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When EMR Software Became Free…Or Does It Cost

Posted on July 14, 2008 I Written By

John Lynn is the Founder of the 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 and 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 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.

Health Information and the New iPhone

Posted on July 13, 2008 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A few days ago I got the following email to my EMR and HIPAA email address. Ignore the part where the company is trying to sell their service and think about 1. Should patients be diagnosing themselves and 2. should EMR companies provide an EMR interface on the iPhone.

This Friday, July 11, the new Apple iPhone 3G becomes available to the public. The new $199 iPhone 3G will make mobile applications even more accessible to consumers and professionals. Healthcare is one of the most popular topics among consumers, and the iPhone 3G enables consumers to access many new healthcare applications including the free A.D.A.M. Symptom Navigator. According to Harris Interactive, nearly 117 million Americans have searched for health information online. Eighty-five percent of those have searched one or more times per month.

The free Symptom Navigator for the iPhone 3G helps consumers match medical symptoms with relevant assessments and appropriate treatments. Symptom Navigator empowers consumers to make the best use of the healthcare system and understand when self-care or a doctor visit is appropriate. To access the Symptom Navigator on the iPhone 3G, visit[Don’t try to go there in a regular browser]. The tool offers possible causes of the symptom and medical condition, how to self treat, when it is an emergency, when you should call a doctor, and how to prevent it in the future.

Here’s my take on the two questions I posed above:

1. Should patients be diagnosing themselves?
The application described above is a very interesting idea. It’s also true that patients are trying to self diagnose whether we like it or not. I know that when something happens to myself or my kids, I always check what’s online. However, I don’t always trust what’s online. I just take it for what it’s worth and then use that to help me communicate in a more effective way with my doctor.

This iPhone application takes patient diagnosis of problems to the next level. I’m not sure I trust an iPhone to diagnose me. As a consumer, would I really benefit from the information it offers? There’s just something really comforting about calling and talking to someone and hearing someone’s voice tell you that your child is going to be fine and not to worry about it or instructions to take them to the doctor as soon as possible to resolve whatever issue they have. I don’t think I’ll get that same satisfaction out of an iPhone health application. Most likely what I’d see happening is people would check that application and then call the nurse just the same. Something every nurse and doctor in the country loves. Patients trying to diagnose themselves.

I also wonder what’s going to happen when the iPhone application misdiagnoses a person and tells them to stay home when they should be rushed to the hospital. Can you imagine the liability this company will have if someone dies because their iPhone told them not to worry about it? Makes me wonder how this company got investment. Now, I’m sick of liability ruining innovation, but you just have to wonder when we’re talking about life and death.

I should also mention that I’m a nerd by profession. If I, being a nerd, don’t think I’d use a service like this I wonder how many less computer literate people will be interested in this application.

2. Should EMR companies provide an EMR interface on the iPhone?
The first person I ever saw with an iPhone was actually a doctor I know. I wonder if he’s ever tried to access his EMR using his iPhone. The above email made me wonder how useful would it be to have an iPhone interface for doctors to access their EMR.

Of course, there’s no arguing the portability of the iPhone and the latest iPhone’s 3G technology means that it should have the bandwidth necessary to accomplish such a task. However, the iPhone is much like Dragon Naturally Speaking (DNS). DNS can pretty much work with any EMR. However, there are deep integrations that can be done with DNS that take DNS from a pure data entry application into something much more powerful. The iPhone can pretty much work with any web based EMR that works with the safari web browser. However, without an EMR interface designed for the iPhone, a doctor won’t benefit from all of the cool user interface and touch screen features the iPhone offers. Does this mean that EMR companies should build a special iPhone interface for doctors?

This is an important question for almost every EMR company. Even client server based EMR products need to ask themselves if they should build a special web based interface for the iPhone. Just because your a client server based EMR doesn’t mean that you can’t build another interface using web based technology. The question is should you?

The answer to the question becomes rather clear when you think about what advantages a doctor receives by being able to access their EMR on an iPhone. Most doctors have NEVER accessed their EMR on their phone. Those doctors I know that have accessed their EMR on their phone fall into one of the following two camps:
1. Tired of scrolling
The first category of EMR users said that accessing their EMR on a phone was painstaking because the scrolling was a constant annoyance. I think we’re all getting spoiled with big 19″ monitors. I know I’ve connected to some of my servers using a phone and scrolling was the biggest problem for me. So much so that I never tried it again. A number of companies are working on roll up screens, but until that happens scrolling seems apart of an internet phone experience. Certainly some could argue that with the iPhone you have an easier method of scrolling. This is certainly true, but it still only slightly diminishes the pains of scrolling in my book.
2. Just meds and allergies
This group seems sensible. What if an EMR vendor offered a small subset of the EMR that was available on the iPhone (or any cellular phone for that matter). Knowing someone’s medications and allergies would be nice to have available on your phone when your visiting a hospital. Why not be able to browse your EMR’s schedule of appointments on your iPhone. Many people probably do that now, but I’m not talking about synching your phone with your calendar. I’m talking about a true real time view of your appointments for that day. Would certainly be a nice way to prevent the doctor getting upset with someone from the front desk because his calendar wasn’t up to date with what was stored in the EMR.

It’s easy to see the advantages of offering a subset of your EMR information on the phone. There’s a lot of things that are useful that won’t ever happen. Unfortunately, I think this is one of those features. At least for now, I don’t know many doctors who are asking for phone integration as part of the EMR RFP process. EMR vendors are in the business of selling EMR software. If their users aren’t demanding it, then I don’t see many EMR vendors providing it.

No, I won’t be surprised if some EMR vendor comes out with an iPhone interface. Some EMR companies could do it rather quickly because of the way their EMR is designed and they might as well enjoy a little bit of PR benefit from having an iPhone application. I’ll be excited to see what that company provides, but don’t count on many EMR vendors to follow suit. It just wouldn’t be smart business for most.

One final thought. The iPhone has been a real internet darling that has garnered lots of good press. It’s what Steve Jobs is great at doing and the iPhone is no exception. The problem is that the last time I checked, the iPhone was less than 2% of all the phones sold in the US. The incredible user interface of the iPhone can’t be argued. The problem is that software companies very rarely want to develop software for 2% of the market. Until iPhone establishes user interface standards that other companies adopt, don’t expect EMR companies to start developing software for the iPhone.