How does a company that provides a free electronic health record system make money? Do they need to make money? Why should I care if they do not charge my pediatric practice to use their system? Advertising to you while you use a system is one way for a free EMR vendor to generate a small amount of revenue; another method is to sell your treatment patterns and patient data to health plans and other organizations. By agreeing to a well written user agreement, a free EMR company will request you to authorize them to do both. The free system containing a user agreement to provide a company the right to sell your data to payers and other organizations could potentially cost you personally thousands of dollars in reduced income per year. This cost could be substantial even with the promise of using a free system.
The “free” EHR Company might be sharing each of your charts, patients, and billing practices with some of the insurance plans. Imagine your Health Insurance plan being able to audit all your charts and know where
they can pull back payments for what they believe is not enough documentation (they have the file, how easy is it to look before sending the request back for a retraction of money). Of course, the health plans will not audit your charts and show all the visits for which the practice “under coded” visits. This under coding is the loss of revenue to the practice. Additionally, with a list of all your patients listed in the “free” EHR system for which the insurance company has access rights to the data, an insurer will be able to calculate what percent of your revenue if from their insurance company versus other plans. This provides a Health Insurance plan data so they have the opportunity to determine/forecast how to minimize your fee schedule. I could see insurance carriers using sliding scales to determine the amount of pay increase or even decrease payments for a practice. Image an employee from a health plan whom receives a bonus for decreasing payments to providers know that 40% of your practice is with their insurance plan, why not decrease your practice’s payment by 10%?
There are other risks with a “free” EHR company selling your data. One risk is that a health plan or other organization will know the breakdown of the number of patients for each disease. For example, maybe you are very aggressive at identifying and treating ADHD to a point that you do not miss a signal diagnosis as well as treat patients with the most innovative methods. This ability has made you the “go to” pediatrician in the practice and/or community. However, since your “free” EMR allows your data to be sold, a health plan or other group might label you as an “over user” of ADHD medications. Do they send you letters directly to address their concerns or do they develop a list to ‘report overuse’ which in fact is not really overuse based on your patient profiles. The problem is, this list might not be accessible to you or known to you and who knows what they will do with the list (do they lower reimbursements or audit higher for Pediatricians on this list?).
The “free” EMR Company might advertise that they store your data in a secure manner. They should advertise how they make money as well as that users of their system provide them the authority to sell your data to organizations that have their own agenda (e.g. insurance companies). I believe many physicians whom ‘gave away’ their rights to their data are not aware of the potential risks to their income and the way they practice medicine. The user agreement is found when you sign up and there is a prompt that states you agree to their user agreements (you can click to review). If you are not sure, before using a system, ask for a signed letter stating that the company will not sell your data.
How do you know if a ‘free’ EHR company has the right to sell your data? REVIEW the USER AGREEMENT. If the user agreement is more than 7 pages, usually this is a reason to be very concerned (some agreements that allow the ‘free’ EHR company to sell as much of your data as possible have greater than 15 pages). Our user agreements are usually 4-5 pages, we only provide access to the data to the users of the practice as well as our staff (we maintain the servers and data files), we maintain the data with triple backup and use firewall systems designed for commercial grade systems. We do not sell your data and do not have any right to sell your data. Our interests are to serve our pediatric practices.