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“You get what you pay for.” Such advice, so commonplace, hardly seems fitting on a health technology website, where sophisticated topics such as predictive analytics and cross-platform connectivity hold sway. Yet even here, this sage advice holds true. You get what you pay for.

Why do I bring this up? Too many practices, especially smaller practices, are falling for the ruse of a “free” EHR. But just as freedom isn’t free, neither is a “free” EHR.

What is the cost of a “free” EHR?

Vendors that offer “free” EHRs must recoup their costs. To do so, they may use less-straightforward approaches, such as the following:

  • Online advertising – sponsors may pay for ads that display while you use the EHR
  • Patient pay-to-play – your patients may need to pay for use of key features such as online scheduling
  • Add-ons – while the clinical EHR itself is free, you must pay for additional components to make it an effective solution for your practice1
Not only do you get what you pay for—you or someone else will pay for what you get. Each of these alternative revenue models can pose problems for your practice.

The fringe of privacy

Seeing ads in the context of using an EHR may be disruptive to your work. What’s more, online advertisers commonly mine user data to promote relevant products based on online searches and other trackable information. EHR vendors that rely on advertising revenue may allow data mining to target ads.

For example, when using an advertising-supported EHR to access a patient’s record, you may be shown an ad for a pharmaceutical product indicated to treat that patient’s health condition. To target ads so precisely, the advertiser must mine data that is considered protected health information—a red flag for intrusions on patient privacy and potential HIPAA violations.2

Creating a class system

Asking patients to pay to use online scheduling or other features of your practice’s EHR creates two tiers of patients: paying and non-paying. The system, for example, may allow paying patients preference for prime appointment hours. Patients who can’t afford to pay may feel resentful. Patients who foot the bill may resent it as well. 3

Don’t buy now, but pay later

Once you’ve committed to using a “free” EHR, you may need additional solutions, such as practice management software. If you converted patient records to meet the requirements of the “free” system, you will be more likely to continue to use the same vendor. 

Costs associated with these upgrades are often high, as the revenue from add-ons enables the vendor to compensate for the cost of providing a “free” EHR. Your total cost may be higher compared to using a paid option from the beginning.4

Questions to consider

Here are questions to consider before adopting a “free” EHR:

  • Are there limitations on free usage? Can any number of physicians use the system at the “free” level? 5
  • How much developer time and talent will be required to customize the software to meet your practice needs? Does the required effort match the knowledge and experience of your staff? 6
  • What specialty content is available? Does the system accommodate templates for specialty practices?
  • Will the system be updated to keep up with regulatory changes and support your practice in meeting compliance demands?
  • What is being done to protect the security of patient data? Does an independent third party verify or certify the vendor’s security practices?

Investing in your practice’s future

Your EHR is the technology backbone that supports practice administration. It is essential for providing higher quality and safer care as well as ensuring financial survival and growth. It is worth your time to investigate which EHR is best for you. It is also worth making an investment in the future of your practice.

To put it another way: You can’t afford the price of a “free” EHR.

Learn more about our independent and small practice solutions NextGen Office and NextGen Enterprise.


1,2,3,4 "You Get What You Pay For: Hidden Costs of The Free EMR," Nextech (blog),, May 31, 2017.
5,6 Cathy Reisenwitz. "The Top 7 Free and Open Source EMR Software Products," rel="noopener noreferrer" Capterra (blog),, March 23, 2018.

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Headshot of Robert L. Murray, PhD, MD, FAAFP

Robert Murry, PhD, MD, FAAFP

Chief Medical Officer

Dr. Robert (Bob) Murry joined NextGen Healthcare in July 2012 and was appointed chief medical officer in December 2021. He brings to this position more than 20 years of extensive clinical experience and background in health IT. Previously, Dr. Murry served as the company’s Chief Medical Information Officer (CMIO) since May 2017. During his time as CMIO, he was the "Voice-of-the-Physician" across specialties, product safety, and government/regulatory affairs. Before becoming CMIO, he was the company's vice president of Clinical Product Management, responsible for clinical oversight and workflow design.

Previously, Dr. Murry served as Medical Director for Ambulatory Informatics and CMIO for Hunterdon Medical Center, where he continues to practice family medicine at Hunterdon Family Medicine at Delaware Valley.

He is board certified in Clinical Informatics by the American Board of Preventive Medicine and board certified in Family Medicine by the American Board of Family Medicine. He is also a Fellow of the American Academy of Family Physicians. Dr. Murry holds an MD from The University of Texas Southwestern Medical Center, Dallas; a PhD in Physical Chemistry from Boston College; and an MA in Physical Chemistry from the Massachusetts Institute of Technology.