Free EMR’s Meet Physicians’ Fiscal Needs
Like their clinical colleagues, physicians in smaller, office-based practices are also faced with the looming deadlines related to Meaningful Use and adoption of electronic medical records (EMRs)
USA (March 29, 2011) –
Like their clinical colleagues, physicians in smaller, office-based practices are also faced with the looming deadlines related to Meaningful Use and adoption of electronic medical records (EMRs)
Unlike their hospital-based brethren, these physicians are faced with tight IT budgets, prompting many to question whether it is worth their time, effort and money to invest in a new digital system that may disrupt daily workflows and elicit concerns over security.
“I had been looking at EMRs and was wondering how I could possibly afford it, because margins are pretty tight in family practice,” explains Dr. Lynn McCallum, whose practice is based in Redding, Calif. Dr. McCallum had given thought to low-cost solutions from Amazing Charts and eClinical Works, and those in development from CollaborateMD and Epocrates, but had trouble overcoming the sticker-shock. She was equally discouraged by reports that detailed legacy EMR systems as hard to implement and maintain, and worst-case scenarios of physicians switching systems after just a few years.
“You take out this huge loan to get this legacy system in place, and you get rid of it before you’ve even paid it off?” she asks. “That doesn’t make any sense to me financially. Why get in the car if you can’t afford to drive it?”
Changing the Business Model
Dr. McCallum is not alone. Some physicians are aligning themselves with local hospitals, which in return may offer healthcare IT ( HIT ) subsidies if physicians use certain HIT vendors. Those that want to remain independent are taking a long, hard look at free EMR products in an effort to counter cash-flow problems related to a shrinking patient base and late payments from insurers.
Vendors like Practice Fusion and Mitochon Systems both offer successful free EMR solutions, and make their money via the third-party advertising incorporated into their products. “It’s ironic that all of our paid competitors are $45,000 to $60,000 as a total cost of ownership over the next five years,” says Chris Riley, CEO of Mitochon Systems. (Providers who use EMRs and meet certain requirements may be eligible to receive up to $44,000 over five years through Medicare, or up to $63,750 over six years through Medicaid.)
Physicians who choose to pay for an EMR are in essence, according to Riley, spending the ARRA incentive money they hope to get back after implementation. “As Blumenthal said, physicians aren’t really the beneficiaries of the stimulus funding, they’re just the guardians of it, because they’re going to give it to a vendor,” Riley says. “In our case, we leave it in their pockets to develop their practices.”
Overcoming the Stigma of “Free” Dr. McCallum, who has been a Practice Fusion customer since 2009 and officially paperless since the beginning of this year, often gets looks of surprise when she tells colleagues she uses a free EMR . “There is some kind of stigma associated with the word ‘free.’ Initially they think it can’t be any good because it’s free,” she says. “Once I show them some of the documents it produces, they’re quite shocked at how really good it is.
“As with anything that follows a free model, you have to prove the legitimacy of the product,” explains Dr. Robert Rowley, CMO at Practice Fusion and owner and medical director of Hayward Family Care in Hayward, Calif. “Free has not been an approach used in healthcare IT previously. The business model around free has been explored in other areas, but this is more of a business application. In having something that can spread through word of mouth, it moves healthcare IT from being a capital expenditure to being a commodity.”
Rowley’s explanation echoes that of Riley’s, who likens the concept to banking. “Our analogy is, ‘If you can use Bank of America, you can use Mitochon Systems.’ It’s got to be that simple. You must have a system that is user-friendly – free doesn’t mean poor quality. In our world, it also doesn’t mean ‘freemiums,’ where you pay for the base and have to be charged for the higher level.”
EMR Solution Born Out of Physician Experiences
Dr. McCallum’s practice has experienced a substantial improvement in workflow since implementing the Practice Fusion EMR , which is one of the main goals of the system.
Both Practice Fusion and Mitochon were created out of their respective founding physicians’ needs for more coordinated, collaborative care. Rowley evolved his homegrown Medical Chart Wizards product into today’s current Practice Fusion product when he joined forces with company CEO Ryan Howard in 2005.
“Back in the ’90s, I became increasingly frustrated with paper charts not having information that I wanted in my hands at the time,” he explains. “I would say 100% of my charts were about 80% correct. There was always something a little bit off.”
Readily available, accurate information at the point of care; and easily retrievable, organized documents provided Rowley’s impetus for a better solution. “I knew that the future was going to be increasingly digital,” he explains. “An e-platform was infinitely better. How it would roll out, of course, one didn’t know, and certainly, at the federal level, encouraging physicians with incentive monies to go in that direction was something that wouldn’t have been thought of even five years ago. I kind of knew that was the direction things were going to go in – the path is always a surprise. In our practice we actually abandoned the use of paper charts in 2000/2001.”
Dr. Andre Vovan, co-founder of Mitochon Systems, used his experience – and similar frustrations – as a triple board certified physician and director of critical care at Hoag Hospital in Newport Beach, Calif., as inspiration for several pre-EMR technology solutions. In an effort to move these ideas forward in the ambulatory environment, where technology has not been as widely adopted, Vovan spoke with 300 physician colleagues in order to determine what sort of solution they would ultimately to deliver better care.
“What those physicians told him, unanimously in his view,” explains Riley, “was they want to be able to collaborate and connect with colleagues, which is their referral network, and to communicate with patients electronically at little to no cost.”
Mitochon first started off on a proof-of-concept model in which its EMR was used to connect Hoag Hospital with physicians in the local ambulatory environment. “We proved to them that we could take an ambulatory piece of clinical data and move it into their side of the house,” says Riley, “and then take their in-house messaging and bring it to the ambulatory environment.
“Our whole process is based on the idea that an ambulatory physician needs to know what’s going on in the hospital – what the discharge notes are, what medications have been changed, what procedures were carried out – and equally the fellow inside of the hospital … should be able to review the patient’s history on the ambulatory side.”
Evolving with the Market What will happen to EMR Vendors when federal incentive dollars have been doled out? There seems to be a general consensus that the HIT market will see some consolidation, which begs the question, how will free EMR solutions maintain relevancy?
Riley believes that the future generation of providers will have a lot to do with his company’s continued success. “There’s a need to service that influx of physicians that will come into the industry over the next few decades,” he explains, adding that a free solution will make the burden of paying off student loans that much easier to bear.
Mitochon has also invested heavily in creating a Virtual Medical Community(TM) of its physician users upon which it is continuing to build a Health Information Exchange (HIE) solution.
Practice Fusion is looking to tailor its solution even further to comply with what physicians will need for the various stages of Meaningful Use. “We’re still finishing out some of the big pieces – clinical quality measures and clinical decision support pieces – that we’ll have in the product by this summer so that everything needed for Stage 1 will be available.” Practice Fusion will also continue to promote its open platform as a means by which other developers can leverage its data to create additional, innovative healthcare applications. “We can’t think of all the different ways in which this health information can be used,” Rowley says, “but having it reside in an open environment as opposed to what I’ve heard called the ‘walled garden’ is the way to go. There’s a lot of work to do.”
Source: Mitochon
