"Free" EMRs: Making the Doctor the Product

Free ServicesYour mother was right, nothing in life is free. Every business exists to make money and they do that by selling a product to a customer. No product, no paying customer, no revenue, no business. Companies offering "free" EMRs to physician practices are no different. They are not defying the laws of nature. They are selling a product to a customer. But the product isn't an EHR system and the customer isn't the doctor.

The doctor and his/her patients are the product being sold!  The customer is companies willing to pay to use the data collected in the EHR to sell a product or a service to the practice and its patients.

So what happens when you become the product being sold instead of a customer?  First of all, you should have no expectations of any customer service - you aren't the real customer. Training will be minimal. Your support requests will sit in queue. Since you aren't paying anything, the company won't expend any real resources on your behalf. The software will be bare bones - again, it isn't the real product that generates revenue for these vendors so it won't be the focus on the company's efforts.

With a system as critical as a practice management system or electronic health record solution, how can a practice afford to implement a throw-away product that offers no real support or training or is unlikely to advance functionality to keep up with market needs?

As if this wasn't reason enough to steer clear of systems touting themselves as free, there is the often hidden downside of how these companies actually make their money. They are selling the practice - selling its data - every progress note, every diagnosis, every patient, every visit. At the practice level, product companies are willing to pay for this data in order to better target their advertisements. If a physician diagnosis a patient with allergies, for example, an ad for Zyrtec or a similar product, will pop up immediately. If a doctor is prescribing more of a competitors drug or product, companies will have access to that information and may target the practice for aggressive marketing.

They also have access to your patient's data. Where they live, how old they are, their health status, what pharmaceuticals they use and on and on. It is one small leap for these companies to move from selling you to selling your patients. One company, in fact, has already signalled its desire to do just that. With their launch of Patient Fusion in 2012, Practice Fusion started directing communication directly to patients. In August of last year, the story broke that Practice Fusion had collected almost 2 million reviews on close to 30,000 providers. The company was emailing patients after a visit and asking them to "rate their providers."  This was done without practices agreeing to or approving this activity. In fact, the email was designed to make it look like it came from the doctor!  The next question, of course, is where Practice Fusion sold these ratings.

So if you are going to consider selling your practice's and your patient data to Practice Fusion or another "Free" EMR company, you should understand what they will be selling. Read the user agreement carefully, the user agreements will generally include a clause (seemingly innocuous) about being able to sell or license "blinded" data to (unnamed) third parties. Be aware that these clauses mean that these companies are free to sell whatever data you enter into their system for any purpose. Even if companies state that they will not sell your data today, you should realize that you have very little leverage in a relationship where you are not a paying customer. If the company decides to change the terms of the contract to maintain the "free" part of the contract, you will have no leverage other than terminating.

So practices should carefully consider the costs of the becoming a product for a company to sell. Better yet, stick with a company that considers you the customer, not the product.


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