RE: SpringCharts EHR

[Guest guest]

I used to use SpringCharts for 5 years until I switched to Practice Fusion 2 years ago. Here is what I wrote about it back in 2009:I have been using the Mac-version of SpringCharts for the past 5 years. It has been relatively inexpensive, although they keep raising the upgrade price every year. There is an annual support fee but I have rarely had to use them, and when I did, they were very responsive and helpful. I have the single-user version because I am the only one who uses it, plus it is cheaper than the multi-user version. All the data sits in my laptop's hard drive (which I back up daily). I like the fact that the company could go out of business tomorrow and I could keep using SpringCharts for the next 5 years if I wanted to.It doesn't look particularly Mac-like because it is written as a Java-based program in order to be compatible with Macs, Windows and Linux. It gets a little quirky sometimes because the windows and buttons don't respond the way you expect a "normal" Mac program to respond.It is organized more or less by SOAP format. There are separate entry fields for CC, Subjective, ROS, Vitals, Exam, Dx, Rx, Tests, Procedures, Other Tx, Follow up. There are "quick lists" that your can click on for frequently used text. You can set up templates for things like Routine Physical-Male, Well Child Check, but I haven't used them very much. It has databases for drugs, ICD9 codes, CPT codes but no drug interaction detecter. There is no e-prescribing yet but I hear it is coming. It has no patient registry function so while I can look up which patients have DM, it can't tell me which of my diabetic patients need their HbA1C done.There is a scheduling function that I never use because I prefer to use iCal for scheduling. There is an e-mail function that is pretty primitive so I don't use that either. There is a patient tracking function that I never use because, frankly, I always know where the patient is. There is a lab interface which I got about 2-3 years ago which automatically downloaded lab results from Quest. However, I found it to be cumbersome and time-consuming and stopped using it. Maybe it is better now. There is no practice management function but they sell an interface that exchanges data which MacPractice which is the practice management program I use. They have a demo that you can download: http://springmedical.com/scdemo.htmlBottom line: I think SpringCharts is an inexpensive, competent EMR that is good enough but not great. But so far it keeps getting better every year. I imagine they have made some improvements over the past 2 years. SetoSouth Pasadena, CA

Any user here ?

[Guest guest]

CHanging EMRs !?!   Wasnt that a nightmare?  I have briefly considered then dismissed the aspect of changing from my current EMR  to another:  the idea of changing data bases seems like a hugh undertaking, bound to be full of unforseen format incompatibilities and requiring alot of custom computer consult  time.  Did you find this to be the case with your change of horses?

 

Any user here ?

[Guest guest]

I am considering switching EMRs after finding out that to get my current EMR up

to MU standards, it will cost me $11K the first year and then about $5K/year

thereafter. I will not be eligible for the EMR incentives because I have

limited my Medicare population over the past several years and have less than

20% in my practice. I do not accept Medicaid. However, I do accept Tricare

which pays 90% of Medicare rated, but that won't qualify me. I'm close enough

to retiring to think it's not worth the effort to switch.

Interesting thread...

Pam

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[Guest guest]

,Fortunately the transition from SpringCharts to Practice Fusion was pretty easy but I can see how it might have been a nightmare if they had been different EMRs. • The data on SpringCharts is entirely on my laptop. I have the standalone version that does not depend on Internet access and functions only on one computer. I continue to have access to my data even if I stop paying SpringCharts any money. • Rather than try to "move" all the data from SpringCharts to Practice Fusion, I "froze" the data on SpringCharts. That is, I left the data on SpringCharts intact but stopped adding any new data. After October 15th, 2009, I entered any new visits into Practice Fusion whether they were for new or established patients. If I needed to refer to any old notes, I open up SpringCharts and copy and paste as needed into Practice Fusion. • No format incompatibilities. No need for custom computer consult time. As time has gone on, I use Practice Fusion more and more, and SpringCharts less and less. • The fact that Practice Fusion is free helped me test out Practice Fusion since there was no financial risk. The biggest cost to me was my time entering data and learning how to use it. Even now I could switch back to SpringCharts with no financial cost, but there is no reason to. I feel that the pace of improvements for Practice Fusion is faster than for SpringCharts, I like being able to access data from any computer with Internet access, I like the fact that Practice Fusion works equally well on a Mac or PC, and I like not having to worry about backing up the data. I also like knowing that if I decide to change EMRs again (which seems unlikely at this time), I won't have invested a lot of money in an EMR that I won't be using anymore. SetoSouth Pasadena, CA

CHanging EMRs !?! Wasnt that a nightmare? I have briefly considered then dismissed the aspect of changing from my current EMR to another: the idea of changing data bases seems like a hugh undertaking, bound to be full of unforseen format incompatibilities and requiring alot of custom computer consult time. Did you find this to be the case with your change of horses?

Any user here ?

[Guest guest]

,I currently just use PF for storing patient demographics and scheduling since I am still paper. Do you have any experience with PF and any self scheduling systems like appointment quest? Rhonda To: Sent: Sun, May 15,

2011 11:59:40 AMSubject: Re: SpringCharts EHR

,Fortunately the transition from SpringCharts to Practice Fusion was pretty easy but I can see how it might have been a nightmare if they had been different EMRs. • The data on SpringCharts is entirely on my laptop. I have the standalone version that does not depend on Internet access and functions only on one computer. I continue to have access to my data even if I stop paying SpringCharts any money. • Rather than try to "move" all the data from SpringCharts to Practice Fusion, I "froze" the data on SpringCharts. That is, I left the data on SpringCharts intact but stopped adding any new data. After October 15th, 2009, I entered any new visits into Practice Fusion whether they were for new or established patients. If I needed to refer to any old notes, I open up SpringCharts and copy and paste as needed into Practice Fusion. • No format

incompatibilities. No need for custom computer consult time. As time has gone on, I use Practice Fusion more and more, and SpringCharts less and less. • The fact that Practice Fusion is free helped me test out Practice Fusion since there was no financial risk. The biggest cost to me was my time entering data and learning how to use it. Even now I could switch back to SpringCharts with no financial cost, but there is no reason to. I feel that the pace of improvements for Practice Fusion is faster than for SpringCharts, I like being able to access data from any computer with Internet access, I like the fact that Practice Fusion works equally well on a Mac or PC, and I like not having to worry about backing up the data. I also like knowing that if I decide to change EMRs again (which seems unlikely at this time), I won't have invested a lot of money in an EMR that I won't be using anymore.

SetoSouth Pasadena, CA

CHanging EMRs !?! Wasnt that a nightmare? I have briefly considered then dismissed the aspect of changing from my current EMR to another: the idea of changing data bases seems like a hugh undertaking, bound to be full of unforseen format incompatibilities and requiring alot of custom computer consult time. Did you find this to be the case with your change of horses?

Any user here ?

[Guest guest]

I have just as of April switched form Practice Partner to Practice Fusion. I would say that my plan and experience mirror 's exactly!

My personal take on all the EMR's is that within 5-6 years there will only be 4-5 that are certified (powerful companies are powerful that way). I refuse to spend any more money on a product I cannot guarantee is not going to driven out or bought out. No matter what happens with PF....at least I didn't spend any money to get there. Furthermore its easy to use. My biggest issue with it is that there is no way to set up a remn=inder/recall system for upcoming tests/repeat paps etc. I am still looking for a way to manage this.

Warm Regards,

Dannielle

To: Sent: Sun, May 15, 2011 11:59:40 AMSubject: Re: SpringCharts EHR

, Fortunately the transition from SpringCharts to Practice Fusion was pretty easy but I can see how it might have been a nightmare if they had been different EMRs.

• The data on SpringCharts is entirely on my laptop. I have the standalone version that does not depend on Internet access and functions only on one computer. I continue to have access to my data even if I stop paying SpringCharts any money.

• Rather than try to "move" all the data from SpringCharts to Practice Fusion, I "froze" the data on SpringCharts. That is, I left the data on SpringCharts intact but stopped adding any new data. After October 15th, 2009, I entered any new visits into Practice Fusion whether they were for new or established patients. If I needed to refer to any old notes, I open up SpringCharts and copy and paste as needed into Practice Fusion.

• No format incompatibilities. No need for custom computer consult time. As time has gone on, I use Practice Fusion more and more, and SpringCharts less and less.

• The fact that Practice Fusion is free helped me test out Practice Fusion since there was no financial risk. The biggest cost to me was my time entering data and learning how to use it. Even now I could switch back to SpringCharts with no financial cost, but there is no reason to. I feel that the pace of improvements for Practice Fusion is faster than for SpringCharts, I like being able to access data from any computer with Internet access, I like the fact that Practice Fusion works equally well on a Mac or PC, and I like not having to worry about backing up the data. I also like knowing that if I decide to change EMRs again (which seems unlikely at this time), I won't have invested a lot of money in an EMR that I won't be using anymore.

Seto

South Pasadena, CA

CHanging EMRs !?! Wasnt that a nightmare? I have briefly considered then dismissed the aspect of changing from my current EMR to another: the idea of changing data bases seems like a hugh undertaking, bound to be full of unforseen format incompatibilities and requiring alot of custom computer consult time. Did you find this to be the case with your change of horses?

Any user here ?

[Guest guest]

I had an IT guy build a nifty reminder recall system for my EMR by tapping into it via an ODBC interface.  Most EMRs offer this type of interface or similar.  Quite likely you can have an inexpensive reminder recall system if you can find 20 other PF users to share the one time coding cost.   Same for any other EMR.  I can give you a contact to start with but there are likely quite a few PF consultants that do this type of thing.  It all depends on what you want.  My system is mixed email+phone messaging.  It’s a great feature to have. If you can get PF to show you how to tap in with an ODBC interface (or their equivalent) you will have a great tool to help you see many more opportunities for adapting your EMR.   The opportunities are endless and most of the neat ideas you have will never be offered by your vendor or any other vendor.  What we want is an extension of how we think and few of us will ever want the same combination of add-on features.   Meantime to disappointment with an EMR is usually about two or three years.   It’s not that we don’t have the best EMRs but the fact that they don’t keep up with our expanding expectations. Given that PF has made indications of encouraging a development community there is hope.  However, don’t be surprised that PF will prefer to sell services based on access as extras.  No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money.  Just be sure to sort out promises vs. generalities.   Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years.   Can you issue and download results of any arbitrary query?  Can you issue and upload any arbitrary database update?  It’s really that simple to ask.  Tell us about PFs guaranteed availability of these auxiliary interfaces to your data.  Neighbors, MDHuntsville, Alabama Solo using FlexMedical EMR since 2/2009 From: [mailto: ] On Behalf Of Dannielle HarwoodSent: Sunday, May 15, 2011 2:23 PMTo: Subject: Re: SpringCharts EHR I have just as of April switched form Practice Partner to Practice Fusion. I would say that my plan and experience mirror 's exactly!My personal take on all the EMR's is that within 5-6 years there will only be 4-5 that are certified (powerful companies are powerful that way). I refuse to spend any more money on a product I cannot guarantee is not going to driven out or bought out. No matter what happens with PF....at least I didn't spend any money to get there. Furthermore its easy to use. My biggest issue with it is that there is no way to set up a remn=inder/recall system for upcoming tests/repeat paps etc. I am still looking for a way to manage this. Warm Regards,Dannielle To: Sent: Sun, May 15, 2011 11:59:40 AMSubject: Re: SpringCharts EHR , Fortunately the transition from SpringCharts to Practice Fusion was pretty easy but I can see how it might have been a nightmare if they had been different EMRs. • The data on SpringCharts is entirely on my laptop. I have the standalone version that does not depend on Internet access and functions only on one computer. I continue to have access to my data even if I stop paying SpringCharts any money. • Rather than try to " move " all the data from SpringCharts to Practice Fusion, I " froze " the data on SpringCharts. That is, I left the data on SpringCharts intact but stopped adding any new data. After October 15th, 2009, I entered any new visits into Practice Fusion whether they were for new or established patients. If I needed to refer to any old notes, I open up SpringCharts and copy and paste as needed into Practice Fusion. • No format incompatibilities. No need for custom computer consult time. As time has gone on, I use Practice Fusion more and more, and SpringCharts less and less. • The fact that Practice Fusion is free helped me test out Practice Fusion since there was no financial risk. The biggest cost to me was my time entering data and learning how to use it. Even now I could switch back to SpringCharts with no financial cost, but there is no reason to. I feel that the pace of improvements for Practice Fusion is faster than for SpringCharts, I like being able to access data from any computer with Internet access, I like the fact that Practice Fusion works equally well on a Mac or PC, and I like not having to worry about backing up the data. I also like knowing that if I decide to change EMRs again (which seems unlikely at this time), I won't have invested a lot of money in an EMR that I won't be using anymore. SetoSouth Pasadena, CA CHanging EMRs !?! Wasnt that a nightmare? I have briefly considered then dismissed the aspect of changing from my current EMR to another: the idea of changing data bases seems like a hugh undertaking, bound to be full of unforseen format incompatibilities and requiring alot of custom computer consult time. Did you find this to be the case with your change of horses? Any user here ?

[Guest guest]

Rhonda,I use Practice Fusion and AppointmentQuest but they do not integrate with each other. I use AppointmentQuest to give patients the ability to schedule their own appointments online. Once they do that, I transfer the appointment information to my iCal calendar program on my laptop because it allows me to see my work schedule as well as my personal schedule at the same time. I don't use Practice Fusion's scheduling function at all since there is no advantage to doing so. Practice Fusion has a free patient portal called Patient Fusion, and I expect them to give patients the ability to request or schedule their own appointments online, similar to AppointmentQuest. If and when that happens, I will stop using AppointmentQuest and start using Patient Fusion. Other than inertia, is there a reason why you are still using paper and not using Practice Fusion for recording progress notes? It does take longer at first, but it gets faster as you become more experienced. SetoSouth Pasadena, CA

,I currently just use PF for storing patient demographics and scheduling since I am still paper. Do you have any experience with PF and any self scheduling systems like appointment quest? Rhonda To: Sent: Sun, May 15,

2011 11:59:40 AMSubject: Re: SpringCharts EHR

,Fortunately the transition from SpringCharts to Practice Fusion was pretty easy but I can see how it might have been a nightmare if they had been different EMRs. • The data on SpringCharts is entirely on my laptop. I have the standalone version that does not depend on Internet access and functions only on one computer. I continue to have access to my data even if I stop paying SpringCharts any money. • Rather than try to "move" all the data from SpringCharts to Practice Fusion, I "froze" the data on SpringCharts. That is, I left the data on SpringCharts intact but stopped adding any new data. After October 15th, 2009, I entered any new visits into Practice Fusion whether they were for new or established patients. If I needed to refer to any old notes, I open up SpringCharts and copy and paste as needed into Practice Fusion. • No format

incompatibilities. No need for custom computer consult time. As time has gone on, I use Practice Fusion more and more, and SpringCharts less and less. • The fact that Practice Fusion is free helped me test out Practice Fusion since there was no financial risk. The biggest cost to me was my time entering data and learning how to use it. Even now I could switch back to SpringCharts with no financial cost, but there is no reason to. I feel that the pace of improvements for Practice Fusion is faster than for SpringCharts, I like being able to access data from any computer with Internet access, I like the fact that Practice Fusion works equally well on a Mac or PC, and I like not having to worry about backing up the data. I also like knowing that if I decide to change EMRs again (which seems unlikely at this time), I won't have invested a lot of money in an EMR that I won't be using anymore.

SetoSouth Pasadena, CA

CHanging EMRs !?! Wasnt that a nightmare? I have briefly considered then dismissed the aspect of changing from my current EMR to another: the idea of changing data bases seems like a hugh undertaking, bound to be full of unforseen format incompatibilities and requiring alot of custom computer consult time. Did you find this to be the case with your change of horses?

Any user here ?

[Guest guest]

,Thanks so much for the information.Inertia is indeed a powerful force! I am still a low tech kind of doc. I have a well established paper chart practice and don't type fast or accurately. I am not tech savvy. Went solo last year and needed a scheduling system which didn't cost an arm and leg. PF was free and has been wonderful so far. They uploaded all my patient information into the system for free and it has been hassle free (can you tell I like free?) They e-mail patients reminders about upcoming appointments.I like that I can gradually incorporate more of what PF has to offer as time goes on - as my comfort level grows.

Rhonda To: Sent: Sun, May 15, 2011 3:12:22 PMSubject: Re: SpringCharts EHR

Rhonda,I use Practice Fusion and AppointmentQuest but they do not integrate with each other. I use AppointmentQuest to give patients the ability to schedule their own appointments online. Once they do that, I transfer the appointment information to my iCal calendar program on my laptop because it allows me to see my work schedule as well as my personal schedule at the same time. I don't use Practice Fusion's scheduling function at all since there is no advantage to doing so. Practice Fusion has a free patient portal called Patient Fusion, and I expect them to give patients the ability to request or schedule their own appointments online, similar to AppointmentQuest. If and when that happens, I will stop using AppointmentQuest and start using Patient Fusion. Other than inertia, is there a reason why you are still using paper and not using Practice Fusion for recording progress notes? It does take longer at

first, but it gets faster as you become more experienced. SetoSouth Pasadena, CA

,I currently just use PF for storing patient demographics and scheduling since I am still paper. Do you have any experience with PF and any self scheduling systems like appointment quest? Rhonda To: Sent: Sun, May 15,

2011 11:59:40 AMSubject: Re: SpringCharts EHR

,Fortunately the transition from SpringCharts to Practice Fusion was pretty easy but I can see how it might have been a nightmare if they had been different EMRs. • The data on SpringCharts is entirely on my laptop. I have the standalone version that does not depend on Internet access and functions only on one computer. I continue to have access to my data even if I stop paying SpringCharts any money. • Rather than try to "move" all the data from SpringCharts to Practice Fusion, I "froze" the data on SpringCharts. That is, I left the data on SpringCharts intact but stopped adding any new data. After October 15th, 2009, I entered any new visits into Practice Fusion whether they were for new or established patients. If I needed to refer to any old notes, I open up SpringCharts and copy and paste as needed into Practice Fusion. • No

format

incompatibilities. No need for custom computer consult time. As time has gone on, I use Practice Fusion more and more, and SpringCharts less and less. • The fact that Practice Fusion is free helped me test out Practice Fusion since there was no financial risk. The biggest cost to me was my time entering data and learning how to use it. Even now I could switch back to SpringCharts with no financial cost, but there is no reason to. I feel that the pace of improvements for Practice Fusion is faster than for SpringCharts, I like being able to access data from any computer with Internet access, I like the fact that Practice Fusion works equally well on a Mac or PC, and I like not having to worry about backing up the data. I also like knowing that if I decide to change EMRs again (which seems unlikely at this time), I won't have invested a lot of money in an EMR that I won't be using anymore.

SetoSouth Pasadena, CA

CHanging EMRs !?! Wasnt that a nightmare? I have briefly considered then dismissed the aspect of changing from my current EMR to another: the idea of changing data bases seems like a hugh undertaking, bound to be full of unforseen format incompatibilities and requiring alot of custom computer consult time. Did you find this to be the case with your change of horses?

Any user here ?

[Guest guest]

Below is a firm that claims to know how this is done. I have no idea who they are other than an ad I noticed. Why not ask what they offer? Tell us what you learn. http://www.ellkay.com/emr2emr_info.html From: [mailto: ] On Behalf Of Sent: Saturday, May 14, 2011 8:06 PMTo: Subject: Re: SpringCharts EHR CHanging EMRs !?! Wasnt that a nightmare? I have briefly considered then dismissed the aspect of changing from my current EMR to another: the idea of changing data bases seems like a hugh undertaking, bound to be full of unforseen format incompatibilities and requiring alot of custom computer consult time. Did you find this to be the case with your change of horses? Any user here ?

[Guest guest]

If your old program will keep running on one laptop or tower, we took 's old Toshiba and let the last of her first year of charting on our old Chartware (not a User Friendly product or company at least back then) program and just let it sit basically. It's one job is to be vault with those really old notes which may or may not ever need to be used except to copy or send out once or twice a year now.... Just made a clean break with it to AC early in 2006 and simply added most of the patients basic demographics as they called or came in for a visit. If things were slow then we might add the entire family if it was a multi patient family... Soon enough every last active patient was in AC and all without any expensive conversion program and database tuning and the like....

To: Sent: Sun, May 15, 2011 6:56:11 PMSubject: RE: SpringCharts EHR

Below is a firm that claims to know how this is done. I have no idea who they are other than an ad I noticed.

Why not ask what they offer? Tell us what you learn.

http://www.ellkay.com/emr2emr_info.html

From: [mailto: ] On Behalf Of Sent: Saturday, May 14, 2011 8:06 PMTo: Subject: Re: SpringCharts EHR

CHanging EMRs !?! Wasnt that a nightmare? I have briefly considered then dismissed the aspect of changing from my current EMR to another: the idea of changing data bases seems like a hugh undertaking, bound to be full of unforseen format incompatibilities and requiring alot of custom computer consult time. Did you find this to be the case with your change of horses?

Any user here ?

[Guest guest]

,I don't know anything about ODBC (open database connectivity) but I am not aware that Practice Fusion has an ODBC interface and could find nothing on Google about one. I read that Practice Fusion uses Salesforce.com for its cloud computing database, and that Salesforce.com does have an ODBC connector to its database. I'm not sure that Practice Fusion would permit any add-ons to its service by third parties.I also could find no mention of Practice Fusion encouraging a development community. Where did you hear about this? On the other hand, it has an active user community which frequently suggests bugs, improvements to the Practice Fusion development team. I, myself, have made several suggestions to the PF team. I don't know what basis you have for making the statement, "However, don’t be surprised that PF will prefer to sell services based on access as extras." According to this January 2011 interview with , CEO of Practice Fusion, Practice Fusion will "always be free".http://www.histalkpractice.com/2011/01/11/histalk-practice-interviews-ryan-howard-ceo-and-chairman-practice-fusion/Q. As a provider, is there anything I pay to Practice Fusion out-of-pocket other than if I want to have the version that doesn’t have the ads?A. Nope. That’s it. It’s the philosophy on my side is to keep the product entirely free. As long as I’m leading the company, the product will always be free.I have no fantasy that Practice Fusion will be free or even in existence forever, but that's a pretty strong statement that they intend for Practice Fusion to be free for a long time. Unless you think they are lying. You also say, "No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money. Just be sure to sort out promises vs. generalities. Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years." I don't think PF has ever claimed that it has an open data system, truly or otherwise. I don't see anything wrong with them locking out systems that want to access their databases, just as I don't see anything wrong with me wanting to lock strangers out of my house. If a third party wants to make money creating their own EMR system, more power to them. If a third party wants to make money by adding on extra paid services that add features to PF, they have no right to force PF to let them in. The key to the future of EMRs is what common interface will become the industry standard. Once that is settled, then the real competition begins. How do you think Practice Fusion would become expensive in future years? If Practice Fusion starts charging money, it will lose users to competing EMRs and they will be no different than any other EMR company (most of which are expensive now).As for your final questions, "Can you issue and download results of any arbitrary query? Can you issue and upload any arbitrary database update? It’s really that simple to ask. Tell us about PFs guaranteed availability of these auxiliary interfaces to your data.", can you explain in non-technical language what these questions mean? I am not an expert in Practice Fusion and I have no financial interest in Practice Fusion or a competing product. But as long as I can access my patient data easily and for free, and as long as nothing better comes along, then I will continue to be a satisfied user of Practice Fusion. I see that you are a featured user of your EMR, FlexMedical, which is developed by Oceris, located in Huntsville, AL, which is also where you are located. http://www.oceris.com/site/flexmedical/2010/11/17/nancyneighbors/What is your relationship with Oceris and do you have any financial interest in it? SetoSouth Pasadena, CAI had an IT guy build a nifty reminder recall system for my EMR by tapping into it via an ODBC interface. Most EMRs offer this type of interface or similar. Quite likely you can have an inexpensive reminder recall system if you can find 20 other PF users to share the one time coding cost. Same for any other EMR. I can give you a contact to start with but there are likely quite a few PF consultants that do this type of thing. It all depends on what you want. My system is mixed email+phone messaging. It’s a great feature to have.If you can get PF to show you how to tap in with an ODBC interface (or their equivalent) you will have a great tool to help you see many more opportunities for adapting your EMR. The opportunities are endless and most of the neat ideas you have will never be offered by your vendor or any other vendor. What we want is an extension of how we think and few of us will ever want the same combination of add-on features. Meantime to disappointment with an EMR is usually about two or three years. It’s not that we don’t have the best EMRs but the fact that they don’t keep up with our expanding expectations.Given that PF has made indications of encouraging a development community there is hope. However, don’t be surprised that PF will prefer to sell services based on access as extras. No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money. Just be sure to sort out promises vs. generalities. Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years. Can you issue and download results of any arbitrary query? Can you issue and upload any arbitrary database update? It’s really that simple to ask. Tell us about PFs guaranteed availability of these auxiliary interfaces to your data. Neighbors, MDHuntsville, Alabama Solo using FlexMedical EMR since 2/2009

[Guest guest]

, I have no financial interest in FlexMedical. They happen to be an outstanding EMR with great service in my area. They have been around maybe 8 years and were certified for MU last week. FlexMedical comes with a 100% open data systemthat has been a valuable feature when I have needed to make custom changes. In all fairness, most EMRs have open datasystems in theory but in practice are intractable due to vendor concerns about others encroaching on their territory IMHO. From: [mailto: ] On Behalf Of SetoSent: Sunday, May 15, 2011 7:28 PMTo: Subject: Re: SpringCharts EHR ,I don't know anything about ODBC (open database connectivity) but I am not aware that Practice Fusion has an ODBC interface and could find nothing on Google about one. I read that Practice Fusion uses Salesforce.com for its cloud computing database, and that Salesforce.com does have an ODBC connector to its database. I'm not sure that Practice Fusion would permit any add-ons to its service by third parties. I also could find no mention of Practice Fusion encouraging a development community. Where did you hear about this? On the other hand, it has an active user community which frequently suggests bugs, improvements to the Practice Fusion development team. I, myself, have made several suggestions to the PF team. I don't know what basis you have for making the statement, " However, don’t be surprised that PF will prefer to sell services based on access as extras. " According to this January 2011 interview with , CEO of Practice Fusion, Practice Fusion will " always be free " .http://www.histalkpractice.com/2011/01/11/histalk-practice-interviews-ryan-howard-ceo-and-chairman-practice-fusion/Q. As a provider, is there anything I pay to Practice Fusion out-of-pocket other than if I want to have the version that doesn’t have the ads?A. Nope. That’s it. It’s the philosophy on my side is to keep the product entirely free. As long as I’m leading the company, the product will always be free.I have no fantasy that Practice Fusion will be free or even in existence forever, but that's a pretty strong statement that they intend for Practice Fusion to be free for a long time. Unless you think they are lying. You also say, " No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money. Just be sure to sort out promises vs. generalities. Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years. " I don't think PF has ever claimed that it has an open data system, truly or otherwise. I don't see anything wrong with them locking out systems that want to access their databases, just as I don't see anything wrong with me wanting to lock strangers out of my house. If a third party wants to make money creating their own EMR system, more power to them. If a third party wants to make money by adding on extra paid services that add features to PF, they have no right to force PF to let them in. The key to the future of EMRs is what common interface will become the industry standard. Once that is settled, then the real competition begins. How do you think Practice Fusion would become expensive in future years? If Practice Fusion starts charging money, it will lose users to competing EMRs and they will be no different than any other EMR company (most of which are expensive now). As for your final questions, " Can you issue and download results of any arbitrary query? Can you issue and upload any arbitrary database update? It’s really that simple to ask. Tell us about PFs guaranteed availability of these auxiliary interfaces to your data. " , can you explain in non-technical language what these questions mean? I am not an expert in Practice Fusion and I have no financial interest in Practice Fusion or a competing product. But as long as I can access my patient data easily and for free, and as long as nothing better comes along, then I will continue to be a satisfied user of Practice Fusion. I see that you are a featured user of your EMR, FlexMedical, which is developed by Oceris, located in Huntsville, AL, which is also where you are located. http://www.oceris.com/site/flexmedical/2010/11/17/nancyneighbors/ What is your relationship with Oceris and do you have any financial interest in it? SetoSouth Pasadena, CA I had an IT guy build a nifty reminder recall system for my EMR by tapping into it via an ODBC interface. Most EMRs offer this type of interface or similar. Quite likely you can have an inexpensive reminder recall system if you can find 20 other PF users to share the one time coding cost. Same for any other EMR. I can give you a contact to start with but there are likely quite a few PF consultants that do this type of thing. It all depends on what you want. My system is mixed email+phone messaging. It’s a great feature to have.If you can get PF to show you how to tap in with an ODBC interface (or their equivalent) you will have a great tool to help you see many more opportunities for adapting your EMR. The opportunities are endless and most of the neat ideas you have will never be offered by your vendor or any other vendor. What we want is an extension of how we think and few of us will ever want the same combination of add-on features. Meantime to disappointment with an EMR is usually about two or three years. It’s not that we don’t have the best EMRs but the fact that they don’t keep up with our expanding expectations.Given that PF has made indications of encouraging a development community there is hope. However, don’t be surprised that PF will prefer to sell services based on access as extras. No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money. Just be sure to sort out promises vs. generalities. Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years. Can you issue and download results of any arbitrary query? Can you issue and upload any arbitrary database update? It’s really that simple to ask. Tell us about PFs guaranteed availability of these auxiliary interfaces to your data. Neighbors, MDHuntsville, Alabama Solo using FlexMedical EMR since 2/2009

[Guest guest]

You ask about PF consultants. I periodically receive promotional email from local/regional PF consultants. I get similar generalized promotional email directly from PF. Just assumed everyone did. As you have come to expect their consultant following is huge! Well, so they say. To put big numbers in perspective 80,000 PF users and 10,000,000 patients works out to 125 patients per provider. Now what could that mean? To be sure PF has fun playing with numbers that we mortals struggle with. Most providers have 1000+ patients and some upwards of 3000+. Does it mean that 80,000 tried it and mostly abandoned the product after adding a few patients? Knowing that someone downloaded a free product doesn’t tell me how many wrote it off as unusable. Perhaps you can put a more positive spin on PFs amusing numbers. While some free web product become sensations, most never make the cut - think web groceries, etc. Some take a couple of years to hit the limit of investor tolerance. I have no idea what PFs future holds. Really wish all PF users the best and will be ready to use the next best thing myself - when I see it. Certainly hope you will keep clearing up the PF story for us. Neighbors, MDHuntsville, Alabama Solo using FlexMedical EMR since 2/2009 From: [mailto: ] On Behalf Of SetoSent: Sunday, May 15, 2011 7:28 PMTo: Subject: Re: SpringCharts EHR ,I don't know anything about ODBC (open database connectivity) but I am not aware that Practice Fusion has an ODBC interface and could find nothing on Google about one. I read that Practice Fusion uses Salesforce.com for its cloud computing database, and that Salesforce.com does have an ODBC connector to its database. I'm not sure that Practice Fusion would permit any add-ons to its service by third parties. I also could find no mention of Practice Fusion encouraging a development community. Where did you hear about this? On the other hand, it has an active user community which frequently suggests bugs, improvements to the Practice Fusion development team. I, myself, have made several suggestions to the PF team. I don't know what basis you have for making the statement, " However, don’t be surprised that PF will prefer to sell services based on access as extras. " According to this January 2011 interview with , CEO of Practice Fusion, Practice Fusion will " always be free " .http://www.histalkpractice.com/2011/01/11/histalk-practice-interviews-ryan-howard-ceo-and-chairman-practice-fusion/Q. As a provider, is there anything I pay to Practice Fusion out-of-pocket other than if I want to have the version that doesn’t have the ads?A. Nope. That’s it. It’s the philosophy on my side is to keep the product entirely free. As long as I’m leading the company, the product will always be free.I have no fantasy that Practice Fusion will be free or even in existence forever, but that's a pretty strong statement that they intend for Practice Fusion to be free for a long time. Unless you think they are lying. You also say, " No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money. Just be sure to sort out promises vs. generalities. Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years. " I don't think PF has ever claimed that it has an open data system, truly or otherwise. I don't see anything wrong with them locking out systems that want to access their databases, just as I don't see anything wrong with me wanting to lock strangers out of my house. If a third party wants to make money creating their own EMR system, more power to them. If a third party wants to make money by adding on extra paid services that add features to PF, they have no right to force PF to let them in. The key to the future of EMRs is what common interface will become the industry standard. Once that is settled, then the real competition begins. How do you think Practice Fusion would become expensive in future years? If Practice Fusion starts charging money, it will lose users to competing EMRs and they will be no different than any other EMR company (most of which are expensive now). As for your final questions, " Can you issue and download results of any arbitrary query? Can you issue and upload any arbitrary database update? It’s really that simple to ask. Tell us about PFs guaranteed availability of these auxiliary interfaces to your data. " , can you explain in non-technical language what these questions mean? I am not an expert in Practice Fusion and I have no financial interest in Practice Fusion or a competing product. But as long as I can access my patient data easily and for free, and as long as nothing better comes along, then I will continue to be a satisfied user of Practice Fusion. I see that you are a featured user of your EMR, FlexMedical, which is developed by Oceris, located in Huntsville, AL, which is also where you are located. http://www.oceris.com/site/flexmedical/2010/11/17/nancyneighbors/ What is your relationship with Oceris and do you have any financial interest in it? SetoSouth Pasadena, CA I had an IT guy build a nifty reminder recall system for my EMR by tapping into it via an ODBC interface. Most EMRs offer this type of interface or similar. Quite likely you can have an inexpensive reminder recall system if you can find 20 other PF users to share the one time coding cost. Same for any other EMR. I can give you a contact to start with but there are likely quite a few PF consultants that do this type of thing. It all depends on what you want. My system is mixed email+phone messaging. It’s a great feature to have.If you can get PF to show you how to tap in with an ODBC interface (or their equivalent) you will have a great tool to help you see many more opportunities for adapting your EMR. The opportunities are endless and most of the neat ideas you have will never be offered by your vendor or any other vendor. What we want is an extension of how we think and few of us will ever want the same combination of add-on features. Meantime to disappointment with an EMR is usually about two or three years. It’s not that we don’t have the best EMRs but the fact that they don’t keep up with our expanding expectations.Given that PF has made indications of encouraging a development community there is hope. However, don’t be surprised that PF will prefer to sell services based on access as extras. No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money. Just be sure to sort out promises vs. generalities. Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years. Can you issue and download results of any arbitrary query? Can you issue and upload any arbitrary database update? It’s really that simple to ask. Tell us about PFs guaranteed availability of these auxiliary interfaces to your data. Neighbors, MDHuntsville, Alabama Solo using FlexMedical EMR since 2/2009

[Guest guest]

,Actually I didn't ask about PF consultants. You had mentioned a "development community" which I took to mean third party developers creating add-ons to Practice Fusion. I see now that you were actually referring to consultants, people with computer experience who would be paid by individual practices to help them get started with PF. I found this press release that explains it better:http://www.reuters.com/article/2010/03/02/idUS127626+02-Mar-2010+PRN20100302Practice Fusion consultants work with medical practices to set-up technology

appropriate for their particular needs; from selecting an EHR system to

outfitting a practice with hardware. Consultants offer a range of expertise

to help practices increase productivity and profitability as well as take

advantage of the latest technology.

I do recall getting some mail or e-mail from certified consultants offering to help me with Practice Fusion, but I immediately tossed them. PF has been so easy for me to implement, I had no need of them.As far as Practice Fusion's "amusing numbers" which include a current claim of 80,000 users, I prefer not to "spin" things. I prefer hard evidence, if I can get it. The following is a trimmed down edit of a January 2011 interview of , CEO of Practice Fusion, that I had linked to earlier today. It gives some insight into the question of how PF counts "number of users". I'm including more of the question than perhaps I need to in order to show that this interviewer was really not taking 's numbers at face value, and pressing him to explain his numbers in greater detail:http://www.histalkpractice.com/2011/01/11/histalk-practice-interviews-ryan-howard-ceo-and-chairman-practice-fusion/Q. Sure. I guess the biggest two areas of questions really have to do with the number of providers using the system and number of providers getting on. And based on some of the information you had sent over, the numbers just didn’t add up for me, so I just wanted to get a handle on that. The numbers I was given said about 40% of your users are MDs or DOs, which doing the math, I would say equates to about 20,000 [PF had 50,000 users at that time]; and that you’re bringing on a total of about 200 new users a day; in other words, about 80 new providers a day. I was just trying to understand if my math was correct. If you back out 80 new providers a day, the numbers suggest that you’re adding 29,000 new providers a year, which doesn’t quite sound right if you only have 20,000 total providers. I’m just trying to get a feel for the actual number of doctors today and how many are being added. And then, how do you actually count a provider? Are they actively using the system and how is that math done?What you need to keep in mind is the cadence of our growth has changed over time. From a static perspective, Practice Fusion is currently bringing on about 200 users a day. It’s a little over that. Now about six months ago, we weren’t, though, right? Or a year ago we weren’t. So our velocity is faster at any given time. If you look at our growth curve, it kind of looks like a sloped hockey stick.In 2010, we had around 500% growth on the physician side and on the patient side and on the volume side. Through our platform, we see about 1.3 million patients a month. That specifically means that doctors and practitioners on the system are seeing and pulling 1.3 million patient charts a month.Q. OK.A. The net is that the data is accurate. I stand by those numbers, they’re right. Six months ago we were probably bringing on 100 users. Right now it’s more like 230 users a day to 250.Q. And a “user” means they’re actively going in, documenting charts, that type of thing? They’re not just loading it on there and testing it out?A. There’s always a long tail of users testing the system that aren’t officially active. We only count an active user as a user that is actually seeing a specific benchmark of patients...(edited)...It’s doing a go-live, it’s become fully active, it’s seeing 100 patients. That is our definition.Q. Seeing 100 patients?A. There’s some different rationale around that number. Once the user has seen 100 patients, there’s a wide belief internally — based on analysis and product managers spending time with the users and our implementation team’s insight — that that user has mastered the system. They know it inside out. They don’t need any further training. The flip of that is that from the data side we know that the attrition rate at that point becomes single-digit percentage, so the user knows the system so well that they’re not just kicking the tires anymore because the data showed that.So according to this article, PF counts a "user" as someone who has entered at least 100 patients. If that is so, I think these are not users who are just testing out PF anymore and abandoning it. I suppose it is possible that some PF users will enter 100 patients and then give up, but I would guess that number is low. Less than 10 percent according to the interview. Here is a number that is harder to "spin". Practice Fusion was ranked #1 in customer satisfaction in an independent survey of over 30,000 ambulatory primary care specialists:http://www.practicefusion.com/pages/pr/top-emr-vendor-primary-care-specialties.htmlBrown- ordinarily sells its Black Book Rankings Report of Top 20 Family Practice EMR Software Vendors for $199:http://www.amazon.com/gp/browse.html?ie=UTF8 & marketplaceID=ATVPDKIKX0DER & me=A10RN1BMFYMS9FHowever, Practice Fusion makes this report available for download from its website for free:http://www.practicefusion.com/resources/black-book-rankings-of-top-ehrs.pdfI agree that there are many "free" web services and products that never make the cut. I also have no idea how successful Practice Fusion will be or whether it will fizzle out like WebVan.com. [spin Alert!] But my experience as an early Mac user struggling to stay relevant in a Windows world taught me early on that sometimes thinking different is the right thing to do and will be eventually successful. Just like being told I was crazy for wanting to go solo and become an IMP. Maybe this crazy, disruptive idea of a free EMR isn't so crazy after all.[end Spin Alert]As I have said before, I have no financial interest in Practice Fusion or any competing product. But it bothers me when I feel like Practice Fusion is being criticized unfairly. SetoSouth Pasadena, CA

You ask about PF consultants. I periodically receive promotional email from local/regional PF consultants. I get similar generalized promotional email directly from PF. Just assumed everyone did. As you have come to expect their consultant following is huge! Well, so they say. To put big numbers in perspective 80,000 PF users and 10,000,000 patients works out to 125 patients per provider. Now what could that mean? To be sure PF has fun playing with numbers that we mortals struggle with. Most providers have 1000+ patients and some upwards of 3000+. Does it mean that 80,000 tried it and mostly abandoned the product after adding a few patients? Knowing

that someone downloaded a free product doesn’t tell me how many wrote it off as unusable. Perhaps you can put a more positive spin on PFs amusing numbers. While some free web product become sensations, most never make the cut - think web groceries, etc. Some take a couple of years to hit the limit of investor tolerance. I have no idea what PFs future holds. Really wish all PF users the best and will be ready to use the next best thing myself - when I see it. Certainly hope you will keep clearing up the PF story for us. Neighbors, MDHuntsville, Alabama Solo using FlexMedical EMR since 2/2009 From: [mailto: ] On Behalf Of SetoSent: Sunday, May 15, 2011 7:28 PMTo: Subject: Re:

SpringCharts EHR ,I don't know anything about ODBC (open database connectivity) but I am not aware that Practice Fusion has an ODBC interface and could find nothing on Google about one. I read that Practice Fusion uses Salesforce.com for its cloud computing database, and that Salesforce.com does have an ODBC connector to its database. I'm not sure that Practice Fusion would permit any add-ons to its service by third parties. I also could find no mention of Practice Fusion encouraging a development community. Where did you hear about this? On the other hand, it has an active user community which frequently suggests

bugs, improvements to the Practice Fusion development team. I, myself, have made several suggestions to the PF team. I don't know what basis you have for making the statement, "However, don’t be surprised that PF will prefer to sell services based on access as extras." According to this January 2011 interview with , CEO of Practice Fusion, Practice Fusion will "always be free".http://www.histalkpractice.com/2011/01/11/histalk-practice-interviews-ryan-howard-ceo-and-chairman-practice-fusion/Q. As a provider, is there anything I pay to Practice Fusion out-of-pocket other than if I want to have the version that doesn’t have the ads?A. Nope. That’s it. It’s the philosophy on my side is to keep the product entirely free. As long as I’m leading the company, the product will always be free.I have no fantasy that Practice Fusion will be free or even in existence forever, but that's a pretty strong statement that they intend for Practice Fusion to be free for a long time. Unless you think they are lying. You also say, "No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money. Just be sure to sort out promises vs. generalities. Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years." I don't think PF has ever claimed that it has an open data system, truly or otherwise. I don't see anything wrong with them locking out systems that want to access their databases, just as I don't see anything wrong with me wanting to lock strangers out of my house. If a third party wants to make money creating their own EMR system, more power to them. If a third party wants to make money by adding on extra paid services that add features to PF, they have no right to force PF to let them in. The key to

the future of EMRs is what common interface will become the industry standard. Once that is settled, then the real competition begins. How do you think Practice Fusion would become expensive in future years? If Practice Fusion starts charging money, it will lose users to competing EMRs and they will be no different than any other EMR company (most of which are expensive now). As for your final questions, "Can you issue and download results of any arbitrary query? Can you issue and upload any arbitrary database update? It’s really that simple to ask. Tell us about PFs guaranteed availability of these auxiliary interfaces to your data.",

can you explain in non-technical language what these questions mean? I am not an expert in Practice Fusion and I have no financial interest in Practice Fusion or a competing product. But as long as I can access my patient data easily and for free, and as long as nothing better comes along, then I will continue to be a satisfied user of Practice Fusion. I see that you are a featured user of your EMR, FlexMedical, which is developed by Oceris, located in Huntsville, AL, which is also where you are located. http://www.oceris.com/site/flexmedical/2010/11/17/nancyneighbors/ What is your relationship with Oceris and do you have any financial interest in

it? SetoSouth Pasadena, CA I had an IT guy build a nifty reminder recall system for my EMR by tapping into it via an ODBC interface. Most EMRs offer this type of interface or similar. Quite likely you can have an inexpensive reminder recall system if you can find 20 other PF users to share the one time coding cost. Same for any other EMR. I can give you a contact to start with but there are likely quite a few PF consultants that do this type of thing. It all depends on what you want. My system is

mixed email+phone messaging. It’s a great feature to have.If you can get PF to show you how to tap in with an ODBC interface (or their equivalent) you will have a great tool to help you see many more opportunities for adapting your EMR. The opportunities are endless and most of the neat ideas you have will never be offered by your vendor or any other vendor. What we want is an extension of how we think and few of us will ever want the same combination of add-on features. Meantime to disappointment with an EMR is usually about two or three years. It’s not that we don’t have the best EMRs but the fact that they don’t keep up with our expanding expectations.Given that PF has made indications of encouraging a development community there is hope. However, don’t be surprised that PF will prefer to sell services based on access as extras. No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money. Just be sure to sort out promises vs. generalities. Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years. Can you issue and download results of any arbitrary query? Can you issue and upload any arbitrary database update? It’s really that simple to ask. Tell us about PFs

guaranteed availability of these auxiliary interfaces to your data. Neighbors, MDHuntsville, Alabama Solo using FlexMedical EMR since 2/2009

[Guest guest]

,Thank you for clarifying this. SetoSouth Pasadena, CA,I have no financial interest in FlexMedical. They happen to be an outstanding EMR with great service in my area. They have been around maybe 8 years and were certified for MU last week. FlexMedical comes with a 100% open data systemthat has been a valuable feature when I have needed to make custom changes. In all fairness, most EMRs have open datasystems in theory but in practice are intractable due to vendor concerns about others encroaching on their territory IMHO.

[Guest guest]

, Are questions unfair criticism? Are opinions unfair criticism? Let’s not go in that direction. I remain amused by PFs number of users as well as their explanations of these numbers. You may believe what you wish but I find marketing types rarely provide unbiased information regardless of the EMR they sell. With regard to the free $199 report. Now, that is genuinely amusing. Let’s see, I can buy it on eBay for $199 or get it free at PFs web site. Are we saying this report has a real value of $199? I wonder how many EMRs get rated #1 by “independent ratings each year?” I’ve seen at least three other EMRs ranked #1 recently by “prestigious” concerns. No idea how many other #1s I missed. This stuff gets cooked up too often to be surprising. How many #1 EMRs can there be? Ask PF how much they paid for the privilege of giving away a $199 report - then ask how they could possibly have no financial interest in how the survey was conducted. Most industry observers had a good chuckle when they saw the report. For fun subscribe to the Hulbert report which ranks financial investment rating firms and you will discover there is little correlation between value of the rating service and cost of the advisory services. Should we be surprised that marketing types cook up ratings reports in other industries? I have no idea what PFs future holds and no facts about their product since I haven’t used it. I appreciate what you share from direct personal experience and look forward to hearing more from you. From: [mailto: ] On Behalf Of SetoSent: Monday, May 16, 2011 12:06 AMTo: Subject: Re: SpringCharts EHR ,Actually I didn't ask about PF consultants. You had mentioned a " development community " which I took to mean third party developers creating add-ons to Practice Fusion. I see now that you were actually referring to consultants, people with computer experience who would be paid by individual practices to help them get started with PF. I found this press release that explains it better:http://www.reuters.com/article/2010/03/02/idUS127626+02-Mar-2010+PRN20100302Practice Fusion consultants work with medical practices to set-up technologyappropriate for their particular needs; from selecting an EHR system tooutfitting a practice with hardware. Consultants offer a range of expertiseto help practices increase productivity and profitability as well as takeadvantage of the latest technology. I do recall getting some mail or e-mail from certified consultants offering to help me with Practice Fusion, but I immediately tossed them. PF has been so easy for me to implement, I had no need of them. As far as Practice Fusion's " amusing numbers " which include a current claim of 80,000 users, I prefer not to " spin " things. I prefer hard evidence, if I can get it. The following is a trimmed down edit of a January 2011 interview of , CEO of Practice Fusion, that I had linked to earlier today. It gives some insight into the question of how PF counts " number of users " . I'm including more of the question than perhaps I need to in order to show that this interviewer was really not taking 's numbers at face value, and pressing him to explain his numbers in greater detail:http://www.histalkpractice.com/2011/01/11/histalk-practice-interviews-ryan-howard-ceo-and-chairman-practice-fusion/Q. Sure. I guess the biggest two areas of questions really have to do with the number of providers using the system and number of providers getting on. And based on some of the information you had sent over, the numbers just didn’t add up for me, so I just wanted to get a handle on that. The numbers I was given said about 40% of your users are MDs or DOs, which doing the math, I would say equates to about 20,000 [PF had 50,000 users at that time]; and that you’re bringing on a total of about 200 new users a day; in other words, about 80 new providers a day. I was just trying to understand if my math was correct. If you back out 80 new providers a day, the numbers suggest that you’re adding 29,000 new providers a year, which doesn’t quite sound right if you only have 20,000 total providers. I’m just trying to get a feel for the actual number of doctors today and how many are being added. And then, how do you actually count a provider? Are they actively using the system and how is that math done?What you need to keep in mind is the cadence of our growth has changed over time. From a static perspective, Practice Fusion is currently bringing on about 200 users a day. It’s a little over that. Now about six months ago, we weren’t, though, right? Or a year ago we weren’t. So our velocity is faster at any given time. If you look at our growth curve, it kind of looks like a sloped hockey stick.In 2010, we had around 500% growth on the physician side and on the patient side and on the volume side. Through our platform, we see about 1.3 million patients a month. That specifically means that doctors and practitioners on the system are seeing and pulling 1.3 million patient charts a month.Q. OK.A. The net is that the data is accurate. I stand by those numbers, they’re right. Six months ago we were probably bringing on 100 users. Right now it’s more like 230 users a day to 250.Q. And a “user” means they’re actively going in, documenting charts, that type of thing? They’re not just loading it on there and testing it out?A. There’s always a long tail of users testing the system that aren’t officially active. We only count an active user as a user that is actually seeing a specific benchmark of patients...(edited)...It’s doing a go-live, it’s become fully active, it’s seeing 100 patients. That is our definition.Q. Seeing 100 patients?A. There’s some different rationale around that number. Once the user has seen 100 patients, there’s a wide belief internally — based on analysis and product managers spending time with the users and our implementation team’s insight — that that user has mastered the system. They know it inside out. They don’t need any further training. The flip of that is that from the data side we know that the attrition rate at that point becomes single-digit percentage, so the user knows the system so well that they’re not just kicking the tires anymore because the data showed that.So according to this article, PF counts a " user " as someone who has entered at least 100 patients. If that is so, I think these are not users who are just testing out PF anymore and abandoning it. I suppose it is possible that some PF users will enter 100 patients and then give up, but I would guess that number is low. Less than 10 percent according to the interview. Here is a number that is harder to " spin " . Practice Fusion was ranked #1 in customer satisfaction in an independent survey of over 30,000 ambulatory primary care specialists:http://www.practicefusion.com/pages/pr/top-emr-vendor-primary-care-specialties.html Brown- ordinarily sells its Black Book Rankings Report of Top 20 Family Practice EMR Software Vendors for $199:http://www.amazon.com/gp/browse.html?ie=UTF8 & marketplaceID=ATVPDKIKX0DER & me=A10RN1BMFYMS9F However, Practice Fusion makes this report available for download from its website for free:http://www.practicefusion.com/resources/black-book-rankings-of-top-ehrs.pdf I agree that there are many " free " web services and products that never make the cut. I also have no idea how successful Practice Fusion will be or whether it will fizzle out like WebVan.com. [spin Alert!] But my experience as an early Mac user struggling to stay relevant in a Windows world taught me early on that sometimes thinking different is the right thing to do and will be eventually successful. Just like being told I was crazy for wanting to go solo and become an IMP. Maybe this crazy, disruptive idea of a free EMR isn't so crazy after all.[end Spin Alert] As I have said before, I have no financial interest in Practice Fusion or any competing product. But it bothers me when I feel like Practice Fusion is being criticized unfairly. SetoSouth Pasadena, CA You ask about PF consultants. I periodically receive promotional email from local/regional PF consultants. I get similar generalized promotional email directly from PF. Just assumed everyone did. As you have come to expect their consultant following is huge! Well, so they say. To put big numbers in perspective 80,000 PF users and 10,000,000 patients works out to 125 patients per provider. Now what could that mean? To be sure PF has fun playing with numbers that we mortals struggle with. Most providers have 1000+ patients and some upwards of 3000+. Does it mean that 80,000 tried it and mostly abandoned the product after adding a few patients? Knowing that someone downloaded a free product doesn’t tell me how many wrote it off as unusable. Perhaps you can put a more positive spin on PFs amusing numbers. While some free web product become sensations, most never make the cut - think web groceries, etc. Some take a couple of years to hit the limit of investor tolerance. I have no idea what PFs future holds. Really wish all PF users the best and will be ready to use the next best thing myself - when I see it. Certainly hope you will keep clearing up the PF story for us. Neighbors, MDHuntsville, Alabama Solo using FlexMedical EMR since 2/2009 From: [mailto: ] On Behalf Of SetoSent: Sunday, May 15, 2011 7:28 PMTo: Subject: Re: SpringCharts EHR ,I don't know anything about ODBC (open database connectivity) but I am not aware that Practice Fusion has an ODBC interface and could find nothing on Google about one. I read that Practice Fusion uses Salesforce.com for its cloud computing database, and that Salesforce.com does have an ODBC connector to its database. I'm not sure that Practice Fusion would permit any add-ons to its service by third parties. I also could find no mention of Practice Fusion encouraging a development community. Where did you hear about this? On the other hand, it has an active user community which frequently suggests bugs, improvements to the Practice Fusion development team. I, myself, have made several suggestions to the PF team. I don't know what basis you have for making the statement, " However, don’t be surprised that PF will prefer to sell services based on access as extras. " According to this January 2011 interview with , CEO of Practice Fusion, Practice Fusion will " always be free " .http://www.histalkpractice.com/2011/01/11/histalk-practice-interviews-ryan-howard-ceo-and-chairman-practice-fusion/Q. As a provider, is there anything I pay to Practice Fusion out-of-pocket other than if I want to have the version that doesn’t have the ads?A. Nope. That’s it. It’s the philosophy on my side is to keep the product entirely free. As long as I’m leading the company, the product will always be free.I have no fantasy that Practice Fusion will be free or even in existence forever, but that's a pretty strong statement that they intend for Practice Fusion to be free for a long time. Unless you think they are lying. You also say, " No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money. Just be sure to sort out promises vs. generalities. Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years. " I don't think PF has ever claimed that it has an open data system, truly or otherwise. I don't see anything wrong with them locking out systems that want to access their databases, just as I don't see anything wrong with me wanting to lock strangers out of my house. If a third party wants to make money creating their own EMR system, more power to them. If a third party wants to make money by adding on extra paid services that add features to PF, they have no right to force PF to let them in. The key to the future of EMRs is what common interface will become the industry standard. Once that is settled, then the real competition begins. How do you think Practice Fusion would become expensive in future years? If Practice Fusion starts charging money, it will lose users to competing EMRs and they will be no different than any other EMR company (most of which are expensive now). As for your final questions, " Can you issue and download results of any arbitrary query? Can you issue and upload any arbitrary database update? It’s really that simple to ask. Tell us about PFs guaranteed availability of these auxiliary interfaces to your data. " , can you explain in non-technical language what these questions mean? I am not an expert in Practice Fusion and I have no financial interest in Practice Fusion or a competing product. But as long as I can access my patient data easily and for free, and as long as nothing better comes along, then I will continue to be a satisfied user of Practice Fusion. I see that you are a featured user of your EMR, FlexMedical, which is developed by Oceris, located in Huntsville, AL, which is also where you are located. http://www.oceris.com/site/flexmedical/2010/11/17/nancyneighbors/ What is your relationship with Oceris and do you have any financial interest in it? SetoSouth Pasadena, CA I had an IT guy build a nifty reminder recall system for my EMR by tapping into it via an ODBC interface. Most EMRs offer this type of interface or similar. Quite likely you can have an inexpensive reminder recall system if you can find 20 other PF users to share the one time coding cost. Same for any other EMR. I can give you a contact to start with but there are likely quite a few PF consultants that do this type of thing. It all depends on what you want. My system is mixed email+phone messaging. It’s a great feature to have.If you can get PF to show you how to tap in with an ODBC interface (or their equivalent) you will have a great tool to help you see many more opportunities for adapting your EMR. The opportunities are endless and most of the neat ideas you have will never be offered by your vendor or any other vendor. What we want is an extension of how we think and few of us will ever want the same combination of add-on features. Meantime to disappointment with an EMR is usually about two or three years. It’s not that we don’t have the best EMRs but the fact that they don’t keep up with our expanding expectations.Given that PF has made indications of encouraging a development community there is hope. However, don’t be surprised that PF will prefer to sell services based on access as extras. No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money. Just be sure to sort out promises vs. generalities. Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years. Can you issue and download results of any arbitrary query? Can you issue and upload any arbitrary database update? It’s really that simple to ask. Tell us about PFs guaranteed availability of these auxiliary interfaces to your data. Neighbors, MDHuntsville, Alabama Solo using FlexMedical EMR since 2/2009

[Guest guest]

I think part of the PF users are the patients who sign up to use the portal. This may account for some of the difference in the numbers you are referring to .I have to say....I have been actively using an EMR for more than 10 years now and I could not be happier with my PF experience. It does not have every bell and whistle but I definitely feel like I am getting my moneys worth and so much more.Dannielle Harwood, MDwww.MyStudioMD.com Re: SpringCharts EHR ,Actually I didn't ask about PF consultants. You had mentioned a "development community" which I took to mean third party developers creating add-ons to Practice Fusion. I see now that you were actually referring to consultants, people with computer experience who would be paid by individual practices to help them get started with PF. I found this press release that explains it better:http://www.reuters.com/article/2010/03/02/idUS127626+02-Mar-2010+PRN20100302Practice Fusion consultants work with medical practices to set-up technology

appropriate for their particular needs; from selecting an EHR system to

outfitting a practice with hardware. Consultants offer a range of expertise

to help practices increase productivity and profitability as well as take

advantage of the latest technology.

I do recall getting some mail or e-mail from certified consultants offering to help me with Practice Fusion, but I immediately tossed them. PF has been so easy for me to implement, I had no need of them.As far as Practice Fusion's "amusing numbers" which include a current claim of 80,000 users, I prefer not to "spin" things. I prefer hard evidence, if I can get it. The following is a trimmed down edit of a January 2011 interview of , CEO of Practice Fusion, that I had linked to earlier today. It gives some insight into the question of how PF counts "number of users". I'm including more of the question than perhaps I need to in order to show that this interviewer was really not taking 's numbers at face value, and pressing him to explain his numbers in greater detail:http://www.histalkpractice.com/2011/01/11/histalk-practice-interviews-ryan-howard-ceo-and-chairman-practice-fusion/Q. Sure. I guess the biggest two areas of questions really have to do with the number of providers using the system and number of providers getting on. And based on some of the information you had sent over, the numbers just didn’t add up for me, so I just wanted to get a handle on that. The numbers I was given said about 40% of your users are MDs or DOs, which doing the math, I would say equates to about 20,000 [PF had 50,000 users at that time]; and that you’re bringing on a total of about 200 new users a day; in other words, about 80 new providers a day. I was just trying to understand if my math was correct. If you back out 80 new providers a day, the numbers suggest that you’re adding 29,000 new providers a year, which doesn’t quite sound right if you only have 20,000 total providers. I’m just trying to get a feel for the actual number of doctors today and how many are being added. And then, how do you actually count a provider? Are they actively using the system and how is that math done?What you need to keep in mind is the cadence of our growth has changed over time. From a static perspective, Practice Fusion is currently bringing on about 200 users a day. It’s a little over that. Now about six months ago, we weren’t, though, right? Or a year ago we weren’t. So our velocity is faster at any given time. If you look at our growth curve, it kind of looks like a sloped hockey stick.In 2010, we had around 500% growth on the physician side and on the patient side and on the volume side. Through our platform, we see about 1.3 million patients a month. That specifically means that doctors and practitioners on the system are seeing and pulling 1.3 million patient charts a month.Q. OK.A. The net is that the data is accurate. I stand by those numbers, they’re right. Six months ago we were probably bringing on 100 users. Right now it’s more like 230 users a day to 250.Q. And a “user†means they’re actively going in, documenting charts, that type of thing? They’re not just loading it on there and testing it out?A. There’s always a long tail of users testing the system that aren’t officially active. We only count an active user as a user that is actually seeing a specific benchmark of patients...(edited)...It’s doing a go-live, it’s become fully active, it’s seeing 100 patients. That is our definition.Q. Seeing 100 patients?A. There’s some different rationale around that number. Once the user has seen 100 patients, there’s a wide belief internally — based on analysis and product managers spending time with the users and our implementation team’s insight — that that user has mastered the system. They know it inside out. They don’t need any further training. The flip of that is that from the data side we know that the attrition rate at that point becomes single-digit percentage, so the user knows the system so well that they’re not just kicking the tires anymore because the data showed that.So according to this article, PF counts a "user" as someone who has entered at least 100 patients. If that is so, I think these are not users who are just testing out PF anymore and abandoning it. I suppose it is possible that some PF users will enter 100 patients and then give up, but I would guess that number is low. Less than 10 percent according to the interview. Here is a number that is harder to "spin". Practice Fusion was ranked #1 in customer satisfaction in an independent survey of over 30,000 ambulatory primary care specialists:http://www.practicefusion.com/pages/pr/top-emr-vendor-primary-care-specialties.htmlBrown- ordinarily sells its Black Book Rankings Report of Top 20 Family Practice EMR Software Vendors for $199:http://www.amazon.com/gp/browse.html?ie=UTF8 & marketplaceID=ATVPDKIKX0DER & me=A10RN1BMFYMS9FHowever, Practice Fusion makes this report available for download from its website for free:http://www.practicefusion.com/resources/black-book-rankings-of-top-ehrs.pdfI agree that there are many "free" web services and products that never make the cut. I also have no idea how successful Practice Fusion will be or whether it will fizzle out like WebVan.com. [spin Alert!] But my experience as an early Mac user struggling to stay relevant in a Windows world taught me early on that sometimes thinking different is the right thing to do and will be eventually successful. Just like being told I was crazy for wanting to go solo and become an IMP. Maybe this crazy, disruptive idea of a free EMR isn't so crazy after all.[end Spin Alert]As I have said before, I have no financial interest in Practice Fusion or any competing product. But it bothers me when I feel like Practice Fusion is being criticized unfairly. SetoSouth Pasadena, CA You ask about PF consultants. I periodically receive promotional email from local/regional PF consultants. I get similar generalized promotional email directly from PF. Just assumed everyone did. As you have come to expect their consultant following is huge! Well, so they say. To put big numbers in perspective 80,000 PF users and 10,000,000 patients works out to 125 patients per provider. Now what could that mean? To be sure PF has fun playing with numbers that we mortals struggle with. Most providers have 1000+ patients and some upwards of 3000+. Does it mean that 80,000 tried it and mostly abandoned the product after adding a few patients? Knowingthat someone downloaded a free product doesn’t tell me how many wrote it off as unusable. Perhaps you can put a more positive spin on PFs amusing numbers. While some free web product become sensations, most never make the cut - think web groceries, etc. Some take a couple of years to hit the limit of investor tolerance. I have no idea what PFs future holds. Really wish all PF users the best and will be ready to use the next best thing myself - when I see it. Certainly hope you will keep clearing up the PF story for us. Neighbors, MDHuntsville, Alabama Solo using FlexMedical EMR since 2/2009 From: [mailto: ] On Behalf Of SetoSent: Sunday, May 15, 2011 7:28 PMTo: Subject: Re: SpringCharts EHR ,I don't know anything about ODBC (open database connectivity) but I am not aware that Practice Fusion has an ODBC interface and could find nothing on Google about one. I read that Practice Fusion uses Salesforce.com for its cloud computing database, and that Salesforce.com does have an ODBC connector to its database. I'm not sure that Practice Fusion would permit any add-ons to its service by third parties. I also could find no mention of Practice Fusion encouraging a development community. Where did you hear about this? On the other hand, it has an active user community which frequently suggestsbugs, improvements to the Practice Fusion development team. I, myself, have made several suggestions to the PF team. I don't know what basis you have for making the statement, "However, don’t be surprised that PF will prefer to sell services based on access as extras." According to this January 2011 interview with , CEO of Practice Fusion, Practice Fusion will "always be free".http://www.histalkpractice.com/2011/01/11/histalk-practice-interviews-ryan-howard-ceo-and-chairman-practice-fusion/Q. As a provider, is there anything I pay to Practice Fusion out-of-pocket other than if I want to have the version that doesn’t have the ads?A. Nope. That’s it. It’s the philosophy on my side is to keep the product entirely free. As long as I’m leading the company, the product will always be free.I have no fantasy that Practice Fusion will be free or even in existence forever, but that's a pretty strong statement that they intend for Practice Fusion to be free for a long time. Unless you think they are lying. You also say, "No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money. Just be sure to sort out promises vs. generalities. Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years." I don't think PF has ever claimed that it has an open data system, truly or otherwise. I don't see anything wrong with them locking out systems that want to access their databases, just as I don't see anything wrong with me wanting to lock strangers out of my house. If a third party wants to make money creating their own EMR system, more power to them. If a third party wants to make money by adding on extra paid services that add features to PF, they have no right to force PF to let them in. The key tothe future of EMRs is what common interface will become the industry standard. Once that is settled, then the real competition begins. How do you think Practice Fusion would become expensive in future years? If Practice Fusion starts charging money, it will lose users to competing EMRs and they will be no different than any other EMR company (most of which are expensive now). As for your final questions, "Can you issue and download results of any arbitrary query? Can you issue and upload any arbitrary database update? It’s really that simple to ask. Tell us about PFs guaranteed availability of these auxiliary interfaces to your data.",can you explain in non-technical language what these questions mean? I am not an expert in Practice Fusion and I have no financial interest in Practice Fusion or a competing product. But as long as I can access my patient data easily and for free, and as long as nothing better comes along, then I will continue to be a satisfied user of Practice Fusion. I see that you are a featured user of your EMR, FlexMedical, which is developed by Oceris, located in Huntsville, AL, which is also where you are located. http://www.oceris.com/site/flexmedical/2010/11/17/nancyneighbors/ What is your relationship with Oceris and do you have any financial interest init? SetoSouth Pasadena, CA I had an IT guy build a nifty reminder recall system for my EMR by tapping into it via an ODBC interface. Most EMRs offer this type of interface or similar. Quite likely you can have an inexpensive reminder recall system if you can find 20 other PF users to share the one time coding cost. Same for any other EMR. I can give you a contact to start with but there are likely quite a few PF consultants that do this type of thing. It all depends on what you want. My system ismixed email+phone messaging. It’s a great feature to have.If you can get PF to show you how to tap in with an ODBC interface (or their equivalent) you will have a great tool to help you see many more opportunities for adapting your EMR. The opportunities are endless and most of the neat ideas you have will never be offered by your vendor or any other vendor. What we want is an extension of how we think and few of us will ever want the same combination of add-on features. Meantime to disappointment with an EMR is usually about two or three years. It’s not that we don’t have the best EMRs but the fact that they don’t keep up with our expanding expectations.Given that PF has made indications of encouraging a development community there is hope. However, don’t be surprised that PF will prefer to sell services based on access as extras. No better time to find out if PF will become a truly open data system or will choose to maximize profit by locking out add-on competition that really makes money. Just be sure to sort out promises vs. generalities. Without a clear open data access option via an industry standard interface it’s easy to see how PF could become expensive in future years. Can you issue and download results of any arbitrary query? Can you issue and upload any arbitrary database update? It’s really that simple to ask. Tell us about PFsguaranteed availability of these auxiliary interfaces to your data. Neighbors, MDHuntsville, Alabama Solo using FlexMedical EMR since 2/2009