Back in February, major pharmacy chains including Walgreen Co., CVS Caremark,
From all I can tell, consumers are getting better access to their own health records, thanks to growing demand for such access as well as from Stage 2 of the federal Meaningful Use EHR incentive program, which requires a degree of consumer engagement. Stage 2 is off to a rocky start for sure and consumer demand for health records still seems to be confined to a relative handful of highly engaged patients. Accordingly, health information exchange continues to lag.
I bring this up because I had the occasion to visit a Minute Clinic at a CVS in DeMotte, Ind. (population 3,900), about 65 miles southeast of Chicago, a couple of weeks ago, for an insect bite on my right knee that had become infected while I was on a bicycle tour. With a high-deductible health insurance plan, I'm pretty conscious of costs, so a visit to a hospital emergency department was my last resort. The walk-in clinic was a good option, and I was lucky to find one within 10 miles of where I had stayed the night before.
I have to say the experience was quite pleasant and efficient, even if I had to wait 40 minutes because there were others ahead of me because it was July 5, the morning after a holiday when the clinic was closed. Check-in took place on a touch-screen kiosk, where I entered my medical history and insurance information via a dynamic questionnaire, saving me from the dreaded clipboard and automatically populating my medical record for when I got in to see the nurse practitioner.
During the exam, the NP had all of the information right in front of her, including the note that I am allergic to sulfa drugs, an important thing to know when prescribing antibiotics. It turned out that, as I suspected, I likely had cellulitis (Minute Clinic doesn't have an on-site lab to test cultures). She electronically prescribed oral and topical antibiotics, which went right into the CVS pharmacy's queue, though the scripts could have gone to any other pharmacy I specified. (Thanks to the Surescripts network, there is pretty good interoperability when it comes to prescribing and collecting medication history.)
Two weeks later, I can say the antibiotics have worked, and the wound is almost gone.
I got a printed clinical summary to take with me from Minute Clinic's home-grown EHR, which I perused while waiting for the pharmacy to fill my prescriptions. But I was not given the option to have the records sent electronically to my primary care physician or to download a copy via a portal; in fact, the only promise the pharmacy chains made about Blue Button was that people would be able to download and share pharmacy records, not more complete medical records.
CVS is replacing the current EHR with one from Epic Systems, to, according to a press release, "facilitate connectivity with health care providers nationwide that currently use Epic, including many major health systems, hospital networks and physician groups currently affiliated with MinuteClinic." It doesn't say anything about connectivity with non-Epic users, however.
Even though CVS says more than half the U.S. population will have a record stored in an Epic implementation by the time current Epic installations are complete, interoperability within one vendor's EHR is not the kind of full interoperability Presidents Barack Obama and George W. Bush have promised the American people over the past 10 years. We continue to fall far short, and patients are the one who suffer from these major gaps in data sharing.
