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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 the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager 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, a role he recently repeated for a Council member.

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.

New Healthcare Facility Experiences IT Growing Pains

Posted on November 15, 2012 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.

Well, dear readers, if it’s not one thing it’s another. Our family has been plagued by broken bones (documented in a recent blog), as well as the sinusitis and bronchitis that have plagued so many other families as of late. Like a typical mother, I put off going to the doctor in the hopes that the malady would run its course, as my colds typically do. But after four weeks (one spent on holiday in the Virgin Islands), I woke up with new, more intense symptoms, and so decided to seek professional help. (I’ll leave it to you to determine if the copious amounts of rum punch and lengthy amount of time spent getting to and from Tortola in any way impacted my condition.)

I was faced with several options: try to get seen by my primary care physician, who, since my move, is now inconveniently located. (Note to self: seek new PCP closer to home.) Try my luck at the Walgreens clinic nearby. Or, go to the urgent care center down the street.

I bypassed Walgreens because I’ve had insurance issues there in the past. (As I drove past, I noticed they are excitedly welcoming back Blue Cross Blue Shield customers.) I faced the same problem at the urgent care center, so decided to try my luck at a previously unconsidered option – the new WellStar Acworth Health Park.

Larger than a typical medical office, but smaller than a typical WellStar hospital, the health park offers a variety of services – urgent care; pediatrics; a variety of specialists; pharmacy; and family, internal and OB/GYN medicine, among other services. I was pleasantly surprised to find that its café offers Starbucks coffee.

Just a few months old, its interior and exterior are pristine – open, airy spaces, fountains and lots of glass accents are certainly a nice change from the typical, closed-in feel of most phsyicians’ offices I’ve visited. The staff was welcoming, sympathetic and accepting of my insurance, much to my relief.

It even had a concierge/upscale feel. Complimentary single-serve coffee was available in the urgent care waiting room, as were a variety of cold beverages. A good portion of the waiting area was given over to kids’ amusements, which I hope my girls will never have to amuse themselves with! I definitely appreciated the wifi throughout the facility. These little perks are so nice when a long wait is in front of you and you’re well enough to take advantage of them.

Being that it is a new facility, it is still experiencing growing pains, most noticeably in the need for additional physicians. Fortunately, I didn’t arrive on a day where patients were wrapped around the building waiting for the doors to open, as the pharmacist told me has happened before. Nevertheless, I did wait a considerable amount of time on the single physician on staff that day. Even he mentioned the need for additional MDs in the face of great community need.

He was cheerful and paid attention to my concerns, even apologizing for the paper prescriptions. Turns out WellStar plans to transition from NextGen to Epic early next year, and is waiting for that process to start in order to bring the health park on board with new, system-wide electronic medical records and e-prescribing. He was very enthusiastic about the conveniences afforded by healthcare IT, which makes me think perhaps I should consider a WellStar physician in my search for a PCP closer to home.

The pharmacy was experiencing its own growing pains, most notably with its consumer-facing payment system, and phone lines. But, the staff’s smiling faces, good attitudes and a fresh cup of coffee helped allay any frustration on my part.

Coincidentally, I came across a press release later that day detailing WellStar’s just-announced partnership with Piedmont Healthcare. They’ve teamed up to form the Georgia Health Collaborative, which, according to Piedmont’s press release, will enable the two “to share intellectual knowledge concerning clinical care and seek cost reductions through economies of scale.”

I’m all for economies of scale, but hope my family won’t have to experience them via unexpected or put-off illness anytime soon.