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Mitochon Shuts Down Free EHR Service

Posted on May 20, 2013 I Written By

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

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.

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

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
about.

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
quality.

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
policy?

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.

New Media Meetup at MGMA 2011 #HITsm

Posted on October 7, 2011 I Written By

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

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)
RSVP:
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 http://mitochonsystems.com/.

Event hosted by HITECH Answers and HealthcareScene.com

Epocrates EHR Should be Free

Posted on September 14, 2011 I Written By

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

I came across this article on Lab Soft News (he does great work) that talked about some Ethical Questions that related to Epocrates recently launched EHR software and their existing pharmaceutical relationships. Here’s one section from the post:

Very distressing to me, however, is the clear link of the company [Epocrates], and its software, to the pharmaceutical industry. … 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.

I’ll leave the highly discussed topic of pharmaceutical influence for another post and the comments section. However, when I read this I couldn’t help but wonder why Epocrates isn’t offering a Free EHR.

If you think about most Free EHR models, one of the core revenue paths is through advertising. Let’s not kid ourselves here. When they talk advertising, they’re talking about pharmacy ads. Sure, they might sell some other ads, but the majority of the big dollars for EMR advertising is from pharmaceutical companies.

With this understanding, doesn’t that mean that Epocrates relationships with these pharmaceutical companies would be perfectly positioned to execute on the Free EHR model?

I just checked the Epocrates EHR pricing page and it has the pricing as a $359 monthly subscription per seat. It’s also interesting that they’ve chosen to integrate with Nuesoft’s PMS which will cost $200/month per seat. They also require the purchase of the Epocrates EHR Quick Start Package. Not sure the cost on that. Sounds a bit pricey to me, but that’s a topic for another post.

I keep asking myself as I’m writing this post, Epocrates is perfectly positioned to execute the Free EHR Pharma advertising model and yet for some reason they’ve chosen not to do it. Remember, Epocrates has been executing the free software for Pharma advertising for a long time. Why did they choose not to do the same model with their EHR? Do they know something we don’t know?

I don’t know the answer to these questions, but I’m sure to ask them next time I see them. Maybe they’ll be at AHIMA or MGMA.

Interview of the Happy EMR Doctor – Dr. West

Posted on June 2, 2011 I Written By

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

Hi Dr. West, could you tell us your educational background and EMR experience?

I completed my fellowship in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. I began using an electronic medical record when I opened my practice in December 2009.

1. You’re on your second EMR after a failed EMR experience. I know you can’t reveal the name of your first EMR vendor, but what went so wrong?

Lots of things, but mainly it was the fact that it didn’t perform as the vendor described it would. Different parts were always malfunctioning. For example, the History of Present Illness section of my notes would sometimes get deleted when we tried to format the notes for faxing to a referring doctor. Different buttons on the screen which were supposed to be for functions were never functional. You would click them and nothing would happen. The accounting part of the software would not allow patients to be issued refunds in the case of overpayment, and so our financial books could not be kept accurate. Etc, etc.

2. What frustrated you the most about your first EMR?

That the company would make promises to fix it and never completely get it done. When one fix was completed, another part of the system would develop a new bug that was not there before. I think they were amateurs who basically got in over their heads and could not dig themselves out of the hole.

3. I know you are very happy with your current Free EMR, Practice Fusion, but after your failed EMR experience did you want to quit using EMRs all together? If not what or why were you still convinced there had to be a way to make EMRs work for your practice?

No, we had heard stories of other companies who had needed to change vendors and were prepared to keep on our mission of being an electronic practice. But it was indeed a scary time because we had just gotten burned with our first vendor. That said, I can see how many doctors who are less certain about the EMR concept for their practices may not have tried again at that point.

4. What do you think other doctors and healthcare professionals should avoid so that their initial experience with EMRs are less traumatic and more rewarding?

I think they should avoid rushing into a relationship with an EMR vendor; they should avoid signing a contract that does not include a satisfaction and money-back guarantee; and they should avoid continuing with an EMR vendor that has not provided a system to their satisfaction after an introductory period.

5. What should doctors and practice managers be looking for in their pursuit of finding an EMR that fits their needs?

I recommend searching for a vendor that is willing to let a provider test drive the EMR in the provider’s practice for an introductory period before committing to it. I think that a month would be enough time to find out all the problems, if any. There may need to be a deposit for this, but that should be fully refundable. They should be looking for a vendor that does not have a lot of very specific hardware requirements since hardware is not easy to return in the case where a provider needs to switch to an different EMR vendor.

6. What specific questions should other practices ask before signing a contract to have an EMR software package installed?

I think many of the answers are in my answer to question 5.

7. American Medical News reported the results of a recent study conducted by UC Davis which connected decreased productivity with EMR systems because of a lack of customization for given specialties. Was this an issue for you?

No. Practice Fusion is designed such that you can build your own templates to include whatever you like in the notes. After you create your own templates to your liking, I found that I could see patients faster and complete their notes sooner than before. All of my daily notes are essentially done by 5 pm.

8. Did you try other EMR software in between your first disastrous EMR experience and your current EMR?

We interviewed other vendors and viewed demos, but we had no other EMR in practice.

9. If you did, could you tell us about why you chose not to use them and could you tell us what the Practice Fusion EHR had that enticed you to go with them?

We went with Practice Fusion because it was free and web-based. Therefore it could be tried and discontinued, if necessary, without additional cost to us.

10. You’ve commented on your time being freed up because of using EMR, what was the most time consuming element in your pre-EMR life that no longer exists in your current, happy, para-EMR life?

If you mean before using any EMR whatsoever, then I would say charting in general. At Hopkins you had to dictate all your notes, spend additional time reviewing and editing them, and then sign. Now, using customized templates that I designed myself, that is all gone.

11. Besides Practice Fusion being free, can you tell those who might want to test the waters what you like the most about it?

It’s very intuitive. I like to call it the Gmail of EMRs. I imagine that eventually nearly everyone will have an account.

12. Explain the benefits of customized templates and details regarding how you designed your templates?

Benefits include a more uniform approach to common problems, such as diabetes and thyroid nodules. All patients with these conditions follow a thorough and well-defined path of questions designed to gather the most meaningful and relevant information.

13. How have you handled the issue of making each record unique to your patients’ medical issues when using templates?

Well, you still have to add unique contextual details, and for this you have to type a sentence here and there. These can be as long or short as you like.

14. Medicare and Medicaid decided to eliminate consultation codes. Is that one of the reasons you have decided against taking Medicare patients?

Yes, but only one of many reasons.

15. Why did you opt out of participating in the EHR government incentive plan? Aren’t you forfeiting a substantial sum of money by not participating?

On the surface it would appear so. It’s been an issue of angst for me personally, and I may blog on this inner struggle in the future over at happyemrdoctor.com.

16. In a recent survey conducted by the AACE, it was revealed that because of Medicare’s decision to remove the code allowing the consult charge, 4 out of 5 endocrinologists were going to reduce the number of patients seen in their practice. Are you aware of any groups working to reverse Medicare’s decision? What impact will this have on the future of Medicare?

I previously blogged on this at Happy EMR Doctor.

As far as groups working to reverse Medicare’s decision, I am aware that AACE already sent CMS a letter, and I found this letter as well.

In making this change, Medicare will save a lot of money for itself and shift the burden of payments back to patients who cannot find a subspecialist within travel distance who will accept Medicare. They will be forced into paying out-of-pocket for needed medical services. What most patients don’t know is that, under current Medicare rules (unlike commercial insurance companies like Blue Cross Blue Shield), patients cannot send in claims to Medicare for services rendered by doctors who have opted out of Medicare. To see an opted-out doctor, patients are forced to sign a Medicare contract stating that they will not send in any claims, despite having had necessary medical services. Medicare makes it more financially painful not to use their contracted doctors than do commercial carriers who have out-of-network options. As for the future of Medicare, I think that less doctors will be available in the system to supply demand to a growing number of baby-boomer Medicare patients.

The Risk of Free EHR Starting to Cost

Posted on May 10, 2011 I Written By

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Free HD TV Giveaway Winner at HIMSS Sponsored by Practice Fusion

Posted on March 10, 2011 I Written By

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

Many of you that I saw at HIMSS were aware that I participated in a Free HD TV Giveaway contest with fellow blogger: Dr. Joseph Kim. The giveaway was sponsored by Free EHR vendor Practice Fusion.

I’m really happy to say that @WesBates picture with me won him a 42″ HD TV and thanks in large part to those who attended the New Media Meetup I was able to beat out Dr. Kim as well. I just got the TV yesterday and it’s awesome. Thanks Practice Fusion!

It was pretty interesting wearing a Practice Fusion shirt around the HIMSS exhibit hall. Many of the people that I talked to asked about the shirt. However, I was a bit surprised that I didn’t get more people riping the Free EHR business model. Instead, it seemed like most people were familiar with it.

The 3 questions I did get asked the most about Practice Fusion was about their long term viability, how they make money offering a Free EHR, and whether a Free EHR is as good as the other EHR that you pay a lot of money to get. I asked Emily from Practice Fusion these questions and here were her responses:

1. Viability – We had 500% user growth in 2010 and doubled our team. The company has been very successful in attracting advertisers, partners (Dell, DeVry, Microsoft) and investors. We have 70,000 users serving 8 million patients today. And we bring on 300 more each day (compared to AthenaHealth brining on 600 docs in Q4). There’s a lot of strength in our numbers. Happy to answer any specific questions here.

2. How does Practice Fusion make money – Our favorite question! Practice Fusion is ad-supported, just like the radio, Gmail and EMR & HIPAA. Our discrete advertising allows the EHR to be available entirely free for any doctor in the US.

3. Quality – We were so honored when Black Book Rankings announced we were voted #1 EHR for 2011 primary care in January. Practice Fusion was up against EHRs that cost tens of thousands and still came away with the most #1 awards for categories including reliability, support, best-of-breed technology and delivery excellence. Forget “you get what you pay for” – that report proved that a free EHR could definitely be the best EHR.

To expand on all three of these: one thing that’s core to Practice Fusion is our alignment with our users. Since we’re an ad-supported product, we only succeed if doctors actually use the product. Our focus is on support, training and continuous product enhancement because of this. You saw it yourself when we completely re-did the getting started process inside the EHR over the end of the year. Keeping our users happy is fundamental to our growth. It seems simple, but surprising rare in the health IT sector.

It was fun to take pictures with so many cool people. Unfortunately, I did a poor job of keeping track of all the pictures. However, here’s a few of them that I did get to give you a flavor for the cool people I met:

EMRandHIPAA.com’s HIMSS11 coverage is sponsored by Practice Fusion, provider of the free, web-based Electronic Medical Records (EMR) system used by over 70,000 healthcare providers in the US.

HIMSS11 EMR Company and EMR Market Wrap Up

Posted on February 25, 2011 I Written By

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

It’s going to take a couple weeks to really process all that I saw and heard at HIMSS 2011. In fact, there’s no doubt that much of the content I publish over the next month or two will be things I learned from the people I learned from at HIMSS or influenced by what I saw and heard. However, after a good night’s sleep in my own bed I’m really happy with my experience at HIMSS. The energy and passion for healthcare IT that was found at HIMSS was really powerful and wonderful to be apart of.

I think those people out there that are asking if we’re in a healthcare IT bubble right now are on the mark. There’s very little doubt in my mind that we’re in a healthcare IT bubble. It’s a feature of $36+ billion in EHR incentive money being given out by the government. I can’t remember the size of the EMR market numbers off the top of my head, but $36 billion in money coming into what is a relatively small market is going to change things dramatically. So, it makes sense that this type of infusion of money would create a bubble of sorts.

One person in their comments that we’re in a healthcare IT bubble asked if the bubble would pop before HIMSS 12 in Las Vegas. I believe we have at least one or two more years before the healthcare IT bubble pops. In fact, if you thought that HIMSS 11 in Orlando was big, I predict that HIMSS 2012 in Las Vegas will be even bigger. The EHR incentive money will have started flowing and the trench battles will be in full swing as the 300+ EMR vendors battle each other for customers.

EMR software was obviously my focus at the conference and despite my comments about the lack of innovation by EMR vendors and the future of EMR, I think there are a ton of really interesting EMR approaches that in aggregate are going to impact the EMR world in really dramatic ways. Here’s some examples:

  • Azzly described a meeting of EHR vendors they attended with ONC. The question was asked which EHR vendors in the room started development after the HITECH act was announced. Azzly was the only one to raise their hand. I’m sure there’s other EHR vendors in that same boat, but it will be interesting to see an Azzly EHR that was built post incentive go up against the legacy EHR software.
  • ClearPractice was the first native iPad EMR (called Nimble) that I’d seen and there’s no doubt they’ve made a big play in that space. Will that combined with the backing of John Doerr and their internet driven sales change EMR as we know it?
  • Will larger companies like Greenway and Sage continue to gain market share as they go after the EMR market while maintaining their customer experience? Or will they head the way of the Misys of the world and be bought up by other EMR vendors?
  • What about NaviNet‘s entrance into the EMR world? Can they leverage their existing connections with so many providers to be a major player in not just interoperability but in EMR as well?
  • Even the big behemoth of a company, GE surprised me when I visited with them. There was a polish and a professionalism that I loved about my visit with GE and GE’s Centricity Advance people. I think there’s a fair comparison with Microsoft. Something about the nature of the US loves the underdog and hates the big name player. Yet, the big company just keeps executing their vision and many doctors are going to happily buy and use their products.
  • What about Ingenix‘s multiple EMR offering strategy? Will it just be confusing to clinicians or will they effectively differentiate their various offerings while providing a backbone for interoperability as well? Is the future large EMR vendor one that aggregates a bunch of niche specific EMR companies?
  • What impact will the transcription based EMR vendors have on the market? I wrote about the change from transcription company to EMR vendor earlier this week. Watch for the names MD-IT, FutureNet, Intivia, and MxSecure.
  • Many people probably don’t recognize the name MedPlus. However, everyone knows the company behind the MedPlus Care360 EMR: Quest Diagnostics. There’s something powerful about being able to turn on an EMR in a medical practice with basically the flip of an electronic switch. That’s what MedPlus can do since Care360 is already being used in so many clinics that use Quest for their lab work. Add in their existing lab sales staff that already have relationships with large numbers of clinics and they’re going to be a very interesting player in the EMR space.
  • Free EMR is a really compelling marketing tool. There’s a reason that Practice Fusion and Mitochon Systems free EMR offerings get so much press and so many doctors evaluating their EMR offerings. While many might disagree with their model or even believe that it will fail, these companies have and will have an interesting impact on the EMR landscape.
  • MicroMD offers an interesting approach. First, because of their existing LONG term practice management clients. Second, because of the interesting integration with the supply side of their company. Not to mention, the executives that I met with were some of the most realistic people and well thought out people I met at HIMSS.
  • Props to EMR company MIE that could use a fake EMR company (Extormity) to launch themselves into the EMR discussion while also helping to open up the discussion as well.  If I were a doctor, I’d want to demo their EMR just so I could see if I could find any Extormity features in their EMR.  Although, maybe that’s just the blogger in me.

I could keep going on, but that gives you a bit of flavor of some interesting EMR vendors and their market approaches. Plus, this is just 16 of the 300+ EMR companies that are working in this space. Each one with their own interesting story.

The most exciting thing for an EMR nerd like myself is that we’re really only at the beginning. Wait until we get beyond 15-25% adoption and reach 50% adoption. Then, the fun really begins.

Full Disclosure: Practice Fusion, MD-IT, MxSecure, and Mitochon Systems are all advertisers on this site. EMRandHIPAA.com’s HIMSS11 coverage was also sponsored by Practice Fusion, provider of the free, web-based Electronic Medical Records (EMR) system used by over 70,000 healthcare providers in the US.

Terrible Forbes Article – “Open Source Debut in Healthcare”

Posted on December 13, 2010 I Written By

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

I still have a hard time calling myself a writer or even press (although it’s convenient for getting into conferences). Plus, I think I reach, influence and interact with as many or more people than the traditional healthcare journalist. However, there’s something liberating about being called a blogger instead of a journalist because the standard and approach is different.

At least I thought that was the case until I read this article on Forbes.com which declares Allscripts new API as “Open Source’s Debut in Healthcare.” Ok, to be fair, it was written written on a Forbes healthcare blog and not their magazine, but as a blogger I’m embarrassed that a Forbes blogger would write such a terrible article.

Let me set the record straight. Allscripts launched an interesting API (which they call an “Application Sote & Exchange”). It’s a sort of app store for healthcare IT. This is interesting news and worthy of a story. What it’s not is open source entering healthcare.

Maybe there is some sliver of open source software that’s part of the Allscripts API/App store (or maybe not), but that’s backed by a heavy set of proprietary Allscripts software. It’s not like Allscripts has open sourced their MyWay or Allscripts Professional EHR. Then, you could really talk about Allscripts entering the open source EMR world. This is NOT!

Besides the fact of saying that is open source when it’s not, is the blogger’s headline that this is the first open source in health care. That’s just absolutely silly. Here’s just a few of the Open Source EMR on the EMR and HIPAA wiki page that have been around for quite a while and led I believe by OpenEMR and the various flavors of Open Source Vista EMR.

Honestly, Zina Moukheiber should be embarrassed by what she wrote. Even a blogger should be held to a higher standard than what she wrote. Of course, the sad part is that her mistakes likely drove a ton of traffic to the post. It’s her top post with 51 people tweeting the post and 15 people sharing it on Facebook. Too bad she lost all credibility in the process so the short term spike won’t turn into long term readers.