Free EMRs, Ads and EMR Pricing

Last week, I wrote about a conversation with a physician friend on the costs of moving to an EMR. That conversation segued into a discussion of free EMRs and how they can be a good thing for small (definitely a game changer for solo or two-practitioner) practices. This week, I’m analyzing free EMRs from the advertising angle. My friend made a comment during our discussion that gave me pause. He said he didn’t want advertisements distracting him when he was talking to a patient, he’d rather spring for a package that charged him a few dollars a month than one that had ads embedded inside it.

I think the ad question is pertinent to both sides of the equation. As a physician, I don’t want the 15 minutes I spend per patient cut down even more, because I want to get rid of those pesky pharmaceutical ads. As a patient, I don’t want to get the feeling that I’m the third wheel in the space between my doctor and his iPad.

And frankly, the low or no-cost, high volume Walmart strategy doesn’t make much sense to me in the long term. This is not based on some well-pedigreed consumer behavior study but what I’ve generally witnessed, or done myself. I’ve trained myself on the art of selective blocking. When I’m on Google, I studiously avoid looking at the highlighted links on the right, and top of the page. The same way, on eBay, when I’m looking for job opps, I generally skim past the purple highlighted vendors. If you’re a TV junkie, think about when you take your bathroom breaks.

In other words, we all have our own blocking strategies to ignore ads, which is probably not such good news for advertisers. This is not to say that advertisers won’t advertise, or vendors won’t make money.

If doctors already have some amount of natural reticence to ads, how are free EMR vendors going to make money? (I’m not sure if the ad model in free EMR packages is click/pageview driven, or a set price for simply being placed on the page, like magazine ads.) Free EMR vendors might then also offer ad-free versions, for additional dollars a month. At this point, they become just like other EMRs – i.e. when the costs are non-zero, price will not be the only differentiating factor when you’re judging EMR quality.

And yet, if my friend spends $100 a month for an ad-free EMR, as one vendor is offering, he’ll spend only $1200 a year personally for EMR, and be able to avail his Medicare 44K, as opposed to the 80K-100K EMR bids he’s currently getting. Even when ads (or lack of them) are factored out of the EMR pricing, the ad-removal-for-a-price model tends to work better for smaller practices.

Based on this, I feel like we’re going to see some steep discounting in EMR prices.

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.


  • Priya,
    Interesting discussion of the ad model for Free EHR. The only caveat I’d add is that at least so far the ads I’ve seen in Free EHR aren’t obtrusive and don’t obstruct the clinical workflow of a Free EHR. It’s not like you have to click through the ad to be able to prescribe the drug or something. So, it’s hard to say that the ad is really getting between the doctor and the patient.

    The only exception to this is when you talk about the possible impact on the decision making of a provider when he sees an ad versus not. Will he change his prescribing based on an ad on the side? Possibly. Certainly it will have some influence over the doctor. That’s why the drug companies will pay for it.

  • John, that’s pretty much how I assumed they would be – that the ads probably wouldn’t retract from the actual business of using the EMR, but I guess the annoying popup perception exists.

    Dr. West, thanks for your reply. Interesting post. I’m a (very occasional) ad glancer too, and I rarely click on ads. But just as a mind exercise – is there a way ads can become made relevant to you? Would a model that maybe suggested drugs to prescribe based on your patient’s condition (similar to Google’s ads based on keywords) induce you to click on it? Or would you pay additional for an EMR feature that created an unbiased shortlist of drugs for you?

  • As for making ads relevant to me, I don’t spend much time thinking about that. I really prefer that they aren’t that relevant. Otherwise, too much potential for a conflict of interest. I like to feel honest when I say the drug ads don’t influence me. If they were too relevant, then I couldn’t say that with a clear conscience.

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