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The Time Has Finally Come for MU, It Really Is Now or Never

The following is a guest blog post by Lea Chatham.
Lea Chatham

The healthcare industry has been talking about Meaningful Use (MU) for years now. The program started in 2011, but there were discussions and planning going on years before that. It’s become a ubiquitous topic in healthcare publications and blogs. So much so that many providers probably still think that they have time to decide if they are really going to attest or not.

The truth is that 2014 is last year to initiate participation for Medicare to receive incentive payments. To avoid the first adjustment of 1%, providers must attest for Stage 1, Year 1 no later than the third quarter of 2014 (July 1 – September 30, 2014). You can still start MU in future years to avoid additional penalties, but you won’t get any incentives and you will still have the 1% deduction on your Medicare Part B Claims starting in 2015. That penalty doesn’t go away if you start MU in 2015 or 2016.

What this means is that the estimated 40% of America’s physicians who don’t’ have an EHR and haven’t yet begun to attest for MU have a decision to make—now. And there are essentially three options:

  1. Choose an EHR and attest in 2014
  2. Accept the penalty (which increases each year)
  3. Request a hardship exception.

Here is what you need to know about each of these options so you can make the right choice for your practice.

Choose an EHR & Attest

Over $16 billion in incentives has been paid out to providers who have been attesting for MU. If you start in 2014, you’ll still get $24,000 over three years for your efforts. You’ll also avoid the penalties, which start with 1% in 2015 and increase each year for a minimum of three years. The larger your Medicare pool of patients, the more sense this makes financially.

If you are going to adopt an EHR now, be sure to choose the right solution for your needs. Many of the providers who have not yet implemented an EHR, are small practices (10 or fewer providers). According to a survey conducted in January by SK&A, the smaller the practice, the lower the adoption rate. Small, independent practices don’t have staff, time, or money to waste. So it has to be right the first time. Take these factors into consideration:

  1. Cost: There are now free and low cost EHRs that can offer almost any specialty the tools they need to reap the benefits of an EHR.
  2. Cloud-based and Mobile: Its 2014, don’t choose an EHR unless it offers anytime, anywhere access and true mobile connectivity.
  3. 2014 Edition Certified for MU: As of January 1, 2014, you need a 2014 Edition certified EHR to attest for MU. Only about 12% of complete EHRs have this certification, which narrows the field.
  4. Total Integration: You can get more from your EHR if it is fully integrated with your practice management and billing system. You can meet MU and streamline many other functions. As a bonus it can actually increase both charges and collections. A UBM white paper showed that the average increase in revenue was $33,000 per FTE provider per year!

Accept the Penalty

So you are thinking you’ll just take the penalty. This may be because you don’t serve Medicare patients or at least not that many. It could also be that you are planning to retire soon and don’t think you’ll be around in another couple of years. But consider this, with MU, PQRS, and eRx penalties, it reaches over 10% in total adjustments to your Medicare Part B claims in five years. If you do start seeing more Medicare patients (as your patients age) or you don’t retire, 10% is nothing to sneeze at. If you are a solo doc and you generate an average of $30,000 a month and about 30% of your patients have Medicare, that’s $10,000 a month. A 10% cut adds up to $12,000 a year. To make that up, you would have to conduct about 100-120 more patient visits a year (if your average visit reimbursement is around $100-150).

And here is something else to consider. Perhaps you are willing to take that hit, and you are sure that you don’t want to attest for MU. But does that mean you don’t need to implement an EHR? Not these days. Patient expectations are changing, and to stay competitive you need to meet those expectations. A study conducted by the Optum Institute showed that 62% of patients want to correspond with their physician online and 75% are willing to view their medical records online. Another survey conducted by Deloitte showed that two-thirds of patient would consider switching to a physician who offers secure access to medical records online. You need patients to stay in business so take their changing needs seriously or you may struggle to stay competitive in changing times.

Request a Hardship Exception

The first thing that needs to be said here is that not everyone can apply for a hardship exception. If you’d like to attest for MU, but need more time AND you meet one or more of the criteria, then you should definitely consider this option. This is a summary, check the CMS tipsheet to find out more:

  1. Your area lacks the necessary infrastructure (i.e., no broadband)
  2. You’re a new provider
  3. Natural disaster or other unforeseen barrier
  4. Lack of face-to-face interaction with patients
  5. Practice in multiple locations
  6. EHR vendor issues (i.e., your current vendor was unable to certify for 2014 edition)

For most providers who are practicing full time in a single location and have not yet chosen an EHR, these exceptions won’t apply. This leaves you with choices and one and two above. You will still need to decide if you want to attest or not.

If you are still on the fence, consider this… Beyond MU, practices are facing the ICD-10 transition and a changing reimbursement landscape with ongoing reform from of the Affordable Care Act (ACA). Technology can be a very effective tool to help you manage these changes and turn this set of challenges into an opportunity to optimize your practice and position your business for success no matter what comes your way.

About Lea Chatham

Lea Chatham is the Content Expert at Kareo, responsible for developing educational resources to help small medical practices improve their businesses. She joined Kareo after working at a small integrated health system for over five years developing marketing and educational tools and events for patients. Prior to that, Lea was a marketing coordinator for Medical Manager Health Systems, WebMD Practice Services, Emdeon, and Sage Software. She specializes in simplifying information about healthcare and healthcare technology for physicians, practice staff, and patients.

March 27, 2014 I Written By

Practice Fusion’s Free Chromebook Comes at a High Price

Update (4/2/14): I just got word that Practice Fusion has updated their terms page and removed the negativity clause.

Practice Fusion’s offering a free Google Chromebook to docs who sign up for its free, web EHR. It’s one thing to give’em the razor and charge for the blades, but this offering goes that one better, you get both, gratis. Or so it seems, but there is a catch you should know about before you click in.

The Deal

The heart of the offer is a free Google Chromebook worth about $300. Chromebooks are hardware platforms for Chrome’s browser, which acts as its operating system. They come in two screen sizes, eleven and fourteen inch and are made by several different vendors, such as HP and Toshiba. Google also provides 100 gigs of on line storage for two years.

Cromebooks have lightweight magnesium cases, a 1366 x 768 screen, 2 USBs, webcam, 2 gigs of RAM and a 16 gig solid state drive. They are WiFi only devices with Bluetooth. PF does not specify which vendor’s unit or screen size that it offers, though it refers to HP’s as an example. As a side note, John has the HP Chromebook and loves it and especially the 10-12 hours of battery life.

The Offer

To qualify, PF requires that you meet these standards:

  • License. Be a licensed US healthcare provider at least 18 years old. (Sorry, Doogie)
  • Status. Be a US Citizen or permanent legal resident
  • New User. Not been a PF user before
  • Account. Successfully signed up for a PF account
  • Rx User. Become one of their e-Prescribing users
  • Survey. Participate in a PF survey of eligible users
  • Agreement. Agree to their terms and conditions for the program.

As you would expect, PF puts in several clauses to protect itself and to comply with privacy and similar considerations. Oddly, I could not figure out what happens to the Chromebook if you quit PF or if they end the program.

The Gag Rule

So far, so good, but there’s a gotcha in Section 5d of the offer’s terms and conditions, which says:

Negativity. You will not disparage Practice Fusion, Inc., our Services, the Program, products, employees, partners, affiliates, contractors, or portray them in a negative or derogatory manner.

I don’t know what prompted PF to put this in. There’s nothing new in the PF technology or using a Chromebook to access it. It’s understandable that PF wants to make sure it’s getting new subscribers who are doctors, but this language is not related to the offer. It’s not part of PF’s standard agreement, which has nothing like this clause.

It’s easy to come up with questions about the language. Here are a few:

  • Scope. Just who isn’t included in this rule? It applies not only to PF and its employees, but also in this case to Google or HP, etc., including their contractors without limit.
  • Disparage. What do they mean by disparage, they don’t say. Commonly, it means to belittle or demean. So, if I say to a friend that my Chromebook’s OK, but it’s no MacPro, is that a violation? What if I post a problem on PF’s Community Support forum that’s an impediment to my work, am I liable under this section?
  • Negative or Derogatory Manner. I guess this means if you are going to say something less than flattering, you’ll have to damn with fait praise. For example, “Considering how short staffed they are, it’s amazing their backlog isn’t worse.”
  • Reviews. If I’m a doc who writes a review of PF under this program, am I barred from pointing out problems? Do they have a right to sue me for violation of the terms, if they think I said something negative?
  • Legal Recourse. If I file a complaint with a consumer protection agency, the FTC, FDA, etc., does this section open me to legal action?

All these are problematic, but the greatest problem with this clause, and similar ones that other vendors impose, is not what it does to their users. It’s what it does to the vendor and its products. These gag rules, which are intended to insulate the vendor from hostile comments, etc., also isolates them from important feedback.

As I’ve noted elsewhere about the gag rules some vendors include:

Agreements. Your company lawyer did a great job of protecting you from being sued. Are you so protected, though, that your client can’t talk about problems? Client complaints may be on target or way off, but if they are afraid to tell you or discuss it with anyone, how will you know?

With Section 5d’s language, PF thinks it’s shielding itself from adverse attacks, but it’s really blinding itself to legitimate criticism and suggestions for improvement.

There is also one other factor. PF has put this language in a program aimed at practicing physicians. Shouldn’t these doctors be considered partners in their efforts to make a quality EHR? Why would Practice Fusion not want both positive and negative feedback from these core users?

Maybe this was just missed by the Practice Fusion team and wasn’t their intent. It’s not hard in these situations for a legal team to add something that’s not the intent of the company and is missed in the terms review by the company. Balancing the legal is hard, but PF ought to trim this language way back or just toss it.

February 4, 2014 I Written By

When Carl Bergman’s not rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Will We See More Free EMRs?

Wondering what’s up in the free EMR world? In a recent article in the redoubtable, an author described three current EMRs which are free to physician users:

* Hello Health, which collects fees from patients ranging from $36-$120 per year but charges no fees to physicians. (Patients who pay for Hello Health get various privileges, including online appointment scheduling with blocked out periods of time reserved for Hello Health patients, the article reports.)

* Kareo, which gives away its EMR in hopes that medical offices will buy its other products, including practice management and billing services.

* Practice Fusion, whose business model allows physicians to use its EMR for free in exchange for tolerating ads on screen.

To me, what’s interesting about these models is that there are so few of them. When Practice Fusion first emerged years ago I assumed that there would be tons of other free EMR plays emerging to compete with it. That has not been the case.

To me, this fits in with John’s observation that the Golden Age of EMR Adoption is over, or as he puts it, that “we’re now getting ready to enter the nasty, ugly, dirty, swamp – filled waters of EMR adoption.”

Five years ago or so, free EMRs were just one of the neat new EMR business models emerging as vendors went after Meaningful Use money. Fast forward, to today, and you find that things have gotten a lot simpler and clearer. While early players like Practice Fusion may have seen good adoption of their free EMR, I don’t think they’re going to have much competition for that business model in the future. The market just isn’t as open to new ideas as it was.

While there may be other viable free EMRs not mentioned in the blog item, I think the industry has concluded that at best, pay-for-play EMRs are more viable over the long run than most free EMR models floating around the vendorsphere. Although, Practice Fusion’s new $70 million round of funding will keep them in the game for a while to come. What do you think?

September 24, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Practice Fusion Announces 3 Billing Partners

With the news of Mitochon shutting down their Free EHR business, that really only leaves a couple players left in the Free EHR space. The largest one is Practice Fusion, but it has challenges of its own. You might remember the announcement that Kareo bought the Epocrates EHR and is offering the EHR for free.

You could tell that Practice Fusion was put in a bad position when Kareo decided to basically part ways and offer a competitive product to Practice Fusion. Although, no doubt Practice Fusion and Kareo both knew it was going to happen sooner or later. The key question was how Practice Fusion was going to respond to the move by Kareo since Practice Fusion was sorely lacking in the billing department.

Well, the answer is now in. Practice Fusion just announced 3 preferred billing partners: NueMD, CollaborateMD and ADP AdvancedMD. You can see NueMD’s press release about the partnership here. Both NueMD and CollaborateMD are offering their billing solution starting at $149/month. ADP AdvancedMD offers “customized pricing” which means they don’t want to commit to a price and likely change the price based on the size of the practice.

The Practice Fusion announcement I got did say that these integrations will happen “later this summer.”

It’s an interesting choice on Practice Fusion’s part to continue down the integration road versus developing their own billing software or just buying one of the billing software that’s out there. I wonder if this is going to pose a long term problem for them. I wonder if Practice Fusion learned from the Kareo experience and the contracts with NueMD, CollaborateMD, and ADP AdvancedMD take this into account.

No doubt Practice Fusion comes at the EHR world with a different business model in mind, but it could be a mistake for them to not also have a hand in the purse strings (billing). Sure, they’ll get some short term financial bump from these three partnerships, but are they trading revenue for long term connections with the doctors?

May 29, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: and, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

simplifyMD New “Free” Patient Room Cartoon

A while back simplifyMD sent me a link to their EHR cartoon gallery. I’ll admit that I was a little underwhelmed with their first set of cartoons. They looked professional, but the content and writing needed some help. I happened upon the gallery again today and found a new cartoon called, ‘Easy Street Family Practice installs a “Free” patient room.’ Check it out (click on the image to see it full size):
simplifyMD Ad Supported Patient Rooms

I thought this was a hilarious jab at our societal move to “Free” everything. It’s a bit of an exaggeration of what it’s really like to get something for free in return for time spent seeing ads. This is especially true of Free EHR where the ads are as unobtrusive as any ads I’ve seen on anything. However, it does illustrate the reason why many people aren’t comfortable with the Free EHR model.

I did have one user of the Practice Fusion Free EHR recently tell me that if the EHR weren’t free, there’s no way they’d still be using that EHR. I thought it provided an interesting perspective on the value of free. We’ll see how this plays out long term for Practice Fusion and if these type of experiences taint the Free EHR market for everyone else.

Plus, I couldn’t write about Free EHR without mentioning that just because an EHR doesn’t cost money doesn’t mean that there aren’t other costs. Some people are ok with the Free EHR costs of advertising and data. Others are not. The key is to be aware of the hidden costs of using a Free EHR.

Going back to the cartoon, I think I might prefer some in exam room advertising if it would replace my co-pay. I’d be fine with a nice Pepsi ad in the exam room in return for lower healthcare costs. Although like most things in life, it can certainly be taken too far if we’re not careful.

Full Disclosure: simplifyMD is an advertiser on this site.

April 24, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: and, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospital EMR Vendor Consolidating, But Physician EMR Market Still Dynamic

If you don’t check out the HIMSS group on LinkedIn from time to time, you should. I always pick up something to think about when I visit, and this time was no exception.

A group of IT pros, most of whom seemed to have plenty of institutional memory of EMRs gone by, were talking about whether the current leaders of the EMR vendor pack would take over and most of the rest fall away.  The consensus, not surprisingly, was that hospital CEOs are herd animals, and that a few leaders are likely to take most of the market.

As things stand today, even EMRs that seem to be a better fit usually lose to the Epics, Cerners and Meditechs of the world, writes Richard Rauber, FHIMSS.

“Let’s say the preferred EMR has 10 clients similar to their facility, and the second choice has 75 clients in the same bed range with a high level of user satisfaction. Is the risk/reward ratio low enough to go with the smaller vendor? It today’s market it would be unlikely.”

If these posters are right, the hospital market is going to standardize on a dozen or so of the most successful vendors. Unfortunately, that’s likely to lead to some really nasty implementations, suggests Terry Montgomery, PMP: “I had such a project last year. They had to move the go live date three times and there were still bugs they had to fix.”

That being said, I think there will be a lot more dancing when it comes to the physician EMR market.  You’ve got breakout models like the no-cost Practice Fusion — and its bundle of VC cash to fuel the fire — iPad-based DrChrono, Free Mitochon PMS-EHR-HIE and a growing number of elegant, doctor-crafted implementations like SOAPware and Amazing Charts.

While the dynamic of hospital IT purchasing is to standardize on the big boys (the old “nobody gets fired for buying IBM” syndrome), physicians can’t afford to buy a system just because the practice across town thought it was cool. Not that such doesn’t happen, but it’s less likely.

I predict that doctors will have some great options to choose from when they hit HIMSS13 next year, systems integrated intelligently with revenue cycle needs but also cleanly designed and physician friendly.

The smaller EMR companies focused on doctors are just doing a better job of mirroring a doctor’s process, there no doubt in my mind. If only such logic would float upward to the billion-dollar boys behind the hospital giants.

Full Disclosure: Practice Fusion, Mitochon, SOAPware and Amazing Charts are advertisers on this blog.

March 6, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

5 Questions with EHR Vendor Executives at #HIMSS12 – Founder of Mitochon Dr. Andre Vovan

As mentioned previously, I’m planning to do 5 questions with as many EHR vendor executives as possible at HIMSS12. I plan on posting at least one of these videos each day of HIMSS on EMR and EHR. Plus, each day I’ll plan on doing a HIMSS12 overview post each day on EMR and HIPAA.

First up in our 5 questions with EHR vendor executives is the Dr. Andre Vovan, founder of Free EHR software vendor Mitochon.

See more of Mitochon’s HIMSS12 Announcements on EMR News.

Be sure to check out all of the 5 Questions with EHR Vendor Executives at HIMSS 2012 videos.

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

February 21, 2012 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: and, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Quest Diagnostics Offers Big Discount On Its EMR-Practice Management System

In the past, I’ve written volumes about hospital attempts to lock in doctors by offering them access to a free or deeply-discounted EMR. I haven’t heard much about this strategy of late — either the approach was dropped or it’s gone underground — but it seems that other players are still giving it a shot.

This time, in what seems to be a fairly logical step, Quest Diagnostics has kicked off a program offering medical practices a steep 85 percent discount off of the retail price of its Care360 EMR and practice management bundle.  The announcement follows up on its 2011 regional giveaway program, which Quest says attracted thousands of physicians.

The deal, which reduces the physicians’ out of pocket cost to less than $100 per month,  also includes training, hosting, maintenance and 24/7 support for Care360. The lab giant says physicians can get Care360 up and running in about 45 days.

I can’t think of a reason why this wouldn’t make great sense for Quest; if my contacts are to be believed, it has no better reputation than its key competitors when it comes to customer service and follow-through on clinical testing.

On the other hand, if I were a doctor I’d think long and hard before agreeing to a deal like this, even though the software is just about free. There’s simply too much at stake to plunge in.

Yes, Care360 is ONC-ATB certified by CCHIT and, intriguingly, has incorporated the Direct Project specs allowing doctors to share information with patients and hospitals. And yes, it seems to have made efforts to support EMR access via mobile devices. This is all good. And of course, the price is right.

On the other hand, I’m not sure I’d want to make this big of a commitment to any particular service provider, be it a reference lab, a radiology provider or the people who stock my vending machines with sodas.

I’d argue that the more important the service is, the less you want to be beholden to the vendor. After all,what if Care360 isn’t your cup of tea?  Do you really want to disrupt your relationship with a critical provider like Quest?

Not only that, it’s risky to lock in an EMR just because it’s cheap. If Care360 takes 45 days to get installed (activated, configured, trained, etc.), it’s not going to be possible to uninstall it in a day or two, and that could mean misery on wheels if the product doesn’t work for you.

Besides, it’s possible to get Web-based, easy to adopt or drop EMRs for only a couple hundred dollars a month more. It wouldn’t make sense to go for an EMR that might not work just to save that little. (If your margin is tight enough that a savings of $200 or $300 a month is critical, you have worse problems than finding the right EMR!)

I guess I’m saying that even if the EMR is nearly free, caveat emptor. You don’t want to get saddled with an albatross system just because the price was right.

February 3, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

The Online Medical Visit … For Free

In every situation online it seems like at some point someone takes the business model as deep as it goes and then someone just finally says, “Let’s make it free.” Readers of this site will be familiar with the leading Free EHR companies Mitochon and Practice Fusion (both advertisers on this site). They both seem to be doing really well and are working on some really interesting business models.

With my familiarity with the Free EHR business model, I was intrigued when I read about HealthTap’s model for basically providing an online medical visit for free. This was particularly interesting since I knew that HealthTap had received $11.5 million in funding recently.

Andy Oram summarizes what HealthTap is trying to solve really well:

In this digital age, HealthTap asks, why should a patient have to make an appointment and drive to the clinic just to find out whether her symptoms are probably caused by a recent medication? And why should a doctor repeat the same advice for each patient when the patient can go online for it?

Plus, he makes two important observations of what HealthTap has found:
1. Doctors will take the time to post information online for free.
2. Doctors are willing to rate each other.

It’s pretty interesting when you think about how many doctors visits could be saved using something like HealthTap. On face, I’d think that a site like this wouldn’t make much sense. Although, as I think back on my medical experiences I can think of about a dozen or so times where I tapped into my physician friends before going to the doctor. Basically, I wanted to know if going to the doctor would be worth my time or not. In about 90% of those cases I ended up not going to the doctor since the doctor wouldn’t have really been able to do much for me anyway.

As I think through these experiences, I realize that many people aren’t lucky enough to be like me and have lots of physician friends around to ask the casual medical question. I could see how HealthTap could fill that role.

One key to this model is that it doesn’t always replace the visit to the physician. In fact, in a few cases I was told that I’d need an X-ray and that I better go see the doctor. In that case I was more likely to go to the physician since I knew I needed to get something done. I already knew the physician would do something for me when I went so I didn’t have the fear that they just tell me to take some Tylenol and be careful with it.

I’m not quite sure if doctors would be glad to actually have only people that are sick visiting their office or not. Maybe they enjoy the break of the easy patient that doesn’t require any effort on their part.

I think there are still questions about the quality of information that patients will get on HealthTap. This is going to be the most interesting issue to follow. No doubt they’re going to be toeing a fine line called medical advice. However, whether it’s HealthTap or some other online source that someone likely finds through Google, people are going to be looking for this kind of health information online. The idea of a free online medical visit sounds good to me.

Let’s also not be surprised if the Free EHR vendors eventually get into online visits as well. Seems like a natural progression for them to offer this service if they wanted to go that direction. From what I understand they have plenty on their plates right now, but a few years from now it could get pretty interesting.

January 3, 2012 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: and, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Free EMRs, Ads and EMR Pricing

Last week, I wrote about a conversation with a physician friend on the costs of moving to an EMR. That conversation segued into a discussion of free EMRs and how they can be a good thing for small (definitely a game changer for solo or two-practitioner) practices. This week, I’m analyzing free EMRs from the advertising angle. My friend made a comment during our discussion that gave me pause. He said he didn’t want advertisements distracting him when he was talking to a patient, he’d rather spring for a package that charged him a few dollars a month than one that had ads embedded inside it.

I think the ad question is pertinent to both sides of the equation. As a physician, I don’t want the 15 minutes I spend per patient cut down even more, because I want to get rid of those pesky pharmaceutical ads. As a patient, I don’t want to get the feeling that I’m the third wheel in the space between my doctor and his iPad.

And frankly, the low or no-cost, high volume Walmart strategy doesn’t make much sense to me in the long term. This is not based on some well-pedigreed consumer behavior study but what I’ve generally witnessed, or done myself. I’ve trained myself on the art of selective blocking. When I’m on Google, I studiously avoid looking at the highlighted links on the right, and top of the page. The same way, on eBay, when I’m looking for job opps, I generally skim past the purple highlighted vendors. If you’re a TV junkie, think about when you take your bathroom breaks.

In other words, we all have our own blocking strategies to ignore ads, which is probably not such good news for advertisers. This is not to say that advertisers won’t advertise, or vendors won’t make money.

If doctors already have some amount of natural reticence to ads, how are free EMR vendors going to make money? (I’m not sure if the ad model in free EMR packages is click/pageview driven, or a set price for simply being placed on the page, like magazine ads.) Free EMR vendors might then also offer ad-free versions, for additional dollars a month. At this point, they become just like other EMRs – i.e. when the costs are non-zero, price will not be the only differentiating factor when you’re judging EMR quality.

And yet, if my friend spends $100 a month for an ad-free EMR, as one vendor is offering, he’ll spend only $1200 a year personally for EMR, and be able to avail his Medicare 44K, as opposed to the 80K-100K EMR bids he’s currently getting. Even when ads (or lack of them) are factored out of the EMR pricing, the ad-removal-for-a-price model tends to work better for smaller practices.

Based on this, I feel like we’re going to see some steep discounting in EMR prices.

September 19, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.