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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.