In 2013 the company was said to be valued at $700M[3] and in 2014, Practice Fusion was the largest cloud-based electronic health record (EHR) platform for doctors and patients,.[4] Practice Fusion is used by more than 112,000 monthly active healthcare professionals with over 100 million patient records under management. In 2014, Practice Fusion's EHR facilitated over 56 million patient visits (approximately 6% of all ambulatory visits in the US) and was the fastest growing EHR in the US.[4]
In 2015, Howard left the company[5] and Tom Langan became interim CEO.[6][7] Under Langan's leadership, the company contributed to the opioid epidemic in the United States by engaging in a kickback scheme to increase the volume of opioid prescriptions amidst its clients and their respective patients.[8] The company has been charged a $145 million fine, the largest criminal fine in Vermont's history.[8] According to Bloomberg: "Practice Fusion admitted to the scheme with an unnamed opioid maker, though the details of the government case closely match a public research partnership between Practice Fusion and Purdue Pharma Inc., which makes OxyContin".[9] In June 2018 the company transitioned over to a paid subscription based system.[10] Practice Fusion is available to users in the USA only.
History
Practice Fusion is an electronic health record (EHR) company, founded in 2005 by Ryan Howard, Alan Wong, Jonathan Malek, and Matthew Douglass.[11] The first version of the product was launched in 2007 and initially gained little traction in the tough economy.[12]
The company began to grow in 2009, when the EHR and customer support were made free of charge.[13] In May 2009, Band of Angels and Felicis Ventures became the first major investors in the company, followed by Salesforce.com in June, Morgenthaler Ventures in December 2010,[13][14] and Founders Fund in April 2011.[13] The company closed a $70 million Series D round of financing led by Kleiner Perkins Caufield & Byers in September 2013, followed by a $15 million Series D extension in December 2013 led by Qualcomm Ventures, bringing total funding to date to $149 million.[15]
In June 2011, the product achieved Office of the National Coordinator for Health Information Technology Meaningful Use Certification.[16] From 2011 to 2013, it was named the No. 1 EMR for customer satisfaction among primary care providers in addition to being named No. 1 for e-prescribing client satisfaction and helping doctors achieve Meaningful Use by Brown-Wilson's Black Book Rankings.[17][18] In September 2013, KLAS Reports named it the No. 1 EHR system for value among ambulatory professionals.[19]
In 2013, a State of the Small Practice survey conducted by Practice Fusion indicated that 36 percent of providers were using three- to six-year-old computers. In response, the company launched a "Free EHR + Free Laptop" campaign in 2014. The campaign supplied a complimentary Google Chromebook to new physician users of Practice Fusion's EHR platform to increase incentive.[citation needed]
In 2015, Howard left the company[5] and Practice Fusion was starting to look for a buyer. In 2016, an IPO valued the company at up to $1.5 billion.[20]
In the fall of 2016, under Tom Langan's leadership,[6] the company accepted remuneration from a "major" manufacturer of opioids, referred to as "Pharma Co. X" in exchange for clinical decision support, to prompt doctors to take certain clinical actions in order to increase prescriptions of extended-release opioids.[21]
However, in 2018 Practice Fusion was sold to Allscripts for only $100 million. While its ordinary 200 employees and common stockholders made no profit or lost money, managers, including Tom Langan, Jonathan Malek, Matthew Douglass, Rich Loomis, Stephen Byrnes, Riyad Omar, Stacey Rubin, Derek Tan, and Eric Weis,[22] made millions in profit from a pre-arranged carve-out.[20]
In January 2020, the company (as a subsidiary of Allscripts) admitted in court to have accepted $1 million in kickbacks by "Pharma Co. X" in return for a deferred prosecution agreement.[8] Practice Fusion was fined $145 million for the misconduct by the Department of Justice for the District of Vermont.[23] In the DOJ investigation, Langan and Loomis are identified as the primary operates in the scheme.[21]
Subsequently, Howard published, "How to Prevent Your Company from Being Used for Evil From a Founder Who's Been There,"[24] and has become an advocate to other founders to help them prevent their companies from being corrupted and being used for evil.[citation needed]
Services
The Software as a service startup has been providing physicians and medical professionals with advertising-supported electronic health records and medical practice management technology[25] which included charting, scheduling, e-prescribing (eRx),[26]medical billing,[27] laboratory and imaging center integrations,[28] referral letters, Meaningful Use certification,[16] training, support and a personal health record for patients.[29]
Products (2013)
Practice Fusion: Web-based electronic health record (EHR) software for physicians and medical professionals. The EHR system includes medical charting, e-prescribing, clinical decision support advisories, online booking and scheduling, online referrals and messaging. Its lab, imaging, and billing modules integrate with a network of third-party laboratories, medical imaging centers and medical billing services. Free support is available for EHR setup and usage; Meaningful Use, PQRS, and ICD-10 incentives; and technical issues. All offerings are HIPAA-compliant.[citation needed]
Patient Fusion: Personal health record (PHR) system that gives patients access to their prescriptions, diagnoses and test results. Records update as physicians adds information to their patients’ charts. Consumers can search physicians by location and specialty, and request an appointment online.[30]
Insight by Practice Fusion: An analytic product based on the Practice Fusion dataset of 81 million patient records. Real-time data provides perspective on clinical trends[31] and helps with population health management and clinical decision support.[citation needed]
An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.
Medical practice management software (PMS) is a category of healthcare software that deals with the day-to-day operations of a medical practice including veterinarians. Such software frequently allows users to capture patient demographics, schedule appointments, maintain lists of insurance payors, perform billing tasks, and generate reports.
OpenEMR is a medical practice management software which also supports Electronic Medical Records (EMR). It is ONC Complete Ambulatory EHR certified and features fully integrated electronic medical records, practice management for a medical practice, scheduling, and electronic billing.
Epic Systems Corporation is an American privately held healthcare software company. According to the company, hospitals that use its software held medical records of 78% of patients in the United States and over 3% of patients worldwide in 2022.
First Databank (FDB) is a major provider of drug and medical device databases that help inform healthcare professionals to make decisions. FDB partners with information system developers to deliver useful medication- and medical device-related information to clinicians, business associates, and patients. FDB is part of Hearst and the Hearst Health network.
Patient portals are healthcare-related online applications that allow patients to interact and communicate with their healthcare providers, such as physicians and hospitals. Typically, portal services are available on the Internet at all hours of the day and night. Some patient portal applications exist as stand-alone web sites and sell their services to healthcare providers. Other portal applications are integrated into the existing web site of a healthcare provider. Still others are modules added onto an existing electronic medical record (EMR) system. What all of these services share is the ability of patients to interact with their medical information via the Internet. Currently, the lines between an EMR, a personal health record, and a patient portal are blurring. For example, Intuit Health and Microsoft HealthVault describe themselves as personal health records (PHRs), but they can interface with EMRs and communicate through the Continuity of Care Record standard, displaying patient data on the Internet so it can be viewed through a patient portal.
Health information technology (HIT) is health technology, particularly information technology, applied to health and health care. It supports health information management across computerized systems and the secure exchange of health information between consumers, providers, payers, and quality monitors. Based on a 2008 report on a small series of studies conducted at four sites that provide ambulatory care – three U.S. medical centers and one in the Netherlands, the use of electronic health records (EHRs) was viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system.
Athenahealth is a private American company that provides network-enabled services for healthcare and point-of-care mobile apps in the United States.
Electronic prescription is the computer-based electronic generation, transmission, and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, physician assistant, pharmacist, or nurse practitioner to use digital prescription software to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient's team of healthcare providers to facilitate knowledgeable decision making.
The MediNotes Corporation was a private, independent software vendor (ISV) based in West Des Moines, Iowa. They manufactured and published, maintained, and supported an Electronic Medical Records solution called MediNotes e. MediNotes was featured in Inc. Magazine as part of the Inc. 500 list in 2005 and 2006, and as part of the Inc. 5000 list in 2007.
DrChrono is an American digital health technology company that provides software and billing services on a platform of web apps and cloud-based apps for doctors and patients. The company makes electronic health records (EHR), practice management software, and medical billing software and provides medical revenue cycle management (RCM) services. The company is based in Sunnyvale, California.
InterSystems Corporation is a privately held vendor of software systems and technology for high-performance database management, rapid application development, integration, and healthcare information systems. The vendor's products include InterSystems IRIS Data Platform, Caché Database Management System, the InterSystems Ensemble integration platform, the HealthShare healthcare informatics platform and TrakCare healthcare information system, which is sold outside the United States.
NextGen Healthcare, Inc. is an American software and services company headquartered in Atlanta, Georgia. The company develops and sells electronic health record (EHR) software and practice management systems to the healthcare industry. NextGen Healthcare also provides population health, financial management, and clinical solutions for medical and dental practices. On September 7, 2018, Quality Systems, Inc. changed its name to NextGen Healthcare, Inc. and on September 10, their stock ticker symbol changed to NASDAQ: NXGN.
Veradigm is a publicly traded American company that provides physician practices, hospitals, and other healthcare providers with practice management and electronic health record (EHR) technology. Veradigm also provides products for patient engagement and care coordination, as well as financial and analytics technology. The company has more than 180,000 physician users and has products in 2,700 hospitals and 13,000 extended care organizations. The company formally changed its name from Allscripts to Veradigm in January 2023.
Nightingale Informatix Corporation, commonly abbreviated as Nightingale, is a public company headquartered in Markham, Ontario, Canada with offices in Rancho Cordova, California, Cambridge, Ontario, Kansas City, Missouri, Pembroke, Massachusetts, and Wexford, Pennsylvania. Nightingale provides products and services that support physicians, allied healthcare practitioners, hospitals and other healthcare organizations with their clinical and operational requirements. Nightingale provides EHR and Practice Management services, as well as a Patient Portal, Revenue Cycle Management and Medical transcription services to solo physicians, group practices and large clinics across the United States and Canada. The EMR/ EHR by Nightingale is a web-based program and is hosted in a secure ASP environment.
The Health Information Technology for Economic and Clinical Health Act, abbreviated the HITECH Act, was enacted under Title XIII of the American Recovery and Reinvestment Act of 2009. Under the HITECH Act, the United States Department of Health and Human Services resolved to spend $25.9 billion to promote and expand the adoption of health information technology. The Washington Post reported the inclusion of "as much as $36.5 billion in spending to create a nationwide network of electronic health records." At the time it was enacted, it was considered "the most important piece of health care legislation to be passed in the last 20 to 30 years" and the "foundation for health care reform."
The adoption of electronic medical records refers to the recent shift from paper-based medical records to electronic health records (EHRs) in hospitals. The move to electronic medical records is becoming increasingly prevalent in health care delivery systems in the United States, with more than 80% of hospitals adopting some form of EHR system by November 2017.
Greenway Health, LLC is a privately-owned vendor of health information technology (HIT) including integrated electronic health record (EHR), practice management, and revenue cycle management solutions. Intergy, Greenway’s cloud-based EHR and practice management solution, serves ambulatory healthcare practices. The company has offices in Tampa, Florida; Carrollton, Georgia; and Bangalore, India.
Federal and state governments, insurance companies and other large medical institutions are heavily promoting the adoption of electronic health records. The US Congress included a formula of both incentives and penalties for EMR/EHR adoption versus continued use of paper records as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the, American Recovery and Reinvestment Act of 2009.
RXNT is an American privately held healthcare software technology company. The company provides ambulatory practices, hospitals, medical billers, and other healthcare professionals with digital health tools. The company was created in 1999, as a standalone e-prescribing system.
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