1. A tricky precarious situation, especially one that leads gradually but inexorably to disaster
2. A dangerous course, one that can easily lead to catastrophe
Today, Andy Robineski broke the story that Practice Fusion has partnered with Google to offer a free EMR to the public using an adsense business model (just talk to Guy Kawasaki about the revenue generation from his popular blogsite). Practice Fusion is a relatively new player to the healthcare information technology space and is attempting to deliver an innovative, web-based electronic health record delivered in a software as a service model. Apparently, they have been involved with RHIO’s, interoperability, and are now just preparing for their “Go To Market” approach.
I believe that conceptually, Practice Fusion is absolutely on the right track. Having a functional (user friendly), web-based (ubiquitous), interoperable, no cost (OS equivalent), highly functional, seamless software solution for physicians, providers, and related healthcare entities is fabulous. Having 600 physicians sign up in a short time of offering the service and then announcing the offering in conjunction with partnering with a like Google is also impressive. Furthermore, their tagline is also completely 100% buzzword compliant:
- Headquartered in San Francisco, California, Practice Fusion addresses the complexities and critical needs of today’s health care environments by proving a revolutionary application and delivery model for Managed Care Organizations and RHIOs, physicians and patients. Practice Fusion offers an integrated, on-demand health care platform delivered in a software-as-a-service model. Practice Fusion’s services require no on-site software installation, eliminating the complexities of licensing, implementing and supporting traditional enterprise software solutions. Practice Fusion removes the need for integration, hardware and software between Managed Care Organizations and RHIOs and their physician community, dramatically reducing cost and complexity, while enabling providers to deliver the highest level of care possible to their patients.
All this “paradigm shifting” and “revolutionary” talk is good – way good – and part of the fulfillment of the vision that so many within healthcare IT have had. However, the means by which they are able to deliver it FREELY raise the inevitable red flags. I have several major issues with the enabling mechanism of this “free”dom (or more appropriately Free Dumb).
While I have never been a huge privacy guy, and not being an information conspiracy theorist, I am still pretty concerned about how personal health information can be utilized (this post is from Practice Fusion CEO own blog). I am growing increasing concerned, as the general consumerism movement takes off, regarding who will ultimately control the personal health information that HIPAA was (mis)designed to protect. I get particularly concerned when employers, plans, or other conflicted third parties want to offer free software that holds personal health information hostage.
Lets be clear – the information belongs to the patient/consumer. Medical providers should be proactively granted the right to be the authorized custodians of personal health information as it relates to the management of their health. In the past, this “ownership” of medical records, has been voluntarily transferred to the physician in the previous era of paternalistic care and medical information arbitrage. However, in the information age and as a result of the value-driven healthcare reform movement, these relationships will all be changing. This new paradigm places the patient/consumer back in the driver seat (and along with the new freedoms of health management come the new responsibilities of health outcomes).
In the Practice Fusion model, this Free Dumb is enabled through Adware – which as every single person knows who has ever surfed the web knows – is incredibly irritating at best and concerningly invasive at worst. Practice Fusion CEO Kevin Howard states that the Google technology will be embedded into the Electronic Health Record and will react with keywords relating to a patient’s condition, diagnosis and treatment codes. While there is a promise that “we never send confidential data” and “[Google never has] access to patient data“, I think the Orwellian slippery slope is self-evident.
Many “free” software offerings have met with limited success within healthcare before. The problem is not with the price (even free is considered too expensive in the healthcare setting). The problem has always been with value (outcome/price) that these systems deliver. That is why “free” offerings like AthenaHealth (software is paid for by revenue savings from efficient revenue cycle management) are imminently so much more valuable to clients. Getting a free system, but having to deal with the irritating Adware is problematic. Worse still, how can your privacy be protected if they are using your personal health information to return searches. Finally, how can you ensure that your provider isn’t somehow being influenced by the Adware.
I am willing to give Practice Fusion an opportunity here, particularly given all the compelling aspects of what they are doing. However, I would like to understand how they are going to stay on the “straight and narrow” path as opposed to the “wide and broad” path that inevitably leads the unknowing “carefully” down the slippery slope.