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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Adware within Healthcare: Software Free Dumb

Slippery Slope (slĭpə-rē slōp) n.

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.

8 comments on “Adware within Healthcare: Software Free Dumb

  1. Shahid says:

    Good article, Scott. Having built out half dozen EMRs in my career, it’s good to see a company like Practice Fusion giving adware a try — I don’t think they have anything to lose.

    I hope they can succeed where other EMRs have failed (or at least not done so well). The technology behind EMRs is embarrassingly easy to create nowadays — most EMRs are just simple databases that act like electronic typewriters and simple filing cabinets. In fact, kids in high school doing game programming are doing more difficult things with computer science concepts than EMRs. What’s really hard about EMRs are dealing with the integration and usability headaches — which are no easy tasks. However, if you create a single-site solution where all the users connect together in one place and not have to worry about cross-site integration and the mismatch between concepts across EMR packages then it could be a winning solution.

  2. Roy Schestowitz says:

    I had a real kick reading Fred Trotter’s pirce about in in Free Software Magazine. Wave-riding, deceptive folks…

    Speak out about it in order to pressure them to walk out in shame. They dilute the terms Open Source and Free software, which ruins it for everybody else.

  3. Even Walser says:

    Dr. Shreeve,

    As the Director of Sales for Practice Fusion I wanted to help clear up several misconceptions surrounding our model. Additionally, I would like to thank you for your positive comments regarding our technology. Just to be absolutely clear our model is not built around nor utilizes AdWare. We have integrated direct to physician messaging within our solution suite. The messaging that is delivered is relevant, exclusively health focused, text based and discrete. Adware would imply that our software installs an ad server on our client’s machines which is simply not the case. Our solution is delivered via a SOA architecture and RIA (rich internet application). which has embedded messaging, which is relevant and discrete. It is completely private, non-intrusive, and physicians have no obligation to click on ads. One of the major barriers to entry has been price for most physicians. Our model eliminated this barrier. If physicians do not want to see the ads, we offer an ad-free version of the solutions for a nominal $250/month per seat.

    I hope this clears up any notion that our solution is adware. Once again I sincerely appreciate your interest in our model and your positive comments about our company.

    Even Walser

  4. Anonymous says:

    Practice Fusion recently beat out AthenaHealth for the Fierce Healthcare’s Innovative Solutions for 2007:

  5. Ash says:

    Free EMR is a good way to go. Those starting to use them have to be aware that there will be a cost involved in terms of your workflow changes and the way you will practice after you start using any EMR -in that respect it does not matter if you got the EMR free or you paid for it.

    I am a proponent of SaaS and RIA EMRs as they get the flexibility into the product to incorporate several modalities of delevering healthcare at various healthcare provider facilities.

  6. Anonymous says:

    As a consultant I have seen a variety of these solutions on the market, but feel that cost is still the biggest issue to physicians and this may address that issue. I have seen their product on the Adobe Showcase and must say it looks better than most:
    Practice Fusion EMR Featured In Adobe Showcase

  7. Jim Nolan says:

    Thanks for sharing your info. I really appreciate your efforts. i read lot of blog post and i never heard of topic like this. i love to read urs. Visit here best Free EMR SaaS
    for more information

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