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Wal-Mart. I'll Take Two EMRs, Ninety Lipitor, a Flu Shot and a Thirty Pound Bag of Pistachio Nuts.

March 12, 2009
by James Feldbaum
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It was announced (leaked maybe) that Wal-Mart has teamed with Dell and eClinicalworks to provide hardware and software for an EMR with e-prescribing. The system is touted as “low-cost” or around $25,000 for the first user and $10,000 for each additional user.

Although the word is that they will offer support and maintenance, the big question is how? Wal-Mart and Sam’s Club already have the formula for low-priced shopping, but an EMR?

This is, of course, the same Wal-Mart that plans to directly compete with physicians for services by opening 2000 medical walk-in clinics over the next five or so years.

I suspect that a discounted EMR will shake up the industry and put price competition on vendors. Still, I remain hopeful for a grass roots EMR that grows thru Health Information Exchanges an RHIOs.

We will see. Maybe they are on to something.

What we obtain too cheap, we esteem too lightly. Thomas Paine (1737-1809)

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Comments

Anthony, the power is mainly 'decision rights.' It's phenomenally frustrating to physicians to know what the most effective treatment is, and have to negotiate with a high school trained clerk, over the phone, to get approval for it. Just this week, I heard about it from a busy, practicing internist. This 'intrusion into the patient-physician relationship' has taken many forms.

Do you think that purchasing and EMR/PM system (and ASP) from Wal-Mart, a remote and sterile transaction, will be preferred to obtaining the system thru their HIE? Does it represent a different power dynamic?
I agree that the stumbling block is at the utilization level. In defense of doctors, there is an under-appreciation of the disruption in workflow that can translate into a big hit to production and income. The national mandate will help in overcoming our present inertia, but the majority of practices will be late-adopters.

Joe. Can you go into the idea of power shifting a little more. Do you mean a loss of control over data, power loss to patients, to office workers, to the techies that actually know how to work the system?

Anthony,
My friend and colleague, Dr Jeff Rose, coined a term, "InfoBia" (or perhaps inphobia) it was the combination of two concerns on the part of doctors: 1) I wont be able to figure out how to use the technology, and 2) Once I do use it, it will fundamentally change the power structure I work in, to my detriment.

Sounds to me like you and Jeff have arrived at the same conclusions. I think the first part, use, is becoming less of an issue. The second part, shifting power associated with the fabric of EMRs is a very concern, and rightly so.

I've consistently argued that it's not cost which keeps docs from adopting EMRs, rather it's the absolute and all-consuming fear that such technology will completely disrupt the way they practice medicine and, perhaps more importantly, wreak havoc on their billing. I don't know if this deal changes any of that.

James Feldbaum

Jim Feldbaum is a physician consultant specializing in clinical transformation, CPOE, and...