Records in Cyberspace

Electronic medical record systems make plenty of promises—reduced costs, fewer errors and better outcomes, among them. The technology’s potential to improve healthcare delivery in the United States has generated broad industry appeal; the Bush administration has called on the nation’s healthcare providers to fully adopt EMR by 2014.

Yet such enthusiasm often fades quickly when physician groups shopping for EMR systems encounter the daunting issues of price, mind-crushing complexity and a lack of industrywide standards of compatibility among operating systems. Many fear that as universal standards are adopted, the $20,000 EMR system a physician group buys today could be worthless in just a few years. Nobody wants to get stuck with the EMR equivalent of Betamax.

Maintaining records online is one way some smaller providers are looking to take the EMR plunge without some of the usual logistical headaches—especially if it doesn’t cost anything. One San Francisco-based company, Practice Fusion Inc., has crafted a deal with Google to offer physicians a free Web-based EMR system that is funded entirely by advertising. When a physician uses the EMR to review a patient’s records, Google’s AdSense program recognizes keywords and sends condition-specific ads from insurers, medical equipment suppliers and pharmaceutical companies to the patient’s EMR page.

“It’s hosted, so if there is a change in HIPAA standards or CCHIT standards, we can make the changes on our system,” Practice Fusion Chief Executive Officer Ryan Howard says. “They’ll just continue to use the database. We can make changes perpetually to the system, and for them there is no rip and replace, no new investment in software.”

Internet-based record systems are not a new phenomenon and have yet to see widespread provider adoption. But the prospect of paying nothing for the technology could prompt more physician groups to make the leap. Physicians Integrated Medical Group in San Francisco was already considering an EMR system when Practice Fusion sweetened the deal by removing the price tag, says CEO Jim Rodriguez. The independent physician group will install electronic claims billing this month and expects to have about 75 percent of the group’s 500 physicians use electronic billing. An EMR was the next logical step, Rodriguez says, because less than 20 percent of PIMG’s physicians have made the move away from paper medical records.

Rodriguez believes online record-keeping could help groups like his overcome the sizable obstacles of compatibility and usability. “It’s going to take a while to get everybody to change from paper to EMRs, but if you could have a product that is easy enough to use and it gives you a fair amount of information at your fingertips, the compliance will come around fairly rapidly,” he says.

Linking keywords in patient data with an advertising-supported Web search engine has raised some eyebrows among privacy advocates. But Rodriguez says he’s not overly concerned with EMR privacy or security issues in an arrangement with a program like AdSense. “They are fully HIPAA compliant, and they have a fair amount of safeguards in place for that data to remain where it needs to be: safe and secure,” he says, adding that another concern—pharmaceutical advertising unduly affecting physician care—is also unfounded. “Physicians constantly have a lot of drug salesmen come by their office every day. They get a fair amount of literature in the mail. Now, they’ll just see it on the screen,” he says. “Maybe it’s better for them that way. They will have the option of clicking on it or not.”

Practice Fusion offers physicians the option of blocking the ads in its online EMR by paying a $250 monthly service fee. Howard says that’s an expensive and unlikely option for larger physician groups, however. “At the end of the day, $250 a month per physician might not seem like a lot, but if you’re selling to a large group of, say, 1,000 doctors, that is a tremendous cost—$3 million a year.”

—John Commins