You all are frightening me to death....

[ecmcdougall]

I've been skulking for a while on this board, looking for an EMR to replace PMSI's Practice Partner garbage.

In all truth, the stuff I'm reading in this forum is giving me an ulcer. I've read about mandatory EMR, government "standards" for EMRs, "carrot and stick" practice standards for Medicare, patient-controlled internet based medical records, on and on and on, and I seriously wonder whether I'll be able to stand practicing for the next 25 years..... does the government seriously think that they'll make things BETTER by interfering? Like HIPPA made things better?

Tell me it'll be all right.....

[BigDoc]

I've been skulking for a while on this board, looking for an EMR to replace PMSI's Practice Partner garbage.
In all truth, the stuff I'm reading in this forum is giving me an ulcer. I've read about mandatory EMR, government "standards" for EMRs, "carrot and stick" practice standards for Medicare, patient-controlled internet based medical records, on and on and on, and I seriously wonder whether I'll be able to stand practicing for the next 25 years..... does the government seriously think that they'll make things BETTER by interfering?

ECMC, welcome to Docsboard, sad but true, if we don't do anything about this mess, someone else will :(

[bioisnonsense]

Tell me it'll be all right.....

there, there...

[patting ECM on head]

And if that doesn't help - there's always ECT.

Or good old fashioned lobotomy!

Don't worry, be happy.


:)

[pprescot]

Good luck. Don't count on the AMA and the other letter groups to intervene. Most have financial connections and political connections that are much more important to them. And decisions like this are generally more political and financial, than reality based. Just cross your fingers and hope it works for the best. HIPPA hasn't. JCAHO hasn't (how many of their rules have actually improved patient safety?).

Sorry, I'm a cynical curmudgeon after 30 years of this c**p. HMOs, insurance companies, big Pharm get what they want. And docs will never group together enough to effectively speak up. We let our "groups" speak for us. Good luck.

[Tim2]

Dr. McDougall, the tighter they squeeze the more sand will slip between their fingers. They focus on things they cannot fix or achieve. Ignore it. Laugh at it. They are not going to approach and fix the problem the way you would That is, if you are a person driven by the motivation to get things done. Most people are not that way. They are mstly motivated by fitting in. Meetings and comittees to fit in; not accomplish.

What is your goal? To help people or to make a living and provide for your family? Helping people is not the goal of the bean counters. Their goal is 5/5 on patient satisfaction surveys. 5/5 is a poor medical objective, because we cannot tell them what they want to hear. Roll your eyes at all of this smoke and mirrors. Try to have a bit of fun; enjoy the scenery a bit along the way.

[Kursk]

Hey the Govt knows they can make it better - VISTA is the proof!

And if that doesn't scare you ....

[Kursk]

I've been skulking for a while on this board, looking for an EMR to replace PMSI's Practice Partner garbage.

Tell me it'll be all right.....

Hey, tell us why Practice Partner is garbage!
How long have you been using it?

[mwarddoc]

I'm aware of some of the concerns with Practice Partner, having looked at it three years ago, and it is a fairly big player in my area. But why are you specifically giving up on it?

They all have problems, just like paper charts.

I use Soapware and have gone paperless, I've had problems, all resolvable.

I had a lot of questions. Recently installed and began running HL7 lab interface and that cost me some personal time to learn and look for glitches. But, 1 month after installation we have things running so smoothly that everyone who had labs done today, at our outside lab, has them downloaded today, straight to the record, reviewed today, signed off today, and comments on labs typed directly onto the report itself...no nurse time involved unless I request a call.

Every six weeks a large locked, 40 gal, cannister of paper is picked up and shredded by docu-shred...this is for one doctor...that would all be in the charts if I had paper.

But, you have to figure out how to apply the EMR to your practice, and that takes a lot of work. I have a system with templates and consent report generator, for giving vaccine, such as the fluvax (I got 160 doses), and it works so well that my nurse never has to look for the lot number, expiration date, write a patient name, or do anything but make a few mouse clicks and give the vaccine. She scans in the consent, and tosses it into the shred pile. But, it took a while to figure out that part.

[Kursk]

Which lab did you interface to?

I find many mislabled lab reports - has this been a problem for you?

How much time does the scanning take?

Have you found any reduction in FTE, more patients/day, increased charges/visit or any of the other purported financial benefits?

Thanks for posting your experience.

[DrWinn]

I've been skulking for a while on this board, looking for an EMR to replace PMSI's Practice Partner garbage.

In all truth, the stuff I'm reading in this forum is giving me an ulcer. I've read about mandatory EMR, government "standards" for EMRs, "carrot and stick" practice standards for Medicare, patient-controlled internet based medical records, on and on and on, and I seriously wonder whether I'll be able to stand practicing for the next 25 years..... does the government seriously think that they'll make things BETTER by interfering? Like HIPPA made things better?

Tell me it'll be all right.....

My magic mirror says that by 2010, EHR technology will be legislated by the government, that payments will be tied to demonstrating that certain quality thresholds have been achieved and that physicians will become increasingly marginalized as physician extenders gain more power and responsibilty. A single payor system is around the corner and independent physicians will have a tough time competing with monolithic, assembly line primary care organizations staffed by technicians with clinical decision support systems. All primary care specialties will be eroded by these less expensive providers (and eventually will die out). Some specialists will see their unique procedures (colonoscopy for instance) taken away from them as government trained procedurists crank out these procedures in assembly line fashion. Physician's will eventually be tracked down and herded into 'Compliance Centers' for reprogramming of their temporal lobes for their non-conformist behaviors....

Oh wait, thats not my mirror, that's my plasma TV playing Logan's Run!! Wait a minute, what is soylent green doing in here? :eek:

[bioisnonsense]

Physician's will eventually be tracked down and herded into 'Compliance Centers' for reprogramming of their temporal lobes for their non-conformist behaviors....

Oh wait, thats not my mirror, that's my plasma TV playing Logan's Run!! Wait a minute, what is soylent green doing in here? :eek:


Soylent green is Doctors.

[Kursk]

Dr. Winn, has such a dystopia occurred in other Western cultures that have gone with a single payor? Wouldn't you expect Canada and England to have implemented your scenario with 'paraprofessionals'?

[DrWinn]

Dr. Winn, has such a dystopia occurred in other Western cultures that have gone with a single payor? Wouldn't you expect Canada and England to have implemented your scenario with 'paraprofessionals'?

Actually, it is EMR technology that I expect will enable paraprofessionals to practice medicine like real doctors. They won't have the intuition and expertise that comes with a medical degree and years of experience, but they will be a whole lot cheaper, and the feds will have a comfort level because of decision support and best practices built into these systems. I believe, assuming we don't blow ourselves up first, that quantum computer technology will become a reality within the next 50 years and computers will become 'intelligent' and be able to practice medicine (or any profession) better than humans. Of course, I expect to be pushing daisies by then. With smart computers, robotics will eventually evolve to handle the fine motor skills of surgeons - but by then the irobot or terminator scenario will play out and we will be the endangered species.
Nah, we'll blow ourselves up before that ever happens. ;)

[Kursk]

Nah, we'll blow ourselves up before that ever happens. ;)

Wow. Having a bad day (month, quarter)?

I see your points, but on my most cynical days I suspect that the govt won't wait for decision support, use just paper forms, enabling the nurse practioners and PAs to practice independently with check box medicine.

Sadly, the budget model has its proponants and it will cover more people with minimal standards. That might even sum up to better population based care, at least for the things we are measuring now.

I have to laugh though when I look back and see all the predictions that consumerism would lead to intelligent 'self care', eliminating a lot of doctor visits.

[DrWinn]

Wow. Having a bad day (month, quarter)?


Uhhhh.... assumimg we (mankind) do not blow ourselves up first.

[ecmcdougall]

Thanks for the replies.... I guess I'll be all right (?).

I don't doubt that Practice Partner is a rare and unusual EMR - it's not a good product. I was thinking of doing a review later, but I'll be happy to give you a bit of a rant here, if you like.

One of the main reasons we're trying to drop Practice Partner is because it's extremely expensive - $14,000/year for license renewals for a 6 doc office. I originally didn't have any say in buying in to PMSI - I was way too junior. I did have a lot of trouble swallowing the $145,000 startup cost, but was told it would come back eventually because of the promised "paperless office" benefits. Unfortunately, Practice Partner doesn't allow you to go paperless; there's no way to store scans of letters, consults, etc, and entering data as you're in with the patient is too slow. So, we're having to use both paper charts and electronic charts together - no savings at all; and the chart is split so you don't know what's going on without both together.

Other promised "features" never materialized; there's no help at all with ICD-9 coding, no help with E&M levels, no way to search the charts for specific diagnoses or drugs, so you can't find out who was prescribed (eg. Vioxx...). There's no way to set an alert to remind you of a missed A1C or INR, either.

Otherwise, Practice Partner is no better than anything out there, as far as I can tell; in some ways a lot worse - stability has been a big problem. It's not in any way customizable; the so-called "templates" were abandoned as unusable - we cut 'n paste soap notes from Viavoice or Dragon now. PMSI has been terrible - they bilked a $30,000 fee out of us last year for an "upgrade" that actually didn't do anything at all, and caused even more stability issues that have continued to this day. We've been paying extra for independant tech support to keep the system running - to the tune of $15,000 yearly.

The stuff that I like - the prescription writer, the drug interaction checker (that we have to pay again for every 3 months), and the lab interface - are all available elsewhere, with better features, and for a lot less money.

So, to summarize, we feel like we've been shafted. We pay $145K up front and $30K yearly; we get no office cost savings, no increase in efficiency with patient flow, no improvement in record keeping, and no support from the company. Practice Partner is about milking us for as much money as possible; it's not a complete EMR solution, and PMSI has no interest in improving their product at all. I'm a bit astounded that we were fooled so completely in the first place, but at that time, apparently, very few EMR's were actually advertising their existence and we only had a handful that we were aware of to pick from.

Anyways, that's my rant. If you want to know more, I'd be happy to answer questions; I hope you understand I'm not exactly a fan of the product, though.... I'm going to test-drive a couple of other EMR's, probably starting with Amazing Charts, Soapware, Chart Logic, etc. I'm a bit more senior now and I have a bit of say. I'm certainly not going to allow another PMSI into the office....


ECM

[Kursk]

Thanks for the cogent reply. Great analysis, damning report on PMSI. I bet few EMRs would be brave enough to stand behind their claims of savings with an 'enterprise partnership' arrangement where they live off the cost savings they provide to your practice!

Ouch!!

[Surgeon]

Wow, that was brutally frank. Thanks for the information, learning other peoples problems always gives you insights to your own advantages. I must say that most of the problems you mentioned do not exist with chart logic, scanning in is done by my office, but their not complaining so I assume its going pretty smoothly. I have no charts, my 'super-bill' is a computerized sub-section select list within the chart that is done with relative ease(mostly voice recognition) at the time the chart is done. We do use one piece of paper to retain information between patient face time and computerized chart time, but this is discarded immediately afterwards, so there is no developed dependence on any piece of paper. I've been using this since starting practice, so I don't have much comparison, but I can say that no-one in my office spends a single minute looking for a chart, which I consider to be a substantial savings in man-hours. My biggest complaint is the documentation sucks, so I always get the feeling this program would do a great more for me if I understood it better, patient education info, pictures, etc. I'm still working on that aspect, using it to the fullest. The cost was no where near the type of numbers you describe, although of course its only for one practicioner

[pprescot]

Unfortunately, until you've actually used an EMR it's very difficult to know what to look for. There are so many facits to medical practice, so many different documents/records, needed searches, etc. that I have yet to see a product successfully do them all. Then you get to the Windows GUI - let's see, 3 or 4 or 5 or 6 or more mouse clicks to enter one or two things, then the same number of clicks back out (at least in the ones I have used). What searches can be run often produce many irrelevant results. And then there are yearly coding changes, mandated filing formats, etc. Good luck keeping up with an ever changing system, or security, and heaven help you if you don't backup - backup - backup. (How many use RAID 0 and think that's sufficient?)

I'm not against the concept of EMR, just all the present implementations I've seen so far. The KISS principle has been forgotten and Murphy's law will prevail. Maybe sometime in the future it will be better, but now it's a stop gap for too many, and a lousy one at that.

[pprescot]

And I forgot to mention the point Surgeon brought up. The learning curve. Programs are written by programmers with little/no understanding of process, only coding. For a population that to large extent never figured out how to set a VCR clock, good luck again. And so many times the manuals appear to have been written in Chinese (or computer geek) and roughly translated to English.

KISS.

[Surgeon]

The thing anyone not familiar with computers or EMR's doesn't realize is that switching from the mouse to the keyboard becomes incredibly time consuming when projected over the number of times you need to perform your routine operations. As a person who types I'd rather have it all keyboard based, although it takes a little longer to learn the keystrokes, it is markedly faster.

[mwarddoc]

I interfaced to Olympia Medical Laboratories via PacLab which is the "report delivery" vehicle, also known as PAML.

No mislabeled reports.

I do have to "map" patients periodically.

As for FTE's, I started with the emr and cannot quote reduction of FTE. However, I've practiced in a large number of settings and I expect to never need more than 2.0 FTE's in the office based on my currrent practice, outsourced billing, remote transcription, and practice style. I run a slow, geriatric practice, with sick patients, we handle large volumes of incoming faxes and documentation, and labs. My staff probably have a good 30% "underwork" at this time.

Scanning is less time consuming than paper filing in charts, by a large degree. Single page documents take around 1 minute, from starting the process with paper in hand to refile of the electronic chart. Multipage documents take practically the same amount of time. However, the chart is still available to everyone, we don't have to look for it. By comparison, two local docs that I know use PP and do scan to OCR for incoming letters, they have a full time filing clerk doing scanning and OCR. I deal with images, not OCR.

Increased charges, and reimbursement, for notes is a fallacy and, in my view, a way of falsifying documentation. I could use Soapware as a note generator, instead of a true EMR, and create long notes with report generator for each visit making it look like I did a lot more with ROS, PMHx, etc. I know of docs using their EMR just this way and their notes coming in to me SUCK and are basically worthless reprints of data that they personally did not deal with.

You either spend the time, or don't, and taking a history is not a high school graduate's job, that is a docs job in geriatric's.

I get outside notes that say

Medications: (Believed to Be) followed by a list of names without doses or frequency...from GI and Cardiology docs.

Hey, I look at the damn bottles.

I also was deposed last year, and my ex practice associates exams for years were a series of checkmarks in "normal" for entire systems, and occasionally a line drawn down a page through all the normals. They settled, I got dropped out, but the documentation sucked and everyone who reviewed it knew it.

[Surgeon]

I always like that pride in medicine thing. I have in-office billing, coding, Voice recognition dictation, and just hired my second FTE, with my nurse being part time for office hours 2-3 days a week only.(I'm married to her though, so I pay her quite well)I don't do much volume being consulting only and sort of sub-specialized.

[mwarddoc]

I didn't see your response prior to me just posted lengthy post.

When I reviewed PP, I was a bit taken aback by the lack of spit and polish compared to the price. I actually visited an office with experienced users and although they recommended it, and were happy with it, I don't think they had much choice after 18 months of buy in, they were financially vested in believing they had made the right decision. They, a two doctor shop, spent 50K on software and licenses to set up.

PP wanted 21-25 K from me for a single doc shop. That would be fine, if it did everything and could be flexibly operated, but I never saw that.

[Kursk]

Thanks for the reports! Best EMR discussion I have read in the last year.

[ozzie]

A single payor system is around the corner ? , not while insurance companies and legal beagles exist.

[EMRhelp.org]

Good luck. Don't count on the AMA and the other letter groups to intervene. Most have financial connections and political connections that are much more important to them. And decisions like this are generally more political and financial, than reality based. Just cross your fingers and hope it works for the best. HIPPA hasn't. JCAHO hasn't (how many of their rules have actually improved patient safety?).

Sorry, I'm a cynical curmudgeon after 30 years of this c**p. HMOs, insurance companies, big Pharm get what they want. And docs will never group together enough to effectively speak up. We let our "groups" speak for us. Good luck.

Doctor groups should NOT have any say in EMR.
HIPPA and other standards are needed of EMR will never be interoperable.

[EMRhelp.org]

My magic mirror says that by 2010, EHR technology will be legislated by the government, that payments will be tied to demonstrating that certain quality thresholds have been achieved and that physicians will become increasingly marginalized as physician extenders gain more power and responsibilty. A single payor system is around the corner and independent physicians will have a tough time competing with monolithic, assembly line primary care organizations staffed by technicians with clinical decision support systems. All primary care specialties will be eroded by these less expensive providers (and eventually will die out). Some specialists will see their unique procedures (colonoscopy for instance) taken away from them as government trained procedurists crank out these procedures in assembly line fashion.

I seem to agree with all of this. :eek: :eek: :eek: Whether or not the future is better or worse for patients is hard to determine. :) I don't agree with Primary Care actually dying out. Primary Care is what ties the medical system together. Patients will always want one doctor to act as a steward. I do feel that paraprofessionals will be integrated into medicine, which is probably OK as I dont want to see 5 sore throats per day. I do feel that patients often are not interested in seeing "someone other than the doctor".

[ecmcdougall]

Hey, I'm a refugee from the Canuck experience.... let me tell you about the single payor system....

The single payor system worked pretty good from a doctor's POV, I did a locum right after residency in a 9 doctor office that had 1 person to do all the billing - the office manager. It took her all of 1/2 day a month to submit the claims to the health system. Some of the hassles were still there; we usually had ~5% refused outright and another maybe 5% sent back for clarification. That usually took her another day.

Downside was we were pretty much dependant on the government to set the rates we were paid - they were pretty similar to the Medicare rates here, actually. Patient care in the office was a bit simpler, there were fewer papers to fill out for referrals, and relatively few prescription refill requests - if your prescription ran out, you generally went back to see your doctor about it.

The other downside was the occasional efforts by the government to control where, when, and how physicians practice. Quite intrusive, actually. When I finished my residency, I was told that I could practice in the city I always wanted to - as long as I was willing to accept a 50% pay cut. The established docs in western Canada were in an "eat our young" mode right about then; they were feeling threatened by funding cuts. I was told that there were GREAT positions available in Fort McMurray, Alberta.... Think rural North Dakota but with oilworkers, and REALLY cold weather. I came down to the good ol' USA soon after. Those same docs are now wondering whether they'll be able to find someone to take over their practices when they want to retire.... too bad, eh? Hosers.

I doubt anything like the Canadian system could be established here in the States - for one thing it wouldn't be legal to limit "competition" in that way. Maybe a shared risk pool system that investors could buy shares in, like Lloyds of London would be acceptable to the health insurance lobbyists.... I don't know. The basic flaw is that EVERYONE would HAVE to buy in; no exceptions allowed. I don't think that would fly.

Anyways, sorry for the long post... It's an interesting question, one that I'm asked about all the time. One thing to remember is that most of the information that comes our way in the States is from the health insurance industry's point of view - it always seems to have a "communist medicine" twist. Also understand that here you're always hearing about the cranks and malcontents in the Canadian system, not the millions who are happy. Most docs in Canada like the fact that they don't have to worry about whether a procedure will be paid for, whether they'll get on a plan or not, whether the plan will try to screw them, etc. etc. and can concentrate on patient care.

Anyways, my two bits.
ECM

[pprescot]

....Downside was we were pretty much dependant on the government to set the rates we were paid - they were pretty similar to the Medicare rates here, actually.... ECM

As opposed to giant HMOs setting your rates, cutting them at will, and dropping you from the program if you don't accede to their wishes? Just so they can afford their 15-30% overhead, compared to Medicare's 3-4%?

No, telling docs where to practice would never work here. It's been tried, through loan forgiveness programs, etc. Didn't work too well.

OTOH, as insurance rates skyrocket and more and more people have to do without, something has got to change.

[ecmcdougall]

"As opposed to giant HMOs setting your rates, cutting them at will, and dropping you from the program if you don't accede to their wishes? Just so they can afford their 15-30% overhead, compared to Medicare's 3-4%?"

Yeah, exactly. I'm not really happy with the health insurance industry here in the States, either. However, it's a stick that hits at both ends - I can drop them as quickly as they can drop me.....

In the Canadian system, you're at the mercy of a single payor - the provincial government. When times are tough and government revenues are down, who's the first to get slammed by the government PR folks? Not the porkbarrelling pols. Clearly, it was the greedy physicians (who accounted for all of 15% of the dollars spent on health care) that were causing the billions in deficits. The vitrol the provincial gov'ts dished out in the mid-90's towards doctor's incomes was, well, just sad in retrospect.... and, as I said, the established docs reacted by excluding the next generation of physicians from populated areas, to try to restrict supply. Government was happy to go along, because, after all, fewer doctors means there'll be fewer folks sick, right? That was their PUBLIC stance, for G's sake - who knows what they were saying behind closed doors....

So, yes, the single payor system has it's downs, too. I'd be hesitant to trust the governments here in the States even as much as I trusted them in Canada; well-funded lobbyists seem to get their way most of the time here. I would assume that a single payor system would leave doctors even more excluded from the process, quite frankly. Unless, of course, doctors could get their act together and stop backstabbing every time a pay cut comes along.... And maybe if we could get a REAL lobby group of our own going, rather than the AMA....

Gee, you know, I'm coming across as really bitter about all this.... I'm really not, actually. Governments are doing what they will always do, and so are doctors. I guess "resigned" would be a better word for how I feel. Getting back to my original post topic, I think that's why some of the things I've read here are so frightening - they're going to disturb the status quo, and not in a good way. What I've seen here is further attempts to push yet more liability and cost into the laps of physicians, and to remove even more responsibility from people for their own health. In the end, who paid the bill for HIPPA implementation? Did Medicare increase reimbursement rates to cover the costs? Did my liability go down with HIPPA? Hmmmm.....

ECM

[Kursk]

Here's some other frightening news:
The evolution of viruses: (http://www2.cio.com/research/security/edit/a01142005.html)
"I asked Shannon if the developer in her could appreciate that Witty was, well, clever. If she was, in a crooked sense, impressed by its sophistication. "Impressed?" she asks, surprised. "Horrified is a better word. It was disappointing. And disturbing." She adds that as sophisticated as the attack was, the implications of Witty's attack mode were more frightening. Witty, she says, looked a lot like a test run. A proof-of-concept that one could disable security infrastructure to open up wider access. Destroy the gate and then storm the unprotected castle."

[macleod]

i look at the post office and veteran's administration everytime i worry about the gov't building a single payer system. i'm a lone wolf, type, always was, always willbe, and i was when i was a cop. i know i would never fit into a sytem that advertises one set of values(QUALITY PATIENT CARE) but which is truly driven by politics of the petty, personal and global.
long ago, patients became an afterthought, when hmo's were allowed to quantify them and " manage" their care like so many hamburger patties on the production line at macdonald's.
i just show up everyday, to do what i do, the best i can do it, until someone tells me i can't do it anymore. i deal with the things i can control, and try not to stress on the things i can't.

[ecmcdougall]

i look at the post office and veteran's administration everytime i worry about the gov't building a single payer system. i'm a lone wolf, type, always was, always willbe, and i was when i was a cop. i know i would never fit into a sytem that advertises one set of values(QUALITY PATIENT CARE) but which is truly driven by politics of the petty, personal and global.
long ago, patients became an afterthought, when hmo's were allowed to quantify them and " manage" their care like so many hamburger patties on the production line at macdonald's.
i just show up everyday, to do what i do, the best i can do it, until someone tells me i can't do it anymore. i deal with the things i can control, and try not to stress on the things i can't.

I hear your concerns - the U.S. Gov't and their love of porkbarreling and micromangagement is not the way to go for a single payer system.

OTOH, despite the malcontents and insurance company propaganda you hear all the time in the U.S., I can tell you that as a PATIENT, the Canadian system was pretty sweet when I was growing up. $60/month (now more like $150, I've heard, but still) for a no-provider-panel, fee-for-service system; the system's overhead was 2% (ie. your taxes weren't being wasted), and access was excellent. The politicos got their fingers into it and have now ruined it, but it was a great system for 30 years. The problems started when medical costs started to rise in the 1980's - CT scans, then MRI's; angioplasties, tPA, chemo regimens, etc. etc - the added costs were more than the taxpayers could tolerate, especially during a recession, and the pols made hay on it. Drug costs were a factor in some provinces, but many provinces didn't even pay for drugs until you hit 65 y.o..... Too bad they didn't think of reducing the porkbarrelling first.

I keep thinking about a shared risk pool, like Lloyds of London; current insurance co's would just by blocks of risk with a set profit margin (?5%?). Spread the risk around more, so liability for any one individual is low. Everybody would pay for it through taxes, so nobody would not participate. It's probably too simple an idea. Besides, how would you keep the Gov's sticky fingers out of such a big pie? Sigh.

ECM

[Falball]

Are you kidding? What kind of problems are you having with Practice Partner. I started with them after a very extensive review of numerous programs, beginning years ago and have gone on to PP since 6/2003. Having been using computer systems since 1990. This is my third incarnation, by far the best and definately last one. I started with PP V7.6 using the PM/Sched/EMR components and have been using all the integrated features into the very robust, easy to use and easy to learn and teach PP V8.1.1. The company has been very supportive, helpful, cooperative with excellent support and responsiveness. When did you get on board with PP and what version are you using and what seems to be the problems that you are having? Is it truly a problem you have with PP EMR or is it hardware, local vendor support related. I have heard all sorts of various stories. PP has been great by us and for well over a 1000 other users I know.
Sincerely, Alan Falkoff, M.D. Stamford, CT High Ridge Family Practice

[ecmcdougall]

Are you kidding? What kind of problems are you having with Practice Partner. I started with them after a very extensive review of numerous programs, beginning years ago and have gone on to PP since 6/2003. Having been using computer systems since 1990. This is my third incarnation, by far the best and definately last one. I started with PP V7.6 using the PM/Sched/EMR components and have been using all the integrated features into the very robust, easy to use and easy to learn and teach PP V8.1.1. The company has been very supportive, helpful, cooperative with excellent support and responsiveness. When did you get on board with PP and what version are you using and what seems to be the problems that you are having? Is it truly a problem you have with PP EMR or is it hardware, local vendor support related. I have heard all sorts of various stories. PP has been great by us and for well over a 1000 other users I know.
Sincerely, Alan Falkoff, M.D. Stamford, CT High Ridge Family Practice

Huh. It's like you're talking about a different product. Overall, it's been everything we didn't want an EMR to be - expensive, difficult to use, not adaptable, bug-prone, and it slows the work flow.

We have had absolutely NO support at all - they don't even answer our phone calls any more; they've not been to our site since we signed the contract. We have constant problems with the program crashing; they have never answered any of our questions about this. None of the physicians have been able to get the program adapted to their personal needs for documentation; the program clearly expects YOU to adapt to IT - not going to happen, not with doctors. The preventative care reminders they finally implemented in version 8.1 are a nightmare; we're desperately trying to find a way to turn them off, because they disrupt work flow so badly. Worst of all, they still have done nothing at all to work towards a paperless office; it's still impossible to get reports, consults, and other pieces of paper stored in the patient's electronic chart. So much for cost savings - we still have to maintain both paper and electronic charts on each patient.

One of our docs has commented that Practice Partner seems to be designed for administrators, not for physicians. I'd second that notion, I'm afraid. We're still looking for a replacement.

ECM

[ozzie]

I keep thinking about a shared risk pool, like Lloyds of London; current insurance co's would just by blocks of risk with a set profit margin (?5%?). Spread the risk around more, so liability for any one individual is low. Everybody would pay for it through taxes, so nobody would not participate. It's probably too simple an idea. Besides, how would you keep the Gov's sticky fingers out of such a big pie? Sigh.

ECM

Lloyds of London is broke now and any future schemes are closer to ponzi schemes.
you cannot have calculated risk with uncalculated/ uncontrolled expenses

[docporter]

Actually, it is EMR technology that I expect will enable paraprofessionals to practice medicine like real doctors. They won't have the intuition and expertise that comes with a medical degree and years of experience, but they will be a whole lot cheaper, and the feds will have a comfort level because of decision support and best practices built into these systems. I believe, assuming we don't blow ourselves up first, that quantum computer technology will become a reality within the next 50 years and computers will become 'intelligent' and be able to practice medicine (or any profession) better than humans. Of course, I expect to be pushing daisies by then. With smart computers, robotics will eventually evolve to handle the fine motor skills of surgeons - but by then the irobot or terminator scenario will play out and we will be the endangered species.
Nah, we'll blow ourselves up before that ever happens. ;)

I'm a bit uncomfortable with your attitude regarding current trends in health care and with some of your predictions, which seem to be based on scripts from popular science fiction movies (though I think you are probably just being humorous there). What seems to be happening is the attempted removal of humanity from Medicine, the destruction of our profession and the creeping (galloping lately) encroachment of totalitarianism. I don't mean to give offense, but I must ask you how you feel about the fact that your company contributes to and benefits from all this? I have to wonder if your attempts at levity might not be an avoidance mechanism to keep you from thinking of the more serious implications and your part in bringing all this about? :confused:

[K9American]

I have to wonder if your attempts at levity might not be an avoidance mechanism to keep you from thinking of the more serious implications and your part in bringing all this about? :confused:

No ad hominen attacks intended but "castigat ridendo mores."

Get back to me after you've been in the trenches for another ten years or so.

:)

[K9American]

Get back to me after you've been in the trenches for another ten years or so. :)

Retraction. Scratch that. Sorry.

[BigDoc]

Read my post #2, someone else wil make all the decisions for us, if we don't :eek:

[docporter]

Read my post #2, someone else wil make all the decisions for us, if we don't :eek:

What you seem to be saying is that we need to fall on our own swords before they come for us. Or are you saying all is lost anyway so we should join them?