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eClinicalWorks Settlement Hasn’t Led To Customer Defections, Yet

Posted on August 7, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Loyalty is a funny thing. You’d think that when a vendor let you down spectacularly, you wouldn’t do business with them anymore. But the truth is, when it comes to health IT it’s not that simple. In many cases, vendor-customer relationships are more like marriages than formal agreements. Even if things start to go south, customers have so much invested in their vendor relationship that backing out may not seem like a realistic possibility.

Yes, I’m pontificating here, but not without a point. What I’m responding to here is a recent KLAS survey which found that while many customers of the now-tarnished eClinicalWorks have lost confidence in the company, many are still on board for now.

As many readers will know, in May eCW settled a whistleblower suit against the company for $155 million. The suit, which was brought by the US Department of Justice, asserted that the vendor got certified for incentive payments by putting deceptive kludges in place.

After agreeing to pay a massive penalty to the feds and putting a “Coprrporate Integrity Agreement” in place, it’s little wonder that some customers don’t trust eCW anymore. But the reality of the situation is that they’re not exactly free to jump ship either.

The study, which was reported on in HIT Consultant, found that 66% of customers polled by KLAS said their perception of eCW had moderately or significantly worsened after the settlement. Meanwhile, 34% of current eCW customers plan to look elsewhere when they make their next health IT investment.

Another third of respondents said they felt stuck in their current eCW contract, though they would consider switching vendors when the contract expires or they have more resources to invest. Still, only 4% of KLAS respondents said they were leaving specifically because of the settlement.

Meanwhile, there’s apparently a subset of eCW customers who aren’t that worried about the settlement or its implications. One-third of respondents said that it had little impact on them, and some noted that eCW is probably just the first of many vendors whose meaningful use certification will be called into question.

The reality is that while eCW customers were a bit shaken by the settlement, it didn’t exactly come as a shock that the vendor was playing it close to the edge, with one-fifth noting that the settlement was “unsurprising.”

I would tend to side with the eCW customers who predict that this settlement is the tip of the iceberg, and that it’s likely to come out that other health IT vendors were gaming the certification process. The question is whether these settlements will merely inconvenience providers or lead to serious problems of their own. If the feds ever decide that providers should have known about faked certifications, the game will get a lot more complicated.

eCW (eClinicalWorks) Settles Whistleblower Lawsuit for $155 Million

Posted on May 31, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In many of my press panels and other discussions at the Healthcare IT Marketing and PR Conference, I’ve argued that there’s very little “Breaking News” when it comes to healthcare IT. Today is an example where this is not true. The news just broke that EHR vendor, eCW (eClinicalWorks), has settled a whistleblower lawsuit against them for $155 million.

The suit was filed by Brendan Delaney, a software technician formerly employed by the New York City Division of Health Care Access and Improvement, by his law firm Phillips & Cohen LLP against eClinicalWorks. eClinicalWworks and three of its founders (Chief Executive Officer Girish Navani, Chief Medical Officer Rajesh Dharampuriya, M.D., and Chief Operating Officer Mahesh Navani) are jointly liable for the payment of $154.92 million. Separately, Developer Jagan Vaithilingam will pay $50,000, and Project Managers Bryan Sequeira, and Robert Lynes will each pay $15,000. As a whistleblower, Delaney stands to receive $30 million of the settlement.

Here’s the summary of the complaints against eCW from the Justice Department’s press release about the settlement:

In its complaint-in-intervention, the government contends that ECW falsely obtained that certification for its EHR software when it concealed from its certifying entity that its software did not comply with the requirements for certification. For example, in order to pass certification testing without meeting the certification criteria for standardized drug codes, the company modified its software by “hardcoding” only the drug codes required for testing. In other words, rather than programming the capability to retrieve any drug code from a complete database, ECW simply typed the 16 codes necessary for certification testing directly into its software. ECW’s software also did not accurately record user actions in an audit log and in certain situations did not reliably record diagnostic imaging orders or perform drug interaction checks. In addition, ECW’s software failed to satisfy data portability requirements intended to permit healthcare providers to transfer patient data from ECW’s software to the software of other vendors. As a result of these and other deficiencies in its software, ECW caused the submission of false claims for federal incentive payments based on the use of ECW’s software.

Most people are writing about how eCW didn’t fully integrate the RxNorm codes, but instead hard coded the 16 codes that the certification process used. That’s embarrassing so it’s not a surprise that so many people are sharing that part of the story. However, I think the bigger part of the violation is probably around the data portability requirements. I bet a lot of EHR vendors are sweating right now as they look at the way they implemented those requirements. Not to mention the EHR audit logs which are poor in many EHR. Plus, the scariest claim is eClinicalWork’s inability to reliably record diagnostic imagine orders or perform drug interaction checks. Those are patient safety issues and exist in many EHR software.

If you want to dig into the weeds like I did, then you can see the government complaint against eClinicalWorks that was filed May 12, 2017 and the final settlement agreement with eClinicalWorks. Even more insightful was looking at the original complaint from Delaney against eClinicalWorks. Comparing the original whistleblower complaint to the government complaint against eClinicalWorks is very interesting. You’ll see that the government didn’t grab on to everything that was originally filed by Delaney. I imagine that’s a standard legal practice to file as many areas as possible and see what the government decides to use. It seems like Phillips & Cohen have represented a number of whistleblowers so I’m sure they were expert at this.

Girish Navani, CEO and Co-Founder or eClinicalWorks, offered this statement about the settlement:

“Today’s settlement recognizes that we have addressed the issues raised, and have taken significant measures to promote compliance and transparency. We are pleased to put this matter behind us and concentrate all of our efforts on our customers and continued innovations to enhance patient care delivery.”

Looking at the bigger picture, I’m certain that every EHR vendor is going through their EHR certification process and looking at all the statements they’ve made to make sure they’re not going to be in a similar situation. Not to mention the anti-kick back laws that were mentioned in the settlement. I’m sure there are other EHR vendors that are in violation of both of these items just as much as eCW.

Former ONC National Coordinator, Farrzad Mostashari seems to agree with me. Farzad tweeted, “Wow!! I hope this changes the attitude of the EHR vendor space more broadly.” Then, he later tweeted, “Let me be plain-spoken. eClinicalWorks is not the only EHR vendor who flouted certification /misled customers
Other vendors better clean up.”

Farzad then nailed it when he tweeted “There are a LOT of doctor’s office staff looking at their EHR today and wondering if there’s $30M worth of false promises hidden there”

I do wonder if Farzad Mostashari feels a little guilty of the role he played in this process since he oversaw such a porous EHR certification process. I’ve been against EHR certification for a long time because I thought it provided so little value to providers. The fact that it can be gamed by 16 codes being hard coded is a perfect example of why EHR Certification is a waste. Although, one could argue that without EHR certification, this suit would have never happened and maybe eClinicalWorks could still be selling the same product today.

I do find this quote from the US Attorney’s Office for the District of Vermont press release a little over the top (which I think is common on these things):

“Electronic health records have the potential to improve the care provided to Medicare and Medicaid beneficiaries, but only if the information is accurate and accessible,” said Special Agent in Charge Phillip Coyne of HHS-OIG. “Those who engage in fraud that undermines the goals of EHR or puts patients at risk can expect a thorough investigation and strong remedial measures such as those in the novel and innovative Corporate Integrity Agreement in this case.”

Another topic I haven’t seen anyone else cover is the impact that this settlement will have on eCW’s customers that used eCW to attest to meaningful use. Technically it shows that eCW wasn’t appropriately certified, so that means that they weren’t using a certified EHR and therefore shouldn’t have been eligible for meaningful use incentives. I asked one friend about this and he suggested that CMS had previously said that it would not hold eligible providers and eligible hospitals responsible for EHRs that calculated the meaningful use measures the wrong way. So, we’ll probably see this same approach with eCW users that got EHR incentive money on what we now know was not appropriately certified.

I was also intrigued by the Corporate Integrity Agreement (CIA) that eClinicalWorks entered into with HHS-OIG. There are a lot of details and oversight that eCW will get from OIG, but it also required eClinicalWorks to “allow customers to obtain updated versions of their software free of charge and to give customers the option to have ECW transfer their data to another EHR software provider without penalties or service charges. [emphasis added]”

Free updates is pretty clear and ironic since not wanting to update all their clients is one possible hypothesis for why they didn’t really push the proper upgrades. Hopefully all eCW users will do it now or they might be facing their own violations for using outdated software that has known clinical issues. However, the kicker in the CIA detail above is that eClinicalWorks has to give customers the option to have eClinicalWorks transfer their data to another EHR without penalty or service charges. I wonder how many will take them up on this requirement and what the details will be. I still wish this was required of all EHR vendors, but that’s a story for another day.

How many EHR vendor marketing groups are putting together their eClinicalWorks Rescue Plan to take in the downtrodden eCW users? I’m not sure these will be as successful as other EHR switching marketing efforts like those we see when an EHR is being shut down.

I’m sorry to say that I think this is likely only the beginning of such lawsuits. In fact, it’s probably already woken up a lot of potential whistle blowers. Hopefully it’s woken up a lot of EHR vendors as well.

Integrating Telemedicine And EMRs

Posted on May 17, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Have you considered what an EMR would look and feel like if it integrated telemedicine? Rashid Bashshur, director of telemedicine at the University of Michigan Health System, has given the idea a lot of thought.

In an interview with InformationWeek Healthcare, Bashshur tells IW’s Ken Terry that it’s critical to integrate HIEs, ACOs, Meaningful Use and electronic health records.

Makes sense in theory. How would it work?

To begin with, Bashshur said, healthcare providers who have virtual encounters with patients via a telehealth set-up should create an electronic health record for that patient.  The record could then be ported over to the patient’s PHR.  The physician can also share the health record via an HIE with other providers.

When providers attempt mobile and home monitoring, it steps the complexity up a notch, as such activities generate a large flow of data. The key, in this situation, is to use the EMR to sensitively filter incoming data.

Unfortunately, few EMRs today can easily pinpoint the information providers need to process, so most organizations have nurse care managers sift through incoming monitoring data. That’s the case at University of Michigan Health System, where care managers sift data manually to determine whether patients seem to be seeing changes in their conditions.

Unfortunately, even attentive care managers can’t catch everything a properly-designed system can, Bashshur notes.  To integrate EMRs and telemedicine/remote monitoring, it will be important for EMRs to have sophisticated filters in place which can pinpoint trouble spots in a patient’s condition, using a standard protocol which is applied uniformly.

According to InformationWeek, vendor eClinicalWorks has promised a new feature which can pick out relevant data from a large data stream. But until eCW or another EMR vendor produces such a feature, it seems that remote monitoring will be labor-intensive and expensive.

Private Payers Need to Join Humana, CMS With EHR Subsidies

Posted on June 30, 2011 I Written By

Ever since the American Recovery and Reinvestment Act became law in February 2009, giving birth to the phrase “meaningful use,” I’ve wondered when private insurers would follow the federal government’s lead and start offering financial carrots and sticks for using and not using EHRs. After all, one of the purposes of the Medicare and Medicaid incentive program was to address the fact that payers tend to reap the greatest financial gains from hospitals and physicians adopting EHRs, even though most if not all of the cost of acquiring the technology falls on the provider.

Federal officials have made it clear all along that “meaningful use” is just that, the meaningful use of the technology. The government was not simply going to write checks so providers could go out and buy technology. As the country’s largest purchaser of  healthcare services, CMS wanted some value for its money (not exactly something you hear every day when it comes to government spending).

I’d been hearing for years that major commercial health insurers also were willing to share some of the savings from EHR adoption, but not until the largest payer of them all, Medicare, did so first. The private sector usually does follow Medicare’s lead when it comes to major policy shifts. Medicare now has done so, but private payers have been mostly silent. Mostly.

This month, as InformationWeek reports, Humana teamed up with Allscripts Healthcare Solutions to offer physician practices financial incentives for purchasing Allscripts EHR systems. The deal is similar to one Humana cut last year with Athenahealth. A few Blue Cross and Blue Shield plans, notably in Massachusetts and Rhode Island, have led similar programs at the state level, with eClinicalWorks the main partner.

But unless I’m forgetting something, Humana is the only big payer that has jumped into the game. Where are the UnitedHealthcares, Aetnas, Cignas and WellPoints of the world?

Payers, it’s time to make good on the lip service you gave years ago and start passing on some of the savings you will realize from Medicare, Medicaid and hundreds of thousands of providers spending billions of dollars on EHR technology and health information exchange efforts.

 

EMR Companies Holding Practice Data for “Ransom”

Posted on January 19, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

UPDATE: JamesNT sent me an update to his comments in this post. It’s interesting to see the EHR vendors’ evolution on the question of openness.

JamesNT wrote a really interesting forum post recently about how a number of EMR vendors are holding doctor’s patient information “ransom” (his word) from them. Here’s his whole description and he even names a few EMR vendors and the challenges related to getting the EMR data out of their systems:

To many EMR’s lock up the practice’s data and hold it for ransom. The data entered into an EMR belongs to the practice, not the EMR. It is not fair for EMR’s to not provide ways to interface or export data from the database. If a doctor wants to hire an IT person or developer such as myself to write custom reports or export data from the EMR, then it should be possible. Consider the following examples:

Amazing Charts: They use SQL Server 2005 Express as their database but they remove the built-in Administrator account from the SQL instance and change the SQL Server SA password. This means anyone hoping to interface or export data is at a loss – and Amazing Charts will not share the SA password. Amazing Charts also does not publish a database diagram.

eClinicalWorks: Overly complicated database. Does not publish mySQL password (you can find it, though). Does not publish database schema. If you ask them for help, they want to charge $5000 to build an interface.

PODMED (now TrakNet): Kudos for sharing the SQL Server SA password – but does not offer a published database schema.

GE Centricity: Database schema available – if you are willing to tell a bold-faced lie to someone to get it.

Medinotes: Even after sunsetting the product, Allscripts refuses to give out the ODBC driver and database password.

MD Logic: Uses a pathetic HL7 file interface. You can place only one patient demographic in each file – so if you have 200 patients to update that means sending 200 files.

Officemate: Uses SQL Server and it is easy to get to their database – but they do not offer the schema.

I find this situation deplorable. Every EMR should make it easy to get to the data and not try to hide it or charge outrageous amounts for an interface. Seriously – who here would pay $5000 to make an interface?

Of course, he’s just highlighting the EMR software he’s used. I’m sure there are hundreds more EMR vendors like this.

Then, there’s also EMR vendors that don’t hold your EMR data for ransom like Medtuity. Here’s what Matt Chase from Medtuity said about what they provide to users of their EMR:

At Medtuity, we provide open access to the SQL database. We also provide an export facility under Options. You can export each and every encounter, years and years worth if you wish, to a PDF file for each visit, neatly labeled with the date of the encounter and pt’s name to keep it from colliding with other PDF documents. You can also export a CCR for each pt.

We also have our own proprietary format in XML. For a group with a huge number of records, they may wish to hire a consultant to write a program to consume that xml into a new system. Our xml format is most complete and includes the stuff you would not usually wish to transfer (the audit trail on that chart, for example). But it is there. We also have CSV format, but let’s face it, you cannot export sophisticated data in a CSV format. It’s fine for demographics.

How “liquid” is the data in your EMR software? This discussion is a very important one between you and your EMR vendor when you’re selecting an EMR. Make it part of your EMR contract.

More EMR vendors need to voluntarily step up to the plate and provide this type of EMR data liquidity.

Dell EMR

Posted on September 10, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

Another Example Why Small EHR Companies Face Tough Challenges

Posted on May 27, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

No doubt many small EHR companies have been looking at themselves in the mirror long and hard and asking themselves how they’re going to survive this rough market. Not only did the HITECH act slow purchasing of EHR systems, but between “certified EHR” and “meaningful use” many are questioning where the small EHR vendor will fit into the EHR market.

I could (and probably will at some point) expound on each of the topics above, but I think that EHR vendors have an even more difficult challenge on their hands. The challenge comes in the form of incredibly large number of marketing dollars and splashy partnerships.

Here’s just one simple example of what I’m talking about. It was just announced that HEALTHeLINK, The Western New York Clinical Information Exchange, now has formal agreements in place with Allscripts, eClinicalWorks, McKesson, MedAppz, NextGen Healthcare Information Systems and Pulse Systems. [Hailing out of Buffalo, I’d love to meet up with the people at HEALTHeLINK sometime when I’m visiting family in the area.]

I’m not sure how much of an impact this particular partnership will have on EHR adoption in upstate New York. However, that’s not really my point. My point is that this is just one small example of a partnership that the “big boy” EHR companies are going to use to market their product. Consider that the marketing budget for these large EHR companies is quite possibly larger than some smaller EHR companies entire budgets. That’s pretty formidable.

I’m not saying that small EHR companies should close their doors and stop competing. In fact, I hope just the opposite happens. I’m all for innovation and the most innovative products usually come from small companies who have to be innovative to survive. I’m just saying that these small EHR companies better come ready to fight. It’s not going to be a pretty couple months in the EHR industry. Only the strong will survive.

Of course, all is not lost for small EHR vendors that survive. Assuming EHR implementation failure rates continue at their current dismal rates, then there will be a tremendous opportunity for a number of companies to take care of those who fail to implement unusable EHR systems.

Sam’s Club Listing for eCW and Dell EMR Package

Posted on May 8, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

Thoughts on Walmart, eCW and Dell EHR – eCW and Dell’s Perspective

Posted on March 14, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

Thoughts on Walmart, eCW and Dell EHR – A Doctor’s Perspective

Posted on March 13, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.