“The Future of a Radical Price” indeed.

Practice Fusion:

Practice Fusion is an ad-supported product. Practice Fusion’s medical advertising placements are non-intrusive, completely private and never pop-up. If you decide you don’t like the ads, you can switch to an ad-free version for a $100 a month per practitioner at any time.

42 USC § 1320d-6 (b)(3)

if the offense is committed with intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm, be fined not more than $250,000, imprisoned not more than 10 years, or both.

Scope of Criminal Enforcement Under 42 U.S.C. § 1320d-6

For the foregoing reasons, we conclude that covered entities and those persons rendered accountable by general principles of corporate criminal liability may be prosecuted directly under 42 U.S.C. § 1320d-6 and that the “knowingly” element of the offense set forth in that provision requires only proof of knowledge of the facts that constitute the offense.

New HITECH Enforcement: Effective 17 February 2010

111 H.R. 1 § 13404. Application of Privacy Provisions and Penalties to Business Associates of Covered Entities

(b) …shall apply to a business associate described in subsection (a), with respect to compliance with such subsection, in the same manner that such section applies to a covered entity, with respect to compliance with the standards…

(c) In the case of a business associate that violates any provision of subsection (a) or (b), the provisions of sections 1176 and 1177 of the Social Security Act (42 U.S.C. 1320d-5, 1320d-6) shall apply to the business associate with respect to such violation in the same manner as such provisions apply to a person who violates a provision of part C of title XI of such Act.

111 H.R. 1 § 13410. Improved Enforcement

(d) Enforcement by State Attorneys General

…in any case in which the attorney general of a State has reason to believe that an interest of one or more of the residents of that State has been or is threatened or adversely affected by any person who violates a provision of this part, the attorney general of the State, as parens patriae, may bring a civil action on behalf of such residents of the State in a district court of the United States of appropriate jurisdiction

111 H.R. 1 § 13411 Audits.

The Secretary shall provide for periodic audits to ensure that covered entities and business associates that are subject to the requirements of this subtitle and subparts C and E of part 164 of title 45, Code of Federal Regulations, as such provisions are in effect as of the date of enactment of this Act, comply with such requirements.

Template Letter to Medical Providers

[Medical Provider] has contracted with third party Practice Fusion to disclose Protected Health Information (PHI) for commercial advantages including medically relevant advertising, marketing, and research in exchange for free telecommunication and Health Information Technology (HIT) services including Electronic Medical Record (EMR) search, storage, and transmission. This contractual agreement cannot be reconciled with federal law and PHI policy which forbids such a disclosure by a covered entity and its business associates. This violation is subject to federal civil penalty as per 42 USC § 1320d-5.

The witnessed receipt of this message satisfies the discovery of noncompliance as specified in 42 USC § 1320d-5(b). The law provides that you 30 days to comply without imposed penalty on the first date the person liable for the penalty knew that the failure to comply occurred.

Statement of Non Retaliation

This publication is federally protected. 45 CFR § 160.316

A covered entity may not threaten, intimidate, coerce, harass,discriminate against, or take any other retaliatory action against anyindividual or other person for … (c) Opposing any act or practice made unlawful by this subchapter provided the individual or person has a good faith belief that the practice opposed is unlawful, and the manner of opposition is reasonable and does not involve a disclosure of protected health information

Commentary

“The highest return on your investment because Practice Fusion is free.”

The biggest unexpected expenses for small medical providers are legal compliance and forced obligations to vendors providing services beyond the technical sophistication of  local staff. I disagree that Practice Fusion “is the highest return on your investment” because it’s illegal and that’s expensive.

It’s also a bad idea.

Example: Greenwich Hospital spent $225 million for an electronic systems upgrade this year, and Greenwich Hospital is already one of the most technologically sophisticated hospitals in the nation. How does the return on Greenwich Hospital’s $225 million investment compete with Practice Fusion when Practice Fusion is free? Know: Regionally-aggregated Protected Health Information is the most valuable information in the world. It is the most complete demographic information of all people. It includes life history financial details rivaled by the IRS. It is professionally audited by medical doctors, government agencies, and health institutions from birth until death.

$225 million is value difference between sharing control and keeping control of Protected Health Information —per hospital.

Protected Health Information so valuable that the federal government makes it a Class D Felony to disclose it unless absolutely necessary.

And companies like Practice Fusion —and their advertisers— want all that Protected Health Information in exchange for “free use” of software that’s about a $300k and 6 months of software contract in Adobe Flex to build yourself.

As proudly published by Practice Fusion, as featured in Wired Magazine, as announced on Practice Fusion’s blog —Practice Fusion’s Intent:

Sell access to your data.

Aside: Today, a CTO of a start up company that I like asked me what I thought of Practice Fusion. Answer:

The first rule of healthcare is that you do not disclose healthcare. The second rule of healthcare is that everybody is stupid. That’s why healthcare is 1/6 of the national economy. Everybody is just too stupid to illegally sell their business for $100 to internet advertisers. They’re too busy earning 8% on gross revenue sending faxes.