I have quite a bit of history writing about the various Dell EMR offerings and also the Practice Fusion Free EMR. So, you can imagine my interest when I saw the announcement that Practice Fusion and Dell were partnering to offer a free EMR on Dell hardware.

Of course, this is kind of a no brainer for Dell. At least if they like the Practice Fusion EMR product. Dell is all about getting distribution for it’s hardware. Why not bundle that hardware with a Free EMR? As long as it doesn’t hurt Dell’s existing EMR partnerships with: Allscripts, NextGen and eCW then it seems good for Dell. Dell obviously has a big interest in healthcare IT with all these EMR partnerships along with their purchase of Perot Systems.

I did have a few questions about the Practice Fusion side which I posed to Ryan Howard, Chairman and CEO of Practice Fusion. The following are my questions and his answers:

Will Dell be marketing the Practice Fusion EMR as well, or is this mostly just a Practice Fusion tie in with Dell hardware?
Ryan: The strength of our partnership with Dell is that it is a true joint program. Both Dell and Practice Fusion are promoting the affordable EMR bundles for physicians. Dell through their 866-Dell-EMR hotline and on their Dell Healthcare website. Practice Fusion through www.practicefusion.com/dell. Both companies are dedicating marketing resources to reaching the small medical practice sector with this offer.

Why would a doctor buy the Dell products through Practice Fusion instead of just on their own? Do you offer a better discount?
Ryan: Doctors get a significant discount through Dell/Practice Fusion over the general Dell retail prices. It varies per piece of hardware, but is as much as 40% off. We directly negotiated these deals for our user community and Dell’s team tested each piece of hardware to make sure it would work well with Practice Fusion. You can see all the discounts here.

Isn’t it a little ironic that the “Free EMR” now has a link to “Apply for financing”?
Ryan: No. Although Practice Fusion’s EMR is free, doctors still often need to purchase new computers, scanners, printers, etc. Even with the Dell discounts, it can add up quickly for a small medical practice – the Dell financing deal relieves that last bit of financial pressure from the practice and gives them some flexibility on repayment.

Full Disclosure: Practice Fusion is an advertiser on this site. Although, they didn’t pay me to write this blog post or filter the questions I asked Ryan in anyway. I just love to post anytime I see Dell and EMR in the same sentence.

Once again, you can go and check out many of the tweets I did during my various activities at HIMSS on my two twitter accounts: @techguy and @ehrandhit.

The day started with the Blumenthal keynote. I can’t say that he really said anything earth shattering. It was a bit interesting to hear an overview of his perspectives. However, my favorite part of his speech was his opening story about how he got involved in healthcare IT and the time when he was a doctor and his EMR saved him from making a major medical mistake. It was really smart of him to tell a story like this. He also had some really good one liners (see my twitter accounts) that indicate his goals. So, I guess the David Blumenthal HIMSS keynote wasn’t completely meaningless.

Then, the rest of the afternoon was fantastic since I was able to spend almost the entire rest of the day roaming the floor. I had a number of interviews with vendors on the floor, but it was nice to just be able to be on the floor and learning in the booths. I think that some people don’t like it, but I really like browsing through the mayhem. I love seeing the message people are trying to send. I won’t go into all the details of people I talked to, but will be posting about them over the next couple weeks. I did get a number of videos that I think people will really enjoy.

I will just quickly mention the coolest swag I got. One place was handing out candy bars. I love chocolate so that was a big deal. Practice Fusion was fantastic since they treated me like a rock star for some reason and they gave me a cool jersey shirt. Very nicely done. I also got a $25 amazon gift certificate from Nuance thanks to seeing a tweet to go to their booth. Twitter definitely pays off.

However, the best giveaway I got was the Econo-keys completely waterproof keyboards. Yes, that’s right. You can actually clean these keyboards. The best news about this free swag is that I got a few of these keyboards to give away to readers of this site. So, watch for the video of these keyboards and an opportunity to get your own washable, flexible keyboard. They’re super cool.

Ok, enough about the swag. Sorry if you don’t like these summary posts. I’ll plan on posting more substantive posts tomorrow. For now, I’m going to bed. 15 hour days wear you out.

Many of you probably realize how much fun I have ragging on the SaaS (hosted) EMR model. I admit that I love playing devil’s advocate. I think that’s what makes me great when working with an EMR, but I digress. What people don’t realize is that I really love the SaaS EMR model and I think it’s just as viable an option as a client server EMR. I just haven’t drank the Kool-aid for either side yet.

With that background, I was excited for the chance to do an interview with one of the biggest fans of the SaaS EMR model, Practice Fusion. In fact, they’ve even taken it one step further in providing a free, ad-based EMR. The following is an email interview I did with Practice Fusion CEO, Ryan Howard.

Give us a summary of Practice Fusion for those who aren’t familiar with the company.

Practice Fusion provides a free, web-based EHR for physicians. We’re the fastest growing electronic health record community in the country, just passing the 20,000 user mark in September.  Our system includes charting, scheduling, integrations with lab networks and billing providers, eRx (in October) and unlimited support – all at no cost.

What guarantee do you provide to users that are concerned about their data being stored offsite?

Our guarantee to our physicians is that Practice Fusion provides a level of service that is dramatically higher than they could ever do on their own. From a practice’s perspective, they have access to world-class infrastructure that only a Fortune 500 company could afford. This includes data redundancy, automated back-ups, biometric security, Cisco firewalls and bank-level encryption. For a physician to build this independently would cost millions of dollars.

What about those who might be concerned that Practice Fusion might not be around forever (always a possibility) or will be acquired by another EMR vendor and they’ll be unable to get access to their EMR data to move if they wish?

A practitioner always retains ownership of their data. They can choose to export their data from our system at any time – just as we offer free uploads of data into the EMR, our team will also assist with free exports as requested. This would be true in the highly-unanticipated event of a merger or closure of our system as well.

Do you provide any mechanisms for doctors to take their data from your system and move to another EMR?

Practices using our EHR always retain ownership of their data and can export any time if needed. Just as we offer free imports of data into our system, our support team can also assist with extracting records to be transferred to a different EMR.

What do you tell doctors who are concerned about how they’ll continue seeing patients if their internet goes down?

There’s risk with both paper and electronic methods. Think about what a doctor does in his office with paper records: what happens if the offices burns down or records are stolen?

Internet connectivity is generally a concern for all internet-based models. Practice Fusion has a number of ways to circumvent this issue. While a doctor is using our EHR, data entered about the patient is constantly being saved. If the computer crashes or the internet fails, the visit is automatically saved. The physician can log back in, pick up where the session was lost and continue directly with patient.

Specific to the operations of a practice facing long-term downtime issues with their broadband company:  Practice Fusion has partnerships with various hardware providers who offer network redundancy utilities for physicians. For example, these systems can seamlessly transition to a cellular network if there is a broadband issue in the office.

How will Practice Fusion be approaching EHR certification and the billions of dollars in EHR stimulus money?

Practice Fusion is pushing toward HHS certification aggressively. Our physician team – Dr. Laffel and Dr. Rowley – has been working closely with the HIT committee and other thought-leaders throughout the past year to ensure that the final criterion for “meaningful use” reflects what is best for physicians and patients. The criteria for EHR certification are still in development but we’re certain that Practice Fusion’s system will meet the requirements. And, if something emerges that we weren’t expecting in that process, Practice Fusion’s SaaS-based platform allows us a degree of flexibility that other systems can’t match. We’re very comfortable with the certification road ahead.

What effect do you think the EHR stimulus money will have on adoption of EHR software?

It’s the silver bullet. The EHR stimulus incentives are helping to push widespread EHR adoption in a sector that has traditional been hesitant to make the switch away from paper. And, honestly, physicians were hesitant for good reason considering the expensive, bulky, IT-intensive solutions that dominated the market in the past.

Now, things are changing quickly and the market is in a frenzy. Vendor bottlenecks are already becoming an issue with the surge in demand. Traditional EHR systems with 12+ week integration schedules can’t keep up with requests. I see Practice Fusion’s five minute online set-up process, Live in Five, as a big advantage in the market as this tidal wave approaches.

Which standards are Practice Fusion adopting to provide for portability of data between Practice Fusion and other EHR vendors?

Practice Fusion’s open platform accommodates HL7, CCR and XML portability. And as one of the only true SaaS based EHR’s, we can quickly adapt our system as new portability standards emerge.

Practice Fusion will also be launching an innovative new feature called Chart Share at Health 2.0 this fall. This system allows physicians to securely share crucial patient data with other providers at no cost with no integration. It’s a major step toward collaborative care and will allow doctors who don’t have interconnected EHR technology or haven’t made the switch to an EHR to still receive and use digital records in their practice.

Describe 3 specific features which make Practice Fusion special (not including your pricing plan).

• Practice Fusion is the only EHR with a true SaaS-based model. Other vendors – such as eClinicalWorks and Allscripts – claim to be SaaS but in fact use old-school ASP technology.
• Our ‘Live in Five’ set-up process is unique in the market.  Physicians who are interested in Practice Fusion’s EHR can sign up online and start charting in five minutes. An entire practice can be set up in a single afternoon.  No risks, no consultants, no downtime – fast and simple integration is key.
• I am also proud of Practice Fusion’s advances in connectivity. Physician using our free EHR can access integrated Surescripts along with real-time Quest Diagnostics and BioReference labs within the system. And we’re constantly working on adding new integrations to this list based on our community requests. With Practice Fusion, doctors are set-up with these sophisticated integrations with no cost and no development time.

What technologies and devices do you think will be the future of EMR software?

I fundamentally believe that the only way to solve the problem of national adoption of EMRs is to accommodate physicians through a web or cloud-based platform. Once this is implemented, the benefit will be unprecedented. Central reporting and trending of patients’ chronic conditions will enable providers and caretakers to identify emerging trends and truly perform evidence-based medicine.

What is needed is a unified platform to be a conduit between patients and their doctors. There are a lot of devices – such as Continua and smart phone applications – that monitor patients’ chronic conditions. The challenge is to integrate this data in EMR’s in a meaningful way to improve the quality of care.

In my recent post about hosted EHR versus client server EHR Dr. Rowley commented on the various scenarios that could occur for sharing a patient record. The comment was so worthwhile that I wanted to make it it’s own blog post and add a few comments of my own. Here’s Dr. Rowley’s comments on data sharing scenarios with various EHR:

Whether you are an enthusiast of free, hosted, web-based EMRs, or an enthusiast of local client/server installations (or a wait-and-see skeptic), the question of data sharing is one that is important to us all.

Maybe the discussion can be best moved forward by considering a real-life scenario and examining how data sharing can occur in different situations. Let’s say that I am the Family Practitioner taking care of Mr. Chest-Hurts, who just was released from the hospital after a heart attack, and you are the cardiologist who saw him there. Mr. Chest-Hurts is in my office for post-hospital follow up, wants a referral to see you as an outpatient, had numerous tests done (which I don’t have in my records when I see him), states that you changed several of his medications on discharge and is confused as to which ones to take (and did not bring them with him for his visit). I just did some lab test and found his cholesterol to be not-quite-at-target. Let us assume that the referral is a simple administrative matter that happens anyway. What is important for patient care here is for us to share our records with each other – we need to reconcile his meds lists, you need the labs I just got, I need the cath report from the hospitalization, etc. Now let’s explore how we share data, given different scenarios:

1. Neither of us have EMRs; we both use paper charts. In this case (the traditional one in medicine), we copy and fax information to each other from our charts. We take each other’s faxes and make them permanent parts of our own separate charts.
2. I have a client/server EMR and you use paper charts. I generate a fax to you from my EMR, which you place in your paper record. You fax records to me, which I scan and import into my EMR.
3. I have Practice Fusion, and you use paper charts. Several options exist here: (a) I can generate a fax to you, like scenario #2 above; or (b) you sign in to Practice Fusion (after all, it’s free, and with “Live in Five” provisioning, you will be able to have access almost immediately). You can then print out what you might need, for inclusion into your own paper chart.
4. We each have client/server EMRs (maybe the same one, or maybe different). Like with paper, we each have separate chart records, and there is no unified patient identifier. A few options exist here: (a) we each have our systems fax out the desired records to each other, and import the data as scanned documents into our separate charts; (b) we each output a Continuity of Care Record (CCR), and somehow push it to each other. There are some efforts (like Relay Health, for example) who are trying to build an infrastructure to be an intermediary for CCRs – I push out a CCR and post it to Relay Health, and you look there and import the CCR directly into your EMR. This need to build a connection between local installs is a challenge (weakness, in my view) of local client/server systems, and will take effort and money to build. There is a lot of activity here.
5. I have Practice Fusion and you have a local client/server EMR. Several options can take place: (a) we each fax our information to each other; (b) we exchange CCRs (like #4 above); (c) I give you access to Mr. Chest-Hurts’ chart (like #3 above), so that you can see the record, and copy-and-paste between the systems if desired.
6. We each have Practice Fusion. We can share the same record on the same patient, and with the right permissions, can see each other’s notes, shared lab values, meds lists, etc. No uploading or downloading of CCRs required. No faxing needed. This is the most compelling scenario.

Pardon my long-windedness here, but my belief is that the discussion of data sharing is very important, and vital to unlocking the true potential of e-tools in improving health care in this country.

I’ll be posting my comments on these scenarios in my next entry.

I’ve recently been rather critical of Practice Fusion’s free EMR offering. I honestly don’t think that any of my feelings have changed about their offering. However, here’s a part of their press release that at least shows they’re getting some traction

Practice Fusion, the leader in free, web-based physician practice applications, announced today the addition of 1,300 medical professionals since its launch in November of 2007 and is currently serving more than a quarter million patients.

That should be a large enough sample size to get some interesting feedback about the product. The question is whether the product is really that good or whether the people at Practice Fusion are just great at marketing. Granted, marketing a free product is easier than getting people to pony up money. It will be interesting to see if their revenue model is sustainable. The problem is that a doctor’s office won’t know if it’s sustainable. I’m still not sure I put my practice on the shoulders of an unproven model. At least not yet.

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.