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A Practice Fusion IPO?

Posted on August 20, 2015 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 just did a search on this blog and I found that I’ve mentioned the name Practice Fusion in 88 different posts over the years. Needless to say, Practice Fusion has been one of the most interesting EHR vendor stories out there. I’ve seen it first hand since they started advertising on EMR and HIPAA very early on in their life. I was even on stage talking about meaningful use at the first Practice Fusion user conference. We didn’t know very much about meaningful use at the time, but we put on a good show and shared what we knew at the time.

In the early days, many EHR vendors were really scared by Practice Fusion. Offering a Free EHR is a drastic thing to do and absolutely shook up the EHR industry. Much like Dell did in the PC market (and probably some others), Practice Fusion’s low price forced most other EHR vendors to lower their prices in order to compete. I saw the drop in price first hand as EHR after EHR dropped their price. At the same time as these price drops, EHR vendors were shifting from these massive front loaded EHR purchases to monthly price models that could compete with SaaS EHR pricing. The mix of pricing model changes and competition with a Free EHR was great for the industry.

With this as background, I definitely am intrigued by the news that Ryan Howard has been replaced as CEO of Practice Fusion. Tom Langan, Practice Fusion’s Chief Commercial Officer has taken the helm as interim CEO. The article I linked to above suggested that this and other personnel changes point to Practice Fusion possibly preparing for an IPO. In fact, they’ve had so many personnel changes over the years, most of the people I’ve gotten to know have left.

I’m not sure if Practice Fusion is preparing for an IPO or not, but I wouldn’t be surprised if they’re running out of money. Yes, it’s crazy to think that they could be running out of money after raising $70 million about 2 years ago along with $15 million more a few months later. CrunchBase has their funding to date at $157.5 million. However, I’m sure they have a high burn rate. Their leadership and investors have set ambitious goals for Practice Fusion to own the healthcare market (A goal which I’ve said is impossible. The EHR market will be heterogeneous!). I’m sure their spending habits match those ambitious goals. An IPO would be one way to fund that continued ambition. If they did do an IPO, we’d get some really interesting insights into their business model.

There’s some mystery surrounding how Practice Fusion makes money. I think you can summarize their income streams into three categories: advertising, data, and third party apps. Most people glob onto the first piece, but from what I understand it’s far from being their largest source of revenue. In fact, I wouldn’t be surprised if it was their smallest. The second piece is quite interesting. I once heard someone say that Practice Fusion made their money from selling health data, but then they were corrected by someone saying that Practice Fusion doesn’t sell data. Instead, Practice Fusion sells the insights from that data. A subtle difference, but an important one. The question remains, how valuable are insights from EHR data? Many other EHR vendors sell their EHR data. Is it just a matter of time until Practice Fusion does too? Will they be forced to in order to meet revenue goals?

The last piece of revenue is the one that most people ignore. However, it probably is the largest piece of the revenue pie. My guess is that their practice management system vendor partners are one of the most significant portions of their third party revenue. Practice Fusion doesn’t have their own PM and so they refer their users to an outside PM vendor. When they do so, Practice Fusion gets a cut. I’m sure this is not an insignificant number. It’s not hard to imagine Practice Fusion doing something similar with a whole marketplace of third party offerings that tie into their Free EHR.

Over the years, I’ve talked to a lot of investors and potential investors about Practice Fusion. I’ve always told them that Practice Fusion has definitely created value. They’ve done a good job leveraging the Free EHR to bring doctors in. What’s not as clear to me is whether they’ve created enough value to justify the $157.5 million they’ve raised. If they really are preparing for an IPO, then I guess we’ll find out soon. The revenue numbers that come out during the IPO process and how the street reacts to those numbers would be fun to watch. Yes, I know. I am an #HITNerd.

Mitochon Shuts Down Free EHR Service

Posted on May 20, 2013 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.

The news just came out the Mitochon is shutting down their Free EHR service. They aren’t closing as a company (more details below), but they will no longer be offering EHR software. Here’s the full shutdown message:

Effective mid June 2013, Mitochon intends to exit the EHR market and cease our physician service.

We are sensitive that our providers’ medical practices will be affected by this. However this difficult decision has been driven by the need to focus on other lines of business, and the increasing liabilities we are incurring while supporting our free EHR service.

We will keep our active subscribers updated in the coming days as to how we will address the important issue of clinical data retrieval as well as possible alternate systems and solutions we are in discussion with.

It is with a heavy heart that we are existing the EHR market. The Mitochon team appreciates the support all of our clients have shown to us over the past few years and will work diligently to ensure this transition will be as smooth as possible for their practices.

Best Regards,
Dr. Andre Vovan & Mr. Chris Riley

Mitochon has been a great supporter of EMR and HIPAA over the years, and so I’m sorry that Dr. Vovan won’t be able to see his vision come to fruition with the Mitochon EHR. He was one of the first people I met who was talking about a community based approach to caring for patients. It’s interesting to see many of the topics he told me years ago are being talked about so much now in the world of ACOs.

As for the Mitochon EHR software, I won’t be surprised if some other players in the EHR space decide to take over the code and EHR business from Mitochon. There are actually a number of companies that have been white labeling the Mitochon EHR and it won’t surprise me if one of those companies takes over the codebase and users.

What’s likely more interesting is where Mitochon plans to take the company. Ever since I first met Mitochon years ago, their goal had been to build their own ad network and supply other third party networks. Now their focus will be exclusively on their content delivery and advertising network business. As Chris Riley, CEO, mentioned to me in an email, being in the EMR business and trying to partner with EMR vendors can often be a big issue.

Mitochon has some patents around CPT and ICD level targeting of ads. So, it will be interesting to see if Mitochon can become the pharma ad network for EMR companies. Although, there are a lot of non EMR opportunities for Pharma advertising as well. It will be interesting to see where Mitochon takes the company going forward.

Practice Fusion EMR Brings Patients Into The Picture

Posted on April 22, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

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.

An Interview with Mitochon About Their Recently Launched EMO (Electronic Medical Office)

Posted on February 27, 2013 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.

The following is an interview with Mitochon about their newly launched EMO (Electronic medical Office) and a discussion of some of the various trends happening in healthcare IT like: ACOs, Meaningful Use, and HIEs.

Q: Tell us about your recently launched EMO (Electronic Medical Office) product.

A: Our Electronic Medical Office product is a complete end-to-end solution for the modern day medical practice. Allowing the practice to accomplish all their daily task in one solution. One application, one vendor, one solution….. EMO.

Q: When did you start thinking about a suite of applications beyond just EHR?

A: We have seen for years the issues the practice has had to endure when dealing with multiple vendors, products and interfaces. The finger pointing and passing the buck when many different vendors are involved. Its the old right hand left hand issue. Just over two years ago as a team we knew we had to step forward and develop an end-to-end solution and give the practice the continuity and consistency of dealing with one vendor and one solution to take care of all the practice needs from the Patient accessing their medical records and financial data from their own PC to the tracking of insurance claims and collections.

Q: Will EMO (Electronic Medical Office) be free like your past Free EHR offering?

A: Yes EMO will be a FREE offering. In addition to our FREE EMO we are offering a plus package, with EMO+ you get all the features of EMO and back office Revenue Cycle Management. With EMO plus the practice pays only 2.85% of their monthly collections and we handle all the billing and collections from a back office perspective.

Q: In this world of EHR consolidation, EHR’s closing down, etc, why should a doctor feel comfortable choosing Mitochon?

A: We started Mitochon with the belief that Health IT services are too expensive and too complex! We wanted to take away the cost barrier that many independent physicians couldn’t previously overcome, enabling them to provide better patient care while qualifying for Meaningful Use incentives. Our advertising business model is proven, sustainable and successful and is a similar model that works for TV, radio, newspaper and the web. We’re here to stay!

The Mitochon application is used in other markets on a paid basis. We are saddened by the fact that companies still pay to use systems that were closed down such as Kareo and Epocrates recent announcement, they are late and trying to resurrect a system that was closed down. We understand other free vendors have over spent on promotion and the day of reckoning is coming closer, we gain 30% of our new users from other free systems that offer poor support, when the investors get sick of running a business with scant regard to profits they will go the way of MySpace, remember them?

Q: Do you think that most of the doctors using your EHR will becoming “meaningful users”?

A: The question should really be if the physicians believe the meaningful useage criteria, as defined, really add to their patient care or do they see it more of a hassle or prying eyes of payers. The vast majority of our users have achieved Meaningful Use. We are a conservative company owned by physicians, we build a real base of users, no hype. We believe we likely have the highest percentage of users achieve MU versus any other EHR.

Q: The claims clearinghouse is a new Mitochon feature. Tell us more about that part of the product.

A: EMO would not be an end-to-end solution if we did not include medical claims clearing. There are no gimmicks or gotchya’s with our clearinghouse. The sending of medical claims as well as status updates of those claims is FREE as well! We are redefining the end the end solution

Q: What other applications aren’t part of EMO (Electronic Medical Office) that you’ll look at incorporating in the future?

A: We have appointment reminders, Statement printing, fully integrated credit card processing that is linked to a users account. We have the in built HIE that allows Physician to Physician referral as well as the soon to be launched Patient Health Record. As the market demands we will continue to add features and functionality. In office dispensing solutions can bring Physicians significant revenue, up to $7,000 per month profit depending on sub-speciality. We are also working to bring an integrated sample closet so physicians can add further value to their patient interaction. Also remember we also have free mobile access to our EHR.

Q: How do you think what you’re doing fits in with other trends like ACOs (Accountable Care Organizations)?

A: In an ACO the goal is population management, better outcomes with lower cost. As such you have to manage the 30% of chronically ill patients who are utilizing 60-70% of the health care dollars. To do so, every provider needs to be engaged, integrated and connected. So our free solution has a role to complement the other solutions so that an ACO can gather information from all their providers. The risk is very high for an ACO that has a leaky infrastructure because the management of risk will be exposed and the cost curve will not be bending, hence no savings will be generated. Our EMO solution is created for instant collaboration and coordination because of the built in HIE function. In our network physicians who care for the same patients instantly are connected and can share medication list, problem list, labs, radiology and progress notes without the additional cost of integrating. We have contracts with 3 ACO’s.

Q: What’s your take on mobile adoption by doctors, particularly when it comes to products like EHR?

A: Mobile phones are ubiquitous in the medical community. We see Physicians and Nurse Practitioners adopting our mobile solution. It is unlikely they will undertake a full clinical interaction on an iPhone but they do use our native iPad App. The key here is it is a tool for the Doc on the run. The office based PC will always be the tool of choice in the foreseeable future, many have just purchased them recently!

Q: What’s something that doctors aren’t paying enough attention to right now?

A: Connectivity. They have just paid for a stand alone EHR, now they need to coordinate care with other providers/hospitals/labs etc. These other entities are cherry picking and paying certain providers who have enough volume or contribution to the hospital or system. It is a cost that may be just as expensive as the EHR in the long term for the physician. This is a crucial part of the solution and why we have an inbuilt HIE functionality allowing physicians to immediately refer patients across our system. This is particularly attractive to the ACO market.

Also, the meaningful use subsidy will end in a few years, if a provider is using an expensive system, how will that affect the ability for the provider to sell their practice to a new physician who is already in debt from med school. We have many fat cat EHR vendors just milking the Physician who they see as an equal opportunity victim. How many EHR’s are showing 60% revenue growth since 2009? This will come to a end soon and the physician will be leveraged again unless they are using a system with an alternate revenue model. Thats where our Mitochon Patent comes in, introducing contextual clinical content into the workflow and subsidize the Physician’s cost.

Full Disclosure: Mitochon is an advertiser on EMR and HIPAA.

Some Inside Baseball for the EHR World

Posted on February 22, 2013 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 thought I’d take this moment to take a quick look at what many might consider inside baseball when it comes to the EHR world. Although, I’ve been intrigued by a couple announcements that were made recently.

The first announcement is Kareo buying the Epocrates EHR which came just in time for HIMSS. You might remember that I covered the Epocrates EHR on a number of occasions. I first saw the Epocrates EHR at HIMSS in 2010, and subsequently wrote about Epocrates “killing” their EHR immediately after launch. When that happened, I think we all wondered what would happen with the Epocrates EHR code base. You don’t just throw a meaningful use certified EHR to the curb do you?

We now know the answer to that question is no. Kareo saw fit to acquire the Epocrates EHR software and Dr. Tom Giannulli, formerly of Epocrates, is now the Kareo CMIO. I can imagine that Dr. Giannulli wanted to stay with his baby (the Epocrates EHR). I’m also quite intrigued that Kareo is offering the EHR for free (at least for now?). The funny thing is that I had written that the Epocrates EHR should be free. I guess I was sort of right, but I definitely didn’t think that the Epocrates EHR would become free since Kareo makes their money from the Practice Management and billing side of the house. We’ll see how that strategy works for Kareo. In some ways it’s taking a page out of the AthenaHealth playbook.

What might be simply an odd coincidence of timing (or not), Practice Fusion just sent out a letter (shown below) to its users from Practice Fusion Founder and CEO, Ryan Howard. In it he acknowledges Practice Fusion’s past challenges with billing, and he outlines their strategy on making the Practice Fusion billing situation better.

Does this relate to Kareo? Maybe, maybe not. What I do know is that many Practice Fusion users are on Kareo as well since it was Practice Fusion’s only major Practice Management software partner when Practice Fusion started. It seemed like a great match since Practice Fusion only had EHR, and Kareo only had Practice Management. Kareo now has an EHR, and Practice Fusion is working on billing and practice management. I guess we should have seen this coming.

Here’s the full email I got from Practice Fusion (Full Disclosure: They said Dr. Lynn, but I’m not a doctor.):

Hi Dr. Lynn,

The Practice Fusion team takes pride and appreciates your role in making us the fastest growing EHR community in the US.

We also recognize that billing has not been our strongest suit. Improved superbills and an updated payer list have been highly requested by our user community.

That’s why, by the end of March, we’re going to deliver you major new enhancements to your billing experience:

• A comprehensive, streamlined superbill, directly integrated with your workflow
• Flexible reports for billing users
• The ability to export billing data to most major billing systems
• New billing software and service partners with more economical pricing

This means you can stick with the exact billing workflow and system you use today in your practice. We’re building the ability to integrate directly by allowing you to export data to your billing system via HL7. If you prefer superbills, you’ll soon have a drastically improved superbill to work with. And if you’re looking for a new billing system altogether, we’ll also have new, low-cost partners coming soon.

We’re excited to be making your EHR faster, more flexible and easier-to-use. Lastly, our commitment to you has not changed since the day you signed on—Practice Fusion will deliver all this for free. Stay tuned for our billing revamp at the end of March!

Ryan Howard
Founder and CEO
Practice Fusion

New Open Source (Free) EHR Offering Developed by A Doctor

Posted on October 25, 2012 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.

In a recent comment, a physician told me they were developing their own open source EHR called New Open Source Health (or NOSH) ChartingSystem. As a huge fan of open source and also since I consider myself a Physician advocate, I had to learn more about what this doctor was doing. The following is an interview with Michael Chen, MD who is developing this new open source EHR.

Tell us a little about yourself and your open source EHR software.

Briefly, I’m a board-certified family physician and I spent 9 years as
a solo practitioner in a low-overhead, micropractice model where it is
just me without any additional ancillary staff. I was not able to
make this possible without the maximum use of technology to help me.
That is why having a robust EHR system was vital for my practice from
the beginning.

I began development of my own open source EHR software in 2009 in
response to the changes in the EHR landscape following the 2009 HITECH
Act and the pending changes to Medicare reimbursement that would
directly affect my practice.

My open source EHR software is called the New Open Source Health (or
NOSH) ChartingSystem. It is a web-based EHR where the user interfaces
the program through any web-browser that is connected to the network
where the NOSH ChartingSystem is installed. It is a based off a MySQL
database and programmed using PHP, HTML5, and Javascript. Many of the
components are based off of other open-source code (the PHP framework,
Javascript framework and plug-ins) It is meant to be run on an Apache
web server.

Why did you choose to develop your own open source EHR software instead of going with the other open source EHR out there?

I initially started work on contributing to the OpenEMR open-source
EHR that has been in development since the late 1990’s. However, over
time, I became disillusioned with the underlying project and the fact
that no matter how I wanted to improve the user interface (which was
my ultimate criticism of the project, even though the rest of the
project was exemplary), it required that I entirely “redo” the whole
system – you can’t fix a user interface as a piecemeal project. I
began to understand that the user interface (like the adage that form
follows function) really starts from the fundamental core of how the
system is developed. OpenEMR, like the other EHRs that I have used,
is designed with the hospital administrator and biller in mind and the
physician interface was a mere afterthought.

My other job before I embarked on my EHR project, besides being a solo
physician, was a medical director of a child abuse assessment center.
Part of my job is to review chart notes from other physicians in the
community and I can tell you that the ones that used EHRs were very
difficult to read at a glance. Even though the information appeared
complete, it was difficult to sort out all the “useless” information
that was contained in the record and to get to the core of clinically
relevant information. That really speaks to where the focus of EHRs
are designed. It really was not for the physician in mind.

After my frustration, I decided to expend my energy more wisely in
starting a new project from scratch as it was already envisioned in my
own practice and in my experience as a physician how a electronic
health record should be.

How far along are you in the development of your EHR software?

It is fully developed for real-world use right now. The Ubuntu
installer and source code has been available to be downloaded and
installed since October 15, 2012. Of course, with all projects, there
are new features, updates, and specific modifications that are a part
of the project life cycle.

Do you think that an open source EHR software can keep up with the well funded EHR vendors out there? Will your EHR software be able to keep up with the changing EHR landscape?

I think there is one specific challenge that will determine if an open
source project can keep up with the well funded EHRs. That challenge,
of course, is the financial means to maintain a project. There is a
second challenge that I’ll go over in more detail regarding your
question about certification.

Regarding the financial component, this project for me started out as
a pro-bono thing for me, with the aim that I could practice medicine
the way I want. I didn’t initially envision that I would release it
for others, but after I spoke to a few other physician colleagues and
saw my project, they were in awe with the simplicity and
user-friendliness of the system and wished they could use an EHR like
mine…of course, they were working in larger organizations that
already have an EHR implemented already. However, as I re-looked at
the landscape of physicians who were satisfied with their EHR system
since the meaningful use incentives began (after I came out of my
developer’s “hole” for a couple of years), I realized that there was a
“great divide” among physicians and the health IT community. If you
look at the Sermo forums and even talking to physicians one-on-one,
many are not happy with the EHR systems they are using. Most feel
that the EHR’s they used affected their workflow negatively and they
have to recoup their cost and efficiency in other ways, all in trying
to not affect patient care, which is very stressful. Most doctors
are angry that this is somehow being “forced” on them and they have no
choice but to comply. This leaves many of my colleagues
disillusioned, not just in the EHR realm, but for the whole profession
as well. Many keep asking (most without any answers, unfortunately),
“why can’t Steve Jobs build an EHR for them”? The key part of that
question, to me, is “for them”. That has been the missing piece that
no amount of incentives can rectify. The process of incentiviation
for lackluster products to doctors is going to lead to a dissolution
of the profession (especially those in primary care) and throwing out
the talent that is out there who really want to make a difference in
healthcare…unfortunately, it is already happening.

One thing that a vibrant, community-supported open source project can
do (that is a significant advantage compared to other EHR products) is
that the open source EHR can be continuously improved upon and adapted
to the needs of physicians, not just now, but in the future. There
are many examples of open source projects that have really done well
over the life-span of the project (Linux and its distributions, but
also Firefox, Android, Drupal and Puppet). I hope and envision NOSH
ChartingSystem to head in the same trajectory with the community
support coming from medical providers and developers alike.

The best open source software projects involve a community of developers and users. How far along are you in building the Nosh EHR community?

Since I just released my project in October, 2012; building my
community is at its infancy stage right now. I hope that having
medical professionals actually try out my project, know that it is
“real” and that they too can be a part of a movement and a project
that will work for them, will continue to build that community.

I’m also planning on working with individuals who are in the forefront
of health care reform to see where this project can go and how it can
work towards those goals. I feel that the EHR, if implemented with
the medical provider in mind, can transform health care in subtle, but
also profound ways, with physicians in the driver’s seat instead of in
the back seat.

Does the trend of hospitals acquiring physician practices concern you since there will be fewer doctors who can use your products? Or do you plan to scale your open source EHR for acute care?

Yes, the trend that there are few and fewer smaller or physician owned
practices does limit my project potential, but on the flip-side, I see
this as a possible way that my EHR can impact health care reform in a
bigger way, if the community support grows significantly and
physicians have voice again.

My focus right now is to make sure EHRs are accessible to the doctors
least able to afford them, even with incentives programs out there.
Those would be the smaller and solo-practice doctors, likely in the
primary care sector and also those in the rural setting, or any
physician or clinic that does not have the means to afford one. That
was why I ended up making my own EHR…because I couldn’t afford the
one I used to have since certification was “needed” for meaningful use
incentives, and even thought I met all the meaningful use criteria
with my older system and my own “modifications”, I would not have been
able to get reimbursement because my system was not “certified”.

I am betting that if a physician sees a truly user-friendly EHR, it
doesn’t need to take incentives for them to jump on board. Because I
feel that most physicians are already ready to jump on board…there
just isn’t something for them to jump on board to that they feel good

One key point, and one that physicians who have implemented an EHR or
thinking about implementing an EHR have noticed, is that the EHR is
not just a product…it’s creating a level of service to make sure a
transition to the EHR is as minimally disruptive as possible to their
practice. It’s not realistic to assume that any switch will not
impact, but I think most physicians have been given a false hope that
with one EHR product is claimed to be overly superior to another that
it would not cause those impacts. I think that too many physicians,
hospital systems, and statewide health systems have been “burned” by
the process and so I’m focusing on offering this EHR project (which
does not cost anything to use and that one can modify it to their
heart’s content without penalty) alongside with consultation services
(which would be my source of revenue) to best incorporate my system to
their practice. EHR implementation is definitely not a
one-size-fits-all approach, so I think the value of these consultation
and personalization services in addition to the physician being a part
of a community, will make happier physician clients overall.

How do you balance the need for an EHR to complete sophisticated tasks, but still keep the interface simple?

It really goes back to the adage of form follows function. You don’t
have to sacrifice function for form. In fact, most of the functions
that NOSH ChartingSystem has is very much what most other EHRs have,
its just presented in a very different way and in a way that (I think)
makes sense to most physicians. Even though I designed this system
for physicians, I know that there are certain non-clinical information
that is important. For instance, if you’re a clinic administrator or
a solo physician like me, there is information in NOSH ChartingSystem
that shows monthly statistics for how many patients have been seen and
how much each insurance company is reimbursing for each visit type or
what has not been paid yet so you can keep track of those accounts
receivables. You can also quickly query a list of all active patients
who are male and have diabetes so you can keep track of your practice

It’s not just even what type of information is being presented or how
it is entered, the whole system was meant to evoke the feeling of
calmness. As a physician, the last thing I need is a system that
looks like you’re operating a military-grade dashboard with
multi-colored panels with tons of information, and I have decide at
that moment what is important or not without fearing that I’m going to
do something catastrophic with the system. I don’t want to be playing
the “Where’s Waldo” game when I’m working one-on-one with a patient.
As a physician, I’m there to listen, examine, and diagnose…not
figure out minute-by-minute how to enter this finding or locate a
medication allergy or issue for this patient. It just has to be,
almost literally, at my fingertips.

What is the best feature you’ve created in your EHR that others don’t have?

I think I mentioned it before, but it bears mentioning again, a user
interface that is familiar to physicians. One that does not need a
book, tutorial, or class to learn how to use. That is the best
feature of my EHR. For busy doctors, the last thing they need is to
learn something new that takes a lot of time to learn. My philosophy
is that the EHR should be an everyday tool, like a pen, so that
physicians can do the work of physicians. If a patient that you treat
does not know that you are using an EHR while you’re in the middle of
an encounter, that is an example and a testament of a great EHR. If I
can do my part to let physicians be physicians again, I can say that I
successfully accomplished my goals with my EHR project.

What features are still on your EHR roadmap that you haven’t been able to create yet?

My next priority is to port my project to a mobile application; it’s
not a daunting task given the structure and framework that this system
already has, but it just takes a little more time. I think there are
always different customizations one physician would like over another,
which one could consider them as features, but I like to present them
as options rather than adding unnecessary overhead to the core project
over time.

Do you plan on getting your EHR certified? Can a doctor show meaningful use and get the EHR incentive money with your open source EHR?

That is very good question. At this point, I’m hesitant for getting
my EHR certified for the following reasons. I feel that the current
EHR certification process, at its core, is not compatible to the
open-source philosophy. Certification, in it of itself, is a good
idea for any software or service, but the devil is in the details. If
an open-source developer cannot afford certification (like myself),
there’s something to be said about exclusion and giving the upper hand
to already established entities that have a foothold in the EHR
marketplace. For instance, the cost of certfication only applies to
the specific version that is being tested. Updates need to be re
certified, at the same cost of initial certification. Over time, that
can be very costly to a small developer. Certification ought to
promote and encourage innovation (which the current process does not).
I see this issue as a potentially huge challenge for my project as
meaningful use incentives are tied to certified EHR products. I think
there are many examples where a practice or physician is able to meet
meaningful use in a defined and measurable way, but because they
didn’t use a “certified” product, they will get penalized (like me
when I was in practice). What is the point? All the process did was
to disincentivize me into using EHRs as it would cost me nothing if I
used a paper and pen and I stopped seeing Medicare/Medicaid patients.
Is that really want the government wants? Is that good public health

I believe most physicians are unaware that certification means that
the costs get passed down the physicians and practices. I knew that
it happened to me in 2009 before I started my own project. But most
physicians don’t own their own practice so the issue isn’t even in
stream of consciousness. But as they become more disillusioned with
the MU incentives program as time goes on, it’ll be clear to them that
the real winners here are the established EHR system providers and the
certification bodies and not to the doctors and the patients. This is
where I am actually outraged, from a physician standpoint.

So, I’m not sure I’m going to go the certification route (both
financially and philosophically).

Like I’ve said before, I think a good EHR product should stand on its
own merits without incentives. Physicians are savvy enough to know
what works and most have already caught on to smartphone technology.
Why? Because it’s intuitive to use. Like other human beings,
physicians don’t like to be patronized and told to adapt to a system
that doesn’t make sense to them. Physicians are really looking for
something that works for them. There are just not many options out
there, but I’m offering mine to see where it goes.

What do you see as the future of EHR in healthcare?

Recently, I came across these “10 Commandments of Healthcare
Information Technology” by Dr. Octo Barnett, who penned these way back
in 1970. You can see them on my project website. I found it
fascinating that these concepts are very much what I envision
healthcare information technology to be even now. I found it
disturbing, though, that a lot of what has been happening in
healthcare IT, unfortunately, goes against these concepts. I feel
that for EHRs to succeed in healthcare, we really have to go back to
these concepts. Only then, will EHRs be accepted and used by
physicians. After all, the physicians are the ones that enter the
information in these systems. The value of EHRs and the information
provided is only as good as how the information is entered. We’ve
totally missed the boat on this, from a health IT standpoint in my
opinion…leaving the physicians behind so to speak, but I don’t think
it is too late to change course and start over again. Generations of
younger physicians are craving for a good functioning EHR (I was
astounded that my first job over 20 years ago as a cash attendant at a
cafe involved these touch screen systems that were really easy to use
and then to find that my stint as a medical student, I had to resort
to using paper charts and pens…it’s really telling how far behind we
are on EHR implementation…and that was 15 years ago!). I think it’s
about time that there is something real for physicians to use.

Chris Riley Interview from eDTC Revolutions: Innovation and Opportunity in EHR

Posted on October 8, 2012 I Written By

Chris shares his overview of Mitochon, an innovative EHR system that enables peer-to-peer connectivity. The first, truly complete ONC-ATCB certified free EHR platform, Mitochon offers a cloud-based solution reflective of how healthcare segments access and consume information at the point of care and beyond. Chris also discusses the importance of privacy and transparency, and how cloud-based systems such as Mitochon can ensure data security and integrity.



Watch the video.

EHR Incentive Inflates EHR Pricing

Posted on July 25, 2012 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.

In a recent conversation I had, the question of EHR pricing came up. It was suggested in the conversation that EHR incentive money was inflating EHR pricing.

I wish that I had harder data on the price of EHR software. Unfortunately, there’s no really good source of EHR pricing across all the 600+ EHR comanies. At one point I considered the idea of creating such a resource, but the challenge of getting that type of information is ominous and might be impossible since many EHR vendors keep that information very close to the chest.

Since we don’t have the quantitative data that we’d love to have in this situation, instead let me offer some observational data on EMR pricing.

In my first couple years blogging about EMR software (I started EMR blogging 6+ years ago), I was able to witness a dramatic shift in the price of EHR software. The norm 6+ years ago was for an EMR for a small clinical practice to cost somewhere in the $30,000 range. For a larger group practice they were easily paying $100,000-200,000 for their EHR software. In almost every case this was a huge up front lump sum payment for the EHR software. Although, many of them conveniently offered financing for your purchase. These EHR were almost always an in house EMR software that needed a lot of up front costs for things like a server.

In those early years, we started to see a wave of mostly SaaS EHR software enter the market at a much lower price point. In most cases they were offering their EHR software for a small monthly fee (usually around $350-500/doctor). Of course at this same time a number of Free EHR software entered the market as well. Both of these entrances forced the price of EMR software to decrease dramatically. Sure, a few EMR software vendors pillaged a practice for an ourtrageous price, but for the most part the price of EMR software came down. Plus, the movement to the monthly charge pricing model for EMR software took hold. In most cases, EMR software vendors would offer a one time fee EMR pricing model along side a monthly per doctor EMR pricing model.

Over the past couple years I think we generally saw a leveling off of EMR pricing. However, I have seen one major thing happen with EMR pricing since the EHR stimulus money was introduced. The new bar for EMR pricing was set at $44k over 5 years. You can be certain that every EHR vendor has looked at their EHR pricing and compared it to the $44k over 5 years.

While I can’t say I’ve seen long time EHR vendors increase the price of their EHR to match the $44k of EHR incentive money, what I have seen is new EHR vendors pricing their EHR software accordingly. Instead of pricing their EHR according to market pricing, they’re generally inflating their EHR price to match the EHR incentive money. I believe this has driven the overall cost of EHR software up thanks to the EHR incentive money. Plus, it has held the EHR pricing of some EHR vendors higher than it would have been if the EHR incentive money weren’t there.

One other thing worth considering is the long term effect on EHR pricing because of the EHR incentive money. EHR incentive is creating an artificial pricing bubble, but eventually the incentive money will run out and I expect a number of EHR vendors to drop their price when that happens. However, what might have an even longer term impact on EHR pricing is the increased number of EHR vendors thanks to the EHR incentive money. Standard economics says more EHR competition leads to lower EHR prices.

What have you seen related to EMR pricing? I’d love to hear your thoughts and experience.

Riskiness of Pharma Ads in EHR

Posted on November 23, 2011 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 having a number of really interesting conversations with people about Pharma ads appearing in EHR and other clinical software. Most people’s gut reaction is that they don’t want their doctor seeing a pharma ad while he’s ePrescribing. However, most people also agree that there’s too much Pharma money for it not to happen.

In an article at Lab Soft News a few months back, they discuss the challenge and issues surrounding Pharma ads in an EHR:

Very distressing to me, however, is the clear link of the company, and its software, to the pharmaceutical industry. I have blogged on numerous occasions about some of the ethical and legal lapses of some of these companies (see, for example: On the Corrosive Influence of Big Pharma on Academic PhysiciansMerck Creates Phony Peer-Reviewed Medical Journal to Dupe PhysiciansDetails Emerge About Ghost-Written Medical Articles for Wyeth). 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.

Certainly there are some really great points made. Absolutely there’s a risk that a doctor could be influenced by a pharma ad in an EHR. Will it make them provide a lower quality care because of the ad? I’m not sure it would. Could the care cost more because of the pharma ad? Possibly so. Do we not trust our doctors to do what’s best for us regardless of the other outside influences?

Back to the initial premise, many are concerned with Pharma ads, but they’re bound to happen anyway. So, I ask you the question, is there any way to have Pharma ads without compromising the integrity of the visit? Is there a way to minimize the influence of Pharma while still allowing them a way to talk with the doctor?

No doubt this discussion is going to come up again and again. With Pharma unable to even give a doctor a pen we’re going to see new creative ways for Pharma to be seen by doctors. Advertising Pharma products to patients won’t be enough.

New Media Meetup at MGMA 2011 #HITsm

Posted on October 7, 2011 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.

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)
Fill out the form embedded below so we know how many to expect:

Or Complete this form to RSVP

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

Event hosted by HITECH Answers and