Which EMR Product Are You Using?

[dancar22]

I am a surgeon in northern Alabama and have been using Medamation for the past eight months and have been very happy with this EMR. It has worked seamlessly with Dragon NaturallySpeaking and the template creation process has been very simple and straightforward.
Rich

[Mike]

Tried SOPWARE, good for small practice on a budget

Amazing Charts - steep learning curve

WebMD Intergy - Recently Instaled, will give give feedback later

[mel]

A lot of EMRs get very expensive as you add modules
M

[romelarj]

I haven't seen anybody mentioning this EMR in this forum.
It has a 3 months totally functional trial. Current version 1.2.6
It is practical, easy to learn, with fair costumization, especially the templates for notes writing. And, a very important plus is the price. It cost 500 dollars.
This week I learned from one of its reps that the version 2.0 is coming in July '04. It should include a document scanning support and an interface for faxes and/or Lab reports. Also, he told me that the scheduling module is enhanced.
I am looking foward to try this upgrade.

[buslick]

I use Praxis 3 beta.

[dougdykman]

We are using Alteer an integrated front and back office system and EMR. It works great

[RoyF]

Hi,

I use Patient Minder. User friendly, cost effective, geared for the small office. It has a 60 day downloadable demo. In all fairness I need to disclose that I developed the software and my company markets and sells it. I hesitated to post here, as I don't want this to come off as an advertisement, but since the thread asked what I am using, I thought I would at least answer the question.

Roy F.

[statdoc]

In my 5 physician, 5 mid-level emergency medicine practice, we use an EM-specific product that is no longer available. It is the Lernout & Haupsbie Clinical Reporter. It is a template-based, voice-recognition system. We have heavily customized it to suit our needs, including specific paragraphs that address EMTALA screening exams, use of restraints, etc. It prints our prescriptions for us, as well.

Although it is several years old, it is running very well. We feel that it has saved us on several potential liability issues, because of the detail and legibility. We also get a 5% discount on our malpractice insurance each year, because of it.

[BigDoc]

From a user who prefers anonymity
"ibex, but it for ERs only, and I do not know the cost, but they have a website, www.ibex-systems.com/"

[alborg]

>>> I use Praxis 3 beta.

Oh wow! A real live Praxite! <g> What became of the POL Praxis discussions? It's like everyone disappeared...

Anyhow, I use my own MS Access 2000 (Jet 4.0 backend) EMR that I have set up in a 5 computer LAN. I now have 2 of the computers attached to Airpanels (i.e. Windows CE devices that integrate each with one of my Windows XP Professional computers via a separate 802.11b wireless connection). Works great... No fees...

Regards,
Al

[lbernstein]

We are a multi-specialty practice of approx. 135 docs and have been using the Allscripts product Touchworks. It consists of a modular approach and have thus far implemented their "Dictate and Documents" module and their "Results" module which allows access to lab results. We will be going up on their e-prescribing module called "Rx+" in the next few months.

[Hal333]

I tried Welford Chart Notes.

Not too many people have heard of it but it is fairly amazing.

It parses notes as you write them and helps you write according to many algorithms.

It excells at long-term follow-up of medical patients.

I returned it because it was really too much for a surgeon who sees patients only three times.

If you are an internal medicine or primary care group you should definitely do the demo.

My total cost was $2500 for purchase but this was refunded.

<From their web page>

"Welford Chart Notes interprets each sentence of your note as you write it and automatically updates the other sections of the chart for you (such as the problem list, medication list, allergy list, past history, lab results, ordered tests, and referrals) as well as automatically preparing prescriptions, patient education brochures, and patient visit summaries from the mere act of writing your note. It also uses its ability to interpret free text to automatically warn you about allergies, interactions, precautions, contraindications, inappropriate dosages, and formulary violations."

http://www.emirj.com/WelfordChartNotes.html

I am now using Amazing Charts. More on that later.

Hal

[Surgeon]

Voice recognition driven charting soft ware, has some nice features, but service calls are difficult to set up in rural area, and documentation absolutely stinks, worse than worthless. Requires separate billing/scheduling software, for which I used DataStrategies which is actually better than the charting software. Didn't really review enough options prior to buying, and it is highly unlikely that you can 'test drive' any software enough to find out the problems before buying. I think this system was relatively expensive, but at the end of doing my visit note the note is coded, referral reply is sent, and prescriptions can be sent or faxed, and can be associated with the diagnosis. Some bugs in the interface with Dragon Naturally Speaking, which is truley amazing voice recognition, but I have very little accent. With this I have one person who can handle all of my coding, billing, reconciliation, etc., with little outside overhead except I think a clearing house cost.

[GrenadaDoc]

I'm a solo general surgeon in North Middle Mississippi. I've been using e-MDs' TopSuite for the last three years. Works very well. Tightly integrated product (EMR/Scheduler/Billing/DocumentManagement. Template driven with easy to customize templates.

[happydoc]

I am still using paper, but that Welford Chart notes sounds fantastic for an internist like me! Templates and mini artificial intelligence capability is very important when patients vary as much as they do in my office.

[fpmdtx]

not using EMR

[Surgeon]

Can anybody list the types available. So far every poster is using something different, and I know what it means if there are fifty different medicines for one condition. None of them work!

[BigDoc]

Can anybody list the types available. So far every poster is using something different, and I know what it means if there are fifty different medicines for one condition. None of them work!
DrKadel, we will do, please be patient :D

[doc88]

I use MedAxxis by Per-Se technologies

[asnmd]

I am not using anything yet but always open to increase efficiency

[volker]

We use FreeMED in our 5 member multispecialty practice. Easy template creation, fax interface for importation of reports and for sending, secure web based access, integration with voice dictation, operating system independent, 25 modules.
Paid only for hardware and support as needed.

[BigDoc]

We use FreeMED in our 5 member multispecialty practice. Easy template creation, fax interface for importation of reports and for sending, secure web based access, integration with voice dictation, operating system independent, 25 modules.
Paid only for hardware and support as needed.
Is this Ozz's product? :confused:

[ozzie]

Is this Ozz's product?

OK for the umpteenth time it is NOT MY product if anyone's its YOUR poduct as freemed is for physicians..
its open source meaning it open to anyone to modify.
I just help people set it up etc..

And no Volker is not schill I invited him and some other docs over.. most use freemed or are interested in freemed and thats how I know them ..

[BigDoc]

Is this Ozz's product?
OK for the umpteenth time it is NOT MY product if anyone's its YOUR poduct as freemed is for physicians..
its open source meaning it open to anyone to modify.
I just help people set it up etc..
..

Oops :p
Sorry Ozz,
B

[ozzie]

I guess I dont explain the open source idea that well or much or both..

There are many variants of open source when it comes to licenses.
As far as Freemeed is concerned the license means
no fees ,
no one owns it ,
anyone can change it,
So the free is more to do with freedom, being free as in no cost is a side effect.
So the software is free.. however to customise for your practice is not free unless you write php code..
So it still will cost you money to deploy.

In the bigger picture where open source become very attractive is when a bunch of people get together with a common need/problem then share the cost of development of that need and or resolution of the problem.
Look at 100 oby gyn's all spending say $1000 one could have the ultimate EMR for oby gyn's.

And that buys a bunch of code, but also one gets the input from 100 users who know the oby gyn needs.. So it more like Burger King and you can have it your way..
Also now the core shell for oby gyn is say 85 % complete the other 15 % is really local mandate, be it legal and or personal..

The core shells can be customised down to the needs of each practice also..

if the 100 could agree to disagree on the same labs and billing corp all the cost of intergrating lab and billing will get paid buy the lab and billing corps.

then if all were in the same state maybe a premium reduction and bingo your emr cost is nearly free..

Hmmm should the AMA be doing this ?? :confused:

wake up wake up wake up :eek:

Oh sorry I must of dozed off ;)
I must have been dreaming

[dleibow]

My clinic uses EPIC (Madison, WI). This system seems to be installed only in pretty large places. My impression is that the company discourages small facilities, because the cast is too high. Kaiser-Permanenta is switching to EPIC sometime in the next couple of years. We have used it for 4 years. It has its good and bad points. In general, it has slowed everyone down. Doing all the documentation and ordering in EPIC takes longer than doing it on paper did. Theo ther problem is that since the medical record is totally electronic, if it goes down, everything is completely screwed until it comes back. There is a new version of EPIC out that has an interface that is more Windows-like, but it still has a very steep learning curve. If I was running my own office, I would try to find a more user friendly program.

[ozzie]

Single point of failure is a big issue which gets set aside in many cases..
the answer is "oh yes thats why you have backups"
But at 3 am who is going to do the backup ?
If it were an hardware failure where would you get the hardware etc on a public holiday..

The simple answer is redundant systems, just like in the OR ( I hope)
But this is costly both hardware and sofware.. kinda stinks to pay a bunch for licence you may never use..

My solution for linux based stuff is very simple and cheap.. I run a virtual machine on Vmware on another pc and have the database backed up pretty close ( a few seconds) to real time..
So in the even of a gross server failure the users would just use another url and be back in biz. in seconds..

Should the building burn down or whatever the real time backup across the web would be up to date .. that can be on a live server also..
or in an archive form .
The reality of the above is that paper system would in greater trouble .. (sigh)

Thinking about that what is your legal position if the pat records are destroyed who is liable for reconstruction ??


oz

[Seasoned User]

I've been using the above General Electric Healthcare medical software since the de novo formation of my solo family physician office in south Texas in January 2001. I started with these suites prior to GE's purchase when the companies were Medicalogic (Logician/CPO EMR) and Millbrook (Paradigm/CPO PMS).

I had a demographic and scheduling interface from the start, so that my staff did not have to double-enter data.

Also I had a scanning solution from the start, using Encore Imaging's Magician (Fujitsu 15C Scan Partner, Ascent Capture, IMRR Alchemy) which ties nicely into CPO.

I use a Small Business Server platform and thus use the shared fax and modem utilities integral to this suite. I have been faxing internally all of my prescriptions to pharmacies since June 2001 - excepting Schedule II drugs, I haven't handwritten a prescription since then.

I have a module that permits patients to enter data into their charts, by answering questions on a computer through the internet browser; this is a great way to prepopulate the Review Of Systems (ROS) and to increase the overall value of the encounter.

I have a built-in gateway for lab data, and an interface to some national reference labs, but am in a remote area with a bunch of local labs, to which I have not as yet gotten a "custom" interface done.

I hope to do a hardware upgrade this summer and perhaps add a DinaMap automated vital signs machine to the mix. This machine (coincidentally owned by GE also) would automatically import the data values into the requisite fields: temp, pulse, BP, saturation.

Another feature to add is a secure messaging module through a company called Kryptiq.

One of the really hot items for use with CPO is a speech recognition tool that permits seamless structured data entry, field to field. The automation of this aspect of care is exciting, particularly for new users, as they transition to this new world of electronic medical care.

While I really like my GE software, I LOVE electronic medicine even more, at least for the potential to change the focus of medical care, directing more attention to what matters, and what does not. I expect that the paradigm shift to digital healthcare will come at the cost of a lot of work, perhaps without great monetary return. But how is that to compare to the unfathomable reward of knowing that you really were involved in medical care that mattered. How many practices were DOGMA 10 years ago and are now beyond passe? Let's work together, with these tools, to structure what is unstructured, to find order in our disorder, to transform North American healthcare in a greater way than even Abraham Flexner's report did 100 years ago.

Sincerely,

[Kursk]

Sounds like a nice system and efficient workflow. But would GE even talk to you these days as a single doc practice?

[buslick]

Praxis 3 beta build 48T
Server: desktop machine running Windows 2000 Pro. (not a real server but it works)
Clients: Mixture of Windows XP Pro and Windows 2000 Pro
LAN: Main server is a Windows Small Business Server (2000)
Cost of networked version of Praxis with Oracle database in 10/2002= $8200
Cost of support and training and upgrades=Free for life.
Any more details that you want let me know.

[MHDoc]

Praxis 3 beta build 48T
Server: desktop machine running Windows 2000 Pro. (not a real server but it works)
Clients: Mixture of Windows XP Pro and Windows 2000 Pro
LAN: Main server is a Windows Small Business Server (2000)
Cost of networked version of Praxis with Oracle database in 10/2002= $8200
Cost of support and training and upgrades=Free for life.
Any more details that you want let me know.

Support for life?? How do they manage that? :confused:

[Seasoned User]

Pricing of software is high, a common reason folks don't pursue them. It is difficult to quantify VALUE in this very dynamic and complex market, further obfuscating reasonable comparisons of software.

At the time of my purchase, I hunted down through careful research (late 2000) who the market leaders were and why. I also looked at close competitors to try to detect the differences in the software. Then I asked what could most nearly get me what I perceived I needed, given my level of knowledge.

The price of the suites is much better now, and really, I think, a steal, for both the quality of material and the level of service afforded. Still, one has to figure out for oneself the value of a thing. If you want a walkthrough of CPO/Logician, go to www.medicalogic.com/products/logician/# and click on the Product Demo.

[Tim2]

Welcome Happydoc.

[Tim2]

Rats, can't edit anymore. And welcome Seasoned User

[alborg]

MHDoc:

I thought that Praxis got rid of the support for "life" last year... The problem I see with Praxis is that they are constantly in a "beta" mode. That sucks considering that for the multi-thousand dollar investment one does expect a completed software.

Seasoned User:

>>> The price of the suites is much better now, and really, I think, a steal, for both the quality of material and the level of service afforded.

That depends on the software that you look at... there are still many software titles that cost more than $5000 as an "up front" cost, not including the cost of installation and training. I still feel that the optimum cost of any medical EMR should be less than $1000.00 for it to be a truely cost-effective investment.

Regards,
Al

[volker]

Is this Ozz's product? :confused:
FreeMED is a product of the FreeMED Software Foundation. Ozz and others provide support for this EMR.

[MHDoc]

That depends on the software that you look at... there are still many software titles that cost more than $5000 as an "up front" cost, not including the cost of installation and training. I still feel that the optimum cost of any medical EMR should be less than $1000.00 for it to be a truely cost-effective investment.
I am with you on this one Al, considering if you read the fine print of the EMR vendor contracts, they are indemnify themselves of almost anything that can go wrong with software, some even offer no guarantees it will run :mad: and they charge $10,000 for this?
M :rolleyes:

[buslick]

For people who bought version 2.19 support for life is included. If you wait and buy version 3 when it is released support is going to be 15% a year. The price of version 3 will also be much higher that version 2.19 but the final price has not been decided since it hasn't been released yet. This is how they fund their R&D since they have no venture capital.

[mel]

For people who bought version 2.19 support for life is included. If you wait and buy version 3 when it is released support is going to be 15% a year. The price of version 3 will also be much higher that version 2.19 but the final price has not been decided since it hasn't been released yet. This is how they fund their R&D since they have no venture capital.
so, if you call with version 2.19, tech support will blame every issue on the version? :confused:

[Kursk]

MHDoc:


That depends on the software that you look at... there are still many software titles that cost more than $5000 as an "up front" cost, not including the cost of installation and training. I still feel that the optimum cost of any medical EMR should be less than $1000.00 for it to be a truely cost-effective investment.

Regards,
Al

Al, how did you arrive at this amazing price point? For larger groups would it be 1000 per doc? All open source? No MS licenses, all MySQL or what?

[Seasoned User]

Or maybe, screeeeeeeeeeeeeeech. :D

Thats how tight you guys are being to think that 1,000 bucks is going to get you your dream EMR. But, honestly, maybe that depends on what you want out of your EMR, or perhaps how long you will have to wait to get it. In 5-10 years that price might get you more, who knows?

I'm not trying to prodigally waste my money, and, Al, I know from the ol' pol site that you've been in the business longer than me, plus you actually know and use phrases like "endif" with regularity. Still, most of us aren't there yet. I am trying a little programming, so look out.

Anyways, you get what you pay for, usually less than you expect, but hopefully a little more than you would otherwise have. Value all depends on your perspective.

All the best in ya'lls' hunt,

[rwhalterman]

Tried Praxis 2.19/3 Beta for several months. Support was very good, training also. Learning curve steep. I found out more about myself. I like the flexibility of changing my dictation, and my patients did not fit even the customized templates I built--again, says more about me than the patients, perhaps. I would prefer more information available on the "first page" just as I have on my current problem list page. There are those who like this product very much (yes, the old POL discussions). This product takes a lot of input from the physician to customize it for your use. Getting a refund has been a bit challenging.

[alborg]

Al, how did you arrive at this amazing price point? For larger groups would it be 1000 per doc? All open source? No MS licenses, all MySQL or what?


Hi guys:

Kursk>>> :rolleyes: Well, I looked into my wallet... saw I had only fifty bucks. Then I looked at my 3 starving kids (MAMSI cutbacks, you know :( ) and then there's my poor blind dog... so I came up with the $1000.00.

Once MS instituted its "licenses" into MS Access, I stopped purchasing upgrades to their product. Soooo I don't have to worry about these little things anymore (Microsoft does, though, as they "wither on the vine" with their greed :D ).

Seasoned User>>> Al, I know from the ol' pol site that you've been in the business longer than me, plus you actually know and use phrases like "endif" with regularity.

Actually, if you want to *** really *** learn something neat, read my tips (average: 1 per day) that I post in the newsgroups "microsoft.public.forms" and in "microsoft.public.formscoding". Do an Edit>Find>Message in this folder and search for "Borges". Lots of If... End Ifs there, that's for sure! These are some of the topics that I've tackled in the past 4 weeks:

1) How to enumerate FORM list elements.
2) Working with hyperlinks.
3) Refreshing subform data.
4) Using parameters to display stuff in fields.
5) Tackling the 3020 error.
6) Using the IIf statement in controls.
7) Copying stuff from a previous record.
8) Maximizing your application at startup.
9) AddNew... Update event.
10) NOTINLIST capture event in comboboxes.
11) Trapping duplicate records, then selecting the one with the higher number in one field.
11) Do Menu Item / using a field's TAG property to check for nulls
12) Deleting items from a listbox.
13) DoCmdGotoRecord
14) DSum() for calculated textbox in a continuous form.
15) Creating a recordset from a parameter query using ADO
16) Passing a string to a form name.
17) Copy data from table 1 to table 2.
18) Color coding form controls programmatically.
19) Deleting a "no current record" error.
20) ADO > Populating a combobox with matching data.
21) Workdays between 2 dates
22) Record corruptions (oh no!)
23) Setting a printer thru a form in Access 2000
24) Using the TOP function in a recordset.
25) Setting up a "week at a glance" form based on a calendar ActiveX control.
26) Determining the "active page" in a multi-page form.
27) Field colors- programmatically making conditional changes... also how to make colors blink.
28) The problem with lost references (i.e. getting rid of error messages)
29) Updating a form by reloading the RowSourceType method...
30) Using listbox selection values in a query.

For you programmers out there, this really is a goldmine site for adding really neat code to your software! Most of the above is clipped right out of my own medical database software.

Regards,
Al

[alborg]

Bug:

Here are the correct URLs-
"microsoft.public.access.forms" and in "microsoft.public.access.formscoding"

Al

[winwin35]

Hi, I'm a late comer to this thread. I'm impressed with all the technical knowledge here. I'm just an enduser but I have had experience with 2 programs. WHen I was in a 40 man group, I've been using the Practice Partner EMR for 2 years. I adapted to it and made the most of it, but many of my colleagues didn't like it, even though our resident EMR "expert" thought it was the most "doctor friendly" of all the program he evaluated. But it is expensive!! About $200,000 for the group, with probably $100,000 a year for support! And that was just the EMR module, not integrated with the billing or scheduling at all! WHen I left the group in March, I found Altapoint (you can check the demo at www.altapoint.com), a reasonably priced integrated practice management/scheduling/EMR program that costs between $2000 to 3000 per doc, for 5 computers. It still has some kinks to work out, but I can use it in my solo pediatric practice. Has anybody used it too? As I gain more experience with it, I'd like to report to you all again.

[sjdavidson]

Lots of users, experts and interest here. All of which is a good thing.

I run a big ER in Brooklyn and implemented an EDIS beginning in April 2002. I've written about initial implementation (http://sjdavidson.typepad.com/leadership_outlook/2002/06/implementing_yo.html) and subsequent first year experiences. (http://sjdavidson.typepad.com/leadership_outlook/2002/11/computerbased_p.html) Feel free to peruse my blog archives.

We recently sustained nearly 30 hours of unscheduled downtime :( , despite the efforts to avoid a single point of failure that an earlier commentator remarked upon. Unfortunately, redundant PC-based servers and hard-drive systems, even RAID arrays are not immune to failure and even more so, failure in a mode that reports no errors. PC monitoring tools and error reporting tools are just not as sophisticated as the mainframe world. Yet. I'm not prescribing a mainframe based system by any means.

An earlier commentator mentioned IBEX and that's a good product. We're quite pleased with HealthMaticsED (http://www.a4healthsystems.com/acute-care-information-systems/) despite our recent experience. For us, the interfaces to hospital systems and vendor support have been key issues.

ED systems are a tiny subset of the whole issue of electronic records. Those of you in small and medium size practices have a huge challenge and I'm curious as to whether locally implemented systems or ASP-based models will co-exist or one or the other win out.

Regards to all./Steve

[ozzie]

We recently sustained nearly 30 hours of unscheduled downtime :( , despite the efforts to avoid a single point of failure that an earlier commentator remarked upon. Unfortunately, redundant PC-based servers and hard-drive systems, even RAID arrays are not immune to failure and even more so, failure in a mode that reports no errors. PC monitoring tools and error reporting tools are just not as sophisticated as the mainframe world. Yet. I'm not prescribing a mainframe based system by any means.


I am in Brooklyn too I am asumming NY.. 30 hours downtime is totally unacceptable if single point of failure was addressed..
In reality the tools for PC's are far more sophisticated.
Mainframes run on software and hardware redundancy and generally are on redundant private leased lines. Also you can't really compare server pc systems to mainframes unless you compare equal system both software and hardware..

[PulmDoc]

I'm a pulmonologist in a group of nine. We have used a web-based product called MedicalNotes.com for 5 years. It is inexpensive ($ 250/mo ) and provides us an easy way to get remote access to our dictations. We primarily dictate our records. Our transcriptionist does the transcription, sends the usual paper etc, and then uploads the transcriptions to our account at www.medicalnotes.com. Our dictations are then available wherever we have internet access (ie on the wards, ICU etc). This has worked fine for us.

One of us does voice-recognition for his office consults, and two of us create our hospital notes online using templates. This has the advantage of allowing us to quickly do CMS compliant notes by importing the previous day's note and making the few changes needed. We design our own templates to fit our practice style.

We haven't gone completely paperless because of the expense and because most of whats in a chart doesn't have to be available online and its expensive to scan unnecessary stuff in. Also, although all of us use the computer to lookup records, most of us prefer dictation for input, since it is still the most efficient method for a consultative practice.

[BigDoc]

I'm a pulmonologist in a group of nine. We have used a web-based product called MedicalNotes.com for 5 years. It is inexpensive ($ 250/mo ) and provides us an easy way to get remote access to our dictations.

PulmDoc welcome
BD

[Gogia7]

I am in India and have made my own. It is called Medic Aid. I wonder if some users would like to try out the same but some changes (Currency is Indian as is Date format - dd/mm/yy) would be required. A limited usage version is downloadable at www.amlamed.com

[MHDoc]

I'm a pulmonologist in a group of nine. We have used a web-based product called MedicalNotes.com for 5 years. It is inexpensive ($ 250/mo ) and provides us an easy way to get remote access to our dictations. We primarily dictate our records. Our transcriptionist does the transcription, sends the usual paper etc, and then uploads the transcriptions to our account at medicalnotes.com. Our dictations are then available wherever we have internet access (ie on the wards, ICU etc). This has worked fine for us.
What of Prescriptions?
M

[fblum]

We have a busy 3 office, 4 MD dermatology practice and we are very happy with MediNotes Charting Plus. We are "paperless" and much more organized now that we are electronic. We write notes that are much more thorough, improve patient care, and (for once!) actually detail what we have done.

[MHDoc]

We have a busy 3 office, 4 MD dermatology practice and we are very happy with MediNotes Charting Plus. We are "paperless" and much more organized now that we are electronic. We write notes that are much more thorough, improve patient care, and (for once!) actually detail what we have done.
Welcome, how long have you been using Medinotes?

[mel]

We still need more comments either by PM or here.
This is what we have done with your comments so far
http://www.docsboard.com/forums/faq.php?faq=emr_faq
or
http://www.docsboard.com/forums/faq.php?faq=vendor_list
We hope this will help other physicians thinking of buying an EMR for their practice.
.and BTW, no consultation fee, it is free :)
Mel

[alborg]

Although I personally still use my own MS Access EMR, my associate who shares my office with me uses eCW- he has an almost completely paperless office. He seems to be happy with it, unlike his experience with SOAPware. Hopefully in the fuure I'll be able to interface him into my MS Access application alongside the eCW for prescriptions, consultations, and other printouts, s.a. lab requisitions.

Regards,
Al

[cyberdoc]

not using emr

[r2t2ellis]

A couple of people have asked which EMR I use.

I developed a program that I call The Chart! for busy doctors . Lots of people just call it The Chart! . I developed it because I culd not find an EMR that I could customize the way that I feel one should be related to the H&P process. With so many EMRs on the market I cannot begin to actually know what each one offers, however many of them offer about the same things e.g.
Expensive
Pre-set data items for data entry
Formats that I find confusing or difficult to apply


So what have I done differently? Or what will you see w/ The Chart!?:

Data entry based on the H&P format we all learn in training
SOAP Notes also available
Full flexibility for users to enter descriptors that they want
No rigid preset list of descriptors
Flexibility to apply to multiple specialties
Users may have shared or private descriptors available
Patient Interface to collect patient demographics and basic Hx
Rx Pad allows for 2 DEA #s for two locations
View scanned forms or Rads
Appointment Scheduler
Counsult and Referral Response letters can be generated
Reminders & Intra Office Mail
Problem Lists w/ alerts
Operative Report builder for in office procedures especially those requiring sedation
Built on MySQL to allow multiple users at a low cost


I developed it for myself. Others saw it and said "You should market this." Okay, so I set it up for a 90 day free trial at www.r2t2software.com


Where does the r2t2 come from? Okay I admit it, I grew up in the late 60s & 70s so with my name being Roger Terry Ellis, r2t2ellis naturally followed the r2d2 when i made my e-mail address. So the name stuck...:eek:

I do not intend to tout this program so much on this board, but I am not bashful to say it is available. I am a surgeon by trade and a programmer by hobby...it works for me. I have been using the program two years and have ~3500 patients on the database that I share between two offices and 14 + computers.

Thanks for reading this.

Also, the Avartar is the logo I use with the program... :D

Terry

[kid@heart]

I'm a child and adolescent psychiatrist. Finding good psychiatry EMR is rough, especially when your field is a meld of psychiatry, developmental pediatrics, special education and peds neurology. I produce a lot of narrative-style H and P's. The language can appear awkward when driven by templates.

These days I use Pocket Chart for Pocket PC, loaded on my Hitachi Pocket PC phone--it's formatted for the way I work, prints out my H and P automatically and I don't need more than my cell phone to write my notes. It's accomplished with pull down menus with items pertaining to my H and P, which looks pretty smooth for a template-driven system. When I click on pertinent items on the pull downs they are incorporated into the chart note, which comes out on a Word document with a signature space--date is automatic--no transcriptionist required--along with main problems and diagnoses and codes. I can write scripts with it as well. I understand the new version allows physicians to fax scripts to pharmacy.

Because templates provided were not specific to my practice there was considerable modification to do, but because of my (self-taught, school of hard knocks) computer background I felt comfortable altering the templates provided and didn't do a bad job of it, if I say so myself.

If your practice is mainstream, like primary care, you may find Pocket Chart's basic template to be well suited to your needs as is, a real advantage.

Another advantage is price. I paid $1500 for it a number of years ago and only pay yearly upkeep fees. I think my last fee was around $750 for the year to secure the option to upgrade. 'Not bad, IMO.

They provide a certain number of hours of support as well for no extra charge, and can customize your templates for you during those hours, another advantage.

I do not know, however, if you can scan in documents. When I was in touch last year that was not an option, but things change. The records come out on Word documents anyway, so you could establish folders for your patients on your PC and scan the documents into those folders.

I purchased a Hitachi Pocket PC cell phone through Sprint, that hooks to the Web and has a camera (for chart ID photos, curious findings and "funny looking kids"). Pocket Chart does well on that phone. I can carry my patient records with me, in my phone, a real advantage when I am called by a patient but am away from my desk. As for the phone itself, it's not GSM and I've had a few things fail on it like the AC charger input and the Key Guard, so if a better quality phone with the same features comes along I'm in the market.

I wish Pocket Chart worked on tablet PC, but perhaps that's in the works. As for practice management (billing, etc), on the last version of Pocket Chart I had that aspect was limited. I believe they've upgraded but I do not yet have a copy of the upgraded program.

They have a Trauma version and some other special versions for particular specialties. They also provide a broad number of templates already tooled for a large number of medical fields, from PCP to subspecialty, with systems templates for in depth HEENT, Skin, CV, GI, GU, etc. if I'm not mistaken they provide a template for chiropractics and a few other fields as well.

You can check it out at Care Tools:

http://www.caretools.com/index.cfm

I believe Care Tools is now a subsidiary of GE Medical.

[consult]

Praxis 2.19 (released in 1998). Interfacing with Lytec practice management (3k) via X-link (an extra $700). I cannot fathom practicing medicine without Praxis.....It frees up so much of my time. Have a computer in each exam room (1k each, add hardwired to a compaq server that cost me 4.5K 2 years ago).

Server: desktop machine running Windows 2000 Pro. (not a real server but it works)

Clients: Windows 2000 Pro

LAN: Main server is a Windows Small Business Server (2000)

Cost of networked version of Praxis with Oracle database in 1/01= $6200. Added another doc (license) for $2200 last year.

Cost of support and training and upgrades=Free for life. Not only do most other programs charge an arm and a leg, they cost more up front. I have never had any down time with Praxis.

[kid@heart]

I just got a call from Pocket Chart. They tell me upgrade/maintenance is $495 for the year.

Also, according to another source, Pocket Chart is complimentary with Medisoft.

[d11aad38d]

undefinedundefinedundefined
May I look at this from a different angle? There are >400 commercial EMR Programs available. Most want to demo what they have and then sell us on how much better they are than the others. Most are look-alikes in most areas.
How many of the frustrations come about because of datathat we want is not there or not in a form that we use?
How many started by making a list (several subparagraphs deep) of the data that we want, and how it will be displayed (allergies under pharmacy or as a separate category)?
Most EMR companys sent sales people to us. Some EMR's are designed by physicians. How can we possibly expect someone in the "system" to guess what will work for us??
And for those who are insisting that only a brain can deal with the complexities of medicine, please look at the most common symptoms of the most common types of visits in 1 day or 1 week or 1 month. Now look how quickly we jump to the most common diagnosis for those most common symptoms (probably a few seconds). And now, list the differential diagnosis for those most common symptoms - was your brain able to review that list before making your diagnosis and developing a treatment plan?
So as an MD-IT person, can I say that I have seen just about everything that is good and bad about our way of communicating our way with our perspectives and everyone else's limitations?
We are enablers of Care; computer folks are facilitators of care. Those facilitators cannot enable care.
'nuf said. d11

[EMRhelp.org]

Hello DocsBoard,

When looking for an EMR, it is helpful to know what the cost of these babies are. Centricity will cost you more that a Porsche 911 Carrera. Amazing Charts is cheaper than a digital camera.

Please post the price of your EMR. Thanks.

:)

[Surgeon]

I am becoming pretty comfortable with chart logic, and feel that due to voice recognition, in the end it will not only save me money, but result in a finished note that is more in keeping with what I use and the way I think. Still a few bugs, and it wasn't cheap, but the more I use it the better I get with it, and the rep is making another on-site visit(even here in the 4 seasons empire region, which no one even recognizes by its nickname) to upgrade and work out any remaining bugs. Most of my problems are not with Chart logic, but with the interface with Dragon, and with Dragon itself, (ie 'specially marked' words which I cannot delete from the vocabulary)

[Desert Allergy]

Greetings,
I am thinking about using the GE Centricity (Logician/Millbrook) EMR/PM system for my new allergy and immunology practice. The cost is a bit steep, but most of this is in the hardware and support, not the actual cost of the software. I would like to hear more from those using Centricity and how they are inputing new patient data.
Thanks,
Sean

[mel]

Greetings,
I am thinking about using the GE Centricity (Logician/Millbrook) EMR/PM system for my new allergy and immunology practice. The cost is a bit steep, but most of this is in the hardware and support, not the actual cost of the software. I would like to hear more from those using Centricity and how they are inputing new patient data.
Thanks,
Sean
Welcome to Docsboard, the cost is steep partly because it is one of the bigger players catering for larger practices, see FAQ (http://www.docsboard.com/forums/faq.php?faq=vendor_list#faq_centricity). we have to date one user Seasoned User (http://www.docsboard.com/forums/member.php?userid=295) should be able to answer some of your questions, PM him/her :)

Mel

[LGrant]

Greetings,
I am thinking about using the GE Centricity (Logician/Millbrook) EMR/PM system for my new allergy and immunology practice. The cost is a bit steep, but most of this is in the hardware and support, not the actual cost of the software. I would like to hear more from those using Centricity and how they are inputing new patient data.
Thanks,
Sean
Sean, if you are a solo, have you looked at other products like EClinicalWorks? I am not sure Centricity is the way to go
L

[JeromeJim]

I am solo endocrinogist (internist).
In 1987, I had to send HCFA 1500 forms to Medicare. That was obviously a computer job. So I looked at what was available and ended up with a Mac software program done by a local programmer turned M.D. I had an Apple, so going to a Mac program was no stretch. The IBM PC programs missed a few things I needed. (Billing separately to Medicare for labs, but patient able to pay for the office visit.)
In 17 years, they have kept up with Medicare requirements (and BC BS) for electronic claims and have done good book keeping. The appointment module has been there for 15 years or more, but we have never used it.
When my building emptied out two years ago with the fire trucks outside, I began to realize that my daily CD backups of the financial program might do well to have ALL of my office notes in it.
So I began. Each office note is copied from the SOAP note of the previous visit and edited. I don't have a fancy module to soak up the lab reports, I just enter the pertinent stuff from the lab reports the next day. I just bought a two-side printing printer, so I could print the notes and save them in a real paper chart. I like paper, it is handy, but I also like electronic storage. I do a CD backup of the data file each evening and it takes 3-4 minutes.
I have front office, two exam rooms, my office running this database-system software. I have lost 15 minutes of work with hard disk crashes about 3 times in 17 years.
It just works. My "templates" are all my own, they are easy to use. I do not have any voice recognition software, it could be used and entered via cut and paste, but that doesn't fit the "criteria" for a good EMR with voice recognition.

Jim in Maryland

[mel]

I am solo endocrinogist (internist).
In 1987, I had to send HCFA 1500 forms to Medicare. That was obviously a computer job. So I looked at what was available and ended up with a Mac software program done by a local programmer turned M.D. I had an Apple, so going to a Mac program was no stretch. The IBM PC programs missed a few things I needed. (Billing separately to Medicare for labs, but patient able to pay for the office visit.)
In 17 years, they have kept up with Medicare requirements (and BC BS) for electronic claims and have done good book keeping. The appointment module has been there for 15 years or more, but we have never used it.
When my building emptied out two years ago with the fire trucks outside, I began to realize that my daily CD backups of the financial program might do well to have ALL of my office notes in it.
So I began. Each office note is copied from the SOAP note of the previous visit and edited. I don't have a fancy module to soak up the lab reports, I just enter the pertinent stuff from the lab reports the next day. I just bought a two-side printing printer, so I could print the notes and save them in a real paper chart. I like paper, it is handy, but I also like electronic storage. I do a CD backup of the data file each evening and it takes 3-4 minutes.
I have front office, two exam rooms, my office running this database-system software. I have lost 15 minutes of work with hard disk crashes about 3 times in 17 years.
It just works. My "templates" are all my own, they are easy to use. I do not have any voice recognition software, it could be used and entered via cut and paste, but that doesn't fit the "criteria" for a good EMR with voice recognition.
Jim in Maryland
Jim, Impressive work, those days computers didn't have hard drives, just a 720kb floppy, you could fit the entire operating system on a floppy disk. :) It was easy to remember what each one of the 40something DOS commands did.
Welcome to Docsboard
Mel

[Mike]

Greetings,
I am thinking about using the GE Centricity (Logician/Millbrook) EMR/PM system for my new allergy and immunology practice. The cost is a bit steep, but most of this is in the hardware and support, not the actual cost of the software. I would like to hear more from those using Centricity and how they are inputing new patient data.
Thanks,
Sean
Sean, I agree with above posters, GE Centricity is not ideal for a solo practitioner

[mwarddoc]

Jim's experience is very impressive. I've had an EMR for 3 years, and am satisfied with it. However, I've had far more than 15 minutes of work lost in three years due to various unpredictable issues. Most recently my server stopped assigning addresses to all the PC's on the network, completely baffling the techs, and clearly being a software issue with MS Server 2000 after all the testing, but 500 dollars of tech time couldn't isolate it...no changes had been made recently.
My initial network switch failed nearly three years ago and that cost around 250 dollars to fix.

My server, functioning without a glitch, completely filled up with fragmented files, going from 5-6 GB of data to 20 GB apparently without explanation, after months of flawless service. All of this was resolved, but it took some time and interrupted my work.

My server failed, chip failure, which cost me nothing but lost time...that was expensive, and Dell's customer service started sucking since I opened my practice.

So, I am paperless, and I must have a fully functioning system at all times, and as the old saying goes, "shit happens", and it is expensive to deal with, but the EMR has a lot of benefits.

I've had 4 pc's fail, one server processor failure, one switch failure, Dell's service went down the tubes (from excellent to quite frankly shit) and Gateway (we have 4 and will have no more) closed their local stores and their service on the 4 PC's that we bought all was transferred to Texas. I decided to go local with an expensive local vendor who does all the HP and Compaq stuff for local bigger businesses. They may be expensive, but they definitely want my dollar as quickly as possible.

Soapware with X-link to Medisoft Advanced Single User - Satisfied User

[Surgeon]

My charts with chart logic have -always- been available, every day since purchase, and so far the system has not been down.

[mel]

My charts with chart logic have -always- been available, every day since purchase, and so far the system has not been down.

Surgeon, we need some more info on Chart Logic
Mel

[Surgeon]

Some little company in Utah, which provides full paperless charting, uses Dragon Naturally speaking, and meshes pretty well with Data-strategies front office software for scheduling and billing, which my office manager likes. Probably not very good for a high volume low-complexity fp type office, but I find that it seems to be working well for me. The hardest part is the discipline to do the chart immediately after the visit, but isn't that the case with all medical paperwork. I like it because it results in a coded visit with immediate referral reply letter, which my sources seem to appreciate. My long term concern is because not very many people seem to be using it, when the true top-down dictated mandated conversion occurs, I'm going to be forced to change due to incompatibility with the Feds, the hospital, whatever.

[JeromeJim]

I beg to clarify. I have lost about 15 minutes on three occasions. Even that may be a stretch. It took longer to fix the problems, but the lost entries amounted to about 15 minutes to reconstruct those losses.

It is a very fine database system "Omnis from 'Raining Data'" and when it goes down, it basically has done so gracefully.

I have been running an Apple Macintosh system for these past 17 years. I have had my failures, but only three and each was a dying hard disk. I was just warned when I bought my last Mac that they are no longer the BEST hard drives and memory chips, just the cheapest for the week.

[Surgeon]

As far as lost time, I just had my biggest hit with chart logic. The tech is here loading the newest version(a freebie benifit) and states I have to redo all of my previous voice training, about which I have been very meticulous. Only about an hour of up-front voice training, but then the inevitable retraining of Dragon while doing charts in the next few months as I use new words. ARRRGH.

[mwarddoc]

Frequently, it isn't your EMR that is the problem, but all the supporting structures (network cables, switches, hard drives, backup tapes, and chiefly...USERS).

Teaching staff how to use a system is also an issue.

[FP_DOC]

SOAPWARE, time to look for something better.

[mwarddoc]

FP Doc

How long have you been using Soapware? I am almost to three years and find the flexible nature of the program quite a utility. I am an FP and have a primarily geriatric and sick patient population.

With customization it is doing a great job for us.

I am paperless, scanning all incoming documents, my database is quite large on SQL Server 2000 but functions quite rapidly.

My new HCA is a far better PC user than my prior LPN and has greatly eased my workload. Training her was a snap, and she made training modules for new hires in the future.

[FP_DOC]

FP Doc
How long have you been using Soapware? I am almost to three years and find the flexible nature of the program quite a utility. I am an FP and have a primarily geriatric and sick patient population.
With customization it is doing a great job for us.
I am paperless, scanning all incoming documents, my database is quite large on SQL Server 2000 but functions quite rapidly.
My new HCA is a far better PC user than my prior LPN and has greatly eased my workload. Training her was a snap, and she made training modules for new hires in the future.

One year, I cannot get anyone else in the office to use it, we are shopping for another EMR.

[Surgeon]

6.0 Chart Logic is now up and running in my office, easy interface with Data Strategies, many nice new features including easier writing of referral and referral reply letters, better voice recognition, ability to scan previous visits, writes scripts with ease based on either ICD-9 diagnosis or on previous script history. Still learning the newest version, but had a pretty busy office day today, and it really didn't slow me down at all.

[mel]

6.0 Chart Logic is now up and running in my office, easy interface with Data Strategies, many nice new features including easier writing of referral and referral reply letters, better voice recognition, ability to scan previous visits, writes scripts with ease based on either ICD-9 diagnosis or on previous script history. Still learning the newest version, but had a pretty busy office day today, and it really didn't slow me down at all.
Surgeon, I emailed Dr. Bruce Jorgenson for information about ChartLogic 2 weeks ago for our FAQ, no reply, you sure they are still in business? :rolleyes:
Mel :)

[Surgeon]

Yes, I'll get you the email address by tuesday. ChartLogic 6 was just installed in my office as part of the initial contract agreement(IE no additional cost) Wednesday.

[mwarddoc]

FP DOC

A bit of caution, if you've been using the product, any product of an EMR, regardless of how cheap or expensive, for 1 year and can't get anyone else in the office to use it, you are going to have a major problem setting up with any EMR. You have to learn every system. A lot of groups have spent scores of thousands of dollars and dumped everything in the end.

Everyone has to be committed to the changeover, or get out of the market for an EMR, in my opinion. There is a lot of adjustment, that needs to take place, and planning on how to handle things. I started from scratch, a much easier step than switching over. Half measures just increase the frustration.

There will be problems, and at times they can seem overwhelming, but they are easier to handle in a group...money helps immensely and groups can split the costs of tech time, servers, backup programs, PC's, etc.

[DrWinn]

FP DOC

Everyone has to be committed to the changeover, or get out of the market for an EMR, in my opinion. There is a lot of adjustment, that needs to take place, and planning on how to handle things....

I know of a few offices that have 1 EMR user and 1 EMR 'refuser'. The EMR user still benefits, but it is not nearly as smooth as it could be. For this to work, these offices print a note from the EMR each visit and store it in a traditional paper chart (yech). My personal opinion is that EMR user should try to 'convince' the non-user to convert or failing that, get a divorce and join a group of like minded EMR users.

[ObDoc]

There are still a few bugs which they promised will be fixed by October. Generally the functions are very easy to customize, charting is fast, price is "reasonable" for EMR, and the intergrated PMR saves a lot of work. We installed in May and have been happy with it. :)

[BigDoc]

There are still a few bugs which they promised will be fixed by October. Generally the functions are very easy to customize, charting is fast, price is "reasonable" for EMR, and the intergrated PMR saves a lot of work. We installed in May and have been happy with it. :)
Welcome ObDoc, we are short of OBs :) BTW,'like your avatar :D
B

[ObDoc]

Thanks BD,
Avatar is from my 3D ultrasound. Pretty cool!

[ozzie]

There are only 10h types of people in the world, those that understand hexadecimal, and those that don't.
looks better

oz

There are only 16 types of people in the world, those that understand hexadecimal, and those that don't.

[BigDoc]

Thanks BD,
Avatar is from my 3D ultrasound. Pretty cool!
Forgive my ignorance, modern ultrasounds can do this? :confused:
BD

[mknauss]

We have a busy 3 office, 4 MD dermatology practice and we are very happy with MediNotes Charting Plus. We are "paperless" and much more organized now that we are electronic. We write notes that are much more thorough, improve patient care, and (for once!) actually detail what we have done.
Hi, I am just setting up my office for Medinotes. Since you are using this could I ask a couple of questions? What method of backup do you use? What type of server setup did you incorporate?
Thanks for any input!

[ecmcdougall]

I'm presently using PMSI's Practice Partner, in a small group office. I'm not a happy customer, though; we're in the process of trying to find another solution - mainly because Practice Partner is too expensive, with yearly license fees that are higher than most competing EMR's total cost. Setup for 6 docs was $144,000 with a server, and some networking infrastructure. Licensing is about $14,000/year.

I recently had a nice rant about Practice Partner that goes into more of the details; that message is here:
http://www.docsboard.com/forums/showthread.php?t=1177&page=2&pp=15

Anyways, I'm looking into other EMR's. I wouldn't recommend Practice Partner to anyone; we definitely didn't get what we thought we were paying for.

ECM

[Surgeon]

Surgeon, I emailed Dr. Bruce Jorgenson for information about ChartLogic 2 weeks ago for our FAQ, no reply, you sure they are still in business? :rolleyes:
Mel :)

jamesderse@chartlogic.com
(888)337-4441

[ozzie]

Anyways, I'm looking into other EMR's. I wouldn't recommend Practice Partner to anyone; we definitely didn't get what we thought we were paying for.
ECM

When you have time I would like to learn where the system failed ??


oz

[ecmcdougall]

When you have time I would like to learn where the system failed ??


oz

Well, the worst is the stability issues - the program crashes routinely(daily). The data is reasonably safe, though - we haven't lost any despite a couple catastrophic server crashes. The other big issues include:

1. no facility to import consultant letters, path. reports, or any of the other millions of pieces of paper we get every year into the patient's electronic chart. PMSI sold us a separate program that stores scans, but it's full of bugs, and it doesn't catalog the scans in any useful way - I have patients who have 200-300 pages of notes; I have to go through the scans one by one to find what I need, and it's slow - it takes a few seconds to load each page. My paper charts are much better organized. This is the main reason PP isn't a paperless solution.
2. Lack of ICD-9 coding or E&M level assistance. I admit, a luxury, but it was one of the things they used to sell the program- "It'll help keep your E&M coding legal"! Nope, it doesn't.
3. No way to fax prescriptions to pharmacies. Again, a luxury, but a necessary one.
4. Incredibly primitive text editing in the notes and messages, like it was programmed by a first-year computer science major 15 years ago. Not a consistant interface either - there's different rules for entering and correcting text in notes vs. messages.
5. Primitive office messaging system. It takes 7 mouse clicks and a password to properly answer a simple "yes or no" message. Multiply that by 50-100 messages a day, and you're getting a sore wrist from the mouse, and a headache from all the time you're wasting. Most other programs do the same thing in 3 clicks or less.

Overall, it needs a major overhaul - it was due at least 5 years ago. PMSI hasn't indicated that they're going to do anything in the next while; the last "major upgrade" we got sucked into didn't change the interface or capabilities of the program at all. I suspect that they're content to just milk their licenses for as long as someone's willing to pay - it doesn't cost them anything.

ECM

[pprescot]

4. Incredibly primitive text editing in the notes and messages, like it was programmed by a first-year computer science major 15 years ago. Not a consistant interface either - there's different rules for entering and correcting text in notes vs. messages.
ECM

The lack of a consistent interface has been one of the biggest problems I've encountered with EMR. While the program may be Windows based, different keys/keystrokes are used in different modules to do the same thing.

What do companies do? Have teams work on each module separately with no communication and no first-line plan?

[ozzie]

What do companies do? Have teams work on each module separately with no communication and no first-line plan?

Sadly yes..
Clickability is never a high priority, thats why in some ways open source shines as each module has to be totaly independant. Web based software is so much easer to change

oz

[volker]

If you are interested in the technical aspects of computing and EMR's then I would recommend FreeMED to you.
FreeMED has the ability to import faxed data from hospitals, labs and other providers - no costly hl7 interfaces needed. This EMR has templates, ability or print or fax reports and prescriptions, HIPPA compliance, secure access from remote locations, integration with Dragon Dictate and a hl7 facility (if you want to integrate it with your practice management program). There is also an integrated billing program.
We chose FreeMED after commercial vendors gave us quotes of $200,00 up front and $12,000 a year for license fees, upgrades and support.
We are using FreeMED in our group of 5 surgeons and gastroenterologists in two separate offices. We've kept our own practice administration program therefore don't know anything about the billing abilities of Remitt which is the new integrated billing program.
The FreeMED software and updates are free. There are no monthly fees. Hardware, networking infrastructure, installation, reliable support and special features designed for an individual user are not free.
I.d be willing to answer questions about FreeMED in case you are interested.
Volker

[ozzie]

hey Volker about time you got off your elbow LOL

oz

[mbenjam]

FreeMED: It slices! It dices! It has no useable documentation! How do you add a new encounter? How do you set up a template? How do you import faxes? How do you customize the interface?

Having the source to unuseable free software is NOT better than paying for documented commercial software. Open source evangelism is a wonderful thing, but at least SOAPWare came with a manual designed for an end user. What a novel concept.

:)

[ozzie]

mbenjam
Here I was helping some poor soul on the street with an ailment.. unpaid and just trying in my own way to help the world be a better place. After giving some basic first aid and a couple of unmarked bandages. The patient become snippy and preceded to complain and act like they were in a first class care facility and paid a $2000 a day bill..
Yelling about how the bandages did not have any instructions.. Odd really as all the patient has to do was unwrap the package and they would have seen that it was very simple.

Doc you really need to understand the reality of the market,
Most Dr's are technology anemic.
Most Dr's have no time to learn systems
Most Dr's have very poor practice management skills
Most Dr's resist change.
Most Dr's need to change a lot of their practice BEFORE they get an EMR.
Most Dr's have zero capability of setting up a server based system.
Most Dr's don't understand that there is not and probably never will be a true plug in play and run EMR system.
Most Dr's don’t understand that as group they have the power to have the best EMR system in the world.
Most Dr's understand basic ABC (Airway Breathing Circulation) is as vital to a kid who fell of a bike and to a person in surgery having a heart transplant.
Most Dr's do not understand Open Source.
Most Dr's do not understand how open source is important to serve this web page as it is to create research capabilities like this http://www.scholar.google.com/

So I don't expect an apology but I do expect you to understand

oz

[Surgeon]

That's a slightly depressing but very realistic depiction of the situation. I have a paperless office system, and the first doc I saw who had one was in 1993 in Beaver Falls and saw the potential. My only concern now is that I'm not using it to it's fullest capabilities, patient education, diagrams, the finer points.

[ozzie]

Sorry to ruin your day ..
I dont make the news I just report it LOL

[Surgeon]

I think documentation was a huge problem in the earlier commercial sofware business, which they fixed because they got pounded by the calls for tech support. Medical soft-ware does not appear to have learned this lesson. Chart-logics written documentation support is worth than useless.

[mbenjam]

The open source watchword seems to be, "The world owes me a profound debt for making this software, so how could it be so greedy to want documentation too?" Often when there are docs, they consist of an installation howto. Nothing about the subtleties of the interface. I'm sorry, but if you have the greatest software in the world, how is anyone gonna appreciate how great it is without a manual?
Maybe the world doesn't need a manual for a word processor or spreadsheet by now. It's all pretty self-explanatory by now. But this is software that is markedly different from vendor to vendor. Maybe it's worth learning about how the developer meant for it to be used!

I also see an attitude among open source developers that if you want documentation, you "don't get it" or worse, you're "one of them." I think this is counterproductive, and continues to alienate people from the open source movement. Like I say, you could have the best program in the world, and it don't mean a thing if nobody knows how to use it. It's one thing to tell the user, "RTFM." It's another if there's no "FM" to begin with!

Saying that the end user has to adapt his workstyle to fit the software is also counterproductive. UPS made clipboards for their deliveryguys probably with the input of management and delivery workers. When you rent a car, the guy has a combo scanner/printer that both checks your car into the lot and prints your receipt. Is it too much to ask for a doctor to want his information technology to mesh as accurately with his workflow?

Saying that the end user has to be an expert in all things computer is also counterproductive. You know that drivers of automobiles used to have to know how to fix them, because they were always breaking down. Cars were simpler when they first came out, so this was a reasonable task. Nowadays, cars are a lot more complex and specialized workers fix them. But they don't really break down a lot, and the end user is now insulated from the inner workings of the machine. This level of insulation is what the world apparently wants from complex technology: it's part of the reason why MacOS continues to be so popular, and why Microsoft keeps getting further away from the command prompt. If you're interested in this line of reasoning, there's a whole issue of the Economist from two weeks ago devoted to it. I think it's probably required reading for this audience.

To me, at the end of the day, I want to be a doctor. I want to see patients, get paid, and go home. I don't want to have to spend endless time wandering through yet another EMR package hoping to find something that usually isn't there. I don't want to have to learn yet another programming language just to see a patient. I just want a system that works as well for me as the FedEx guy's works for him. Is that too much to ask?

MySQL has documentation. Apache has documentation. R has documentation. I don't think documentation is the antithesis of open source. It's the symbol of a mature project.

Mike

[volker]

Hi,
You're right of course. There is inadequate documentation for FreeMED right now. The documentation will be completed after all of the desired features are in FreeMED. In the meantime, friendly folks will answer your questions. There are many FreeMED users.
1. How do you enter an encounter?
Register the patient. Do this by going to Patients ->New. After the patient is registered, go the patient's chart and write a progress note. Do this by going to Patients -> Select. Go to Progress notes and click on Add.
2. How do you add a template.
You can construct templates for progress notes and for letters. Let's say you want to add a template for an entity that may see repeatedly (I saw a lot of inguinal hernias, for instance). Click on Progress Notes->Add. Next to Progress Notes Templates click on Add.
3. How do you import faxes?
Connect your modem to the server and make sure that hylafax is installed on your server. The faxes will automatically go to a category named unfiled faxes. The faxes are then filed to a specific patient, physician and fax type.
4. How do you customize the interface?
The modules that installed are controlled by going to Patients->Configure. The position of each chosen module can be set anywhere on the page.

Now my friend, I must say that I disagree strongly with the statement " Having the source to unuseable free software is NOT better than paying for documented commercial software".
First of all FreeMED is useable. We are doing this every day in our five member practice.
Secondly, commercial vendors wanted 180,000-$209,000 up front and $12,000 a year forever for a documented package. I'd rather spend $25,000 once and spend some time learning. I bet you would too.
By the way, I'm not an evangelist. Just telling folks what we found to be extemely useful.
Feel free to write if you have further questions.
Sincerely,
Volker
volker@srnet.com



FreeMED: It slices! It dices! It has no useable documentation! How do you add a new encounter? How do you set up a template? How do you import faxes? How do you customize the interface?

Having the source to unuseable free software is NOT better than paying for documented commercial software. Open source evangelism is a wonderful thing, but at least SOAPWare came with a manual designed for an end user. What a novel concept.

:)
:)

[volker]

To me, at the end of the day, I want to be a doctor. I want to see patients, get paid, and go home.

Mike

Mike,
I understand your point of view and have heard you loud and clear.

Respectfully,
Volker

[mbenjam]

Hi, thanks for the thoughts. Since the thread started, I had a baby boy, bris ceremony today. So I haven't been around here much.

To stay sane, I'm trying to learn Tk for Perl. I am not that happy with the web-browser as an application server for EMR. It's kind of slow with large databases. I'm experimenting with GUI toolkits, and the best documented is Perl/Tk. There are a few visual Perl/Tk RAD tools out there, and I am experimenting. I downloaded the Eclipse package for Java development, and it's pretty impressive. I really don't want to have to learn a whole new language--Perl gets the job done and is fairly simple to use. Microsoft just released a Visual Basic beta for free--look on slashdot.

Anyway, I will check out freemed--it's not terribly high on the agenda. I am mostly looking to add on to SOAPWare at this point. I really like the sophisticated reports it generates, and the macros (text shortcuts). I would add on a charge parsing tool and a flow sheet extraction tool (flow sheets are too hard to use currently). I'm kind of stuck in first gear for these tasks.

Regards,
Mike

[volker]

Hi, thanks for the thoughts. Since the thread started, I had a baby boy, bris ceremony today. So I haven't been around here much.

Anyway, I will check out freemed--it's not terribly high on the agenda.
Regards,
Mike
Congratulations! Wonderful time in your life.
You sound quite knowlegable. Let us know what you develop. We would be very interested.
If you should want to check FreeMED out some time, go to http://www.freemed.info/index.php
User demo, password demo
The beginning of the documentation project is found at http://www.freemed.info
Volker

[mel]

Hi, thanks for the thoughts. Since the thread started, I had a baby boy, bris ceremony today. So I haven't been around here much.


Congratulations :D

[mbenjam]

(Trying not to get too far off the thread here...)

I'm thinking of studying Visual Basic as an EMR platform. I know Al Borg's had a lot of success at that...

[Kursk]

VBA vs VB vs VB.net?

[Scroggie]

If I had to pick (having done all mine VB in VBA with access), I would pick VB.net as that's what they (MS) are moving towards.

That said you can pick up a VB6 book cheap and most of the syntax is translatable. As for cost, VB6 and .net I think are separate $$ programs while VBA is included in Office suite.

[Kursk]

To my primitive mind .net is several orders of magnitude more complex than VB. I have been porting some of my code to asp.net and the learning curve for . net is wee bit steeper....

But then I have always felt brute force trumps elegance.

[ozzie]

But then I have always felt brute force trumps elegance.

So why dot.crap then ?? .crap to Very Bad is leap but only hop..
if going net use the REAL net not the faux pas
Go go deep and indefinite

[Kursk]

I live in an MS world at work where my painfully amateur projects must evolve or become extinct. Free thinking is not a virtue in this environment.

Can you offer some elegant, detailed criticism of .net and its purported crappiness?

[ozzie]

I live in an MS world at work where my painfully amateur projects must evolve or become extinct. Free thinking is not a virtue in this environment.

Can you offer some elegant, detailed criticism of .net and its purported crappiness?


Sure oh great one follow thy heart believe in thyself.
Trust your own words..
open source will always evolve ( yes and some will dissolve too ) MS versions become extinct by design. Their sibling survival depends on it.

So are you creating solutions or dependencies ???

Open source MS to a point is like bottled water the water is free but you have to buy the packaging..

I did trust MS at one point in time but not any more.

oz

[ShringkRap]

QuicDoc seems to be a great option for mental health types. It syncs with a billing program called Office Therapy by the same company, and can import your contacts to use with it's word processing software.This is good for sending info to referring providers. I am a child psychiatrist and I have not before found a program that addresses so many of my needs. It can also work with Lexicomp for upgradable pharm info, and generates patient info sheets.

[Kursk]

The organization is migrating to active directory.

Its the End Of The World As I Know It.

Pray for me.

[ozzie]

Better light a candle for the DNS server too,
it dies so does your network (unless you have a manual DNS chart on every desktop )
if you have to do any windows admin stuff I know
a great book that shows you clcik by click how to do just about anything..

[Kursk]

Yup, I definitely need a book. Many are enthusiastically endorsed on Amazon. I'd love to hear your pick.

[ozzie]

Yup, I definitely need a book. Many are enthusiastically endorsed on Amazon. I'd love to hear your pick.
2000 or 2003 ??

[Kursk]

2000 or 2003 ??
Its 2003

[ozzie]

Master Active Directory Visually was the book I used. I already knew about the idea of active directory which is just the MS implementation of X.500 or subtitled how to charge for industry standard protocols..

I liked this book because it had screen shots step by step of how to do just about anything. Anything deeper I got from the MS site..
AD is one of those deals where you learn what you need to know and then move on .. Dont get lost in the details because the details are endless..

its nothing more than a database and externally looks like DNS internally its just a bunch of requests hitting databases..

MS had to get away from "browsing" So this was one way to do it and also have multiple subdomains under a master domain

oz

[Seasoned User]

I use Centricity (more than I use this board regrettably -- this IS a pretty nifty site) PM and EMR since 1/2001, having started when it was Millbrook and Logician. It is well-suited for sites with full-time IT, as this permits more rapid engagement with its many functionalities.

GE has also given the small user market (I think that their cutoff is 5 users) to VARs, largely from the PM side. They are still learning and understanding the EMR part, so this has kept that aspect of marketing relatively low on the radar screen I think.

Lastly, GE is hoping to put the suites on the same database engine, SQL (Yukon), which in preliminary tests is working promisingly. Nonetheless, their commitment to a well-integrated SQL (PM) and Oracle (EMR) environment is paramount, and I think that they have succeeded admirably in pushing the "apparent" duality into the background.

In that regard, the IT maintenance duties are pretty easy (periodically shutting down the interfaces and databases -- with a script -- doing a "cold" back-up -- and starting things up again. I have to resolve rare interface conflicts. My staff forget to put in one of the critical pieces of info, such as gender, for instance). Configuring the software to one's own style is evolutionary, and not easily restrictable given the marvelous flexibility of the suites. I set up a bunch of medication and problem custom lists early on, the former of which are wonderfully useful for my nurse when I want an antibiotic prescription written, for example. Just pick the med and the rest is filled in and faxed. Subsequent changes really deal with the manner in which one wants his software to incorporate the structured data already entered to automate further processes. Centricity has a built-in language for users to do this.

All of this is to say that the product -- because it was initially marketed to larger groups and is relatively expensive, because it possesses a level of flexibility and thus relative complexity (to permit multiple users different ways of interacting within the same system), and because GE Healthcare corporately has insulated themselves from the small user market with VARs (though the VARs seem to be tackling the job with verve) -- has not been well-associated with small users.

But that does not have to be. I have found it a terrific value, and a wonderful tool for managing my solo family medicine office. I have not realized all that I want to be in that arena, but GE Centricity has never limited me. I would encourage those who relegate it to the realm of larger practices to consider its functionality anew for their small offices. It can hold its own against the best, I believe. It has been there longer than most. And, most importantly, it has the strong committment of GE behind it, assuring it an enduring legacy.

[echopappa1]

Thank you for this site and info. I am a surgeon in a small town, one other shares office with me. I am just now looking for the right EMR to try. Cost is a big issue, as I can't even fund retirement this year. Oddly, I've noticed that expenses go up, and income goes down, every year, and paperwork always increases. As we say in the Army, "Outstanding!"

[mwarddoc]

Medicare gave us a 1.5 % raise this year, what are you complaining about. Take that and subtract your rental costs increase of 3.75%, your insurance increase of 20%, and give your staff get a cut of pay to offset any losses, drop their health benefits, essentiallydrop their retirement plan by cutting their wages to the point they can't put any money into it and avoid the matching costs, cut their vacation pay (you don't get paid when you don't work so why should anyone else), drop their sick pay and sick leave, and outsource your billing and transcription to India.

You'll do just fine.

[drcarol]

Just to put in a plug for AmazingCharts--Was using the 1.2.6 version and wondering if I should convert..then the 2.0 version came out and the office is pretty glad we stayed with the plan..my office staff would kick me if I went back to regular dictation as it saves both the encounter, dx codes and cpt codes. Plus when Jon Bertman (a real FP) says no BS he isn't kidding. Got online instant support and repair (they use a Citrix system to do online system checks, and for 63/month support plan it's a pretty good deal. I am told it works with Dragon Naturally Speaking, but after kicking my headset around trying to use Via Voice I think I'll stick with typing and templates for now.

[Trephine]

Have been using TurboDoc for > 12mos. As we are surgeons, it works well for us. Does all clinic notes, op notes, orders, scans in x-rays, face sheets, consults etc. and custom forms. We like it since it is totally customizable. We are also paperless with old charts scanned into Adobe. We enter notes using a combination of tapping selections from templates, voice recognition with Dragon and some typing.

[mel]

Have been using TurboDoc for > 12mos. As we are surgeons, it works well for us. Does all clinic notes, op notes, orders, scans in x-rays, face sheets, consults etc. and custom forms. We like it since it is totally customizable. We are also paperless with old charts scanned into Adobe. We enter notes using a combination of tapping selections from templates, voice recognition with Dragon and some typing.
Welcome to Docsboard
How many physician users?

[Surgeon]

Echo, you might really want to look into ChartLogic, I continue to be happy with a totally paperless office, voice recognition, and in-house coding and billing for a solo sub-specialty practice.

[Trephine]

Mel - There are just two of us now. TurboDoc is an Access database so it is probably suitable for up to 5 docs. We have a dedicated server, with a Raid 1 array. We (the docs) use tablets and when we return to the office we "sync" with server but can carry all of charts with us. 1500 patients is about 6 megs. There is nothing like a relational database!

[bileduct]

Echo, you might really want to look into ChartLogic, I continue to be happy with a totally paperless office, voice recognition, and in-house coding and billing for a solo sub-specialty practice.

Surgeon,

I'll be in a similar situation soon - starting solo general surgery practice and am looking at having an EMR in place when the door opens. I've heard some positive things about chartlogic but the price I saw at the ACS last fall was pretty steep, still waiting on a quote. How much did it cost for you? Also, what PM software do you have (back and front office) that obviously works well with it.

[BigDoc]

Surgeon,

I'll be in a similar situation soon - starting solo general surgery practice and am looking at having an EMR in place when the door opens. I've heard some positive things about chartlogic but the price I saw at the ACS last fall was pretty steep, still waiting on a quote. How much did it cost for you? Also, what PM software do you have (back and front office) that obviously works well with it.
Welcome to Docsboard

[nowwut]

Anyone out there using A4? Had a demo today and the opinions were all definitive - for and against. Nobody in the middle. Would love to hear any input from others.

Thanks

[Kursk]

Nowwut can you fill us in on the arguments given for and against?

Was it against EMR in general or a specific problem with A4?

[nowwut]

Here's a quote from one of my associates who has been most actively involved in the EMR search for the practice:

We had two site visits to practices using A4. One was in North Carolina, and reportedly the system was well implemented, and everyone was happy. The site I visited had no complaints either. However, the doctors were "free texting" many of their EMR visits. The docs also told us that they spent 1-2 hours a night after seeing patients writing templates for A4's EMR. The EMR and PM components were not connected in this practice. Even though they bought the software for both PM and EMR, they were still using paper superbills. (!) The practice administrator couldn't pull up many of the reports that the company profiled in its demo.

My assessment was that the system was "bare bones" and implemented poorly. When I questioned the A4 reps about this, they maintain that it is better for a practice to have the tools to build clinical templates than it is for them to have templates available for customization. They also stated that practices really didn't need extra time for implementation and that the practice I visited "would catch up". I was not comforted by this response. I am interested in other practice's experiences with implementation of A4...was it smooth? Are you using all the tools and components the way that is it demonstrated?


In contrast, other members liked the single company aspect and the flexibility. One person commented about how good the screens looked.

[mwarddoc]

I can't comment on A4, but I can comment on Templates, and I can understand the comment by the A4 rep. I use Soapware and don't use any of the templates it came with, not because they aren't any good, but because they don't reflect the type of work that I do.

However, in this program, you can input any type of template that you want, and use a report generator to print out many types of customized reports and forms that you create. It does take work to set up, but allows great flexibility.

I get records from "templated" offices. They are useless, meaningless, to both the patient and me. This applies to paper and electronically generated records. Docs use templates in a variety of ways, and for their own purposes. You need to be able to design your own. I'm in primary care, and most of my patients are sick, sick, sick and on tons of meds. So, templates are not easy to design for the multisystem, multiproblem visit.

However, in Soapware, I could design and implement a template for an ophthalmology visit in less than 30 minutes, including a printed report where free drawing could be scanned in from the exam, and it would suffice for better than 90% of all ophthalmology visits.

You really need to look at how you will implement and use the system, it isn't any easy task unless you have a lot of experience.

[Desert Allergy]

Greetings again,
I have now been using GE Centricity (Version 5.6) in my solo allergy/immunology practice for the past 2 months. It takes awhile to get everything up and going, but overall I am impressed with the capability of the software. I am using the CCC Speak forms along with their Dragon voice recognition system. There are many nice features and I have been working to customize the system to fit my exact needs. We use both the EMR and the PM products and have had minimal downtime, except when I accidently shut down the server or we lose power in the community!
I am utilizing a VAR by the name of HealthCo, based in the NorthWest, and they have been very responsive to my requests and concerns. Overall, this is a system that can easily work for a single user and has the capacity to expand to cover many users.
Take care,
Sean :cool:

[samadoc]

We have been live with a4 for 3 years. We initially used all of the a4 templates that come with the system. We found these to be very useful but we have since modified them to fit our needs. In hind sight, a4 makes building and using the templates so easy we would have built all of ours from scratch. It is not that tedious or hard. I typically see 22-30 patients a day and only spend 5-10 minutes after the last morning patient and 5-10 minutes after the last evening patient completing charts. We are paperless. Billing goes across electronically. We have been extremely happy with a4 and our EMR.

[nffmjrm]

My practice has been on EMR since 1998. It has been a life saver for us. We are not a bunch of computer geeks (possible exception being me) and we were able to implement it easily and quickly. It has changed our cash flow, patient flow, quality of care, continuity, etc. I have seen places where the implementation of A4 was a problem but every one of them was user error or not having a "champion". If you are dedicated to making it work, it is great and is not that hard to do. Templates were created over a weekend. Interfaces are great. I don't have complaints at all. And thay have plenty of other solutions...

Last year we implemented a patient portal. It's called HealthMatics Access and has totally changed how we communicate with about 85 percent of our patients. It's a secure portal they can use for messaging, labs, refills, appointment, see their vital signs, see their problem lists. I have a patient who was in Utah skiing and got altitude sickness. When he went to the ER he did not remember his meds and the ER doc got into his Access account and could se the meds listed there. Not a personal health record but close. It is a wonderful thing.

You just have to have an EMR!




Here's a quote from one of my associates who has been most actively involved in the EMR search for the practice:

We had two site visits to practices using A4. One was in North Carolina, and reportedly the system was well implemented, and everyone was happy. The site I visited had no complaints either. However, the doctors were "free texting" many of their EMR visits. The docs also told us that they spent 1-2 hours a night after seeing patients writing templates for A4's EMR. The EMR and PM components were not connected in this practice. Even though they bought the software for both PM and EMR, they were still using paper superbills. (!) The practice administrator couldn't pull up many of the reports that the company profiled in its demo.

My assessment was that the system was "bare bones" and implemented poorly. When I questioned the A4 reps about this, they maintain that it is better for a practice to have the tools to build clinical templates than it is for them to have templates available for customization. They also stated that practices really didn't need extra time for implementation and that the practice I visited "would catch up". I was not comforted by this response. I am interested in other practice's experiences with implementation of A4...was it smooth? Are you using all the tools and components the way that is it demonstrated?


In contrast, other members liked the single company aspect and the flexibility. One person commented about how good the screens looked.

[mel]

Welcome Samadoc and Nffmjr to Docsboard, and thanks for the info, good to see 2 happy A4 users :)

[Sprocket]

Hello all. Glad to be here.

I will be starting up my own private primary care practice (solo, and a half--my wife is the half-timer) this summer, and WILL be using an EMR. I WILL, I WILL...I hope.

I have narrowed my list down to:
SOAPware
eClinicalWorks
Misys (!)
A4

Misys has a very "put-together" package, and an established history. BUT...I just got the quote from the rep, and for hardware included it's almost $70K!!!! For a solo practice. That's just not gonna happen, now, is it? And the maintenance is nearly $10K a year!!!!! I think that's the killer.

I am trying to arrange a site visit with an eCW user. This is probably the front-runner now, since they have integrated PM also.

A4 is also on the list, but for some reason, they have not responded to my inquiries about pricing, etc... Hmmm....

Opinions, please? I am getting behind on my schedule, but this is important!

[Kursk]

What did the list look like at the start?
E-MDs is getting some good buzz of late due to the latest product changes (I have not seen them though). Your experience with A4 is not unheard of for small practices.

[Sprocket]

What did the list look like at the start?
E-MDs is getting some good buzz of late due to the latest product changes (I have not seen them though). Your experience with A4 is not unheard of for small practices.

Well, I have been following the biz for several years, now. I researched the "core partners" of the AAFP's program, and then branched out. I also had a bunch of demo's a couple of years ago for my current hospital-owned practice before they decided that they weren't going to foot the bill after all. Just one of the many reasons I'm leaving that situation.

Yes, price does matter, and if the software is more than 20K or the "maintenance" is more than a few hundred dollars a month, it's just not an option, period. I know you get what you pay for, but it's not so accurate when you're talking exponential increases in price.

Anyone here use eClinicalWorks????

[BigDoc]

Anyone here use eClinicalWorks????

Welcome
We have one (http://www.docsboard.com/forums/faq.php?faq=vendor_list#faq_ecw) user, forget which one

[ktdodson]

Sprocket:

I've been looking at EMRs now for 3 years and have purchased 2 (Medinotes and e-MDs). Looking at your list, I think you should eliminate Misys and A4. I could be wrong, but I think Mysys runs on a Unix-type system and both systems are very expensive. They often won't waste their time with small practices.

[Scroggie]

GE Logitian is here in my conference room wowing my partners. Ahhhhhhh, ohhhhhhhh pretty.

I'm in a bit of a quandry: if I want the office (40+ docs) to get an EMR, they want GE. If I vote against GE we'll stick with paper charts and dictation (I can still use my own homegrown EMR).

What to do? Can I vote against technology?

[Sprocket]

Sprocket:

I've been looking at EMRs now for 3 years and have purchased 2 (Medinotes and e-MDs). Looking at your list, I think you should eliminate Misys and A4. I could be wrong, but I think Mysys runs on a Unix-type system and both systems are very expensive. They often won't waste their time with small practices.

I got my quote from Misys :eek:, and lets just say they are off the list


The yearly "maintenance" fees were more than I planned to spend for software alone...
And the required hardware is way, way more expensive than others.
It looks nice though. Just not for me and my solo startup...

[jlindsey]

IM. My NP loaned me the 20,000 plus to buy e-mds and we like it. Using it 2 months without training yet, and practice is too busy for us to make our own templates, etc. yet. We still get done faster, get better coding, and get great notes with the system as it came. Great for primary care or specialties where you see patients with multiple problems long term. Probably more than needed for ortho, surgeons, etc. Went through Soapware, Logician on-line, Sevocity (avoid), Soapware again, Medical Office Online (specialists should check out this one!), and Soapware yet again.

[BigDoc]

IM. My NP loaned me the 20,000 plus to buy e-mds and we like it. Using it 2 months without training yet, and practice is too busy for us to make our own templates, etc. yet. We still get done faster, get better coding, and get great notes with the system as it came. Great for primary care or specialties where you see patients with multiple problems long term. Probably more than needed for ortho, surgeons, etc. Went through Soapware, Logician on-line, Sevocity (avoid), Soapware again, Medical Office Online (specialists should check out this one!), and Soapware yet again.
welcome aboard, you will be pleased to know e-md CEO is one of our members

[jonp]

Office setting: 2 doc + one part time NP, semi-rural primary care practice in northern California. I'm a 55 year old internist, partner is a 58 y/o FP.

System: Win2000 DELL server, 1 GIG RAM, Xeon 2.4 processor, 80 GB RAID Hard drive. 6 ethernet stations for MAs, back and front office. 3 Motion tablets for providers accessing the network wirelessly through Linksys access points.

Practice Management: a system which works well but is little known outside the northern Sierra, DAL.

EMR: Chartware. Haven't seen any postings from users of this system. We've had it for two years and works well. Handles multiple problem visits well, no need for dictation

[jonp]

Forgot--price: Hardware for the system, ca $18K. Chartware EMR each license was $6K when we bought it; today's version around $9k per license, now running under SQL server (we haven't upgraded yet to this, and are still using the Access database version.) Yearly maintenance per license $1900.

[BigDoc]

Forgot--price: Hardware for the system, ca $18K. Chartware EMR each license was $6K when we bought it; today's version around $9k per license, now running under SQL server (we haven't upgraded yet to this, and are still using the Access database version.) Yearly maintenance per license $1900.
Welcome, you are the first Chartware user to join Docsboard. Why didn't they pick a less confusing name, Chartware, Chartlogic, Chartnotes :eek:

[jonp]

Dunno, another name in the legion of EMR systems. Actually, I've heard of few of the programs on this thread other than SOAPware. We reviewed PMSI Practice Partner, found its template system unworkable, especially for the complex, multi-problem visit. PMSI's subsequent support costs are frankly extortionary.
I don't find dictation, even into the excellent dictatation software available today, a very good solution to charting in primary care, as one must still chart outside the room. The grail for me is to complete all aspects of the patient's visit when I leave the room, including generating a complete note along with all prescriptions, fee slips,
orders, referrals, the works. Then all I've got at the end of the day are the last refills and call backs.
With Chartware the HPI & ROS are not in complete sentence form, but they contain all the symptoms and modifiers to describe the illness, and I am entering the data in real time. Same with the exam, quite complete, assessment and plan/dispensation/documentation of patient education and follow up.
Primary care is unique in its multisystem charting complexity. Make sure whatever system you buy can reflect that, work in real time, and not cost the farm.

[margesimpson]

I am startind a solo IM practice in one month and will use PowerMed, a 12000$ Mac EMR. It looks acceptable, I am still learning to use it. I had a hard time to work with their support people, though (a bit of an attitude).

[mel]

I am startind a solo IM practice in one month and will use PowerMed, a 12000$ Mac EMR. It looks acceptable, I am still learning to use it. I had a hard time to work with their support people, though (a bit of an attitude).
Isn't that a bit pricey for a solo IM?
Does this include the scheduling and billing modules? How many users?

[margesimpson]

I own it and don't have to pay anything else. Can have 3 users but now I am the only one. No, billing is separate. It is more expensive but I had the hardware already and Mac EMR's are rare. Plus my husband will maintain the whole thing.

[byke32]

I am thinking of using powermed myself for my solo practice. The quote I got is EMR for 11000, practice management for 5000, monthly clearinghouse is about 250/month, or you can hire Powermed for billing service. Please update us on your experiences with Powermed.

[margesimpson]

Sure. Just make sure you put everything in writing before you pay.

[rmhansonmd]

We are in our 8th year of using Practice Partner Patient Records, as well as the billing program and the appointment scheduler. I would have to disagree with JonP's statements regarding templates and support costs. Our support costs run just over $1,000 per doc per year - well below the positive effect to the bottom lines in terms of savings in staff costs and improved productivity. With regard to the templates, we have made extensive customization and are able to do exactly what JonP says he would like - that is, to complete all documentation during the patient encounter. Anyone interested in more details can check out our website:

www.docudox.com

[mel]

We are in our 8th year of using Practice Partner Patient Records, as well as the billing program and the appointment scheduler. I would have to disagree with JonP's statements regarding templates and support costs. Our support costs run just over $1,000 per doc per year - well below the positive effect to the bottom lines in terms of savings in staff costs and improved productivity. With regard to the templates, we have made extensive customization and are able to do exactly what JonP says he would like - that is, to complete all documentation during the patient encounter. Anyone interested in more details can check out our website:
www.docudox.com

Welcome, I got 404s on some of the links

[mwarddoc]

We are in our 8th year of using Practice Partner Patient Records, as well as the billing program and the appointment scheduler. I would have to disagree with JonP's statements regarding templates and support costs. Our support costs run just over $1,000 per doc per year - well below the positive effect to the bottom lines in terms of savings in staff costs and improved productivity. With regard to the templates, we have made extensive customization and are able to do exactly what JonP says he would like - that is, to complete all documentation during the patient encounter. Anyone interested in more details can check out our website:

www.docudox.com

I looked over your website and the demo on your notes. Your notes are like other notes I've received. I don't mean to be insulting. But, your note is just crap, like many templated notes on paper with docs scribbling on them. In this case, the scribbling is typed and the notes are just jumbles of data. Is it OK to do so, Yes. Does it look good, No. Would I use a consultant who sent me notes back that looked like that, Not if I had any other choices. Is it profitable, Yes.

But, I've seen notes from offices that date back to the 1950's that are better and communicate the events of the visit better, and I think that sort of documentation is unnacceptable, particularly the plan.

[kidneydoc]

Hi all,

can anyone who had experience with the above 2 ASPs post their reviews ?
MOO advertises what appears to be a full featured product including billing for 250 / month.Medcere is closer to 1000/month for all features including billing.
thanks

[BigDoc]

Hi all,

can anyone who had experience with the above 2 ASPs post their reviews ?
MOO advertises what appears to be a full featured product including billing for 250 / month.Medcere is closer to 1000/month for all features including billing.
thanks
Thanks for delurking

[jonp]

While you are trying to find out if one or another ASP is any good, you better ascertain 1. how many EMR companies/providers have gone out of business in the past years, and 2. how may have written the records in a proprietary format, such that you could conceivably have trouble accessing the record after God-like EMR, Inc. goes belly up. $250/mo sounds too expensive to me with such a risk.

Standard should be: a guarantee from your provider to export the notes into either a text file format or XML files viewable with a standard web browser. 'EMR' and can't view the data later? Bad plan.

[kidneydoc]

While you are trying to find out if one or another ASP is any good, you better ascertain 1. how many EMR companies/providers have gone out of business in the past years, and 2. how may have written the records in a proprietary format, such that you could conceivably have trouble accessing the record after God-like EMR, Inc. goes belly up. $250/mo sounds too expensive to me with such a risk.

Standard should be: a guarantee from your provider to export the notes into either a text file format or XML files viewable with a standard web browser. 'EMR' and can't view the data later? Bad plan.
Your concerns are valid and the availablity of the data in a usable format is key.I do not have any data on the success of ASPs....share your information if you have some.Will post any information that I come by.
I think with it becoming cheaper to develop and deliver product for the developers,the ASP route will likely be the most competitive and may bring the overall costs down of using an EMR.
Again if there are any discussions of experience with ASPs on this site or elsewhere,please post the links.

[Scroggie]

Welcome Kidney doc.

[mel]

GE Logitian is here in my conference room wowing my partners. Ahhhhhhh, ohhhhhhhh pretty.
I'm in a bit of a quandry: if I want the office (40+ docs) to get an EMR, they want GE. If I vote against GE we'll stick with paper charts and dictation (I can still use my own homegrown EMR).
What to do? Can I vote against technology?

What did you end up getting?

[Scroggie]

Ah, well we voted to try it with 10 licences, then tabled it for another year. I think we'll end up with it eventually, but man you really have to be into it in order to get that elusive ROI. If you're just dictating or looking at old notes it's never gonna be worth it.
So I continue with my homegrown jobbie. I've starting doing some light voice recognition just to add another layer->see my discussions with myself.

[Mtbcrash]

I've been using Medical Manager's "legacy" system for 1 year, basically it is a databasethat allows a paperless chart.Will be switching to WEB MD's Intergy with our multispecialty group of approx. 85 practitioners.Looks good in demo's but until you use it.... Waiting for data conversion,should be up in spring 06.

[KingofTown]

Just signed a contract last week with NextGen for both EMR and Practice managment (replacing our old PM Misys). We are eight docs, primary care IM. Trying to go paperless in a year. Docs to use wireless tablets (convertibles or slates yet to be decided), nurses and MA's to use small wireless Fujitsu touch screens.

Looked over many systems over the last 3 and a half years. Needed a fairly robust company for support and implementation because of the size of the practice (>20K active patients) and the varied amounts of computer saavy in the group. I liked the NextGen interface and unified database the best despite its premium price.

Will keep the group posted over the next 12 months how the roll out goes.

KoT

P.S. Saw you in the funny papers Big Doc! :)

[BigDoc]

Just signed a contract last week with NextGen for both EMR and Practice managment (replacing our old PM Misys). We are eight docs, primary care IM. Trying to go paperless in a year. Docs to use wireless tablets (convertibles or slates yet to be decided), nurses and MA's to use small wireless Fujitsu touch screens.

Looked over many systems over the last 3 and a half years. Needed a fairly robust company for support and implementation because of the size of the practice (>20K active patients) and the varied amounts of computer saavy in the group. I liked the NextGen interface and unified database the best despite its premium price.

Will keep the group posted over the next 12 months how the roll out goes.

KoT

P.S. Saw you in the funny papers Big Doc! :)

Thanks KoT,
keep us posted :)

[DOCIM]

Just signed a contract last week with NextGen for both EMR and Practice managment (replacing our old PM Misys). We are eight docs, primary care IM. Trying to go paperless in a year. Docs to use wireless tablets (convertibles or slates yet to be decided), nurses and MA's to use small wireless Fujitsu touch screens.

Looked over many systems over the last 3 and a half years. Needed a fairly robust company for support and implementation because of the size of the practice (>20K active patients) and the varied amounts of computer saavy in the group. I liked the NextGen interface and unified database the best despite its premium price.

Will keep the group posted over the next 12 months how the roll out goes.

KoT

P.S. Saw you in the funny papers Big Doc! :)
Hello KoT:
I have just registered and read your note with interest. We have just started using NextGen as well. We are a group of 8 Internists. I would be interested in your experience over the last few months. Also, if anyone else is using NextGen, I would like to know if DNS 8 has been helpful with this software and which TabletPc is recommended. Thanks.

[Rprap]

I signed up with DigiChart in July, and thus far, the only thing up and running is my PM software, Advanced MD. It was the PMS suggested by Digilhart, and so far, it's the only thing I can recommend about them. Even though I have their preferred PMS, months later DigiChart still can't communicate with it. Most of my interactions with the trainers have been concluded with long lists of set-up tasks that they rightfully should be doing-for me.
Are there any Digilhart customers out there who are having a better experience?

[mel]

I signed up with DigiChart in July, and thus far, the only thing up and running is my PM software, Advanced MD. It was the PMS suggested by Digilhart, and so far, it's the only thing I can recommend about them. Even though I have their preferred PMS, months later DigiChart still can't communicate with it. Most of my interactions with the trainers have been concluded with long lists of set-up tasks that they rightfully should be doing-for me.
Are there any Digilhart customers out there who are having a better experience?


Welcome, are you a solo? :confused:

[Rprap]

Yup. Solo in Fountain Valley, CA. I thought that because I was starting a new, solo startup, EMR would be easy to implement.

[aurora]

I’m interested in obtaining information about people’s experiences in setting up EMR in an inpatient setting. I've already read many of the threads in this section. At this point I have a basic understanding of some EMR systems from descriptions of use in outpatient offices.

Our situation is quite different from what has been described in this section of Docsboard. Our facility is a 75 bed psychiatric hospital with fairly rapid turnover for most patients, overall LOS is about 12 days. Approximately 40 to 50% of the psychiatric inpatients have concomitant medical problems that also need to be followed by a primary care physician and her ANP staff.

The hospital is looking into acquiring a totally integrated system that will ultimately allow multidisciplinary access to EMR for a wide variety of functions -- psychiatric diagnostic assessments, psychological testing reports, general medical assessment and follow up of complex medical problems, nursing (and nursing assistant) progress notes, rehab staff entries, physician charting, medication orders, 30-day med reviews for longer-term patients, comprehensive treatment plans (a JCAHO requirement for psychiatric facilities, different from nursing care plans used in general hospitals), discharge summaries, and (ideally) everything tied in with the business office to streamline billing and collections.

At present our hospital is using only paper records. Admissions and discharges are dictated and transcribed by clerks. Progress notes are typed by hand in a rather crude online format that was put together by our IS folks using MS Visual FoxPro -- it's cumbersome, it is not searchable, it does not link to any other part of the chart, and it is time consuming for the typing impaired. Check-box templates may be useful in some settings, psychiatry requires the need for being able to individualize the content of chart entries and add narrative-style descriptions.

At this point I don't know which (if any) products have been explored for possible use. A program developed by the state hospital in Utah was investigated about 5 years ago and the idea was shelved – the program was terribly cumbersome, user unfriendly, and it was not adaptable to our rapid turnover inpatients.

A system such as this would need to be able to cull crucial items from the physician assessment and carry them into the Master Treatment Plan and separate Problem Statements (again, an area unique to psych) that need to be addressed q shift and weekly. It also would need to be searchable so that it isn't necessary to scroll through window after window to locate specific information. Example -- psychology staff might need to pull up only psych notes to read for continuity, whereas the psychiatrist may want to pull up notes from every discipline to get a more comprehensive picture of the patient's function across a segment of time.

Most of the software that I've seen mentioned here is all geared toward outpatient practice. So far, the most glowing comments have been about NextGen and I've spent some time visiting their website. It looks very good but it isn't clear whether it's adaptable to interdisciplinary, inpatient use for a psychiatric specialty hospital.

Some Questions --

1) Is anyone using EMR for only inpatient work?
2) If so, which system do you use and why?
3) How well does the system integrate with your pharmacy?
4) Does your system allow for use of PDA's interconnecting with the desktops for data entry or prescribing?
5) Does your system support or allow for use of voice recognition software?
6) How well do the various chart sections (admission work up, progress notes, tx planning, discharge summary, etc) link with each other -- how easy is it to have information seamlessly connected/linked between sections to limit the need for reentering the same information multiple times?
7) How well does the system link to the business office for coding and billing?
8) What hurdles did you find that interfered with use of the system?
9) Do you have any other recommendations for inpatient-oriented or inpatient-specific EMR sources to investigate?

I know this is a tall order. Thanks in advance for any input or comments.

[RDGelzer]

Aurora, your post does not convey what problems your institution has identified that will be solved by a technology implementation, or what needs will be met, or what future plans require new technology to achieve. Perhaps your institution has indeed done this. If not, if the project goal is to "implement an EMR", your odds of failure are high if for no other reason because the definition of "success" has not been established.

All the questions you pose are valid ones but please add at least one or two more. (I have posted to this point on the "What EMR Are You Using, Part Deux") Make sure whatever documentation tools you implement actually can meet the standards for a legal medical record. Make sure that the system you implement has business rules that meet your state's legal requirements for medical records functions. (Some states are quite undefined and lax, some are quite detailed.)

Unless you have a specific set of measurable, defined objectives for what your institution wants to accomplish with a technology implementation, do that first. The two identified best predictors of successful business transformation are 1. A plan and 2. Leadership. Without these the best technology platform in the world can fail to meet the first requirement, actual installation and use.

I am not personally aware of any similar entity that has done what your describe. I recommend you identify one or more before proceeding, in order to establish expectations and achieveable objectives based on actual experience by organizations you would regard as peers.

Not exactly what you were looking for I know, but needed precursors if not already addressed.

Best of luck, your eventual selection process will be of interest to all here I am sure.

RDGelzer

[RDGelzer]

I mentioned this previously but in case any missed it, the American Health Information Management Association (AHIMA) National Convention is in San Diego this October, with pre-sessions starting Saturday the 15th. EHRs will be the centerpiece of many of the presentation; evaluating them from the point of view of Health Information Management and Coding.

http://www.ahima.org/convention/2005/index.asp

Also of interest, a report is due out soon from an AHIMA contract with Dr. Brailer's office, regarding the role of EHRs in Health Care Fraud.

http://www.ahima.org/press/press_releases/05.0615.asp

This should greatly accelerate the development of functional standards for EHRs and assist greatly in illuminating the medical-legal risk factors that previously have been greatly underappreciated.

Watch for it.

RDGelzer

[alborg]

Great URLs! Thanks again Reed. Why are all of the good meetings held on the west coast? Nothing about EMRs ever happens here in the Washington, DC area. Shucks.

Al

[RDGelzer]

I beg to differ! I spoke in DC for the local chapter of AHIMA just a few weeks ago on "EHRs: New sources of variance in data quality", clearly a pivotal event!

But seriously, the Medical Records Institute's EMR Roadshow will be in DC in late November. If this link does not work, go to the MRI website and click on the icon for EMR Roadshow.

http://www.medrecinst.com/conferences/roadshow/ConferenceHome/index.asp?EV200_EVT_ID=5189

Others interested in learning more about when these events will occur can check the MRI site for events in your area.

Other DC events pertaining to EHRs, the National Committee on Vital and Health Statistics (an HHS function) is holding hearing on topics relating to national health info infrastructure, lots of talk in EHRs.

MRI's 2006 National Convention will be in Baltimore, just up the road from DC.

RDGelzer

[alborg]

Cool! You can count me in... Anytime you come to town to speak, let me know!

Al

[aurora]

Aurora, your post does not convey what problems your institution has identified that will be solved by a technology implementation, or what needs will be met, or what future plans require new technology to achieve. Perhaps your institution has indeed done this. If not, if the project goal is to "implement an EMR", your odds of failure are high if for no other reason because the definition of "success" has not been established......

Unless you have a specific set of measurable, defined objectives for what your institution wants to accomplish with a technology implementation, do that first. The two identified best predictors of successful business transformation are 1. A plan and 2. Leadership. Without these the best technology platform in the world can fail to meet the first requirement, actual installation and use.

I am not personally aware of any similar entity that has done what your describe. I recommend you identify one or more before proceeding, in order to establish expectations and achieveable objectives based on actual experience by organizations you would regard as peers......


RDGelzer


Sorry for the delay, Dr Gelzer. I appreciate the time it took for you to craft your reply, but I think your approach is far beyond my basic inquiry. Please allow me to try to clarify.

I am not directly involved in the decision to move to EMR or EPM at our hospital. I have no direct input into the complex decision-making -- so I am not the one who will be "defining measurable objectives" or "planning to transform business," or do any of those other influential steps.

My questions are very concrete. I'm trying to find out, from end users of hospital based systems, what their experiences have been with the EMR system that was chosen. My agenda is to be able to provide input back to our small medical staff about other physicians' experiences with the EMR systems. The goal is to help us be educated about some of the benefits and pitfalls of various systems. Perhaps then, as a group, the small medical staff can provide some opinion to the administration or the state about a computerized paperless medical record for psychiatric admissions.

If it helps, apparently those with the decision-making authority are considering Meditech and Avatar (Creative Socio-Medics). The med records director has some interest in Cerner.

So from a front line standpoint -- not an administrative standpoint -- what have been people's experiences with hospital EMR?

Some Questions Restated from my Previous Post:

1) Is anyone using EMR for only inpatient work?
2) If so, which system do you use and why?
3) How well does the system integrate with your pharmacy?
4) Does your system allow for use of PDA's interconnecting with the desktops for data entry or prescribing?
5) Does your system support or allow for use of voice recognition software?
6) How well do the various chart sections (admission work up, progress notes, tx planning, discharge summary, etc) link with each other -- how easy is it to have information seamlessly connected/linked between sections to limit the need for reentering the same information multiple times?
7) How well does the system link to the business office for coding and billing?
8) What hurdles did you find that interfered with use of the system?
9) Do you have any other recommendations for inpatient-oriented or inpatient-specific EMR sources to investigate?

[RDGelzer]

Sorry for the delay, Dr Gelzer. I appreciate the time it took for you to craft your reply, but I think your approach is far beyond my basic inquiry. Please allow me to try to clarify.

I am not directly involved in the decision to move to EMR or EPM at our hospital. I have no direct input into the complex decision-making -- so I am not the one who will be "defining measurable objectives" or "planning to transform business," or do any of those other influential steps.

My questions are very concrete. I'm trying to find out, from end users of hospital based systems, what their experiences have been with the EMR system that was chosen. My agenda is to be able to provide input back to our small medical staff about other physicians' experiences with the EMR systems. The goal is to help us be educated about some of the benefits and pitfalls of various systems. Perhaps then, as a group, the small medical staff can provide some opinion to the administration or the state about a computerized paperless medical record for psychiatric admissions.

If it helps, apparently those with the decision-making authority are considering Meditech and Avatar (Creative Socio-Medics). The med records director has some interest in Cerner.

So from a front line standpoint -- not an administrative standpoint -- what have been people's experiences with hospital EMR?

Some Questions Restated from my Previous Post:

1) Is anyone using EMR for only inpatient work?
2) If so, which system do you use and why?
3) How well does the system integrate with your pharmacy?
4) Does your system allow for use of PDA's interconnecting with the desktops for data entry or prescribing?
5) Does your system support or allow for use of voice recognition software?
6) How well do the various chart sections (admission work up, progress notes, tx planning, discharge summary, etc) link with each other -- how easy is it to have information seamlessly connected/linked between sections to limit the need for reentering the same information multiple times?
7) How well does the system link to the business office for coding and billing?
8) What hurdles did you find that interfered with use of the system?
9) Do you have any other recommendations for inpatient-oriented or inpatient-specific EMR sources to investigate?


Thanks for another shot at your inquiry, I apologize for not answering your question. In order to help make your questions even more concrete, you will be greatly assisted by establishing even more specific inquiries. From what I gather from your notes, the best way to do this would be to construct specific patient care testing scenarios against the requirements list you generated above. This would be relatively easy since there are public-source examples you can use. Here is what I would suggest.

First: From your professional peers, find out who (if anyone) has an EHR worth evaluating. It sounds like others' in your organization may have already narrowed it down to a short list. If that is so, then do the following ASAP:

1. Construct specific patient care scenarios that address your known requirements. For examples of how to do this, look at the scenarios posted for public comment on the CCHIT website at www.cchit.org. You can even use their format for identifying pass/fail. This sort of tool will greatly simplify your work because each reviewer will have notes for each site, each product so they won't confuse one with another, etc.

2. Your inclusion of a medical records expert in the discussion singles your organization out as one with unusual foresight: surprisingly most organizations leave them out. Have the medical records/HIM person help you craft the following into your scenarios:
a) Amendments to a closed record (including corrections, clarifications, addenda)
b) A coding audit review
c) A documentation audit review
d) Documentation where one author changes another author's input, (in order to, for example, make sure all versions are available for review)
e) Release of Information protocols (physicians don't see this sort of function a lot but its of great interest to those who are sending patient records to insurers, lawyers, etc.
f) Patient instructions

3. Have your scenario include the functional requirements you want to see, including pharmacy and voice recognition functions.

4. Billing linkage may best involve steps you may not ask about, so get you coders into the mix as well if possible. Some systems "dump" provider documentation extracts from coding engines directly into the billing system. This bypasses any ability to have coding review prior to billing which, unless your docs are coders, is not a great idea (for example.).

5. Forms development and forms control functions for embedding into your system the care quality objectives and/or necessities for your organization.

Some rules:
A Cardinal Rule: Do not believe the function exists unless the vendor can show it to you on a live, implemented system. It is not that vendors necessarily lie, its just that they may have a beta version with your critical need met, but the beta version may be two years from deployment. (Also, two years can turn into 3 or 4 or 5 quite quickly if the vendor suddenly has competing demands for development resources.)

I guarantee you that your evalution team will get a lot further, faster and more effectively using patient care scenarios as testing protocols than with questions about whether it does x or y or z. There are innumerable ways to define pharma interoperability and, as you see other systems in action, you will learn new ways to skin cats that you will then want to include in your requirements.

Hope that helps a bit more. Good luck, and keep the thread posted on your progess and what works.

RDGelzer

[DrWinn]

Here is a October 2005 survey of physician users of different popular EMRs and their satisfaction/dissatisfaction levels. http://www.aafp.org/fpm/20051000/29aneh.html

And yes, I am posting this because my child is on the A Honor Roll.

[techdoctor]

Can anybody list the types available. So far every poster is using something different, and I know what it means if there are fifty different medicines for one condition. None of them work!

You are correct in that the EMR industry has been getting started
for ten years now and everyone is wondering when it will "take off."
There are some signs that some leaders are emerging. I help judge a
national "Best Practice of the Year" for Physicians Practice journal and
this year I noticed that a few of the better run groups were using the
Healthmatics products (no, I'm not on their payroll, I just write on these
topics monthly).

I'm going to be researching EMRs more for future writing. In the meantime,
a little known fact is that there's an informatics society contest every
year to see if EMRs can beat handwritten or dictated chart notes for
office visits in terms of visit detail and efficiency of entry. So far, the old
fashioned way has won every time.

For now, the bigger payoff for medical groups is in choosing the right billing
software (or billing service if you outsource) -- not in the EMR itself.

Best Regards,

G. Steve Rebagliati, MD, MBA

[EmergGuy]

I'm an emergentologist (ie "emerg doc"), and have used a Palm ED specific EMR called da-ER for the last year, which worked OK although a little 'yes-no' oriented, making for a disjointed end result. Anyway the #$@%^& thing crashed again two weeks ago (has happened a few times, not Palm OS 5 compatable, everytime I lose my personalised templates, etc),...so I took the big step and tried a new product.
Called CodoniXnotes, web-based, CHEAP at $89-129/month (depending on whether you want your EMR stored on their server), and has a FREE trial month to try it out.
Have used it for 3 shifts so far (all fortunately not too busy) and it works great with really great looking final chart. I find the web-based server a bit slow compared to my Palm program, but like the style of the report. Has an extensive procedural database, big formaulary, ability to generate and print prescriptions and patient info sheets.
Also comes in an "office variant", presumably for solo practitioners.
They aim at the soloist, whose group/hospital are stalling, and are definitely wort a look.
www.codonixnotes.com

[Gazzini]

To Mtbcrash,
We have been using Web MD's Ultia for 3 years. Its format is much like the Intergy product. Just no note generation. Ultia is old enough that it will not be supported much longer. Currently notes are scanned in like you describe. Labs and perscriptions have been done with Pocket PCs (and desktops). With our pracitice of 9 Internists it has been a money saver. Going to a product that does note generation and calculates level of visit will be a big jump. One of our big questions will be getting conversion of current files into the new system. Hope it works well.

[wendlaanna]

I'm a child and adolescent psychiatrist. Finding good psychiatry EMR is rough, especially when your field is a meld of psychiatry, developmental pediatrics, special education and peds neurology. I produce a lot of narrative-style H and P's. The language can appear awkward when driven by templates.

These days I use Pocket Chart for Pocket PC, loaded on my Hitachi Pocket PC phone--it's formatted for the way I work, prints out my H and P automatically and I don't need more than my cell phone to write my notes. It's accomplished with pull down menus with items pertaining to my H and P, which looks pretty smooth for a template-driven system. When I click on pertinent items on the pull downs they are incorporated into the chart note, which comes out on a Word document with a signature space--date is automatic--no transcriptionist required--along with main problems and diagnoses and codes. I can write scripts with it as well. I understand the new version allows physicians to fax scripts to pharmacy.

Because templates provided were not specific to my practice there was considerable modification to do, but because of my (self-taught, school of hard knocks) computer background I felt comfortable altering the templates provided and didn't do a bad job of it, if I say so myself.

If your practice is mainstream, like primary care, you may find Pocket Chart's basic template to be well suited to your needs as is, a real advantage.

Another advantage is price. I paid $1500 for it a number of years ago and only pay yearly upkeep fees. I think my last fee was around $750 for the year to secure the option to upgrade. 'Not bad, IMO.

They provide a certain number of hours of support as well for no extra charge, and can customize your templates for you during those hours, another advantage.

I do not know, however, if you can scan in documents. When I was in touch last year that was not an option, but things change. The records come out on Word documents anyway, so you could establish folders for your patients on your PC and scan the documents into those folders.

I purchased a Hitachi Pocket PC cell phone through Sprint, that hooks to the Web and has a camera (for chart ID photos, curious findings and "funny looking kids"). Pocket Chart does well on that phone. I can carry my patient records with me, in my phone, a real advantage when I am called by a patient but am away from my desk. As for the phone itself, it's not GSM and I've had a few things fail on it like the AC charger input and the Key Guard, so if a better quality phone with the same features comes along I'm in the market.

I wish Pocket Chart worked on tablet PC, but perhaps that's in the works. As for practice management (billing, etc), on the last version of Pocket Chart I had that aspect was limited. I believe they've upgraded but I do not yet have a copy of the upgraded program.

They have a Trauma version and some other special versions for particular specialties. They also provide a broad number of templates already tooled for a large number of medical fields, from PCP to subspecialty, with systems templates for in depth HEENT, Skin, CV, GI, GU, etc. if I'm not mistaken they provide a template for chiropractics and a few other fields as well.

You can check it out at Care Tools:

http://www.caretools.com/index.cfm

I believe Care Tools is now a subsidiary of GE Medical.

Hi
I am also a child and adolescent psychiatrist. I run a clinic in Los Gatos California (www.solutionspa.com). Some years ago we developed our own EMR/EHR out of the inability to find what we needed on the market. That product, PsychNotesEMR, is now available to the public at www.psychnotesemr.com. You might want to check it out. It is a full service, server based (or single copy down loadable) software application at very low cost that provides charting, billing, scheduling, voice recognition and lots of other cool stuff. Best of all it was built specifically for the Tablet PC which I use every day and I love. You can check out the demo video at the website and give us a call if you want a live demo or more information. There is a free trial available if you just want to try it for a while and see what you think.
Good luck to you.
Wendla

[wendlaanna]

I realize some of these posts are very old but my response is that my office (www.solutionspa.com) is using and has been using PsychNotesEMR since November of 2004 with fantastic success. I am a child psychiatrist and I run a large clinic including multiple psychologists and psychiatrists in the Slilicon Valley. We were fortunate to be placed in the middle of tech central when I found the market sorely lacking in EMR for mental health. We found programmers capable of writing the sophisticated code necessary to supply what we really needed and ultimately what evolved was this program that is now available to the public (www.psychnotesemr.com). With PsychNotesEMR I can use my TabletPC or regular computer (mac or pc) to access all my patient's records, we can do billing, scheduling, coding, report writing and use voice recognition software seamlessly. It's pretty neat.
Anyway, good luck to all of you. I know the search is not easy.

[IMADO]

I had a chance to see PsychNotes demonstrated at the APA Convention in San Diego. VERY IMPRESSIVE. PsychNotes seems to have learned from the mistakes of others what works best. Simple, clean, well organized interface and seriously Psych specific. Also inexpensive. If we weren’t a Family Practice, using Amazing Charts (and completely smitten) it would definitely get a serious test drive here. We were also impressed with the spirit of the developer/designers- a father daughter team I believe. With a family run outfit you get the feeling there's some commitment there.