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Thoughts on Practice Fusion Raising $70 Million

Today, Practice Fusion announced that they have just closed a $70 million round of funding. This series D round of funding brings Practice Fusion’s total funding to $134 million and a valuation estimated at $700 million. The round was led by Kleiner Perkins Caufield & Byers, OrbiMed Advisors, and Deerfield Management Company.

We’d heard that this round was close almost 2 months ago. I’m not sure what took them so long to finally close the round. I also found it interesting in this Forbes article about the funding round that “Practice Fusion leads vendors this year in acquiring Allscripts’ former customers.” I have a feeling Aprima might have something to say about that.

In that same article, Practice Fusion declined to disclose revenues, but Ryan Howard suggested that he expects Practice Fusion revenues to triple next year. Then, it was suggested in the article that payments from labs connected to Practice Fusion customers would make up a significant source of revenue. You might remember that Practice Fusion lost one revenue stream when Kareo decided to launch their own free EHR. Practice Fusion has since rolled out 3 new billing companies and so they could have made up that revenue.

The article also suggests that revenue is available from Pharma for mining the Practice Fusion data for insights. Then, they’ve always talked about the potential for pharma advertising in the Free EHR. I also had someone suggest to me recently that Practice Fusion could be making money off of selling leads to the various healthcare education companies out there. Considering the number of emails I get from these healthcare education companies, they definitely have money to spend on targeted leads.

The question I’ve asked for many years isn’t whether Practice Fusion has created value. No doubt their current user base and data set has value. The question that remains is whether they’ve created a company that merits a $700 million valuation and whether the $134 million investment will yield a quality return. Plus, can Practice Fusion build the company’s revenue while still maintaining physicians’ trust in Practice Fusion. They now have $70 million in funding to find out.

September 24, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Aprima EHR’s Offline Functionality

I’ve been writing for a number of years on the challenge that EMR downtime causes a clinic. In case you missed them, check out some of the following posts:
My EMR is DOWN!!!
Working Offline When Your EHR Isn’t Available
Cost of EHR Down Time
Reasons Your EHR Will Go Down
SaaS EHR Down Time vs. In House EHR Down Time

Not to mention Katherine Rourke’s recent post titled, “When The EMR Goes Down, Doctors Freak Out.” Obviously, downtime is a big problem as doctors become more reliant on their EHR software. Plus, as I state in some of the article, downtime is inevitable.

One of the most common comments I got on those posts was doctors asking why they couldn’t work in the EHR software even when it was down. My answer was usually that the EHR vendor could do that, but that it would require them to architect the EHR to be able to support offline use of the EHR and that wasn’t a simple task.

Turns out that Aprima has built this functionality into their EHR called Aprima Replication. Here’s their description of the replication feature:

Every installation of Aprima EHR includes the Replication functionality. This allows physicians to continue working within patient charts when they are not able to be connected to their server (whether it is hosted locally in their office or in the cloud). They have identical functionality as if they were fully connected with the ability to look up or enter data, perform everyday tasks such as messaging and tasking, create orders, review results, etc. Everything is stored locally on their hard drive in a secure and encrypted environment and automatically syncs information the next time they are online whether that be over a mobile wireless connection, wifi + VPN over a public network, back in their office over a wired or wifi network, at home, or wherever and however they are able to connect. Additionally, all of the synchronization is done behind the scenes allowing the provider to continue working live without having to wait for the replication to complete.

Aprima Replication goes beyond other mobile technologies because this does not require connectivity, and even more importantly it is not simply a copy of the server that is “read only,” or a partial export of charts that leaves the server side locked until the provider “checks the chart back in.” This is fully functional on the provider side while disconnected AND allows others to also continue to make updates and changes to the chart, patient scheduling, handle all the needs surrounding coordination of care, billing and collections, etc. This can also be used as a great “downtime” alternative to paper in the event of an internet outage for those using the cloud or a server failure when running it locally.

I asked a couple follow up questions to clarify exactly how the offline EMR functionality worked. Here are my questions and their answers (originally an email exchange):
The challenge I have is understanding how the patient records are available without an internet connection. You can’t be downloading every single patient record locally are you?

In our unique, patent pending Replication process, every provider has a profile unique to their needs and preferences. This includes a subset of patients based on their previous schedule, future schedule, open orders and tasks, a specific facility they may be servicing such as a nursing home, their messages, attachments, (they can set size limits to address minimal bandwidth environments such as wireless air cards) etc. Based on these parameters the appropriate patient charts are “replicated” to their tablet/laptop computer. This is an ongoing, real-time process while they are connected to the network that keeps the data current. Any time they disconnect, or even lose connectivity if there is an outage, they continue to have full chart access for reviewing, adding, and editing as if they were still connected. As soon as connectivity is restored the synchronization starts up again and continues until all of their work, plus all of the work done simultaneously on the server side, is merged back together.

Does it just download some “active patient” list or the records for the patients on your schedule for some certain time period? It’s a really beautiful thing that you’re program can work without the internet. I assume all of the drug databases, etc are downloaded and available locally as well?

Yes, they are, including all drug interaction checking which remains fully functional while off line. Any orders for scripts, labs, diagnostics, or anything else, can be created offline and then processed when the computer is back in network range. So the script or order will be ‘staged’ and ready to go. It’s just like when you write an email when your offline, then when you get in range, the emails in your outbox just go.

The other question I have is how the records deal with multiple people modifying the record in a disconnected mode. What if the nurse accesses the record and documents something and then the doctor gets in and document something. Does the record get reconciled once it’s reconnected?

Yes indeed it does.

Are there every any issues that have to be reconciled manually?

There is a “collision” report. These “collisions” are rare but we do accommodate them very well. If a Replication “save” conflict occurs, a message will be sent to the user group that is defined to be notified. Replication conflict messages contain details of the conflict and the name of the associated patient if applicable.

The next time I see Aprima at a conference, I plan to check out this feature first hand. Reconciling a patient record that two people are editing can get pretty complex. I’d like to see how it handles it. Plus, I’d love to see how well it does at resyncing the data after being offline for a while. Not to mention how well it does at identifying the patient info it should have stored locally.

This is a really challenging feature to implement. I think it says something about Aprima that they took it on. If it works well, I know there are a lot of doctors that would love this feature in their EHR.

August 29, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Allscripts MyWay to Allscripts Pro Migration

We’ve been tracking the major news that Allscripts was discontinuing MyWay since the news first came out. One of the major questions I had was how the VARs were going to react to the news. Aprima has made a big case for MyWay users to go with them and they have a pretty compelling case to make.

I got an email that a VAR sent out to its users that makes a pretty compelling case for Aprima versus Allscripts Pro. I copied part of the email below. When you look at the list of items that won’t be moved from Myway to Allscripts Pro, I think my prediction that few users will make that transition is ever more solid. Although, the question still remains how many will go with Aprima versus some other EHR. If Aprima does a solid job with the VARs, then it could be a really big win for them.

Here’s part of the email the VAR sent:

Aprima’s Upgrade Program Gives You…

  • Free Aprima licenses for Allscripts customers whose product is being migrated – no need to re-buy software!
  • Same core product – the Allscripts product being migrated started as Aprima 2008
  • Same look and feel with nearly 1,000 enhancements
  • Minimal learning curve of new features, minimal to no downtime
  • Your existing data intact; this is a proven product upgrade, not a conversion
  • Live webinars and on-site training available
  • Ongoing upgrades and development of the product, no end of life sun setting
  • Product will meet Meaningful Use and support ICD10
  • Support is U.S.-based

It is important to note with the migration to Allscripts PRO, data will be exported from one system into another and not all data will come across during this process.  MyWay and PRO are very different.  As a result, you will need to be retrained on the new system and create new workflows. Most significantly, none of the financial data will be included, so you will be left with running down old balances in MyWay while setting up the new PRO PM. See below for a list of data points that will not be migrated:

  • Financial Transaction Data
  • Financial History, Superbills, Payment, and Adjustment transaction detail will not be migrated into the Allscripts PM system.
  • Allscripts MyWay clients will continue to use their current system to work down their previous Accounts Receivable for a period of time.
  • Current Patient account-forward financial balances in Allscripts MyWay will not be migrated to Allscripts PM.
  • PM reporting details and history will not be migrated from Allscripts MyWay into the Allscripts PM system.
  • Practice management reports will be replaced by the Allscripts PM reporting capabilities.
  • Insurance claim status and reimbursement history will not be migrated from Allscripts MyWay into Allscripts PM.
  • The Integrated Easy Pay credit card processing feature in Allscripts MyWay is not compatible with Allscripts PM and will not be migrated. Clients can use the Intuit Pay Page functionality in Allscripts PM or use a non-integrated credit card solution for credit card processing.
  • Allscripts MyWay Audit Trail detail will not be migrated into Allscripts PM.
  • Will require retraining for you and your staff
  • Will require additional data conversion
  • Online training + potential weekend time if you want live, hands-on sessions
  • Possible reduced patient load during transition
November 26, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Allscripts and Aprima Settle MyWay Lawsuit

Many of you will have read my post talking about the news that Allscripts was discontinuing development of their MyWay EHR product. It was very big news because so many had adopted the MyWay EHR and so many Vars were affected by the decision. Aprima saw it as a great opportunity to “rescue” MyWay EHR users since Aprima (formerly iMedica) created the MyWay software in the first place and then licensed it to Allscripts. Although, they retained rights to the software as well and with that they changed iMedica to what is now known as Aprima.

With this history it made a lot of sense for Aprima to offer Allscripts MyWay EHR users an alternative. In fact, I think you can make a great argument for why MyWay users could more easily transfer to Aprima than any other Allscripts EHR product. Although, considering the dissatisfaction I saw from MyWay users, I expect many will be looking for a complete EHR change. I’m sure Aprima would argue that their almost 1000 enhancements make it a much better product than what current MyWay users have been given.

Regardless of the choice that current MyWay users make, Allscripts didn’t take kindly to the nature of Aprima’s marketing when the news of MyWay’s condition was announced and so Allscripts filed a lawsuit against Aprima.

I just received a copy of a press release from Aprima stating that Aprima and Allscripts have reached a settlement in the lawsuit that Allscripts filed. You can see the press release below.

If you’re a MyWay user or MyWay Var, I’d love to hear your perspectives, plans, and thoughts. Feel free to leave them in the comments or privately on our EMR Thoughts contact page.

Settlement reached ON ALL LEGAL MATTERS and the Aprima Rescue PlanTM remains in place for customers of Allscripts MyWayTM.

Dallas, TX (November 8, 2012) – Aprima Medical Software announced today that it has reached a mutually agreeable settlement in the lawsuit brought on October 19, 2012 by Allscripts Healthcare Solutions, LLC. In that lawsuit, Allscripts alleged that some of Aprima’s advertising copy violated various state and federal laws. The parties reached an amicable resolution and will continue pursuing their respective business goals. Under the settlement terms, Aprima has modified some of the advertising copy associated with its Aprima Rescue Plan™ for those who currently use the Allscripts MyWay™ product, and who may be looking to replace that product in light of Allscripts’ October 3 announcement about its future.

Allscripts MyWayTM is the EHR product offered by Allscripts that it has opted not to develop or update to be in compliance with government incentives and requirements such as Meaningful Use and ICD-10.

The Aprima Rescue PlanTM remains in place for customers of Allscripts MyWayTM. Many believe this program – and Aprima’s EHR and PM products – to be the most practical and viable option for providers, since the original Allscripts MyWay™ application was based on the source code that Allscripts licensed from Aprima in 2008.

Allscripts MyWay™ resellers and customers can maintain and even strengthen their current business relationships. Aprima is offering an easy upgrade for practices that may feel frustrated by Allscripts’ announcement about MyWay™ and anxious – or even outraged – about the prospect of a potentially expensive conversion if they want to demonstrate 5010 and ICD-10 compliance, or qualify for government incentives including Meaningful Use Stage 2, PQRS, e-Prescribing, and others.

Providers who bought Allscripts MyWay™ for a specific reason, such as the unique non-template approach to charting, the speed and ease-of-use, and the adaptive learning feature, are typically averse to having to change to something that is very different.

Aprima Rescue PlanTM for customers of Allscripts MyWayTM includes:
• Free Aprima licenses for each Allscripts MyWayTM license – no need to repurchase software; up to an $8,500 savings per provider
• Similar look and feel; Aprima has made nearly 1,000 enhancements since it licensed the original source code to Allscripts in 2008, including hundreds of substantive improvements to the Practice Management system
• Minimal learning curve, since it is only needed for the new features
Allscripts and Aprima Settle Legal Matters, continued
Aprima is a registered trademark of Aprima Medical Software. All other trademarks are the property of their
respective owners. Allscripts MyWay™ is a product of Allscripts HealthCare Solutions, LLC. Aprima is not affiliated
with Allscripts HealthCare Solutions, LLC. Page 2 of 2
• Minimal downtime compared to what is typical when changing systems and having to re-learn many new workflows
• Existing data remains intact; this is a proven product upgrade, not a conversion
• U.S.-based support

Aprima is pleased to be able to offer a lifeline to these users for minimal cost and with virtually no downtime. This will circumvent the need for Allscripts MyWayTM users to switch to another Allscripts EMR product, which would require a change in systems, plus a potentially arduous data conversion and retraining period, thus creating additional mental, physical and financial disruption to the practice.

“Ironically, Allscripts MyWayTM users can avoid such a potentially expensive and disruptive situation by switching to Aprima instead of another Allscripts product. We welcome these customers to the Aprima family and we are thrilled to be able to easily upgrade our ‘cousins’ to the Aprima way,” said Aprima president and CEO Michael Nissenbaum. “The difference between a conversion and a simple and proven upgrade can also make the difference on whether practices will achieve compliance on important healthcare initiatives. We are very pleased with the outcome of this legal situation.”

More Information
For more information, or to sign up for the Aprima Rescue PlanTM for customers of Allscripts MyWayTM, visit www.aprima.com/rescue, call 866-960-6890, option 7, or email rescue@aprima.com.
About Aprima Medical Software, Inc.

Aprima provides innovative electronic health record, practice management and revenue cycle management solutions for medical practices. The Aprima EHR/PM is an integrated system built on a single database. Aprima uses a fast, flexible design that adapts automatically to a physician’s workflow and sets the benchmark for ease-of-use, speed and flexibility. Aprima is one of the few companies with a 14-year track record of success, including CCHIT Certification consistently every year as well as ONC Certification for 2011/2012. Thousands of Aprima users are benefiting from improved quality of care, improved patient satisfaction, improved quality of life and an improved bottom line. Based in Carrollton, TX, Aprima performs all development, support, and implementation from the U.S. To learn more about how Aprima can help your practice, please visit www.aprima.com, call us at 866-960-6890, option 7, or email us at info@aprima.com.

# # # #

Contact:
Judy Friedman jfriedman@aprima.com (214) 466-8093

November 8, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Allscripts to Discontinue MyWay EHR

The rumblings are starting to get more and more solid about Allscripts plans to discontinue MyWay. It seems they’ve started by informing their VARs and that’s where the word has gotten out most. Allscripts hasn’t quite said that they’ll be sunsetting MyWay, but the writing is on the wall.

One person I talked to about this said that the fact that Allscripts discontinuing MyWay wasn’t much of a surprise considering what a terrible product it’s been. The term he used most often to describe the product was “buggy.” This wasn’t surprising to me since one of my most discussed posts was one on Evaluating Allscripts EMR which I wrote on my EMR & EHR website.

It seems that Allscripts plan is to discontinue MyWay and try and move those users to Allscripts Professional. The migration of the data seems like it will be free, but it doesn’t seem that Allscripts has yet indicated whether they’ll tack on an extra fee for the more expensive Allscripts Pro product.

I was told that Allscripts did say that they’d be incorporating the best features of MyWay into Allscripts Professional. The person I talked to about this laughed a bit since there were very few features in MyWay that users loved. He assumed that it HAD to be referencing the Full Note composer in MyWay which he said providers seemed to like for documenting the clinical side of things.

I’ve also heard a rumor that Allscripts might be looking for a way to do the Allscripts professional training through some sort of online means. Considering the complexity of Allscripts pro and the configuration and training required to make it functional and workable, this seems like a failed strategy to me. We’ll see how this plays out since I’m sure Allscripts is still defining this strategy.

Of course, the VARs that are supporting all the MyWay implementations will be scrambling with their own plan. I expect many of them won’t be happy with the idea of switching from MyWay to Allscripts professional and will consider other EHR. The obvious option is Aprima since they created the original MyWay and then forked the project to create their current Aprima EHR offering.

I’m told that Aprima has totally redone the PM side of their Aprima EHR which is a good thing since many weren’t satisfied with the PM in MyWay. It certainly makes a lot of sense for Allscripts MyWay VARs to consider Aprima since it will provide a similar user experience for their users and I have little doubt that Aprima will be able to port the data out of MyWay and into Aprima. My only question is if that’s the right move. Should you move to Aprima because it’s an easy transition or should a Var instead search to find the best EHR out there (which could be Aprima in the end anyway, I’ll leave that judgement to others)?

No doubt many of the other EHR vendors out there are going to look at this as a great opportunity for them as well. I’d be interested to learn more about Allscripts MyWay technology structure and how well the data can be ported to another EHR.

It must be an interesting time at Allscripts with this happening along with talks of Allscripts considering a sell out to a Private Equity Buyer.

UPDATE: Aprima sent out the following offering for Allscripts MyWay users.

PLEASE NOTE: In some earlier communications, Aprima had used the word ‘ABANDON’ to describe Allscript’s approach to its MyWay customers. Instead of using the language ‘ABANDON,’ what we should have said is that it is no longer developing or updating the MyWay product, including compliance for government incentives and requirements such as Meaningful Use and ICD-10. We apologize for any confusion.

APRIMA OFFERS LIFELINE TO ABANDONED MYWAY CUSTOMERS

According to Allscripts, the MyWay product will not be enhanced to meet Stage 2 Meaningful Use and customers are being told they will need to convert to an alternative Allscripts product starting in January 2013. There is an announcement posted at this link: http://blog.allscripts.com/2012/10/05/evolving-industry-evolving-ehrs/.

However, that is not the only option MyWay customers have. You may not be aware that MyWay is based on Aprima’s PRM 2008 version. Since that time, Aprima has made almost 1,000 enhancements to the product!

With the Allscripts announcement to discontinue development efforts on MyWay, and force a conversion to another product, the time and effort required of a practice will be enormous. The lost productivity of converting could negatively impact the practice for many months if not a year.

Providers are not “stuck;” they have the opportunity to UPGRADE to Aprima.

Aprima will not charge a license fee to any MyWay customers who sign a maintenance and support agreement. You may continue to work with your existing MyWay reseller (requires the reseller to become an Aprima Reseller), and your data will migrate as part of the UPGRADE. Training is limited to only learning the new features so there is virtually no downtime.

Aprima has successfully UPGRADED MyWay customers with no data loss – there is no conversion required. (Small UPGRADE labor fee required per database.)

Please contact Aprima at mywayrescue@aprima.com or your current reseller for more information.

I also got this message from Allscripts about their decision to end MyWay EHR:

It’s no secret that the healthcare IT market is changing rapidly. To enable our clients to succeed, we must change as well. That’s why, to better meet the needs of small and mid-sized practices, we are providing a free upgrade from Allscripts MyWay to a new converged platform that leverages the Professional Suite.

This upgrade better equips our clients to meet increasing regulatory pressures and shifting payment models to value-based care. And, by focusing our investment on a single EHR for this market, we can deliver innovations faster. Innovations like Allscripts Wand™, our native iPad solution, which is getting rave reviews from clients. Over time, we will deliver a converged clinical platform that delivers the best of both solutions.

We based this decision on client input on prioritization of new features and functionality. The upgrade will immediately deliver key benefits of our converged platform:
• Powerful Practice Management
• Robust Analytics
• Community Connectivity, and
• Anytime, Anywhere Mobile Access.
We’re working closely with our clients to deliver a simple upgrade process that included advanced toolkits, pre-built templates, and customized training. We’re confident this move will enable our clients to succeed in the ever-changing healthcare industry.

October 5, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.