EMR & EHR Blog for Physicians

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Did you know that there are 1000's of searches every month on Google from people interested in ‘Free EMR Software' in different forms:

Free EMR  2,900
Free Electronic Medical Record  480
Free EMR Software  480
Free Electronic Medical Records  390
Free EHR  320
Free EMR download  260
Free Electronic Medical Record Software  140
Free Electronic Medical Records Software  91

However, economists tell us that "there ain't no such thing as a free lunch" which essentially means that it is impossible to get something for nothing. Yet people search for ‘free EMR' in the hope of finding something which may work for them and that would not cost them several thousand dollars to implement and support.

IMHO, there are at least three flavors of ‘free EMR':

a. Open Source EMR
b. Low end versions of full fledged EMR Systems offered at zero cost
c. Commercial EMRs supported by ads and selling of anonymized data (data which has been stripped of identifying attributes) offered at zero cost

Open Source EMR

It is well known that open source software movement is gaining ground. Wikipedia maintains a list of open source EMR / EHR software.

When you opt for open source EMR, you get full ownership of the code under GNU General Public License which gives you freedom to share and change all versions of a program to make sure it remains free software for all its users. You do get the license at zero license cost. So what is the catch? While the software may be free, you have to consider the following:

1. What is the total cost of ownership of an EMR / EHR solution? You will find that the cost of license is only about 20% of the cost of implementing a Client Server version of EMR.
2. What is the size of the community supporting ongoing development and enhancement of that EMR?
3. What is the guarantee that the open source EMR will continue to meet ever changing Governmental regulations?
4. What is the support structure of the company to help implement, train and support the EMR?

In a survey conducted by Computer Economics, 44% of the users quoted ‘less dependence on vendors' as the leading advantage of using open source software. Note that lower TCO was not the main advantage cited by the respondents.

It is important to realize that EMR purchase is quite sticky and it is not easy to change the EMR that you implement in your clinic. Therefore, I would not recommend smaller clinics to stay away from open source EMR or EHR for many reasons:

a. None of the currently known open source EMR systems are commercially proven unlike other vendor systems.
b. Implementing any open source EMR will need customization or upgrade services which will add to the cost of implementation.
c. What is the current and forecast future availability of required technical expertise at reasonable prices? Will you have the time, patience and expertise to find the right talent at a later date to support your changing requirements?

If the open source EMR, on the other hand, is procured by a hospital which has invested significant amount of money in information technology and therefore has the expertise to customize the open source EMR to meet its current and foreseeable charting requirements and governmental regulations, the hospital will stand to benefit from open source EMR / EHR in the long term.

Free versions of full-blown EMR Software

There are many vendors that offer free EMR products (like eMDfix) while at the same time offering full fledged EMR products which are paid products. As you will figure out soon, there are costs involved with implementing a new EMR which will put it in pretty much the same price range of a non-free EMR. You will also find that the free version of the software lacks some important features that are important for you to work efficiently. As I mentioned before, EMR purchase is sticky business and if you have been using the free version for some time, you will be forced to upgrade to a paid version. To top it, it has been our experience that providers (barring a small minority) need a lot of hand holding in order to make an EMR work. When you sign up for free EMR, you essentially sign up for ‘no obligation' from the free EMR vendor's end. Guess what - it means that you are pretty much on your own even though you may get some email based support which will, in most cases, not be sufficient.

Free EMR Software? What is the financial model?

Let us talk a little bit about the third kind of free EMR software systems like Practice Fusion which recently received investment from Salesforce.com (the leading name in SaaS based CRM software). What is the financial model behind this EHR? There are two aspects:
(1) This is an advertisement supported EHR System. It essentially means that you will see advertisements from vendors interested in selling to the medical community. Will you get distracted by such advertisements? I will leave it to you. (They also offer an ad-free subscription for an additional $100 per month per physician.)
(2) The vendor reserves the right to sell the data that is collected in the course of hundreds of physicians charting patient visits. Of course, the data is sanitized (anonymized) so as to remove any and all attributes that help identify a patient. This is a sensitive topic and at this point of time, I will leave it for you to decide if you are comfortable with this model.

What are the other issues with this free EMR? It does not come with an integrated billing module. You will need to export the billing information on a periodic basis and send it to your billing company or system. You will have to check out the compatibility of your billing system to receive the billing information from your new free EMR system. If you use a PM system in-house, you will find that your patient scheduling information is now split between the EMR and PM system with no way to synchronize them.

It claims to allow you to start charting in 5 minutes after signing up. I find this statement hard to swallow considering the amount of training that most providers and their staff need before they can start using the EMR. In most cases, we insist on an onsite training component from 3 to 5 days to adequately prepare the physician and staff. Will the vendor of the Free EMR Software work with you until you successfully implement EMR Software?

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Learn about the top 10 EMR Software features that you should be looking for. Download our free article on Top 10 Electronic Medical Records features for every physician.

RevenueXL can not only help you select the right EMR Software, but also guide you in implementing your chosen EMR Software a.k.a. EHR Software.

________________________________________________

RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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How Much Does Electronic Medical Records Really Cost Your Practice?

When prospective EMR clients ask me "so how much does Electronic Medical Records or EMR cost?", the immediate answer to this somewhat of a thought provoking question is, "well, how much time do you have on your hands today to listen to the answer?" Meaning, are they looking to just find out about the cost of the EMR Software itself, or are they really interested in understanding the Total Cost of Ownership (TCO) as it relates to implementing an Electronic Medical Records solution in their practice successfully.

So, what are the true total costs of implementing Electronic Medical Records (EMR) Software?

For the purposes of this blog article, I will confine myself to a Client Server kind of installation where the EMR Application Server is installed on a Server (typically a Windows Server 2003) located within the premises of a medical clinic. Total cost of implementing an Electronic Medical Records system can be divided into two main groups: Product Cost and Services Cost.

Let us explore these two main cost components and then dive down further into their respective sub-components.

I. Product Costs

a. Software costs

i. EMR / Practice Management Software License Cost (for Provider and other staff like PA, RNs, etc,)
ii. Procedure, Diagnosis & HCPCS codes
iii. Drug Interaction Database (with or without dosing)
iv. Patient Education Advisors
v. Code scrubbing software
vi. Recurring annual maintenance and support costs

(Complete list available in the downloadable Excel Template below.)

b. Interface(s) and Conversion Costs

i. Lab interfaces (may be offered free from the EMR Vendor side but, there usually will be a charge for the lab side of the interface, which the lab may pay for)
ii. Medical device interfaces (as required)
iii. Practice Management interface (if required to interface with an existing Practice Management application)
iv. Data conversion
v. Electronic Remittance Set up
vi. Other compatible third party interfaces

c. Hardware Costs

i. Windows Server
ii. Windows workstations / Laptops with flat screen monitors
iii. Scanner
iv. Scanner and OCR for Drivers license and Insurance card
v. Insight Scanner and Docuscan from Scantron
vi. Tablet PC

(Complete list available in the downloadable Excel Template below.) 

II. Services Costs

a. EMR Implementation and Training Services Costs

i. Onsite implementation and training costs
ii. Travel costs (Flight, hotel, boarding, commute, etc.)
iii. Remote training (using software like Webex)
iv. Project Management
v. EDI Set up and training

(Complete list available in the downloadable Excel Template below.) 

b. Installation, Configuration and recurring IT Services Costs

i. Installation of Windows Server, workstations, printer, fax server, scanner, tablet PC, etc.
ii. Network setup (Router, Switches, etc.)
iii. Configure outbound and inbound fax services
iv. Configure VPN and / or RDP for remote access
v. Installation services for EMR/PM client software (if required)

(Complete list available in the downloadable Excel Template below.) 

c. Electronic Billing Costs (recurring monthly costs)

i. e-Prescribing via Surecripts, re-fills, etc.
ii. Electronic Medical Claims processing
iii. Medical Paper Claims processing
iv. Electronic Remittance processing
v. Statement Service
vi. Credit Card processing service
vii. Appointment reminder service

Does this seem staggering? Does everything listed here apply to your practice? If not, what things are must have and what's optional? Which costs are one-time upfront only, or monthly or annually recurring? My answer is really quite simple, find and work closely with a good independent certified EMR consultant that will provide you with these answers throughout your EMR selection process and do so, at no cost to you. Yes, you read that right. 

So, when an EMR vendor quotes you a price for an EMR solution be sure to ask them to address and clarify as to what components are really included in their proposal and quoted price? I am certain that you will be quite surprised and taken back by the responses you get.

Well, enough for now, but I promise to provide more detailed explanations about these popular components and their related costs and variations, that you should be aware of throughout your EMR selection process. Keep an eye out for more of my articles on this topic and others.

Total Cost of Ownership of an EMR

Learn more about different cost components of an EMR and break them out into one-time and recurring costs. Download free template on EMR Implementation Cost Computation.

RevenueXL can not only help you select the right EMR csetificate, but also help to get handle on total cost of implementing EMR Software a.k.a. EHR Software.

________________________________________________

RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.