Free EMR – A Boon for Small Practices?

I was talking to a physician friend during the week, and getting his take on EMR implementation. He would dearly like to implement an EMR in his practice. However, the major roadblocks he’s experiencing are in terms of costs. The quotes he has received for EMR implementation runs close to 80K. If he bills patients 500K a year, if he does not implement an EMR solution at all, the differential on the Medicare rebates in the first year would be 1 percent of $500,000, which is $5000, which is a number he says he can live with. If he implements an EMR, his two physician practi ce stands to make $88,000 from Medicare (they don’t see many Medicaid patients). In other words, if he spends 80K for his practice, or shells out 40K personally, he stands to gain $44,000. If on the other hand, he maintains status quo, he loses just $5000. Given the pain of choosing an EMR and EMR implementation, he’s probably better off doing nothing, he believes. And let’s not forget, it’ll be live people working with an EMR system, and productivity will actually take a hit before rising slowly back to pre-EMR levels, as this Feb post by Robert Rowley on Practice Fusion’s blog shows.

In other words, there are monetary incentives but sometimes just don’t make real-world sense.

This same math would look a lot different in a multi-physician practice. The same EMR implementation cost would be spread over a larger base, and more of the incentive money would actually reach the physician.

Which brings us to Practice Fusion. On this blog and elsewhere, Practice Fusion has got a lot of press (Full Disclosure: Practice Fusion is an advertiser on this site), not all of it positive.  Not being a medical practitioner, and never having used any EMR personally, my idea of how Practice Fusion stacks up functionally against other EMRs is pretty much second-hand info gleaned from reviews (John had a recent post on Black Book rankings. It’s interesting to me that Practice Fusion shows up in only the 1-Physician Practice rankings among the top 20.) There are those that caution the model of free. There’s also some debate whether a one-size-fits-all approach will benefit every kind of practice. But just based on its economic model, Practice Fusion is a system I would at least recommend my friend look into.

About the author


Priya Ramachandran

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.


  • Does the opportunity exist for this physician, and others, to join forces and buy in ‘bulk’? Are there any EMR vendors who would be willing to look at practices on an individual basis and adjust contracts accordingly? It seems to me that a legislated purchase should have some sort of funding or tax credit structure to offset the cost of implementation as each practice has different needs and resources.

  • Al Hunt,
    I always thought that the RECs should have done this. They should have figured out which EHR software their users wanted to use and then gone to those EHR software companies to get a bulk discount on that product. Sadly, none of them did this.

    I haven’t seen any other models that try to get the bulk discount. Not sure how you’d model it to make sense.

    I wouldn’t trust the Black Book Rankings that you link to at all. It’s an interesting data point, but really isn’t an effective way of trying to rank EHR software.

  • John

    Why would you not also mention other advertisers (disclosure) who offer an EMR and Physician to Physician connectivity underwriting their referral network and who were certified first of any free system?

    We are experiencing significant growth as we are able to bring physicians offices up to speed and acheive MU incentives this year, we have a Cleint Services team dedicated to our physician users giving exemplary support in adopting and using our free service.

  • Good question Chris. Probably has to do with Priya Ramachandran (who wrote the post) not knowing all of the advertisers on the site. She’s still learning the EMR market.

  • Al, Chris, John – thanks for your responses.

    Chris, I missed Mitochon in my post because I didn’t know about it. Now that I do, I can learn more about it, and present Mitochon too as an alternative to my friend.

    Al, your comment has made me think that EMR vendors probably need different pricing models, depending on the sizes/kinds of practices they’re targeting. Or like John suggested, RECs/physician groups should take the lead in collective bargaining with vendors.

    John, thanks for the heads up about Black Book rankings.

  • I use MDBlackBox free EMR I find it better than high priced EMR’s because it was designed by a doctor frustrated at the other EMR’s

  • Jane – Thanks for your comment.

    Does anyone know of any EMRs that can be test-driven online? I would really like to get hands-on experience with an EMR (I’m not looking to see a demo video). Any vendors who provide demo logins or similar?

  • MDBlackBox is free to signup and can play with it for free – the signup took 2 minutes and was accepted in 2 mintues

  • That was fast 🙂

    Jane, will check out the online link. I wonder if they will be ok with someone who doesn’t practice medicine simply signing up for a demo?

    John, I want to try hands-on EMR use… much prefer it to a demo video.

  • Simply email them and tell them, you are not a doctor but trying it out for a client. I think they will be fine. – They have been excellent to me.

  • I had problems with PracticeFusion, it was confusing to use, not what I thought it be for how professional it looked. I did try couple open source EMR and discovered no real customer support which ended up not working due to bugs at some point or another.

  • I am surprised at your focus on only one EMR that is free. I also think you need to dig deeper as to the reason for putting in an EMR. If this was a new system that would reduce accidents on highways by 50% people would be all over it. So why all the concern over an EMR? Well the reason may be that basically all an EMR does is create electronic files out of paper docs. What if you were able to share information seamlessly between all physicians. Patients would then be able to receive better care, especially those frequent flyers.
    So consider a combined clinical HIE/EHR/PHR that is also free. Now your cooking!
    I am surprised you mention an advertiser even with the disclosure.
    Let’s focus on patient care and not the cost.
    If it was your son or daughter driving on the highway wouldn’t you want the best safety tool for them?
    Name of free HIE/EHR/PHR withheld on purpose. Maybe the author will expand on his first post?

  • Jane, I’ll ask for a demo id, and see how it goes. Thanks for your suggestions.

    Jim, thanks for your comment. To address your observations:
    As to why I didn’t include other free EMRs, a) I didn’t know about others, and b) this post was pretty much a reaction post to the Technology Review article.

    “Lets focus on patient care and not the cost”: Some physicians will continue to make the call based on cost, so it’s really up to the vendors to make themselves attractive to smaller practices. Free EMRs are filling an obvious need.

    I’m a “she”, by the way.

  • A free EHR is not free. There are many hidden cost. Support and sevrice is going to cost money. Labor cost of work arounds that your practice needs that are not in your free EHR. Efficiency required to reduce staff only comes from customized EHR solutions. Interfaces to digital xrays, ultrasound technology, cameras, scanners, printers, labs tend to be very difficult to achieve with web based EHR’s. You want to buy an EHR where you control all of your data. Make sure your EHR will help you pass audits, improve quality of care and reduce your expenses.

  • Hi Priya, thanks for sharing your experience… its true, very true that the cost factor is a biggest hurdle in the process of emr implementation. For sure a free web based EMR would definitely help, however, it must comply with HIPAA and healthcare industry requirements, thanks again…

  • PatrickSF techcrunchemr
    As an independent IT Consultant who supports several medical practices and has had some dealings with Practice Fusion, I must say that PF is an overly simplistic and disappointing product. At first I was excited about the possibilty of a free EMR product, but I was soon forced to drop PF as an EMR option for several reasons.PF completely lacks or is extremely weak in the areas of workflow & status tracking, reporting, billing and data access. furthermore, PF lacks the ability of in-house lab results entry. 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 completely unusable. I, and many others have repeatedly requested the addition this functionality, but all have received the same, standard PF smug snub.

    While the oft 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.

    The overriding premise is that EMR vendors and sales persons are interested not primarily, but only in money. I am aware of several examples of physicians being completely taken advantage of by dubious vendors and their third party intermediaries. In one such case the intermediary was a Medisoft “VAR,” an acronym (and product) that I have learned to despise. The acronym VAR stands for Value Added Reseller, but I’ve found that generally not to be the case. The VAR’s, like the actual software vendor are interested solely in money. Also, the VAR’s lack the ability to make any substantial improvements to the software. It’s a system concocted by vendors who don’t want to entangle themselves with actual users and their questions, needs or criticisms. So, be very careful about EMR products marketed & sold through third party “VAR’s.” That is a recipe for disaster.

  • There is a distinct difference between price and cost. Sure PF and a couple others are priced at zero, but the total cost to use them is much higher. Physicians pay for this in time. Time to find workarounds for EMRs that are too simplistic. Time to train themselves and their staff because the UI is not intuitive. Time to build a hybrid of paper and electronics because the EMR cannot do everything they need. In addition to time, they pay big fees to customize the free system to meet their needs.

    Think about it this way. If you save $5000 per year not buying an EMR that works the way you do. If your free EMR forces you and your staff to spend 20% more time doing your job. How long before that 20% pay cut exceeds the price of purchasing and EMR that makes you more productive?

    Selecting an EMR that works for you requires an investment in time and research. Taking the first thing you find because the price is too good to turn down, is just lazy and costly. Would you buy the first suit/dress you see on the rack or do you patiently look for something that is attractive? Do you buy the first car you see on the lot, or do you spend time finding one that fits all your needs at the right price. Since an EMR can build or destroy your business. Why would you even consider taking a shortcut here?


  • Good discussion Mike. Although, I think the example of the suit/dress or car buying isn’t a good analogy. Many do just buy the first one they see. I know I do with suits. The better analogy is like buying a house. You’re going to live in it for a long time and people don’t take that decision lightly. That’s how an EHR should be looked at.

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