EHR's: THE FUTURE IS FREE
San Juan Capistrano, California, Oct. 24, 2011--The only way we will achieve a truly effective nationwide system of electronic health records connecting virtually every physician and hospital is by offering office-based physicians a free EHR. By free, I mean a reliable, easy-to-use, meaningful-use certified, web-based ambulatory EHR offered to physicians through an ad-supported model.
While a number of other industrialized countries (e.g. Holland, Australia, New Zealand) have 90% or more of their physicians on an EHR, we are struggling to reach 50%. In the past year, thousands of U.S. physicians have moved to EHRs, but the adoption rate among small medical groups – which include 60% of practicing physicians – remains frustratingly low. Several recent surveys put it in the 15-20% range.
We have a created a series of “digital islands” across the U.S. as many large medical groups like Kaiser Permanente, Intermountain Health Care and the Cleveland Clinic have connected large numbers of their own physicians, exchanging clinical information and improving clinical care. They, of course, are well funded and have large IT staffs to train users and maintain their EHR systems.
In contrast, small medical groups operate on low margins, have little investment capital and usually no IT staff. In addition to the cost barrier, there is a perception problem among many of these physicians. They simply don’t see the value in paying out of their own pocket for software that currently has nebulous value for them.
For these physicians, a web-based, ad-supported free EHR system offers many advantages. There is no capital outlay or maintenance fee. The software is delivered through the SaaS (software as a service) model. The software is regularly upgraded and improved and every time the user logs on, he gets access to the most current version.
With traditional, pay-up-front software vendors, small medical groups are at a distinct disadvantage. They simply don’t have the bargaining power with a vendor that is possessed by hospitals and large medical groups. In fact, many large EHR vendors don’t even market their systems to small groups because they see no profit in it.
In contrast, a company offering a free, ad-supported EHR must supply a product that is highly reliable and easy to use for physicians. Under the free EHR model, the software company makes money from “eyeballs.” Advertisers want regular counts of page views and click throughs. If physicians aren’t using the system, ad sales will fall.
An ad-supported EHR might have seemed unorthodox five years ago, but in today’s world of Gmail, Google search and Facebook, it is not only familiar, it is highly attractive. Physicians are sophisticated consumers and most are enthusiastic consumers of other forms of ad-supported services.
An ad-supported EHR is much like Facebook or Gmail in that you get to use the service in exchange for being exposed to targeted advertising. However, the pioneering company that shows the potential for improving services to physicians and consumers and patients is eBay. The online selling service is not free (sellers pay fees based upon sales price), but it was this web-based model that transformed retail selling.
Prior to eBay, buyers and sellers were constrained by time and geography. Shoppers had to go to a store during business hours to view and compare merchandise. With eBay, buyers could access merchandise from sellers around the country at any time of day or night. Also, eBay empowered small operators to compete with large retailers in terms of access to customers and reduced cost of sales.
In a similar manner, most healthcare services are currently delivered by organizations within four walls during business hours. Large medical groups enjoy cost advantages over solo practitioners. The majority of small medical groups still transmit clinical information by fax or via the patient themselves. If we are ever going to bend the cost curve and improve clinical care in the U.S. this has to change. Until physicians and patients are able to upload and access the clinical information they need, anytime and anyplace, we will continue to be burdened with redundant medical tests, prescription errors and poorly informed consumers.
In his seminal article, Free! Why $0.00 is the Future of Business that first ran in the February 2008 issue of Wired magazine, author Chris Anderson noted that “free” model of doing business is not new. It was first used in 1903 by King Gillette who gave away safety-razors in order to sell his disposable blades. Later, commercial radio and TV broadcasting generated mass audiences based on a free or ad-supported basis.
It was the rise of the Internet, however, that really made it possible to deliver highly sophisticated services on an interactive basis. Anderson described six possible free business models in his article. They include freemium, ad-supported, cross-subsidized, zero-marginal cost and labor-exchange.
We believe the most appropriate free business models for EHRs is the ad-subsidized and cross-subsidy model. In the ad-supported model, described above, the EHR is given free to physicians by the software vendor in exchange for viewing ads.
In the cross-subsidy model, a large integrated medical organization can license the EHR from the vendor and then provide it free to its affiliated physicians. Rather than run ads, it could display targeted clinical messages alongside the EHR. For example, anytime a physician uses the EHR to prescribe, hospital messages about drug interactions or a health plan formulary could appear. The system can also target physicians, directing certain messages to specific specialists such as cardiologists, ophthalmologists or primary care physicians.
Because it is offered via the Web through the SaaS model, the free EHR model is very flexible. It can be easily adapted for mobile devices and can easily serve remote, rural communities. The free EHR model is just getting started but we believe it is truly the wave of the future. Advanced health IT services have been out of reach for many small, independent physicians who are responsible for more than 70% of ambulatory care.
Imagine how the cost of care and quality of care will be affected if a complete Certified ONC-ACTB becomes free and accessible to these physicians. The future is the free model and we have taken the first step into it.
Andre Vovan, M.D. MBA, a critical care physician, is the founder and chairman of Mitochon Systems, based in San Juan Capistrano, which offers the first free, fully certified EHR allowing small physician practices to deliver integrated healthcare.
Press Contact: Barbara Barry bbarry@mitochonsystems.com 949.481.2500
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