Who wants a free lunch?
By Carl Green, NAPP
Many providers sell their EHR solutions. Shocker, right? Many don’t: They give it away. For free. So why would you pay us, or any other EHR vendor? Often there are strings to that free lunch. Well, you know what they say. If it looks too good to be true, it probably is. Let me explain.
There are several business models for the free software approach. Unsurprisingly, each involves your money at some stage. However philanthropic the software authors may be, they do not supply it as Open Source. It costs each of them time and money to write and maintain the software, and naturally they want some return on that.
Model 1: Trial-ware
Several EHR vendors offer time- or function-limited versions of their software for download at zero cost. This gives a no obligation 
opportunity to evaluate whether their software is a good fit for your needs. Though you can often continue to use such software indefinitely, there may be a restriction on the number of records you can store, or watermarked reports, or a limited number of available templates. Upgrades to the full version, without such restrictions, come at a cost. This is the best free model.
Model 2: Sell the data
Some vendors have zero restrictions on their software. Use it as much as you want. They will simply aggregate the data within your database and sell it on. Read the small print. Many web-based providers reserve the right to ‘de-identify personal information’. They then sell access rights to anybody that wants it. Color me dubious, but I don’t like the sound of that.
Model 3: Government Funded
In this newer model, software is free because the vendor is funded by government at state level. This model is paid for by your tax dollars. First seen in Wyoming, the state, in conjunction with a private organization, released a free web-based EHR aimed at Medicaid providers. So, no Medicaid, no EHR. But thanks for your tax dollars. Support levels and flexibility will be comparable to that of any government controlled and managed software. So, if you are part of the Medicaid program, enjoy bureaucracy, and live in Wyoming, you’re gold.
Model 4: Bill the Patients
Here’s a good one. Free software, unlimited use, and no restrictions! Woohoo! Each patient in your database simply pays a regular subscription fee, based on a pricing structure and frequency set by the vendor. Overlooking the workflow, you and your patients dance to their tune. This is unlikely to be popular with patients. And what happens if a payment is missed?
Model 5: Enjoy the Ads
Unsurprisingly, advertising funded EHR programs function perfectly, but display offers on each screen. Vendors sell advertising space to recoup investment costs. Patients seeing your screen may be disconcerted and unimpressed by offers for vehicle sales or Viagra. Ads are pulled from third-party servers and displayed alongside your data. This is a significant red flag. Beyond the security concerns of connecting an ad server to your medical database, each advertiser becomes a HIPAA Business Associate and potential security breach, since each advert links back to their site. Read that again.
Note also, items 3 through 5 may be combined with item 2. Nothing prevents vendors using multiple channels to earn income. This is business, after all. Governments particularly may wish to recoup investment costs by selling data.
A paid solution, such as that provided by Sigmund, gives full technical support from a vendor with a proven track record of security, flexibility and customer satisfaction.
I’ll let you decide whether lunch is worth paying for.
About the Author: Â Carl Green is the graphic designer and web developer for the VSS Medical Group of companies, and writes a regular blog for Sigmund Software, providers of the Sigmund behavioral health EHR system. Carl has a 25 year background in IT consultancy and software development, database systems, network security and media design. This post was originally published in Sigmund Software blog and is reprinted with permission.