Although some studies doubt the benefits of electronic health records to patient care, the transition of the health care system to the technology is well on its way.

Some providers are eligible for up to $44,000 of incentives, which in theory should offset the cost of the health IT investment, but one company says you can have your cake and eat it, too.

DOTmed News spoke with Dr. Robert Rowley, the chief medical officer of San Francisco-based Practice Fusion, about the company’s free, web-based EHR service. Dubbed the "Superman/Clark Kent” of the office by the company’s staff, Rowley divides his time between Practice Fusion and a family practice. He talked about the philosophy behind the company's service and the elements that make up this Web-based EHR.

How did you come up with the idea to offer a free, Web-based electronic health record?

It actually evolved over the last couple of years. We started out by combining two different companies. One was a company that I had built which was a local EHR for primary care physicians, and another was our CEO Ryan [Howard’s] vision of something that could be free to physician end-users, subsidized by alternative revenue streams -- similar to how to Yahoo Mail or Google Mail offer free services, but make money off other revenues, primarily advertising.

We merged the ideas together and realized that particularly small physicians are pretty overwhelmed by the prospect of installing EHRs that are locally based. That means they have to worry about having servers, software, having a network, security, backup –- all the things that make it impossible for small practices to really adopt.

We pioneered the whole concept and the whole space of Web-based services being a place that’s legitimate for health IT. We had the challenge of building adequate security and privacy around that. Fortunately, we’ve got the experience of about 20 years worth of Internet banking to learn our lessons from. We were able to build something that is highly secure and always up and functional and relieving the physician of the worry how to locally secure PHI...As a result of that, we’ve been wildly successful. We just passed the 6 million-patient mark and the 60,000-user mark. We’re still adding a couple of hundred users a day.

Who makes up your user base?

Our sweet spot has been the small physician practices, generally less than 10 physicians. They’re often not affiliated with any particular institution but they’re just out there [spread out throughout the country], which is where, still even today 70 to 80 percent of health care is delivered. These are physicians who aren’t necessarily in big systems that supply some large system to them. They’re facing the need to do something themselves and they’ve adopted our product very enthusiastically.

EHR adoption has traditionally been found mostly in hospitals, in large medical groups, in institutions that could afford IT staff, and small doctors' offices had very low EHR adoption rates. That’s exactly where we’ve been successful and others have not.

What distinguishes your EHR service from others?

There are three main elements to what we offer. One is that it’s Web-based, which means that all of the technical burdens that would otherwise befall the physician go away. All you need is an Internet-connected computer.

The other piece is that it’s free -– subsidized by ads and some other revenue streams. The result is that we’re able to be solvent and profitable as a company and offer a service for free.

And the third piece is that the set up is self-serviced. You don’t have to wait for some consultant to put you down on some schedule and come visit your office three months from now and install something locally and train the staff. You can sign up for the product immediately on the website. You get log-in credentials and you can upload your patient demographics if you can output them, usually from billing.

How much time do users need to grasp the EHR system? How user-friendly is it?

The product itself is built to be very intuitive. There are telephone and webinar trainings that happen a couple times a day. There are videos embedded throughout the product that can teach users about the product. Surprisingly, not that many people need direct contact or hand holding through the steps of how to use the product. We pay a lot of attention to making it user-friendly and we’re able to learn from feedback from our users.

For us, we’re successful if people use the product. So just buying something and sticking it on the shelf and letting it gather dust does us no good... In our opinion, that’s perfectly inline with the intent of meaningful use at the federal policy level.

Are you already certified for all of the meaningful use criteria?

We went through a round of certifications to certify the pieces that we had built...There are more certification pieces than there are meaningful use pieces. We’re currently certified for 16 of those and we are anticipating going back for a second round of certification for the remaining pieces. [We'll do so] probably by the end of the first quarter of 2011 to become a single source solution for physicians, so they don’t have to mix and match what we have with other products.

Do providers bring up questions about security concerns, since it’s a Web-based EHR system?

That’s a concern that’s addressed almost every time we talk to anybody. That is the number one thing...With our system, there is no PHI locally on a local machine. It’s all a view into a Web portal, which means if your machine gets stolen, you’ve gotten a stolen machine but you don’t have stolen PHI. You don’t have the HIPPA breach because there is nothing on that machine.

Yes, there’s a concern and there should be a concern. We take great pains to make sure that we offer security and safety to the best level that anybody anywhere is offering, regardless of where the data is housed.

Practice Fusion offers a free service but is profitable off the ads in the product. Where do users see the ads and what kind of advertising is it?

The ads are banners across the bottom of the main page and on some pages they are columns along the right hand side. They are rotating ads, there are no pop-ups. People who have purchased ads tend to be services, like transcription services or voice dictation or hardware...We haven’t gone yet after health plans to advertise but they might.

We have the ability to target physicians based on their specialty. We haven’t done that much with that yet but that certainly is possible. If you’re targeting diabetes for example, you want to prescribe diabetes drugs. It’s very nonintrusive.

What about providers who would rather not see the ads at all?

We do have an option for physicians who don’t want to look at ads to turn off the ads for $100-per physician per month. Of the 60,000 users that we have, I think about half a dozen have opted for that. People are used to looking at ads –- it’s like reading a magazine, they can read the content and kind of ignore the ads. We try to make the ads something relevant and meaningful. Some of the ads offer services that are useful for the physician, such as CME services.

To read the industry sector report on EHRs/EMRs that accompanies this Web exclusive, go to dotmed.com/dm15143