Couple of points clarified:

A)
“Walmart selling EMR solutions, what a joke. They saw the $20B for EMR’s and want to get their greedy hands on it.”

First of all the way I read this is they are not selling solutions, they are MARKETING a solution by Dell and ECW, two respected names in their industries (no matter what you personally think of their products). That is a huge difference. Huge. You are comparing apples to oranges. If you have studied Wal-Mart at all, and know how the company works, you would know their business strategies are legendary, and are dissected in detail in business courses across the world.

B)
“I hope all Dr.’s boycott all those companies on principle alone, they are obviously not in this for the betterment of patient care its all about the $$$$.”

LOL, and I hope all physicians that are in medicine for the $$$$ retire tomorrow. This is still a capitalist country (well, maybe not for long after Obama and Pelosi push through their agendas) but right now it is. And if a company is not in business for the $$$$, then they are either called a “non-profit” organization or General Motors.

C)
For the record, I am not JD or an employee of Dell, ECW or Wal-Mart. But I know a lot about business, a little about health care, and quite a bit about hi-tech as well.

I notice that too many people take the myopic viewpoint as a user of these products, and make broad sweeping statements about which EMR is “best” and which company is “best”, and what the price should be, etc.

First off – those opinions are ALL highly dependent on the individual physician and their background, their specialty, their staff’s expertise and motivation and the training and implementation they received. Those factors, plus training and implementation are much more important to EMR success than which EMR you choose. Sorry if that offends any EMR vendors, but that’s been proven over and over, (as long as you stick with the top 20 or so EMR’s). To make matters more complicated, your implementation and training might be completely different from your associate who purchased the same EMR, unless the same implementation team did both sites.

Secondly – The price is irrelevant. Like ANY investment, it’s not how much it costs, it’s how much return you get from it. What is your personal ROI, made up of time savings, greater efficiency, better coding etc etc. Let’s not forget that ALL studies on the subject have shown that a good EMR FORCES you to practice better and more consistent medicine, and what that means to your patients (unless you’re just in it for the $$$$ – LOL).
The dirty secret of ANY software infrastructure investment is that the smaller the company (or practice) is the more dependent the ROI becomes on the actions of the physician (boss) and his staff (employees). This is universally true across all industries. What is also true is that you often see the business owner (physician) take on very little accountability for their own success or failure.

Conversely, (and some would also say perversely , the larger any organization, the better any IT infrastructure investment’s ROI can be quantified and transferred to other similar sized organizations because measurable accountability mechanisms can be put in place – IF MANAGEMENT IS COMPETENT. (I put that is bold, because that is not always the case). – You see examples of that everyday, maybe even where you work now.

The perverse part of this equation is, while it is EASIER to implement accountability in a smaller organization, it occurs far less often. Why? The psychologists will probably say it’s due to the fact there are more people to spread the blame around to in a large organization, so failure is not as personal as it is with a small organization. And we humans like to avoid failure and disappoint at all costs.

I apologize, I did not mean to veer so far off topic here, It’s just that business, marketing and change management are all key interests of mine, and to me they can be quite fascinating. Which is why I am extremely intrigued with this joint venture between three very different compnies, and what it may mean for each one, as well as what impact it might have on the overall market that they are trying to jointly penetrate.

I have been involved tangentially with the Primary Care Information Project (PCIP), which is where I first got to know about eCW. I’m impressed by what PCIP has done with eCW in the area of enhancing the decision support, public health and quality reporting. PCIP has helped eCW to be more than a claims-driven EMR, and I do think it has become one of the better products on the market as a result of that collaboration, for what it’s worth.

My main point in the first post, however, was not to hype eCW. My point was that it doesn’t matter so much whether Wal-Mart knew a lot about physician office workflow design or EMR implementation and support, because Wal-Mart wouldn’t be doing those things.

John, thanks for the update. All sound observations, I think.

In the past 9 years, I have used all EHR including eCW, AHLTA, PICIS, Cerner, Epics, and others. None has a platform that can compare to Vista in term of scalability, data transfer from one EHR to another, and configurability to fit your own clinic’s process. After thoroughly analyzed our strategy, our IT team has adopted the Vista software and implementing it through our own house-call network in next 3 months. John, you may want to look into this. LCN.

Walmart selling EMR solutions, what a joke. They saw the $20B for EMR’s and want to get their greedy hands on it.

Believe me the price tag for any EMR is going to reflect what the government reimbursement is, isn’t that going to be about $50k over 5 years…gee what a coincidence thats what Walmart is pricing it at over 5 yrs.

I hope all Dr.’s boycott all those companies on principle alone, they are obviously not in this for the betterment of patient care its all about the $$$$.

First, the EMR market has not yet reached a level of maturity that would argue for a Big Box retailer channel to market. Thus, we do not believe that Wal-Mart is a suitable channel to market for EMR software and favor a VAR channel model.

Second, we refined pint number two to reflect what was our main point here: Wal-Mart sells products it can slap a SKU on. Its core competency is aggressively managing a supply chain to drive costs out of the chain and deliver consistently low prices. This works for many products, say a pallet of toilet paper, but we do not believe it works for selling solutions. The eCW/Dell offering is a solution.

Third, of course they are not buying a private label Wal-Mart brand product, they are buying eCW and Dell, both well-respected products in their respective markets. The key point here is that Wal-Mart is not as well-known for electronics sales, it does not have that reputation. Secondly, in this third point we highlight that the pricing is not all that aggressive. Today, one can buy direct from eCW a hosted EMR-PM solution for $500/month ($6K/yr). Granted, it does not include implementation and training as well as that Dell computer, but still, are those last three worth an extra $19K? Also, many a physician’s office already has a PM and a computer, so one could go to eCW and pick-up just the EMR, again hosted, for $3K/yr. Bottom-line, Wal-Mart has no brand in this sector and Wal-Mart’s reputation for low prices does not appear to bear fruit here.

Lastly, jump from 2-3% adoption to 10% adoption in three years, boy tose are some pessimistic growth projections there JD, though admit, current views from DC that throwing a lot of $$$ at the problem will solve it are mis-informed.

You see a global marketing giant with an enormous physician customer base, a global leader in IT products and remote IT support, and a credible EMR/PM vendor with a working product and a nimble and cutting edge software company (unlike, say a GE). The marking component (Wal-Mart) is also rolling out it’s own emergency clinics in all of it’s locations that will be using this product and technology, and by the way, they also already have a major piece of the prescription pie.

When I look at this at the macro level, (forgetting even for a moment the so called “stimulus money, which will be like throwing gasoline on a fire) I see a potential health care juggernaut that will quickly have the potential to influence national policy at the de-facto- if not legislative levels.

People (individual physicians) don’t have to like it. Frankly, it doesn’t even have to be a great product offering. (Everyone forgets how bad Microsoft was when it started out, and how they actually became the O/S and Application standard it is today.) All it has to do is work. And it will work. This will be a uniquely disruptive event in the marketplace with far reaching consequences for all industry stakeholders.

In response to both your first and second points, EMRs do not have to be a pure commodity product for this to work and Wal-Mart does not need any extensive expertise in physician practice workflow, etc. The reason is that Wal-Mart isn’t installing these EMRs, eClinicalWorks is.

From the Times: “Dell will be responsible for installation of the computers, while eClinicalWorks will handle software installation, training and maintenance.”

eClinicalWorks has, as you know, extensive experience installing EMRs in small physician offices. In fact, I’ll bet that no vendor in the country has more experience in the last 5 years. Two of the largest mass-implementations of small office EMRs in the nation used largely (in MA) or entirely (in NYC) eCW EMRs. They know what they’re doing in small offices as well as anyone.

The response to your third point is related: When a physician buys this EMR package, they aren’t buying it because of the Wal-Mart name. They are buying it because of the eClinicalWorks name and the Wal-Mart price.

If it weren’t for the huge federal EMR funding programs I would expect uptake to be slow because small offices simply aren’t well set up to do a complicated implementation like this. But with those funds, the right price point and experienced hand-holding through the process, we’ll see a far more rapid uptake than before, I’ll predict. I think we can jump from 2-3% small office EMR penetration to 10% in 3 years. This deal puts Wal-Mart at the center of that growth.