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The Risk of Free EHR Starting to Cost

Posted on May 10, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been writing about Free EHR since I first started this blog in 2005. Initially I was mostly writing about the “free” open source EHR model like I did in this Open Source in Healthcare post in 2006. I still remember when I found out about Free EHR vendor Practice Fusion and wrote this post in 2008 about Free EHR Software and Some of the Hidden Costs. I think it’s fair to say that I was a bit more skeptical of the Free EHR model then than I am now. Practice Fusion and Mitochon Systems are both Free EHR vendors that advertise on this site (Full Disclosure). So, I’ve had a chance to talk at length with both companies. I must admit that the more I talk with them, the more intrigued I am with the Free EHR model.

However, there are still challenges that are faced by the Free EHR model. This struck home quite strongly when I saw the relatively recent news about Free accounting software vendor, Outright, changing from a free model to a paid model. Funny thing is that I was really close to using Outright for my accounting, but then opted to go instead for the Free open source software Gnucash. However, this change in direction made me pause and wonder what would happen if a Free EHR vendor chose to switch from the free model to a paid model.

No doubt that any change in Free EHR business model would likely be similar to Outright where they provide a fair amount of time for users to remain on the free model. They’d also have to provide some way to get your data out of the EHR or else their paid model would not likely survive. The bad will that would be created from holding the practice’s data for “ransom” would be terrible for a company. Although, switching from a free EHR model to a paid one would be even more detrimental I think.

Of course, the EHR company could easily argue that at some point they’re faced with only a couple options: close the company or switch from the free to a paid EHR model. Faced with those options, would you rather have your EHR company go under or be able to pay them for the services you’re receiving? Although, as I’ve discussed in other Free EHR posts, just closing the company down completely wouldn’t likely be an option. Instead, the company would instead be acquired for some discounted rate by another EHR vendor. So, the real options would be to switch EHR companies since the acquiring company would likely want you to switch to their EHR or start paying for the EHR services. I think in most cases, EHR users would prefer to start paying for the EHR services. Even if deep down they’d feel like it was wrong and unfair.

As I argued in the post above, the real problem with all of this is that transferring EMR and EHR data isn’t as simple as even accounting data (like the Outright example above). Moving from one EHR to another is a pretty intense process and leaves much to be desired. Although, it’s not like Free EHR software are the only EHR companies that could go under, be bought out, be merged, etc. Everyone says that EHR company consolidation has to happen and so the transfer of data from one EMR and EHR company to another could happen for all sorts of EMR companies large (see Misys) and small.

Also, I think one other difference between the Free EHR companies and the Outright example above is that Free EHR companies aren’t just an ad only business model like Outright. For example, there’s a lot more value in aggregate healthcare data than there is in aggregate accounting data. Even anonymous healthcare data is incredibly valuable if done right. Not to mention a number of other possible business models that could be placed on top of a Free EHR offering.

As always, I’m not trying to scare people away from the Free EHR model or drive people to that model either. My point is to just bring to light all of the possibilities of what can happen if someone should choose to go with the Free EHR model. I’m sure there are even more angles to this which will be brought up in the comments. I look forward to the discussion.

I also sent an email to my contacts at Practice Fusion and Mitochon Systems saying I was going to write an article about this and asked them for a response. Here are their responses and I’m quite sure they’ll join us in the comments as well.

Practice Fusion’s response:
It’s hard to see a young company like Outright struggle with their pricing, but the truth is that being a free, web-based business is not for everyone. Practice Fusion does not succeed by being free alone. Our dedication to delivering the easiest to use product, our phenomenal support team, the support of 80,000 healthcare providers across the country, our sustainable platform – these are the elements that have made us the largest EHR community in the country. We are 100% committed to bringing free EHR technology to every doctor in the country and that will never, ever change.

Mitochon System’s response
There are two key differences between Mitochon’s free EHR model and the small software service company you cited, Outright.

First, Outright offers its services directly to individual consumers. There is no third-party payer involved and the service does not provide value-added for anyone but the individual purchaser. In contrast, healthcare is often compared to a three-legged stool: patients, providers (physicians, hospitals) and payers (health plans, employers). When a physician provides care to a patient, a third-party usually picks up all or part of the bill. Free EHRs can potentially add value for all three parties involved. Our experience has been that both payers and providers are willing to subsidize or support free EHRs through paid clinical messaging (ads, health message reminders).

Second, it appears that Outright tried the ad-supported model and it failed for them. Although the article does not state exactly why the advertisers were dissatisfied, it might be that the user demographic was poor. Perhaps the Outright users just didn’t buy enough of the advertised products.

In contrast, physicians are major purchasers of goods and services for their patients and their organizations. According to Dr. John Eisenberg, a leading medical economist, physicians’ professional fees alone represent about 20% of all health care expenditures and they are responsible for decisions that govern how 90% of each health care dollar is allocated. With annual health care expenditures in the U.S. now topping $2.5 trillion, clearly physicians are a highly desirable audience for paid messaging delivered by many different organizations.

In conclusion, we know for a fact that the free EHR model works now and we believe it will grow and expand dramatically in the future.

New Online Market Place for EMR Transcription Services

Posted on November 17, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Having this blog has given me the opportunity to talk with a number of different transcription companies over the years. I think one thing has become pretty clear. The face of transcription is certainly changing quickly, but the need for transcription is still going to be there for a long while to come. Although, it won’t be the same process of transcription as we know today. Transcription and EMR will start to come together more and more.

Many of us (including myself) were quick to use transcription cost savings as a way to justify the purchase of an EMR. What I think we’ve seen over the 5 or so years I’ve been writing about EMR is that transcription can still be a fantastic compliment to an EMR system. EMR cost justification will often have to come from some of the other EMR benefits.

With that as background, I was quite interested in a company called myMonolog that I met at the Mobile Health Expo. They’re creating an online marketplace for finding and utilizing a transcription service. I’ll admit that I’m not an expert in transcription, but I like the idea that you have a marketplace of transcription providers to choose from and you can see the ratings and reviews from other people who have used that transcription service. I also like that they have an app for Smart Phones to be able to record, send and view the transcriptions.

I’d still like to see them do some deep integrations between their system and EMR vendors, but I think it’s an interesting idea to create a marketplace for transcription services. Plus, if you choose to change transcription service providers, you can still use the same interface with a new provider. Or if your transcription company gets behind, you can just hire another transcription provider to catch you up.

myMonolog has offered Physicians, Nurses or administrators that read this site a 1 week free trial of transcription services if you use the promotion code: “emrandhipaa” when registering. If you need transcription services, try it out and let me know what you think of the service.

Selecting an EMR Vendor

Posted on August 20, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I know that sometimes people don’t like the analogy’s I make on this site. However, I just can’t help but make them. I find them instructive and there’s nothing wrong with people disagreeing with me. In fact, that’s often where I learn the most.

In the comments of a previous post, I was discussing some of the common issues with large EMR vendors (I like to call them Jabba the Hutt EMR vendors). Namely: backlog of training and setup, slow EMR support response times, HUGE up front costs for the EMR, etc etc etc. I’m sure that many of you are familiar with these subjects. For example, you pay a HUGE up front fee, get to wait 6 months to get trained on the EMR (EMR backlog?) and then once you implement your support calls take forever to get responses from the EMR vendor. Unfortunately, this is far too common.

What I don’t get is why people continue to go through this pain.

A few years back I was talking with someone about eating out at restaurants in Las Vegas. Someone was complaining about the wait times at a restaurant to get a table. Then, a long time Las Vegas resident commented that her husband and her NEVER wait for a table in Las Vegas. She then explained that there are SOOO many restaurants in Las Vegas, that if one has a wait they would just go to another one.

Obviously, the comparison to an EMR isn’t perfect, but the number of EMR choices is plentiful and you do have a choice to go with another solution. Sure, your EMR is an absolutely critical decision. You don’t want to make it lightly. However, that’s exactly why I don’t understand users that want to take a $50k-100k+ risk on an EMR software which can barely even support their implementation in the first place.

Is there EMR product really that much more compelling than the other 300+ EMR vendors?

There are plenty of low cost monthly alternatives that have exemplary support out there. The phrase “Buyer be ware” was never more true than with the purchase and selection of an EMR vendor. Don’t be swayed by great marketing and sales people. Take your time and find the right EMR and the right EMR vendor.