In the Aug 17th edition of the Wall Street Journal (WSJ), there tucked within a broader article about Wal-Mart’s strategy to launch smaller, higher-end grocery stores was a reference to Wal-Mart’s current initiative to provide basic healthcare to customers via clinics within their stores. An unnamed source in the article, purportedly close to the Wal-Mart clinic initiative, stated that within five years Wal-Mart intends to be well on its way to becoming the Numero Uno healthcare provider in America hosting up to 2000 clinics across NA.
No doubt, if successful, Wal-Mart’s healthcare clinics will have major repercussions across the industry, from small practices to neighborhood clinics and hospitals. But what is of particular interest to this analyst is what are the repercussions of such an initiative on healthcare IT (HIT)?
Assuming Wal-Mart reaches its goal of 2000 clinics nationwide, each serving an average of 10,000 patients/year we’re looking at 20 million unique patient medical records that will need to be managed in a highly distributed network of clinics, not unlike many of today’s RHIO (regional health information organization) and HIE (health information exchange), which have had a very mixed record of success to date. Could Wal-Mart lead the way as to how the effectively create and operate an HIE?
Wal-Mart will need an EMR solution to manage all those patient records effectively, efficiently and process claims. The solution need not be complex. These clinics will be focused on basic healthcare needs such as managing health history, lab data, medications, etc., but little if any need to manage more complex data such as medical images. Among the HIT vendors, I don’t foresee one of the big vendors (Cerner, Eclipsys GE/IDX, McKesson/Per-Se, Siemens, etc.) that have traditionally served the hospital market(s) winning the Wal-Mart contract. Instead, look to someone like AllScripts, Epic or even one of the newer SaaS-type providers (e.g., athenahealth) to win this one.
Wal-Mart will also want to provide customers with a portal for their personal health records (PHR) to facilitate on-line prescription refills, scheduling appointments and the like to keep those customers coming back. Right now, it is virtually impossible to pick a winner among PHR suppliers as none have truly proven themselves in the market and there still is no clear consensus on what a PHR is, what it should contain, and most importantly, what business model will it operate upon to truly scale. Could they go with WebMD, Revolution Health or even Google’s soon to be released offering? This will be something worth watching as it could substantiate one model over another and give a significant boost to the victor and those with similar offerings, thus defining the future of the PHR market.
nice analysis!!
I am wondering what the payment model will be..how will insurance companies be affected???
In the early 1990’s I oversaw such a facility, a satellite “doc in the box” health clinic of the hospital I worked at. For what it did, it worked pretty well.
There are many limitations to what can be provided in such a setting, especially during times when MD’s are not available.
If Wal Mart will take the types of everyday cases that can be resolved quickly (minor lacerations, minor burns, rash, foreign object in eye, back sprain etc. this would be a good thing. It might relieve primary care physicians from these patients, leaving more time for care of patients with much more complex problems – for example chronic problems where cognitive effort and co-ordination of care are important, and that take time. That is, assuming they can get paid fairly for the effort.
On the other hand, I would not see Wal Mart setting up clinics able to handle acute emergencies. Hopefully Wal Mart will inform the public that if you have crushing substernal chest pain radiating to your shoulder, you should not go to the town Wal Mart as your first line of defense.