The Role of Retail Clinics in the Integration of Electronic Health Records (HER) within Health Organizations
Introduction
The retail health care system, first established in the United States in 2000, has expanded by 2017 to include over 1960 centres across the country (Charland, 2018). Retail clinics represent a shift from the conventional care delivery, being serviced by nurse practitioners (N.P.s), and physician assistants (PAs), and are located within retail stores (Ahme & Fincham, 2010). These clinics deliver essential primary and acute health care services, such as treatment for mild acute medical conditions (i.e. allergies, sore throats, sinusitis, bronchitis, ear infections, and minor skin conditions), vaccinations, and preventive screening services with perks that include; low-cost services with transparent fees, short wait times, accessible locations, as well as evening and weekend care provide (Mehrotra & Lave 2012). As of 2007, surveys conducted on retail clinics across the country indicated a growing number of American families visiting these clinics with up to 16% of the American population having visited retail clinics in the past 12 months (Burkle, 2011). Predictions highlight that these numbers will continue to rise as the demand for convenient, low-cost medical care for minor complaints increases. Furthermore, the retail clinics continue to grow as multinational retail and pharmacy chains enter into the retail clinic business.
Problem Statement
As the retail clinics continue to become increasingly popular and sophisticated, they are expanding their range of services to manage chronic conditions like heart diseases, hypertension, diabetes, and asthma. Some retail clinics offer lab testing services as well. Their increased range of services offers retail clinics increased access to their clients’ medical records, and this helps to round out their strengths further. However, despite their commitment to providing quality healthcare, significant questions remain on the eventual capacity of these clinics to fit into the broader health care system. Of great significance is the issue on the need to integrate the medical health records of retail clinics with other parts of the health care systems across the United States to improve communication and coordination of care (Weinick., Pollack., Fisher., Gillen., & Mehrotra, 2011). Retail clinics are an essential component of the healthcare ecosystem, and growing collaborations with health systems and hospitals highlight their increasingly significant role in the healthcare continuum.
Retail clinics have been established to use electronic health records primarily, and are lauded for their ability to facilitate information sharing between physicians and patients. The CVS Caremark Corporation and Minute Clinic, the largest retail pharmacy in the United States have, for instance, began programs to integrate their electronic medical records allowing them to share the information on their medical interventions and adherence protocols with physicians. CVS has established similar partnerships with the University of Maryland Medical System, the University of Texas Medical Branch at Galveston, and the University of Alabama at Birmingham (UAB) Health System. Besides, CVS has existing partnerships with the Henry Ford Health System and the Cleveland Clinic, as well as affiliations with up to 44 other health systems countrywide (Evans, 2014). Within the integration programs, CVS also shares visit summaries and the medical histories to the partnering medical centres. More hospitals are seeking to work with retail clinic providers in these joint programs and care coordination. As a result, there are crucial interdependencies that underscore the ability to share information through the retail clinics. Furthermore, Walgreens, the main competitor to CVS, has 20 such partnerships of its own, with other retail chains like Target, Wal-Mart, and Safeway establishing their private primary care clinics within their stores.
Despite this growing niche within the retail clinic system to gather and to share patient information, significant concerns remain on the fragmented nature of their health records which are not virtually universal, and interoperable across various health care providers and this presents significant challenges in care coordination. Retail clinics offer substantial challenges, particularly in terms of how patient information flows from one practitioner to another. Part of these challenges is that there are no centralized data systems to handle patient information. There is a lack of uniformity in the usage of Electronic Health Record (EHR) across the country, and this makes it challenging to maintain a universal pool of patient information as needed (Boonstra & Broekhuis, 2010). For instance, when the Henry Ford Health System signed its first affiliation agreement with CVS’ Minute Clinic in 2011, it had not yet connected its EHR system to Minute Clinics’ system because it had not yet completed its HER installation (Evans, 2014). As a result, Henry Ford ended up using the EPIC HER system while CVS maintained their proprietary EHR. This reliance on different patient information storage systems has led to cases of patient care fragmentation where patients’ information is only available to healthcare practitioners who are operating under similar EHR software.
The inconsistent storage of patient information software is heightening the miscommunication of patient information among retail clinics, urgent care centres, and hospital organizations, particularly the emergency room department (E.D.). There have been cases of incomplete patient information transfer among healthcare practitioners within organizational walls that could have been precipitated by the inadequate transfer of patient information from one healthcare organization to another (Evans, 2014). Besides, visits to retail clinics may go unreported to the relevant primary-care doctors, creating fragmented data in patients’ medical histories. Patients visiting retail clinics may be due for more complex care, or screenings that end up missed in the retail settings where the scope of the services offered are limited. The eventual expansion of the services provided by retail clinics poses a further threat to adequate sharing of patient information for the management of more complex conditions that require ongoing management with routine testing and medications.
Moreover, it is essential to note the difficulty in the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Act in the pretext of the retail clinic system which poses significant challenges in healthcare accountability, and access to healthcare information (Boonstra & Broekhuis, 2010). The HIPPA Act actively seeks to prevent patient data from access by unauthorized bodies. Most importantly, the act aims to formalize how patient information flows in the healthcare system; this means that although retail clinics can have patient’s information (personal and clinical), it is tasked by the HIPPA Act to protect that information and only use it (and share it) under strict precepts.
Because retail and urgent care clinics do not share the same advanced data storage systems with most hospital systems, incomplete information is easily communicated. This fragmentation of patient data is the foundational cause for the need to promote partnerships between retail clinics and health systems to allow for data sharing through the integration of electronic health records that enable care providers to access the most recent medical records of their patients (Evans, 2014). Furthermore, it is vital to consider the adoption of other health care delivery partnerships such as the Care-Everywhere channel where different healthcare organizations can communicate patient information. These platforms are, however, yet to receive full participation, and this means the possibility that patient data can be lost, resulting in the communication of incomplete patient reports. In light of these considerations, it becomes clear that an integrated patient information system is crucial to improve coordination of care (Mehrotra & Lave, 2012). Moreover, these collaborations will help to improve the health of the population through joint management of chronic and acute diseases, and conditions.
Significance of the Study
An increasing number of traditional healthcare providers are beginning to partner with retail clinics to improve health services and promote the continuity of care. Such clinical collaborations are completed by sharing information through electronic health records. The electronic health records provide embedded clinical protocols for both retail clinic providers and hospital institutions to allow patients and physicians to access the same care plans despite the differences in care settings (Evans, 2014). This level of access is expected to deliver seamless experiences for patients at different touchpoint and to ensure improved continuity of care while also strengthening health systems partnerships.
Driving communication between retail clinic providers and primary care providers helps to ensure that they touch base whenever they share a patient. This enhancement of communication between healthcare practitioners eases the continuum of patient care, and thus the overall safety of patients. Disclosure of patient information among healthcare professionals has been an area of great concern and focus within the health care industry for many years. Although these communication problems have been addressed and improved upon, the growing expansion and diversity of the healthcare industry necessitates caution when sharing and exchanging patient information. Communication of patients’ information needs to be carefully conducted, mainly because of the patient to healthcare professional ratio and the controversies of a patient’s ethnicity, age and gender in our society today, respectively.
Research Questions and Hypothesis
What is the role of retail clinics in ensuring the successful integration of electronic health records within the health care system?
H1: Retail clinics play a crucial role in the successful integration of electronic health records within the health care system.
It is crucial to establish that a critical analysis of the above question and the discussion on the significance of integrating health records will establish data on how retail clinics can partner with health care organizations to improve patient information sharing among physicians, nursing practitioners and physician assistants. There is a need to provide evidence that retail clinics facilitate information sharing based on their experience of working with off-site physicians. Most importantly, there is the possibility that sharing diagnostic information will help improve the continuity and quality of care.
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