table of contents

3
Employer Clinics Introduction/ Urgent Care Clinics

7 11 Retail Clinics 15

Conclusion

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INTRODUCTION
Recent years have seen the rise of retail clinics as a convenient, often less expensive alternative to a trip to the physicians office. There are more than 1,300 retail clinics operating in the United States currently, according to market research firm Merchant Medicine. A parallel trend of on-site health clinics is on the rise among larger employers. According to data from the Kaiser Family Foundation and the Health Research & Educational Trust, 20 percent of employers with 1,000 employees or more already had an on-site health clinic for employees as of late 2009. Among those surveyed, about 79 percent said the clinics provide care for employees beyond treatments for work-related illness. These clinics have risen up largely in reaction to the rising cost of healthcare. Mobile health tools promise similar benefits as clinics: lower costs and more convenient care. As a result, employer and retail clinics are perhaps the best-positioned healthcare facilities to drive adoption of mobile health services.

We are looking at both provider facing technologies and patient facing technologies to capture data from biometric devices and share that data to support coordination of care.
- Steven Kukulka, Director IT Business and Quality Services, Take Care Health Systems, a Walgreens Health & Wellness Company

URGENT CARE CLINICS

While the advent of urgent care clinics in the United States is not recent they have existed for decades there is still some opportunity for these clinics to offer new and innovative services. According to the Urgent Care Association of America (UCAOA), there were close to 9,000 urgent care clinics in the US in late 2010, with about 300 new clinics opening annually in the years immediately preceding the survey. The UCAOA has created criteria that urgent care clinics must meet. Urgent care clinics must accept walk-ins at all hours of operation. They must offer on-site diagnostic services, including phlebotomy and x-ray. Urgent care clinics must also treat a broad spectrum of illnesses and injuries. Furthermore, these clinics must be staffed by at least one physician, unlike retail clinics, which often are staffed by physician assistants or nurse practitioners. continued on next page

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Given urgent care clinics mandate to accept walk-ins at all times that they are open, potential patients and the clinic staff would both benefit from a scheduling system that provides patients with expected wait times before they arrive at the clinic. Mobile applications like Aetnas iTriage app have relationships with emergency room departments to display wait times. They also provide wait times for ambulances in some locations. A similar offering from urgent care clinics could help patients make a decision to drive a little farther to visit an urgent care clinic that may be farther away from them but has a shorter wait time. A location-enabled mobile app like iTriage can guide patients to other locations in their area. Like ZocDoc, iTriage is also an appointment-booking app. While wait times may not be as useful to paApart from marketing and scheduling apps, urgent care clinics do have a few other mobile health opportunities. Patient education apps like, for example, Blausen Human Atlas and Orca Healths EyeDecide, could prove useful to healthcare providers working in urgent care clinics. These apps are typically best viewed on the providers iPad, which can be turned to share with the patient. These apps can help explain an illness or a surgery to patients during the office visit. Instead of pointing to an anatomy poster on the wall, providers can share dynamic apps offering animations or videos that help illustrate the patients issues. While these types of patient education apps have found early adopters among childrens hospitals looking to engage their young patient population with iPad apps that help explain comBlausen Human Atlas HD (for iPad)

tients with appointments at physicians offices or employer clinics, with millions of downloads these apps can help drive new patients to these other clinics, too. Arkansas-based Sherwood Urgent Care is one of the few urgent care clinic operators that has developed its own native iPhone app. Sherwoods clinics are walk-in and boast extended hours and weekend hours. The app aims to help patients locate the closest Sherwood clinic (there are six) and it provides one-click dialing to call the clinic and inquire about wait times, according to the apps description. The app also includes a puzzle game that can entertain for hours, according to its description in Apples AppStore. Dallas, Texas-based CareNow also offers an iPhone app, called CareNow Web Check-In App, which helps users find the nearest CareNow location, register as a patient, and check-in for an appointment directly from the app. The CareNow app also promises to call the user when the doctor is ready to see them. The clinic operator uses the app to emphasize its value: Talk about convenience! the app description concludes.

plicated surgeries, the same apps could be used at urgent care clinics, too. continued on next page

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stand their treatment plan. Providers can send the JiffTalks to patients via email. Urgent care clinics could have a number of these JiffTalks prepped for the most common injuries and illnesses that they treat at their facilities and provide patients with these videos when they leave the clinic. Pipette, a startup that recently completed the Rock Health incubator program for digital health companies, also offers apps that providers can equip patients with when they are being discharged from the hospital. Pipette works to enable hospitals and care teams to monitor and educate patients during recovery with
JiffPad

an aim to reduce complications and lower the cost of care by enabling early intervention of high-risk patients, according to the company. Urgent care clinics are in a position to adopt similar services for their patient populations.

Another mobile health service urgent care clinics might consider: mobile treatment plans. Many patients have trouble recalling everything their physician said during office visits. A number of mobile health companies are working to create apps that record everything that was said during a visit or apps that provide treatment plans tailored by providers for individual patients. Silicon Valley-based Jiff offers its JiffPad iPad app to physicians looking to solve this problem. The app enables providers to record short videos that include voice notes, frequently asked questions and answers, images, and animations, all with annotations that physicians can record right into the videos. The idea is that patients can review these physician created presentations after their office visit as many times as needed until they underPipette

While the requisite reimbursement and workflow systems are not yet in place to support it, remote virtual consultations, whether real-time or asynchronous, are another opportunity for urgent care clinics in the future. In 2010 one emergency room physician at George Washington University Medical Center began evaluating how accurately physicians were able to diagnose patients wounds if given a picture taken by the patient with their mobile phone. Dr. Neal Sikka asked patients who arrived at the ER with cuts, skin infections, rashes, and other wounds to take pictures of their wounds with their own mobile phone. The patients were instructed to email those images to a secure email account, which physicians accessed on-site to make a remote diagnosis. Since the patients were in the waiting room, soon after physicians saw them in-person to confirm the diagnosis. Sikka said about 90 percent of the remote diagnoses were correct. continued on next page

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Patients told Sikka that remote consultations would save time, reduce costs, and improve communication between patients and providers. Sikka said that the technology would be of most benefit to patients in rural areas who would rather not travel to an urgent care clinic or emergency room to get a diagnosis of a superficial injury. Given the transience of patients visiting urgent care clinics, it is unlikely that providers at these clinics will be motivated to adopt the mobile health services noted above. Under the fee-for-service paradigm, it is better for business if patients show up in-person to receive care and follow-up care. With the exception of working with location-enabled facility finder apps, wait time apps, and scheduling apps like ZocDoc and iTriage, urgent care clinics are unlikely to adopt many of the patient-facing mobile health tools currently available or under development. Employer clinics and retail clinics, however, have other motivations.

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HealthSpot Care4 Station (exterior shown left; interior shown right)

EMPLOYER CLINICS
According to David Chase, CEO of patient relationship software vendor Avado, larger employers are aggressively pursuing onsite clinics because of the annual get less for more story they get from their health plans. Chase says companies like Concentra and CareHere, which setup workplace clinics for large employers, are seeing 100 percent growth year-over-year. Employers and employees both benefit from reduced absenteeism at the workplace and fewer trips to the clinic. Qualcomm has long touted the benefit of reduced absenteeism as one of the reasons it has an onsite work clinic. Qualcomms onsite clinic uses Myca Healths Hello Health platform to maintain or increase employee productivity and activity. Qualcomms workforce is highly As Chase wrote in a recent column for The Huffington Post: Not only is the clinic nearby, but the need to even go to the clinic is reduced. In the flawed fee-foreducated and, therefore, very expensive: 77 percent of the companys employees have PhDs and Masters, which means if they have to leave their desks to go home, get their car and go to the doctors office, it can be extraordinarily expensive for the company. The cost of productivity drove Qualcomm to the Myca platform. Care can be conveniently provided to the employees, who on some occasions can check-in with their doctor via email or even video chats. While the overall trend is certainly motivated by cost pressures, onsite workplace clinics are also convenient. service model, a doctor can only be paid if you visit their clinic. Not surprisingly, many doctors will optimize for the patient to come to their office as frequently as possible as it allows for more billing events. In contrast, [direct primary care] and onsite primary care physicians share the fact that as much as [two-thirds] of clinic visits dont require a face-to-face encounter. Rather, phone or electronic communication is sufficient. For example, one doctor shared how he hasnt seen a patient with Shingles in five years. These patients simply take a photo with their camera phone, email it to him and he can easily tell it is Shingles. He can then call in a prescription, saving everyone time and money.

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EMPLOYER CLINICS CONTINUED...

While Myca Health does not publicly discuss its other major employer customer, Apple, the iPhone and iPad maker, does use Mycas health practice software onsite at its workplace clinic, Apple Wellness. According to Mycas website: Myca is supporting South Bay Sports and Preventive Medicine on-site and online services at Apples corporate campus in Cupertino.

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Trend: Mobile Health Becomes Mainstream We dont merely adopt mobile devices; we marry them -B.J. Fogg, Stanford Persuasive Technology Lab Designing for mobile requires a deep understanding of context: what goals and tasks do your users need to accomplish on mobile? There may be specific features that are more important on a mobile device and those should be available and prominent. Users will have some of the same goals as when using your product in other platforms. But often there are unmet needs that can be addressed and new business opportunities to exploit by leveraging the unique capabilities of mobile devices, such as the integrated phone, camera, accelerometer or GPS. Users have an expectation for mobile apps; they should be purposeful, useful in context and easy to use otherwise users will abandon them. You add little value by simply having a mobile version of your product. The value is added in the execution. Through user-centered design and research, these needs can be uncovered and applications can be designed for maximum engagement. You will also need to consider form factor when deciding on which platforms to develop. The portability and ubiquity of a smartphone makes it useful in many situations, however, data-rich or image-heavy apps could benefit from the greater screen real estate on an iPad or other tablet, provided a tablet device makes sense in the context of use. When designing a tablet solution it is best to have a different user interface from both your smartphone and desktop web applications. You should design a tablet interface that is uniquely suited for the combination of the tablet screen size and touch interface. Using a design technique called Experience Journey Maps, you can visualize the entire experience your users have with your products and services. This technique can be useful to identify gaps where youre not serving users well, and also highlight opportunities for new solutions, such as in mobile. continued on next page

Apple Wellness Dr. Martin Yee conducts virtual visits including live video chat and instant messaging with his patients via Mycas platform. Yee wrote that these may not be appropriate in some situations and are only for established patients, in his bio on Mycas website. An in-office visit is typically required for initial visits with Yee. He also explains that emails should only be used for routine communications and should not be used for urgent matters and questions that require prompt medical attention.

Still, its clear that Mycas platform has helped cut down on some unnecessary or routine visits to the doctor for Apple employees.

While platforms like Mycas help improve online and mobile communications between patients and providers, the next step is equipping patients with apps and health devices that help them manage their own care. Few employers are doing this today, but employer clinics are likely to be one of the first places to drive adoption of these mobile health services.

Large employers with businesses that are already working in mobile health are beginning to adopt the technologies as part of employee wellness initiatives. Qualcomms health division, Qualcomm Life, recently conducted fitness and wellness challenges using BodyMedias connected fitness devices and other connected devices like WiFienabled weight scales. Employees at Sprint have participated in similar challenges between work colleagues. While neither company has publicly announced leveraging similar health-focused devices as part of a care program overseen by their companys onsite clinic, it seems likely such programs will begin to find their way into these clinics soon.

Another large employer that is actively working in the mobile health space, AT&T, was one of the first to make available WellDocs mobile health program, DiabetesManager, a mobile and Web-enabled virtual coaching program that has been clinically proven to reduce A1c levels. AT&T said that while some of its employees are using the program today, it does not have an employer clinic on-site, so those employees are using the program with their own off-site primary care providers. Now that programs like DiabetesManager are FDA-cleared and available, it is likely that employer clinics will begin adopting and offering them to patients soon. continued on next page

MOBIHEALTHNEWS 2012REPORT

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Trend: The Rise of Retail Health Clinics

CONTINUED

EMPLOYER CLINICS CONTINUED...

Connected health devices, particularly blood pressure cuffs like the one offered by iHealth, have begun to find early adopters among some primary care providers across the US.These cuffs are controlled by an iPhone or iPad app that also automatically logs the reading with a time stamp for trend analysis and later review. Some primary care providers have recommended devices like this to patients with high blood pressure to get a more accurate and consistent reading of their BP Daily readings can paint a more accurate picture than infrequent readings at . the doctors office where patients may actually suffer from white coat syndrome, which is when a patients blood pressure spikes in the presence of doctors. Of course, it only begins with blood pressure monitoring. Consumer-facing, connected health tools are already on the market (or soon-to-be) for a wide range of chronic conditions. These devices and related services can help employers cut down on health costs by helping employer clinic providers spot health issues in their early stages. Keeping an eye on the trend data flowing from these mobile health services will support preventive care. Heres a short list of example devices and services that employer clinics should consider adopting: Cellular-enabled or smartphone-based blood glucose meters are one of the newest, but long-awaited, health tools to gain FDA-clearance recently. Sanofis iBGStar, which was developed by AgaMatrix, received FDA clearance at the end of 2011, which made it the first iPhone medical peripheral to receive the greenlight from the agency. Sanofis meter is a tiny device that plugs into the bottom of the iPhone. The device uses AgaMatrix test strips and automatically logs the blood glucose readings in a companion iPhone app. These data can be emailed to a care provider with the push of a button. Another diabetes meter company, Telcare, recently received FDA clearance for

The demand for primary care services in the US outmatches the availability of primary care physicians. At the same time, there is an exponential increase in healthcare costs and high percentage of under-insured patients. This climate has created a demand from patients for lower cost care and more convenient access. Retail health clinics are one solution. Walgreens, CVS and Wal-Mart are the top three providers, offering clinics in many of their stores. Retail clinics typically offer basic preventative care services such as flu shots and treat low severity illnesses such as colds. These services are short in duration and the patient volume fluctuates and is unpredictable because patients can walk-in. Technology tools are required that help the staff manage this type of schedule. A positive patient experience in the retail clinic is dependent on accurately setting expectations of wait times, creating easy to use self-service tools, and creating an in-store experience that supports the retail clinic. And mobile solutions that allow patients to easily find a nearby clinic location and schedule an appointment are necessary to support the immediacy of these types of health conditions. Viewed in isolation, market trends such as the rise of retail and worksite clinics, the expansion of home-based care, and the proliferation of information and communication technologies can seem unrelated. However, when viewed holistically, these trends demonstrate that the landscape of primary care appears to be undergoing a significant transformation. *
* PRIMARY CARE, EVERYWHERE: CONNECTING THE DOTS ACROSS THE EMERGING HEALTH LANDSCAPE. JANE SARASOHNKAHN FOR THE CALIFORNIA HEALTHCARE FOUNDATION (2011).

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its cellular-enabled blood glucose meter, the Telcare BGM. This device has embedded wireless connectivity so no companion mobile phone is necessary to send data to the cloud where providers can keep track of readings in real-time. However, Telcare has developed smartphone apps to help patients and providers alike keep tabs on readings, diet, and trends. continued on next page

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Connected weight scales like ample. The device can help providers at clinics determine how severe a patients asthma has been lately since increased inhaler usage is an important indication of a worsening condition. AliveCors iPhone ECG case enables patients to capture a clinical grade electrocardiogram right from their smartphone. Patients with chronic heart problems can send providers an EKG as often as a provider likes to do quick scans for arrhythmias and other heart issues before they turn into more serious cardiac events. As of this reports publication, the iPhone ECG device was not yet FDA-cleared, however, the clearance is expected soon. Devices for remotely tracking and managing diabetes, obesity, high blood presAsthmapolis is bringing to market a tracking device for asthma patients that use inhalers. The little device sits atop the inhaler cartridge and takes a time stamp every instance the inhaler is used. If the user has a smartphone, the device can with communicate sure, asthma, and heart conditions are just the beginning. There are already more than a dozen connected fitness devices available on the market that can help employer clinics motivate employees to get in shape. New, wrist-worn sensors can detect the wearers emotional state, which could help people with anxiety or stress to track their condition and pinpoint potential triggers by keeping a log in an companion smartphone app. Increasingly, companies like Philips and Azumio are finding ways to passively measure heart rate and breath rate from smartphone and tablet cameras. Philips iPad 2 app can fairly accurately measure a users heart and breath rate just by analyzing the flow of blood in the users face. Most of these devices will cost aabout $100. Many of the apps are free. These frugal innovations, as the West Wireless Health Institutes Vice Chairman Dr. Eric Topol calls them, can help employer clinics keep employees well, out of the physicians office, and productive at work. For employers looking to take control of their health costs, connected health services like those listed out above should soon find champions at their clinics.

iHealths Bluetooth-enabled scale or Withings WiFi-enabled WiScale help users track their weight, body fat percentage and body mass index. The weigh-ins are automatically sent to a web portal that feeds into iPhone and iPad apps. Connected weight scales are also useful for heart patients who often show a dramatic spike in weight just before a heart episode. Without consistent weigh-ins and the resulting trend line, however, it is difficult to discern this telling spike in weight.

an app on the users phone via Bluetooth and leverage the phones GPS capability to take a location stamp, too. The resulting map of inhaler usage can point to problem areas for asthmatics that can help users change behavior. If it seems to correlate with inhaler usage, stop driving past the refinery on the way to work, for ex-

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RETAIL CLINICS
In 2009 Deloitte noted that retail clinics had entered into a period of contraction because of the nationwide economic downturn. Deloitte predicted that this period was just a breather prior to retail clinics finding a more refined business model to drive renewed, but slower, growth. That prediction proved true: In mid-2009 there were about 1,100 retail clinics in operation. As noted above, there are only about 1,300 in operation today, according to Merchant Medicines count. In 2009, Deloitte expected total retail clinics in the US to number close to 1,800 by the end of 2012. The consulting group predicted that a second wave of rapid growth would begin in 2012 and last through 2014 as retail clinics move into new markets and begin to offer new services. CVS Caremark spokesperson Brent Burkhardt confirmed that while MinuteClinic In its report, Deloitte wrote that retail clinics operating in retail pharmacies and grocery stores offer opportunities for sell-through of services in addition to prescription fulfillment and over-the-counter health care products. These clinics could help increase the basket size of shoppers at their retail locations by encouraging consumers to purchase health devices and services (like those listed above) that are sold in-house. CVS offers an iPhone, Android, and BlackBerry app for smartphone users that gives them access to a number of different features related to shopping at CVS, prescription filling at CVS pharmacies, and services available at CVS MinuteClinics. continued on next page information can be accessed by CVS pharmacy stores mobile app, [MinuteClinic is] not currently using other mobile technology or apps with its patients. The market leaders for retail clinics today, however, are CVS MinuteClinics and Walgreens Take Care clinics, which are the two largest nationwide clinic chains in the country. By many accounts, Take Care is the more innovative of the two, but MinuteClinic has more locations. In October 2011 Walmart made headlines after it sent out a request for information (RFI) to vendors that stated the company was seeking help to dramatically ... lower the cost of healthcare by becoming the largest provider of primary healthcare services in the nation. While the news shook up the healthcare industry, the company quickly backtracked and stated that the RFI was overstating its intentions. What is now clear, however, is that Walmart is very interested in the potential of its budding retail clinic business. While overall growth in terms of the number of retail clinics has not lived up to even the more modest growth projections from 2009, there are many indicators that many more clinics could open soon. One medical device maker that works closely with retail pharmacies and retail clinics said that retail clinic customers with diabetes who enter the retail location spend ten times as much as other customers on prescriptions, devices, and other retail goods every time they enter the store. Offering chronic condition management services will likely bring more customers in the door, which means bigger basket sizes and bigger sales overall.

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One device maker that works closely with retail pharmacies said that customers with diabetes who enter the retail location spend ten times as much on prescriptions, devices, and other retail goods.

The smartphone apps help users find the closest CVS locations, refill and transfer prescriptions (including refill by scanning medication barcodes with a smartphone camera), access prescription history, scan QR codes for coupons, create weekly shopping lists, schedule a flu shot, check MinuteClinic locations and services as well as insurance plans accepted at those locations. While the app still has limited functionality related to CVS retail clinic, the company has created a smartphone app that bridges its retail clinic, pharmacy, and store. Its a promising first step. The CVS Pharmacy app does enable users to schedule a MinuteClinic flu shot appointment, but users cannot schedule any other kind of appointment through the app. While retail clinics are widely marketed as walk-in clinics, the convenience of having an appointment and cutting down on wait times is still an opportunity worth realizing.

Like CVS, Walgreens mobile app bridges its clinic, pharmacy, and retail businesses, but the clinic-related functions are very limited. Walgreens has apps available for iOS, BlackBerry, and Android devices users. The Walgreens apps enable users to look up the locations of Walgreens Take Care clinics, but the mobile apps do not offer any appointment scheduling features yet. The apps also provide users with a virtual tour of the services the clinics offer. Walgreens does already offer online appointment booking for its clinics, so it is likely this will move to mobile apps soon, too. We are building a series of mobile apps right now for our providers and their associates working at our clinics, Steven Kukulka Director IT Business and Quality Services, Take Care Health Systems, a Walgreens Health & Wellness Company said. Our patient portal sends out text message alerts to patients for upcoming appointments and alerts for when a secure message is waiting for them on their patient portal. We are also looking at both provider facing technologies and patient facing technologies to capture data from biometric devices and share that data to support coordination of care and patient engagement. We are investigating those currently both for biometrics captured in [retail and employer] clinics and at home. On the retail pharmacy side Walgreens has led the pack. The company first launched apps back in 2010 that let its pharmacy customers refill prescriptions by scanning their medications barcode with their camera phones. The app quickly became the most popular way that customers refilled prescriptions via their mobile phones. More recently Walgreens added a medication reminder feature to its mobile app as well as the ability to transfer a prescription from a different pharmacy to the users local Walgreens. continued on next page

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Weve driven strong adoption and customer engagement through our mobile applications, and these mobile pharmacy features are also great tools for helping people manage their health, said Sona Chawla, Walgreens President of eCommerce. This is another way were extending the access to Walgreens pharmacy to patients on the go and helping them stay well. Medication non-adherence is Retail clinics are also likely to be a key driver of the connected wellness market. These clinics already provide wellness and physical exams that include coaching for how patients can keep themselves well. Since these clinics are attached to a retail store, the providers are in the best position to direct patients to an aisle in the store that sells connected health and fitness devices. As noted above there are a growing number of consumer health devices that track activity, sleep, weight, mood, blood pressure, and much more. Some stores that have retail clinics onsite are already stocking some of these fitness and wellness devices. Many more
Walgreens iPhone app

Last year Walgreens made it possible for customers to refill their prescriptions via text messaging. The retail pharmacy also has a text messaging service that alerts customers when a prescription is ready for pickup. While analyst firm Asymco expects that more than 50 percent of people in the United States with mobile phones will be smartphone users by the end of June 2012, today a majority of people dont use apps. Offering complementary text message-enabled services to its customers make Walgreens mobile health services more accessible to the wider population.

one of the biggest hurdles in treating illness today, responsible for more than $100 billion each year in avoidable hospitalizations, said Walgreens CMO Cheryl Pegus. Personalized services that can help patients remain compliant with their prescription regimens can be effective in lowering health care costs and improving patient care.

will in the coming years. continued on next page

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While the patient-provider relationship is generally weaker at retail clinics, these health tracking devices and apps can help strengthen it. If a patient who uses an iHealth blood pressure monitor shows up at a retail clinic with a few months worth of daily blood pressure readings on his iHealth blood pressure app, that data could prove helpful to a nurse practitioner looking to put the patients current blood pressure reading in context. Like many retail clinics CVS MinuteClinics already advertise wellness services that aim to help consumers identify lifestyle changes needed to improve their current and future health, including screenings and monitoring for diabetes, high blood pressure and high cholesterol. Mobile health biometric devices and companion apps can support and extend such programs to become continuous, daily monitoring programs. Dublin, Ohio-based HealthSpot Under this agreement it is likely that MinuteClinic will help TriStar prevent hospital readmissions and manage patients with chronic conditions on an ongoing basis. Partnerships like this one will change the game for retail clinics. As they shift their services to become a partner in healthcare costs management, mobile health tools will likely become even more attractive. Recently MinuteClinics in Tennessee inked a deal with HCA-owned hospital group TriStar Health to create a collaborative care system in Middle Tennessee. Under the agreement, TriStar Health physicians will serve as medical directors for MinuteClinic locations in that part of the state. MinuteClinic and TriStar Health will collaborate on patient education and disease management initiatives and will inform patients of the services each offers. From now on the health system will accept patients that have issues that the MinuteClinic is unable to treat, and the two organizations are now working to fully integrate their respective EMR systems to more efficiently coordinate each individual patients care. While there are signs that retail clinics are beginning to augment the services they provide, it is clear that many see an opportunity to play a role in accountable care organizations (ACOs) or similar outcomes-based reimbursement models that are beginning to go into effect as healthcare reform slowly rolls out across the US. ing running over Sprints 4G network. The kiosks come equipped with digital medical devices that allow doctors to collect health information during the remote visits, including 3M Littmanns Electronic Stethoscope Model 3200, which enable clinicians to listen in real-time to critical body sounds during remote examinations of patients using the medical kiosks.

recently embedded cellular connectivity to its primary and specialty care kiosks, called HealthSpot Care4 Stations, that are designed for pharmacies, supermarkets, and workplaces. Patients using the kiosk can visit with doctors in real-time via high-definition videoconferencA Take Care clinic

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CONCLUSION
As new entrants like Walmart step up to build out retail clinics that provide primary care services, large employers continue to roll out onsite clinics, and existing retail clinic chains ink deals with local hospital groups to form collaborative care systems, mobile health services will have an increasing presence at the clinic. While a handful of disparate primary care providers will adopt these connected health services, none can match the scalability that Walgreens Take Care clinics, CVS MinuteClinics, or the many planned Walmart clinics can offer mobile health services. If any of these large national retail clinic chains decides to launch mobile health services at its clinics, they will immediately be one big step ahead of the majority of primary care providers. Clearly, mobile health is the clinics next step to becoming even more cost effective and convenient for its patients. While the number of retail clinics has not grown as quickly as most industry analysts predicted, the coming year could still prove to be a pivotal one for clinics. The opportunity for new services and revenue streams is ripe. New consumer health devices and apps enter the market each month.
A RediClinic at a Walmart store