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What Happens When Billing Is Optimized?

Posted on May 27, 2015 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 my recent EHR workshop in Dubai I talked with them about the many changing EHR business models that I’ve seen over the last 10 years. I was really trying to highlight how these new business models have generally been good for healthcare since it’s caused EHR prices to drop to a much more reasonable price point.

Take for example the Free EHR model. Whether you love it or hate it, one thing is certain: Free EHR has caused all the other EHR vendors to lower their price. I’ve seen this over and over again with EHR vendors. It’s hard to compete with an overpriced product against free. So, they had to lower their price so that the price of their EHR didn’t look as bad against free.

One model that I mentioned to those who attended my workshop was that some EHR vendors charge a percentage of billing in order to use their EHR software. athenahealth is the most famous for this approach. Their business model has worked pretty well for them because they’re able to say that not only will the practice get the EHR software for free, but athenahealth also can make the case that by having them assist with the practices billing, then they can help to better optimize the practices billing as well. So, the practice is getting more effective billing and a free EHR. This is why athenahealth could charge such a high percentage of an organization’s billing.

Turns out that there are a lot of billing companies that make a similar business case. Pay me 4-6% of your billing and we’ll optimize your billing which will actually make you more money than you’re paying us. Most of the billing management companies work off of this approach. Of course, this approach works best when you’re talking about practices that aren’t doing a good job managing their billing. This actually seems to apply to most practices.

What I’ve started to wonder is what’s going to happen once all of these practices’ billing is basically optimized? Now the percentage of billing starts to feel really expensive. Practices won’t be good at realizing the optimization that’s occurred and I’m sure that many will choose to take on the billing again. As they take on the billing, they’ll head back to a less than optimized state and then they’ll be ripe pickings for a billing company again.

I can see this cycle happening over and over again. Plus, if you’re a billing company or a company like athenahealth that makes your money off of a percentage of billing, then there’s always new practices that are at every stage of the cycle. So, there’s new business all over the place. The key for these organizations is to find the practices that are at the right place in the cycle.

Will anything happen to stop this cycle?

Will We See More Free EMRs?

Posted on 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 FierceHealthcare.com 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Wondering what’s up in the free EMR world? In a recent article in the redoubtable KevinMD.com, 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?

simplifyMD New “Free” Patient Room Cartoon

Posted on April 24, 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.

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.

Hospital EMR Vendor Consolidating, But Physician EMR Market Still Dynamic

Posted on 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 FierceHealthcare.com 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

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.

The Online Medical Visit … For Free

Posted on January 3, 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 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.

Free EMRs, Ads and EMR Pricing

Posted on 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.

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.

Free EMR – A Boon for Small Practices?

Posted on September 12, 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.

I was talking to a physician friend during the week, and getting his take on EMR implementation. He would dearly like to implement an EMR in his practice. However, the major roadblocks he’s experiencing are in terms of costs. The quotes he has received for EMR implementation runs close to 80K. If he bills patients 500K a year, if he does not implement an EMR solution at all, the differential on the Medicare rebates in the first year would be 1 percent of $500,000, which is $5000, which is a number he says he can live with. If he implements an EMR, his two physician practi ce stands to make $88,000 from Medicare (they don’t see many Medicaid patients). In other words, if he spends 80K for his practice, or shells out 40K personally, he stands to gain $44,000. If on the other hand, he maintains status quo, he loses just $5000. Given the pain of choosing an EMR and EMR implementation, he’s probably better off doing nothing, he believes. And let’s not forget, it’ll be live people working with an EMR system, and productivity will actually take a hit before rising slowly back to pre-EMR levels, as this Feb post by Robert Rowley on Practice Fusion’s blog shows.

In other words, there are monetary incentives but sometimes just don’t make real-world sense.

This same math would look a lot different in a multi-physician practice. The same EMR implementation cost would be spread over a larger base, and more of the incentive money would actually reach the physician.

Which brings us to Practice Fusion. On this blog and elsewhere, Practice Fusion has got a lot of press (Full Disclosure: Practice Fusion is an advertiser on this site), not all of it positive.  Not being a medical practitioner, and never having used any EMR personally, my idea of how Practice Fusion stacks up functionally against other EMRs is pretty much second-hand info gleaned from reviews (John had a recent post on Black Book rankings. It’s interesting to me that Practice Fusion shows up in only the 1-Physician Practice rankings among the top 20.) There are those that caution the model of free. There’s also some debate whether a one-size-fits-all approach will benefit every kind of practice. But just based on its economic model, Practice Fusion is a system I would at least recommend my friend look into.

One Former Practice Fusion Consultant’s Issues and Practice Fusion’s Response

Posted on August 18, 2011 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, 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.

As most of you know, I don’t often point out individual vendors all that much. However, on occasion I get something sent to me that I think could add to the conversation around various EHR software. I got one of those emails from long time reader, Carl Bergman. He chose to no longer be a Practice Fusion consultant and wanted to share the issues he had with the current Practice Fusion EHR product.

I haven’t had the time lately to be able to dig into Carl’s comments myself, so that I could make an assessment of his comments about the Practice Fusion EHR. However, in the interest of sharing both sides of the story I asked Practice Fusion to comment on Carl’s thoughts on their EHR software. So, below you’ll find Carl and Practice Fusions comments.

As with most things in life, take everything you read in this post with a grain of salt and evaluate what each side says for yourself. Either way, I think it could start a helpful discussion for those considering the Practice Fusion EHR.

Letter sent from Carl Bergman to Practice Fusion:

I have been a certified Practice Fusion Consultant for several months. I’m writing to ask that you remove me as a PF consultant.

I have given this decision a great deal of thought, but I do not believe that I can market PF in good conscious. This is not due in any way to how I have been treated, nor is it any reflection on the support that PF offers to its consultants, which is considerable.

Rather, it is based on what I believe are important, missing product features. This lack of features makes it impossible for me to recommend PF to any of the leads that you have generously shared with me. (Please note, I have not and will not approach any of those leads due to your referral.)

I was initially attracted to PF due to its web basis, ease of use and, simple set up and good support. However, as I went through PF I saw that it was lacking in four important areas: Workflow, Billing, Security and Reporting.

Workflow. Each patient in a medical practice presents a different set of circumstances, attributes and issues. These require that the practice be able to respond in a concerted and orchestrated way. PF lacks this ability. Specifically:

Appointment Type. PF has six fixed appointment types, New, Recurring, etc. They may not be changed, deactivated or added to. Appointment duration is set separately for each appointment. An appointment’s specifics are kept in a note.

Appointments are key to a practice’s workflow. For example, PF has a wellness appointment type. However, there is no ability to link the appointment type to look for outstanding labs before the appointment is set. Nor can appointment type reserve a room or assign a tech to take vitals, etc., as part of an exam. As a result, a practice is left to its own, non traceable, ad hoc methods for preparing for and carrying out the exam.

Shared Task List. When a practitioners decides on a course of treatment, this can set a number of things in motion:
• Labs
• Rx
• Recurring Appointments
• Procedures
• Referrals
• Billing

Each of these also is an assignment to someone else to carry out a portion of the plan. While PF has lists for a patient and individual task lists for each person, it does not have an overall view of pending tasks so a manager can see bottlenecks or assign workloads.

Security. PF has four fixed levels of security: Staff, Nurse, NP/PA and PA. Users are assigned to one or more of these levels and optionally as administrators. As with appointment types, the categories may not have their attributes modified or may new ones be added.
I found a definition of the categories in the Support Forum/Getting Started, which defines different user’s edit rights. It is silent about how, if at all, access is limited. Apparently, any user may view all parts of a record. Allowing any user to view anything in an EMR is a dangerous policy because it allows confidential information, such as an AIDS test result, to be known by those who have no need to know it.
Billing. PF includes elements, such as insurance plans, copays, etc., that are usually associated with practice management and billing systems, so it is surprising that it does not include billing as well. Instead, it integrates with third party billing systems, such as Karo.

I have long been biased against systems that tie an EMR from one vendor with billing from another. No matter how well designed, the attempt to integrate two different data structures just doesn’t work well. While PF states that is it fully integrated with Karo, an on line subscription based billing system, but neither site has much detail on the integration much less a data model. I think a user should also know what, if any, terms, relationship, contract, etc., exist between PF and Karo or other billing services.

Aside from detracting from the free nature of PF, the question of the degree of integration is major. For example, who is responsible for the interface’s operation PF or Karo?

Is a demographic change in either reflected in the other? From what I read in the PF Community Forum, the answer is no. I would like to know whose reporting module, if either, can access the combined data from the two systems?

Also, if I use Karo, does that mean I have to set up a separate security system. To look at billing do I have to go from PF and log into Karo?

Reporting. A major advantage of an EMR over a manual system is not only the ability to find and retrieve a specific record, but also the ability to find and report on a selected set as well. For example, if the FDA notifies physicians that they should review all cases of Crone’s disease that are more than three years old who are on a specific dose of a particular antibiotic, PF could not do this.

PF’s reports are limited to searching and reporting on specific topics. In this, it compares unfavorably to a host of other EMRs on the market. If it did have a well developed reporting function, it could make up for some of its lack of workflow abilities, but it does not. This lack of reporting ability when combined with the lack of an internal billing function is a deal killer.

I regard each of the issues that I’ve listed to be a major problem any one of which would cause me to be skeptical of a product. Taken as a whole, and I am aware of the wide adoption of PF, I find that I cannot recommend PF as an EMR.

Carl Bergman
President
SilverSoft, Inc.

And Practice Fusion’s response:

Here’s some notes back. In general, Carl doesn’t seem to have a very deep understanding of the product. A failure on our part, perhaps, but these answers are easily given from our support team:

– Appointment type: EHR accounts come with six default appointment types, but any Admin level user is free to create their own to match their workflow. This setting is under the “admin” tab in the EHR.

– Task list: Each practice manages the passing back and forth of tasks a little bit differently. Most use the secure message feature to send follow-up, billing, lab messages, etc. A practice manager could review these messages or, more easily, could use the Live Activity Feed to see where there are bottlenecks. Since most of our practices are small (under 10 doctors) this doesn’t seem to be a big issue.

– Security: Each user has just one level of permission inside the EHR. Their individual login dictates the level of access they have. It is certainly not true than any user has the same access rights to any record. Plus, our activity feed gives an added level of transparency where you can see exactly who has accessed what, any actions they’ve taken, etc. That’s a unique Practice Fusion feature. However, it is a great suggestion to add more customization to these edit levels, that’s a popular request from our users as well and we have it on our development roadmap.

– Billing: We have the opposite bias from Carl here. We believe that being billing agnostic gives Practice Fusion users a great deal more flexibility in how they choose to manage their billing and an easier transition to EHR since they don’t have to change their billing process at the same time. Kareo is just one option that we provide our users, they are free to use whichever biller then would like. Their low-cost, integrated billing software is popular with our users. The integration today is fairly light, but we are working on ways to make it a more robust connection.

– Reporting: Practice Fusion does have some basic reporting features built in to the EHR today. For example, the reporting feature has assisted doctors with managing the Darvocet recall and with identifying H1N1 high-risk patients. The Crohn’s (note the spelling) disease example he gives would actually be fairly easy to run within PF. You would just do a report on ICD-9 code 555.9 with the date range set and then filter the resulting patients based on prescription (or run a second Rx report and merge). I don’t have any Crohn’s patients in my test account, so I ran a report on chronic migraine instead, below. However, we are in the process of upgrading the reporting feature for both Meaningful Use and our own planned enhancements.

There you have it. I’ll let you be the judge for yourself. Plus, I’m interested to hear what other Practice Fusion users have to say about the various opinions stated in this post. One thing that Practice Fusion has going for them is they at least don’t charge anything for their EHR. So, it’s not like a doctor using it can complain that they didn’t get what they paid for.

I have a feeling that this conversation will continue in the comments. See you there.

Full Disclosure: Practice Fusion is an advertiser on EMR and EHR. Although, I’d provide the same opportunity to any EHR vendor that would like to respond to comments I get about them.

Certified Open Source EHR

Posted on August 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 the various open source EHR software options for about 5.5 years right now. I’ve been intrigued with open source for much longer, so it just made natural sense for one of the first things for me to look at would be the various open source EHR options.

5.5 years ago the open source EHR market (although EHR really wasn’t in vogue yet back then) had a solid foundation, but still had quite a ways to go for it to be a great option for doctors interested in an open source EHR option.

I haven’t done an in depth look at the various open source EHR options for a while (I should), but I think the fact that many open source EHR software are now certified EHR and can help physicians show meaningful use and receive EHR incentive money is a good sign. Most of you know that I’m not a big fan of EHR certification, but I do believe that EHR certification takes a certain level of commitment to be able to achieve. Therefore, I think it’s a great sign that the open source EHR options have enough steam and commitment behind them to become certified EHR.

A recent Open Health News post listed the following certified open source EHR:
Ambulatory Open Source EHR
ClearHealth
OpenEMR
Tolven eCHR
Vista (inpatient) Open Source EHR
WorldVistA EHR
OpenVistA
vxVistA
Other (inpatient) Open Source EHR
Indian Health Services’ RPMS

I’d love to hear reviews and experiences that people have working with open source EHR software.

EMR Doctor’s Blog: Ways to Save Money in a Modern Electronic Medical Practice: Part Two

Posted on January 18, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.

Here’s another tip I learned over the first year in my solo practice that has really added efficiency and productivity to my office.

Tip #2. Use an electronic health / medical record system (for free, if you can).

I’ll admit I’m biased here. I hate buying something that I can get legally for free.  And as far as EMR systems go, there’s more than one option on the market at the present time.  In my office, we use the guilty pleasure of Practice Fusion and have been pretty freaking happy for a year now. Mitochon Systems is another company that offers such an EMR system, although I confess I haven’t tried it.  Practice Fusion now claims about 60,000 users, although these are not all physicians. For a recent review of their stats, an interview with the CEO can be found at HisTalkPractice.com.  These companies often use alternative sources of income in order to avoid passing on their business costs to the providers and staff using their systems. In the case of Practice Fusion, we see small ads for medications at the bottom of the screen or off to the side.   For me, this is tolerable, and I don’t feel any pressure to prescribe these drugs. They are not popup boxes that would require you to close before being able to work on patient charts, and so this allows them to be minimally invasive into your daily activities.

In bipartisan fairness, there are a variety of systems that you can pay for if desired, and indeed there is a pay-for option to use Practice Fusion without the ads for around $100 per month.  If you have ethical qualms about using a reportedly “free” system due to supposed “hidden costs”, financial and “otherwise”, that someone else will need to pay for, then you may wish to pay yourself. Just please please please don’t make the mistake of thinking that free systems are somehow less capable or functional, simply because they are free to users, and “after all, how good could it be if it’s not expensive?”.  As the old saying goes, “Don’t knock it until you’ve tried it.”  Now, as for my soapbox on drug companies and their tactics to ruin physicians’ ability to choose drugs they would really like to prescribe, we’ll have to save that one for another post…

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.

Full Disclosure: Practice Fusion and Mitochon Systems are both advertisers on EMR and EHR, but I’m not sure Dr. West even knew this when he wrote the post. Plus, Dr. West didn’t get paid to write this post either. He just loves EMR and is glad to share his good and bad experiences with it.