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News Flash: Physicians Still Very Dissatisfied With EMRs

Posted on October 18, 2016 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.

Anyone who reads this blog knows that many physicians still aren’t convinced that the big industry-wide EMR rollout was a good idea. But nonetheless, I was still surprised to learn — as you might be as well — that in the aggregate, physicians thoroughly dislike pretty much all of the ambulatory EMRs commonly used in medical practices today.

This conclusion, along with several other interesting factoids, comes from a new report from healthcare research firm peer60. The report is based on a survey from the firm conducted in August of this year, reaching out to 1,053 doctors in various specialties.

Generally speaking, the peer60 study found that EMR market for acute care facilities is consolidating quickly, and that Epic continues to add market share in the ambulatory EMR market (Although, it’s possible that’s also survey bias).  In fact, 50% of respondents reported using an Epic system, followed by 21% Cerner, 9% Allscripts and 4% the military EMR VistA.  Not surprisingly, respondents reporting Epic use accounted for 55% of hospitals with 751+ beds, but less predictably, a full 59% of hospitals of up to 300 beds were Epic shops as well. (For an alternate look at acute care EMR market share, check out the stats on systems with the highest number of certified users.)

When it came to which EMR the physician used in their own practice, however, the market looks a lot tighter. While 18% of respondents said they used Epic, 7% reported using Allscripts, 6% eClinicalWorks, 5% Cerner, 4% athenahealth, e-MDs and NextGen, 3% Greenway and Practice Fusion and 2% GE Healthcare. Clearly, have remained open to a far greater set of choices than hospitals. And that competition is likely to remain robust, as few practices seem to be willing to change to competitor systems — in fact, only 9% said they were interested in switching at present.

To me, where the report got particularly interesting was when peer60 offered data on the “net promoter scores” for some of the top vendors. The net promoter score method it uses is simple: it subtracts the percent of physicians who wouldn’t recommend an EMR from the percent who would recommend that EMR to get a number from 100 to -100. And obviously, if lots of physicians reported that they wouldn’t recommend a product the NPS fell into the negative.

While the report declines to name which NPS is associated with which vendor, it’s clear that virtually none have anything to write home about here. All but one of the NPS ratings were below zero, and one was rated at a nasty -73. The best NPS among the ambulatory care vendors was a 5, which as I read it suggests that either physicians feel they can tolerate it or simply believe the rest of the crop of competitors are even worse.

Clearly, something is out of order across the entire ambulatory EMR industry if a study like this — which drew on a fairly large number of respondents cutting across most hospital sizes and specialties — suggests that doctors are so unhappy with what they have. According to the report, the biggest physician frustrations are poor EMR usability and a lack of desired functionality, so what are we waiting for? Let’s get this right! The EMR revolution will never bear fruit if so many doctors are so frustrated with the tools they have.

Enterprise EHR Vendors Consolidating Hold On Doctors

Posted on September 9, 2016 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.

When I stumbled across a recent study naming the EHRs most widely used by physicians, I don’t know what I expected, but I did not think big-iron enterprise vendors would top the list. I was wrong.

In fact, I should have guessed that things would play out this way for giants like Epic, though not because physicians adore them. Forces bigger than the Cerners and Epics of the world, largely the ongoing trend towards buyouts of medical groups by hospitals, have forced doctors’ hand. But more on this later.

Context on physician EHR adoption
First, some stats for context.  To compile its 2016 EHR Report, Medscape surveyed 15,285 physicians across 25 specialties. Researchers asked them to name their EHR and rate their systems on several criteria, including ease of use and value as a clinical tool.

When it came to usage, Epic came in at first place in both 2012 and 2016, but climbed six percentage points to 28% of users this year. This dovetails with other data points, such that Epic leads the hospital and health system market, according to HIT Consultant, which reported on the study.

Meanwhile, Cerner climbed from third place to second place, but it only gained one percentage point in the study, hitting 10% this year. It took the place of Allscripts, which ranked second in 2012 but has since dropped out of the small practice software market.

eClinicalWorks came in third with 7% share, followed by NextGen (5%) and MEDITECH (4%). eClinicalWorks ranked in fifth place in the 2012 study, but neither NextGen nor MEDITECH were in the top five most used vendors four years ago. This shift comes in part due to the disappearance of Centricity from the list, which came in fourth in the 2012 research.

Independents want different EHRs
I was interested to note that when the researchers surveyed independent practices with their own EHRs, usage trends took a much different turn. eClinicalWorks rated first in usage among this segment, at 12% share, followed by Practice Fusion and NextGen, sharing the second place spot with 8% each.

One particularly striking data point provided by the report was that roughly one-third of these practices reported using “other systems,” notably EMA/Modernizing Medicine (1.6%), Office Practicum (1.2%) and Aprima (0.8%).

I suppose you could read this a number of ways, but my take is that physicians aren’t thrilled by the market-leading systems and are casting about for alternatives. This squares with the results of a study released by Physicians Practice earlier this year, which reported that only a quarter of so of practices felt they were getting a return on investment from their system.

Time for a modular model
So what can we take away from these numbers?  To me, a few things seem apparent:

* While this wasn’t always the case historically, hospitals are pushing out enterprise EHRs to captive physicians, probably the only defensible thing they can do at this point given interoperability concerns. This is giving these vendors more power over doctors than they’ve had in the past.

* Physicians are not incredibly fond of even the EHRs they get to choose. I imagine they’re even less thrilled by EHRs pushed out to them by hospitals and health systems.

* Ergo, if a vendor could create an Epic- or Cerner-compatible module designed specifically – and usably — for outpatient use, they’d offer the best of two worlds. And that could steal the market out from under the eClinicalWorks and NextGens of the world.

It’s possible that one of the existing ambulatory EHR leaders could re-emerge at the top if it created such a module, I imagine. But it’s hard for even middle-aged dogs to learn new tricks. My guess is that this mantle will be taken up by a company we haven’t heard of yet.

In the mean time, it’s anybody’s guess as to whether the physician-first EHR players stand a chance of keeping their market share.

Practice Fusion Settles FTC Charges Over “Deceptive” Consumer Marketing

Posted on June 20, 2016 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.

In what may be a first for the EMR industry, ambulatory EMR vendor Practice Fusion has settled Federal Trade Commission charges that it misled consumers as part of a campaign to gather reviews for its doctors.

Under the terms of the settlement, Practice Fusion agreed to refrain from making deceptive statements about the privacy and confidentiality of the information it collects from consumers. It also promised that if it planned to make any consumer information publicly available, it would offer a clear and conspicuous notice of its plans before it went ahead, and get affirmative consent from those consumers before using their information.

Prior to getting entangled in these issues, Practice Fusion had launched Patient Fusion, a portal allowing patients whose providers used its EMR to download their health information, transmit that information to another provider or send and receive messages from their providers.

The problem targeted by the FTC began in 2012, when Practice Fusion was preparing to expand Patient Fusion to include a public directory allowing enrollees to search for doctors, read reviews and request appointments. To support the rollout, the company began sending emails to patients of providers who used Practice Fusion’s EMR, asking patients to review their provider. In theory, this was probably a clever move, as the reviews would have given Practice Fusion-using practices greater social credibility.

The problem was, however, that the request was marketed deceptively, the FTC found. Rather than admitting that this was an EMR marketing effort, Practice Fusion’s email messages appeared to come from patients’ doctors. And the patients were never informed that the information would be made public. And worse, a pre-checked “Keep this review anonymous” only withheld the patient’s name, leaving information in the text box visible.

So patients, who thought they were communicating privately with their physicians, shared a great deal of private and personal health information. Many entered their full name or phone number in a text box provided as part of the survey. Others shared intimate health information, including on consumer who asked for dosing information for “my Xanax prescription,” and another who asked for help with a suicidally depressed child.

The highly sensitive nature of some patient comments didn’t get much attention until a year later, when EMR and HIPAA broke the story and then Forbes published a follow up article on the subject. After the articles appeared, Practice Fusion put automated procedures in place to block the publication of reviews in which consumers entered personal information.

In the future, Practice Fusion is barred from misrepresenting the extent to which it uses, maintains and protects the privacy or confidentiality of data it collects. Also, it may not publicly display the reviews it collected from consumers during the time period covered by the complaint.

There’s many lessons to be gleaned from this case, but the most obvious seems to be that misleading communications that impact patients are a complete no-no. According to an FTC blog item on the case, they also include that health IT companies should never bury key facts in a dense privacy policy, and that disclosures should use the same eye-catching methods they use for marketing, such as striking graphics, bold colors, big print and prominent placement.

Practice Fusion Founder Launches Wearables Startup

Posted on May 31, 2016 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.

Free EMR vendor Practice Fusion has always been something of a newsmaker. Since its launch in 2005, the company has drawn both praise and controversy for its revenue-generation approach, which has included the analysis and sale of de-identified patient data and advertising to physicians.

But it’d be hard to question Practice Fusion’s success, particularly given that it found its legs during a hyper-competitive period of EMR vendor growth capped by the Meaningful Use incentive program. Over the company’s lifespan, it has grown to serve over 110 million patients, and reportedly supported more than 70 million patient visits over 2015. It also attracted over $150 million in venture and private equity funding. Will it provide a great return for investors, time will tell, but they’ve definitely left their mark on the EHR industry.

At the helm of Practice Fusion until last year was CEO and Founder Ryan Howard. Howard – whom I’ve interviewed now and again over the years — certainly doesn’t lack for confidence or creative thinking. So I was intrigued to learn that Howard has stuck his toe into the wearables market. Clearly, Howard has not wasted time since August 2015, when he was booted out as Practice Fusion CEO. And if he believes a wearables startup can make money in this rapidly-maturing niche, I’m inclined to give it a look.

Howard’s new startup, dubbed iBeat, is creating a watch which constantly monitors and analyzes users’ heart activity. The device, which transmits its data to a cloud platform, can alert emergency medical services and, using an onboard GPS, provide the wearer’s location when a user has a heart attack or their heart slows down below a certain level. Unlike competitor AliveCor, whose electrocardiogram device can detect heart rhythm abnormalities such as atrial fibrillation, it has no immediate plans to get FDA approval for its technology.

iBeat expects to sell the device for less than $200, though if users want the emergency alert service they’ll have to pay an as-yet unnamed extra monthly fee. That puts it smack in the middle of the pack with competitors like the Apple Watch. However, the startup’s focus on cardiac events is fairly unusual. Another unusual aspect to the launch is that Howard is targeting the 50- to 70-year-old Baby Boomer market. (Imagine a more-focused version of the LifeAlert “I’ve fallen and I can’t get up” service, which focuses on the 75-plus market, Howard told MobiHealthNews.)

My take on all of this is that there may very well be something here. As I wrote about previously, my own heart rhythm is being monitored by a set of devices created by Medtronic, a set-up which probably cost a few thousand dollars in addition to the surgical costs of implanting the monitoring device. While Medtronic’s technology is doubtless FDA approved, for not-so-serious cases such as my own a $200+ plus smart watch might be just the ticket.

On the other hand, I doubt that uncertified devices such as the iBeat watch will attract much support from providers, as they simply don’t trust the data. So consumers are really going to have to drive sales. And without a massive consumer marketing budget, it will be difficult to gain traction in a niche contested by Apple, Microsoft, Fitbit and many, many other competitors. Not to mention all the competitors in the “I’ve fallen and I can’t get up” category as well.

Regardless of whether iBeat survives, though, I think its strategy is smart. My guess is that more-specialized wearables (think, I don’t know, iSugar for diabetics?) have a bright future.

Dumb Question 101: What’s Workflow Doing in an EHR?

Posted on March 29, 2016 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.

This was going to be a five year relook at Practice Fusion. Back then, I’d written a critical review saying I wouldn’t be a PF consultant. Going over PF now, I found it greatly changed. For example, I criticized it not having a shared task list. Now, it does. Starting to trace other functions, a question suddenly hit me. Why did I think an EHR should have a shared task list or any other workflow function for that matter?

It’s a given that an EHR is supposed to record and retrieve a patient’s medical data. Indeed, if you search for the definition of an EHR, you’ll find just that. For example, Wikipedia defines it this way:

An electronic health record (EHR), or electronic medical record (EMR), refers to the systematized collection of patient and population electronically-stored health information in a digital format.[1] These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.[2]

Other definitions, such as HIMSS are similar, but add another critical element, workflow:

The EHR automates and streamlines the clinician’s workflow.

Is this a good or even desirable thing? Now, before Chuck Webster shoots out my porch lights, that doesn’t mean I’m anti workflow. However, I do ask what are workflow features doing in an EHR?

In EHRs early days, vendors realized they couldn’t drop one in a practice like a fax machine. EHRs were disruptive and not always in a good way. They often didn’t play well with practice management systems or the hodgepodge of forms, charts and lists they were replacing.

As a result, vendors started doing the workflow archeology and devising new ones as part of their installs. Over time, EHRs vendors started touting how they could reform not just replace an old system.

Hospitals were a little different. Most had IT staff that could shoehorn a new system into their environment. However, as troubled hospital EHR rollouts attest, they rarely anticipated the changes that EHRs would bring about.

Adding workflow functions to an EHR may have caused what my late brother called a “far away” result. That is, the farther away you were from something, the better it looked. With EHR workflow tools, the closer you get to their use, the more problems you may find.

EHRs are designed for end users. Adding workflow tools to these assumes that the users understand workflow dynamics and can use them accordingly. Sometimes this works well, but just as often the functions may not be as versatile as the situation warrants. Just ask the resident who can’t find the option they really need.

I think the answer to EHR workflow functions is this. They can be nice to have, like a car’s backup camera. However, having one doesn’t make you a good driver. Having workflow functions shouldn’t fool you into thinking that’s all workflow requires.

The only way to determine what’s needed is by doing a thorough, requirements analysis, working closely with users and developing the necessary workflow systems.

A better approach would be a workflow system that embeds its features in an EHR. That way, the EHR could fit more seamlessly its environment, rather than the other way around.

Practice Fusion Cuts 25% of Staff

Posted on February 4, 2016 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 our post a few weeks ago about the potential Practice Fusion IPO, news just came out that EHR vendor, Practice Fusion, has now cut its staff by 25%. The Techcrunch report says that the cuts were across the board and affected roughly 74 people. Many are suggesting that the two reports are related since cutting staff is a great way to improve your profit numbers before an anticipated IPO.

While I think the IPO could be in mind, I think there are likely some other trends at play too. While Techcrunch notes that it’s a down market for many IT companies, I think it’s fair to say that many EHR vendors have felt the pinch of late. I wrote a year or so ago that the golden era of government incentivized EHR sales was over and we’re entering a much different market. So, it shouldn’t be a surprise that an EHR vendor might go through some cuts as the false market created by meaningful use disappears. I won’t be surprised to see more layoffs from other EHR vendors. Especially ambulatory EHR vendors like Practice Fusion.

No doubt another factor at play is that Tom Langan replaced Ryan Howard as CEO back in August. It’s very common for a new CEO to go through a round of layoffs after taking over a business. Doing so is hard for the previous CEO who’s so connected to the staff. Not that layoffs are ever easy, but it’s much easier for a new CEO to layoff people in order to make the organization more efficient. That’s particularly true when the previous CEO was the original CEO and Founder of the company.

The cynical observer could also argue that Practice Fusion needed to do these layoffs in order to slow their burn rate since they aren’t in a position to raise more capital. You’d think the $150 million they already raised would give them plenty of run way. However, you’d be surprised how quickly that disappears with that many staff on payroll (Not to mention rents in San Francisco). I personally don’t think this is a case of Practice Fusion cutting staff because they can’t go and raise money. However, it could be Practice Fusion cutting its burn rate so that they have some flexibility on when they go public without having to raise more money.

All of this said, 74 people lost their jobs at an EHR vendor. That’s never fun for anyone involved. At least they’ll likely have plenty of job opportunities in silicon valley. Unless that bubble pops like some are suggesting. It will be interesting to see how many now former Practice Fusion employees search for another job in health care IT.

Is Practice Fusion Heading for an IPO?

Posted on January 21, 2016 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 New York Times recently reported that Practice Fusion is said to have hired JP Morgan Chase to evaluate an IPO. Here’s a look at the estimated IPO number for Practice Fusion according to the New York Times:

Practice Fusion later created a way to estimate its I.P.O. valuation if revenue came in at $155 million in 2018 instead of $181 million, according to one of the people. Using the lower revenue assumption, the company could command a valuation of $1.1 billion to $1.2 billion if it goes public. It is unclear if the lower revenue estimate was made in response to the market turmoil.

Practice Fusion itself is of course not really commenting on their plans for an IPO or not. However, since it has raised $149 million to date at a valuation of $635 million, you have to imagine that an IPO is in their future. However, many big silicon valley companies have stuck to the private market lately and avoided the IPO. I’m not sure Practice Fusion will be in a similar position to them though. A look at their revenue numbers is one indication of why they’re a bit different than other companies that have raised larger rounds in the private markets:

Practice Fusion’s revenue was $26.9 million in 2014 and was expected to increase by 71 percent to $46.1 million in 2015, with the company projecting it would pare losses by 40 percent to $25.8 million in 2015, according to the document prepared by bankers and the company.

At the time the document was prepared, the company estimated revenue would hit $70 million in 2016.

I personally think that an IPO is in Practice Fusion’s future. It’s just a question of when it will happen. Certainly the market volatility we’ve seen lately isn’t helping their case to do an IPO. However, I bet the bigger challenge is going to be creating attractive revenue numbers that make sense to the public markets. I believe public markets have a hard time valuing number of users and other metrics that make Practice Fusion look attractive.

Ever since the first venture capitalists asked me about Practice Fusion, I’ve said that the company has created value. The number of doctors they were able to sign up on their platform was impressive. That’s the power of offering something for free that other doctors pay hundreds of thousands of dollars to buy. No doubt their network of physician users is a valuable asset. I hope it is since they raised $149 million to build it.

The real question for me around Practice Fusion isn’t whether they created value. Instead, the question is how valuable is what they created? I once heard Peter Thiel suggest at their user conference that Practice Fusion was building the platform for healthcare. Building that would be worth multiple billions of dollars. However, Practice Fusion hasn’t built anything close to that since Practice Fusion is doing nothing in the hospital EHR space. It’s naive to think that Practice Fusion could compete in that piece of healthcare. Not to mention they have a very small part of the hospital owned ambulatory practice space where the trend is to go with the integrated hospital EHR solution.

Long story short, I think that Practice Fusion will do an IPO. I could even see them doing an IPO for a billion dollars. I’m sure that’s what Ryan Howard, Practice Fusion Founder and former CEO, wants so he can claim his startup unicorn status. Although, I’ll be interested to see how Practice Fusion’s revenue grows between now and an IPO. The golden age of EHR is over and we’re entering the dirty slog of EHR sales and EHR switching. I don’t think that makes for a compelling story for investors.

Practice Fusion’s Free Chromebook Comes at a High Price

Posted on February 4, 2014 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.

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.

Health IT Venture Funding For EMRs At Low Ebb

Posted on January 17, 2014 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.

For several years, most health IT venture funding has focused either on EMRs or data and network infrastructure to support EMRs.  With the EMR market arguably completely saturated, it seems the money is flowing in a different direction.

According to a new report by Mercom Capital Group covered in iHealthBeat, health IT venture capital funding hit  $2.2 billion across 571 deals in 2013, nearly double the $1.2 billion and 163 deals executed in 2012.

So where did the money go? According to Mercom, consumer-centric health IT companies raised $1.1 billion, personal health companies raised $198 million and social health companies raised $166 million last year.  The mobile healthcare sector raised almost $564 million, not surprising at all given the speed at which mobile health is accelerating.

Meanwhile, roughly $1.1 billion was raised by medical practice centric companies, including $179 million by population health companies, $162 million but practice management companies and a scant $166 million by EMR companies.

According to the report the top five venture funded companies of 2013 were Evolent Health, which raised $100 million, Practice Fusion, which raised $85 million, Fitbit, which raised $73 million, MedSynergies, which raised $65 million, and Proteus Digital Health, which raised $45 million.

So, as it turns out, Practice Fusion took the lion’s share of EMR venture funding last year, leaving the rest of the industry to scavenge for what remained in terms of VC interest.

What does it say in terms of the health of the EMR business?  Well, it’s not necessarily a sign of anything terribly negative in terms of EMR vendors’ future; after all, you’re not seeing a lot of new EMR companies jumping into the business, for good reason.

On the other hand, it does suggest that the market for EMRs has solidified, and is not perceived to have dramatic growth potential by VCs.  I suppose we shouldn’t be surprised or concerned for that matter. If EMR vendors aren’t in explosive growth mode at this point, it’s just because they’re serving the customers they’ve got. It could be worse.

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?