Though services are technically free, Practice Fusion does charge a nominal $50 a month ongoing support fee. Howard points out itís still the lowest total cost of ownership of any available solution on the marketplace, including open source.

Practice fusion subsidizes its free EMRs by selling de-identified data to insurance groups, clinical researchers and pharmaceutical companies and by placing medically relevant ads within the EMRs, Howard said.

The secondary use of de-identified data has drawn increasing ire from privacy activists who claim patients are unaware of the use of their data. In its November meeting, leaders of the American Health Information Community, the Department of Health and Human Services' premier healthcare IT advisory panel, called for an in-depth look at how to ensure patient protection in the secondary use of healthcare data.

Howard said he does not expect data-sharing will be a concern to physicians who use Practice Fusion's EMRs.  "Every healthcare vendor is selling data. Everyone has this data, but weíll have more of it and it will be real-time and aggregated," Howard said. "We will be able to help drive the patient community toward better care by providing data on the causes and trends of certain conditions over time."

As far as the security of Practice Fusion's medical records, data stored on Practice Fusion has the level of security equal to online banking, he added.

"The reality is that the data is much safer with us - the level of service we offer is much higher than any practice could put in place themselves without spending hundreds of thousands of dollars and having full-time staff on-site," Howard said.