Sunday, October 16, 2011

EHR Bargains Review – Practice Fusion

(Survival Tips for Small Practices)

If you subscribe to Prof. Clayton Christensen’s theories of innovation, Practice Fusion is to the EHR industry what Southwest Airlines was to the air travel industry, ad extremis, with no thrills, no frills and no peanuts. Practice Fusion is completely and truly free to users, and it will take you from point A to point B in a straight and short line, with point A being paper charts and point B being a Meaningful Use incentive check.

The Model

Practice Fusion is a web-based EHR and it is free to use no matter who you are. The company website has a self-provisioning button where any visitor can sign up for a free account and immediately start using the software. All you need is a valid email address. The company prides itself in taking users live on the EHR in 5 minutes. It actually takes much less than 5 minutes to get to a point where you can begin charting, but it takes a week or more to hook up to electronic prescribing and lab interfaces, and this is very much in line with industry practice. Practice Fusion offers free connectivity to national reference labs and a handful of regional ones as well. Just like there are no charges for electronic prescribing, there are no interface fees for the currently available lab connections and no mention of “custom” interfaces built for a fee. You get only what you see.

Since we all know that there is no free lunch, how is it possible to get a free EHR, including significant interoperability? The standard answer to this is that Practice Fusion is ad supported. Just like you get free email services from Google in return for agreeing to see ads on every email page, when you sign up for Practice Fusion, you are agreeing to see ads on every EHR page. To my pleasant surprise, the ads are mostly limited to about one inch of space at the bottom of the screen, and are not at all intrusive in the workflow. I actually don’t quite see how these ads support anything, since with the exception of one Dell advertisement they all seem to be Practice Fusion self-promotions. Furthermore, the fairly new Patient Fusion portal displays no ads at all. Similar to most other EHRs, the Practice Fusion end user agreement reserves the right for the vendor to aggregate and monetize EHR data, and perhaps this is a possible explanation for this free lunch.

Functionality

The best description for Practice Fusion’s functionality is bare-bones. There is no fluff, no bells and no whistles to be found in the very simple, very clean user interface. After muddling through a variety of top-shelf EHRs with double and triple menu-bars and icon studded task-bars on every page, the Spartan look & feel of Practice Fusion is quite refreshing. Although there are multiple training aids in the system, if you are an average computer user (e.g. email, Word), you should not need much coaching to become productive at very short notice. This of course eliminates another hefty expense associated with EHR adoption: training.

Whatever free-form stuff you are now doing on paper, you can do in Practice Fusion, pretty much the same way. It comes with a simple set of SOAP templates consisting mostly of questions where you get to type in the free text response. You can also type directly into the note and probably use Dragon as well. You can create your own sets of questions, or add to existing ones. You can order meds, labs and imaging and print those, or send electronically if connected. Scanned documents can be uploaded to any particular chart. There is no clinical content available for decision support, at this time. Registry functions are in their infancy and the handful of available reports is very simplistic. Disappointingly, the Meaningful Use report does not automatically calculate numerators and denominators for core and menu items, but clinical quality reporting is automated. There is very little customization possible and none is required.

For patients, there is Patient Fusion, a simple web-based portal that allows patients to see appointments, meds, allergies, immunizations and labs. It also provides some links to medical content on the web. It seems that the portal is very much a work in progress, but just like the EHR, its user interface is clean, simple and appealing. Unlike the EHR, which is Flash based and therefore unavailable for use on Apple mobile devices, the portal is accessible from an iPhone or an iPad. Practice Fusion did announce recently that a native version of its EHR for the iPhone is due to be released soon. 

Viability

Practice Fusion is privately owned and has been around since 2005, but started taking off in earnest around 2009. Its recent growth coincides with the HITECH act and the advent of Meaningful Use. Although it is possible that it will follow a trajectory similar to Southwest Airlines and blossom into a major EHR vendor, it is also possible that it would make a rather attractive acquisition target for one of the much bigger fish circling health care IT right now. Will it remain free to end users? There seems to be no current intent to charge customers for software usage, but Practice Fusion received over $36 million in venture capital, which usually comes with expectations of short term spectacular returns. Time will tell.

Bottom Line

Practice Fusion is currently certified for Meaningful use as a Complete EHR, which means that you don’t have to buy additional software in order to achieve Meaningful Use requirements. As is the case with all web-based EHRs, you will have to buy desktop (or mobile) hardware, internet services and networking hardware. You will still need to pay for a Practice Management system and billing, and unless you choose to utilize the sole Practice Fusion partner for these activities, you will need to budget staff time for double data entry. You will not need to pay for the EHR, its server and its maintenance. If you are interested in Meaningful Use incentives, and if you practice in a small group, and if the cost of EHR seems prohibitive (or a waste of good money), and if you have no use for bells and whistles above and beyond a paper chart, then by all means, go ahead and try it out. It’s free.

18 comments:

  1. Great review, Margalit! As for the advertising: new users see a higher percentage of "house ads" to help them get started. Once you're more active, you'll start to see paid ad campaigns running in the EHR.

    Emily
    Practice Fusion

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  2. Thanks, Emily. Will the campaigns take more space, or are they still limited to the current strip I see on the bottom?

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  3. Good site. I as a viewer do heartily appreciate the site and the information of such value very much. Thanks for the post

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  4. This in quotes below, which may have been true in October has now changed as Practice Fusion's Meaningful Use Dashboard displays numerators and denominators which are updated automatically once each day at around midnight.

    "Disappointingly, the Meaningful Use report does not automatically calculate numerators and denominators for core and menu items, but clinical quality reporting is automated. There is very little customization possible and none is required."

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  5. Glad to hear that improvements are being made.

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  6. nice review. With regards to EHR maybe you are interested to read this article regarding, "More Doctors are Now Using EHR: Know their Reasons" posted at http://blog.pulsestore.com/post/2011/12/13/More-Doctors-are-Using-EHR-Know-their-Reasons.aspx

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  7. if you could only print a 1500 claim form and do actual billing, this would be perfect.

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  8. Okay the old adage, their aint nothing for free. I've seen the software companies come and go and if they go as I've seen in the past what happens to my data?

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    1. Robert, this is a very important question, and not just for Practice Fusion, and not just for web-based EHRs.
      The truth is that if a particular product folds, for whatever reason, it will be next to impossible for you to get ALL your data out, no matter which EHR that is. In most instances, you will be able to get PDFs of your charts, sometimes by printing them out yourself and sometimes by paying the vendor to export. For anything more, you will be charged exorbitant amounts, and there is no guarantee that it will even be possible.

      Hopefully as health care gets more interoperability standards implemented, this too will become easier. Until then, it's buyer beware.

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  9. Thanks for asking and responding This is my concern as well. I'm a brand new potential user and wonder if I can save the patient data to Zip drive or some other system?

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    1. As far as I can tell Practice Fusion does not have the ability to do what you are envisioning, and no exiting EHR has such functionality built in.

      You can ask the vendor for scheduled exports of your data from their database to some other storage format. Not many vendors agree to do that.

      There is however one thing you can do: you can create those visit summaries after each visit, print them to PDF and store them locally. Periodically, you can create a full clinical summary and save that as well.

      This is a manual and time consuming process, but if you save the files in the original CCD format (not PDF), you will be able to eventually upload them to other software, if necessary.

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  10. A great addition to Practice Fusion is the ability to send appointment reminders, by call or text. Ntegrus Solutions has been doing this for over 2 years, for just pennies a reminder, and it works great. See www.Ntegrus.com or www.Facebook.com/Ntegrus.

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  11. I like practice fusion for my new business. I have tried several Android tablets and so far it does not I have tried several Android tablets and so far it does not work well on any of them. Can you recommend an Android tablet that it will work well on?

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  12. Practice fusion is good for a startup practice where volume is low, inefficiency is not an issue, and money is tight. As practice grows, inefficiency will cause issues both slo you down and/or not allow to manage your practice properly. I am telling this from experience. After using it for a year I am trying to switch.

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  13. Are there any Cardiology Practices willing to comment on this system since the Vendor will not release any current clients?

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  14. As a previous poster stated, 'ain't nothing for free', the cost to a reference laboratory to transmit results is a one-time fee of $10,000 and a monthly fee per practioner. That is very high for result-only interfaces.

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  15. As a Hospital based Radiology practice group, we are exploring to use Practice Fusion for Meaningful Use. The local hospital has EPIC EHR.

    Any experiences with interoperability of Practice Fusion will be appreciated.

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  16. God know what else they are looking at? As a practice owner, they are many things that is internal to my business. I am deleting my free account.

    http://www.forbes.com/sites/kashmirhill/2013/10/24/practice-fusion-reviews-whoops/

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