One Former Practice Fusion Consultant’s Issues and Practice Fusion’s Response

As most of you know, I don’t often point out individual vendors all that much. However, on occasion I get something sent to me that I think could add to the conversation around various EHR software. I got one of those emails from long time reader, Carl Bergman. He chose to no longer be a Practice Fusion consultant and wanted to share the issues he had with the current Practice Fusion EHR product.

I haven’t had the time lately to be able to dig into Carl’s comments myself, so that I could make an assessment of his comments about the Practice Fusion EHR. However, in the interest of sharing both sides of the story I asked Practice Fusion to comment on Carl’s thoughts on their EHR software. So, below you’ll find Carl and Practice Fusions comments.

As with most things in life, take everything you read in this post with a grain of salt and evaluate what each side says for yourself. Either way, I think it could start a helpful discussion for those considering the Practice Fusion EHR.

Letter sent from Carl Bergman to Practice Fusion:

I have been a certified Practice Fusion Consultant for several months. I’m writing to ask that you remove me as a PF consultant.

I have given this decision a great deal of thought, but I do not believe that I can market PF in good conscious. This is not due in any way to how I have been treated, nor is it any reflection on the support that PF offers to its consultants, which is considerable.

Rather, it is based on what I believe are important, missing product features. This lack of features makes it impossible for me to recommend PF to any of the leads that you have generously shared with me. (Please note, I have not and will not approach any of those leads due to your referral.)

I was initially attracted to PF due to its web basis, ease of use and, simple set up and good support. However, as I went through PF I saw that it was lacking in four important areas: Workflow, Billing, Security and Reporting.

Workflow. Each patient in a medical practice presents a different set of circumstances, attributes and issues. These require that the practice be able to respond in a concerted and orchestrated way. PF lacks this ability. Specifically:

Appointment Type. PF has six fixed appointment types, New, Recurring, etc. They may not be changed, deactivated or added to. Appointment duration is set separately for each appointment. An appointment’s specifics are kept in a note.

Appointments are key to a practice’s workflow. For example, PF has a wellness appointment type. However, there is no ability to link the appointment type to look for outstanding labs before the appointment is set. Nor can appointment type reserve a room or assign a tech to take vitals, etc., as part of an exam. As a result, a practice is left to its own, non traceable, ad hoc methods for preparing for and carrying out the exam.

Shared Task List. When a practitioners decides on a course of treatment, this can set a number of things in motion:
• Labs
• Rx
• Recurring Appointments
• Procedures
• Referrals
• Billing

Each of these also is an assignment to someone else to carry out a portion of the plan. While PF has lists for a patient and individual task lists for each person, it does not have an overall view of pending tasks so a manager can see bottlenecks or assign workloads.

Security. PF has four fixed levels of security: Staff, Nurse, NP/PA and PA. Users are assigned to one or more of these levels and optionally as administrators. As with appointment types, the categories may not have their attributes modified or may new ones be added.
I found a definition of the categories in the Support Forum/Getting Started, which defines different user’s edit rights. It is silent about how, if at all, access is limited. Apparently, any user may view all parts of a record. Allowing any user to view anything in an EMR is a dangerous policy because it allows confidential information, such as an AIDS test result, to be known by those who have no need to know it.
Billing. PF includes elements, such as insurance plans, copays, etc., that are usually associated with practice management and billing systems, so it is surprising that it does not include billing as well. Instead, it integrates with third party billing systems, such as Karo.

I have long been biased against systems that tie an EMR from one vendor with billing from another. No matter how well designed, the attempt to integrate two different data structures just doesn’t work well. While PF states that is it fully integrated with Karo, an on line subscription based billing system, but neither site has much detail on the integration much less a data model. I think a user should also know what, if any, terms, relationship, contract, etc., exist between PF and Karo or other billing services.

Aside from detracting from the free nature of PF, the question of the degree of integration is major. For example, who is responsible for the interface’s operation PF or Karo?

Is a demographic change in either reflected in the other? From what I read in the PF Community Forum, the answer is no. I would like to know whose reporting module, if either, can access the combined data from the two systems?

Also, if I use Karo, does that mean I have to set up a separate security system. To look at billing do I have to go from PF and log into Karo?

Reporting. A major advantage of an EMR over a manual system is not only the ability to find and retrieve a specific record, but also the ability to find and report on a selected set as well. For example, if the FDA notifies physicians that they should review all cases of Crone’s disease that are more than three years old who are on a specific dose of a particular antibiotic, PF could not do this.

PF’s reports are limited to searching and reporting on specific topics. In this, it compares unfavorably to a host of other EMRs on the market. If it did have a well developed reporting function, it could make up for some of its lack of workflow abilities, but it does not. This lack of reporting ability when combined with the lack of an internal billing function is a deal killer.

I regard each of the issues that I’ve listed to be a major problem any one of which would cause me to be skeptical of a product. Taken as a whole, and I am aware of the wide adoption of PF, I find that I cannot recommend PF as an EMR.

Carl Bergman
President
SilverSoft, Inc.

And Practice Fusion’s response:

Here’s some notes back. In general, Carl doesn’t seem to have a very deep understanding of the product. A failure on our part, perhaps, but these answers are easily given from our support team:

– Appointment type: EHR accounts come with six default appointment types, but any Admin level user is free to create their own to match their workflow. This setting is under the “admin” tab in the EHR.

– Task list: Each practice manages the passing back and forth of tasks a little bit differently. Most use the secure message feature to send follow-up, billing, lab messages, etc. A practice manager could review these messages or, more easily, could use the Live Activity Feed to see where there are bottlenecks. Since most of our practices are small (under 10 doctors) this doesn’t seem to be a big issue.

– Security: Each user has just one level of permission inside the EHR. Their individual login dictates the level of access they have. It is certainly not true than any user has the same access rights to any record. Plus, our activity feed gives an added level of transparency where you can see exactly who has accessed what, any actions they’ve taken, etc. That’s a unique Practice Fusion feature. However, it is a great suggestion to add more customization to these edit levels, that’s a popular request from our users as well and we have it on our development roadmap.

– Billing: We have the opposite bias from Carl here. We believe that being billing agnostic gives Practice Fusion users a great deal more flexibility in how they choose to manage their billing and an easier transition to EHR since they don’t have to change their billing process at the same time. Kareo is just one option that we provide our users, they are free to use whichever biller then would like. Their low-cost, integrated billing software is popular with our users. The integration today is fairly light, but we are working on ways to make it a more robust connection.

– Reporting: Practice Fusion does have some basic reporting features built in to the EHR today. For example, the reporting feature has assisted doctors with managing the Darvocet recall and with identifying H1N1 high-risk patients. The Crohn’s (note the spelling) disease example he gives would actually be fairly easy to run within PF. You would just do a report on ICD-9 code 555.9 with the date range set and then filter the resulting patients based on prescription (or run a second Rx report and merge). I don’t have any Crohn’s patients in my test account, so I ran a report on chronic migraine instead, below. However, we are in the process of upgrading the reporting feature for both Meaningful Use and our own planned enhancements.

There you have it. I’ll let you be the judge for yourself. Plus, I’m interested to hear what other Practice Fusion users have to say about the various opinions stated in this post. One thing that Practice Fusion has going for them is they at least don’t charge anything for their EHR. So, it’s not like a doctor using it can complain that they didn’t get what they paid for.

I have a feeling that this conversation will continue in the comments. See you there.

Full Disclosure: Practice Fusion is an advertiser on EMR and EHR. Although, I’d provide the same opportunity to any EHR vendor that would like to respond to comments I get about them.

About the author

Carl Bergman

Carl Bergman

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com.For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst, a role he recently repeated for a Council member.

14 Comments

  • John,

    Thanks for posting the full conversation on PF. Here’s my response to their comments:

    1. Appointment Types. I stand corrected, in part. You can create a new appointment type, but you can’t add anything to it. I stand by my initial observation:

    [Th]ere is no ability to link the appointment type to look for outstanding labs before the appointment is set. Nor can appointment type reserve a room or assign a tech to take vitals, etc., as part of an exam. As a result, a practice is left to its own, non traceable, ad hoc methods for preparing for and carrying out the exam.

    2. Task List. These are not just for finding bottlenecks. They provide each member of a team with knowing who has to do what, for whom and its status.

    3. Security. They do not address the criticism that you can not change security types, nor can you change privileges. Also, they do not explain why they call their system edit levels. Other than showing how to set up security, there is no documentation I could find on their approach. Also, there is no way to mark an individual field, such as an AIDS test result, for additional security.

    4. Billing. Their statement that “The integration today is fairly light, but we are working on ways to make it a more robust connection.” Caveat Emptor.

    5. Reports. I plead guilty to not spelling Crohn’s correctly. More to the point, they state: “Practice Fusion does have some basic reporting features built in to the EHR today.” They show what would have to be done to report my hypothetical example. In doing so they make my point, PF lacks a general reporting tool, and say, “However, we are in the process of upgrading the reporting feature for both Meaningful Use and our own planned enhancements.” Until then?

  • Personally I am a consultant and honestly PF is a basic EHR and it is FREE! We showed several EHRs to a few physicians and they chose PF so we are going to make the implemenation as seamless and smooth as possible. Not all EHRs are alike but if a Physician chooses PF we are going to be there ot help them out! Just because PF is not the best solution does not mean that Dr.s should not choose it. My goal is to help practices implement technology into their practice and the EHR is a part of that. If PF is a way for Dr’s to get in the Technology world then I am all for it. My feeling is that PF may be a beginning but not the end for Dr’s. Perhaps PF will continue to change and grow and become the best but right now they are a low cost option and a pretty decent one.

  • It’s an interesting conversation. Have to admit that I’m highly biased in favor of PF because they took my practice from shambles after a previously failed EMR to exactly what we wanted and needed. We’ve been humming along with very few bumps, maybe 2-3 over the past 18 months since we started.

  • PF is a great option for practices who – for whatever reason – aren’t willing or able to invest the time and money in a more customized or mature solution, so there will always be a place for advertising-based free software such as this.

    Just remember: You usually get what you pay for.

  • As an end user who has experienced several EMRs and different sites and facilities, i will say that two if Carl’s obsetvations are a bother to me. The task list issue and the reporting. Having said that, when i cimpare functionality for my solo practice and for the group practice I’m in with PF to many other EMRs i am quite pleased with the performance.

  • In fairness, PF is by no means alone falling short in these two areas. For example, I’ve seen first hand the problem of not having a shared task list in an ER.

  • As a long-time solution provider, albeit in a completely different area-SaaS marketing and business relationship management, I think I can bring a different perspective to this discussion.

    When we build and release software, we shoot to release something that is “good enough” that early users will appreciate as well as offer suggestions on how it can be better. We try not to waste time on unnecessary features. Employing Agile Software Development methods means that we can do frequent releases of software updates, some small, others much larger. If we waited to release something that’s deemed “perfect,” it would never be released and/or it wouldn’t really fit the needs of users.

    I’ve experienced consultants and customers for whom it’s easier to find fault, than appreciate what’s already been released, understand that it will be built out, and offer constructive suggestions while understanding that software is always a work in progress. It’s usually an excuse for a myriad of reasons.

    PracticeFusion has built a true *solution*, one that works, easy to implement, easy to use, and easy on the wallet. This is in stark contrast to a lot of really crappy, expensive apps built to cash in on MU requirements. PracticeFusion has conquered the classic challenge – Good. Fast. Cheap. Choose two. They’ve delivered all three. I’m sure they will continue to enhance their technology and deliver an even greater experience for their customers.

  • My multi-site health center has been using PF for over a year. Administration absolutely hates it, the providers are OK with it. The loathing from administration is mostly due to the lack of reporting. Simple reports like “How many Medicaid visits did we have today?” turn into a staffer manually having to open each visit and then look at each patient’s insurance. Because it is written in adobe flash this is a ridiculously slow process. The only other option is to do all of your reporting through Kareo but not all of the data gets transferred to Kareo (an example is check-in time, time in-room, prescribed meds, etc). We have begged them to just allow us to have a button to export all of our data until they get around to making reports for administration. That way we can use spreadsheets to create our own reports. They don’t seem to listen and only give you a canned response (See the PF forum for examples of their canned responses). All and all PF is a free EHR that will keep up with the data ok but don’t expect it to help you make your practice function more efficiently from an operations perspective. They simply won’t give you access to the data. Another thing that happens is that sometimes a provider will forget to start a Kareo bill for a claim. When this happens there is absolutely no way to track it down. It doesn’t show under the Kareo submitted claims report because it wasn’t started. And there is no encounter report to compare with Kareo to even know that you are short a claim. So you have to keep track of encounters externally on paper to compare with Kareo to make sure the providers don’t forget to create a bill. PF seems it is designed around physicians and the data they might want that relates to medical services with very little thought to the running of the actual practice. I would not recommend PF to anyone except my competitors. lol

  • It looks like the market has spoken – less than 2500 physicans, PA’s or NP’s have been able to attest (get paid for using and EHR) using practice fusion. Free? Hardly the business model is based on the premise of reselling the patients data to drug firms and now they are suggesting drugs to providers (not generics) and want to have online scheduling.

    http://techcrunch.com/2013/04/08/book-doctors-appointments-online/

    Bascially they have failed to get docs to use their system and are now trying to compete with zoc doc.. One interesting concern is that they are a third party now has the personal email of 1,500,000 visits? Are they using regular email to communicate the name and the visit to patients? How is that not a huge privacy violation? If you use google for your email you just disclosed your doctor visit to them as well.

  • Brainiac Doc,
    Some really interesting observations. The 1.5 million visits is interesting, because that’s a lot of patient emails. Although, I expect the unique patients is less and the number of patients where email has been collected is less as well.

    There are ways to send a secure email notification. I imagine that’s what PF is doing.

    JW,
    The 150,000 is a vanity metric for sure. It’s interesting to compare it against the number of MU attestations. I see a post coming.

  • As an independent IT Consultant who supports several medical practices and has had some dealings with Practice Fusion, I greatly appreciate this post and all the comments. I too was forced to drop PF as an EMR option, but primarily for a different reason. PF lacks a user accessible or editable table for lab results. True, PF does offer integration with numerous third party lab companies, but that is only of secondary interest for most of my clinical clients. A few of my clinical clients do almost all of their labs in house. So, the lack of a user accessible & editable lab results table renders PF unusable. I, and many others have repeatedly requested this functionality, but all have received a smug snub.
    The comments above regarding workflow & status tracking, reporting, billing and data access are certainly just as valid and significant. I just couldn’t get past the lack of in-house lab results entry functionality to even bother with addressing those issues.
    While the repeated comment “You get what you pay for” is certainly valid in the case of PF, I honestly have to question the basic validity and intent of the ONC’s certification program for EMR’s. I have yet to discover any EMR/EHR solution that actually aids and improves the practice of Clinical Medicine, but how such a primitive and simplistic product like PF could possibly be considered certified by the ONC for Meaningful Use simply devalues the whole concept of Meaningful Use. I guess the ONC’s concept of Meaningful Use has less to do with the improvement of Clinical Medicine than it does with appeasing big money lab companies, advertisers and EMR/EHR vendors. It certainly isn’t benefiting Clinical Medicine.

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