Why Not Use a Free EHR?

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Why Not Use a Free EHR?

There are a handful of free EHRs and who doesn’t like free? However, before you jump in with both feet, you may want to know some facts. First I don’t personally know of any behavioral health EHRs for private practice that are free. So if you want to use a free EHR, you’re probably going to have to be OK with a medical product that’s been designed for agency use. The cost factor of these types of EHRs has been eliminated, but there are still some reasons you may not want to use them.

User Testimonial

“I have tried other free EHRs which were difficult to use, had very limited (if any) technical support, were geared toward the medical community and were not well informed about HIPAA compliance. I’ve returned to PSYBooks!”

Second, it costs a LOT of money to produce a good EHR. Lots and lots, actually. So you have to ask yourself, “Who would offer that kind of product for free?” The broadest form of the answer is simple; someone who wants something different from you – something other than your money. This means that to stay in business, they have to be getting their money elsewhere and that’s where problems can arise.

Within this broad category, there are at least three different sub-categories – possibly more. The three main ones are:

  • Companies who want to use your clients’ data. Specifically, they de-identify it and sell it to willing buyers.
  • Billing companies who want you to sign up for their services (for a fee) and who offer to “give” you a free EHR to do so.
  • Companies who are paid per claim fees by insurance companies and are hoping to make money when you efile or possibly on other types of interactions you may engage in with insurance companies.

The first one is, in my mind, the most problematic. What these companies are doing is legal because they list their intentions in the fine print you have to agree to in order to use their products. You might be thinking, “I support research. As long as they de-identify my clients’ data (which they claim to do) that might be ok.” However, they don’t only sell your client data for research purposes. What you sign pretty much gives them carte blanche to sell the data to any willing buyer. Possibly the worst example of this is that one company solicited the patients of their subscribers. The PATIENTS, not the doctors or therapists themselves. To make matters worse, what they asked the patients to do was to rate their doctor for something that was later published online. However, when you read some of the reviews, it’s obvious that the patients did NOT understand that their reviews were not going to be anonymous or that they would be seen by anyone but their own doctor. The doctors, on the other hand, did not know they were being reviewed – nor had they knowingly given their consent. Needless to say, this was not received well by the patients whose reviews were published, nor by the therapists and physicians who had been using that particular EHR.

Furthermore, even though such companies de-identify client data (which is how they get around the HIPAA privacy laws), there are some cases where data that’s been de-identified has been “re-identified”, exposing PHI and other vulnerable information about your client to people for whom it was never intended. For these reasons, you may well be unknowingly compromising your client’s privacy and/or your own just by using these types of EHRs.

The second category – billing companies who want your business – may be ok if you don’t want to do any of your own billing. However, compare the costs. It’s often quite a bit more expensive to hire someone to do your billing than to pay the subscription fee for a good EHR. Also, if the EHR is built to be user-friendly, billing is usually extremely easy to do – typically just requiring a few clicks. Personally, if I were interested in hiring someone to help me with billing, I wouldn’t want to pay them to do it all. I might want to hire them for an hour a week – maybe just an hour a month – to make any phone calls to insurance companies that need some follow-up. That’s really the only time-consuming part of billing. Also, if you do decide to go the billing-company-disguised-as-free-EHR route, before you sign up, make sure and ask them what happens if you decide to not use their service anymore. Do you get to keep the EHR? Your data? Do you have to sign a contract to use their services for a certain period amount of time? What are their policies around using de-identified client data?

EHRs in the third category – those that are paid by insurance companies – are typically built by clearinghouses, or in some cases, by a specific insurance company serving as a clearinghouse. The problem with these EHRs tends to be that they’re difficult to learn, even among experienced users. Once again, they were created as large scale medical/agency EHRs that use a shared chart model. Both of these things add layers of complexity to the product that those of us in private practice don’t need. Also, since they’re not specifically made for behavioral health, they don’t usually offer some of the things we DO need, such as a way to enter personal psychotherapy notes that we don’t want to be included in the client’s medical record.

Bottom line: if you want to try a free EHR, be prepared to read the fine print so you know exactly what you’re agreeing to. Also, you might do yourself a favor and sign up for a free trial of a web-based EHR that’s been made just for behavioral health practitioners in private practice while you’re also trying the free EHR. You may be amazed at the difference in simplicity and ease of learning of the subscription-based EHR and decide that the price is well worth it.

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