Wal-Mart Mandates E-Health Tools For Patient CareWal-Mart Mandates E-Health Tools For Patient Care

Are a patient's symptoms more likely to get digitally documented into an electronic medical record at the convenience clinic inside Wal-Mart than at his or her own doctor's office? Possibly.

The emergence in the last few years of convenience health clinics operated in the stores of retailers such as CVS, Walgreen's, and now Wal-Mart has brought with it an unexpected twist.

Besides providing quick tests for strep throat and prescriptions for antibiotics by nurse practitioners working in small spaces set up somewhere between the cosmetics and pet food aisles, these retailers are deploying technology tools in their clinics that most doctors still lack in their offices -- e-health records and decision-support systems.

It's estimated that fewer than 20% of U.S. doctors have deployed e-health record systems in their offices, despite the urging by health-industry experts and government officials, who have been spotlighting IT in recent years as important tools to reduce medical errors and costs.

When it comes to the largest chain retailers, these clinics are typically run as division of the retailer or are operated by a third-party health-services provider (such as a hospital group) but co-branded with the retailer.

For instance, MinuteClinic, which was acquired a few years ago by CVS, is operated as a subsidiary. So, MinuteClinic either owns and operates clinics or manages them for another company, depending on various state regulations. On the other hand, the new "The Clinic At Wal-Mart" sites are actually owned and operated by third-party health care providers that are co-branding their clinics with the Wal-Mart brand at Wal-Mart's stores.

Wal-Mart unveiled the first of these co-branded clinics earlier this month in Arkansas and has plans for more than 400 by 2010 in Atlanta, Little Rock, and Dallas, including some rebranding of the approximately 60 clinics that currently operate in Wal-Mart stores.

Right now, Wal-Mart also has about 55 in-store clinics that are leased and operated by independent companies. However, a Wal-Mart spokeswoman said that as those leases expire, Wal-Mart hopes to change those sites over to the new co-branding model.

As part of this push, which could end up with Wal-Mart opening more than 2,000 clinics by 2014, Wal-Mart said it signed a letter of intent to work with RediClinic and local hospital systems to open co-branded walk-in clinics in 200 Wal-Mart Supercenters. The retailer has also signed a letter of intent to partner with St. Vincent Health System, part of the Catholic Healthcare Initiatives system, to open four co-branded clinics in Little Rock.

RediClinic also runs about 30 in-store clinics under the RediClinic name elsewhere and uses proprietary e-health record software for patients at those sites, said a RediClinic spokeswoman.

However, as part of the Wal-Mart co-branding deals, the retailer is "requiring" that the operators of its clinics -- including RediClinic -- use e-health record and practice management software from eClinicalWorks, a privately held vendor in Westborough, Mass. "Wal-Mart wants to be consistent with all its clinics," said the RediClinic spokeswoman. A Wal-Mart spokeswoman confirmed the requirement for eClinicalWorks software to be used in its clinics but declined to elaborate.

An eClinicalWorks spokeswoman said Wal-Mart attorneys have requested that the company not publicly discuss its Wal-Mart relationship. While eClinicalWorks, which posted revenue of $60 million last year, is tiny compared with e-health record vendors like General Electric and Epic Systems, eClinicalWorks is also playing a key role in a few high-profile regional e-health projects involving multiple health care providers, including the Massachusetts eHealth Collaborative, which has hundreds of doctors using eClinicalWorks software in their practices. To be sure, Wal-Mart is not the first retailer to deploy e-health records for patients of its in-store clinics. In fact, e-health record systems are being used in just about every in-store health clinic in the United States, of which there were about 500 in late 2007, but could grow to more than 1,500 by end 2008, said Mary Kate Scott, principle of health clinic consulting firm Scott & Co.

"One of the biggest ironies in this is that the AMA [American Medical Association] has set guidelines that clinics should have electronic medical records, while simultaneously not mandating that for doctor practices," she said.

For example, MinuteClinic, a subsidiary of drug store chain CVS, has be using e-health record software since it launched its first retail clinics in 2000, said MinuteClinic CIO Cris Ross. The company now uses in its 485 clinics in 25 states a proprietary e-health record system that's complemented by third-party components, for processes such as e-prescribing, drug-interaction checks, and insurance claims transmission, he said.

About a year ago, the company converted its homegrown e-health record system to comply with industry organization ASTM's continuity of care guidelines, he said. But the real jewel of MinuteClinic's e-health system is its evidence-based decision-support tools, which guide in-store clinicians on medical industry best practices, such as the appropriate steps to take if a patient's strep throat test result is negative versus positive, he said.

In addition to using e-health record software, just about every in-store clinic also relies on decision-support tools like MinuteClinic's, said Scott. That's because the business model of these clinics -- which is to provide consumers with a limited array of low-cost and quick health services in small spaces, requires quality assurance and standards of care that are supported by tech tools, like e-health records and e-checklists, Scott said. "It's not possible to do this without a technology backbone," she said.

Also, the security and privacy concerns that plague paper records, not to mention the space limitations at these clinics, make digital records a must for in-store clinics, said Christina Chang, a health IT analyst at research firm Datamonitor.

"It doesn't make any sense to start a clinic -- or a new doctor's practice -- today with paper files," she said.

Despite their leap toward digitization, however, most in-store health clinics haven't attempted the biggest hurdle that other tech-savvy health-care providers are also still tackling -- exchanging patient data electronically.

While MinuteClinic clinicians document patients' visits electronically, after the visit, patients and their doctors are provided with a paper copy of the visit summary. "In the last five months, we've mailed or faxed 300,000 medical records to 18,000 medical practices in 50 states," Ross said.

The lack of secure, trusted, tested, and interoperable health exchange networks to share and transmit patient health information with other clinicians is the obstacle, said Ross. Nonetheless, MinuteClinic is "working with a number of [electronic] exchanges" in forging possible data sharing relationships, Ross said, declining to disclose details.

In the meantime, MinuteClinic's e-health system "is paying off in quality and efficiency," he said. That includes the quality of care patients receive through help of the clinical decision-support tools and electronic drug-interaction checks, as well as MinuteClinic's not needing to keep paper files for each patient.

When clinicians enter patient information into MinuteClinic's e-health record systems, the data is sent to MinuteClinic's centralized server and retained according to government regulatory requirements, he said.

In 2004, President Bush set out the goal for most Americans to have electronic health records by 2014, and among retailers, Wal-Mart seems intent on doing its part to help the effort.

Not only is Wal-Mart using e-health record software for patients treated at its in-store clinics, the retailer is rolling out personal e-health records to tens of thousands employees and their dependents as part of the Dossia effort, a consortium of about 10 large employers (including Intel and AT&T) that is in the pilot stages of providing digital health records to workers.