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Another Look: The Wal-Mart and E-ClinicalWorks Deal

Portrait2The New York Times reported this week (Wal-Mart Plans to Market Digital Health Records System) that 
the company’s Sam’s Club division will bundle eClinicalWorks
electronic medical record software, Dell computers, installation,
maintenance and training to offer to small physician practices. Pricing
is about $25,000 for the first physician in an office, and $10,000 for
each subsequent physician. Annual maintenance and support costs will be
about $4,000 to $6,500 (though it doesn’t say whether that’s per
physician or per practice).

Wal-Mart says its package deal of hardware, software,
installation, maintenance and training will make the technology more
accessible and affordable, undercutting rival health information
technology suppliers by as much as half…

Dell will be responsible for installation of the computers, while
eClinicalWorks will handle software installation, training and
maintenance. Wal-Mart is using its buying power for discounts on both
the hardware and software.

This program has promise, but it isn’t revolutionary and is by no
means certain to succeed. Interestingly, the Wal-Mart PR people, who
usually send me a heads up about any new Wal-Mart move in health care,
didn’t tell me about this one. It makes me wonder what’s really going
on. There are a couple of very promising aspects of this program:

  • The company partnered with eClinicalWorks (eCW), which based on my
    experience is the best system for small and mid-sized practices. The
    software is easier to install and use than competitors’ programs, and
    has a lower total cost of ownership. eCW has done an excellent job with
    the Massachusetts eHealth Collaborative, for example.
  • The program addresses one of the key bottlenecks of EHR adoption
    for small practices: distribution. It’s painfully difficult and
    expensive to sell EHRs to physicians and that’s a big part of a
    vendor’s costs. I don’t know what Sam’s Club plans to do in that
    regard, but if they figure how to sell to physicians efficiently that
    could be a big deal. Physicians are starting to realize that they need
    an EHR, so perhaps it will be easier than in the past to make the sale.
    Having said that, I’m not convinced Wal-Mart has any idea how to do
    this.

There are also unanswered questions and some key elements that the program doesn’t address:

  • It’s hard to tell if the pricing is attractive or not. It’s
    notoriously difficult to make an apples to apples comparison of EHR
    costs and there is not nearly enough information in the article to know
    whether there will be any savings at all from the typical eCW pricing.
    The claim of “undercutting… by as much as half” can be said about eCW
    anyway, with or without Wal-Mart. This is not like the $4 Wal-Mart
    generic program where Wal-Mart really did undercut existing pricing
    dramatically.
  • After cost-effective distribution (mentioned above) the main
    bottlenecks in EHR adoption are finding enough good technical people
    and change management people to help physician practices transition to
    the new workflow patterns that EHR adoption brings. Successful
    companies like eCW already strain to find enough talent to meet the
    demand. And it looks like eCW will still be responsible for all of
    those activities –not Wal-Mart. I don’t think Wal-Mart adds any value
    to this part of the equation.

So overall, thanks Wal-Mart for giving this a go. At least you
picked the right EHR vendor to work with and are raising awareness
among small physician practices. If you make this program a big success
I’ll be impressed and surprised.

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AbhishekMD as HELLRobRobert Rowley, MDjd Recent comment authors
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Abhishek
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http://www.waitingroomsolutions.com
Awarded web based EMR software, EHR software,
Medical billing and medical Practice Management
Software.
Waiting Room Solutions,
2004 Route 17M,
Goshen, NY 10924

MD as HELL
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MD as HELL

I can’t see buying an expensive system like this for my 10 doc, 10 PA group unless I can reduce my coding and billing staff to offset the costs.

Rob
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Rob

As someone who installed eCW in a number of small to medium sized offices, it’s kind of stunning to see that WalMart’s pricing isn’t that much lower than I’d charge. The difference is in the “service” fees, which I’ll wager pays for not very personal service, compared to a small vendor.
This may have the OPPOSITE effect from what the conventional wisdom desires. Poor service will drive practices away, after they’re done being seduced by the idea they’re getting a deal.
Pity.

Robert Rowley, MD
Guest

The article in NYT about WalMart selling a pre-packaged Dell-eCW EHR package, actually didn’t come from WalMart – it came from an interview with eCW (http://www.histalkpractice.com/2009/03/11/eclinicalworks-to-sell-pmemr-package-through-sams-club-girish-kumar-interview/). Since the source did not come from WalMart (as you mentioned, you didn’t get a heads-up from them about this), the Washington Post, who also picked up the NYT story, later retracted the story ( http://www.washingtonpost.com/wp-dyn/content/article/2009/03/11/AR2009031101740.html). Regardless of all this, the question still exists: is the packaging of an EHR for $25,000 sold via WalMart a good thing for healthcare? Firstly, $25,000 per MD is fairly pricy – perhaps less than some systems, but… Read more »

jd
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jd

I don’t see how Wal-Mart owns this data. The physician maintains the data, the patients have the right to access and share it (or prevent it from being shared, except in emergency), and it will be physically held on eCW servers. From what I can tell, Wal-Mart will no more own the data than it owns the content of cell phone conversations just because it sells a cell phone. Or does it monitor what you watch when it sells you a TV? I’m not a fan of Wal-Mart. In fact, I refuse to shop there because they are so virulently… Read more »

lodefinition
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lodefinition

I’m a techie… I have but one question no one seems to ask or note, but which is _essential_ with respect to EMRs:
Q: Does eCW offer a “cloud computing” type of solution?
Me thinks not… as if so, why would Dell or -any- hardware provider be specified?

HealthCareDev
Guest
HealthCareDev

Here’s hoping Walmart doesn’t do to health care what it has done to American manufacturing.
Good grief, how anyone can be pleased about this company getting involved in the space is a mystery to me. And no one has noted the irony that this is a company that still leaves the overwhelming majority of its own workers without health coverage.

Parley
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Parley

David – So yes, you anticipated that Wal-Mart is angling to become physician employer. And EHR would be “a platform they can leverage” towards this goal – or an enticement. But it is not too hard to imagine how ownership of clinical data could become tool to pressure physicians into a relationship they may not necessarily desire. Again, that may not be part of the plan, but I think to downplay that potential is to exhibit a certain amount of “trustanoia”. And what’s with “thanking” Wal-Mart for “giving this a go”? That’s very revealing. Since when do we thank corporations… Read more »

John@Chilmark
Guest

Good marketing ploy by eCW, but overall bad strategy. 1) EMRs are not yet a commodity, perceived or otherwise. Hooking up with Wal-Mart conveys a commodity product. Personally, would not want to see my product commoditized. 2) Wal-Mart certainly is a big brand name, but they are not a brand name in selling solutions. Will eCW need to put a trained staff person in each Sam’s Club similar to what Apple does today at Best Buy? 3) And most important, what does this change in channel strategy do to existing partners/VARs. If I were a reseller, I may well be… Read more »

Healthcare Guru
Guest

When Walmart gets involved, things happen. However, there is a lot of work to be done to tie the clinics, the pharmacies and the patients.
One of the fundamental need of the time is to create the EHRs patient owned.
Clinical process etc of course remains to the ownership of hospitals
rgds
ravi
http://www.biproinc.com
blogs.biproinc.com/healthcare

David E. Williams of the Health business blog
Guest

Parley, you may be right about this. Here’s what I said on the topic back in 2006: http://www.healthbusinessblog.com/?p=910
“I wouldn’t be at all surprised to see Wal-Mart start to hire significant numbers of doctors and put them to work in its stores.
If Wal-Mart can spur significant reductions in the cost of routine services and products, it will go a long way to cutting overall costs.”
I don’t think Wal-Mart will actually suck doctors in the way you’ve described –by controlling their EMR data. However it may provide a platform they can leverage.
As far as I’m concerned it would be a good thing.

Parley
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Parley

Is selling and profiting from ehr’s really the extent of Wal-Mart’s business model here? The press I’ve read about the Wal-Mart/eCW partnership has tended to focus on questions of technical mechanics, clinician adoption, cost analysis, is ehr a retail commodity?, etc. These are all important areas to examine and debate, but I’m wondering if we are missing the bigger picture here. Lets just start off with the value-neutral observation that Wal-Mart’s interests and the public interest only occasionally (and coincidentally) coincide. Then consider what the rise of Wal-Mart has meant for small, independent businesses in communities across the nation. In… Read more »

Bridget Reno
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Bridget Reno

Everyone gets sick at some point in thier life. Medical bills can costs a lot if your are diagnosed with a condition that might take quite a few trips to the doctor to remedy. It can also get really overwhelming when these medical bills start to exceed you financial budget and you have no where to turn. This is why it is always wise to have a good health insurance plan to cover you in case something unexpected happens in your life. Health insurance is something that every American should have. There are in fact some great companies out there… Read more »

Bridget Reno
Guest
Bridget Reno

Everyone gets sick at some point in thier life. Medical bills can costs a lot if your are diagnosed with a condition that might take quite a few trips to the doctor to remedy. It can also get really overwhelming when these medical bills start to exceed you financial budget and you have no where to turn. This is why it is always wise to have a good health insurance plan to cover you in case something unexpected happens in your life. Health insurance is something that every American should have. There are in fact some great companies out there… Read more »