While I bought the very netbook on which I am composing this essay at Wal Mart, along with the shirt I'm wearing and the astronomy magazine I will soon read, considering the exploratory nature of clinical IT and the expertise needed to install, manage, maintain, train, customize, remediate, and back up EHR's, as well as the history of health IT misadventure on a national scale, I will only provide a few comments on the following, including this pithy one:
Rotsa Ruck.
Wal-Mart to market EHR system to small practices.
On the front page of its Business Day section, the New York Times (3/11, B1, Lohr) reports, "Wal-Mart Stores is striding into the market for electronic health records [EHRs], seeking to bring the technology into the mainstream for physicians in small offices, where most of America's doctors practice medicine." Partnering "its Sam's Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software," Wal-Mart aims to "make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half." In doing so, the company will offer a "package deal of hardware, software, installation, maintenance and training." The package will "be made available this spring" for "under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor." According to experts, "traditional health technology suppliers...have tended to shun the small physician offices because it has been costly to sell to them." But, "Wal-Mart...has the potential to bring not only lower costs but also an efficient distribution channel" through the "200,000 healthcare providers" among its Sam's Club members.
Next, McDonald's.
Can I have an EMR with that cheeseburger?
(Oh, wait. McDonald's already cornered the Pharma market.)
Seriously, all I see with yet another intermediary between the vendors and the physician is more money taken out of healthcare and given to yet more nonmedical for-profits, and this for a technology our own National Research Council tells us does not meet clinicians' needs, and may in its present form actually hamper healthcare improvement.
Walmart has expertise in supporting ultra-specialized, cross-disciplinary enduser technologies such as an EMR like I have expertise in, say, nuclear engineering or high energy physics. (Maybe less, as I took physics in high school and college and did quite well in them.)
It may be just me, but I've never thought of Walmart as the place to support ultra high tech virtual clinical devices such as EMR's. Sell cheap imported stethoscopes for blood pressure measurement, yes. Sell a device that our National Research Council says is not quite ready for prime time clinician use, that's a bit more iffy.
Then, what would a Walmart EMR department look like? Shrink wrapped Acme Anvil EMR boxes stacked to the ceiling on warehouse shelves? Huge banners proclaiming "PRICE DROP: TODAY ONLY, $23,999.00?" What?
Price drop: Acme Anvil EMR, regularly $25,000.Special today, only $23,999!
Would it not be cheaper for the HIT vendors to simply post billboards for their products and services in small towns across America?
This entire scheme reminds me of the cockamamie dot-com boom, free mortgages, and arcane financial instruments that have recently caused certain tectonic shifts in our society. With perhaps a touch of the Ol' West snake oil salesman entrepreneurship thrown in.
Finally, why WalMart? RadioShack is also widespread and have a technology focus. They were a computer pioneer, and even used to have their own computer centers.
Even Best Buys has far more extensive computer departments, including Apple in this area, and a knowledgeable sales team and technical "Geek Squad" to help support IT.
I can't even believe I'm writing such things. Medicine has truly gone bananas when such issues even need to be written about.
-- SS
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