Walk-in clinics based in grocery stores, drug stores and other retail outlets are a growing option in some parts of the country for treating minor illnesses like ear infections or sinus infections. Often open seven days a week and operating with minimal staff, these clinics tend to be staunch users of electronic medical record (EMR) technologies and other means of increasing efficiency in patient care.

The Little Clinic, a subsidiary of Kroger supermarkets, has taken its electronic records initiative a step further, rolling out an automated patient registration kiosk in most of its 116 locations. In an interview with FierceCIO, Mat Waites, CIO for The Little Clinic, talked about how automating the registration process and integrating it with the EMR system is saving time and money. Without adding staff, the clinics gained greater capacity to treat more patients.

FierceCIO: Why was it necessary to automate the registration process at Little Clinic locations?

Mat Waites: The company implemented electronic medical records about four and a half years ago, but they did not implement an automated registration method. There was the old-fashioned clipboard method for patients to sign in on the waiting list. After signing that clipboard, they would have to pick up another clipboard and fill out the dreaded patient information form.  

Sometimes it's hard to manage the line in the clinics. We had logistic problems. Some of our busiest clinics have an administrative person for some hours of the day, but at most of our clinics the nurse practitioner is the only person there. 

Also, we wanted to be able to track the registration data centrally. We wanted to capture a small set of demographic information and pull it back into the (EMR) database. 

FCIO: How did you select your automated registration system?

Waites: We developed an electronic registration kiosk ourselves because we couldn't find a commercial product that did exactly what we wanted it to do. [Our EMR technology] eClinicalWorks does not have a kiosk interface. It's rare to find an EMR that has a kiosk interface.  

The kiosk is a touch-screen PC that captures the patients' entry of their own demographics: We ask them what they're there for, what their symptoms are, their date of birth, how they want to pay; we ask for their first name, last name, gender and for their address, zip code and phone number; email address is optional. We used to pass out those restaurant buzzer things [to patients], but we came to the conclusion that pretty much all of our patients have a cell phone. They can go ahead and do some shopping while they're waiting for us to call them. Finally, we ask them to give consent for treatment.

FCIO: How much skill does the automated registration process require on the part of users?

Waites: It's very straightforward. A field comes up on the kiosk and you need to type in a name. A keyboard pops up on the screen, and it looks like a screen on your computer. It's pretty much self-training for people unless they're just totally unconnected with computers. The main demographic that struggles is the older folks. We do have an alternate registration method available.

FCIO: How is the registration data pulled into the EMR system?

Waites: The data is housed in a database that we created, and we need to get it out and into eClinicalWorks. We don't have the ability to write to the eClinicalWorks directly. We have read-only access to that database. I asked eClinicalWorks if they had a way for us to import registration information into the application. No they don't, and they weren't interested. 

We ended up developing the integration ourselves using Boston WorkStation. We settled on Boston WorkStation because they've got a real healthcare focus and have made a big investment in healthcare applications.

FCIO: What has been the feedback from the staff at the clinics?

Waites: They are thrilled overall. We are rolling this out in concert with another piece of technology oriented toward scanning driver's licenses and insurance cards. If you take these two pieces together, it makes our entire registration process paperless in the clinic. Just the kiosk part saves them time in the cycle of the patient encounter. It frees them up to potentially see one more patient in the day. 

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