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Practice Fusion’s EHR: Can Google’s “Endorsement” Overcome a Weak Business Model?
Practice Fusion (PF) has announced a deal with Google to provide a free electronic health record (EHR) to physicians. The EHR will be supported by ad revenues from pharmaceutical companies, insurance companies and others. Read more here.
What’s the connection to care management and chronic disease? EHRs and personal health records (PHRs) are wildcards in the care management equation. You can look at this two ways: 1) The lack of EHRs and PHRs is a potential rate-limiting step toward true population health management, and/or 2) Management of chronic diseases and conditions promises to be a killer application to justify the costs of EHRs/PHRs.
There are many positives about the Practice Fusion EHR. Offering it for “free” to physicians addresses one major barrier to adoption. PF describes their offering as “interoperable”. It will be web based — a promise of ubiquity. What company wouldn’t salivate at the prospect of a partnership deal with Google. Finally, the web site speaks of a PHR coming late in 2007; an integrated PHR/EHR would be a very powerful offering.
However, for now IMHO, the negatives surrounding the PF EHR will prevent significant market traction:
- Privacy advocates are going to go beserk. The issue is not the actual privacy and security of PF’s offering, but the perceived privacy and security. This deal will become very visible due to Google’s participation. Critics will use it as a lightning rod to heap FUD (fear, uncertainty, doubt) on an advertsing based EHR.
- Free isn’t cheap enough. This point has been raised repeatedly relating to EHR adoption. The price of the software itself is only one aspect of the total cost — the implementation and support costs are a far greater deterrent to the adoption of EHRs.
- Where is the evidence that doctors actually like to use this thing? As I perused the web site, I saw only one physician testimonial — a Dr. Flash Gordon (I’m not making this up), who is also an advisor to the company.
- Business model — yellow flags!! I can’t tell you how many road-kill autopsies I’ve seen performed on companies that premise their business model on “We get the doctors to change their minds, their behavior or their workflow”.
For further reading, see Scott Shreeve’s insightful blog, Innovative IT for Healthcare, Government Health IT, and ZDNet.
Your thoughts?
Update: March 20, 2007: A road-kill autopsy for PF might be in order even sooner than anticipated. Digital Healthcare and Productivity reports:
A Google spokesman says that this is not the long-anticipated major entry into healthcare for the Mountain View, Calif.-based Internet search giant. This shouldn’t be interpreted as a product move on Google’s part, says Brandon McCormick. This is not any more [of a business relationship] than we would make for any other mid-size company.
Update: May 11, 2010: Practice Fusion has made tremendous progress since this blog post was written in 2007. They have made many smart decisions:
- Hiring some great people
- Promoting an innovative business model (free)
- Advancing their technology
- Attracting new investors
- Achieving initial adoption among physicians
In hindsight — if you’re reading this in 2010 or later — consider the events discussed here as an unfortunate blip on the radar screen; the company made some poor tactical judgments. If you’re a physician, nothing written here should discourage you from considering Practice Fusion as a viable option for your EHR technology.
This work is licensed under a Creative Commons Attribution-Share Alike 3.0 Unported License. Feel free to republish this post with attribution.
As a physician and founder of a personal health record company (http://www.PassportMD.com), I believe I have a unique perspective on all of these issues.
Practice Fusion is a “coming of age” attempt to jump over the hurdle of “slow adopters” which are physicians…traditionally and particularly in this case. The premise that they make is that “cost” is the major hurdle to physician adoption and that pharma sponsorship with google ad technology can “lessen the blow”…well that is partly correct.. but it also is not the main determinant… though it is one of them.. The other critical hurdles to physician adoption are maintanence, security, work flow integration, technology integration, and transformation.
I am comfortable commenting on these issues as I can attest to being on both ends..ie PassportMD that I have created for consumers to live safer with a free personal health record service (and not be deterred by slow physician adopters) and on the physician end..as I have a multi physician multi location specialty practice in which I have implemented EHR’s for the entire practice. So, I am a proponent of EHR’s for medicine and medical practices but do think there are many complicated issues, cost, being only one of them, that keeps the docs from adopting…
Eventually, these issues, too many to describe here, and which I have never seen any EHR company yet accurately get a grip , is a multi factorial, interdependent, institutional and third party, private payor, insurance, medical liability, technology support quagmire.. For now.. it will be interesting to watch the attempts of different companies try to address the needs but I am skeptical that they will really understand the complexity of the doctors motivations and suppressions to this eventuality.
As it relates to PassportMD.com and personal health records, this service helps people through the often-tedious process of creating a very valuable, and potentially life saving tool, the personal health record without waiting for all doctors to be up and running with an ehr. Companies like PassportMD.com are giving people, seniors, adults, children, in particular with a history of at least one chronic medical disease, or on multiple medications, or with a history of allergies access to a system that can help save their lives. Doctors need to have access to reliable information that is legible and accessible and PassportMD provides this needed function even before they and their colleagues adopt their own system.
Medical Mistakes are common, hospital errors are responsible for over 100,000 deaths per year and these could be preventable. Information about drug interactions and cross reactivity combined with allergy alerts lead the way in being critical to every healthcare provider before initiating care.
Scenarios where this type of service makes the most sense is baby boomers that are responsible for managing their elderly parents medical care and doctors visits, or seniors that live alone or are responsible for managing their own care and visits to their doctors. Or,snowbirds that share many doctors between more than one state would benefit from PassportMD.com. Alternatively, children, before they go to summer camp, if they have an allergy or take chronic medications for chronic problems. Anyone with any chronic disease, diabetes, hypertension, heart disease, for example would benefit from websites like PassportMD.com. Additionally, active, healthy individuals that are pro-active with their health in preparation for unexpected and unpredictable medical problems would benefit from personal health record management. People that travel frequently, cruise to the islands, or boat, would be especially susceptible to medical emergencies without their accurate medical history.
In conclusion, the doctors are very slowly adopting electronic health records. This adoption is way too slow and is very complicated. It has many factors in play as it relates to the economics of medicine. Although privacy is considered an issue, the true issue is cost, but cost disguised in many ways, including time costs, disruption costs, lost opportunity costs, implementation and maintanence costs. All are too burdensome in light of decreasing physician reimbursement. Thus, only 7.5 % of physician practices are currently adopting electronic health records. Though, if you poll the remaining 92.5% of physicians, probably all would agree that electronic health records are better for medicine and for the patient. Adoption is inevitable but the pace and time period for adoption is dependent upon many factors.
Some privacy wonks will get in a snit about Google ads just like they did when Google mail came out. Despite the angst, gmail went on to become a highly sought after mail service, and privacy concerns faded away.
With Google’s brand name, I wouldn’t be surprised if a simlar snit is ultimately rejected by the physician market – as it should be.
Whether Practice Fusion can generate enough adoption, even for free, remains to be seen.
Not sure this will really take off, EMR adoption is already picking up. Sure it will speed adoption, but having looked at their site I have no idea what the product looks like.
Flash Gordon is a real doctor (he is one of our prospects right now). You are right behavior change is hard, but the physicians will adopt this tool, real challenge is will they use it to its fullest potential.
Will all the naysayers on Practice Fusion please take a deep breath? This is America, the land of free enterprise where solutions like PF emerge as a realistic option for physicians to initiate an EMR.
Let’s give the marketplace a chance to work — PF exemplifies the type of intiative that this country needs to jump-start EHRs and provide long-term traction that will benefit every healthcare system stakeholder.
Let’s not criticize an intiative that is making good sense for all.
It turns out that the story here is not the one that I thought it was. I thought this story was about Google’s long anticipated entry into health care. That story will have to wait for another day.
I do know that I feel deceived as this story has unfolded. The actual story is about PF claiming to have some deal with Google and Google in turn denying any special relationship. I am amazed that the blogosphere and “journals” are not all over this asking questions about how this could have happened. Neil Versel’s story in http://www.digitalhcp.com/hitw/newsletters/2007/03/20/emr-business-model revealed a lot of smoke, and where there’s smoke….
I’m also still left with questions about Practice Fusion. I don’t claim to know all the facts here. But I know enough to ask a few questions:
1) How ETHICAL are these folks at Practice Fusion? Was their announcement a publicity stunt to generate some sales leads under the pretense of a deal with Google? Their announcement led me to their website to sign up for some “whitepapers”. Is this the right thing to do? (and I’m still waiting for my whitepaper).
….and did they instigate this story about a supposed partnership with Google? if so, doesn’t that seem deceptive? if not, why didn’t they clarify that their deal with Google is really nothing special?
are they claiming they didn’t know that the world has been expecting an announcement of Google’s steps into health care? And they are surprised the media jumped all over their ‘announcement?’
2) How SMART are these folks at Practice Fusion?
…to arguably deceive folks into believing that there’s a BIG deal here? to gloat about the story being a ploy to generate sales leads? not to recognize that Google might deny having any special deal with them and would say “Practice Fusion who?” when asked about the relationship?
…one more thing that doesn’t fit…Google AdSense revenue is peanuts, see, e.g., http://blog.guykawasaki.com/2007/01/a_review_of_my_.html .
certainly not enough to sustain an EHR.
On the other hand, you would think that PF would have negotiated a special click thru rate with Google AdSense knowing that doctor eyeballs poised on an EHR at the point of care would be worth a lot more that an average eyeball.
….which could suggest that indeed there is a special deal with Google here after all….???
…but which Google now denies ??? it just doesn’t fit.
…there is still a lot of smoke… These are questions to which investors, customers and partners of PF might want some straight answers.
Vince,
You, along with a few others, have taken some of the press of of context. When we announced our partnership with Google, we never started that our partnership was exclusive. I’m sure you did your research before posting your comments and read the other articles published(http://www.healthcareitnews.com/story.cms?id=6678, http://www.healthcarefinancenews.com/story.cms?id=6223) and noticed that Google participated in the providing quotes for the partnership – so I am confused about your comments regarding Google denying the relationship when they obviously participated.
Also, this is not a simple Adsense relationship. We worked closely with Google Adsense team to develop a custom API to send keywords to Adsense and retuen relative content. Along with that, since this was a new model, we worked closely with healthcare attorneys, Davis Wright Tremaine, to validate that the solution was completely HIPAA compliant and that privacy was handled appropriately. As you can see, the model has extensive time and development in it.
Regarding your business model comments, Adsense is not our sole source of revenue and comparing Guy Kawasaki’s CPC/CPM to Practice Fusion’s is obviously an apples to oranges relationship.
If you have further questions of would like an interview please feel free to email me at jonathan AT practicefusion.com.
Best,
Jonathan Seb
Marketing Director
Practice Fusion
Jonathan,
Thank you very much for your comments. I think think coming forward to clear things up and speak for your company is the best thing you can do in this confusing situation.
Vince
Vince – Thank you for being receptive. If anyone has any questions, please feel free to email us.
-Jonathan
As a follow-up on this thread – Practice Fusion was number 2 on Fierce HealthcareIT’s 2007 Innovative Solutions http://www.fiercehealthit.com/innovators/2007/practicefusion
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Great article, Vince. As usual. I really enjoy reading your blog, I will keep coming back
Eventually, this kind of software will be very cheap, like MS Doc. The practice is so universal that I would be supprised if Microsoft or other software providers won’t jump on it to offer as cheap as Windows OS.
I think practice fusion may be a great opportunity for physicians to get on board ehr’s. The start up cost of ehr products represent another tax on the medical profession, even if we really do get our refunds. In essence we are making interest free loans to the federal government. Why don’t the feds just provide doctors with a web based ehr. A central server by state would get more doctor’s onboard. Our financials are poor enough without this 44,000 burden. Nevermind the other demands convrsion to ehr places on our practices. It’s just another tax by big government.