If retail health clinics become the major trend some are predicting, it may help accelerate the rate of adoption for electronic health records.
Staffed mostly by nurse practitioners and located in drug, department and grocery stores, there are only about 100 of these clinics right now, but Wal-Mart is beginning a 12-store pilot test and similar programs have already been launched in Bartell, Cub Foods, CVS, Eckerd, Osco, Rite Aid and Target stores.
While organized medicine has often been accused of trying to postpone the inevitable, the American Academy of Family Physicians has announced that it recognizes that such a strategy would ultimately be a waste of energy and has instead tried to provide guidance so that the clinics operate in a manner that supports the AAFP's goal of improving community health. (The American Medical Association has not yet taken a formal position on retail clinics.)
EHRs part of guidelines
The AAFP issued a list of "desired attributes" that retail clinics should have, such as: a well-defined and limited scope of clinical services; the use of evidence-based and quality-improvement oriented clinical services and treatment plans; formal connections with community physicians; codified systems for referring patients whose symptoms exceed the clinic's scope; and the use of electronic health records.
"It's my understanding that not only are these types of clinics going to happen, but it's recognized that they can be partners and share in the care and the health of the community," said David Kibbe, M.D., director of the AAFP's Center for Health Information Technology. "We simply want to make sure that the care provided is good and that records are kept electronically so that the family physician in the community can see what was done and the patient can get good continuity of care."
Kibbe explained that the desire is to ensure that records of any diagnosis or medical procedures performed (such as immunizations) are stored in an electronic format so they can be accessed by a primary-care physician or hospital emergency department. "I don't think it's a whole lot more complicated than that," he said.
AAFP has been working with two leading retail clinic companies -- Minneapolis-based MinuteClinic and Take Care Health Systems based in the Philadelphia suburb of Conshohocken, Pa. -- and Kibbe said everyone appears to be on the same page.
Already in the plan
"In my experience with the people in leadership of these organizations, there has been no disagreement on this at all," Kibbe said. "They were already planning to do this -- we were not introducing the concept of electronic health records to them at all."
Take Care spokesman Darren Brandt said his company is in full agreement with the entire AAFP list of attributes, adding that EHRs will be a necessity to fill the healthcare niche that Take Care seeks to occupy.
"This is something we've been focused on and sure of since we launched this company, and we know these are the things we need to have in place -- it was sort of a no-brainer," Brandt said. "We think software, connectivity and being wired is a must for companies like us to make us part of the system and not outside of the system. It's certainly not a burden to us; it's something we've had since Day One -- which was not too far back."
Brandt said Take Care first opened in the Kansas City, Mo., area in November 2005 and in Portland, Ore., last month.
Dick Gibson, M.D., the chief medical information officer for Portland's Providence Health System, said that -- if retail clinics take off -- it shows that the existing healthcare system is too inflexible to meet patients' needs.
"Consumers will be voting with their feet for more convenience -- and the profession should respond," Gibson said, adding that retail clinics' use of electronic medical records may also prompt more physicians to adopt health information technology.
"We need to get all doctors on EMRs and then we need to get them connected," he said. "If Wal-Mart or Target build their systems so that they're connected, that would further help us to get where we want to go."
According to a Wall Street Journal Online/Harris Interactive Health-Care Poll, the concept of retail health clinics has public support -- even if they also have concerns over quality of service.
Of the 2,245 adults surveyed between Oct. 12-14, 2005, 75% expressed concern about receiving an accurate diagnosis at a retail clinic, but 83% also said they thought such facilities would be useful for receiving basic medical services during evening hours or weekends when doctors offices are closed.
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