We’ve been keeping tabs on Practice Fusion since the early days and THCB regulars will have noticed several comments and an article from CMO Robert Rowley. CEO Ryan Howard’s been hinting for a while that they were going to be getting into bed with a major software player, that shared their SaaS approach, and today they announced an investment from Salesforce.com, who we also know has been sniffing around health care too. This will include Practice Fusion becoming part of the Force.com (kind of an app store for the Salesforce.com ecosystem, although my guess is that few physicians are going there right now to look for records (not sure they’re going to Wal-mart either, though)

Practice Fusion is claiming that 19,000 users are already on its system which includes basic practice management, as well as a pretty complex EMR workflow. Coming soon will be a greater ability to share information with patients and other physicians over the platform—which allows it to spread via viral marketing. i.e. I’m referring you this patient, click here to get their data and sign up for this free EMR too. It’s not yet CCHIT certified, but Howard is aiming to be eligible for “meaningful use” money when the criteria are finally established.

I’m not too sure what SalesForce is getting other than a financial investment, as the extension from sales CRM to physician clinical workflow isn’t that obvious, but perhaps there are other behind the scenes activities going on there.

And of course the whole thing is funded by contextualized ads, which appear to the right of the screen in a similar manner to Google Adwords, but are of course targeted at a much more valuable population. Yup, with Practice Fusion we are finding out that free may just be cheap enough.

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21 Responses for “Practice Fusion gets investment from Salesforce.com”

  1. I’ve been hungering for “SalesForce EMR” ever since I saw Dr. Larry Brilliant speak at Salesforce’s Dreamforce conference last November. He was at Google Foundation at the time, talking about what they’re doing to monitor realtime health data from clinics around the world. It was a BIG epiphany moment for me, the start of my awareness of what could be done by smart tools using good quality data, well managed.
    Then in February I spoke at TEPR+ in Palm Springs and heard many (and I mean many) docs moaning about how their EMR systems were hard to use, expensive to start up, and didn’t match their workflow. As a Salesforce admin I know SF is pretty configurable – not perfect but certainly better than what these people were griping about. And getting started with Salesforce is trivial – you go sign up for the free trial and you’re off and running, and the same system can scale up to run a huge enterprise. (Cisco has a site license for the whole company.)
    And I heard one prominent figure speak about how his EMR’s data went down the tubes and his SQL Server guy couldn’t get it back for months. Then Adam Bosworth stood up and basically said “Dude, haven’t you heard of cloud computing?? We run our company in the cloud, and we don’t do backups, and we don’t lose data. We don’t even own the system – we rent it, and they do the backups for us.” I know firsthand that that’s how Salesforce works.
    (I opt to receive a weekly email saying that my weekly backups are ready for me to download, just because I like to know that I have history. Extra cost for that backup service: $0.)
    Since November I’ve twice written to people I know at SF and asked them to pass my thoughts upstream. Dunno whether they did.
    Disrupt away, PracticeFusion. The dominant dinosaurs need to have a big chunk bitten out of their behinds.
    (Mind you, I’ve never touched their system. I’m just saying what I said, nothing more.)

  2. propensity says:

    Has this device been validated as safe? Is it cost effective?

  3. Nick F says:

    Hopefully this will make some headway toward allaying the privacy and security fears of the EHR SaaS model. I’ve never used Salesforce apps before, but would assume they provide a higher level of protection than what a small startup could provide on its own.
    Perhaps this will open the door to other small startups to also offer their product through the AppExchange. And of course there are some interesting implications for HIE…

  4. Painkiller1 says:

    The pains are sometimes reflected as something very badly; this is a warning of some ailment which we pruned to suffer. Sometimes we feel a pain in the waist and one in one of the kidneys which we can worry about. These pains are deceptive and sometimes the importance is not relevant. For this reason it is recommendable to get a physical control to recognize the ailment that causes the pain and power and to fight its origin. The pain in the waist, that can be acute or long lasting can return as chronic and is know to medics as lumbar pain. This is a disease that strikes millions of people throughout the world; findrxonline and said that according to statistics 70% of people who have suffered at some point in their life.

  5. I want to be careful not to mix up what Salesforce is and what PracticeFusion is, because they’re unrelated technically; SF merely invested in PF, with no common DNA.
    But having said that:
    Re address the issue of uptime, consider how transparent Salesforce is regarding its status: the continuously updated trust.salesforce.com status reports.
    And every time there’s an outage, I (and every SF admin) gets alerted and gets a root cause analysis pretty promptly after it’s corrected. Those outages or performance degradations show up in the history, such as 7/22/09 on server CS1, which is a “sandbox” server (for customer test & development, not production data).
    Salesforce isn’t perfect – not by a long shot. But it’s also not just one product, it’s an ecosystem, with tons of plug-ins and a wide-open platform for development of others. And, as we know, today’s EMR systems aren’t quite perfect.
    Point of comparison: I heard recently from a doc who punted an EMR system they’d installed because it took his least-computer-savvy peer a full half hour to figure out how to add a patient to the system. You can see for yourself what it’s like in Salesforce by going to http://www.salesforce.com/ and clicking the Free Trial button and making yourself an instant SF user.
    Or, more aptly, try it with PracticeFusion. They do the free thing too. (I didn’t because I don’t gots no practice details to enter into their form!)

  6. The EHR Guy says:

    Folks,
    Do you know that MEDITECH, even it’s older versions, has wide acceptance by the clinician community? I mean, at least it stays where it is deployed. Do you know why? Because it works and it does what it has to, plain and simple.
    Huge IDNs use MEDITECH: CHW, HCA, among many, many.
    The simple menu and key in approach from the way back ol’ days is quite user-friendly (term that was commonly used in the 80s). How do you exit? Just press ESC several times. How do you go to the next step? Just press Enter. Get an error? Read and retype in what you mistakenly entered. Etcetera.
    Did you know that most of the EMRs that get thrown out the hospitals back doors are new applications that have all the bells and whistles?
    Many Health 2.0 apps also suffer from low adoption and high rejection rates.
    Another thing is that they do not flirt around with other industries. They are a healthcare IT company. That’s it! Period!
    Go ahead, flirt around, play at pretending to be a healthcare IT company. Go make a fool out of yourselves. Every single technology company is doing it. This is ludicrous.
    Why don’t you just try to become better at what you alredy do?
    Thanks,
    The EHR Guy (25+ years exclusively dedicated to healthcare IT)

  7. “the whole thing is funded by contextualized ads”
    Very bad idea for an EMR to have any type of advertising. PracticeFusion of course is not the only vendor using that technique for funding.
    I originally thought it a bad idea for even this weblog to have advertising, but have changed my mind on that. It’s non-intrusive and this is a completely different setting that for an EMR system.

  8. The EHR Guy says:

    Wendell,
    I don’t think it can be solely funded by contextual ads.
    I consulted for a now very succesful startup, which I can’t mention it’s name because of an NDA, which attempted to use contextual ads to create revenue. After carefully studying statistics and obtaining advice from experts the number of registered users to be able to create income that would be significant to produce through these ads was around the 6 million mark. Daunting task!
    They must have another model for alternative income streams.
    Anyways, I’ve been using Internet almost since its inception. I have never clicked on an ad. When I want to buy something I go to wherever I deem fit.
    Also, if a product is good people will buy it. There is no need to give away something good for free. It may just be a marketing strategy. Give away today and tomorrow will make it up somehow. Even Microsoft gives their software away for 120 days.
    Thanks,
    The EHR Guy

  9. Chris Anderson, in his new book, “Free: The Future of a Radical Price”, Hyperion (July 7, 2009), says that the alternative revenue is coming from selling charts to medical associations that do research. Not sure what that means, but he says that each chart can fetch between $50 and $500 and can be sold multiple times to various institutions that do these studies (page 104).
    Pretty clever idea.

  10. Yo, EHR Guy: I gotta run (late for work again), but at some point I wanna know more about Meditech. Do they have an animated online demo or some such?
    How come everyone doesn’t buy it? Misguided buying priorities? (Honest question – I have no info and no opinion.)
    Fwiw, re “stick to one industry” – I understand your point, but there are limits to that logic. It would say, for instance, that IBM and Cisco and GE should stay out of HC, yes? (No?) Seems to me (in my 2/3-ignorant state) that we need *more* innovative competition. And it’s fine with me if Meditech wins every face-off!
    (Knowing you, I presume you’re not involved with Meditech, right? Except as a fan?)

  11. The EHR Guy says:

    e-Patient Dave,
    Of course I am not with them or with any other HIS vendor.
    I’ve simply performed consulting services for hospitals for implementing innovative technologies (e.g. CCOW, SSO, etc.) where they have MEDITECH installed. It has staying power. It is most widely installed software in the inpatient setting. Users that I have corresponded with don’t have anything too negative to say.
    I’ve also been in hospitals where they have attempted to install new powerful web based solutions and the users rejected them in favor of continuing with their old software.
    I try to speak facts and not opinions. And I’m really only a fan of the software that I develop. :) Modesty pushed to the side for a minute.
    Thanks,
    The EHR Guy

  12. MD as HELL says:

    Meditech is terrible as a patient care tool. It is not user friendly. It dumbs nursing down to useless. It is archaic and cumbersome and it is s..l..o..w.
    The older version was actually better than the new version we just installed, over the objections of the medical staff.
    It is inflexible and, compared to a modern web page, it is a proprietary, expensive, and hurts productivity. After it was turned on our length of stay in the ED increased by nearly an hour.
    The company is not very responsive.
    It is popular with admin because it does what they need, perhaps, but taking care of patients with it is burdensome.
    Don’t buy it.

  13. The EHR Guy says:

    MD as HELL,
    What hospital do you work at?
    I suggest you seek a new opportunity. It sounds like your are very unsatisfied and mad as hell! :)
    On a more serious tone: What software would you recommend?
    Thanks,
    The EHR Guy

  14. MG says:

    There are already several smaller SaaS EMR vendors that are CCHIT-certified and I would have to see some of the details of this deal to see what it really meant for Practice Fusion and their offerings. Is Salesforce.com just take a very minor equity stake that basically provides additional cash for Practice Fusion or are they also providing more tangible assets including data center resources or support resources?

  15. MD as HELL says:

    EHR Guy,
    I’ve been at my same “opportunity” for 27 years. The powers that be buy every system that comes down the line from Pyxys (another boondoggle) to Cisco phones to you name it. We don’t have a nice bridge yet.
    I will remain at my “opportunity” because other places tend to be worse. I may be MD as HELL, but here I make a difference. As for where, I will remain anonymous.
    I have heard that A4, now owned by Allscripts, is much better.

  16. When I interviewed Practice Fusion’s CEO a few months back for the Health Business Blog he told me they made money from their billing service. To me that seems like more of a money spinner than ads.
    http://www.healthbusinessblog.com/?p=2256

  17. NoVA doc says:

    @MG: could please you link/list the other SaaS vendors? I would like to see a company with its finances as well as its long-term priorities straight when evaluating these products. Logician Internet getting shut down by GE comes to mind. I suspect the hype about the salesforce.com investment is to quell those doubts.
    PracticeFusion has a $100/month tier for supported/ad-free version. An interesting option for a small practice with computer-savvy practitioners with its available billing and scheduling modules. Have yet to log-in to see if there’s a future development road map of features I can’t readily find: eRx, LIS, portal, exchange with other EHR’s/PHRs.

  18. JR says:

    Here is what Mickey Tripathi (who’s model ONC Is following now apparently) said about practice fusion on this very blog a while back.
    “Practice Fusion, a San-Francisco-based startup is its hyper-commercial opposite. Launched last August, the company’s original plan was to offer their EHR without charge in return for access to the deidentified clinical data generated by users, which the company would sell to pharma companies, insurers, and researchers. If that isn’t controversial enough, the company announced last Friday that they’ll be partnering with Google’s advertising arm, AdSense, to put context-sensitive ads on the EHR in real-time.”

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  20. rdg says:

    I’ve started using practice fusion and I kind of like it. You can pay 100.00 bucks to get it w/o ads. Right now, we are being forced to use an EMR. They will give us 44000 dollars for this experiment. I can’t see myself investing in another Medinotes/allscripts fiasco. If they are lying about HIPPA compliance then it is also possible that a whole bunch of local server based ehrs are keeping pt data in hardrives w/o encryption. Everyone is suspect. They will give me my data for fre if I request it in excel format so I my risk is low. I’ve lost more data from hard drive crashes than my simple hotmail account. It may be worth giving it a try. I might even pocket the 44000 dollars and if the process fails, well, I’m not gouged by another vendor again…

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