In 2004, President Bush laid out the goal for most Americans to have electronic health records by 2014, and Wal-Mart seems intent on doing its part. Not only is the retailer rolling out e-health records to tens of thousands of its employees and their dependents in connection with Dossia, a consortium of eight large employers that includes AT&T and Intel, but it's also requiring the use of e-health record software for patients treated at the in-store clinics it's about to launch.

Wal-Mart unveiled the first of its "The Clinic At Wal-Mart" sites earlier this month in Arkansas, and it has plans for more than 400 in Atlanta, Dallas, and Little Rock by 2010, including rebranding some of the 55 or so clinics that now operate in Wal-Mart stores. As part of this push, Wal-Mart says it signed a letter of intent to work with RediClinic, which specializes in walk-in clinics, and local hospital systems to co-brand clinics in 200 Wal-Mart Supercenters. For example, Wal-Mart is partnering with St. Vincent Health System, a part of the Catholic Healthcare Initiatives system, to open four co-branded clinics in Little Rock. Wal-Mart expects to open more than 2,000 clinics nationwide by 2014.

Wal-Mart is requiring that the operators of its clinics--including RediClinic--use e-health record and practice management software from eClinicalWorks, a privately held vendor. "Wal-Mart wants to be consistent with all its clinics," says a RediClinic spokeswoman. EClinicalWorks, which posted revenue of $60 million last year, is tiny compared with health-record software vendors such as General Electric and Epic Systems. But it's playing a key role in a few high-profile regional projects, including the Massachusetts eHealth Collaborative, where hundreds of doctors in Massachusetts are using eClinicalWorks software in their practices.

To comply with American Medical Association guidelines, e-health record systems are used in almost all of the in-store health clinics in the United States. There were more than 700 of them at the end of last year and could be more than 1,500 by the end of this year, according to estimates by Mary Kate Scott, principal of health clinic consulting firm Scott & Co.

TOOLS ARE JEWELS

MinuteClinic, a subsidiary of drug store chain CVS, uses in its 485 clinics in 30-plus states a proprietary e-health record system that's complemented by third-party components for processes such as e-prescribing, drug-interaction checks, and insurance claims transmission, says MinuteClinic CIO Cris Ross. But the real jewel of MinuteClinic's e-health system, Ross says, is its decision-support tools, which guide in-store clinicians on medical industry best practices such as the steps to take if a patient's strep-throat test result is positive.

In addition to e-health record software, just about every in-store clinic relies on decision-support tools like MinuteClinic's, says consultant Scott. That's because the business model of these clinics, which is to provide consumers with a small selection of low-cost and quick health services, requires quality assurance and standards of care that are supported by tech tools like e-health records and e-checklists. "It's not possible to do this without a technology backbone," she says.

Still, by some estimates, less than 20% of U.S. doctors have deployed e-health record systems in their offices, despite the urging of health industry experts and government officials, who have been spotlighting their use in recent years in reducing medical errors and costs. Perhaps Wal-Mart's e-health record push will help set an example for doctors to follow.