Free EMRs: Too Good to be True?
When Allison Blazek, MD, left M. D. Anderson Cancer Center to open her private practice in June 2008, she figured EMRs, rather than paper, made the most sense. After talking with vendors and pricing EMRs, however, Blazek began thinking paper records might be the wiser option after all.
"All of them were going to be tens of thousands of dollars, and I would have to close my practice for a week, and for some I would have to pay for the training," she says. "Starting out new, I thought, 'I'm not going to go into debt trying to get an EMR. I'd rather keep my overhead low.'"
Then, Blazek heard about San Francisco—based Practice Fusion, which offers a free Web-based EMR system. The company is funded by advertising so that when a physician uses the EMR, similar to Google's AdSense program, the system recognizes keywords and sends condition-specific ads from insurers, medical equipment suppliers, and pharmaceutical companies to the EMR page.
"Initially, it was extremely bare-boned, but it did what I needed it to do at the time," she says. "There is this fear that it is too good to be true and that something bad will happen. I've been using it for a year-and-a-half and it has only gotten better."
Initially, Blazek was using the system simply to view the patient's history, look up allergy information, and take notes. But she adds that Practice Fusion has been steadily adding features over time.
"When they got scanned documents, it was a huge deal," she says, explaining that she used to have to store lab charts as paper. Now, she can scan labs and store them on Practice Fusion's servers. Practice Fusion has partnered with Quest Diagnostics so labs will automatically drop into the patient record, and Blazek is hopeful that a similar deal with LabCorp will come along soon.
"The last important piece for me was online prescribing, and they came out with that in January," she says.
David Wyatt, MD, who operates a weight loss and bariatric practice with three locations in Atlanta, is also a fan of the Practice Fusion system. "No one is going to argue with the cost," Wyatt says.
Wyatt signed on in 2008 after he determined the hosted solution was secure. He also wanted something that was easy to use and customizable to his specialty. He says he's satisfied with the system thus far, but is looking forward to some of the applications that are still on the way, such as a patient portal and the ability to share medical records with other providers in a manner that is HIPAA-compliant.
Where's the catch?
The price point is the selling feature for free EMRs, such as Practice Fusion's system or NEPSI (National ePrescribing Patient Safety Initiative), the free e-prescribing application from Chicago-based software vendor Allscripts, says Steven E. Waldren, MD, director of the American Academy of Family Physicians' Center for Health IT. It's often a commercial project that is being repurposed.
"Many times they are not open source, so you can't get access to code," Waldren says.
Before physicians sign up, they should read license and privacy agreements closely to determine what services the vendor is providing, says Waldren.
The following are some key topics to ask about:
- Meaningful use. Providers need to meet the meaningful use requirements for EMRs as outlined in the HITECH portion of the American Recovery and Reinvestment Act of 2009 to claim their share of the incentive payments. The EMR also needs to be from a certified vendor. Providers should have the vendor put in writing that it will meet these certification and meaningful use requirements, advises Waldren.
- System requirements. Physicians should ask what types of hardware or software they will need to use the system. For example, Practice Fusion's system requires only the basics—a computer and scanner. However, Blazek purchased Adobe Acrobat so that her scanned documents could be converted to a PDF format and stored more easily in the system, rather than using JPEGs.
- Support. Physicians should determine whether help desk support is provided. Does the vendor offer only basic services? Does it offer training support? Practice Fusion provides training videos online, says Blazek. She can also call or message tech support.
- Security. An easy place to start is to ask about regulatory requirements, says Waldren. Does the vendor meet HIPAA privacy regulations? Would it pass the Certification Commission for Health Information Technology's privacy and security standards?
Waldren says physicians should learn about all of the offerings available to them—open source, closed source, and free. "Don't just say, 'I'm only going open or closed source or going to use one of these two companies because that is what the two practices down the road are using.'"