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Drop In Clinics: Another EHR Quandary

Posted on March 5, 2014 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

If you go to a walk in health clinic, you’re in good company. These clinics and their users are growing rapidly. So, too, is their using EHRs to document your stay. That EHR use is both good and bad news.

 Clinic Types

There are two basic types of these no appointment, walk in clinics: Retail Health and Urgent Care:

  • Retail Health. These treat minor problems or do basic prevention that usually doesn’t require a physician visit. For example, they give flu shots, treat colds, ear infections, and strep throat, etc. The clinics are often one person operations staffed by a nurse practitioner. You can find them in stand alone settings, but more frequently now they are in major, retail chains such as Target, Wal-Mart, CVS, etc. In addition to their location accessibility, these clinics usually have evenings and weekend hours.
  • Urgent Care Clinics. These perform all the services of retail clinics, and also have extended hours. Importantly they add physician services. For example, they will treat burns, sprains, or run basic lab tests. These clinics usually are part of a clinical chain or may be associated with a local hospital. Unlike retail health clinics, they generally are in their own store fronts.

While their services and settings differ, both accept health insurance. With the projected growth of the insured population under the ACA, their managers are expanding their networks.

Clinic EHR to PCP EHR Problem

Unlike practices and hospitals that have undergone, often painful, transitions from paper to EHRs, these clinics, skipped that phase and have, by and large, used EHRs from the start.

EHRs give them a major advantage. If you visit Mini-Doc Clinic in Chamblee, Georgia and then go to one in Hyattsville, Maryland, the Maryland clinic can see or electronically get your Georgia record. This eliminates redundancy and gives you an incentive to stay with a service that knows you.

If you only go to Min-Doc for care, then all your information is in one place. However, if you use the clinic and see you regular doctor too, updating your records is no small issue. Coordination of medical records is difficult enough when practices are networked or in a HIE. In the case of a clinic, especially one that you saw away from home, interface problems can compound.

With luck, the clinic you saw on vacation may use the same EHR as your doctor. For example, CVS’ Minute Clinic uses Epic. However, your clinic may use an EHR tailored to walk ins. Examples of these clinic oriented, tablet, touch optimized EHRs are:

Your physician may not have the technical ability to read the clinic’s record. Getting a hospital to import the clinic’s data would require overcoming bureaucratic, cost and systems problems for what might be a one time occurence. Odds are the clinic will fax your records to your doctor where they will be scanned or keyed in, if at all.

This is not a hypothetical issue, but one that clinic corporate execs, patient advocates and physicians are concerned about. There is no easy solution in sight.

Recently, on point, NPR’s Diane Rehm show had a good discussion of the clinic phenomena, and included the clinic to PCP EHR record issue. You can hear it on podcast. Her guests were:

  • Susan Dentzer. Senior Policy Adviser, The Robert Wood Johnson Foundation and on-air analyst on health issues, PBS NewsHour.
  • Dr. Nancy Gagliano. Chief Medical Officer, CVS MinuteClinic.
  • Dr. Robert Wergin. Family Physician, Milford, Neb., and President-elect, American Academy of Family Physicians, and
  • Vaughn Kauffman. Principal, PwC Health Industries.

All the actors in this issue know that the best outcome would be transparent interoperability. However, that goal is more honored in the breach, etc., for EHRs in general. The issue of clinic to PCP EHR is only at a beginning and its future is unknown.

Study: EMRs Have Saved Canadian Health System $1.3B Since 2006

Posted on May 3, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

At our current stage of EMR implementation, the evidence is sketchy at best that EMRs are draining costs from the U.S. health system.  But our friends to the north seem to be capturing tangible savings, according to new research by Pricewaterhouse Coopers LLP (PwC).

The PwC study, which was backed by the Canada Health Infoway, a not-for-profit whose focus is accelerating the development of EMRs by family physicians, looked at the implementation of EMRs by family doctors across Canada.  The study focused on the period between 2006 and 2012.

Adoption of EMRs by primary care doctors in Canada has more than doubled between 2006 and 2012, from 23 percent to 56 percent, Healthcare Informatics reports. These EMR investments were paid for largely through investments by the provinces and territories in EMR programs, medical practices and  Infoway.

According to Healthcare Informatics, PwC found that during that period, the Canadian system saved $800 million Canadian dollars in administrative efficiencies, such as staff spending less time pulling charts and less time by doctors reading and maintaining paper files.

PwC also found savings of $584 million Canadian dollars in health system efficiencies, such a drop in duplicated diagnostic testing and adverse drug events.

In addition to concrete financial savings, EMR adoption improved chronic disease management and preventive care, such as mammogram screening rates.  EMR use also improved communication between care providers, as EMRs allowed new providers to quickly and easily research histories on patients without resorting to archaic fax communications.

As part of PwC’s research, they cited examples which paint the picture of how EMRs are changing healthcare in Canada.

Since implementing EMRs, PwC notes, 67 percent of Saskatchewan’s family doctors, office managers and specialists say that their medical practices are more or significantly more productive than before.  Also, 94 percent of of doctors enrolled in Alberta’s EMR program said that patients get their test results faster; in addition, 97 percent said that they’re not needlessly repeating tests and investigations.

Ignore Patient Engagement (and Consumer Reviews) at Your Own Peril

Posted on April 12, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I know several readers of this blog (if not dozens) don’t pay much attention to the world of consumer healthcare reviews. Some seem to think they are populated only by the disgruntled few, and don’t paint a fair picture of providers’ true abilities. Some are of the opinion that too few patients utilize physician review sites (positively or negatively), and don’t present a large enough sample size for reviews to be meaningful. But, like social networks, those that read them are often far greater than those that actively contribute to them, as a recent study by PricewaterhouseCoopers points out.

Scoring Healthcare: Navigating customer experience ratings” points that though only 24 percent of those surveyed have left online reviews, 48 percent have read them. The report also points out that, “Among those who have read healthcare reviews, 68 percent said they have used the information to select a doctor, hospital and to a lesser extent, a health plan, pharmacy and drug or medical device.”

PwC’s U.S. Health Industries Leader Kelly Barnes sums up my biggest takeaway nicely: “As consumerism in healthcare gains steam, customer feedback has become a determining factor in the success of health organizations. Ratings connect consumers’ experience to quality, and quality connects to financial performance, market share and reputation.”

Say what you will about sites like Healthgrades, Yelp, Consumer Reports or Facebook, they are becoming powerful consumer engagement tools, and giving them short shrift will not win providers any points in the countdown to Stage 2 of Meaningful Use. (October 1 is just over 170 days away, in case you were wondering.)

It’s interesting to note in light of the PwC report that the new Patient Engagement Index from Axial Exchange bases 25 percent of a hospital’s score on its social engagement, which includes its ratings on consumer review sites.

What I’d like to know from providers is:

  •  Are you starting to pay more attention to consumer reviews?
  • If so, how are they affecting your overall patient engagement strategy?
  • If not, why? What other baskets are you placing your patient engagement eggs in?

Please share your thoughts in the comments section below.