Electronic Health Records from Wal-mart

Many folks who read Steve Lohr's New York Times column last week "Wal-Mart Plans to Market Digital Health Records System" emailed me and asked - how can this be? The cost seems low, the products seem outside of the scope of Wal-mart's expertise and clinicians may not receive the expert implementation assistance and support that has been well documented to result in successful adoption of EHRs.

To answer this question, I spoke today with the CEO of eClinicalWorks, Girish Kumar, Linda Dillman, Executive Vice President of Benefits and Risk Management for Wal-Mart Stores, and Marcus Osborne, who leads Wal-Mart's healthcare business development team.

Here's the detail:

The cost for a full implementation of the eClincalWorks EHR purchased through Sam's Club is $25,000 for the first clinician in an office and $10,000 per additional clinician. It is a Software as a Service model, leveraging the cloud computing infrastructure that eClinicalWorks has deployed throughout the country. The price includes:

*Office hardware (desktops, laptops, printers)
*Installation of the hardware
*Installation of the eCW software clients which Dell includes as part of the operating system image on the hardware
*Data Center support
*e-Prescribing integration
*Specialty specific templates i.e. cardiology, pediatrics
*12 weeks of project management
*5 days of onsite training by eCW staff
*Free unlimited online webinars (offered 30 times/week)
*The first year of support

After the first year, all support and service is $500/clinician/month.

My experience implementing software as a service models at large scale in Massachusetts has achieved very similar pricing for hardware, software, implementation and support. It's a good deal.

Wal-mart is working on lab interfacing, so we'll hear more about that soon. In addition to the services provided directly by Wal-mart's vendors, Marcus told me that they will encourage complementary community implementation efforts (Regional HIT Extension Centers) to provide additional health information exchange, quality measurement, and local program management to ensure clinicians achieve meaningful use of this new technology. The cost of our BIDMC implementations is about the same as Wal-mart implementations when these additional services are considered.

Wal-mart believes healthcare information technology is within their realm of expertise because of their rich experience with acquiring and implementing IT for their own operations. Their supply chain savvy enables them to achieve best pricing from eCW, Dell, and other vendors in a single package that takes the guesswork out of buying an EHR. There is no RFP and no consulting expense for system selection.

Marcus also told me about their extensive process to select eCW and Dell. They reviewed dozens of vendors and technologies before choosing these partners.

Wal-mart hopes this effort to package hardware, software, implementation, training, and support services together will be disruptive. No longer will clinicians be spending over $60,000 per person to get started with EHRs. This is not turning EHRs into a commodity, it's achieving the best value for clinicians by leveraging economies of scale, cloud computing, and the supply chain.

There you have it - a complete EHR plan from Wal-mart. They've really thought through this one. I have great faith in their ability to make it a success.