Healthcare in a Minute

Where did you get your last flu shot? At the doctor’s office or at your local pharmacy? I usually go to CVS, where the wait is short, plus I get 20% off my next purchase (can be real savings with a teenage girl in the house who always has a CVS list). But have you ever had a check-up for a sore throat, cough or back pain at the drug store?

blood pressure,  healthcare, clinicWith changes to healthcare laws that are necessitating increased access to care, the “minute clinic” or retail clinic is becoming a popular and widespread concept. With nearly 1,600 of them across the country in drug, grocery and big box stores, estimates predict these numbers will double in the next few years.

I saw my first “minute clinic” last year in the back of a Duane Reade in NYC. I was immediately impressed to see a nurse practitioner at a desk, ready and waiting for a customer. What a great idea to bring healthcare to the people!

I talked to someone who recently used a minute clinic because she wasn’t feeling well, was heading out on a business trip and knew she couldn’t get in to see her regular doctor. She was diagnosed with a urinary tract infection. The NP discussed the treatment, the prescription was filled right at the store, and she was on her way. The next day, she received a voice messages from the minute clinic to find out how she was feeling, make sure she was taking the medication and inquire if she had made a follow-up appointment with her doctor. Since she felt good, was taking her meds and had made an appointment, she did not return the calls. However, the clinic kept calling her until they spoke to her. They told her they needed to talk to her directly to be sure she understood all directions and was following up appropriately. Needless to say, she was impressed and spoke highly of her experience.

But not everyone is as enthusiastic. Physicians are concerned not only that these clinics eat into their market share, but more importantly that “stop and shop” medical services may not identify clues to larger problems.

The American Academy of Pediatrics warns against using these clinics for children due to concerns over “fragmentation of care” and missed opportunities to identify more serious problems that might stem from minor complaints.

Patients are concerned about continuity of care - that an NP may not be qualified or won’t know anything about them. Others have strong attachments to their primary doctors and don’t want to give up those relationships.


I appreciate these caveats, but I think the benefits far outweigh the costs. Over the past year, I’ve been involved in national training initiatives to help providers integrate telehealth technology into clinical practice to expand access to care. As more people get insurance coverage through the Affordable Care Act, our medical systems will need to find ways to treat more patients with a variety of resources. The minute clinic can be effective with the following in mind:

Have a primary care doctor. Yes, everyone should have a doctor or clinic that has a record of your health care needs. Even if that’s your local urgent care (mine is also a family practice center), it makes good sense to have that “medical home” that knows and understands you. As noted above, this is especially true when dealing with children.

Regulations are key. There’s great potential for the success of these clinics as long as they are well staffed and regulated. I see a real opportunity for hospitals to collaborate and create partnerships or sponsor these types of clinics, providing another level of care important to consumers.

Take a collaborative approach. Retail clinics should adopt a collaborative team model with other physicians and the community. Medicine is often conducted in silos, but with technology and good practices, there is less fragmentation. The Electronic Health Record (EHR) will be required by all practitioners later this year, so having a more transparent system can start transforming the way we deliver care.

Nurse practitioners are great providers. Like any health care provider, training and supervision are essential. And a well-trained NP is an outstanding asset in any clinical setting. At my doctor’s office, I most often see the NP, and she’s great.  Also, there aren’t that many primary care docs left. The vast majority of students coming out of med school are specializing, not coming out to work with the marginally ill.

Manage Change. Change is hard, and this new model is a change in something very important: the way we get our health care. Patients, providers and the general public will all have to make some changes. So some of this is good old change management. How can we engage people to do something different, something that may make them uncomfortable or threatened? Having a champion of change can be very beneficial – someone who’s already on board, who thinks it’s a good idea.

It can also help to bring in an outside person to lead change: someone objective who can help an organization implement new ways of doing things. One of the main components of the telehealth technology curriculum I teach entails helping people understand how to implement a change process. Whether you’re in healthcare or any other industry and could use some support around making change happen, I’m happy to talk to you about options for consulting or training to meet your specific needs.

What’s your experience with the Minute Clinic? Have you used one? Would you visit one for your healthcare? Share in the comments below.

To hear an excellent story on Minute Clinics, you can listen to this On Point Radio show that inspired this post.

Telehealth Technology Expands Access to Health Care

Have you ever spoken to a doctor or nurse on the phone about a medical condition? Had a radiologist email your x-ray results to your doctor? Had a robot neurologist do a medical exam? Yes, a robot neurologist. And if you don’t believe it, here’s a video with one example of how technology is being used to provide care to patients who might not be able to get it otherwise.

This is an excellent example of telehealth. With the new health care laws and expansion of technology in clinical care, telehealth is here to stay. Let’s take a look.

Telehealth or telemedicine?

Telehealth and Telemedicine: What’s the Difference?

You may have heard both terms used, but there's a difference between telemedicine and telehealth.

According to the Institute of Medicine’s 2012 report, telemedicine is the “use of medical information exchanged from one site to another via electronic communications to improve patient health status.”

Most of us have had telemedicine be a part of our health care without even realizing it. Electronic medical records are a type of telemedicine that allow doctors to share patient records easily. Most radiology is telemedicine, with doctors receiving results from radiologists electronically. It’s pretty common.

That same IOM report defines telehealth as “the use of telecommunications and information technologies to provide access to health information and services across a geographical distance.” This can range from talking to a health care provider on the phone to getting a neurological assessment on an Ipad using Facetime or video conferencing to using an online treatment to gain greater understanding about your substance use disorder.

You can imagine situations when this could be extremely useful, especially in rural areas where people have geographical barriers to accessing care. 

Expanding Access to Care and Enhancing Treatment ServicesJetsons

Over the past few months, I’ve been working on two national projects focused on increasing awareness and adoption of technology to improve patient outcomes in mental health and substance abuse treatment. This includes using video conferencing, online chat, web-based interventions and regular old phone calls (yes, we've finally caught up to the Jetsons!).

In one project, I am delivering trainings for substance abuse treatment administrators and clinicians. In the other, I am on a team developing a training curriculum to introduce administrators and clinicians to research-based technology assisted interventions for substance use disorders.

I’ve learned a lot about the most current research, issues around confidentiality and ethics, funding and policy, as well as some excellent info on guiding change. Integrating telehealth into treatment programs will require serious change management.

What's your experience with telehealth? How have you been on the providing or receiving end of using technology in health care? Share your experience below.

If you're interested in learning more on the topic, sign up for my newsletter, where I'll be sharing the most recent information about telehealth with my readers.


Living a Double Life

SU training cropped I’m in transition: re-evaluating, evolving, exploring and reinventing a long career exclusively involved with helping people learn and better themselves. I started teaching piano when I was 15 and from there never stopped tutoring, mentoring, coaching, treating, educating, inspiring, motivating, connecting and supporting others. It's just what I do. It's what I've always done as a teacher, tutor, mentor, coach, psychologist, supervisor, trainer, speaker and leader.

Over the last five years building my coaching practice, I've continued to work as a training director and consultant on national research projects to develop and test effective treatments for people with addictions, something I've been doing in one way or another since 1990.

When I received my coach certification through the College of Executive Coaching, I imagined a 1-2 year transition out of research and into a full time coaching practice.

It hasn't worked out exactly how I imagined.

In fact, I've been living a double life.


Locally, I am known in the business community: the owner of Optimal Development Coaching, a vice chair on the board of the Camarillo Chamber of Commerce, Instructor for Women’s Economic Ventures Self Employment Training class, a master mind facilitator, speaker and workshop leader with a focus on strengths. I belong to a number of organizations supporting the arts, education and the empowerment of women and girls. I'm a Girl Scout leader and active volunteer in my area.

But to my colleagues in the mental health community I've been a part of for so many years, I'm known as a master trainer, conference and webinar presenter, published author, psychologist, clinical and research supervisor, grant reviewer, curriculum developer, workgroup leader and instructor of clinical psychology at Columbia University.

See what I mean by a double life?

sign picSo now I'm bringing it all together with a variety of different projects, all of which still involve training, educating and coaching. I’m working on national initiatives to educate treatment providers about telehealth, i.e., the use of technology to improve treatment outcomes. This is cutting edge, research-based work that has relevance for changes in our health system as we implement the Affordable Care Act. My goal is to develop tech-savvy leaders in health care.

I will continue to offer workshops and facilitate retreats and team building events focused on developing collaborative, strengths-based, emotionally intelligent people and organizations. I'm excited to collaborate with Susan Ross at the Good Vibe Studio, an amazing work, music and meeting space in Thousand Oaks, CA, a great option to tap into creativity at a personal or professional development event.

Susan and I are also students and zealots of the master mind, each coming at it from different, yet complementary perspectives. For the last few months, we've been running a master mind group at the Studio. What a joy it is to watch these business owners benefit from the collective genius the mastermind brings to brainstorm, problem-solve and create and reach their goals - even the audacious ones!

We meet the third Wednesday of the month, with a 3rd Monday group forming. It's perfect for small business owners who are looking to finish the year strong with a plan to hit the ground running in 2014. Through the end of 2013, a 3-month block of sessions, which includes the monthly mastermind as well as personalized follow-up and feedback, is $149. I'm happy to send more details.

I'm working on two books for 2014 publication. The Optimal Development Leadership System  will bring together work on strengths, emotional intelligence, team building and other important facets of being an effective leader. It's a collection of research-based best practices in effective leadership. 

The ABCs of the Master Mind is a collaboration with my dear friend and colleague Cheri Ruskus as a result of co-hosting Victory Circles Radio Hour on the first Wednesday of each month. We always develop an acronym to help listeners understand the different mindset principles that Napoleon Hill drafted in Think and Grow Rich.

As my path continues to evolve and shift, as I reinvent myself, I'm sure I’ll be updating you again soon.

Do you ever feel like you're living a double life? What's your recent reinvention? Any guidance for me on my journey? Questions about my changing path? I'd love to hear from you.

gloria-miele-head-shotGloria M. Miele, Ph.D. is an author, speaker, trainer and executive coach who uses a strengths-based approach to help individuals, groups and organizations achieve their goals and realize their greatest success.  She also offers training and coaching programs to develop tech-savvy leaders in health care. To learn more, visit where you can sign up to receive a free tool to optimize your strengths.