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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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Software FREEdom – Adware within Healthcare Reconsidered

Reconsider (kən-sĭd’ər) v.

  1. To consider again, especially with intent to alter or modify a previous decision.
  2. To take up for reconsideration, as a matter previously acted on by a legislature.

Almost one year ago I posted a note regarding Practice Fusion’s claims to be partnering with Google, mining patient data, and rapidly signing up new customers. While I was postive on many aspects of their business model, I was staunchly opposed to selling patient information and quite sarcastic when their “partnership” with Google Health proved to be essentially an overblown PR stunt.

Practice Fusion is back in the news over at The Health Care Blog due to a recent post by their Chief Medical Officer, Robert Rowley MD. The post generated some comments for a variety of reason – from reaction to content, to concerns over ethics of business model, to concern over editorial control of THCB, to the free and open exchange of new innovations in that medium. I posted my comment which is reproduced here with light editing.

I have come around on the Practice Fusion concept for many of the reasons that Dr. Rowley and Dr. Kibbe mention. In fact, I would suspect that I am the only commenter that has actually used the software in to take care of patients (Crossover Health personal health advisory service).  Getting a tool (an EMR) into the hands of providers (much better than paper) who can use it to improve patient care is a good thing. The fact that the tool comes with some branded messaging is tolerated because the price (free) and the ease of use is so compelling (installed in minutes).

In terms of EMR software, I have found the features/functionality of the software to be sufficient for now, the look and feel to be adequate (flash based UI), and the rate of ongoing development to be intriguing (several key updates over last several months). There are definitely some holes that need to be plugged, some functionality that needs to be added, but overall I find it from an EMR perspective to be “good enough”.

In terms of business model, the adware component is irritating. They have flashing ads for vendors, devices, drugs, and non-medical things like mortgages. I consider all of this “collateral damage” and just completely tune it out. I never have and never plan to click on any of the ads and just mentally block them out. Again, if this is the way to help “subsidize” my use, then I tolerate it voluntarily. If it becomes too distasteful, than I can pony up $250 per month to have no ads. I know this going in and accept it at face value.

In terms of ethics, come on man. Do you think I am going to start prescribing something because of an ad that I am ignoring? The detail people are much more influential because they develop a personal relationship, buy you food, and provide peer reviewed studies that can alter your decision making. I just don’t see that same type of connection or influence from impersonal ads that I am ignoring anyway.

In conclusion, Practice Fusion represents a Disruptive Innovation for the following reasons:

1. New business model – Dr. Rowley called it Freenomics but it is most appropriately called a “Fremium” model whereby the product is free to most people because it is paid for by a few (ad sponsors or paid users).

2. Technology Enabler – Software as a Service (SaaS), remote training, and shortened development lifecycle

3. Value Added Network – Practice Fusions ultimate success will depend upon the value added partners (billing companies, ad sponsors, etc) that they can bring into the ecosystem which ultimately increase the value of their offering which increases even more as more users adopt the service.

By definition a Disruptive Innovation is NOT for everyone. Practice Fusion is smart to begin targeting non-consumers (physicians not using an EMR for whatever reason – cost, time, lazy, etc) who benefit from their “good enough” product. Over time, as they have already demonstrated, it will continue to compete and probably ultimately challenge some of the competitors in the EMR space.

My only advice to the company, as it ever has been, is to turn down the PR machine with all the wild claims about them leading the HIT market, suspect adoption numbers, and the like which diminish their credibility. Just go heads down, continue to increase the numbers, and pop up one day with 250,000 users and everyone scratching their heads saying, “Where did that come from?“.

Lets see how far they can go with FREE.

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