Nursing Informatics in

Retail Clinics
 Introduction

Disruptive innovation, like the rise of desktop computers replacing mainframes and
smartphones overtaking desktops, has also affected healthcare. Retail clinics are an example of
this innovation, offering convenient, affordable healthcare services in community settings.

The traditional healthcare model is business-centric, not patient-centric, often lacking

transparency and accessibility. Patients must conform to physician schedules, facing challenges
in accessing care when needed. This is where retail clinics step in, meeting consumer demand for
accessible, quality care.

These clinics are typically located in retail spaces, open extended hours, and offer walk-in
services without appointments. They provide a range of basic healthcare services, appealing to
patients seeking convenience and affordability
 Introduction

Factors like rising healthcare costs and limited access to care have fueled the demand for retail
clinics. Their growth addresses the need for accessible, affordable healthcare solutions outside
traditional settings.

To meet the increasing demand for primary care services, innovative approaches like retail
clinics, along with leveraging technology and expanding the roles of Nurse Practitioners and
Physician Assistants, are essential. However, addressing patient needs and integrating these
innovations into the healthcare system are key challenges that need to be overcome.
 RETAIL CLINICS: DISRUPTIVE INNOVATION FOR PRIMARY
HEALTHCARE DELIVERY
Retail clinics, also called convenient care clinics, are a new way of providing healthcare services
that address the needs of many Americans for convenient, coordinated, high-quality, and
affordable healthcare.

Despite efforts to reform healthcare, costs continue to rise, making healthcare unaffordable
for many. Access to healthcare is also limited and inconvenient, with patients often facing long
wait times and difficulty scheduling appointments.

Retail clinics emerged in response to consumer demand for accessible, affordable, and quality
healthcare. They are typically located in retail settings like drugstores and supermarkets,
offering a variety of services without the need for appointments. Most are open seven days a
week, with extended hours, making them convenient for patients
 RETAIL CLINICS: DISRUPTIVE INNOVATION FOR PRIMARY
HEALTHCARE DELIVERY
These clinics are usually staffed by Nurse Practitioners and Physician Assistants, who handle all
aspects of a patient's visit, including registration, diagnosis, treatment, and follow-up.
Technology plays a key role in streamlining clinic operations and ensuring efficient, quality
care.

Retail clinics prioritize quality and safety, adhering to industry standards and regulations. They
use electronic health records (EHRs) to maintain patient records and facilitate communication
with other healthcare providers.

Overall, retail clinics provide a cost-effective and convenient alternative to traditional primary
care settings, meeting the needs of patients seeking accessible and affordable healthcare
services.
TECHNOLOGY USE IN RETAIL CLINICS TO DELIVER QUALITY CARE

Healthcare is a labor-intensive, knowledge-intensive, skill-intensive, and time-intensive activity.

In retail clinics, a one-provider-one-clinic-model is employed, utilizing information technology
to streamline workflows and data sharing across various applications. Electronic Health Records
(EHRs) offer providers a comprehensive view of patient records and provide evidence-based
clinical guidelines and decision support algorithms for diagnosis and treatment.

In retail clinics, technology supports patient self-management, practice management, and

clinical care delivery workflows.
 Patient Self-Management

Engaging patients in managing their healthcare starts with giving them the power to access
care when and where they need it. Retail clinics, located in communities where people live and
work, ensure a consistent experience for patients across different locations. These clinics also
offer a national footprint, allowing patients to access their records no matter where they are.

Online and mobile scheduling systems, similar to those used for booking services like car repairs
or restaurant reservations, help patients book appointments conveniently. Appointment
reminders via text or email increase the likelihood of patients showing up for their visits.

When patients arrive at the clinic, they are greeted by kiosks providing information and
instructions for the registration process. These kiosks replace traditional administrative staff
and collect patient data efficiently.
 Patient Self-Management

Queue monitors in the waiting area inform patients of their place in line and approximate wait
times. Some clinics also display health information on monitors in the waiting area.
Once registered, patients are alerted to the provider's availability, and the provider accesses
relevant patient information from the queue list before meeting with them.

During the visit, the provider uses information technology to manage both administrative tasks
like billing and reporting and clinical tasks like diagnosis and treatment planning. These
workflows are integrated to support the one-provider-one-clinic model effectively.
 Practice Management

Practice management in retail clinics involves using technology to streamline various tasks.
Patient demographic data collected at kiosks is used for the next step, which is capturing
insurance and financial information. This can be done through manual entry or scanning
insurance documents. As more insurers use virtual insurance cards, clinics may need new devices
to capture data from patients' smartphones.

Once insurance data is captured, it's checked for eligibility and verification. If a service isn't
covered, the patient is informed and responsible for payment. Pre-payment processing may
occur before the examination to streamline the process.

Administrative tasks occur throughout the patient's visit, including billing functions like
selecting charges and codes and collecting payment. Evaluation and Management Coding (E&M
Coding) follows standardized billing processes, taking into account the patient's health history,
physical exam findings, and medical decision-making complexity.
 Practice Management

Finally, payment collection is facilitated based on patient preferences captured during

registration. Integration with financial billing systems ensures accurate billing to insurers and
patients, if applicable.

Managing retail clinic practices involves capturing and processing patient demographic,
financial, and clinical data. Electronic Health Records (EHRs) are used for clinical data capture
and integration with billing and external systems to ensure continuity of care.
 Clinical Documentation Management

Electronic Health Records (EHRs) are crucial for the success of retail clinics. Like all practice
EHRs, those used in retail clinics support provider workflows for assessment, diagnosis, and
treatment. They aim to help providers work independently, streamline administrative tasks, and
suggest appropriate actions based on evidence-based guidelines.

During each visit, essential clinical data such as health history, allergies, and medication history
are documented and updated as needed. Retail EHRs focus on a defined scope of services, like
treating acute illnesses and providing vaccinations, with structured assessment processes and
focused templates.

For billing, providers need to assign the correct diagnosis codes. Retail EHRs assist by offering
robust search functionality and quick pick lists for commonly used codes. As the healthcare
system transitions to ICD-10, EHRs will adapt to the increased specificity of diagnosis codes.
 Clinical Documentation Management

Providers may need to order additional tests or medications, which the EHR can transmit to
external systems like lab or radiology. Results are integrated back into the EHR for review, with
system-generated tasks ensuring timely follow-ups.

E-prescribing allows providers to electronically send prescriptions to pharmacies from the EHR,
improving patient care quality and reducing error rates. It also enables access to patient benefit
information, medication history, and drug interaction checking, saving time and enhancing
safety.

Retail clinics prioritize continuity of care by sharing discharge summaries with patients' primary
care providers. Summaries can be transmitted electronically or via integrated faxing solutions.
Additionally, retail EHRs support state immunization reporting requirements through
standardized interfaces.
 RETAIL CLINIC ROLE IN PATIENT-CENTRIC CARE

The healthcare reform movement aims to improve quality of care while reducing costs through
coordinated primary care delivery systems and the promotion of medical homes. Accountable
Care Organizations (ACOs) are networks of healthcare providers that take responsibility for the
quality and total cost of care they deliver.

To achieve their goals, ACOs employ strategies like better care coordination, involving non-
physician providers like nurse practitioners, establishing patient-centered medical homes, and
using information technology.

Patient-Centered Medical Home (PCMH) is seen as the future of primary care. Retail clinics can
play a vital role in ACOs and PCMH by identifying primary care needs, helping patients find
medical homes, and collaborating with community-based providers. This collaboration can
expand the scope of services offered by retail clinics, such as chronic disease management.
 RETAIL CLINIC ROLE IN PATIENT-CENTRIC CARE

Both retail clinics and PCMH will use information technology to manage care. Electronic Health
Records (EHRs) enable documentation and tracking of patient conditions, while clinical decision
support systems help providers make informed decisions. Communication tools facilitate
sharing information between organizations, strengthening team-based care.

As retail clinics join PCMH networks, additional technology needs may arise. Patient
engagement tools and online/mobile applications will allow patients to be more involved in
their care. Telehealth technologies will enable providers to manage more patients and offer
care at convenient times and locations.
 FUTURE OF RETAIL CLINICS

The rapidly changing healthcare market presents a unique opportunity for advanced practice
nurses to deliver high-quality, cost-effective care through retail clinic practices. These clinics
disrupt traditional primary care models by operating outside conventional physician offices.
Technology, including Electronic Health Records (EHRs), e-prescribing, and data exchange, plays
a crucial role in consumer acceptance of retail clinic services.

Since their inception, retail clinics have seen themselves as part of the patient's care team,
offering access to healthcare services. By adopting a team-based approach to care, productivity
and effectiveness can be enhanced. When patients receive care from the right provider in the
appropriate setting, and technology enables communication among all involved parties,
including the patient, retail clinic, and Primary Care Medical Home (PCMH), everyone benefits.
Information technology serves as the foundation of the retail clinic business, allowing them to
quickly adapt to consumer and care delivery partner needs.