times to 1:05 ± 0:36 min and 4:10 ± 1:38 min. Ninety-five percent of subjects reported length of use as "just right," and over 75% of patients found the software easy to use, answered questions without help, and preferred screening on the kiosk to in-person interviews. Favorite aspects of the program included ease of use (52%), privacy (48%), and speed (30%). Sixty-six percent of patients reported there was nothing they disliked or would change.
  
  
  CONCLUSIONS
  ED patient response to the kiosk system was favorable. Subjects easily and quickly navigated the program, with the exception of a login screen, which could be eliminated via automated login using ID bracelet scanners.
authors.affiliation: 1 Department of Emergency Medicine, The Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
authors.forename: Megan
authors.initials: M
authors.lastname: Gauvey-Kern
authors.forename: Alonzo
authors.initials: A
authors.lastname: Woodfield
authors.forename: Stephen
authors.initials: S
authors.lastname: Peterson
authors.forename: Boris
authors.initials: B
authors.lastname: Tizenberg
authors.forename: Joseph
authors.initials: J
authors.lastname: Kennedy
authors.forename: Devon
authors.initials: D
authors.lastname: Bush
authors.forename: William
authors.initials: W
authors.lastname: Locke
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Gaydos
authors.forename: Katherine
authors.initials: K
authors.lastname: Deruggiero
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D015142:Baltimore; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D018570:Risk Assessment; D013997:Time Factors; D014505:Urban Population; D014584:User-Computer Interface; D055815:Young Adult