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.

As promised, I wanted to share a few thoughts about the newly announced Walmart EHR package. I previously posted a nice summary of how the Walmart, eCW and Dell EHR will work. If you’ve never heard about the Walmart EHR, then go read that post and come back.

Offhand it would be really easy to criticize this move by Walmart (really Sam’s Club). I can just imagine doctors going down the aisle of Sam’s Club: toilet paper, candy bars, EHR software, oh yeah, I almost forgot the salsa. Honestly, does that sound right to anyone?

However, I’m certain that many people said the same thing about getting TVs, vacation packages and tires at Sam’s Club when they first started offering those items as well. Toilet paper, candy bars and disney vacation doesn’t sound much better.

All of this said, I still think the idea is crazy. I’m not talking about Walmart, eCW and Dell being crazy. I’m saying that any doctor’s office that chooses to buy this package at Sam’s Club is crazy. Let me explain.

I’ve often talked about your EHR becoming the life blood of your practice. Once you’ve implemented an EHR it becomes apart of almost everything you do in a clinic. I can’t think of any part of a clinical practice that isn’t affected by the implementation of an EHR. Doctors spend as much time on their EHR as they do helping patients.

Yes, I know it’s a sad reality, but it’s the reality. Other people might tell you different, but I don’t think they’re being very honest with you. Is this reason for concern? No, because you could have just as easily said that Doctors spend as much time in paper charts as they do helping patients. Why this is the case is the topic for another post. The point is that the EHR becomes the center of a practice. Still don’t believe me? Watch for a future post on the topic which will include more compelling reasons EHR’s the core of a practice.

Since EHR is the core of your practice, do you really want to get your EHR package at Walmart?

Seriously, think about that. You’re trusting your livelihood and happiness (yes, EHR affects both of those things) to a $25k package you bought at Walmart?

I’m not saying that eCW, Dell and Walmart aren’t great companies. eCW has an EMR product that’s been very successful and is an EMR that many should and would consider for their clinic. I love Dell products and recommend them to anyone. I just don’t see why you’d purchase it at Walmart instead of going directly to Dell and eCW.

Let’s just think this through. First, I’d expect that if I’m buying this EHR package through Walmart, then I’m getting a better deal than if I bought each of the items separately. This means less revenue for eCW and Dell from the start. Next, you take out whatever Walmart’s getting paid to make the sale. The question then remains, how can these companies sell their products cheaper than normal AND share the revenue with Walmart? The answer is easy. They’re going to find other ways to lower their costs.

Let’s think about ways that they can lower your costs:

First, they should have saved money trying to sale you the product.  In theory this is great.  Walmart’s taking care of the marketing and sales of the product, so that’s why the product is cheaper.  Of course, the doctors should be asking themselves if they want Walmart to be the one showing them how the Walmart EHR will work for them.  Ahh, but certainly Walmart won’t be the ones demoing the product to the doctors.  eCW will be taking care of all the demoing and “sales” of the product.  Well, there goes the money eCW was saving by using Walmart.   That basically relegates Walmart to a lead generated for eCW.

Second, eCW could enjoy economies of scale as they support more istances of EHR.  Let me translate what this means for you as a doctor: POOR Support.  Try supporting 25k physicians (number using eCW per NYTimes) spread across the country in every specialty imaginable.  It’s pretty much impossible to expect that eCW could provide personal and quality service to such a large user base.  Just think about how many people eCW would need to hire and train to be able to provide the type of support you’d like to receive if you’re a doctor implementing an EHR (eCW is hiring for those searching).  I’m pretty sure that calling them and telling them that you bought your EHR at Walmart is going to put you at the front of the support line.

EHR vendor support is so important to having a successful EHR implementation.  I’m familiar with a large eCW implementation that was having troubles getting the support they needed.  It seemed that this was probably due to the popularity of eCW.  Credit the eCW sales team for doing a good job selling the product, but if I’m a doctor I’m not throwing my ring into an EHR vendor that can’t support me because they’ve oversold.  Considering you’re buying a cheap (isn’t that Walmart’s motto?) Walmart EHR, don’t expect World Class support when you’re paying Walmart prices.

I could keep going with thoughts about this announcement.  Suffice it to say that from a doctor’s perspective I think you’d be crazy to take it.  Now, if separately you’ve made a decision to choose eCW and the Dell computers they offer and you can get it cheaper at Walmart, great.  However, what are the chances of that happening?

There’s so much more that should be said about this topic.  I’ll be following up with another post tomorrow about the Walmart EHR from an eCW and Dell perspective.  I think you’ll enjoy that post.

I probably should have also mentioned that eCW does have a strong community of users that can be leveraged for support as well.  The point of this post isn’t to lower eCW or Dell in particular.  This could have been any EHR software vendor and hardware vendor and I’d have said the same things.  And yes, I’m still very excited to try out the 2 new Dell dual touch tablets I ordered yesterday.

One final parting thought: if you buy the EHR package at Sam’s Club, does the Sam’s Club return policy apply?  Now that’s something that could change my mind.

The EHR world is abuzz with the Walmart announcement that it would be selling EHR software through their Sam’s Club division. In case you missed it, here’s the important details from the NY Times:

The company plans to team its Sam’s Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software. Wal-Mart says its package deal of hardware, software, installation, maintenance and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half.

They also make a projection of how much Walmart EHR will cost:

The Sam’s Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates.

Walmart estimates that 200,000 health care providers are among the 47 million Sam’s Club members. I also found the following quote from the same article interesting as it talks about how Walmart got into the EHR business:

Wal-Mart’s role, according to Mr. Osborne, is to put the bundle of technology into an affordable and accessible offering. “We’re the systems integrator, an aggregator,” he said.

The company’s test bed for the technology it will soon offer physicians has been its own health care clinics, staffed by third-party physicians and nurses. Started in September 2006, 30 such clinics are now in stores in eight states. The clinics use the technology Wal-Mart will offer to physicians.

“That’s where the learning came from, and they were the kernel of this idea,” Mr. Osborne said.

I’ll save my commentary on this subject for tomorrow. There’s certainly plenty to say about it.