EMRs at Sam’s Club - Watch for Hidden Costs

PACSman: I like Sam’s Club. I’ve been a member for well over a decade back when buying stuff in bulk was much more pragmatic than it is now as a single dad to two teen sons who eat out five times a week. I also like Costo and BJ’s (Wholesale Club that is- get your mind out of the gutter Ms P.). But would I buy my electronic medical records (EMR) system from them? A copy of Turbo Tax maybe, but an EMR? Ah…no…

There are limits to what most physicians can do technology-wise (with the exception of my all-knowing friend The Dalai who is both a computer guru and now plays the role of Cesar the Dog Whisperer as well) but installing an EMR probably is beyond the limits of most docs I know. Heck, just taking it out of the box and plugging it in challenges the capabilities of most docs I know.

That leads me to wonder just what is incorporated in the “on-site technical set-up”. Open up the box and plug it in? Is installation “load the DVD in the DVD player and push play?” Does training consist of a call to Billie in Bangladesh who says “Thank you for buying eClinical Works. What questions can I answer for you?” Come to think of it that sounds like many PACS company’s installation and training programs that you are given the privilege of paying 40% of system list for….but alas, I digress…

Site assessment equals “Do you have power? Cable or DSL hookup? $25K extra in your checking account? We’ll make it work!!” Integration? With what? The operating system? Whoop tee doo!! George Wallace did better with integration than they seem to do. How about integrating the system registration, billing, and financial systems? Hmmmm….

Installment payments? What a novel idea!! Rent-A-Center, Drive Time, Cort, Buddy’s and others would go in shock. Just $49.95 a week for the next 152 weeks and the EMR you could have bought for $1000.00 cash can be yours for the low, low price of just $15,584.00, tax included! Of course it’s zero interest so we can’t say we’re charging you $15,584.00 for a single $1,000.00 CD. It’s a $15,584.00 CD that is interest free for 156 months!! Momma always told me there ain’t no such thing as a free lunch, and at our house if you were hungry you generally had to make that lunch yourself too!!

Working for what you get? My God yet another novel approach!! Send me some of that Bama stimulating money please!! Our President would be so proud that we are using our healthyimagination®. God bless our Obamination and the folks over at Generous Eclectics.

Now that HHS has published the definitions on “meaningful use” will anyone find anything meaningful about it? The matrix they put out identified with these priorities:

• Improve quality, safety, efficiency, and reduce health disparities
• Engage patients and families
• Improve care coordination
• Improve population and public health
• Ensure adequate privacy and security protections for personal health information


Some of the criteria might be difficult to measure and validate, but PACS hits all of these……if you use your healthyimagination that is. So please send me my Sam’s Club coupon, Ms P. I already got my “free” cable conversion box even though my 52” flat panel 120 Mhz Sony LCD TV with 1080i, 4 HDMI ports, a 900,000:1 contrast ratio, four on the floor dual hemis and mag wheels doesn’t require it. After all Momma also told me you should never turn down anything for free…


Ms. PACS: Now that the ‘meaningful use’ definition has squeezed in imaging as “multimedia (e.g. X-rays),” it’s time to get the ball rolling – if you’ve got a roll of cash. So, how are physicians groups going to pay for the EMRs, or even large cash-strapped hospitals for that matter? Cut down on bed pans?

Here’s a more hygienic solution: You can buy an EMR at Sam’s Club! It’s true: Sam’s Club, eClinicalWorks and Dell are offering a “turnkey” electronic medical record (EMR) and practice management package for small physician practices. Dell will provide necessary hardware and site assessment, onsite technical set-up and training as well as integration of the eClinicalWorks software with the operating system, along with hardware warranty support. And it comes at the low, low price of $25,000 - for a three-provider practice - and up to $10,000 for each additional provider. What a deal – right?

But before you reach for your wallet, a PACS veteran with a Belgian accent commented to me over lunch yesterday: “You can buy an EMR in Sam’s Club. But if you try to implement it, you’re on your own.” Good point – especially if you need it to interface with all of the rest of those systems – like PACS.

While you can rely on Sam’s Club for excellent frozen wild-catch salmon, I wonder about EMRs. Here’s an alternative – pay in installments. One of the big three came up with its own EMR-finance program. They call it “Stimulus Simplicity.” Sounds a little like Obama and Philips on a date.

No, they are not dating, but GE is offering its own flavor of a stimulus package. As part of the healthymagination program: “GE’s Stimulus Simplicity program helps physician offices and hospitals that invest in GE’s electronic medical records (EMR) products, GE Centricity EMR and Centricity Enterprise solutions, maximize the potential benefits of the increased focus on EMR under President Obama’s stimulus funding bill…. GE is now offering its HITECH Warranty for Centricity EMR and Centricity Enterprise solutions and zero-interest funding with deferred payments to qualified buyers so they can have immediate access to this technology without the up-front capital costs.”

But before you take out that second mortgage, the public comment period on ‘meaningful use’ is open until Friday, June 26, and as such, we still don’t know for sure what the ‘meaningful use’ language will wind up saying in the end. So, most likely, no one will be rolling the dice on EMRs this week, at least not until they get a coupon in the mail from Sam’s Club.