extra costs to consider

[Ignatz49]

This is not to discourage the adoption of electronic EMR/PM but it is something I did not think about when I started this about 9 years ago and I wish I had (although it wouldn't have changed much of my actions).

The purchase and maintenance of initial systems may not be the only costs involved. In my original "suite", the EMR was terrible but the schedular/demographics/biller was decent. They were outrageously expensive to buy and to keep the service up every year. Due to severe service problems, I dropped the company and replaced the EMR but continued to use the schedular. My IT guy was always nervous about not maintaining a service contract but I was not about to give this crappy company any more of my money even if I could have afforded it (about $100,000 by now just maintenance-- which I couldn't afford). This also meant that I eventually lost the ability to read my original EMR notes.

I bought a new EMR and have used it happily for many years. It doesn't tie into the scheduler but, oh, well.

Last night my PM with schedule and demographics crashed and is not recoverable. The IT guy says the data is still there and could be mined (like I have that kind of money) but the program will no longer read the info. The program was corrupted some how. Evidently this happens even with redundant drives and back up tape etc. Since I have no maintenance contract this can't be remedied.

The demographics will be a pain but not a billing disaster as we outsource billing; it is sent every day with the superbills. Another reason to consider diversifying with outsourced billing.

My current EMR, which I loved, has updated to a CCHIT certified disaster. It is a mess and I can no longer comprehend it. So I have to replace it as the old version is only supported through 2011. I was going to try and see what President Obama did but now I need a scheduler and there is one on the EMR I was considering so it's going to be now.

The whole point of this long winded thread is I will have the costs of maintaining my second EMR (which costs the same every year as if I was using it) to prevent another inaccessible records fiasco. I will have to pay for my new EMR and annual upgrades. If Pres. Obama mandates a different one, I will have to pay annual support for BOTH of my old records and the new one. I will actually be actively maintaining 3 EMRS (with a fourth no longer accessible).

The point is, it is not just the initial cost but any changes and you have added annual costs that can go on for years and years. And don't get me going on the cost of IT support to change and maintain these systems.

So buy cheap.

[DaffyDuck]

What are the EMRs you are using. Which is the one which is giving you the trouble?

[Ignatz49]

Probably in fairness none of them is giving me trouble so much as I made a poor choice initially in companies and subsequently my second EMR company felt the need to "evolve." My initial suite is now owned by Centricity and I can't imagine it is even still available. My second EMR is Soapware which I loved and was a solid booster of for years. One of their reps told me on the phone they had to adopt CCHIT or become "extinct." They evidently couldn't do this in a form palatable to a large number of their standing customers. I know I am not the only one. One of there bits on how to use the new version says, and I quote, "old users of Soapware 4.- may find this confusing." And I find a lot of it confusing. I feel a little betrayed that you would use a program for 5 years and this is the best they could do.

So I have bought Amazing Charts to replace it. It appears to be a solid little program. It is so cheap that I think no matter what happens it won't break our back supporting it.

[sweaner]

This is why I still use good old paper. Well, one of the reasons anyway.

Scott

[Ignatz49]

Yes, I love paper charts. I love the idea of them. I love trying to write a technically beautiful note. The notes of an EMR will never approach a paper note in terms of really depicting the encounter. I love the excuse to use a fountain pen. But then, I also love being able to do without at least one full employee (or maybe two). I love being able to refill Mr and Mrs Smith's disastrous polypharmaceutical list (as someone is inventing a new disease every week) in about 6 seconds. I love being able to do phone messages almost instantaneously without waiting for the chart to be pulled, the message to be affixed, routed, answered, rerouted. I don't miss a pile of charts in my office and others scattered around.

But, unlike the airy-fairy unrelenting proponents of EMRs, especially in my own specialty where they have a gross delusion that they will somehow dramatically effect how we are paid, I think that the drawbacks of the systems require a lot more publicity. The way you develop a delusion in the first place is to believe too much of your own airy-fairy publicity. "If you say it enough it will come true;" that sort of thing.