Rural Urgent Care Medical Clinic in Rural Hawaii (Big Island)

Our urgent care facility is located in a shopping center in rural East Hawaii. The footprint of the clinic is 20’ x 40’, 800 square feet (floor plan attached). We have three exam rooms. Needless to say we have such limited space that making the decision to operate paperless was not a hard one. Resources that contribute to our paperless environment include the following:

1. T-1 line with a rating of “Business Class” (up and down speeds the same) with guaranteed response time in the event of a system failure

2. Digital (VoIP) phone system/server

3. Secure circuit (required for Health Insurance Portability and Accountability compliant)

4. Windows file serve with five Windows Vista clients on the network (including one laptop used as a wireless unit when seeing patients)

5. Patient History (AmazingCharts) and billing software (EzClaims). Any patient information that cannot be input the patient history, is scanned and attached to the patient’s record.

6. We expect to implement electronic prescriptions within the next few weeks as mandated by Medicare. The software we will adopt is a web base solution called “ePrescribe” from Allscript.com.

7. Epocrates is a popular handheld drug reference is continually updated with the latest medications, indications, and interactions. Essentially, it is a prescribing tool used by the providers. We have this on our server and one of our providers has it on her PDA. It is now available for iPhones as well.

8. In our environment we like to think of our IT network as “Computers are Phones and Phones are Computers.” They are integrated. Our Altigen phone system is called “Altiserv.” The system allows us to manage communications in the following manner:

• Incoming calls can be routed to any extension in the clinic as well as to any outside phone number (like a doctor’s cell or home phone). The caller only sees the number at the clinic, therefore protecting the doctor’s privacy.
• The doctor can also call the clinic and ask to be connected to a patient’s phone number. The patient only sees the clinic number.
• Calls routed to a voice mailbox are not only recorded but routed to the email address (as a wav file) of the box holder.
• Files can be attached to a patient’s file for later reference as well.
• We have a series of wav files on the server to play music while anyone is on hold.
• All messages recorded in a voice mailbox are either wav or mp3 files stored on the server. The can easily be routed to an appropriate person and/or stored as an attachment to a patient file.
• We have a professional narrator who donates her services for our voice messaging system. We email her scripts, she records them in a professional studio in either wav or mp3 format, and emails them back to us as attachments to an email. Recorded scripts are stored on our phone server.

9. Our server is backed up on-site and remotely every evening.

10. We have two networked printers, one of which is a laser all-in-one device.

11. In addition to four corded handsets, we have two cordless units for use in the exam rooms.

12. The entire network (phone and computer) are managed by one local IT vendor (NetCom Enterprises).

13. We are a pilot program in rural urgent care delivery. With one physician, we can run multiple clinics staffed with a Physician’s Assistant, an RN, an LVN and a receptionist/staff person. When we open more rural clinics, we can do so with only one physician managing multiple sites. Other sites will be able to access our file server and use our phone server from other locations. We need only add additional workstations and more phone numbers as needed.

We have the ability to tie into HMSA (Hawaii Medical Services Association) on-line care and/or develop our own. HMSA is one of the agencies that provide funding to our clinic. http://www.hmsa.com/ Kaiser Permanente has an email system for patient doctor contact. We are positioned to tie into this system as well. https://members.kaiserpermanente.org/kpweb/signonpage.do Kaiser Permanente has a clinic in Hilo (22 miles away), but they are not open weekends. We are having discussions with them about providing weekend service to their subscribers. Currently their subscribers go to the Hilo Hospital ER for service, at great cost to Kaiser. We opened our doors a little over three months ago. In this short period of time we have seen over four hundred patients and the number continues to rise. Our long-term goal is to have a 15-acre campus with a 24/7 ER, dialysis clinic, wellness programs, behavioral health and delivery of a variety of different kinds of medicine (traditional Hawaiian, acupuncture, etc ) and several satellite clinic of which this clinic will be our first one. It tooks us eighteen months from the time we started the build-out to open our doors. When the word got out, a pharmacy and a branch of Clinical Labs (medical testing laboratory company) opened their doors in the same shopping center. Clincal Labs is right next door to our clinic and the pharmacy across the parking lot. Clinical Labs is already talking about being open more hours and expanding testing services. Prior to the Clinical Labs opening, people had to drive twenty-two miles to Hilo to give blood. (See attached pictures)