Box Store's EHR System Targets Small Practices

The big box store Sam's Club, which is owned by Wal-Mart, is setting its sights on the information technology frontier: The stores are starting to market electronic health record systems aimed at medical practices with one to three physicians.

Not everyone, though, is buying the ability of such off-the-shelf systems to be used in a meaningful way in clinical practice. And with EHR systems being held up as essential to health care reform and the ability to get a grip on unnecessary spending, a lot is riding on these products.

With the package offered by Sam's Club, practices will receive three laptops and a tablet notebook from Dell, a laser printer, and EHR and practice management software from eClinicalWorks. The package also includes 12 weeks of on-site setup, customization, and support. The package costs less than $25,000 for the first physician and up to $10,000 for each additional physician in the practice. The package, which is available for purchase online, is currently being sold only to physicians in Georgia, Illinois, and Virginia, with a nationwide rollout planned for later this year.

"We have 200,000 medical-type [business members] at our 600 clubs nationwide," explained Susan Koehler, senior manager in corporate communications at the Sam's Club home office in Bentonville, Ark. Wal-Mart had amassed some experience using Dell and eClinical Works EHR systems at its walk-in medical RediClinics and it worked well, so the idea was born to start marketing it to Sam's Club members.

The company chose Sam's Club rather than Wal-Mart to distribute the EHR because, unlike Wal-Mart, Sam's Club has a one-on-one relationship with the local businesses that buy their supplies at the club, "so we have relationships at the local level with those doctors," Ms. Koehler said.

Georgia, Illinois, and Virginia were selected for the rollout because "they were a good representation of broad-band access with a mix of rural and small-town community doctors," she said. At the same time, those states include big cities such as Atlanta and Chicago. Ms. Koehler would not say how many systems have been sold since the product was launched in early April, but "we're very pleased with the interest" it has gotten, she said.

Discounted hardware from Dell and some money saved on "interfaces coming out of the box" allowed Sam's Club to price its EHR system aggressively, explained Girish Navani, cofounder and CEO of eClinicalWorks in Westborough, Mass.

Yet the package does not offer any less customization than if a physician practice was to buy a system individually, Mr. Navani said.

Dr. Steven Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians (AAFP), said that packages like Sam's Club's have advantages and disadvantages. Although the product is off the shelf, "it's really a product and service package, not [just] a box of software that you order and then get installed," he noted, yet the disadvantage is that it is prepackaged, "so decisions are made for you when they put it together."

Two factors are key in EHR selection: content and workflow, Dr. Waldren said. An EHR system may have plenty of content, but "does it have the templates you need and want?" If you have midlevel personnel, "how does the signoff process work?" Does the nursing staff put in a review of the present illness "and then you verify that? If [the workflow] doesn't work for you, what type of customization is possible?"

By prepackaging elements together, off-the-shelf systems will be less expensive, "but there are probably going to be disadvantages around customization and the flexibility practices are going to have," he said.

Although the package is aggressively priced, it is designed to be customized.

Source MR. NAVANI

'There are probably going to be disadvantages around customization' and flexibility.

Source DR. WALDREN

The big box store Sam's Club, which is owned by Wal-Mart, is setting its sights on the information technology frontier: The stores are starting to market electronic health record systems aimed at medical practices with one to three physicians.

Not everyone, though, is buying the ability of such off-the-shelf systems to be used in a meaningful way in clinical practice. And with EHR systems being held up as essential to health care reform and the ability to get a grip on unnecessary spending, a lot is riding on these products.

With the package offered by Sam's Club, practices will receive three laptops and a tablet notebook from Dell, a laser printer, and EHR and practice management software from eClinicalWorks. The package also includes 12 weeks of on-site setup, customization, and support. The package costs less than $25,000 for the first physician and up to $10,000 for each additional physician in the practice. The package, which is available for purchase online, is currently being sold only to physicians in Georgia, Illinois, and Virginia, with a nationwide rollout planned for later this year.

"We have 200,000 medical-type [business members] at our 600 clubs nationwide," explained Susan Koehler, senior manager in corporate communications at the Sam's Club home office in Bentonville, Ark. Wal-Mart had amassed some experience using Dell and eClinical Works EHR systems at its walk-in medical RediClinics and it worked well, so the idea was born to start marketing it to Sam's Club members.

The company chose Sam's Club rather than Wal-Mart to distribute the EHR because, unlike Wal-Mart, Sam's Club has a one-on-one relationship with the local businesses that buy their supplies at the club, "so we have relationships at the local level with those doctors," Ms. Koehler said.

Georgia, Illinois, and Virginia were selected for the rollout because "they were a good representation of broad-band access with a mix of rural and small-town community doctors," she said. At the same time, those states include big cities such as Atlanta and Chicago. Ms. Koehler would not say how many systems have been sold since the product was launched in early April, but "we're very pleased with the interest" it has gotten, she said.

Discounted hardware from Dell and some money saved on "interfaces coming out of the box" allowed Sam's Club to price its EHR system aggressively, explained Girish Navani, cofounder and CEO of eClinicalWorks in Westborough, Mass.

Yet the package does not offer any less customization than if a physician practice was to buy a system individually, Mr. Navani said.

Dr. Steven Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians (AAFP), said that packages like Sam's Club's have advantages and disadvantages. Although the product is off the shelf, "it's really a product and service package, not [just] a box of software that you order and then get installed," he noted, yet the disadvantage is that it is prepackaged, "so decisions are made for you when they put it together."

Two factors are key in EHR selection: content and workflow, Dr. Waldren said. An EHR system may have plenty of content, but "does it have the templates you need and want?" If you have midlevel personnel, "how does the signoff process work?" Does the nursing staff put in a review of the present illness "and then you verify that? If [the workflow] doesn't work for you, what type of customization is possible?"

By prepackaging elements together, off-the-shelf systems will be less expensive, "but there are probably going to be disadvantages around customization and the flexibility practices are going to have," he said.

Although the package is aggressively priced, it is designed to be customized.

Source MR. NAVANI

'There are probably going to be disadvantages around customization' and flexibility.

Source DR. WALDREN

The big box store Sam's Club, which is owned by Wal-Mart, is setting its sights on the information technology frontier: The stores are starting to market electronic health record systems aimed at medical practices with one to three physicians.

Not everyone, though, is buying the ability of such off-the-shelf systems to be used in a meaningful way in clinical practice. And with EHR systems being held up as essential to health care reform and the ability to get a grip on unnecessary spending, a lot is riding on these products.

With the package offered by Sam's Club, practices will receive three laptops and a tablet notebook from Dell, a laser printer, and EHR and practice management software from eClinicalWorks. The package also includes 12 weeks of on-site setup, customization, and support. The package costs less than $25,000 for the first physician and up to $10,000 for each additional physician in the practice. The package, which is available for purchase online, is currently being sold only to physicians in Georgia, Illinois, and Virginia, with a nationwide rollout planned for later this year.

"We have 200,000 medical-type [business members] at our 600 clubs nationwide," explained Susan Koehler, senior manager in corporate communications at the Sam's Club home office in Bentonville, Ark. Wal-Mart had amassed some experience using Dell and eClinical Works EHR systems at its walk-in medical RediClinics and it worked well, so the idea was born to start marketing it to Sam's Club members.

The company chose Sam's Club rather than Wal-Mart to distribute the EHR because, unlike Wal-Mart, Sam's Club has a one-on-one relationship with the local businesses that buy their supplies at the club, "so we have relationships at the local level with those doctors," Ms. Koehler said.

Georgia, Illinois, and Virginia were selected for the rollout because "they were a good representation of broad-band access with a mix of rural and small-town community doctors," she said. At the same time, those states include big cities such as Atlanta and Chicago. Ms. Koehler would not say how many systems have been sold since the product was launched in early April, but "we're very pleased with the interest" it has gotten, she said.

Discounted hardware from Dell and some money saved on "interfaces coming out of the box" allowed Sam's Club to price its EHR system aggressively, explained Girish Navani, cofounder and CEO of eClinicalWorks in Westborough, Mass.

Yet the package does not offer any less customization than if a physician practice was to buy a system individually, Mr. Navani said.

Dr. Steven Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians (AAFP), said that packages like Sam's Club's have advantages and disadvantages. Although the product is off the shelf, "it's really a product and service package, not [just] a box of software that you order and then get installed," he noted, yet the disadvantage is that it is prepackaged, "so decisions are made for you when they put it together."

Two factors are key in EHR selection: content and workflow, Dr. Waldren said. An EHR system may have plenty of content, but "does it have the templates you need and want?" If you have midlevel personnel, "how does the signoff process work?" Does the nursing staff put in a review of the present illness "and then you verify that? If [the workflow] doesn't work for you, what type of customization is possible?"

By prepackaging elements together, off-the-shelf systems will be less expensive, "but there are probably going to be disadvantages around customization and the flexibility practices are going to have," he said.

Although the package is aggressively priced, it is designed to be customized.

Source MR. NAVANI

'There are probably going to be disadvantages around customization' and flexibility.

Source DR. WALDREN