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Retail Clinics Rely On Automation
April 1, 2008
Smaller group practices could learn a thing or two about automation from the hundreds of retail clinics that are popping up in drugstores all over the country.
“It’s disappointing that, so far, most small group practices are not seeing these new clinics as an inspiration for automation,” says Rosemarie Nelson, a consultant with MGMA Heath Care Consulting Group, Syracuse, N.Y. Nelson advises group practices on automation and other issues.
“Small group practices that haven’t figured out how to improve their operations through automation are just treading water,” Nelson says.
The new breed of drop-in clinics, usually staffed by nurse practitioners, offer convenient care without an appointment for treatment of sore throats and other minor conditions. Virtually all of them use electronic records.
Since the first of these clinics opened in 2000, the drugstore facilities have multiplied to total 920 as of early 2008, according to a new trade group, the Convenient Care Association, Philadelphia. About 30 companies now operate the clinics, the association estimates. MinuteClinic Inc., Minneapolis, owned by CVS Caremark Corp., Woonsocket, R.I, is one of the largest players, with 482 sites primarily in CVS drugstores. Take Care Health Systems LLC, Conshohocken, Pa., owned by Deerfield, Ill.-based Walgreens Co., has 143 facilities and expects to grow to 400 by year’s end.
A handful of provider organizations, including Sutter Health, Sacramento, Calif., also have opened drop-in clinics in partnership with local drugstores.
“As an industry standard, we have called for all of these clinics to have electronic records,” says Tine Hansen-Turon, executive director of the association.
The retail clinics provide valuable lessons for conventional physician group practices, Nelson says. Faced with declining profit margins, group practices need to devise ways to accommodate quick drop-in visits like the retail clinics, she says. And electronic records are essential to that effort because they save valuable time compared with hunting down paper charts on short notice, she argues.
Homegrown Records
The two big players in the retail clinic sector are both relying on homegrown electronic records systems tailor-made to handling the relatively narrow range of cases the facilities accommodate.
Commercially available electronic health records systems were too broad to meet the emerging clinics’ needs, says Cris Ross, CIO at MinuteClinic. The chain created its own software with structured templates that automatically provide treatment guidelines based on the data the nurse practitioner enters, he explains.
Minute Clinic blended guidelines from three industry sources in building decision support into its records system, the CIO says. This approach is important given that the nurse practitioners, while monitored by physicians, practice independently.
Each site accesses the software over CVS’s national data network using the application service provider computing model. The clinics use desktop thin clients from Wyse Technology Inc., San Jose, Calif.
At the conclusion of each visit, the clinician prints out a record of the treatment for the patient, plus appropriate educational materials. A copy is also mailed or faxed to the appropriate primary care physician if the patient has one.
Ultimately, MinuteClinic hopes to work with a national, secure clearinghouse to share its records with physicians electronically, Ross says. “We’ve sent out over 300,000 patient summaries to over 18,000 practices in all 50 states in recent months on paper or fax,” he says. “To communicate with that number of practices, I need to find some trusted entity that can connect at that level of scope. We think there are opportunities that will emerge soon.”
MinuteClinic facilities transmit electronic prescriptions through the network of Alexandria, Va.-based Surescripts. “We do not steer patients to our pharmacies; they can take the prescriptions wherever they want to, and e-prescribing accommodates this,” Ross says.
The organization eventually expects to add patient self-serve kiosks for self-registration, the CIO adds. “Our first job is to support the nurse practitioner’s ability to provide the highest possible quality of care,” Ross says. “Second is providing the patient with a great customer experience.”
Blending Clinical, Retail
The chain’s approach to automation, as a result, is aimed at “blending a clinical and a retail experience,” Ross says. This is necessary, he says, because the nurse practitioners at the clinics generally handle all functions, from greeting patients to transmitting prescriptions.
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