Practice Fusion was one of the first free, advertising supported, cloud-based EMR to enter the market and has likely been the loudest proponent of free EMR software. Although, they have some interesting Free EMR competitors like Mitochon and Kareo. Since 2007, Practice Fusion has focused on offering unfettered access to its product in exchange for physicians being willing to accept advertisements relevant to the health records they’re using and the aggregate use of the EHR data.
The company, which has raked in venture capital in buckets since its founding, now says it has 150,000 healthcare providers using its EMR and records on 60 million patients, according to a piece in The New York Times.
Now, the company has taken another step in its free-for-all model with a new service it calls Patient Fusion. Patient Fusion is a new service which allows patients using the system to schedule appointments with any participating doctor who uses the EMR. It also allows patients to rate the doctors in question and to access their records with permission. So far, 27,000 of Practice Fusion’s EMR users have signed up for the service, the Times reports.
The Times columnist covering this announcement speculates that Practice Fusion has launched its new product as a means of building up patient traffic, but I don’t see how that would work. Patients may see more of their records, but this won’t necessarily do anything to increase the number of doctor-based views the network can sell to lab companies and pharmas.
On the other hand, Patient Fusion could prove to be a powerful way of attracting and keeping doctors who want to offer easy-to-administer appointment scheduling to patients. Also, getting patients engaged with their medical records is very much in the spirit of Meaningful Use and the ONC’s priorities generally, so this new patient feature could be a beacon for doctors going through MU-motivated EMR switching this year.
Bottom line, this seems like a nifty idea. I predict that most of Practice Fusion’s EMR customers will sign up over the next year or so.
Following on the extremely successful New Media Meetups we’ve held at HIMSS, we decided to do a similar New Media Meetup at MGMA 2011. This time I decided to join up with the great people at HITECH Answers to put the meetup together. Plus, Free EHR vendor, Mitochon Systems, has graciously offered to sponsor the event along with providing the food and drinks.
In case, you’ve missed the previous New Media Meetups we’ve done, this is an event for anyone that participates in new media, is interested in new media, reads new media or just likes hanging out with a bunch of cool people. Yes, that pretty much means that everyone is welcome. Just don’t be surprised if you see people taking pictures and tweeting while at the event.
There’s no specific agenda for the event. Just great networking with interesting people. So, come enjoy some food, drinks and connect with interesting colleagues.
Here are the details for the event: When: Tuesday, Oct. 25 from 5 – 7 pm Where: Suite 2169 at Hilton Hotel (right next to Conv Ctr) RSVP:
Fill out the form embedded below so we know how many to expect:
About Mitochon Systems
Mitochon’s mEMR system is the first, free, fully certified EHR system. Mitochon uses a free, ad-supported model. Ads are displayed within the workflow of the application. The Mitochon mEMR system, designed by physicians for physicians, is intuitive and easy to install. Most customers are up and running in one day. Mitochon Systems was founded in 2006 by André Vovan, MD, MBA, FCCM, the director of a critical care department at a large California hospital. Information: 877-817-0902 or http://mitochonsystems.com/.
I came across this article on Lab Soft News (he does great work) that talked about some Ethical Questions that related to Epocrates recently launched EHR software and their existing pharmaceutical relationships. Here’s one section from the post:
Very distressing to me, however, is the clear link of the company [Epocrates], and its software, to the pharmaceutical industry. … I have also reluctantly come to the conclusion that even apparently trivial advertising connections to Big Pharma can lead to mischief. I had previously thought that inconspicuous advertisements in EMRs by drug companies might be tolerated if the companies were to bear the costs of these systems. I now believe that allowing these companies even a tangential relationship to physician-office electronic medical records is too risky.
I’ll leave the highly discussed topic of pharmaceutical influence for another post and the comments section. However, when I read this I couldn’t help but wonder why Epocrates isn’t offering a Free EHR.
If you think about most Free EHR models, one of the core revenue paths is through advertising. Let’s not kid ourselves here. When they talk advertising, they’re talking about pharmacy ads. Sure, they might sell some other ads, but the majority of the big dollars for EMR advertising is from pharmaceutical companies.
With this understanding, doesn’t that mean that Epocrates relationships with these pharmaceutical companies would be perfectly positioned to execute on the Free EHR model?
I just checked the Epocrates EHR pricing page and it has the pricing as a $359 monthly subscription per seat. It’s also interesting that they’ve chosen to integrate with Nuesoft’s PMS which will cost $200/month per seat. They also require the purchase of the Epocrates EHR Quick Start Package. Not sure the cost on that. Sounds a bit pricey to me, but that’s a topic for another post.
I keep asking myself as I’m writing this post, Epocrates is perfectly positioned to execute the Free EHR Pharma advertising model and yet for some reason they’ve chosen not to do it. Remember, Epocrates has been executing the free software for Pharma advertising for a long time. Why did they choose not to do the same model with their EHR? Do they know something we don’t know?
I don’t know the answer to these questions, but I’m sure to ask them next time I see them. Maybe they’ll be at AHIMA or MGMA.
I hate to keep bashing Silicon Valley, since I’ve come to think that it’s venture capitalists, not tied to one particular region, who are the ones not “getting” healthcare. That said, we got a bit more overblown hyperbole coming out of Northern California this morning from drchrono.
The Mountain View, Calif.-based company, which likely is correct when it says it created the first EHR that it native to the iPad—and a free one at that—announced today that it has received an new round of $650,000 in seed funding from the VC community. (Congratulations on that.) Drchrono today also introduced OnPatient, an iPad app that replaces the hated clipboard and paper form for taking patient history at the doctor’s office. Here are the details, from the drchrono press release:
drchrono Launches iPad App to Replace Paper-Based Check-In at Doctor’s Office; Closes Additional $650,000 in Seed Funding
Free OnPatient App Digitizes Patient Waiting Room and Integrates Seamlessly with Electronic Medical Records
Mountain View, CA – August 18, 2011 – drchrono, the company modernizing healthcare through a free Electronic Health Record (EHR) platform on the iPad, today announced a new patient check-in app which replaces the traditional paper check-in process in the physician waiting room. OnPatient is an app that can be downloaded to the iPad for free and integrated into a medical practice as a stand alone onboard app. The patient check-in app also seamlessly integrates with drchrono’s Meaningful Use-certified iPad EHR.
On the heels of the OnPatient product launch, drchrono recently closed an additional $650,000 in seed funding from prominent start-up investor Yuri Milner, founder of DST Global, and venture capital firm General Catalyst. This follows $675,000 in seed funding from General Catalyst, Charles River Ventures, 500 Startups and angel investors, previously announced in July.
“The OnPatient check-in app digitizes the waiting room and eliminates significant barriers to mass adoption of patient check-in technology by leveraging sophisticated iPad technology. Proprietary check-in hardware is prohibitively expensive and integration with existing EHR systems is too complex,” said Michael Nusimow, co-founder and CEO of drchrono. “We designed the OnPatient app to be intuitive for both physicians and patient users to create a better patient check-in experience.”
OnPatient is a full-featured app with customizable templates that enable physicians to eliminate paper forms and clipboards in the waiting room. There are no contracts or monthly fees; the only hardware investment is the iPad itself. Upon download, the OnPatient app allows patients to:
Complete family medical history and demographic information
Complete insurance information
Snap a profile photo
Sign the HIPAA consent form with a digital signature
The touch screen interface is user-friendly and the information auto-populates directly into the drchrono EHR platform. On subsequent visits, patients do not have to complete duplicate forms—they need only review their information and make any necessary changes on the iPad. OnPatient meets all industry security standards, ensuring the privacy and safety of patient data.
For more information on drchrono and the OnPatient app, please visit www.drchrono.com.
drchrono focuses on Apple’s iPad and cloud computing to build a better healthcare experience.
They offer a free EHR platform built on the iPad that is Meaningful Use certified. drchrono is also the first iPad EHR to implement real time clinical speech-to-text. drchrono handles everything a doctor needs to run their practice, including medical records, electronic prescribing, medical billing, and patient management. For more information, visit https://drchrono.com
The drchrono iPad EHR is 2011/2012 compliant and has been certified by InfoGard Laboratories, an ONC-ATCB, as a complete EHR in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. drchrono version 9.0 was Stage 1 certified on June 3, 2011. The ONC certification ID number is IG-2492-11-0083
What got me was the claim in the e-mail that accompanied the press release. “Today, drchrono, a hot Y Combinator start-up focused on Apple’s iPad and cloud computing to build a better healthcare experience, announced OnPatient, a groundbreaking app that digitizes the medical practice waiting room,” the message started. This was the same claim that drchrono included in a media advisory earlier in the week.
Sorry, there is nothing “groundbreaking” about software that collects medical history electronically and automatically populates an EHR with this information. Instant Medical History, a program from Primetime Medical Software, Columbia, S.C., has been doing this for years. Though it is primarily a PHR vendor, NoMoreClipboard.com‘s name betrays one of its products, a patient portal for medical practices that collects patient history online. ePatientHistory.com is similar.
No, IMH does not have a native iPad app, but it’s worked on tablets going back to the bulky Windows tablets circa 2003, even if few customers actually chose that option. NoMoreClipboard.com is Web-based, which means it’s accessible from any device with a Web browser such as, say, an iPad.
When I called the publicist on the “groundbreaking” claim, I got this back. “Of the physicians I’ve spoken to, the user-friendly interface of the iPad app really makes patient onboarding easy and they love the ‘novelty factor’ of using the iPad as well. It’s less intimidating for patients who have limited experience with healthcare IT.”
Fair enough. But that doesn’t make OnPatient “groundbreaking.” The iPad is groundbreaking. OnPatient is interesting, useful and frankly, long-overdue competition to Instant Medical History. I hope it catches on. But it’s not much of a breakthrough.
I can’t wait to see the breathless coverage from the other tech press who don’t know the, ahem, history (sorry, couldn’t resist). If you want the unvarnished, occasionally acidic truth, come here.
For that matter, here’s the company’s own message, via video:
It’s rather low-key, actually. I have just one question: Why do they say “tax breaks” for meaningful use? The money is in the form of Medicare/Medicaid bonus payments. As EMR and HIPAA readers know, those payments are considered taxable income. Just sayin’.
I’m really happy to say that @WesBates picture with me won him a 42″ HD TV and thanks in large part to those who attended the New Media Meetup I was able to beat out Dr. Kim as well. I just got the TV yesterday and it’s awesome. Thanks Practice Fusion!
It was pretty interesting wearing a Practice Fusion shirt around the HIMSS exhibit hall. Many of the people that I talked to asked about the shirt. However, I was a bit surprised that I didn’t get more people riping the Free EHR business model. Instead, it seemed like most people were familiar with it.
The 3 questions I did get asked the most about Practice Fusion was about their long term viability, how they make money offering a Free EHR, and whether a Free EHR is as good as the other EHR that you pay a lot of money to get. I asked Emily from Practice Fusion these questions and here were her responses:
1. Viability – We had 500% user growth in 2010 and doubled our team. The company has been very successful in attracting advertisers, partners (Dell, DeVry, Microsoft) and investors. We have 70,000 users serving 8 million patients today. And we bring on 300 more each day (compared to AthenaHealth brining on 600 docs in Q4). There’s a lot of strength in our numbers. Happy to answer any specific questions here.
2. How does Practice Fusion make money – Our favorite question! Practice Fusion is ad-supported, just like the radio, Gmail and EMR & HIPAA. Our discrete advertising allows the EHR to be available entirely free for any doctor in the US.
3. Quality – We were so honored when Black Book Rankings announced we were voted #1 EHR for 2011 primary care in January. Practice Fusion was up against EHRs that cost tens of thousands and still came away with the most #1 awards for categories including reliability, support, best-of-breed technology and delivery excellence. Forget “you get what you pay for” – that report proved that a free EHR could definitely be the best EHR.
To expand on all three of these: one thing that’s core to Practice Fusion is our alignment with our users. Since we’re an ad-supported product, we only succeed if doctors actually use the product. Our focus is on support, training and continuous product enhancement because of this. You saw it yourself when we completely re-did the getting started process inside the EHR over the end of the year. Keeping our users happy is fundamental to our growth. It seems simple, but surprising rare in the health IT sector.
It was fun to take pictures with so many cool people. Unfortunately, I did a poor job of keeping track of all the pictures. However, here’s a few of them that I did get to give you a flavor for the cool people I met:
EMRandHIPAA.com’s HIMSS11 coverage is sponsored by Practice Fusion, provider of the free, web-based Electronic Medical Records (EMR) system used by over 70,000 healthcare providers in the US.
I still have a hard time calling myself a writer or even press (although it’s convenient for getting into conferences). Plus, I think I reach, influence and interact with as many or more people than the traditional healthcare journalist. However, there’s something liberating about being called a blogger instead of a journalist because the standard and approach is different.
At least I thought that was the case until I read this article on Forbes.com which declares Allscripts new API as “Open Source’s Debut in Healthcare.” Ok, to be fair, it was written written on a Forbes healthcare blog and not their magazine, but as a blogger I’m embarrassed that a Forbes blogger would write such a terrible article.
Let me set the record straight. Allscripts launched an interesting API (which they call an “Application Sote & Exchange”). It’s a sort of app store for healthcare IT. This is interesting news and worthy of a story. What it’s not is open source entering healthcare.
Maybe there is some sliver of open source software that’s part of the Allscripts API/App store (or maybe not), but that’s backed by a heavy set of proprietary Allscripts software. It’s not like Allscripts has open sourced their MyWay or Allscripts Professional EHR. Then, you could really talk about Allscripts entering the open source EMR world. This is NOT!
Besides the fact of saying that is open source when it’s not, is the blogger’s headline that this is the first open source in health care. That’s just absolutely silly. Here’s just a few of the Open Source EMR on the EMR and HIPAA wiki page that have been around for quite a while and led I believe by OpenEMR and the various flavors of Open Source Vista EMR.
Honestly, Zina Moukheiber should be embarrassed by what she wrote. Even a blogger should be held to a higher standard than what she wrote. Of course, the sad part is that her mistakes likely drove a ton of traffic to the post. It’s her top post with 51 people tweeting the post and 15 people sharing it on Facebook. Too bad she lost all credibility in the process so the short term spike won’t turn into long term readers.
I was recently quoted in an article in Federal Computer Week about the VistA EHR. I think the first paragraph of the article summarizes the article quite well:
Is VistA a diva in disguise? The Veterans Affairs Department’s renowned electronic health record (EHR) software is touted as one of the premier systems in the world. But it also has a reputation as a star performer who’s difficult to manage.
My part of the article is them quoting me saying, “It is amazing how polarizing VistA can be”
A small contribution for sure, but it’s so true. If I want traffic to this site, all I have to do is rip MUMPS and they’ll come out in mass to tell me why it’s great and why it sucks. People have strong opinions both ways. The crazy thing is that both groups are probably right.
P.S. I think we’ll make next week Meaningful Use week. Hopefully time will permit. Lots to still say about it. In the meantime, you should check out my Meaningful Use posts on EMR and EHR.
In the comments of one of my open source (free) EMR posts, we started an interesting discussion about the way that you evaluate a proprietary vendor and how the same methods of evaluation aren’t always possible once you start talking about an open source EMR. To keep things simple, I’ll just focus on one part of the evaluation of an EMR vendor: Stability.
I’m not talking about whether the EMR vendor’s software product is stable. I’m talking about the stability of the company behind the EMR vendor. There are a lot of aspects to consider, but probably the most important is how successful the company is doing financially. Are they making new sells? Is the EMR vendor expanding the business or is their business contracting? Are their current customers renewing or fleeing to other software products? At the end of the day, you’re basically making a judgement on the financial viability of the company. No one wants to deal with the challenge of an EMR vendor going bankrupt, being sold, or going out of business (see my previous post about when a SaaS EMR goes out of business). So, this is a really important issue to consider. Your EMR vendor becomes your partner and you want a reliable one.
The problem is that the same analysis can’t be done on an open source EMR. There is no company behind an open source EMR (usually) and so you can’t look at the company to make a prediction on whether the open source EMR software will be around a couple years from now. Instead you have to look to other indicators.
The most important point to consider with an open source EMR is the health of the community surrounding the open source EMR. If the community is strong, then you’ll see some amazing things happen. If the community is weak, then the open source EMR will still be around in a few years, but no improvements to the software will be made. The way technology progresses means that your software must improve or it will be outdated in a couple years time.
What makes a strong open source community? It can come in a variety of ways. Here’s just a few of them:
-Number of software releases that are made
-Method for delivering software releases
-Number of people with commit privileges on the project
-Number of people contributing code to the project
-Commercial entities backing the project
-Online activity and discussion around the project
-Software downloads over time
I’m sure there’s a lot more. I hope that people like open source EMR fanatic, Fred Trotter, will add to my short list.
It’s just as important to evaluate the health of the open source EMR community as it is for you to evaluate the financial stability of a commercial EMR vendor.
A little while back I read an interesting EMR success story using the open source EMR appropriately named OpenEMR. The story is by Joe Holzer and I got his permission to republish it here for all to enjoy. You can find more about Joe on his website (not the normal website) or at his email firstname.lastname@example.org I think you’ll enjoy his story and some of the unique ways he used OpenEMR to address some challenging problems along with his passion for open source EMR software:
I have implemented OpenEMR in a number of sites, and I advise on its use in their forums at Sourceforge.net. My wife Lynne was my first “client”, and her use of FREE OpenEMR allowed her to eliminate all need for my services as her business office manager, as well as all clearinghouse costs, as it prepares both X12 and CMS 1500 directly.
Because she has a house call practice, and G3 dependability is a joke, I converted the Linux web-based OpenEMR to stand-alone on her windows tablet notebook. That works especially well with the VPN I used, since her biller is at another location entirely, but can do the billing whenever Lynne is at a hotspot without Lynne even having to be aware of it. And every night it backs itself up to our server, which is always accessible by the biller for looking at information which is no more than 24 hours old.
What Lynne gets in her practice is first and foremost the ability to eliminate all the lugging of paper records and the risk of their damage by the elements, etc., to say nothing of the nightly HIPAA backup security which paper could never afford. She uses the hotspots to connect to Allscripts for her FREE e-Rx so she can get the Medicare 2% incentive for 2009, which was simple to setup in OpenEMR both because it is open source, so can be made to do whatever the user wants for greatest efficiency and effectivity for their individual practice, and because it is designed for flexibility in configuration. In fact, the latest version, 3.1.0 just released, is the ONLY EMR system I am aware of which is operable in the native language of the user on a shared system with multiple users. So an inner-city clinic with primarily latino population, but also english speakers, need not have ALL its staff be bi-lingual. And yet it is STILL FREE.
You can see some of the support I have provided others as a volunteer at the OpenEMR forums at Sourceforge.net as ideaman911.
That ANY intelligent user would pay for a proprietary system merely makes me question their grades in economics. Checkout oemr.org for details.
The VA announced about 4-5 years ago that they would be releasing their Vista EMR as an open source package. Of course, the headline read “Government Gives Away Free EMR.” In essence, this was true. The government was making their Vista EMR available for free. In fact, I remember one of the people in HIM had an article on this subject and brought it to me when I first started working with EMR software.
I think this was a really smart move by the VA and the government and I think we’re just now starting to see some of the fruits of it being open source come to fruition. Check out this recent post about Vista on EMR and EHR. I have no doubt that the VA’s Vista EMR (err…the open source version of it) will be a player in the hospital EMR space.
The problem I have with it (and feel free to correct me if I’m wrong on this) is that Vista EMR isn’t meant for small practices like solo docs and small group practices in an ambulatory care setting. I’m not saying that it couldn’t be used that way, but it seems to me like taking a sledge hammer to a 1 penny nail. It’s overkill and is likely to cause more problems than good.
Here’s one example of a “feature” I’ve learned about the Vista EMR (and really the MUMPS database that powers it): “VistA is a multi-user system that actually can get faster with more people in the machine.”
I haven’t personally tested the statement, but it makes since why it could be the case. In fact, it’s a really cool feature for a large hospital with a large number of users accessing the same patients over and over again. Now let’s apply this to a small ambulatory practice. You only have a few people accessing a patient. Does this mean that Vista would actually be slower than other databases when you only have a small user base (ie. a small clinical practice)?
I’m not an expert on Vista (and probably never will be), but it seems to me that the marketing message for Vista should have read, “Government Gives Away Free Hospital EMR.”