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Wal-Mart Stores is striding into the market for electronic health records, seeking to bring the technology into the mainstream for physicians in small offices, where most of America's doctors practice medicine. Wal-Mart's move comes as the Obama administration is trying to jump-start the adoption of digital medical records with $19 billion of incentives in the economic stimulus package. The company plans to team its Sam's Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software. Wal-Mart says its package deal of hardware, software, installation, maintenance and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half. "We're a high-volume, low-cost company," said Marcus Osborne, senior director for health care business development at Wal-Mart. "And I would argue that mentality is sorely lacking in the health care industry." The Sam's Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates. Wal-Mart says it had explored the opportunity in health information technology long before the presidential election. About 200,000 health care providers, mostly doctors, are among Sam Club's 47 million members. And the company's research showed the technology was becoming less costly and interest was rising among small physician practices, according to Todd Matherly, vice president for health and wellness at Sam's Club. The financial incentives in the administration plan - more than $40,000 per physician over a few years, to install and use electronic health records - could accelerate adoption. When used properly, most health experts agree, digital records can curb costs and i

Don't underestimate the maddening complexity and considerable costs of digitizing health care records and processes. That was the overarching message from a dozen or so health care players, some of them doctors, following my recent column urging the industry to bring its IT practices into the 21st century. A few readers took issue with my labeling health care practitioners as "laggards." In fact, argues Dr. Daniel Essin, former director of medical informatics at Los Angeles County + USC Medical Center, "physicians are, and have always been, early adopters of technology." Essin, who's now chairman of an electronic medical records vendor, ChartWare, says many physicians have made multiple attempts to implement EMRs but failed. He cites six main reasons: * They can't articulate a set of requirements against which products can be judged. * EMR systems aren't flexible enough, requiring workarounds even before their implementation is complete. * There's a mismatch between the tasks products are expected to perform and the products' actual functionality. * Some systems are conceived as a "simple" add-on to the billing system. * System workflows consume way too much physician time and attention. * There isn't adequate integration between internal and external systems. Related to most of those obstacles is cost. One EMR kit at the entry level, offered by Wal-Mart's Sam's Club unit in partnership with Dell and eClinicalWorks, is priced at around $25,000 for the first physician and $10,000 for each additional one. After installation and training, annual maintenance and support costs are estimated at $4,000 to $6,500. That's still not chump change, especially for the smallest practices.

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Social networking phenomenon Facebook has beaten out arch-rival and former market leader MySpace by most measures of popularity, except the one that pays the bills. While Facebook has outpaced MySpace in bringing in members - it has 175 million active users at the latest count, compared with around 130 million for MySpace - it has struggled make money from them. While MySpace is closing in on $1 billion in revenues, Facebook generated less than $300 million in sales last year, reports say. Indeed, Facebook's efforts to drum up revenue have led to it repeatedly becoming the target of some of the biggest online privacy protests on the Web. Its most recent fight earlier this month followed Facebook's attempt to redefine its own rules and assert ownership over anything its members posted on the site. The company has since backed off and is rethinking its policies. Why hasn't Facebook benefited from the vaunted "network effect" that makes such services more valuable the more its adds members and connections between them? After all, Facebook is spreading quickly in nearly 100 languages, while MySpace has focused on the United States and five other markets where Web advertising flourishes. The answer may lie in the origins of the five-year-old site started by then Harvard University student Mark Zuckerberg. Its appeal at the outset was that it was a place where users could share tidbits of their personal lives with selected friends and acquaintances. This blurred the distinction between a private space and a public one. MySpace is more explicitly a public place where friends hang out in the equivalent of a cafe or a club and the aim is often to meet new people. Most of all, MySpace is a place to share music with other fans.

One of the nation's largest time-share companies is going to be shelling out nearly a $1 million for making phone calls to people on the national "Do Not Call" list, federal regulators said Tuesday. Westgate Resorts, based in Orlando, Fla., was named in a complaint filed on behalf of the Federal Trade Commission. The agency alleged that Westgate and two other companies placed thousands of telemarketing calls to people on the list. The FTC says Westgate has agreed to pay $900,000 to settle the charges. The commission on Tuesday also announced a $275,000 settlement with another Florida-based travel company, Accumen Management Services Inc., and its subsidiary, All in One Vacation Club, LLC. The company made telemarketing calls to consumers who had filled out entry forms for a sweepstakes to win vacation packages. Many of those called, the FTC said, were on the Do Not Call registry and did not agree to receive the telemarketing pitches for timeshares and vacation getaways. In the case of Westgate, the agency received several thousand complaints from consumers. The commission said Westgate bought phone numbers from an Internet-based lead generator that collected contact information in connection with offerings on its Brandarama.com web site. The two other companies named in the Westgate complaint are: Central Florida Investments Inc., and CFI Sales and Marketing, LLC., which both did telemarketing for Westgate. The combined fines of $1.17 million will go to the U.S. Treasury. Calls to Westgate and Accumen seeking comment were not immediately returned. The latest enforcement actions bring to 40 the number of Do Not Call cases the government has filed against companies since the registry began in June 2003. The biggest case to date involved satellite television provider DirecTV Inc., which paid a $5.3 million settlement. More than 167 million phone numbers have been placed on the Do Not Call registry.