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Sam’s Club to Sell eClinicalWorks EMR Bundle

March 11, 2009 News 65 Comments

A New York Times article reports that Wal-Mart will begin selling small-practice physician systems through its Sam’s Club division, pairing Dell hardware with software from eClinicalWorks in a complete package that include installation, ongoing maintenance, and training.

Marcus Osborne, Wal-Mart’s senior director of healthcare business development, was quoted as saying, "We’re a high-volume, low-cost company and I would argue that mentality is sorely lacking in the health care industry."

Sam’s Club will offer the package this spring starting at under $25,000 for the first physician in a practice and $10,000 for each additional doctor. Ongoing costs will be $4,000 to $6,500 per year.

The package will include a Dell desktop or tablet PC installed by Dell technicians and software-as-a-service applications from eClinicalWorks.

Wal-Mart says it got the idea from its own in-store clinics, which use the same technologies. It says it’s role is simply to bundle the products together into an affordable and accessible offering. "We’re the systems integrator, an aggregator," Osborne said.

David Brailer was quoted as saying, "If Wal-Mart is successful, this could be a game-changer."

I’ve asked Girish Kumar of eClinicalWorks for more information. Meanwhile, your comments are welcome.

UPDATE: notes from speaking with Girish Kumar Wednesday afternoon. Sorry that they are terse and a little raw, but I had 15 minutes between meetings at work and Girish was in the car on the way to the airport.

If a physician buys from Sam’s, will it be the same product, implementation services, and support that eCW offers directly?

Absolutely. We’re trying to make it simple. Everybody says EMRs are hard and implementing change is hard. We realize that. We’ve been doing SaaS since 2003 and have invested a ton on a data center. We wanted system that is ready out of the box, configured, with content, although it will still require on-site implementation and services. It’s the same in terms of product, services, training, but faster and easier to deploy.

Why would a customer buy from Sam’s? Do they save any money? Can they choose a no-services option?

Wal-Mart used its Sam’s Club division because it has a lot of small business customers as corporate members. They buy ongoing stuff every month, not just simple things like gloves and bandages, but have a corporate account and buy copiers, payroll software, etc. They don’t have to go into Sam’s. You call a corporate number, get an assigned representative, talk to them about what you need, and the item is shipped. eCW salespeople will still show the product and talk to the customer. There are packages we want to give them that are pre-configured. The customer will not pick blindly – they will still consult with an eCW person.

Will Wal-Mart do its own advertising and marketing?

There will definitely be a significant campaign. They have 200,000 healthcare professionals today as members, mostly as doctors.

Any projections on volumes?

I have to keep that confidential, but there was a lot of planning on the eCW side. Investments have increased, made the company even more ready. This can have a significant impact on how physicians look at, evaluate, and purchase EMRs. We would like to see taking it away from being a niche sales process, where sometimes we confuse the customer, to make it a very streamlined process so that a customer can make an educated decision. They know how many days to go live, how many days training, cost, etc. eCW does 30 Webinars every week that every customer has access to with a live attendant and all Sam’s members will be able to avail themselves of that.

We believe we are the largest SaaS EMR in the country with 4,000 physicians. If we include hospital customers hosting affiliated physicians and RHIOs, that’s another 4,000. That’s 8,000 today of our 25,000 physicians. We’re trying to leverage that scale to make it easier and cheaper to deploy.

Do you anticipate any product changes?

For primary care, we spent two years working with New York City. We put into the product all the content needed to run a primary care practice – templates, order sets, clinical decision support. That is years of content that we jointly developed. That is all pre-packaged with the product – it’s not just the software any more. On the specialty care, we have about 50 specialty databases. All of that will be available pre-configured when they sign up. When the trainer shows up, all the content will be there and if we want to change it, we can change it together. We will go live with a comprehensive data repository with clinical decision support at no extra cost for the content.

A primary care doctor can go live with the system as it is, with rich content.

What does this to do the competitive landscape?

We’ve always taken tremendous pride on our leadership on price and functionality. 97% of eCW customers surveyed said their total costs met their expectations when they bought and implemented eCW. 93% of physicians said the EMR met or exceeded expectations. I still have to worry about the 7% and I lose sleep about it more than I take advantage of the 93%, but if a package with those numbers is readily available, people will ask the question: if I’m able to get a comprehensive product that people are happy with at this price point with content and support, why should I spend more? Price visibility will be black and white. No longer will you see those quotes saying an EMR will cost $300,000. You will see more informed questions, pricing pressure, and frankly, higher expectations if content is provided. I don’t want to take six months to implement PM and another six months for an EMR. This is a unified product we’re offering, by the way, both EMR and PM. We’re offering five days of implementation on site with the Sam’s Club package and they can buy more for $750 a day plus travel, but our track record is that we can do it in five days.

What are the benefits to eClinicalWorks?

There are many benefits. We want to be a company with 100,000 physicians using our product and 100 million patients whose lives are positively affected by it. There’s a lot more work to be done, but this platform gives us more opportunity.

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Currently there are "65 comments" on this Article:

  1. You’ve got to be kidding me? Physician adoption is bad enough, now a vendor is going to sell software through Sam’s Club? No implementation services? No training? An EMR is not PNP! There are process and workflow issues that must be addressed. I can’t possibly be the only one that thinks this is a stupid idea for far more reasons then I can type here while laughing so hard at the thought of a physician attempting to take this route!

  2. I can see droves of doctors sauntering into Sam’s Club for their discount healthcare digitization deals while picking up a passel of paper towels and toilet paper…in bulk! $25K? What a bargain! (Wonder if you’ll need to clip a coupon from the Sunday paper?)

    I would love to see lower costs, and I don’t mean to downplay their intentions, but I don’t think that, as a physician, I want Wal-Mart to be my “systems integrator…aggregator.” But maybe that’s just me.

  3. Ralph Hinckley Says:

    You’ve got to be kidding me? Physician adoption is bad enough, now a vendor is going to sell software through Sam’s Club? No implementation services? No training?

    Did Ralph not read the article before he wrote his statement?
    A New York Times article reports that Wal-Mart will begin selling small-practice physician systems through its Sam’s Club division, pairing Dell hardware with software from eClinicalWorks in a complete package that include installation, ongoing maintenance, and training.

    Now, I may or may not think this is a good idea, but if you have a problem with it, at least make your comments legitimate.

  4. Dont kid yourself. Medical IT folks have long been touting complexity/workflow/security issues and legacy systems have been getting away with it. I think that it is a good idea and given the rave reviews e-clin-works has been getting thus far, may be this will trigger off something significant. I would watch this closely.

  5. re: Ralph Hinckley’s comment, “…No implementation services? No training? ” The article states “… in a complete package that include installation, ongoing maintenance, and training.”

  6. Regarding Wal-Mart and it’s EMR adventure–Ralph Hinckley is on target. My main disagreement is that this is not a laughing matter. It’s absurd and scary. I have been implementing EMRs for several years. It’s hard enough to get a physician and their staff on board while you are there holding their hands–I can’t even imagine them trying to do this on their own. Please understand that I do not intend to insult a physician or their staff’s intelligence, they simply do not have the time or more importantly, the “patience” to deal with all that is involved in the implementation process. My heart goes out to any practice–the docs–the staff–and most importantly–the patients–that tries to implement an EMR on their own. Wal-Mart needs to stick with selling groceries and leave implementation to the pros.

  7. History shows us that any idea the majority laughs at is one worth watching. Disruptive innovations are in fact the only leaps that have ever changed the world. It may very well fail, but we will all learn from this.

  8. If they are truley not capable, then so be it. But I wouldn’t expect them to jump into EMR delivery, in this economy, if they did not truly believe that they could succeed. Wal-mart is more than a grocery store – the way they handle their logistics is outstanding – so if they force everyone to rethink EMR delivery – is that not good for everyone?

  9. OK… I should have been more specific…

    “a complete package that include installation, ongoing maintenance, and training” — from Sam’s Club? I can’t wait to go the physician office that purchases this “complete package” from Sam’s Club. YES I AM SKEPTICAL! Training by the same blue-vested guy that is stocking toilet paper and office supplies being purchased by the single doc’s office manager.

    I can see it now… standing in the checkout line with the cart full of TP, post-it notes and manilla folders (for all the paper files they will continue to print out), the office manager see “EMR-in-a- box” next to the candy bars waiting for that last minute urge-purchase!

  10. What a brilliant application of “economy of scales.” Perhaps the market will bear eClinicalWorks as the EMR for the rest of us.

    Don’t be so smug about your vendors – maybe the doctors are too good to shop at Sams but their office staff probably buys their paper product, disposables, electronics, etc., etc. from the most cost efficient sources.

  11. maybe established, desktop, preserving status quo won’t, but new, young, trained to use electronic records in school, blackberry/netbook users won’t care where they get it.

  12. Once again, Giresh Kumar trumps the industry by innovating on the marketing side. eCW may not be the best EMR out there, but no one can touch their marketing genius. Into the future, Giresh, my hat is off to you.

  13. What if it does work? Is that what has folks scared and balking at a new idea? Once market penetration is there – all others will follow. Agree with Mr. Tremain – the ideas that make others uncomfortable are the ones that usually have merit. And if eClinical works made it so simple to use that the services aren’t needed? Will it matter if they are successfull.
    Kudos to them for trying something new and different.

  14. I applaud Walmart. Let them “shake things up”. Regardless if their idea flies, this will be a reminder to the rest of us who work feverishly with workflows and complex EMR’s that there just might be a better way to do all of this. The EMR industry and clinicians as a whole must always be receptive to innovation. Bad or failed ideas have historically led the USA to better things.

  15. Not so sure this isn’t good for all the consultants out there either. Just think – they go to Sams to purchase their EMR (if they do) then Walmart/eCW tries to implement. I might work for some savvy offices, but for those that aren’t there will be opportunities for consultants to come in and save the day!! Just a thought.

  16. Hmm. Very interesting idea. There will always be naysayers and we’ll just have to wait to see if it works. However, one can’t argue that eCW has reset the price point in this market, much to the chagrin of the Big Guys. As noted, eCW is not perfect…nor are most other vendors. But they do have a decent product, continue to innovate, and seem to listen to physicians.
    Think about it…perhaps this idea catches on and a spin off industry of implementation consultants grows to help these physicians who “self-install”.
    Time to “think out of the box”!??

  17. Absurd. anyone who thinks you can buy this in a box from Walmart and make it work is a dunce! This level of naivete is bad news for making connectivity work. Even e-clinical works should fear this trivialization of their product.

  18. If they can truly make more of a turn key product, simple to use and maintain…how much support will they need. Like any industry, most people dont need all the bells and whistles. And there are not many physicians I know that would be unwilling to “stoop” to shop at SamsClub it it will save them a bunch of cash in this economy. And I doupt the purchase point will be the local Sams club…Im sure they will make some fancy process to obtain it…I agree …if this works, the whole playing field just changed bigtime

  19. Regardless of how we feel, it is definitley an interesting market strategy. I totally agree with the comment above. There is not question that they are thinking outside the box. I also think that you are giving both physician and cClinical too little credit when it comes to both adoption and delivery. Those physicians that steadfastly refuse to move forward will continue to sit on the sidelines, at least until forced into the arena (or retirement). I have been in healthcare for more than 30 years and can tell you that the vast majority of physicians are frugal with their money. They use the same strategy with their other purchases, and many of the small practices purchase computer equipment from retailers now. Only time will tell.

  20. I, too, am a big fan of the buzzword du jour, disruptive innovation. And, I agree, the marketing via MegaMart in combo with a well-known EHR has a streak of DI to it. But, not everything that is new-ish constitutes DI. (I didn’t see any mention EHRs via Blackberries or netbooks.)

    Remembering that most of my colleagues are status quo types, and that most docs won’t let their staff choose their EHR, I just see a certain disconnect that strikes me as not quite disruptive enough, not quite innovation enough.

    But, as per others, absolute kudos for the courage to try something new and I suspect there will be ripples of real value from this. Watching where this leads will be quite engaging.

  21. Have you ever heard of IHE? The standards are in the works for a fully integrated health enterprise that will share all healthcare information from physician to physician regardless of location. I’m not going to read the article, but hopefully everyone will involve IHE moving forward.

  22. The vendors are reaping what they have sowed with their absurd prices, their overblown hype, their refusal to understand office workflow (they make us bend to the computer), and most important, their mediocre products (lousy interfaces, lousy displays, always having to click on new screens to see needed information, intrusive and stupid CDSS alerts,and arrogant belief that all solutions are found in buying their products.

    I will check out Sam’s Club but I’ll probably wait for a better product.

  23. Old Timer sounds like he is scared…of becoming an old timer. This could end up being a significant turning point, timed with the stimulus package.

  24. For the naysayers: really, guys, read the article. Most negative comments I’ve seen were probably based on the headline, not the story.

    I think that if this works out, eCW will be the winner. But I see the challenges as theirs, not really Wal-Mart. Particularly as Larry mentions, scaling up quickly might be a challenge. That said, maybe I have a poor understanding of the deal, but it seems as if Wal-Mart’s involvement was largely to arrange terms of the package. It’s up to Dell to address hardware and eCW to deliver and mantain the software product/service. Depending on how they structure the transaction, Wal-Mart may be able to wash its hands of any ongoing involvement once the ink dries on the deal.

    I really don’t see this being marketed like Coke or Downy or anything. People mock the idea of shopping for an EHR at Wal-Mart, and rightly so. Wal-Mart is probably making the same jokes themselves. But that’s why I’d be surprised to see much mention of this in the stores. Why bother and waste the space that you could spend on Crest or Downy or something? The market is so miniscule – clinicians, especially primary care (compare to Wal-Mart’s, i.e. potentially every person in the country) – that you wonder why they got involved in the first place. I’d guess that they simply saw a highly fragmented market (it so happens it’s health care), felt they could pick a winner, and thought that selection would help consolidate the market by lowering entry price and arranging favorable package terms. They of course get a slice, which is why they’d bother in the first place. All the work is up front to arrange terms of the deal; the grunt work of getting the system running and keeping it going falls on eCW and Dell. If they meet with tremendous success, the challenges would be scaling up to meet demand but ensuring they’re not getting customers that they wouldn’t otherwise want (i.e. attracted to the deal for the wrong reasons).

    You might argue that for a company the size of Wal-Mart, why are they bothering to dabble in the market? I dunno. They’re not providing any services themselves, so it’s not like the initial concerns about retail clinics morphing into Wal-Care or anything. Or maybe it is, and it’s just not yet obvious. We’ll see.


  25. Innovation is the pico de galo of life…eCW has just made a fresh batch of pico and now we will see who spoons it up.

  26. This is fantastic. While all us navel-gazers sit around complaining about the cost of healthcare but say “it can’t be done, it can’t be done” to every out of the box idea, someone’s going to get off their duff and try something new.

    Those of you who think this is a rotten idea that will never work, stop complaining and start rejoicing. If you’re right and its a disaster, it just goes to prove how worthwhile you are.

    I don’t see a downside to this experiment.

  27. I love how Wal-Mart says they use their bulk purchasing to offer a discount on the software. However the price clearly shown on eCWs website is 10k for the first and 5k per additonal for CLIENT owned. This model is HOSTED and the cost is 25k first and 10k per additional up front. So what are the upfront costs paying for… Training and implementation, and that seems high for an eCW quick and dirty install.

    Hosted model on ecw.com is $400/month and includes support. Walmart is 4000-6500/annual. It’s the same, if not more.

    eCW reps are selling the product, I fail to see what Walmart is selling other than a $450 Dell PC.

    I’m missing where Wal-Mart is bringing any value to the physician..

  28. WalMart is not implementing or training…please read the article before commenting. eCW is doing the implementing and training. Read Girish Kumar’s remarks to understand rather than just typing in uninformed comments.

  29. You know I just thought of something… Costco needs to get in on this. How about a competing product (I don’t know, NextGen, Centricity EMR, etc.) offered up with the Costco discount and then go toe-to-toe to see who comes out? Just think of those possibilities!

  30. I have said for a while that EMR and PM software is becoming a commodity. Looks like we are there.

    Feature/function of these applications are so similar that the differentiators are implementation and service. If you look at the sales talent hired for these sales roles 10 years ago verses today you will notice a marked difference. Much like the pharmaceutical industry moving from sale teams to marketing teams with young, inexperienced good looking kids that pass out pens and candy. I did not think it would get to this, however, what a distribution channel!

    The consolidation of vendors and applications also speak to the market not seeing much difference in the functionality.

    Enter the next generation applications that are easier to support, implement and maintain.

    Time will tell if this experiment will work. It is not that far of base, and look at the publicity it is getting eClinical.

  31. When I first saw this headline, I literally thought it was a spoof from The Onion or something – a very funny one at that. Especially on the pricing side – if anything is clear, one size does not fit all when it comes to implementing EHRs.

    But take a minute to think about what Wal-Mart brings to this (and read the whole NYT article). This grew out of their experience with building drop-in clinics inside their stores. Now think about the affiliation network that a Wal-Mart can create by getting docs in the surrounding area to be a part of this environment.

    eCw can do the training, but they can also leverage the clinics themselves during “slow” times to train docs at the clinics. They will build a staff for their clinics that can work as needed along with an integrated off-hours service that extends the solo/small practice environment to nearly concierge service that keeps the primary care doc in the know of anything that happens at the Wal-Mart clinic.

    Now think about what Wal-Mart does best – more than anything, they know how to churn data for actionable clues on behavior, drive decision-making based upon those data, and make health-related products and services available at the point of need and, finally, drive prices down by knowing more than anyone else – including their suppliers (who now include docs and eCw).

    Still think this is stupid? I’m thinking that this could turn out to be a prescient masterstroke. Stay tuned…

  32. What is next? Girish pitching his wares on QVC, HSN or ShopNBC?
    I can see it now……..introductory price and available for 5 easy payments of 5k on your credit card???

  33. You can buy an EHR for $1500 bucks on-line now a days, so this doesn’t surprise me. An IT person at a multi specialty practice purchased one one of these “low cost” EHR’s and talked the physicians into it. If the clinic has the IT specialists and programmers as well as electronic billing specialists then this is a viable option. However, the success rate of a practice that does it’s own EHR integration template design and work flow analysis isn’t all that great.

  34. Once Wal-Mart connects them into their system, they will next offer physicians an employed model – with Wal-Mart being the employer.

    We already see ehr being viewed by various health networks as “competitive differentiators” to bind patients to a particular provider network. EHR here is being used by Wal-Mart to entice physicians into a binding relationship with Wal-Mart.

    In any case, neither the vendors, the provider networks, insurers, nor physician employer wannabe Wal-Mart will have any incentive for portability and interoperability.

  35. The biggest challenge will be the on-going in-office support. eCW can provide the initial installation support but there are large amounts of continual care and feeding to bring the installation and adoption along. Sign-up “Nerd Herd” for local support and strike a deal with a consultant network for optimization and then Girish expanded his distribution channel, received some press, and may have a winning proposition. Without continual hardware support and optimization services, this will be a challenge for all but a few practices. I applaud them for thinking out-of-the-box.

  36. Coming soon to a TV near you: commercials extolling Walmart’s “pioneering efforts to solve the health care crisis in America”. Excuse me while I ralph.

    Lost in the gold rush for the $19 billion in public monies set aside for ehr is any real notion of the public good…

  37. This is a big gamble for Walmart. When things don’t go right with the EMR down at old doc McGiddy’s office, there’s going to be hell to pay in Bentonville.

  38. Forgive my hesitation…how does an off-the-rack EHR-and-a-PC bundle advance HIT? Aren’t the same issues of resistance by end users still the same? There are already less expensive EHRs. Just because Wal-Mart sells it, do the issues related to workflow, interoperability, usability, and “clunkiness” suddenly disappear? (Maybe eCW has resolved those for Dell PCs?)

    These guys are no dummies: Wouldn’t it have been even more surprising if Wal-Mart had not figured out a way to come after some of the billions in Stimulus money? (Notice that their 5 year price point comes in right around the $44K for EHR adoption & “meaningful use” promised by HITECH? Smart.)

    I am not of the camp that sees cost as being the primary barrier to EHR adoption. Besides adding to eCW, Dell, & Wal-Mart’s coffers, I don’t see major innovative disruption here.

    (That said, I really despise being a naysayer, so I’d happily be wrong!)

  39. several points…
    1. I’d be willing to bet that a higher percentage of doctors (or their spouses) shop at one of the big three warehouse stores. Between Sam’s Club, Costco, and BJs i’ve seen PLENTY of doctors in the area going in and out of these shops.
    2. All the criticism of what Wal-Mart/Sam’s Club is trying to do is a big part of what the problem in healthcare is today and why this country will continue to struggle to move towards a unified healthcare system.
    Every physician, physician practice, and hospital has different workflows and different procedures. Everyone thinks their way is the best way of doing things and are too stubborn to change their ways for the greater good.
    This is only going to continue to lead to increase costs, delays in care, and medical mistakes.
    Think about all the time and money that could be saved if our medical professionals would get over their pride and be willing to change for the greater good.

  40. I love all the comments about how hard it is to re-engineer workflows. I am picturing bunch of dinosaurs crowded around a computer posting comment after comment. Ancient scripture of a consultancy sales team.

    This offering is marketed to a niche that doesn’t need full scale, overcharged support. HIS implementations are NOT rocket science. Vendors/Walmart are welcome to this market, a market that NO consultancy would pickup as a client because the “margin” just isn’t there.

    God forbid someone trying something different, let’s not rock the boat right? Right?

  41. I think the alarm that suddenly physicians will start installing EHRs without assistance is likely unfounded. The interview states that eCW will still be providing the same installation and implementation services they did before. And presumably their R&D and sales demo processes will remain the same. The only difference appears to be how the customer will place their order and the ability to bundle the order for the software with the order for hardware. This appears to be primarily an innovation in how they are marketing their EHR, not a fundamental change in how their EHR will be adopted by physicians.

    Mr. HISTalk, I am curious about one thing: Girish referred several times to eCW having a “SaaS” offering. Of course, there are many definitions of “SaaS” and the SaaS concept encompasses both marketing and technological components, but I’d be interested to know whether he is talking about what most of us would consider a “true” SaaS solution (fully web-based rather than Citrix or Remote Desktop access to a Windows client running on their ASP; true multi-tenant database; single instance of code for the entire customer base so upgrades/enhancements occur automatically and across the entire customer base simultaneously, etc.).

  42. Didn’t anyone see that this “news” announcement was withdrawn an hour after being posted yesterday?

    ADVISORY: Wal-Mart e-records story is withdrawn

    Wednesday, March 11, 2009; 12:55 PM
    The WASHINGTON datelined story “Wal-Mart says will sell e-records to doctors” is wrong and has been withdrawn. The announcement did not come from Wal-Mart.

  43. About the only thing innovative here is the announcement of selling through a Big Box retailer, nothing more. It is a channel play and I wonder how eCW VARs feel about competing with Wal-Mart for business.

    Do see this as a good marketing move by eCW, just look at all the comments.

    Do not see it as good strategy for this market is not yet at a point where it can be considered a commodity, thus being able to be sold retail. No, it is not a QuickBooks market yet. Heck, if you look at other industries (my background is mfg) the ubiquitous AutoCAD is still mostly sold through VARs, not retail stores. Same holds true for Microsoft’s Business Solutions (ERP software, which one could equate to EMR/PM in some respects, at least from complexity/functionality though they do very different things).

    The biggest strategic blunder by eCW maybe the alienation of its reseller/VAR channel, which may create an opportunity for competitors to capitalize upon by recruiting disenchanted eCW VARs to their network.

  44. WOW… What a stir this has created. I am amazed that so many respondents feel that there would be no implementation assistance from eCW. Please note Girish Kumar’s comments about a packaged implementation, plus T&M for more training, as needed. This is an amazing marketing decision for eCW. It will definately not hurt them. I can’t believe that the company will not offer the healthcare provider all support necessary for success. This could be a huge turning point in the area of EMR for the small practice. With the integrated, packaged PM product as well, the physician has everything to gain.

    I think everyone should sit back, relax, and let this play out. I wish eCW total success with this venture. Sams/Walmart is already successful. I would call that a hell of a partnership.

  45. WOW… What a stir this has created. I am amazed that so many respondents feel that there would be no implementation assistance from eCW. Please note Girish Kumar’s comments about a packaged implementation, plus T&M for more training, as needed. This is an amazing marketing decision for eCW. It will definately not hurt them. I can’t believe that the company will not offer the healthcare provider all support necessary for success. This could be a huge turning point in the area of EMR for the small practice. With the integrated, packaged PM product as well, the physician has everything to gain.

    I think everyone should sit back, relax, and let this play out. I wish eCW total success with this venture. Sams/Walmart is already successful. I would call that a hell of a partnership.

  46. Not a Hoax – check out this quote from yesterday’s WSJ – the announcement was probably “leaked” out before all parties were ready for a formal announcement. It sounds like there are a lot of details that still need to be worked out between all three parties, and they all know that. Dell and Wal-Mart are know for their business intelligence, and ECW is know for it’s innovation.

    “”Whether it is a single physician or a physician’s group who comes to us, we can offer a system that enables them to electronically prescribe medication, set appointments, track billings and keep records,” said Gregg Rossiter, a spokesman for Wal-Mart.”

  47. Can anyone say GREED! Who approached who here. The government puts a plan into plce, one that President Obama initiated, and calls it the HITECH Act. In the HITECH Act a physician is entitled to up to $44,000, paid out over a 5 year period of time, 2011 – 2015, in FREE stimulus money, money from me, you, the taxpayor, to invest in an EMR. Now, their price mark for a one doctor practice is “about” $25,000.00 up front for the software, the equipment and the training, (notice they reserve the right to charge you more later . . . because they already know 5 days isn’t enough time) and then $4,000.00 per year for maintenance and support. $4,000.00 a year for 5 years equals $20,000.00. Over a five year period of time, is it just coincidence that number adds up to be “about” $45,000.00. I don’t think so. So again, who approached who here.

    In my opinion, this is not about offering a great product at a discount rate for the benefit of the doctor or the practice, or to some how revolutionize the healthcare software and IT industries, or to be instrumental in somehow helping to lower healthcare costs, or any other Knight in Shining Armor scenario. It is about greed. It is about profit. It’s about Walmart making sure they get some of that pie. It is . . . business in America. It is capitalism. It’s not a revolutionary idea. It’s age old. It’s just getting more press.

    I can’t believe most doctors will fall for this marketing ploy. Any physician that does his homework will poke holes in the product offering. eCW is NOT the best EMR out there. If they were, there wouldn’t have been a website developed a couple years ago about the PERILS of Doctors and the lawsuits filed against eCW for fraudulant claims, poor customer service due to the fact support call centers are from a country that doesn’t speak fluent Englidh, failed implementations, unkept contractural promises. That website, for whatever reason, was taken down (bought) and now directs you to eCW’s website.; how ironic. I don’t buy their 93%’s and 98%’s, those are percentages of customers who bothered to reply. Anyone knows who publishes those types of customer satisfaction reports that typically less than 20% of customers actually reply. The real statistics lie with those that wouldn’t respond.

    ASP should be the most economical means of deployment for a software application, but not by the numbers of this proposed solution. A doctor can outright purchase, implement, train and support an equal or better application for equal or less money.

    With an ASP application, a doctor will never OWN his data.

    ASP implementation forfeits any tax benefits that come from investing in software or capital equipment, IRS Code Section 179.

    ASP deployment fails, often. Ask any doctor who has, or has had, an ASP deployed software application what it’s like when their internet goes down for an hour, for a day, for three weeks. Good luck treating your patients, because you can’t access your electronic patient chart.

    Enough about that. Since this is a forum for opinion, in mine, Girish Kumar you just discredited your product. I’d say you just gave a majority of your competition ammunition to sell against you at the true business negotiating table of the medical practice . . . that you’re trying to bring to the Sam’s Club Cash Register.

    This decision has earned earned a lot of press, a lot of free exposure. But I’m willing to be it will cost eCW in the end. I don’t see how this can NOT alienate their Reseller Network, which is the main reason eCW can even claim to have a satisfied customer base.

    But in the words of one of the other responders above, Bignurse, “. . . this trumps the industry on the Marketing Side. eCW may not be the best EMR out there, but no one can touch the marketing genius”. So doctors, nurse practicioners, you want a good marketing company, call eCW. You want a quality EMR, for recommendations contact your local MGMA or your most reputable Healthcare Consultant in your area . . . not your local Walmart!

  48. I agree with GBT, what a stir. I posted my quick thoughts late last week, and suffice it to say I think this partnership bears watching. The outrageous statements of the nay-sayers only serve to discredit their claims — come on, you really expect WalMart to sell this on the floor? Like other business services, there will be a dedicated group that handles this for WalMart.

    I won’t be surprised for other large firms (financial services, Costco, etc) to jump into the fray with other software partners.

    Regarding Mr Wally’s ASP fears….nice FUD. Cloud computing is the future, particularly for small practices, and you are likely to see all major solutions gravitate that way if they aren’t already. Yes, there are *some* potential issues that physicians need to be aware of, and due diligence is required to ensure the solution & infrastructure are mature, but to completely discount ASP/Cloud based solutions is absolutely ridiculous.

  49. This is just one step in a slow process to demystify the incredible complexity of the HIT space.

    eClinicalWorks is a solid application, and we know the Wal-Mart/Sams folks understand the many issues that surround technology.

    This type of effort coupled with formal adoption of the Patient Centered Medical Home and a focus on patient education through broader use of PHR’s might facilitate some of the positive HIT related changes we have been seeking!

    Kudo’s all the way around!

  50. Implementation of an EMR is a complex process. It is much more that an EMR system ( there are many good ones on the market) and hardware. It is a “people” and organzational task as welll as getting clinic personal to change their method of working. It is about new workflow and new ways of managing patient information. It is one thing to insatll a new system and another to get adoption. Adoption is more than training. I have implemeted an EMR over 50 times, in over 50 different settings, and while there are principles to follow, every experience is different. I have also seen many attemps fail becuase the methods of implementation were crude at best. Installation is not implementation. The Wal-Mart plan can be a good one if, after the sale, there are experts that understand the dynamics of the implemetion process.

  51. Thisd has got to be a joke. I can see it now. Office Manager goes in to Sam’s and buys the “package” over the weekend, brings it in to the physician office and tells them they went to Sam’s, bought tires, groceries, and this new EMR package. Take it and use it! Can you imagine the physician reaction? Does Wal-Mart think physicians are stupid? Implementing an EMR takes a lot of effort and work on both the vendor and user side. You can’t just flippantly go out and buy an EMR package on a whim and expect it to work off the shelf. I hope and pray this venture fails. Otherwise, my faith in the medical field will greatly be reduced!

  52. As a happy user of a competing inexpensive EHR for 5 years, I can only applaud ECW’s success and widespread adoption. Most of the comments are ignorant; as I understand it, ECW is selling this thru this outlet, in addition to thru VARs, and drawing attention to itself.This is the same product and training as you would get buying directly from them, or a VAR. Whether they can keep up with the volume is the next question. One website claimed there was a 4 month wait time for implementation.

  53. This is a joke. I can’t see how anyone would buy eClinicalworks, much less pay 25k for it. Note that I have no conflict of interest. I have used eCW for about 2 years and found that much of the recent negativity about EMR’s to apply wholeheartedly. While I can definitely say eClinicalworks is a piece of junk unfit even for the lowest bidder, most of the CCHIT software are just as bad. Shame on eCW, I cannot believe for a second that a single person would actually benefit or like their obtuse, clunky software. Rather than work on expansion and public relations telling people what they want to hear, they should try and make a more marketable software that actually works well. Please also note that as much as I hate eClinicalworks, I will readily admit it is one of the better packages out there, which speaks volumes as to how inappropriate the current generation of electronic medical records are for patient care.

  54. Great idea except for the proce tag. It should be a box of software for $250 and than the ongoing cost. SaaS is not typically 25k p front not is an asp model, client server for 1 doc would be 25k.

  55. I still don’t get the Wal-Mart angle. The number of docs they can sell to is rather small for a retailer like Wal-Mart. Sure they get a piece of the on-going maintenace which must have nice margins but the revenues won’t move a comma in their revenues. Does anyone know if Wal-Mart can get access to the data in the EMR? Thats gold if they can. Any other reasons why they’d do this?

  56. I own a physician billing service, I would love to see how this works. I have groups on these very expensive EMR systems and they really are not user friendly. I also have groups that could not afford and expensive EMR and this would be perfect. I need to understand how the practice management side works. You can have a inexpensive EMR but if the Financial side does not have the reporting tools and the software for claims to go through with out a hitch, then it becomes a very expensive EMR.

  57. I am working trying to intgrate with eCW now (the vendor not Dell).

    Most of what they have does not work from an integration standpoint and they break more than they fix and are unwilling to adapt easily ot variances in data exchange.

    I really cannot see Physicians ultimately being happy with the reult if they need to integrate with other Providers (like the Hospital_.

  58. The problem with eCW v9 is the support is horrible, horrible, horrible. Fixes are slow to appear and often break something else. Interfaces mostly don’t work or have serious issues. I can’t recommend this product and avise others to steer clear.

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