The three types of free EHR explained

Although it may seem counterintuitive, a free product (even a free EHR platform) can be monetized. One need only browse through the app store on their smartphone to understand that “freemium” has become an increasingly popular pricing model.

We all have seen the popups when downloading a free app such as “contains in-app purchases,” “requires upgrades” or “shares user data with third parties” prior to downloading an app. These warnings are not just the product of overly cautious legal departments at app development firms; rather they are an insight into how a free product can be monetized. Just as developers in the mobile app space have found ways to monetize their “free” products, free EHR vendors also follow suit using some of the same revenue models.

1) Free EHR via ad revenue

Ads….love them or hate them are a permanent part of the IT landscape. Revenue models relying on targeted advertising offer a way to monetize free software. Unfortunately, users bear the brunt of advertising channeled through free EHR. Targeted ads in free EHR use data contained in the system to generate ad content. Therefore, a high incidence of a particular disease in your EHR may result in targeted ads for pharmaceuticals that treat the disease. Therefore, if you click on the ads, the vendor receives revenue, you receive useful advertising information everyone wins (in theory).

However, who wants to be bombarded with ads while entering care notes or reading a patient file. Perhaps even more troubling about the use of targeted ads in this context is the fact that data contained on the EHR system will be scanned to provide the data context for targeting ads, thus implicating the boundaries of privacy and the integrity of your EHR system.

Recommended Reading: EHR Selection Survival Guide - Understand the process of EHR selection before you opt for a free EHR

2) Free EHR via add-ons

The theory behind this monetization strategy is rather straightforward; it goes as follows. You, the user, may have the basic version of our EHR platform; however if you want to upgrade to a better version of said platform, you must pay to add these extra bells and whistles. Think of it like buying a car, you can get the basic model for a great price; however when you want such amenities as satellite radio, custom floor mats, and those sweet alloy rims, you will pay dearly. The same rules apply in the free EHR world; a free base model may be available to practices while add-ons are required for more sophisticated EHR functionality or to achieve meaningful use.

3) Free EHR via pay-to-play

Pay-to-play, as the name implies, means that the provider shifts the costs of the EHR system onto the patient who would be required to pay, usually a yearly fee, to use the EHR system. For example, a paying patient may be able to use a web-based records portal and receive other electronic care management benefits. However, non-paying patients will not be allowed to access all the advantages of the system. The risk in this model, from a provider's perspective, is that you run the danger of alienating patients by shifting an administrative cost to them. Further, if the goal is to improve healthcare delivery with EHR, and only a portion of the patients pay for the system, only a portion of your practice processes will be improved through advanced EHR functionality.

The term “free” in free EHR must be taken with the caveat that there is likely a revenue model to monetize the services. Monetization, unfortunately, comes at the costs of annoyance (of the provider or patients) in the ad based and pay to play models and long-term costs related to upgrading beyond the basic system. As such the decision as to whether or not free EHR is appropriate depends on your tolerance for monetization related annoyance.

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Jeff Green

About the author…

Jeff Green, MPH, JD works as a freelance writer and consultant in the Healthcare information Technology Space.

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Jeff Green

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