Electronic health records (EHR) systems are expensive. Really expensive. In fact, there have been reports of these systems causing significant revenue decreases or business interruptions — such as Henry Ford Health System in Michigan reporting that implementing EPIC was a direct cause of their 15 percent net income decline in 2012. Using a free EHR system is a tempting alternative for many independent doctors or small practices. But are there tradeoffs for doctors who use these free systems?

There are several free EHR systems available, including Practice Fusion, Hello Health and Kareo, but their revenue-generating models all differ. Practice Fusion, for instance, has said it relies on advertising to help keep the system free. The physician will see a small ad on the bottom of the screen that might be targeted to what they’ve diagnosed. For instance, click that a patient has allergies, see an ad for Zyrtec. That in itself has brought up data mining/patient privacy concerns, as well as possible HIPAA rule violations — but more on that later.

Hello Health relies on patient contributions to make its EMR free. You heard right — physicians who use Hello Health ask patients to pay for the system, generally anywhere from $36 to $120 annually. This model is actually billed as potentially revenue-building for offices, as doctors get about one-third of the patient’s total investment directly. In return, however, the patient gets access to things other patients who don’t pay for Hello Health don’t get. For instance, online appointment scheduling with blocked out periods of time strictly for Hello Health patients, virtual visits and emailing their doctor directly. It’s more of the concierge model for patients who want to pay for it.

Kareo has given away its EHR for free in the hopes that offices will buy their other products. The company also offers practice management and billing services.  Add their practice management service to your office and you’re looking at $299 per month per provider (plus the free EMR).

The biggest drawback to these free EMR systems seem to be data and security concerns. Kareo for its part has said on its website that they won’t sell the data to third parties, however, the company doesn’t list a fully privacy policy on its website. And both Practice Fusion and Hello Health make no such claims regarding data selling. This has many users and practices asking who owns the patient data in a free EMR, and what is being done with it?

For instance, a recent article focused on Practice Fusion emailing product reviews directly to the patient with the doctors’ name on the email – making it seem the email came directly from the doctor, when many had no idea this was happening.  And Hello Health’s privacy policy also says that the data they collect can be used to send customers product news, send surveys or collected for research purposes (they do say the data is “anonymized” prior to being sent).  Many have suggested that the real revenue stream for these free EMRs will be the selling of patient data to drug companies, researchers and others.

So while zero dollars is a cost most practices can live with, the real question is what is the true cost of these “free” systems?

Elizabeth Hipp is social media director, Transcription Outsourcing, LLC.  She blogs at the Transcription Outsourcing Services Blog.