Greenway Medical EMR/PMS

[DocRobbs]

I saw this companies integrted product at the American College of Surgeons Meeting. It really seemed exceptional but with only a few minutes to view the demo unit it was quite hard to tell.

They really don't have much presence on some of these forums.

Does anyone have experience with this product?

I am expecting it to rather pricey as they need to see your set up to give you a quote.

[falcon999]

it's very very expensive, something like 60000 per doc or something like that, i got the demo and it looks great, and i have a friend who has it, but for that much money it doesn't work as well as he likes it, plus i think they are having money problems.

[cdoc42]

$60,000 to boost your net by $10,000 a year? Not counting annual "maintenance" costs, that'll take you 6 years just to recapture your investment. If your equipment isn't outdated and in need of replacement before then - or if the insurance industry decides to reduce reimbursement because it recognizes you can, indeed, prove your charge matches your daily work, aside from having nice notes for everyone else to read, what is the advantage to your practice?

[falcon999]

yeah, i agree i didn't buy it. I bought eclinicalworks. i like it, it seems to make my life easier. it's not a lot better than paper, but i think over time it will be.

[cdoc42]

Let me ask you a question: what is the lure of buying into the EMR? In the face of reduced reimbursement, the only carrot I can see is "improved documentation to increase your level of coding." Well, if you simply develop a check-off sheet on 8.5 x 11 paper you can "document" more intensely just 3 patients a day at level 4 which, in 4.5 days a week for 48 weeks, will bring you about $38,000 a year. Why would you spend $25,000 or more to do the same thing?

[DrWinn]

The list of reasons to buy an EMR is extensive. Briefly, the EHR improves patient care and raises income. I would go so far as to say in the very near future the standard of care will demand use of an EHR and there will be very little defense against medical errors deemed preventable by an EHR's 'warning' systems. Here is a list of 50 reasons reprinted from Medical Economics

Better access to data:

1. Pull a patient chart within seconds rather than minutes.
2. Never waste time looking for a chart.
3. Open a patient's chart on any computer in the office.
4. Have two or more people work with a chart at the same time.
5. Have clinical data at your fingertips when a consulting or referring physician calls.
6. Open the patient's chart on a wireless computer when you see him in the hospital.
7. Access a patient's chart online when he calls you at home at 2 a.m.

Better charting:

8. Never worry about illegible handwriting (your malpractice carrier and local pharmacists will be happy).
9. Have patients complete a computer-guided medical history at home or in your office that downloads into the EHR.
10. Update medication and problem lists with every visit.
11. Import lab results, diagnostic images, and hospital discharge summaries into the patient's record.
12. Create flow sheets and graphs for any kind of data—blood pressure, HbA1c, pediatric height and weight, etc.
13. Tap thousands of procedure and diagnosis codes—far more than a paper charge ticket can display.

Better care management:

14. Track pending orders for lab tests and diagnostic imaging—those that are long overdue may signal lost reports or patient noncompliance.
15. Receive automatic reminders in the exam room when a patient is due for preventive or disease-management services.
16. Link to evidence-based guidelines for diagnosing and treating conditions as you talk to the patient.
17. Quickly produce a list of all female patients over 21 who haven't had a Pap test in the past three years (or any time frame you choose, based on age and type of Pap test). Then ask these patients to make an appointment.
18. Print patient handouts in the exam room.
19. Print a copy of the progress note and give it to the patient at the end of the visit. Or put his entire record on a mini "thumb" drive that he can take home.
20. Provide consulting physicians with a list of lab results and current medications by e-mailing or faxing the data directly from the computer.

Better prescribing:

21. Spend less time talking to pharmacists with questions about what you've written.
22. Fax prescriptions from your computer to the pharmacy instead of handing them to patients, who might lose or alter them.
23. Reissue prescriptions with a few mouse clicks.
24. Reduce the number of prescribing mistakes by receiving electronic alerts on drug interactions, allergies, and other situations where you should exercise caution.
25. Identify all your patients who are taking a recalled drug within minutes.
26. Verify compliance with insurance-company formularies incorporated into the EHR.

Greater efficiency:

27. Review a summary of the patient's health information at a glance instead of flipping through pages.
28. Stay on top of your work with an electronic to-do list that includes incoming lab, radiology, and pathology reports as well as in-office messages and telephone calls.
29. Reduce phone tag: When patients call, answer their questions immediately instead of pulling the paper chart and calling them back.
30. Produce referral letters, school and work excuses, and other documents with a few clicks.
31. Send messages to your nurse without leaving the exam room or hollering down the hallway.
32. Reduce staff downtime at the copy machine: When you need to share records with someone, transmit them electronically.
33. Automate the way you report childhood immunizations to state-mandated registries.
34. Order lab tests and diagnostic imaging with a few mouse clicks.
35. Get claims out the door faster by sending encounter information, including diagnostic and CPT codes, straight to your practice-management software.

Lower costs:

36. Save $10,000 or more per doctor per year on dictation and transcription costs.
37. Eliminate positions for file clerks and transcriptionists.
38. Save several thousand dollars a year on paper-chart supplies.
39. Download ECG readings directly into the patient chart and save even more on paper.
40. Spend less on postage by transmitting charts electronically.
41. Build a satellite office without a file room.

Higher income:

42. Qualify for "pay for performance" bonuses by tracking the care you provide and the outcomes you achieve for various groups of patients.
43. Capture all your charges automatically as you record what you do.
44. Reassign your transcriptionist and file clerk to help collect accounts receivable.
45. Confidently code for higher levels of service based on thorough documentation.
46. Get automatic suggestions for E&M coding based on your documentation.

A more robust practice

47. Convert your file room into an extra exam room.
48. Gain an edge in recruiting doctors fresh out of residency who've grown up using computers.
49. Retain topnotch staffers who otherwise would be burned out by the chaos of paper charts.
50. Impress patients by demonstrating that you run a modern, cutting-edge practice.

And I will add a few more.

1) One doctor quipped that he paid for his EHR in a matter of months just by using the system to notify patients that needed a tetanus booster!
What if you have a bone densitometer? The higher efficiency of the recall system would pay for the EHR in weeks - or days.
2) When the patient leaves the room, your notes are complete, professional and most important of all... done. I would say that the EHR has truly allowed me to rediscover the joy of practicing medicine and I go home early... well actually to my second job - designing EHRs for e-MDs.
3) Word of mouth marketing from patients that receive their visit note, patient ed and health summary cannot be over emphasized. When your elderly patient shows up at the ER with their med and problem list, allergies, ECG and pertinent lab, all neatly summarized.... the ER docs begin to take notice and refer patients to you, the high tech doc who is obviously brighter than his stone age, paper bound colleagues. I had one of the busiest, most successful practices in Austin when I was in full swing with my EHR - and I attribute that to community perception that I was a 'state-of-the-art' practice.

Ask any doctor who has successfully deployed an EHR. They ALL say they would never go back to paper. Unfortunately, the data shows that about 10% of docs have a failed deployment. Rather than a lack of intelligence, I believe this is more often than not due to a lack of organization and intolerance of frustration and change. Great rewards await the persistent.

The time for cynicism has passed. Board the ship for the new world; have the courage to strike out for a better life or stay behind and watch everyone else leave you behind.

[DrWinn]

Oh yes, I should reply to the original question posed in this thread. Greenway is a very good product. They use .net, which is the latest and greatest. We write our new apps in .net and are migrating our core modules to this platform. That said, is Greenway worth a $50,000 premium per Doc over other products?

No freakin way!

Do physicians who spend that kind of money on an EHR look.... foolish?

Yes. But then, I tend to see people that drive fancy $500,000 cars and boats as extravagant, wasteful and, well.... stupid... I mean foolish.

[cdoc42]

Dr. Winn, thanks for your extensive reasoning in favor of EMR. What I hope this discussion will not become is a “pro” countered by “con” argument that eventually deteriorates into something totally useless to those lurking or actively participating.

I used the “Epic Care” system during 2001-2003 in an active primary care practice. I was enthusiastic, as was my staff. Overcoming the usual installation traumas, we were completely operative in about 4 months. I am able to type proficiently enough that all of my daily encounters were closed at the end of each patient visit. This was not true for some of my colleagues; some used paper notes and returned as long as two weeks after the encounters to close them off. But because I closed immediately, it took up more visit time and I found myself unable to see as many patients as my colleagues who closed at a later date. I made templates but in a family/general practice setting, these were not too useful because too much of what goes on in each visit is an individual experience, and finding the template, then changing it to make an accurate description of the encounter took more time than free typing. Although it may differ today, the system was unsophisticated in that I had to manually make an association between prescriptions and diagnoses with each drug I ordered or renewed. The same was true of ancillary tests or referrals. That aside, the Rx writing feature was great, although they had to be printed, then signed as we did not have e-mail/fax to pharmacy capability. I was able to review lab data, then prepare a letter to each patient, explaining the results, using templates that were appropriate. The negative side of this was I found myself at the office each Sunday morning from 8Am until noon or 1PM doing so. Communication with staff was strictly via the computer – we rarely talked during office hours. I went from exam rooms to my office to review telephone messages (I could have done it in an exam room), responded to same, forwarded to staff, then back to the exam rooms. I always did this on paper charts but typing was easier and allowed me to be more verbose than I would otherwise have been. The positive feature was the more detailed note was a great malpractice protection.
Unfortunately, over time my productivity suffered enough that my employer and I parted ways and I returned to my solo paper practice. I immediately found I could see 3 to 5 more patients a day using the old paper charts. My patients related to me they were happier that I gave up the computer because they felt I paid more attention to the keyboard than to them. The detailed letters I had sent did not particularly impress patients because all they really wanted to know is “if the tests were alright.” My explanation of total cholesterol, HDL, Triglycerides and the TC/HDL ratio and its ramifications and reasons for care were ignored in favor of just looking at the total cholesterol and recognizing it was “higher” than the last test.

I asked my secretary to review the 50 reasons for going with an EMR and give her opinion. She felt, having been exposed to both systems, the EMR was not worth the expense if an office was as efficient as ours. We see 25-30 patients a day; charts for the next day are pulled before we close and all mail and records are placed in appropriate charts and they are filed before we leave. No phone call message is left unanswered, and all refill requests are phoned or faxed before we leave. I have 3 staff members.

Obviously my experience differs remarkably from yours. The “culture” of the areas in which we practice may make a difference as well. I prefer to spend at least 80% of my patient encounter time communicating with and educating my patients; the physical exam is the least important today as far as I’m concerned, required only to fortify or refute my diagnostic impressions. But copies of encounters (office visits) I receive from my previous position on patients transferring records reveal rather extensive exams that one knows cannot be realistically performed at each visit unless you trade that off against discussion time. The printed visit is usually 5 pages long and has so much trash in it one cannot really tell what the essence of the visit was all about.

We are moving to a time where the medical record will be able to be reviewed by multiple people, perhaps in multiple locations; at the same time we protect privacy with HIPPA. As well, I recall when physicians kept their notes on 4 x 6 index cards, none of which was read – or able to be read – when I received transferred records. But even with the 5-page detailed computer-generated notes of today, who has time to read what amounts to a novel of patient experiences contained in the notes? Don’t most of us simply look at the current meds to determine the current diagnoses, look at recent labs, perhaps ancillary tests or consultant reports and move on from there?

I don’t wish to take issue with any of the 50 reasons; they are all accurate and have their place. But a disorganized physician with a disorganized staff is not likely to be converted to an award-winning facility by a computer system. Neither is a highly organized paper practice going to produce a meaningful practical benefit until the price makes sense. I agree with you that it is the future of medical care; I question if it is as close as you think it is. For your sake and effort expended, I hope you’re right, and I wish you all the good fortune in the world.

[DrWinn]

EPIC is an old system built on an old database (Cache, formally Mumps). Todays inexpensive systems surpass EPIC exept in interfaces where they still maintain a temporary lead. We have had many sales to docs starting a new practice that had used EPIC in residency. Their comments are pretty consistent across the board - that e-MDs is a much more powerful and easier system to use. You should check it out for yourself.

As far as a system is only as good as the doctor and staff (organization), I agree. We have a 6 provider medical practice beneath e-MDs (same building) that serves as our lab to see how 'humans' can subvert a design. If anything, this has taught us how we must automate many processes and not depend on some nurse or receptionist to learn how to use the system correctly. One of the areas where this will become increasingly important is in disease management and the registry. This will funnel information to the patient via a secure portal and automate many disease management processes. In conjunction with this, we are developing an online scheduling and history gathering product that uses 'intelligent' disease specific questions to help gather the history. This serves to collect all relevant info related to any one of over 200 diseases ( no more 'I forgot to ask'), and will make it possible for a provider to use his/her time more efficiently to 'drill down' on positive responses and focus more on the treatment plan than mindless data acquisition.

The registry, portal and online directed history gathering will usher in the next era of EHR advances improving quality of care, patient satisfaction, increased reimbursement (if not be E&M code, then by higher thru put) and better time management. This is all about rediscovering the joy of practicing medicine.

[DrWinn]

Also, your experience has been with very expensive (outrageously expensive) systems. Not all EHRs require you to mortgage your home. See http://www.aafp.org/fpm/20051000/29aneh.html survey of 400+ physicians across the U.S. Each rated the system they were using. You might be surprised that EPIC did not fare so well. This doesn't speak particularly well to the wisdom of Kaiser in picking EPIC at a cost of 1.8 billion.