The consumerization of healthcare is an ongoing trend, and many healthcare industry leaders see a more patient-centric approach to healthcare as the only way for healthcare delivery organizations and providers to keep pace.
Consumers are now empowered by technology to have more access to health information and are taking more of an active role in their care, and are also accustomed to convenience when engaging with other businesses, and are bringing those expectations to healthcare. Case in point, urgent care is now one of the fastest growing segments of the healthcare industry, according to market research firm IBISWorld, as consumers look for faster and more convenient options as an alternative to visiting the emergency room or waiting for an appointment with a primary care physician. The American Academy of Urgent Care Medicine (AAUCM) cites an ongoing shortage of primary care and family medicine physicians, the contraction of emergency departments and patients’ greater access to health information as trends that are fueling the growth of urgent care. There are approximately 9,300 stand-alone urgent care centers in the U.S. and 50 to 100 new clinics open every year, according to AAUCM.
In response to this demand for convenience and with the idea of bringing care to patients where they are, Great Neck, N.Y.-based Northwell Health, in partnership with GoHealth Urgent Care, designed its network of urgent care centers with a focus on transparency and patient-centered care, with health IT and technology playing a large role.
Northwell Health, formerly North Shore Long Island Jewish Health System, began a partnership with GoHealth Urgent Care in November 2014 to operate Northwell Health-GoHealth urgent care centers throughout the New York City area. Through the partnership, Northwell Health-GoHealth Urgent Care now operates 23 urgent care centers, with plans to open 15 more by the end of this year.
The facilities feature windows with smart glass technology for greater transparency
Robert Korn, M.D., medical director for the Northwell Health-GoHealth urgent care centers, says the health system’s expansion into urgent care services helps to further the continuity of care for health system patients. The urgent care centers feature an integrated electronic medical record (EMR) system enabling updated patient medical records to be accessed and shared by providers across the system, including Northwell Health’s 21 hospitals and more than 450 patient facilities and private practices. And, as the center’s have x-ray and laboratory services, any x-rays or diagnostic images taken at the urgent care centers are integrated into the health system’s picture archiving and communications (PACs) system, Korn says.
“Urgent care is a place where patients are going for convenience and that includes people who have gone to Northwell for many years. And, if those patients visit an urgent care center that’s in the Northwell system, then we can wrap that patient back if they need more advanced care to our own physicians and hospitals,” Korn says.
In the exams rooms, physicians and clinicians use surface laptops to connect to the eClinicalWorks EMR system, and the patient record is presented on a large screen, enabling patients to view their patient record along with the physician. Korn, who served as the longtime head of emergency medicine at Northwell’s Southside Hospital, considers this detail—letting the patient see the patient record on a large screen—as a big step forward in enhancing the provider-patient relationship.
“The medical record is not a device to separate me from the patients, it’s a device to integrate the patients into their care,” Korn says. “So with a typical EMR, when a patient goes to the doctor, they have a two-way interaction and then the doctor turns away to work on the computer. The patient spends 10 minutes watching the doctor work. At the same time, the doctor didn’t get the benefit of the patients’ knowledge of their health information while they were working. It’s possible that the doctor writes something down that the patient didn’t say or forgot to write something that the patient said.
Robert Korn, M.D.
He continues, “What we’ve done here is, we have turned that on its head. As I’m talking to the patient, I’m documenting and recording what they are saying, and the patient is watching me and the screen, so it’s a shared experience. It changes the doctor-patient experience to a more egalitarian experience. The patient feels involved. And it’s more transparent as the patient can catch any mistakes.”
“Also, he adds, “I’ve just cut the time it takes to document the patient’s care in half because, instead of speaking to the patient then turn turning away and documenting what they’ve said, I’m using a template and recording what the patient says as we go along and all my time is with the patient.”
Korn says he also uses the medical record and the screen as a teaching tool for the patients’ discharge instructions. “Typically, when a patient goes to the ER, we hand them several sheets of paper with instructions. Here, we can use pictures within the EMR to explain it to the patient. For instance, I can show a picture of the anatomy of the inner ear up on the screen when talking to a patient complaining of ear pain,” he says.
The urgent care centers were specifically designed to bring the best of retail and hospitality into healthcare, Northwell Health officials say. One innovative feature is the use of smart glass technology windows to enable transparency into the exam rooms. When there is a need for privacy, the windows can be dimmed or changed to opaque. “This enables a feeling of openness so the patient can see the facility end-to-end and can see into the exam room so they get a notion of the level of acuity we can do and the care we are able to provide,” says Todd Latz, CEO of GoHealth Urgent Care.
Korn says the openness of the urgent care center design fosters a sense of transparency not typically found in most hospital emergency rooms.
“When you go to an ER what do you see? A window that slides back and someone gives you something to fill out and then you’re left there until they call you back, “he says “Here, our relationship with the patient stars when the patient walks in the door, and even if I’m sitting at my desk, if I raise my eyes, I make eye contact with the patient. So the relationship with the patient is continuous, they walk in and see me working and that works for me, because if the patient sees that I’m very busy, they might be more tolerant about a short wait.”
“We use [smart glass technology windows] across a number of our emergency departments as well to provide that transparent experience,” Adam Boll, vice president of strategic ventures and ambulatory services at Northwell Health, says.
As most of the urgent care centers are located in the five boroughs of New York City, where space is at a premium, the facilities are designed to maximize clinical space and minimize hallways with sliding doors and mobile x-ray equipment.
The urgent care centers also were designed with a focus on a technology-enabled process for patients, with mobile appointment check-ins, the ability to check wait times online and integration with Uber in order for patients to have transportation to or from the centers.
Boll says the partnership with GoHealth Urgent Care is part of the health system’s larger push into leveraging joint ventures with healthcare services and healthcare technology vendors to “bring care into the communities where patients live and work.”
“As a health system, we have put a heavy focus on getting care to people where they live and work, and it’s the same across our other business lines. With our ambulatory surgery centers, the idea is to move surgery that is not appropriate anymore for a hospital setting closer to where patients spend most of their time. And, it’s the same thing with our partnership to operate outpatient dialysis centers throughout the community to make it easier for patients so they don’t to travel to the dialysis centers that are attached to our facilities or our other acute care centers,” Boll says.