Free EMR Software - The truth behind ‘Free' Electronic Medical Records?

Posted by: Alok Prasad

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Free EMR / EHR Software

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.

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 (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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Topics: EHR Software, EMR Software

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