Medtuity (Dr. Ralph Millsaps, the family man)

Ralph D. Millsaps, MD [http://ralphmillsapsmd.com/contact_us.html] may be better known to you as EMR Update Forum member “Cardio1”, an outspoken cardiologist and Medtuity EMR user in Evansville, Indiana. In a phone interview, I asked Dr. Millsaps for his thoughts on EMR:

“I started practicing medicine in 1978 at a large multi-specialty group which I didn’t get along with too well, so I went out on my own in 1980 and established a group that specialized in cardiology. It stayed small until the early 90’s, then, following suggestions from consultants, the practice eventually grew to the size of 17 cardiologists and a cardiovascular surgeon.”

“As new partners developed, some of them did not like the way my senior partner and I were running the business, and they thought they could do a better job of it. We were getting older, so we thought, OK, take over and see how you do with it.”

“During the past few years, care had suffered, I thought, due to financial issues. Then, last year, they tried to change the compensation formula so that we would all be equal, even though I was the lead producer, and I decided that maybe I would be better off on my own.

Well, I didn’t have a covenant not to compete until 1998, when the new management said that even as a ‘founding father’, I should have one too. I never envisioned I’d have to deal with that.

But when I decided to leave, they decided to enforce the noncompete covenant, so I was unemployed from November 14 until March 14 as we went through a legal battle which I have won to this date. It’s going up for appeal, needless to say, but I started back to work March 14. As I looked at opening my own practice, from scratch, I said to myself I want to go paperless if I can. So I got on EMR Update, and to be honest with you, that’s where all my EMR education came from. Reading all the messages, this one versus that one, and so forth, then I spent a good four or five months doing EMR demos.”

“Why, at the age of 58, when I should be retiring, am I continuing? The reason is that I have three children that I adopted who are 9, 10, and 11, and I’ve got to send them to school and that kind of thing, so I’m starting over again at the age of 58.”

“Anyway, in doing that research and being solo, I looked at a lot of the products that are highly-rated out there. I looked at eCW, I looked at eMDs, and several others, but whenever I looked at the dollars invested up-front in software I thought golly this is going to be hard to do. Well then I got ahold of Medtuity and did a demo with them, and then I had my nurse, who’s been with me for 25 years, actually go up to Columbus and do a site visit, and we decided that Medtuity was the way we wanted to go. So, during that time off, I spent quite a bit of time customizing the templates so we would be ready to go on opening day. And that’s worked out very well”

Having three children makes Dr. Millsaps very family oriented in my book, and knowing that Medtuity is a family-owned and operated company, I asked him if the fact that Medtuity is a “family company” was appealing to him?

He replied, “Right! And then, the person who answers the phone is Trish, and that’s Matt’s wife! My main fear is that they are doing such a good job, someone’s going to come along and buy them, and then you won’t have the kind of personal rapport that you have with them now.”

“We were having some flow issues on how to put in patient information on new patients before they come in, and even with LogMeIn and other remote training methods, it just wasn’t working the way I wanted. So I asked Brandon if he would come down here. It’s about a four hour drive from Columbus, and he came down and stayed at my house, and we spent a day and a half really tweaking things; it was really neat.”

“The amazing thing about Medtuity is that somebody is usually there on a Saturday. If I have a question, I might email Brandon and he’ll usually reply: ‘Just call me, I’m here’! On a Saturday. And if I have an idea to improve things, I send it to them and the turn-around time is amazing. It may be 24 hours or less. I’ll give you an example: I told Brandon one of the things I want to have for patients who have had bypass surgery are specific ‘controls’. 24 hours later a patch was available for me to download.”

Does Dr. Millsaps feel that a smaller company provides a more satisfying EMR buying experience than a large company?

“Unquestionably. Here’s another example: I wrote Brandon yesterday; I’m doing ultrasounds in the office, and he created a form for that. I sent some suggestions for changes, and again, 24 hours later, my suggestions were implemented.”

Here’s one doctor who actually seems to like the fact that EMR is still a work in progress. In fact, I asked him if he might perhaps be inclined to take advantage of that fact in some ways?

He answered, “Every day I change this EMR. That’s the advantage of the XML format Medtuity is written in. I can add a new drug interaction in 10 seconds on the fly. I still rely on the folks at Medtuity to help me with the complicated stuff. But each time they help me, I get better at doing it myself.”

For all of you technical folks, I asked what hardware the doctor is currently running in the office. Here’s his list: “We have a server for Medtuity, three hard-wired workstations, one Motion 1600, and an HP TC4200. We’re wireless in the exam rooms. I can use LogMeIn with Medtuity to access my patients’ medical records from my home or from the hospital.”

Dr. Ralph Millsaps does not sound like a typical first-time EMR user, and he is not. He explained, “The practice I left had installed something called GEMMS. It’s a cardiology specific program out of Indianapolis. [See: http://www.gemmsnet.com/gemmshomepage.htm ] I helped pick it out. The EMR was just OK, but the billing and scheduling were excellent. It was the best for us at that time.”

Since Medtuity is strictly an EMR program, and does not include billing, I was curious as to why Dr. Millsaps chose Medtuity after using GEMMS, which he said has a great Practice Management System(PMS)? His statement reflects our many “best of breed” discussions here in the EMR Update Forum, but he states it well, saying: “Maybe one of the reasons Matt Chase has shied away from the putting a PMS with Medtuity EMR is because the productivity—the engine that drives the practice—is the physician. If you make that EMR software so good, it really makes the doctor more productive. And let the scheduling and billing parts be separate, and as good as you can get. But if you want to make a living at it, either as a doctor or as an EMR programmer, you better make sure that the EMR works well.

So which software product does Dr. Millsaps use for billing and scheduling?

“After reasonable investigation, with a little bit of input from Matt and Brandon, we went with Medisoft Ver.11 for the front and back ends. And that’s working OK. Medtuity imports the demographic and scheduling data from the front end. Right now, they’re working on a “handoff” from the charges and codes from Medtuity into the billing software. We were told when we bought MediSoft from the Value Added Reseller(VAR) that there was something called ‘X-Link’ that would allow Medtuity to talk to MediSoft. That turned out to be false. Medtuity sent X-Link several emails saying ‘Tell us what code to write and we’ll write it.’ Never happened. So I actually sent X-Link back to the VAR and got credit for it.”

From our discussions in the EMR Update Forum, it seems that Medtuity people like lots of “granularity”. What does that mean to Dr. Ralph Millsaps as a physician?

“It’s the difference between ‘free-texting’ your HPI(History of Present Illness) and actually having it templated. At some point down the road, if you wanted to look at all patients with angina and a one flight of stairs limitation, you could actually do a search for that and find those patients. It has not yet been useful for me, but I can see where it will come in handy down the road. I use Dragon NatuallySpeaking for my free-text impressions which actually go out to referring physicians. That works well for me.”

Why did Dr. Millsaps choose Medtuity for his EMR?

“To be honest with you, the number one reason is the fee structure—the idea of paying as you go, 75 cents, for a chargeable office visit. You can add telephone notes, labs, triage, and you don’t generate a charge. The only time the cash register rings for Medtuity is when you enter a CPT code and generate a charge for your patient. You get an email every day of how many credits you have left as well as a synopsis of the billable patients.”

Does that seem to you like a fair way to charge for EMR?

“I think so.”

Rather like the way doctors bill their own patients?

“Yeah! You send Matt a check a check for $1,000. He sends you a disk and you’re ready to roll. You’re then good for 750 visits. It’s an amazing deal. I really don’t want anyone to find Medtuity. Every improvement they make for me makes the program better for the next guy. I’ve had a couple of issues regarding stint locations and other models which Matt has helped me with, but in doing this, he’s taught me a great deal about creating tools for myself with Medtuity. I was then able to create my own models for valves and pacemakers. Right now, starting a new practice, I’m only spending about $7.50 a day on EMR, and that’s a very small price to pay. Matt is currently doing a sophisticated BMI(Body Mass Index) calculator for me with obesity triggers. Medtuity tries really hard to keep up with me, and I guess, as you can see, that’s not easy to do.”

Dr. Ralph Millsaps, what would you like to say to other doctors considering Medtuity as their EMR?

“They make a superb support team. I don’t think I could ask for a better team to help me get started in a new practice. The hardware costs are not small. And to start out paperless and not have another 30 or 40 thousand dollars out there, and to know that six months from now, or a year from now, I’m not going to have to lay out another 18% of 30 thousand dollars for upgrades—this all means a lot to someone starting out. We get Medtuity upgrades two or three times a week, remotely installed on my server for me. There is no charge at all for these updates. The only negative you can say about it is that it is not a complete product. But I lived with a complete product, and the poorest part of it was the EMR. I agree with the philosophy of “best of breed” when it comes to EMR. It is the most important software for a doctor. The people at Medtuity are terribly excited about what they are doing in EMR, and I feel they will play a big part in this emerging market.”