By Neil Versel

June 10, 2008 | WASHINGTON—In the realm of health IT, Wal-Mart Stores is aiming far beyond its participation in the Dossia personal health records (PHR) project. The Bentonville, Ark., retail behemoth seeks to become a catalyst for interoperability by paying attention to customer convenience.

Wal-Mart already has made clear its intent to open 400 in-store health clinics by 2010, up from the current 70. “These clinics are like Trojan horses,” John Agwunobi, president of Wal-Mart health and wellness business unit, said here Monday in a keynote address to the midyear Healthcare Information and Management Systems Society (HIMSS) Summit.

He said an electronic health record (EHR) not only will link all 400 clinics, it will serve as a main source of data for the Dossia PHR for Wal-Mart’s 2 million U.S. employees. “More importantly, our vision is that your electronic health record will connect electronically with your own medical home,” Agwunobi said at this small, focused meeting that is the polar opposite of the mammoth wintertime HIMSS annual conference.

According to Agwunobi, 55 percent of patients who visit Wal-Mart clinics lack health insurance. “This interaction with our clinic is how they find medical homes,” he said.

Above all, health care must engage consumers, said Agwunobi, a pediatrician who is a former assistant secretary in the Department of Health and Human Services and an admiral in the U.S. Public Health Service Commissioned Corps. “We think we can do that with the personal health record,” he said.

Wal-Mart’s goal is to provide a “robust” PHR to its U.S. workforce employees by 2010. “Our goal is also to make those 2 million associates advocates for PHRs.”

Agwunobi argued that so many people in health IT focus on one piece of technology in isolation and lose sight of larger goals. “So few people really have a clear picture of what we’re trying to get to,” he said.

He suggested that health IT professionals should understand that they are doing more than simply installing an EHR, e-prescribing, or back-office management system. “The true power is what it looks like 20 years from now, five, 10, 20 iterations later,” Agwunobi said.

And the conversation needs to include all stakeholders in health care, not just health IT insiders. “One of the barriers is that we talk amongst ourselves,” he told the HIMSS gathering. “I learned from retail that the most important person is the customer, the patient.”

Agwunobi said he knew health care had some problems, but had no idea how badly the system was broken until he took the Wal-Mart job last September and saw how efficient a major retail operation could be.

“Retail has gone through a transformation that is beginning to happen in health and health care,” Agwunobi said. For example, bar coding, which has been around for about 35 years, is pretty much the norm in retail environments. But the same technology is in limited use for tracking medications and supplies in hospitals even today.

“Success or failure is dependent upon whether you keep up with your customers or fall behind. Health care fell behind,” Agwunobi said.

“The bottom line is we think this notion of the personal health record is about the customer,” Agwunobi said, and that the customer will come to realize this. “When we give it to her, we will find that she is a better owner than we have ever been.”

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