• Should cash-strapped small practices turn to ad-supported EHRs?

    Author | Date January 22, 2013
    Advertising is everywhere.  From your smartphone apps to your radio station to this very article, ads pay the bills for your favorite news outlets, entertainment destinations, and websites.  Sometimes they’re annoying, and sometimes they alert you to a useful product or service you might not otherwise find.  But should they be integrated into your EHR?  With implementation costs soaring into the tens of thousands and no immediate return on such a massive investment, many physicians are saying yes.
    The market for EHR advertising revolves around cloud-based services, since advertisers need an internet connection to push ads into their product.  With 41% of physicians using cloud services, the market is robust and growing.  “Advertising is a natural fit in the healthcare sector,” Bill Jennings, CEO of Good Health Media told Practice Fusion, one of the leading ad-based EHRs. “Doctors get it; they’re comfortable with discreet advertising inside their medical practice. The advertising programs give a small medical practice the chance to add a time-saving, life-saving technology solution – for free. It’s a benefit for the advertiser, the doctor and the patient.”
    EHR advertising is desirable to large pharmaceutical companies because there’s a high likelihood that the person observing the ad will be a physician.  Physicians spend the most time with EHRs, and are also the decision-makers when it comes to writing prescriptions for brand-name products.  Zach Gursky, VP of sales for Practice Fusion, told American Medical News that 85% of major pharmaceutical companies are running ads with the free service as a result of an explosion of interest over the past year and a half.  Gursky asserts that physicians are finding value in the ads due to the fact that they are highly targeted to them and the types of patients that they treat.
    They are also finding value in the fact that web-based EHR systems require little to no cash output in order to use.  Small practices without a large surplus budget for technology upgrades can use certain free EHRs to attest to meaningful use and receive financial incentives from CMS.  These providers don’t need to worry about ongoing maintenance, software upgrades, or an in-house IT staff, which becomes a very attractive prospect.
    But is there an ethical issue here?  Should providers be wary of relying on a system backed by the big pharmaceutical companies?  Is it right to give profit-driven corporations such an immediate and intimate opportunity to influence prescribing physicians?  After all, if physicians don’t click the ads, advertisers will withdraw their funds and the free EHR will no longer be creating enough revenue to keep it alive.  Physicians are paying for the software with their attention spans, and their patients’ health becomes a commodity.
    Patient privacy is also a concern.  Do advertisers have access to the data in a patient’s chart in order to target an ad to a specific condition or diagnosis?  Jonathon Padron, senior client analyst for comScore, says that they do.  “The system can identify the condition a physician is looking at and automatically pop up a drug that can treat it,” he says.  But when a provider is using an ad-based EHR service, patients don’t have the option to consent to this use of their data.  The legality of mining patient information for advertising purposes is nebulous at best, and providers should ask where the data is being stored, who owns it, and who has the ability to access it before committing to a cloud-based service.
    While Practice Fusion, for example, offers a premium service that removes the ads for a monthly prescription fee, Gursky says that less than 1% of clients take advantage of the option.  Ad-supported EHRs may be gaining in popularity among small providers, but they are no magic bullet.  They may save money up front, but there are hidden costs that providers need to consider before opening up their practice to advertising.
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