July 14, 2008
When EMR Software Became Free…Or Does It Cost
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I’ve been meaning to write about a new Free EMR for a while. One of my most blogged and searched about topics is free EMR. I guess everyone loves to get something free. Why should free EMR be any different?
The problem with free EMR is that while it may be free from a financial perspective there are always other costs associated with free EMR. Here’s an example of a parts of an email I recently got about a new Free EMR. The company is called Practice Fusion and the following is excerpts from the email I received:
Today we have a press release going out (below) about Practice Fusion releasing a suite of physician applications, including Practice Management, Scheduling, Secure Email and Patient Management that are free and web-based. These are effectively ‘Google Apps’ for doctors – everything a practice needs to run their office, manage and schedule their patients, communicate with other members of the office – all web-based and at no cost.
I really liked the marketing angle that this company is taking. I personally am a devoted google apps user and I absolutely love what google apps is doing for me. Google apps is a completely free application that gives my businesses (EMR and HIPAA included) a whole bunch of business services with my very own branding. Most important of which are Email and Google documents. In return for using this free service, Google puts ads around the various services. A small price to pay for me to receive free email.
Turns out, Practice Fusion is offering a free EMR using the same model as Google Apps. My email described Practice Fusion’s free EMR revenue model as follows:
We generate revenue by embedding advertising, including pharmaceutical products, into our physician tools. We also incur revenue through the sale of anonymized patient data to research groups, pharmaceuticals, and health plans.
Basically, their planning on selling ads around people’s patient information. People are still freaking out about Gmail and Google apps placing targeted ads around their email. Why? Because in order to target the ads properly, that means Google has to search all of your “private” emails. Does this mean that Practice Fusion is going to be searching through all of your patient data?
Being completely honest, I personally don’t have much to hide and so Practice Fusion could have a hey day looking through my health information. However, I’m not sure most patients will share my same view. My guess is that most patients would feel very uncomfortable going to a doctor that is using a service like this. I think they’ll feel like their doctor was selling their information to save a buck. It might be one thing if the patient saved some money too, but that’s not going to happen.
Certainly a doctor using this free emr didn’t have to tell their patients that it was paid for by advertising and getting their information sold. However, could you imagine the backlash that would occur if they didn’t tell their patients and then someone found out. I’m honestly not sure how many doctors would want to take that risk. Sounds like the perfect 11 o’clock (it’s later in Vegas) news story to me. Lead Story: “Doctor Sells Patients Data to Save Money.”
Maybe I’m wrong and people won’t care about this or those that do care won’t find out. If that happens, then it’s hard for a doctor to argue with free. I personally haven’t looked at the feature set to know how it compares to other EMR vendors. However, there’s no arguing some of the benefits described in the email I received:
Practice Fusion offers a unique product to small and medium sized physician practices, which was developed using Adobe® Flex® 3 software for creating Rich Internet Applications (RIAs). Practice Fusion’s solutions are web-based, require no upfront costs, no extra hardware, no large software applications to install and rollout, and no backend databases, which are required by traditional vendors such as Misys and NextGen. Where enterprise solutions may take weeks or even months to implement, Practice Fusion’s services utilizes its exclusive ‘Live in Five’ process to enable physician practices to be deployed and up and running within minutes.
Web Based – Awesome! Certainly the future of almost every software application.
No Upfront Costs – Nothing to lose, but also no motivation to avoid EMR implementation failure either.
No Extra Hardware – Very nice for the doctors. Not so much for the IT support people.
No Large Software Applications to Install and Rollout - I hate managing client applications. This is a big plus.
No Backend databases – This isn’t really true since they certainly have a back end database, but the point being you don’t have to manage the backend database. A nice benefit for most doctors.
Now a word about Practice Fusion’s “exclusive ‘Live in Five’ process.” I’m certain that it is true that they can create an instance of their EMR in 5 minutes. However, don’t be misled to think that you can spend 5 minutes and have a fully functioning and fully configured EMR. It’s just not reasonable to think. It’s a nice marketing angle, but it’s just impossible.
Think about this for a second. Assuming a very small practice of 5 staff. It’s going to take you somewhere around 5 minutes just to gather the information and create the user accounts for your 5 staff members. Now add in the myriad of other configurations you’ll certainly have to do and you start to realize that your EMR won’t be setup and ready to go in 5 minutes. In fact, my experience is that the EMR configuration process is an ongoing process that never ends. Practice Fusion’s free EMR could certainly argue that setting it up is faster than setting up other traditional EMR softare, but don’t be fooled by the “Live in Five” marketing.
One final thought before I end this. Let’s go back to my current Google Apps experience. What do I do if Google changes their mind and shuts down their service? There’s not really much you can do. Google’s giving you a free service which they can terminate at any time. Luckily a number of creative IT users have found ways for people to backup their email stored on Google servers.
I finally found a link to this topic buried on the Practice Fusion website. Most of that page talks about how their more reliable than an in house system. Interesting that they didn’t address what happens when your internet goes down and you’re left up a creek without a paddle, but that’s a topic for a different post.
The thing that isn’t addressed by Practice Fusion is what happens if Practice Fusion disappears. Sure, it would be nice to think that Practice Fusion will be around forever and it’s great for them to have that confidence, but it’s just not realistic. What if Practice Fusion sells to another company? What if Practice Fusion goes under? What if the free EMR model doesn’t work and Practice Fusion decides to start charging?
It does alleviate some fear that at the bottom of the linked page Practice Fusion says “It’s your data – always.” However, we’re not talking about a bunch of linear data like email. We’re not talking about something in a standard format that can easily be exported between one software to another. We’re talking about Practice Management, Scheduling, Secure Email, Electronic Medical Record and Patient Management. How do you expect them to provide you a “copy” of this data? Would be an interesting experience to try and see what they provide and how responsive they are to the request.
I’m not trying to be overly critical of Practice Fusion. Maybe they have a great product that’s worth every penny. Wait, of course it’s worth every penny since it’s free. Sorry I couldn’t resist. My point here is that doctors should be careful when evaluating free EMR software. There are certainly benefits to a free hosted EMR solution. Just don’t be blown away by the free tag and make sure you know the challenges of free.
By the way, I hope that Practice Fusion will respond to my various assertions and comments with a response in the comments. They seem like they’re pretty tech savvy. Just the fact that they have a Practice Fusion Blog is enough for me to give them some props (even if they did use typepad and not wordpress). You can expect some future blog posts linking to their blog.
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5 responses to "When EMR Software Became Free…Or Does It Cost"
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There seem to be several concerns raised about free EMRs and potential personally-identifiable patient data leaking into the hands of marketers and vendors (e.g. pharmaceutical companies or insurance companies). Personally-identifiable health data is what is specifically protected by HIPAA – with Practice Fusion, as with any other EMR, individual personal data is protected and private. Period.
What drives Practice Fusion advertising is more on the physician side – the frequency of making prescriptions, dealing with certain diagnoses, or even the declared physician’s specialty are the elements that will target context-appropriate ads to the physician.
From the standpoint of a practicing physician, we are continuously bombarded on all sides by medical advertising – magazines, supplies, samples delivered by in-office sales reps. It is a fact of life. These sorts of ads in an EMR window is no different. Physicians have learned, through the experience of day-to-day professional life, how to judge such ads. Most are not bothered by them and willingly accept “freebies” every day, with ads and logos on them. Some physicians attempt to be “ad-free” and ban all forms of pharmaceutical ads in their offices – Practice Fusion offers an option to such physicians where they can pay a monthly subscription fee in lieu of ads, and their EMR window will thus have the ads suppressed.
Practice Fusion recognizes that physician adoption of EMRs is at a low level in this country, and helping increase e-adoption by physicians is an important element for the health of everyone. The main barriers to adoption of EMRs have been (1) cost, and (2) disruption of workflows (and therefore revenue stream) due to adopting a new system. Practice Fusion has employed a radical new business model to try to break the logjam in EMR adoption by physicians – being free (subsidized by in-product ads) is an important step in that direction. Ease of implementation is another step actively addressed by Practice Fusion. “Live in Five” signifies that a practice can self-provision and start using the product almost-immediately. Of course, training in using the feature set is encouraged, and this can be done with videos found in the product, and by no cost webinars with training staff. If a practice can export a patient demographic list from their billing software, then Practice Fusion can upload that with same-day turnaround, and the new practice will have “charts” for each patient in the practice right away.
Physicians will judge Practice Fusion vs other EMRs largely on ease-of-use of interface, and on feature set. Practice Fusion already has a robust feature set, and has a roadmap for development and release of all the features of established EMRs, so that feature-for-feature comparison will be something in Practice Fusion’s favor. Incremental roll-out of features as they are developed is the Practice Fusion approach, and is easily done by virtue of being web-based – there are new “upgrades” to install.
I’m not too worried about patient’s personal information being leaked. At least not any more than any other EMR. However, that doesn’t mean that patients won’t still feel the impression that their information is being used inappropriately.
I think it’s a great point that doctors are inundated with pharmaceutical advertising already. However, I think that there is a different feel when the ads are being shown at the specific time that a doctor is deciding which medications I should receive. Seems a bit different than a drug rep who is quickly forgotten when they leave.
I think the benefits of a hosted EMR like Practice Fusion are clear. The benefits and challenges have been discussed at length many times, so I’ll leave that to other threads. Practice Fusion has certainly used the marketing angle well in an attempt to increase EMR adoption. I hope that they are successful and that thousands of more doctors are able to successfully able to implement an EMR because of their efforts. My goal is just to help doctors be aware of potential challenges they will face when choosing a free EMR. Hopefully pointing out these challenges will help doctors to not only implement an EMR, but prevent EMR implementation failures.
Time will tell how Practice Fusion does as far as EMR features and business model. Be certain that I’ll be a most interested observer of Practice Fusion and its lofty goals.
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An important consideration when evaluating a “free” EMR is the company’s business model. I would be suspect of an advertiser-supported EMR but some companies might use limited features for free as part of their marketing strategy. For example, you can download VersaForm’s Electronic Medical Records Software for free, but you will be required to purchase a license in order to add features or to get upgrades.
I think putting the medical information in hands of someone else where the medical professional does not any control with the data of its own patients poses great deal of problem to protect the privacy of patients.
This type of information may fall into hands of pharmaceutical, insurance companies that may use it for their own interest.
I believe the solution is to have a product that is affordable and must be running within the provider premises where the provider has a full control of the patients data.
There are some software that offer full suite of medical practice and one of them is EzMedPro http://www.dsoftsystems.com. It provide mostly everything for less then $299.