Practice Fusion Violates Some Physicians’ Trust in Sending Millions of Emails to Their Patients

Update: At the bottom of this post, I’ve included Patient Fusion’s response to this article.

When Practice Fusion asked their users to prepare for some new “patient communication tools”, the outcry from many doctors was for Practice Fusion to stop focusing new features on patients and instead focus on unsolved physician requests that were made years previous. What I found when I started digging into Practice Fusion’s focus on patients through its launch of Patient Fusion was a much more important story where Practice Fusion’s actions were violating some physicians’ trust and might have issues with HIPAA.

The story starts in early April 2012. With little fanfare (only a generic blog post about Measuring the Patient Experience Using Surveys and two mentions in the Practice Fusion “Progress Note newsletter”) (UPDATE: Practice Fusion’s response at the bottom of this post says they did communicate more than is described here.), Practice Fusion turned on a feature that would email every single patient whenever a progress note was created in the Practice Fusion EHR. The email came addressed as being sent from the doctor and asked the patient to rate and review their provider.

In the 17 months since they started sending these emails, 1,844,718 reviews have been submitted across 29,630 providers according to the Patient Fusion website. If we’re really generous and assume a 20% response rate from the emails, then over the last year Practice Fusion has sent out over 9 million emails to patients. It’s truly an impressive feat to have been able to gather that many physician reviews in such a short period. What an amazing asset for any company to have accomplished.

Regular readers will likely remember my previous post titled Physician Ranking Websites – The Bad, The Worse and the Ugly where I discuss in detail the challenges for any physician rating website, so I won’t go into that here. The value of physician ratings aside, I don’t have any problem with Practice Fusion collecting physician ratings and reviews. What I am concerned with is how they did it.

In my research, I couldn’t find a single Practice Fusion doctor who knew from Practice Fusion’s “standard channels” (blog post and email newsletter) that every patient they charted would receive these rating and review emails. What I did find was a doctor who only discovered these emails were being sent to his patients when his brother visited his office and later asked him why the information in the email was incorrect. The doctor no doubt asked his brother “What email?” Other doctors only knew about the emails after hearing about the emails from their patients. One doctor confused a few of his patients’ comments about the ratings emails thinking that they were talking about some other rating service like Yelp, Health Grades or ZocDoc. He was later surprised to learn that Practice Fusion had been sending these ratings emails for months to all his patients and he knew nothing about them.

Imagine being a doctor who discovered your EHR vendor was sending emails to your patients IN YOUR NAME and you knew nothing about it. Shame on those doctors for not reading the Practice Fusion newsletter in more detail.

The physician response once they found out these emails were being sent isn’t surprising. Here are a few of their responses:

“We find this a MAJOR violation of our trust with Practice Fusion.”

“It demonstrates to me that PF has LOST TOUCH with how difficult it is to run a doctor’s office.”

“I just think of all the times I assured people that we would never email them with solicitations or spam, but only would use their private email addresses for emergency purposes or if they emailed us first.”

“Why were we not told? Why can’t we use the emails we enter [into] the system but you can?”

“You should NOT have to opt out of spam! This is an outrage.”

“It’s deception! Unsolicited emails to our patients from PF should never be signed off as the doctor. Where is the trust?”

“PF obviously thought of doctor’s offices more like a restaurant or retail store than the rather unique provider of personal health care and protector of personal data.”

“We were outraged!”

“No physician signed up onto PF thinking they can would treated like HealthGrades or Vitals.”

“The main point of contention has been the fact that we were not aware of the surveys being sent out IN OUR NAMES!”

“Hard to believe that the largest social site for information about my practice was created without my knowledge and I am guessing was directly solicited from my patients in the form of emails.”

“What I hope PF takes from this is that doctors, for the most part, do not like being used to advocate for a product without expressly being told in a bolded out and starred statement “hey, we’re going to use your office to send out email asking for feedback. Is this okay?”

You can read more reactions from Practice Fusion users on this forum post (Note: This post has had many of the comments removed since I posted this article.) including this comment from a patient who received the email:

I’m a patient. I received one of these emails from PF and then a follow up email from my doctor who was simply irate that PF was spoofing his email address. This just defies every email rule there is and PF owes an apology to every provider and every patient who received one.

One doctor I talked to didn’t find out about the emails being sent in his name until almost a year later. PF Staff Kristen offered the following comment in the above forum post, “The goal of patient surveys is to provide both insight and marketing materials for your practice. We will not publish, sell, or otherwise market your practice without your permission.” I think Kristen really believes this. In fact, I talked to Practice Fusion directly and they told me the goal of these ratings and reviews was to provide more transparency between physicians and patients. While I appreciate the noble goal of transparency between physician and patients, I am concerned that Practice Fusion thinks that doctors gave them permission to send these millions of emails. Practice Fusion may legally have permission to send these emails based on the fine print of their user agreement, but permission to me means that the doctor knows what you’re doing in their name.

As one doctor asked, “Why were we not told?” No where in Practice Fusion can a provider see their ratings and reviews and they weren’t published to the Patient Fusion portal until the portal went live a year after they started sending these emails. There’s no notification sent to a provider when a rating is completed. All of the emails and ratings are patient facing, so how would a provider know that reviews were happening? Oh, that’s right, they were suppose to read the email newsletter.

I wonder how many more of the almost 30,000 Practice Fusion providers still don’t know this is happening. I imagine they’ll have similar reactions when they find out.

Maybe I am wrong in my assumption that many doctors still don’t know about these emails being sent in their name. It is possible that most of them saw the newsletter and were happy with the new feature. My problem with this is that I receive the Practice Fusion email newsletters and did not recognize that this is what they were doing. It is hard for me to believe that the majority of busy doctors caught the message.

Turns out that when Practice Fusion first implemented the email ratings feature, the only way to turn it off was by contacting support. There wasn’t even an option inside the EHR to turn off the emails, but that has been added since. It seems to me that they weren’t thinking about their users’ needs when implementing this feature, but likely wanted to get as many reviews as possible in order to compete with the highly funded physician review sites: ZocDoc ($95 million), Health Grades (Acquired for $294 million) and Vitals ($26 million).

Fifteen months and approximately nine million emails later, Practice Fusion finally posted what the emails look like and what emails are sent from Practice Fusion on their new and relatively inactive forum. However, this entire time Practice Fusion could have communicated this new feature to their users directly. In one sense they are an ad platform that communicates to doctors and yet they chose not to use that platform to let their users know what they were doing. I understand there is a balance with how many alerts Practice Fusion sends doctors within Practice Fusion, but sending out thousands of emails in each doctor’s name seems like one worthy of clear notification. (UPDATE: Practice Fusion’s response at the bottom of this post says they did communicate more than is described here.)

Practice Fusion could have easily avoided all the confusion and loss of physician trust if they had just implemented this as an opt in feature as opposed to an opt out feature. Just like the pop up surveys and other notifications they display during login, they could have popped up a request for providers to opt in to this new ratings service. When I asked Practice Fusion about this, they told me that they didn’t do it as an opt out feature because it was a passion project for them and they wanted every Practice Fusion doctor to participate in more physician-patient transparency.

Maybe that was one of the goals of the project, but I think there is more to the story. Think of the value that 1.84 million reviews has created for Practice Fusion. If Practice Fusion had done these ratings emails as an opt in feature, I am sure that very few doctors would have knowingly opted into the service. With very few doctors opting into the ratings emails, Practice Fusion would have missed out on all the value that a large database of physician reviews would create.

Beyond just the forum post linked above, I know that Practice Fusion has heard from doctors who are upset with these ratings emails being sent. From my research, it seems like most doctors’ initial reaction to the emails revolves around fear of being rated by their patients. In fact, I expect this is why on the Patient Fusion website (where all the ratings and reviews are immediately published) it says “98% doctors recommended.” I have little doubt that this statement was added in response to physicians’ fear over being rated. Many doctors likely switched from anger and fear to acceptance when they saw that their patients had rated them well.

Side Note: If almost all of the provider ratings are positive, then do the ratings have any real value?

Maybe this is why Practice Fusion hasn’t had a different response to this issue. They feel that those doctors who were upset at the emails have been pacified with good reviews or the ability to disable the service. I think Practice Fusion considers those complaining in this forum post (Note: This post has had many of the comments removed since I posted this article.) the standard “complain over anything” response from users. The problem is that we don’t know how many more doctors haven’t complained because they still don’t know what is going on. Hopefully by covering it in this blog post we will see how many doctors care about this issue.

If ratings emails sent from medical doctors wasn’t bad enough, it turns out Practice Fusion has been sending ratings emails to psychiatric patients as well. Here’s what one psychiatry NP had to say about the emails:

“As a psychiatry NP I really do not think patients should be asked to rate their therapist. This is actually a conflict with the relationship with the patient. Holding the boundaries with most of my patients is VERY important. They all want to please me. So it really is inappropriate to ask a patient to rate a therapist they have.”

On July 10th this psychiatric NP asked for the emails to be turned off. On August 1st she posted that the emails were still not turned off. Why Practice Fusion’s immediate response wasn’t to reach out to this psychiatrist to turn it off and then to turn off this feature for all psychiatrists is beyond me. Sending out rating emails to mental health patients is a whole new level of trouble and legal entanglement.

Needless to say, there are dozens of other examples of bad situations that could be caused by these emails. Here’s one doctors’ comment about his patient population and these emails:

“One of the things we do is addiction. So I have people where nobody knows they are coming to see a doctor to treat their opiate problem and they are incredibly anxious about anyone finding out. We are the type of practice where people often come to keep their indiscretions hidden. Their affair, their vice, their compulsion. I realize that most just got a dumb email.”

Another doctor offers this insight into his patient population and why this could be a big issue:

“As a doctor, I don’t like this one bit. I’m in pilot country and the FAA takes medication use VERY seriously. what if a doctor mistakenly prescribed a medicine that was on the FAA “not allowed” list (http://www.leftseat.com/medcat1.htm) or sees a psychiatrist and then PF sends an email that the patient was seen at a psychiatrists office to their work email. Their work could be scanning their email for violations like this and BAM! someone loses their job b/c of a PF hipaa violation that reveals the private information that this person had just been to a psychiatrists office and is possibly on psychiatric medications.”

The scenarios are endless. What if the email is coming from an AIDS clinic or a Cancer clinic and no one knows you have AIDS or Cancer? What if the email was from an OB and a boyfriend stumbles upon it?

Some might suggest that this is just a bunch of FUD (Fear, Uncertainty, and Doubt). Maybe it is, but this should be the choice of the patient and the doctor and not the choice of the EHR vendor. If Practice Fusion had done this as an opt in feature, none of this would be an issue. Some doctors are now choosing to not enter emails into Practice Fusion because they are afraid of how those emails will be used. The irony is that Practice Fusion recently made a patient’s email address and phone number required fields. If a clinic doesn’t want to enter that information, they have to check the patient doesn’t have an email or phone check boxes. You just have to wonder why email and phone fields were changed to required fields.

Doctors have always had a general fear of any Free EHR. I have heard many doctors state that they would never use a Free EHR, because they didn’t know what the company would do with their data. I’m certain that actions like the ones described above will do a lot to confirm some doctors distrust of Practice Fusion’s Free EHR. Plus, you can be certain that Practice Fusion’s competitors will be sharing this information with doctors as well.

There will be some that read these physician comments and say, “Stop complaining, it’s a Free EHR. Switch EHR software if you don’t like what they’re doing.” The problem with this rationale is that it’s not “Free” to use Practice Fusion. A doctor “pays” Practice Fusion by allowing them to use their data to make money (See also my post titled “When EMR Software Became Free…Or Does It Cost?“). Turning over the right to use a clinic’s data is why it is SO important for doctors to trust the actions of their Free EHR vendor. Without that trust, many doctors will eventually leave Practice Fusion and doctors will stop signing up.

In response to this situation, one doctor commented on Practice Fusion’s need to work with MDs to avoid situations like this. Practice Fusion’s first Chief Medical Officer (CMO) parted ways with the company back in 2012. A look at their executive team shows no new CMO and no doctors in any executive position at the company. I wonder if a doctor on the executive team would have helped them understand how spoofing the doctor’s name in these emails without their knowledge would be an issue.

While I believe sending these emails in the physician’s name without their knowledge is a big issue for Practice Fusion, the bigger question is whether these actions are indicative of how Practice Fusion will treat doctors in the future. Is this the start of Practice Fusion putting company value over physician trust? Practice Fusion told me that they knew that it would upset some doctors when they rolled out these emails, but they did it anyway. Even if only 5% of doctors are upset over this, what’s to say that the next time you won’t be part of that 5%? I know there are a lot of good people at Practice Fusion, but the company also has to answer to their investors.

On a broader scale, the core question is: Do doctors trust their EHR vendor to communicate any actions they take with your data?

All EHR vendors could have similar physician trust issues to the ones described above if they’re not careful when rolling out new features. This could include vendors who may be tempted to implement a similar email rating and review feature as Practice Fusion. The problem is not with this specific feature, but with how EHR vendors choose to implement and communicate new features to their users. You can be sure we will hear more stories about the relationship of trust between EHR vendors and physicians in the future.

Approximately 9 million emails later, we’ll see the depth of impact these actions have on Physicians’ trust in Practice Fusion.

In the future, we’ll be covering the HIPAA regulations surrounding these emails.

UPDATE: Practice Fusion sent me the following response to this article:

– Practice Fusion updated our community over the course of months about the patient feedback program through numerous blog posts, forum posts, emails and messaging inside the EHR, starting in April 2012. You can read the original message from our CEO about the program online here. Despite our efforts, not every customer was aware of the program immediately. We apologize that this was not more clear and are working to improve our feature update messaging.

– The patient email reminder and feedback program is absolutely HIPAA compliant, under both the current and new Omnibus rules. We conduct thorough compliance research with every single new feature we launch.

– We are passionate about making healthcare better and proud of our work to bring almost 2 million patient voices into the conversation. Patient transparency is a key part of the national move from quantity to quality in healthcare. The patient feedback program is designed to provide your practice with a controlled, quality channel for accurate patient reviews.

– It is easy to opt-out of the patient feedback program anytime. We are happy to help you update these settings inside your EHR account.

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

68 Comments

  • Since I first heard of Practice Fusion and got a look at it, I felt that it was a viable solution for small practices to go EHR. I had my concerns about specific issues on features (like PM integration, ability to retrieve one’s own data, etc.), potential for annoying or inappropriate ads, but never considered this possibility. I would hope that they fully come clean on this and change participation to default of opt out – both per practice and per patient, and that they allow doctors to see how they’ve been rated. This ought to deal with the concern by some practitioners that ratings are inappropriate for certain practices. But I do find it sad that they went and put this in without announcing it or discussing it with their users – between their blogs and newsletters they certainly had the means to do so.

    Ron

  • I’m trying to figure out why the surprise.

    A free EHR…seriously?

    I can’t see any way an EHR can survive simply supplying ads to the providers…I don’t see it.

    So, the next logical step in free is build an audience. The docs really aren’t the value audience to an EHR, the patients are.

    Remember when Google used to be nothing more than a search engine that inserted ads into your search results? Once they maximized that market, they needed new areas in which to grow, now people feign surprise when they discover how deep Google’s claws are in their lives.

    Every free business model attempts to follow this most successful model, so why the surprise?

    When did Practice Fusion stop advertising here?

  • I’m not objecting to the concept. I am objecting to not notifying practices that their patients are being sent emails in their name. And that there was a default opt in.

    I use Gmail and Google search, and I understand my data is being mined for assorted reasons, including to advertise to me. This is different. It was secret, and it went out to patients without doctors knowing. Ratings were done without the doctor’s consent or knowledge. And it went to some patients that it should not have.

  • I don’t get “..Practice Fusion’s actions were violating some physicians’ trust and might have issues with HIPAA.”

    Practice Fusion is a commercial operation, they have to make money like everyone else so if the software is free the physicians’ would reasonably expect what the outcome would be, unless PF expressly stated that no use would be made of patient demographics. If PF did expressly state that no use would be made of patient demographics, individual physician complaints about “violation of trust” would mostly likely fall on deaf ears for the simple matter that the contracts

  • We’re planning to moving to Kareo EHR, after having been on Practice Fusion since 2011. Just waiting for some features to be added, so that our workflow goes faster than the current setup.

    The lack of focus on fixing the EHR product is problematic and disappointing. The emphasis on portal, data collection, and anonymized data analysis is for the venture capitalists and funding, and not of any use to a small practice clinician despite all their recent claims that they support small practices.

  • John Brewer,
    I’m not surprised that Practice Fusion is trying to monetize their users, but I am surprised with their lack of communication to users. A company can monetize their users, but also communicate when what they’re doing will impact the user.

    I think they stopped about a year ago. It’s been a while.

    karl,
    Certainly from a legal perspective, caveat emptor applies. That doesn’t mean that your actions won’t violate users trust which is a valuable asset.

    former Nexus One user,
    I’ll be interested to see how many Practice Fusion users will move to Kareo’s EHR. If you’re a Practice Fusion user with Kareo as your PM system, then it’s not as hard of a switch. Of course, we’ll see if the Kareo EHR they bought (was previously Epocrates EHR) is any good. I saw some very early initial design years ago. It had a real iPad look and feel, but was missing a lot of functionality at the time. I’m sure they’ve come a long way since then.

  • @ R Troy
    The data collection model follows a similar path whether it be a business or the government:
    Entity gathers way more data than anyone ever expected, entity says “oops”…WHEN CAUGHT, and claims they made a mistake.

    Google, Facebook, NSA, Macys, etc.

    My point is this: very little is free…and an EHR just can’t survive on the expectation that a doc will look at ads and react to them.

    Think about this: docs have zero time, especially after they can their transcriptionist and spend hours doing their own input.

    So…for anyone to think that free is free in an EHR has their head stuck in the sand.

    I’ll bet their terms of use never state the won’t email patients…why would they tie their hands with this unless there was an outcry?

  • John Brewer,
    My next post talks about the user agreement and indeed their user agreement says they can email patients. More on that in the next post.

  • Isn’t PF a “fremium” sort of thing?
    They make money (or try to) with clicks, SEO, advertising, traffic, etc.

    Why the continue complaints and barking?
    Is EMR possibly the most hated software product class?

    For organizations that need or want an EMR that meets YOUR terms and conditions, with a feature set and workflow that works for YOU, call us. 🙂

  • John is to be commended for an important, serious, well researched and well written report.

    It’s one thing to urge that the buyer be aware, however vendors have an obligation to spell out their significant changes in their practices and processes when they change their use of PII. A quick read of their terms and privacy policies doesn’t refer to this practice.

    Emailing PII, without permission of either party, may be a violation of HIPAA. If it’s done in plain text, it most certainly is.

    I believe that John Brewer has a plausible theory about PF’s motives. They need to find a larger audience for their ads and their sale of user generated data. Aggravating their core users is an odd way to do it.

  • John – I am an avid reader of the blog and appreciate your efforts on it. I am keen to know your previous financial relationship with Practice Fusion. I have seen their ads on your site in the past and now I see the ads of other EHRs which would lead me to ask if you have a conflict of interest in this story. Why did Practice Fusion stop advertising with you and is this some type of retaliation towards them?

  • Sam Vargas,
    I have no financial relationship with Practice Fusion at this time. Although, the automated Google Ads could put one of their ads there. As mentioned above, I thought that they stopped advertising about a year ago, but I just checked and their last ad stopped on March 31, 2013. I thought it was longer, but I was wrong. There’s definitely no retaliation on my part. I thought it was just an important story to write.

  • Regarding #Sam Vargas’s comments – John – is this true about them being advertisers here in the past? If so it doesn’t feel very clean. My company was considering running an ad with you – is this what we can expect if we stop?

  • Robert Chua,
    See my comment above about them advertising. My track record with former advertisers is clear. The content I create is based on what I find valuable to the reader and I always disclose any financial relationships I have related to the article.

  • John, if you were indeed getting paid and are not now, this feels super sketchy. This feels like the manifesto of a scorn woman, not like objective journalism. Why are there no quotes from the so called upset doctors?

  • “All publicity is good publicity”
    Is that the saying?

    Does it apply to John Lynn and PF equally?
    Both need and want traffic, clicks, users, and eyeballs.

  • Whether choosing a restaurant or a care mechanic, I am able to see customers past experiences with these service providers. A good, ethical doctor will have no issue with this. This who commented above complaining likely have something to hide, and those are the doctors that the market will eventually weed out. I personally commend Practice Fusion’s efforts and courage to bring transparency to the healthcare market.

  • AXEO MED – you’ve got it right – ‘outlandish’ the blog posts results in more people reading. More people reading means more clicks on ads (see ZocDoc and Amazing Charts) on this site. I believe that this is John’s primary source of income – So he is literally paid more to be dramatic.

  • John – how can you post quotes above without sources? This list above without reference not only feels fabricated, but also libelous.

  • Sam,
    Yup — that’s the name of the game.
    On balance though I think John is “cool”.
    And, he didn’t pay me to say that and I don’t advertise on his site. 🙂

    Jeff,
    The Yelp/AngiesList sort of thing for docs?
    Not sure it’s that simple and like beauty, customer service is in the eye of beholder. How many travel site reviews do you believe and act on?

  • You could find many of the quotes I mention right in the Practice Fusion forum post I linked in the article (http://forum.practicefusion.com/practicefusion/topics/any_concerns_on_here_with_practice_fusion_contacting_every_patient_a_doctor_sees_and_asking_them_to_generate_content_on). Unfortunately, that thread use to have 24 replies. Now it only has 10. Not sure where the replies went. The dates of the forum posts also seem to be missing from the forum now too.

  • my favorite part of the post for a competitor’s EHR at the end article. Kudos to unbiased journalism. how much does eMDs pay this blog to advertise?

  • You would think that someone who runs a blog called “EMR & HIPAA” would know the difference between PII and PHI and would be able to discern what is a HIPAA violation and what is not. Accusing a healthcare IT company of breaching sensitive patient clinical information is a serious allegation, so it should not be tossed around nonchalantly like this blogger has done.

  • Someone else said PII. There are some Google Ads in the right sidebar. The DrChrono article was years before they became an advertiser.

    Interesting to see comments with different names from the same location.

  • The EMR is free. Physicians who signed up for this deal should STHU and live with it. They are getting what they paid for.

  • A note to some of the people commenting. 1. John hasn’t yet posted the HIPAA part of his article, only mentioned that he was going to. So we don’t know what he believes the HIPAA issues to be. 2. In the months I’ve been following him, I’ve never seen him not mention a potential conflict.

    We seem to have gotten a bit sidetracked. Please correct me if I’m wrong, but the point of this discussion is that PF some time back started emailing patients directly, apparently to ask for ratings of doctors, etc. The emails appeared to be from the doctors, but were not, and took advantage of the patient email addresses that practices enter into PF. PF started ‘requiring’ email addresses at some point. And practices were not aware that these emails were going out. Some doctors feel that such emails are ok, some don’t, and may even consider them a big problem for certain types of patients.

    We concede for the most part that the agreements allowed such emails, but that no one realized that. We also understand that PF can make certain use of such data, that this is part of what pays for PF. We don’t seem to know if paying practices are exempt from these emails.

    There is also a concern that there COULD be HIPAA issues here, that non-encrypted emails could divulge details of a doctor patient relationship and thus be a HIPAA violation. I’m guessing that most of us have not seen these emails so we don’t personally know.

    Is this about it?

  • For the record our company does not, has never, and does not anticipate advertising on this blog.

    That said, I think the two biggest concerns with the practice of automatically sending emails to patients are:
    1) doing so by indicating the email came directly from the provider – without the provider’s prior knowledge and specific agreement this would be done. As a side bar, providers sometimes finalize an incomplete encounter with plans to amend it. As such, an unknown automated email could also deliver incomplete information to the patient.

    2) sending an email with the provider’s name showing to the recipient without them having to enter a password. Whether or not this is technically a HIPAA violation is for the experts to decide but common sense says such an email from a mental health provider, for example, is problematic.

  • John – you’re not being transparent. The Cerner ad on the ad is clearly from healthscene a site you own, not google. Please be honest with all of us in regards to your past relationship with Practice Fusion and other vendors.

  • Loyal and regular readers of this blog can recognize fake posts without too much trouble. We Know Mr. Lynn and his daily emails well. I think it is fair to ask and bring up about conflicts of course. It looks like he answered them.

    If this was slander or a reprisal for not advertising with the blog it would be pretty stupid and lame of Mr Lynn. It would actually risk him losing all his advertisers if it were proven false. And how would the blog advertiser shake down work? I don’t think I recall that episode of Law & Order. Could someone even make this up. 9 million emails automated without doctors being directly told. How hard would it take reporters to ask a few PF doctors if this was true. How where you told? If you are going to try and hurt someone like that with made up stuff, make something up that is more vague and can’t so easily be disproved.

    What is with Practice Fusion apparently removing all the negative posts in their forum by these doctors. You can tell something isn’t right because none of the posts flow together or make any sense. Did they really just do that?

  • When something online is offered to you for free, you are not the customer, you are the product.

    In addition, Practice Fusion is probably in violation of the new HIPAA Omnibus because the pharma ads directly adjacent to the patient’s encounter note are intended to influence the physician’s decisions. However the patients did not consent to this.

  • When something online is offered to you for free, you are not the customer, you are the product.

    In addition, Practice Fusion is in violation of the new HIPAA Omnibus because the pharma ads directly adjacent to the patient’s encounter note are intended to influence the physician’s decisions. However the patients did not consent to this.

  • PF is still in the dot bomb Y-2000 era and trying to be “disruptive”.

    Takes deep pockets and commitment.

    As I have said before, EMR is probably the very last software area I would try the “fremium” model.

  • Regardless of what I may think about PF’s emailing practices, I’d remind people that a free or inexpensive EHR can make it possible for many small practices to finally dump paper. In one small, part time practice I’m very familiar with, this would allow the solo doctor to finally get rid of piles of paper, and actually be able to chart the progress of patients over time. A bit more money to add PM and payments would truly help. The ability to pump out electronic prescriptions accurately would be huge as well.

    Don’t forget the point of the system. Oh, and no one forces doctors to put in email addresses. The one I mentioned wouldn’t do it until there was a good enough reason.

  • Has anyone seen their response yet? If I was them I would seize on John’s 5% comment and run with that gift. I would apologize for dropping the ball with a very tiny group of doctors that fell through the cracks and take credit for everything else and having a 95% ++positive roll out of this super advanced patient management system. Maybe talk about the challenges and the scale of the project that was partially to blame. I don’t know, whatever they want. Turn it into good press. Didn’t John say that if it was opt in, most of the docs might have been fine with the whole thing? Admit issue with notification and thats all.

    Can you imagine if Facebook decided to email everyone on your 400 person friend list with an email from you that asked them to go to some website to do XY or Z? Then five months later you learn about it from a friend who tells you sent him spam. You go and ask Facebook and they say it was all in the updated user agreement you clicked on back in December. You should have know, it was even in a blog post last year where our CEO spoke all about it. All of us would be furious if we found out something like that had transpired with this level of notification. And patients are much more off limits than social media friends in the minds of the public.

    I suspect that if I presented the basic scenario to any of the doctors I call on regularly in my region, none of them would approve of mass automated messages to millions of patients. Even if it is as little as only 10 or 50 doctors who didn’t know about these emails and were upset. What do they claim here against these doctors who are upset that they didn’t know? I don’t think they can defend their position easily. Reporters are just going to keep asking about how they told doctors and their safeguards. They can dispute a ton of the smaller details, but saying they should have read the blog is not going to cut it for privacy advocates.

  • I don’t think the fact that it is free is an excuse. The fact is the majority of doctors qualify for the EHR incentive funds and there are MANY solid certified EHRs that cost LESS than the incentive funds. So there is no reason for a qualifying provider to use a free EHR with questionable business practices – except to pocket more of of the incentives.

    The dirty little secret in all this is that all of us, as taxpayers, are funding the EHR incentives, and thereby PF – and all EHR vendors. Most on here probably know that but it feels slimy when it is used for questionable business and patient-facing practices designed purely to enrich the vendor. I wonder what the American public would think if they knew about the thousands of Medicaid providers who received over $21,000 each simply by electronically signing a “free” PF user agreement and never even using the system?

  • # former Nexus One user –
    “We’re planning to moving to Kareo EHR, after having been on Practice Fusion since 2011. Just waiting for some features to be added, so that our workflow goes faster than the current setup.”

    If you find the time, I would very much like to hear about features (data and workflow issues) that are missing from incumbent systems. You don’t need to name the systems. TIA.

  • C

    ” I wonder what the American public would think if they knew about the thousands of Medicaid providers who received over $21,000 each simply by electronically signing a “free” PF user agreement and never even using the system?”

    Do you know this for a fact first hand, or just surmising?
    Do you mean providers falsified the entire attestation process?

  • Do you know this for a fact first hand, or just surmising?
    * I have had many providers and REC consultants tell me they did this. Did I stand over their shoulder and watch them? No

    Do you mean providers falsified the entire attestation process?
    * No they did not falsify anything. Medicaid providers qualify for the first year $s by simply “acquiring” an EHR. There is no usage requirement for the first year Medicaid $s.

  • C

    Expand upon this for us.
    So some providers are doing nothing wrong (technically speaking) by simply “acquiring” an EHR, but not using it in the first year, AND collecting stimulus funds?

  • If I was a conspiracy theorist I’d say it looks like PF’s PR response is to divert attention away from their own wrongdoing by flooding the comments section of this article with concerns regarding John’s motivations. I would take note that almost all pot-stirring commenters have only generic first names. Like John I would take note of the IP addresses that these comments appear to be coming from and then compare that to the IP block that PF uses. I would wonder if John would if John intends to investigate this further to ensure his name remains clear. I would find it unfortunate that this PR tactic still works on a lot of people but is pretty obvious to those in the know.

    But that would only be if I were a conspiracy theorist.

  • “So some providers are doing nothing wrong (technically speaking) by simply “acquiring” an EHR, but not using it in the first year, AND collecting stimulus funds?”

    Yes. Unfortunately that is the way the Medicaid EHR incentives were designed. I think the Medicaid EHR incentive designers were stuck in the client-server/high start-up cost time warp. In fact the Medicaid incentives were determined based on the government’s estimate of what an EHR would cost and funding 85% of that estimate. The government thought it would cost the average provider $25k for the first year just to “acquire” an EHR.

    Because the incentives drop to only $8,500 a year after year 1, a lot of Medicaid providers that have no intention of ever using an EHR went with a “free” EHR just to get the first year money. There is no requirement to continue in the program. A provider can get the year 1 incentives for “acquiring” an EHR and then drop out of the program. So the reality is that Medicaid providers intending to actually use the EHR in future years have tended to purchase an EHR that includes live human training, live support and advanced features.

    This may be one reason why “free” systems appear to have a very high ratio of registered providers compared with the encounter volume. A lot of providers are registered users but have never even tried to use it.

    There are no future year penalties on Medicaid like there are for Medicare, so Pediatricians and other providers that take Medicaid but little or no Medicare have less incentive to actually use an EHR – outside of the intrinsic benefits.

  • C
    “There are no future year penalties on Medicaid like there are for Medicare, so Pediatricians and other providers that take Medicaid but little or no Medicare have less incentive to actually use an EHR – outside of the intrinsic benefits.”

    So, in real-world scenarios, what is happening when one actual meaningful user practice tries to interop with one that just rests n vests?

  • Axeo and C Huddle, is there any way you could talk privately and keep this commenting section to the discussion at hand? Not on basic Meaningful Use criteria for Medicaid providers?

    Much appreciated.

    Let’s carry on.

  • We are fortunate to read raw articles such as John’s posting that points out the obvious side effects with free stuff. The first thing you learn in Market class is “FREE” is a dangerous word. There is always a price tag to pay for free stuff. You may not directly pay for it but some how you are paying for it.

    Secondly, user forums are not uncommon these days but what’s uncommon with PF’s Help Forum is that there are essentially no time stamp posted showing user inquiries and “Official Responses”. Why are they not allowing time stamp showing when the content was posted and how recent is that post? And what is with the duplicated “Official Responses” posted by the “Official Rep”? Is that really necessary as page filler? It sure acts like a tree killer for those physicians who still request to print everything. Oh the only time stamp that was spotted is actually a topic that turned into archive stored in future time zone. (It’s 2pm EST right now but the post says it’s been archived 4hrs ahead) http://forum.practicefusion.com/practicefusion/topics/i_tried_to_click_on_the_link_to_disable_the_follow_up_email_after_appointments

    It’s also sad to see great research and positive intentions of sharing and revealing reality only get decomposed and back fired at the blog author to question irrelevant content. Why can’t the comments just stay on topic so other readers don’t lose that extra 5mins of their day which they will never get back?

  • I believe that there are a few things here that should be addressed, particularly since I am one of the physicians quoted in the forums post. PF’s emails were COMPLETELY compliant with HIPAA law.
    The arguments people posted about “someone could find out that I went to an AIDS clinic or a psychiatrist, etc, and fire me” are just plain foolish. If you can get fired for seeing a psychiatrist, don’t be stupid enough to list your work email as your contact information with said psychiatrist. It is NOT a violation of HIPAA to contact patients about appointment information, just like it is not a violation to keep a sign in form at the front desk of a doctor’s office.
    The truth is that PF had great intentions in gathering this data, but it was just poorly implemented, particularly since most physicians didn’t really realize what the surveys entailed.
    But once again, read the communications you “acknowledge” when you log in to your EMR.
    I do think the response has been a bit hysterical and overhyped, but it is definitely an issue that needed response.

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