Now that Walmart’s Sam’s Clubs plan to start selling electronic medical records, one has to wonder how long before Vizio gets in on the partnership and starts installing 46″ LCD monitors in exam rooms as part of the package.

What caught my eye about this news, though, was not the Walmart part, but the emr they’ve partnered with, eClinicalWorks. I’m very familiar with this Westborough, MA based company, having not only done consulting work for them in the past, but also been a customer. In fact, the one and only program icon I have ever designed is still used by eClinicalWorks; an adaptation of that icon (with a reflection I lifted from a web tutorial) is used in the badge at the center of this image.

I’m even more proud, however, of having conceived and designed the prototype of the patient-centric dashboard that the product currently uses. While the final functional iteration is not as attractive as the initial prototype, it is nevertheless a unique and useful addition to the software, and I think that the engineers who coded it are as proud of it as I am.

The folks who run eClinicalWorks are friends of mine and a fine group of very hard working individuals. I’m very excited for the potential implications of this news on the company.

I wish I had the option of using eCW as my EMR today.

Pediatrician Anne Armstrong-Coben offered a bit of editorial comment on electronic medical records in the New York Times last week. Almost all of her comments raise issues which are, I agree, areas of concern. The electronic medical record our hospital and medical school are using, while elegant in some ways, is clunky in others and the cluttered output of its notes makes it particularly susceptible to Armstrong-Coben’s hypothetical point about how difficult it is to read the note after it’s created.

Now a chart is a generic outline, screens filled with clicked boxes. Room is provided for text, but in the computer’s font, important points often get lost. I have half-joked with residents that they could type “child has no head” in the middle of a computer record — and it might be missed.

Electronic medical records are not the panacea that the federal government would have us believe, nor are they as clever or usable as computer geek doctors like me assume they should be. Further, don’t forget privacy issues; you don’t want your whole health history trusted to 2009′s state of the art version of a national electronic chart. This could make Facebook privacy concerns look trivial by comparison. And while the web is evolving sets of microformats, medical informatics is mired in a messy muck of interoperability called HL7, a set of standards that don’t seem to understand what standard even means.

Still, when I was seeing a patient for an ER follow-up this morning, I was able to review all his labs and view his CT scan reports and images in less than 60 seconds. I asked him what the ER thought was wrong with him, he wasn’t really sure, but 15 seconds later I was reviewing the ER doctor’s chart from Jan 28. I ordered a follow-up lab and the by the time the results popped into my inbox scarcely an hour later, he might not even have made it back home. Electronic medical records are far from mature or ready for unified national rollout, and they are indeed fraught with their own set of shortcomings, but don’t doubt that those cons are accompanied by a long list of pros; the benefits of computer medical charting are real.

Conclusion. Medical Informatics is mostly just out of beta, but we’re making slow progress, and our 2.0 version will arrive some day. But, in the meantime, if you request your kid’s medical records, and happen to read that he or she has no head, before you call 911 or run into the street screaming in panic, I’d go down to their bedroom and verify the presence of a noggin. More than likely, all is fine.