One of the consistent comments we receive from users of our web-based Electronic Health Record (EHR) system is that of excellent customer support. Some of these comments can be anecdotally seen on Facebook, but more importantly a large-scale survey of over 6,000 users of ambulatory EHRs conducted by Black Book Rankings listed Practice Fusion as the top-rated EHR in customer satisfaction.
Why is this? Why is a web-based EHR able to distinguish itself from most other vendors in the very-crowded EHR field? Is it simply an internal corporate culture that rewards good service? Or is it something more fundamental?
The answer is simple: it’s the business model.
The free business model is relatively new to health IT, and certainly is new to EHRs. It has been the basis of some very large companies outside of healthcare, so that its viability has a track record – Facebook, Google, Yahoo, YouTube, Twitter are all examples of large-scale companies who have implemented the free business model successfully. And within healthcare, there are also examples of free services: WebMD, Microsoft HealthVault are examples that come to mind.
In order for a company to successfully implement this novel business model, very widespread distribution is key. If revenue to the company is to come from advertising and other sources, then a very wide audience is the lynchpin to success.
In the EHR arena, then, what things lend themselves to widespread distribution? Free, of course, is compelling – especially for small practices with little or no margin for health IT but with incentives (and, eventually, disincentives) for EHR adoption. Beyond free, though, the product needs to be sufficiently robust to address all the needs facing clinical practices, especially the small (often Primary Care) practices who have disproportionately adopted our web-based EHR. Despite being free, the product needs to match-up feature-for-feature to products that cost tens of thousands of dollars – it needs to overcome the understandable intrinsic doubt that clinicians have about “something for free.” Such a build-out is our top priority, in order that our product becomes a fully certified Complete EHR, capable of being the sole-source solution that ambulatory practices need for access to CMS Incentive money in 2011.
The importance of the free business model is fundamental, and a disruptive influence in the EHR vendor community. When a vendor has a product that is sold (whether by up-front fees, or by subscription), then revenues from the sale are what drive corporate income and success. Once the sale is made, there is not as much incentive to maintain the product (from a revenue standpoint) – product support becomes an overhead item (though, yes, there are recurring fees charged for ongoing support by most sales-based EHR vendors).
Not so with the free model. There is no revenue to the company from “buying” the product – there is nothing to buy (think about that the next time you sign in to your Yahoo email account). There is only revenue to the company from use of the product – the more it is used, the more ad impressions there are, and the more successful the company becomes.
What does this mean for customer support of the EHR? Getting users (physician practices) to move from “dabblers” to “power users” is key to our success. The more physicians use the product, the better – so active support of customers, intensive attention to helping practices adopt and meaningfully use their EHR is a central priority. This is what drives a corporate culture of helpfulness and support.
Coincidentally, this approach dovetails very nicely with the hope at the federal level for encouraging Meaningful Use of Certified EHR technology. When our clinician-users actively engage and use the product as an indispensable tool in their daily professional lives, they gain access to Meaningful Use incentives, and we are more successful as a company. And the use of advanced EHR technology, along with the promises it has in improving health care delivery in this country, moves forward as well.
Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR
