Dr. James Coffin, VP of Healthcare and Life Sciences at Dell, has a post up on the Dell Healthcare Community site that looks at the stances of the various Republican candidates for the US Presidential nomination. It’s an interesting read if you haven’t been following the republican candidates very much.

What the article doesn’t address is these candidates stance on the HITECH Act. The key here is to realize that the HITECH act isn’t part of the Affordable Care Act which every GOP candidate is saying they will repeal if they become President. So, where does that really leave the HITECH Act should a republican president be elected?

The problem is that no one really knows. Those who argue that the HITECH Act is safe often lean on the ideas that EMR and EHR has always had bipartisan support. Many often mention that the push for adoption of EHR software was started by a republican president, George W. Bush. I actually agree that both sides of the aisle want to have widespread adoption of EHR. We could certainly argue the benefits or detriments of EHR adoption, but for a relatively uninformed senate, house and president when it comes to EHR, they’re going to easily grab on to the idea that technology can improve healthcare. We may agree or disagree with this point, but I think we’d be hard pressed to find a senator that thinks we shouldn’t have EHR technology in healthcare.

The problem with the above discussion has to do with the way that EHR is being paid for. Again, this isn’t about whether the idea of paying doctors to use EHR software is right or wrong, good or bad. This is more about the political stance of the republicans and how they want government to spend money. It seems very clear to me that Republicans are going to keep sitting on their no spending/cut spending soap box. If a republican becomes President, we’re likely to see widespread cuts. Could HITECH money be a casualty of those cuts? Absolutely. Will they be a casualty? Can anyone predict what Washington will really do?

Should doctors and practices then be afraid of going after the EHR stimulus money? Well, I’ve been advising doctors and practices for the last couple years to not implement an EHR in order to get the government hand out. Those that are doing EHR for “free” government money are going to be disappointed. Not only because the money could be cut, but because sooner or later that money will be gone. So, if you’ve followed my advice, then the loss of the EHR stimulus money will be unfortunate but not too terrible.

On the other hand, those people who only did EHR because the government was waving the carrot and the stick are likely going to be quite disappointed. Particularly if the practice focused on the governments EHR requirements instead of their own individual practice needs when it comes to an EHR. Sadly, I believe there are many clinics in this boat.

I’m sure there are other Washington DC insider workings that are in play as well. Hopefully many of you will share some of what you know in the comments.

Personally, I’m still fairly confident that the EHR stimulus money will play itself out. I’ll be a little surprised if indeed it does get cut. I think republicans will have larger fish to fry. However, there’s certainly that possibility, so doctors should take this into account when they’re selecting and implementing an EHR.

One of the most fascinating people I met on my recent trip to San Francisco was a doctor named Aaron Blackledge from @CarePractice. We spent a great evening together talking EMR, healthcare and entrepreneurship in general. You may also remember me posting about Aaron drinking the CareCloud EHR kool-aid (See also an opposing view of CareCloud and my thoughts after seeing CareCloud), but I digress.

Dr. Blackledge has posted a thoughtful look at how the EHR cost curve has changed over the past few years. It’s an interesting read for those looking for an interesting take from a physician in Silicon Valley and his idea of the value of a widely adopted platform.

I love the idea of a healthcare/EMR platform. Would you rather be a $100 million EMR company or a billion dollar platform company? Think those numbers are exaggerations? That’s the question that SalesForce.com basically answered. They could have easily become a $100 million CRM company, but instead they’re now a multi billion dollar platform company. I won’t be surprised if we see the same happen for some company in healthcare.

Whether you agree or not on the value of a widely adopted platform, one thing is certain: The Free EHR Model (with Practice Fusion as the first to make the big “free EHR” splash) has absolutely brought the cost of EHR down. I’m sure there were some other forces at play too, but I believe the Free EHR model held everyone else accountable for their pricing.

As Dr. Blackledge says in his post, little by little EHR vendors couldn’t get away with charging $20,000 per user up front for an EHR. I started blogging about EMR when this was the norm. Most clinics would take out a hefty loan to buy their $100,000+ EMR software. It was a scary idea and certainly burnt a lot of physician bridges along the way.

Along came a new pricing model where a doctor could pay a small fee per month. Sure, if you evaluated that amount over 5 years it was still a fair amount of money, but no longer were doctors on the hook for the entire amount even if the EMR software failed to deliver on their promises. Plus, the EMR vendor couldn’t come back later and charge them even more money for future upgrades (that’s right…$20k up front and then amazing upgrade fees).

After that, the Free EHR model made a big splash. While certainly viewed with a fair amount of skepticism (myself included), many other industries are proving this model and doing quite well. We still have a ways to go to see which company is going to be able to execute the Free EHR model, but as I discussed in my recent Pharmacy Ads and Free EHR software post there are a lot of pharmaceutical marketing dollars on the table.

Reminds me of the favorite thing my Dell sales and marketing guy loved to say, “Whether you go with Dell or not, we’re keeping prices low so that everyone else has to offer you lower prices.” I believe Free EHR companies have had that same effect on the EHR industry.

I have quite a bit of history writing about the various Dell EMR offerings and also the Practice Fusion Free EMR. So, you can imagine my interest when I saw the announcement that Practice Fusion and Dell were partnering to offer a free EMR on Dell hardware.

Of course, this is kind of a no brainer for Dell. At least if they like the Practice Fusion EMR product. Dell is all about getting distribution for it’s hardware. Why not bundle that hardware with a Free EMR? As long as it doesn’t hurt Dell’s existing EMR partnerships with: Allscripts, NextGen and eCW then it seems good for Dell. Dell obviously has a big interest in healthcare IT with all these EMR partnerships along with their purchase of Perot Systems.

I did have a few questions about the Practice Fusion side which I posed to Ryan Howard, Chairman and CEO of Practice Fusion. The following are my questions and his answers:

Will Dell be marketing the Practice Fusion EMR as well, or is this mostly just a Practice Fusion tie in with Dell hardware?
Ryan: The strength of our partnership with Dell is that it is a true joint program. Both Dell and Practice Fusion are promoting the affordable EMR bundles for physicians. Dell through their 866-Dell-EMR hotline and on their Dell Healthcare website. Practice Fusion through www.practicefusion.com/dell. Both companies are dedicating marketing resources to reaching the small medical practice sector with this offer.

Why would a doctor buy the Dell products through Practice Fusion instead of just on their own? Do you offer a better discount?
Ryan: Doctors get a significant discount through Dell/Practice Fusion over the general Dell retail prices. It varies per piece of hardware, but is as much as 40% off. We directly negotiated these deals for our user community and Dell’s team tested each piece of hardware to make sure it would work well with Practice Fusion. You can see all the discounts here.

Isn’t it a little ironic that the “Free EMR” now has a link to “Apply for financing”?
Ryan: No. Although Practice Fusion’s EMR is free, doctors still often need to purchase new computers, scanners, printers, etc. Even with the Dell discounts, it can add up quickly for a small medical practice – the Dell financing deal relieves that last bit of financial pressure from the practice and gives them some flexibility on repayment.

Full Disclosure: Practice Fusion is an advertiser on this site. Although, they didn’t pay me to write this blog post or filter the questions I asked Ryan in anyway. I just love to post anytime I see Dell and EMR in the same sentence.

Today, CNET posted an article that talked about a Dell EMR. Yes, we’re talking about the Dell that makes computers (and sells everything else under the sun).

We’ve known for a while about Dell’s partnership with eCW and Walmart-Sam’s Club to sell EHR, but the thing that’s interesting about the CNET article is that it calls it “Dell’s EMR software.” I’m certain that Dell didn’t create it’s own EMR software package. I assume it has to just be eCW’s EMR right?

To add to the fun, I even found the page http://www.dell.com/emr which talks about Dell’s foray into the EMR world. However, on that page it links to the Sam’s Club/Walmart/eCW EHR partnership as well.

I have a feeling that the CNET article is just an extension of Dell’s partnership with eCW and Walmart. I’m sure eCW wants to market their EHR as much as possible and Dell is a respected brand on which to market your product.

UPDATE: The following is an excerpt from Healthcare IT News about the Dell EMR:

The Round Rock, Texas-based computer maker on Thursday introduced an electronic medical record system for hospital-affiliated physician practices. The intent, said Dell executives, is to accelerate the sharing and meaningful use of digital patient information among hospitals and physician practices.

Dell executives say their EMR solution is sponsored by hospitals for their affiliated physicians and designed to make it affordable and practical for physician practices to transition from paper to electronic records.

So, it looks like it’s hospitals that will choose to partner with Dell in order to get doctors to buy an EMR from Dell? It still doesn’t say where Dell got this EMR. I think we can rule out them developing their own. So, the question remains: Is this an extension of the partnership with eCW or did Dell purchase another EMR software company?

In summary, a doctor will be buying an EMR sponsored by their hospital association who has an associate with Dell who has an association with some EMR software? Sounds like the perfect recipe for finger pointing.

I previously posted about the EHR stimulus tour (no link since I don’t want to promote them). Today I saw what seems to amount to a press release that talks about the “EHR Stimulus Alliance” and their tour to “educate 500,000 U.S. physicians about opportunities aligned with the American Recovery and Reinvestment Act (ARRA) of 2009.”

This type of puffery just makes me sick. No. Not the educating 500,000 physicians. That’s a good thing and part of the motivation for this blog. The thing that makes me sick is this seems like just a big marketing campaign for Allscripts. Sure they have a list of other partners, but they’re basically partners of Allscripts. Check out the list: Allscripts, Cisco, Citrix, Dell, Intel, Intuit, Microsoft Corp., and Nuance. The press release calls it a “broad coalition of healthcare and technology companies.” Too bad Allscripts is the only true healthcare company in that list. All the others are technology companies that sell some healthcare products.

I just don’t like when an “education tool” is really just being used as a marketing tool for a certain EHR company. If they really wanted to help adoption, they’d sponsor a tour with a whole variety of EHR vendors where they can help doctors to be able to see the wide variety of EHR vendors that exist.

Someone recently emailed me about any conferences that exist for a doctor to be able to evaluate EHR companies all in one place. I know there have been a number of other ones in the past that no longer exist. The only one I know is still going is HIMSS. Does anyone else know of other places where doctors can see a bunch of great EHR? I ask this knowing that many really great EHR just haven’t seen the benefit of these types of shows.

Also, if anyone has a chance to go to one of these EHR Stimulus tour stops, I’d love to have you do a guest post on the experience. I sent them a tweet asking if they can stop in Las Vegas so I can check it out.

Many of you may remember my rather detailed coverage of the impact of Walmart offering an EMR through Sam’s Club and in partnership with eClinicalWorks and Dell. For those that missed my comments, I wrote about the details of the Walmart EMR offering, and then A Doctor’s Perspective on Walmart EMR and eCW and Dell’s perspective on Walmart EMR.

I saw the Walmart EMR listing on the Sam’s Club website a while back, but didn’t have a chance to post it. It’s really interesting to see an EMR listed at Sam’s Club. I also find it interesting to see that they chose to market it as an EMR and not an EHR. I think this actually is a pretty smart move since I think most doctors still call it an electronic medical record or EMR. Those of us in the industry sometimes get caught up in the difference between EMR and EHR, but I think doctors don’t really care about the difference.

I still don’t think that this is much more than the opportunity for eCW and Dell to market their products. However, it is really interesting to see an attempt to commoditize the price of an EMR. As I look through the prices, I think that anyone that tries to buy this package through Sam’s Club is going to be hit by a bunch of hidden costs. Everything from the cost of travel for the eCW trainers to the upgraded hardware support from Dell. At the end of the day, I don’t think it will save doctors anything.

Turns out that the website states: “Availability of this offering is currently limited to Virginia, Illinois, and Georgia with anticipated nationwide coverage by the end of the year” I’d love to hear from someone who has taken the bait and purchased the Walmart EMR from Sam’s Club.

Turns out the fish are starting to feed. Check out this website that talks about the “EHR Stimulus Tour: Educating the Nation.” Ok, I don’t really want you to check out the website, since I think it’s kind of sad. At the bottom it lists the “EHR Stimulus Alliance.” The following companies are listed in this EHR alliance:
Allscripts
Cisco
Citrix
Dell
intel
intuit
Microsoft
Nuance

What a group of large companies trying to sell a bunch of product. I guess we should have expected something like this, but maybe I’m just a little surprised that they made a website for an EHR stimulus tour and everything. Interestingly the twitter link on the site goes to an Allscripts twitter account. I think we can clearly see who’s behind this website.

Honestly, this reminds me of an Amway or other MLM convention. Is it any wonder the type of information that will be given at this type of tour? I guess $18 billion is a lot of motivation to market your EHR software. I just wish they were stopping in Las Vegas so that I could go and check them out.

I found this article which described a number of the offerings that Dell has offered to help Healthcare IT. I’m sure this could sound a lot like a sales pitch for Dell. It’s not intended to be a sales pitch for Dell. In fact, most of the solutions are being offered through Dell partners like Symantec, VMWare, Citrix, etc. I’d caution that you should look around since you can certainly find the exact same products from other sales channels than Dell. As always, it’s best to look around when purchasing any of the products described below.

What I did find interesting was all of the various types of packages that Dell and its partners are trying to offer to healthcare IT. My big question for you, is how can we ever keep up with all these cool technologies?

The following are snippets of the article linked above. I’ll add my commentary in italics below each section.

Dell Mobile Clinical Computing Solution

Among the new offerings announced is Dell Mobile Clinical Computing Solutions. This lets physicians access patients’ records from any terminal using smart cards and Symantec’s (Nasdaq: SYMC) Workspace Corporate product for single sign-on and secure authentication.

This capability is not entirely new, however. Sun Microsystems (Nasdaq: JAVA) has offered roaming capabilities using smart cards and single sign-on access through its Sun Ray technology, both in the U.S. and worldwide, for several years now. U.S. Sun Ray customers in the healthcare field include Denver Health, which provides healthcare for a quarter of all residents of Denver, Colo.

Smart Cards are interesting to talk about and interesting to see in action, but I just personally have never been fond of trying to manage smart cards. They’re expensive and prone to be lost. Can someone else make the case for them? I’d be interested to hear it.

On-Demand Desktop Streaming

Another element of Dell’s new lineup is On-Demand Desktop Streaming. This is for stationary environments where data management and security are critical. Virtual disk images will be streamed to desktops. This enhances security because users get a new, pristine image every time they boot up.

While Dell partners with VMware (NYSE: VMW), Microsoft (Nasdaq: MSFT) and Citrix (Nasdaq: CTXS) for virtualization, it’s likely that Citrix has been picked for this solution, as it is based on streaming images to the desktop.

On demand desktop streaming is a really cool concept. I think that in the next 2 years, the thin client on the desktop will become a major reality. Of course, I think this really only applies to large scale implementations that can benefit from the savings of virtualization and thin clients. Small offices will still be buying the regular old desktops. I don’t know what Dell will do, but I see VMWare becoming the dominate player in this space and Citrix losing some of its hold.

Virtual Remote Desktop

Virtual Remote Desktop offers centralized control and management of end-user devices while enabling personalized end-user desktops, access from any device — whether within our outside the corporate firewall — and session mobility, where a single desktop session can follow the user from one device to another.

The solution was developed in collaboration with Citrix. It consists of Citrix XenServer Dell Edition; Citrix Desktop Delivery Controller; Citrix Secure Gateway; and Citrix Provisioning Server.

This sounds like the idea of taking the desktop to your mobile phone. The mobile phone is getting there now with 3G speeds. I’d like to see this work. I’m afraid it’s still not going to be as nice as using a desktop.

Dell, Perot and the Cloud

In addition to Mobile Clinical Computing, Dell is teaming up with Perot Systems to provide virtualized desktop, storage, server and electronic health records on-premise, hosted off-site or in secure private clouds.

Perot also works with other major vendors in healthcare IT, such as IBM (NYSE: IBM) , HP (NYSE: HPQ) and Sun. “We’re vendor-agnostic,” Moss said. “We work with whatever’s best for the client.”

I don’t know anything about Perot systems, but it sounds interesting. I might have to learn more. Anyone else ever used Perot systems before that can tell me what it’s like?

If you’ve been reading EMR and HIPAA for a while, back in 2006 I came across a really cool company called Sensible Vision that does facial recognition software. You can read about my first experience setting up the facial recognition software and my love affair with facial recognition as the best biometric solution.

I admit that I still have a love affair with my facial recognition software. I use it every day when I sit down at my computer. I can’t imagine not having it. In fact, it’s almost time to replace my computer and I’ll be very sad if I can’t find a way to transfer the software to my new computer. It has its quirks, but I just love the added security that it gives me. I’m far too lazy to lock my computer screen myself and then log back in, but the facial recognition software does that for me. Not to mention the single sign on capabilities.

I was on a support call yesterday with my EMR vendor and when I opened the application my facial recognition single sign on kicked in and took care of the username and password typing for me. The EMR vendor told me that he was amazed at how fast I typed. I do type fast, but not that fast.

I should mention that we haven’t been able to implement this in our clinical environment. A mix of process issues and budget issues has prevented us from doing so. However, I think there are a number of places where facial recognition software could be great for security of your desktops.

I decided to go check on what’s happening with Sensible Vision since I hadn’t spoken to them in a while. Looks like they have a million devices installed and a deal with Dell to offer facial recognition with their computers. Very cool stuff. However, what I found most interesting was Sensible Vision’s reply to the Black Hat presentation about hacking facial recognition. It’s an interesting read for those looking at biometric authentication in health care. Now I just need to find the black hat presentation they’re talking about.

I previously posted a summary of the Walmart EHR package with eCW and Dell.  Then, I followed it up with a doctor’s persctive on Walmart EHR.  At the end, I promised to follow up with a post on the Walmart EHR deal from Walmart, eCW and Dell’s perspective.

I think this was a great move by eCW, Dell and Walmart.  Honestly, what do they lose by trying this out?

Let’s not go overboard here.  I don’t see this offering completely changing the landscape of EHR.  Walmart has done that in a lot of areas, but EHR is not going to be one of them.

However, Walmart could be a good lead generator for eCW and Dell.  Dell certainly has reached a point where they have a strong brand established and scale is their friend.  They want to distribute their product through as many low cost channels as possible.  If this is successful, Dell tablets (a new offering for Dell – second generation just came out for those keeping track) will be in a lot more doctors’ offices.  If it fails, then Dell still will have gotten some PR in front of doctors saying that Dell offers tablets for doctors.  Don’t believe this is happening?  Do a quick search on google news and see all the stories about Walmart EHR.  This blog post is another example of the free PR Dell is getting from this deal.

eCW isn’t quite the brand that Dell has become, but they do have a substantial install base.  Scale really is their friend.  The more EHR software they can sale, the better for them as a company.  EHR sales is a numbers game and the more doctors they have viewing their product the more doctors they’ll have buying it.  Plus, if someone is thinking about EHR at Walmart, then that’s a high quality lead.  The leads won’t be as high quality as say advertising on EMR and HIPAA (excuse the plug), but a lead’s a lead.

Walmart really seems to have nothing to lose in this.  I guess they’re giving up floor space for the product.  I wonder what this will look like at Sam’s Club.  If anyone sees it, take a picture and send it to me so I can post it.  I’m not sure Walmart’s internal projections, but they threw out the number of 200k health care providers are members of Sam’s Club.  I’m a member of Sam’s Club as well, but I can’t remember the last time I was there.  My wife usually takes care of it.  I’m pretty sure many of these doctors are the same as me.

I do think this is a really interesting news item for Walmart.  Walmart has been doing a ton of things in regards to health care lately and so offering an EHR didn’t suprise me that much.  We have Walmart Clinics.  Free or cheap Walmart drugs.  Now we have a Walmart EHR.  Once they offer the Walmart PHR to compete with Google Health and Microsoft HealthVault, then we can really start to wonder if Walmart just has so much money they don’t know what to do with it.