Many of you probably realize how much fun I have ragging on the SaaS (hosted) EMR model. I admit that I love playing devil’s advocate. I think that’s what makes me great when working with an EMR, but I digress. What people don’t realize is that I really love the SaaS EMR model and I think it’s just as viable an option as a client server EMR. I just haven’t drank the Kool-aid for either side yet.
With that background, I was excited for the chance to do an interview with one of the biggest fans of the SaaS EMR model, Practice Fusion. In fact, they’ve even taken it one step further in providing a free, ad-based EMR. The following is an email interview I did with Practice Fusion CEO, Ryan Howard.
Give us a summary of Practice Fusion for those who aren’t familiar with the company.
Practice Fusion provides a free, web-based EHR for physicians. We’re the fastest growing electronic health record community in the country, just passing the 20,000 user mark in September. Our system includes charting, scheduling, integrations with lab networks and billing providers, eRx (in October) and unlimited support – all at no cost.
What guarantee do you provide to users that are concerned about their data being stored offsite?
Our guarantee to our physicians is that Practice Fusion provides a level of service that is dramatically higher than they could ever do on their own. From a practice’s perspective, they have access to world-class infrastructure that only a Fortune 500 company could afford. This includes data redundancy, automated back-ups, biometric security, Cisco firewalls and bank-level encryption. For a physician to build this independently would cost millions of dollars.
What about those who might be concerned that Practice Fusion might not be around forever (always a possibility) or will be acquired by another EMR vendor and they’ll be unable to get access to their EMR data to move if they wish?
A practitioner always retains ownership of their data. They can choose to export their data from our system at any time – just as we offer free uploads of data into the EMR, our team will also assist with free exports as requested. This would be true in the highly-unanticipated event of a merger or closure of our system as well.
Do you provide any mechanisms for doctors to take their data from your system and move to another EMR?
Practices using our EHR always retain ownership of their data and can export any time if needed. Just as we offer free imports of data into our system, our support team can also assist with extracting records to be transferred to a different EMR.
What do you tell doctors who are concerned about how they’ll continue seeing patients if their internet goes down?
There’s risk with both paper and electronic methods. Think about what a doctor does in his office with paper records: what happens if the offices burns down or records are stolen?
Internet connectivity is generally a concern for all internet-based models. Practice Fusion has a number of ways to circumvent this issue. While a doctor is using our EHR, data entered about the patient is constantly being saved. If the computer crashes or the internet fails, the visit is automatically saved. The physician can log back in, pick up where the session was lost and continue directly with patient.
Specific to the operations of a practice facing long-term downtime issues with their broadband company: Practice Fusion has partnerships with various hardware providers who offer network redundancy utilities for physicians. For example, these systems can seamlessly transition to a cellular network if there is a broadband issue in the office.
How will Practice Fusion be approaching EHR certification and the billions of dollars in EHR stimulus money?
Practice Fusion is pushing toward HHS certification aggressively. Our physician team – Dr. Laffel and Dr. Rowley – has been working closely with the HIT committee and other thought-leaders throughout the past year to ensure that the final criterion for “meaningful use” reflects what is best for physicians and patients. The criteria for EHR certification are still in development but we’re certain that Practice Fusion’s system will meet the requirements. And, if something emerges that we weren’t expecting in that process, Practice Fusion’s SaaS-based platform allows us a degree of flexibility that other systems can’t match. We’re very comfortable with the certification road ahead.
What effect do you think the EHR stimulus money will have on adoption of EHR software?
It’s the silver bullet. The EHR stimulus incentives are helping to push widespread EHR adoption in a sector that has traditional been hesitant to make the switch away from paper. And, honestly, physicians were hesitant for good reason considering the expensive, bulky, IT-intensive solutions that dominated the market in the past.
Now, things are changing quickly and the market is in a frenzy. Vendor bottlenecks are already becoming an issue with the surge in demand. Traditional EHR systems with 12+ week integration schedules can’t keep up with requests. I see Practice Fusion’s five minute online set-up process, Live in Five, as a big advantage in the market as this tidal wave approaches.
Which standards are Practice Fusion adopting to provide for portability of data between Practice Fusion and other EHR vendors?
Practice Fusion’s open platform accommodates HL7, CCR and XML portability. And as one of the only true SaaS based EHR’s, we can quickly adapt our system as new portability standards emerge.
Practice Fusion will also be launching an innovative new feature called Chart Share at Health 2.0 this fall. This system allows physicians to securely share crucial patient data with other providers at no cost with no integration. It’s a major step toward collaborative care and will allow doctors who don’t have interconnected EHR technology or haven’t made the switch to an EHR to still receive and use digital records in their practice.
Describe 3 specific features which make Practice Fusion special (not including your pricing plan).
- Practice Fusion is the only EHR with a true SaaS-based model. Other vendors – such as eClinicalWorks and Allscripts – claim to be SaaS but in fact use old-school ASP technology.
- Our ‘Live in Five’ set-up process is unique in the market. Physicians who are interested in Practice Fusion’s EHR can sign up online and start charting in five minutes. An entire practice can be set up in a single afternoon. No risks, no consultants, no downtime – fast and simple integration is key.
- I am also proud of Practice Fusion’s advances in connectivity. Physician using our free EHR can access integrated Surescripts along with real-time Quest Diagnostics and BioReference labs within the system. And we’re constantly working on adding new integrations to this list based on our community requests. With Practice Fusion, doctors are set-up with these sophisticated integrations with no cost and no development time.
What technologies and devices do you think will be the future of EMR software?
I fundamentally believe that the only way to solve the problem of national adoption of EMRs is to accommodate physicians through a web or cloud-based platform. Once this is implemented, the benefit will be unprecedented. Central reporting and trending of patients’ chronic conditions will enable providers and caretakers to identify emerging trends and truly perform evidence-based medicine.
What is needed is a unified platform to be a conduit between patients and their doctors. There are a lot of devices – such as Continua and smart phone applications – that monitor patients’ chronic conditions. The challenge is to integrate this data in EMR’s in a meaningful way to improve the quality of care.
I would love to see a similar interview with the soapware folks. They have a similar service available now that seems to be growing.
Thanks for the great interview John, it really made me realize that the tone of these interviews is also very dependent on the interviewee, great questions, great answers.
[…] (10/5/2009): EMR Vendor Practice Fusion’s CEO Interview Sphere: Related […]
I agree with Brent. I really liked SOAPware when I demoed their EMR. One of the best point and click, pick-list, drop-down menu EMRs!
Wow, both web-based and free. (I wonder what their business model is!?)
I’ve said before that I believe the web-based model will win the day, as it isolates the physician from the technical issues, is platform-independent, and will be easier to “future-proof” against the inevitable interoperability issues to come.
Brent,
I’ll see what I can do. If you have any contacts at SOAPware, send them my way and I’ll try to make time to make it happen. Sometimes these interviews are hit and miss, but if you read them closely there are some good nuggets in them.
David,
I did a number of posts about Practice Fusion’s business model before. It should be found in one of these posts: https://www.healthcareittoday.com/tag/practice-fusion/
Basically, they are ad supported for their free EMR users. Otherwise, users can be ad free for I think $100 a month (which might be wrong and might have changed, but you get the point).
I’m not exactly sure why you think that a web based model is more interoperable than a client server model. Seems like they are interoperability advantages and disadvantages to both designs.
You get what you pay for. Right now they are burning through venture capital money. The ad based model and the $100 per month fee is untested. So, I would imagine they are running a huge deficit. The road is littered with ad-supported dot com companies who have gone bust. All I would say is caveat emptor.
Jonathan,
It’s an unproven model in the EMR world. Although, even outside the EMR world it’s a proven model that ends up selling to another larger company (for the most part). Definitely something to think about.
Of course, this is why I asked the questions about a doctor’s portability of data in the event that something happens to the company.
Practice consultants ordinarily scrutinize the product AND the underlying business model.
Many are very leery of anything remotely connected to the “dot bomb” days.
Axeo,
As so they should. The business model matters. Like it or not, if your EMR vendor isn’t around or if your EMR vendor sales to someone else, it’s a huge impact on your clinic.
Practice Fusion also makes money by selling anonymized patient and doctor data from its system to third parties, maintaining HIPAA compliance along the way. There is a potentially huge amount of money in data mining in the health care industry. I don’t see PF going broke very soon.
Jon,
Thanks I forgot to mention that part of their business model as well. I agree that they won’t be broke very soon. I’m quite sure they have enough VC money to last quite a few years as long as they keep their burn rate relatively low, they’ll be around for a couple years just off of the VC money I imagine.
Agreed. To the provider community, the biz model has to be acceptable and sustainable. Even if the software “works” (clearly not a given), what good is it if the end-user is constantly worried about the vendor machinations going on behind the curtains.
Founder and President Randall Oates: roates@soapware.com
Brent,
Do you have a connection with Randall? It always works better if someone makes the introduction.
Found the information at http://www.soapware.com/Company/Contact.aspx
He is very active in several forums I read. Many talk about the ease of communicating with him via email. It would be worth a shot to try his email.
Thanks Brent.
So much to do. So little time. I’ll see what I can do.
One thing for sure about Practice Fusion that is practically unique: You can try the whole package for free–no need for a demo, which you cannot say about all the other EHRs on the market. I hate the fact that all those other EHR companies refuse to allow one to self-demo the product before purchase. At best, other EHR companies may let you to try a gimped version with claims that it is free, while most only let you get a practiced demo from a salesperson–you cannot actually take the software home or to the office to try out before purchasing. If EHR companies allowed one to demo their software beforehand on real-world workflow situations, then a lot of EHR implementation failures would be prevented. What do you think, John?
Jon,
I agree 100% with you!
I believe that AmazingCharts allows you to use their complete program as a demo before purchasing.
It is so easy for these vendors to give you their complete program for 3 months or a limited number of patients, that I wonder why most don’t do this!
If you are a car dealer and you truly believe in your cars, you let the customer take it for a drive!
So … EMR Vendors … why don’t you let us have complete demo versions to try?
John, maybe they can answer this question for us or maybe we can try to guess!
I can tell you why… All it does is leave the user frustrated. EMR’s are not like Microsoft Word… there is a lot to it and a lot of ways to do it. Without training and implementation you would be lost! Vendors know this and that is why they walk you through it rather than let you become frustrated to the point of never buying. If you fear the investment then find a company who will offer you a refund. There are several that will.
I’ve actually seen a bunch of EMR companies where you can try out their EMR before purchasing. The problem from what I’ve seen hasn’t been the lack of availability to test drive the EMR, but clinicians finding the time to demo the various EMR. That’s a lot of work and time for them to commit and many either don’t have the interest or desire to make that commitment.
With that said, there are some major EMR players that don’t have a full demo/test drive of their system and for good reason. It’s too complex for them to set it up quickly to allow a demo. I think that should say something as well;-)
Tom,
The problem is that far too many EMR vendors don’t “walk you through it rather than let you become frustrated to the point of never buying.” They’ve made the sale and have moved on to the next sale. Long term they’re going to have trouble, but then they’ll have their executive bonuses and be gone (at least many of them).
EMR Vendors could easily set up 10 sample patients with labs, x rays, consultation and hospital reports. They could then give doctor a copy of their software to use with these patients. Doctors could then practice doing progress notes with these patients and practice checking labs and reports using the messaging function.
They key is to let doctors practice with the software doing progress notes. Using the pick lists, the drop down menus, etc. They also need to see how the program tracks and organizes the wellness, health maintainance information (mammograms, colonoscopies, flu shots, HgA1C, etc) and chronic problem data (HgA1C, FBG, Eye Exam, etc).
This is not hard to do and the vendors are not wise if they don’t do this.
The doctor’s main concern is “can I do this”? Will it make me more productive or less productive?
I would love to see a list of EHR companies that have software that is easy enough to use that they would dare put out a demo. I think more docs are becoming computer-savy. If an EHR is too complex to figure out the basics without a customer rep, forget it. Most EHR programs out there seem to still have graphical interfaces that resemble something written in the MS-DOS era or at best, a very old Windows version. If the GUI is bad with a zillion symbol-labeled tabs, you can’t expect much from the user-friendly side of things.
Jeff,
I think the thing you’re missing is that there almost need to be 2 demo systems. One should be a fully loaded system with test patients, results, etc just as you describe. However, I think it’s also very valuable to know what you get when the actual install happens. It’s important to know how much configuration is ahead of you when you get the system. You might love the set of alerts that they have in their system, but then when you get the actual install you find out that they aren’t included in the install for some reason or another.
Point being that a demo system is not the same as what people are given out of the box.
Jon,
I hear you’re call for a list and so a new post will appear tomorrow asking for EMR vendors to let us know who offers an EMR demo of their product. We might just have to make a special page on the EMR, EHR and HIPAA wiki for those that do have demos: http://emrandhipaa.com/wiki/Main_Page What do you think?
[…] example of a discussion that began in the comments is around the benefit of being able to be given a demo EMR system that you can sit down and try. I’m not talking about a demo of the EMR software by someone […]
I must agree with Tom in that EMR vendors are hesitant to give demos to docs that may not know how to fully use the product. We test drive cars because we all know how to drive and national standards and regulations keep the mechanics and operating protocols of a vehicle pretty much the same across the board. And @ Jon, I hear ya and agree that if the EMR is too complicated to operate without a rep its probably not worth it….However, though docs may be able to basically navigate on their own, how can vendors be totally confident that docs will be able to EFFICIENTLY navigate (or take the time to before becoming frustrated) in order to understand the tools that are going to save time and money in the long run? One solution I see is giving a “mini-implementation” and then allowing providers to test-run the product. However, Im not sure how many vendors would be willing to invest time into a potentially profitless implementation–even if just a brief overview.