Publications & Articles

"Free EHRs" are NOT Free

There´s no such thing as a "Free EHR". In fact, these "Free" Electronic Health Record software systems are some of the most costly EHRs around.

Here's why:

Real ONC and CCHIT certified software is expensive to program, expensive to test and expensive to get certified. To do the job right and include an easy-to-use interface costs ONE or more MAN CENTURIES of programming and follow up time. You read correctly. It takes 100 or more good programmers working for a year or more to make it happen. Then there's the time and effort to get the US Government to test and certify it (Think: FDA approving a new drug. It´s almost as bad).

So who's going to "Give away for Free" such expensive software? Sly operators who know the game better than you. That´s who. What do they want? What´s their true motive?

They want captive users and their (your) cash flow.

Remember, once they have your data, there´s no escape. These sly "Cloud" operators do not allow the physician to leave because their software was never designed to run independently from their own network. And presently, there is no law (nor true standard) that says any hosting company MUST comply and give you your data in a format that you could actually use.

In contrast, my company, Castlerock Management Corp, hosts some of the best "Cloud" solutions. Many of our physicians love "ChartMaker-Clinical" EHR software made by STI Computer Services (Which Castlerock hosts for Cloud connections). So with us, you can run your electronic health records from an iPad, a PC, an Android device or a Windows PC. But we also provide physicians with their data AND programming if they want to take their EHR back in house and run it on their office computers. This can dramatically cut costs for retiring physicians who are required to provide access to their records for years.

Also, please don´t be fooled by claims that all certified software must be able to exchange records. While true on a case-by-case basis, one record at a time, none of the current certified systems provide for mass exports of all records. While you may be able to get patient demographics and scanned images, the actual EHR text and form information are usually encrypted in a Binary or "BIN" format that requires extensive programming AND the vendor´s source code (Think program keys) to unlock. And no one ever allows an outside party to have source code because with it, you could also steal their programs.

Here´s a key point:

If you closed your doors tomorrow, as a physician you would have to make your records available FOR AT LEAST 10 YEARS. In some states and some specialties like Neonatology, you have to keep records for AT LEAST 22 YEARS.

Got it yet?

EHR access over time can get REALLY EXPENSIVE.

So even if it "Just costs only" $250 per doctor per month, the physician has to think:

$250 x 12 months x 10 years = $30,000 Minimum.

So these costs continue, even after you retire. And that assumes that rates don´t change. Don´t bet on it. If you read the fine print of most Free "Cloud" solutions, the companies (Sly operators) have the right to jack up rates after the first year or two.

And, the sly operators don't even have to mention this 10+ year continuing cost in their contracts because medical records retention laws do that job for them.

They know that you'll be PAYING in one way or the other FOR YEARS.

But wait. There's more.

Again, there's no "FREE" in Free EHR. This waiving of EHR fees is almost always predicated on the physician handing over his billing (Big Mistake) to the same slimy operator. Let´s explore the billing component.

My company has done billing since 1989, and we successfully acquired a leading specialty New Jersey billing company that was founded in 1983. With Millions of charges compliantly billed and collected, I think we know something about medical billing. So here are several key points to know:

1) EHR Systems are NOT Billing Systems, at least not at this stage in the game. Usually, EHR Templates MISS many billable items because they are not needed to document a patient's chart or because the sly operator´s set-up person failed to include these billable items when installing the physician´s EHR template (Translation: Boiler Plate Templates with the practice name slapped on top). A customized super-bill or charge ticket REMINDS the doctor to check off all services rendered in the logical order of treating each patient. An EHR template rarely does. But these sly operators who require that the physicians include their slimy billing service for "Free" EHR service are just grabbing the electronic files from the EHR, and not reviewing anything for completeness or accuracy, then loading them into sub-standard bill processing software. This isn´t "Billing" it´s just pressing buttons and the results are typically horrible cash flow losses, but once a physician figures out how much he or she has lost, it may be next to impossible to get free from the clutches of the "Free EHR" operators and may have to pay a sizeable early termination fee.

My company currently estimates Billing losses generated from most average EHR installations running at about 20 - 30% of cash flow for specialists. Primary care is not as bad because most PCPs are paid through Capitation agreements and office Co-Pays. But if files are missed or not transmitted, billing losses can soar. These sly operators may not have the facility to catch dropped files, but if it´s your practice, it can really hurt to have your money tied up in Vapor-ware on the Internet and not get any straight answers on when or how much you´ll be paid.

2). Even if you´re lucky enough to only lose 10% of your truly Billable charges via a well set-up EHR, you will still lose on the back end bill processing. How?

These "Free" EHR operators just DON'T DO REAL MEDICAL BILLING. They upload electronic charge files captured through the EHR and download electronic payment files. If you are lucky, they might pursue a few super-high balance accounts, but they won't do the Full, Real job of following up on each and every account by calling delinquent insurance companies and patients or formally appealing claims for FULL PAYMENT.

When you actually read the electronic submission file reports from the top clearinghouse companies, you would be amazed at how often electronic submissions fail to go through all the way to the intended insurance company. This means that knowledgeable humans (i.e. Real Billing People) have to sort out the missed files and re-transmit them in a timely fashion. Then monitor the re-submitted acknowledgement reports to see if files were again dropped. And best of all, "Real" billing people CALL the insurance carrier a few days later and check to see if the claims are actually processing. The sly operators do no such thing. Most don´t even know how because they are NOT "Real" billing companies, but are collections of computer people backed by big money investors out to make a quick buck.

As Yogi Berra famously stated:

"In theory and practice there is no difference. In practice there is!"

Beware of these sly operators. Most have been around for only a few years. And please run away from anyone who wants to charge you a slice of your EHR Incentive money.

There are too many EHR & Billing games being played on physicians to list in this article. And since the 1980s, we´ve seen them all so you can always call us at 1-877-566-5323 (24/7 hotline) and we'll do our best to help. Or e-mail me, and my staff or I will get back to you within a day at: Bill.Wendt@cmcdocs.com

Bill Wendt is the Founder and CEO of Castlerock Management Corporation. Castlerock is a practice management company that has hosted physician and hospital departments since 1989 (Back then using IBM mainframe connections not the internet as we do today). Presently, their customers enjoy some of the highest collection rates and easiest to use certified EHRs, by using either fully-implemented Castlerock solutions, or a hybrid of Castlerock back-office billing & cloud hosting with the physician or hospital department entering front-office data. iPad, Android, PC or Macintosh devices all connect to Castlerock´s Cloud. They also offer a full line of Coding and HITECH HIPAA Compliance auditing and practice management services. Castlerock´s home office is located at:

98 Ford Road
Suite 3-H
Denville, NJ 07834-1356