Interview with ophthalmologist Dr. William H. Constad (NextGen® EMR and EPM software user)

In a telephone interview with Jersey City, New Jersey ophthalmologist Dr. William H. Constad (www.hudsoneye.com email: whconstad-at-hudsoneye.com) we discussed his use of NextGen Healthcare’s EMR and PM software in his practice at Hudson Eye Physicians & Surgeons, LLC. I asked Dr. Constad when he first starting using NextGen. He answered,

He replied, “NextGen also has a module they call ‘ICS’, which is their scanning solution for paper reports. I don’t use that because I developed my own. Years ago, NextGen interfaced with a third party software package for their scanning solution, and I thought it was kind of ‘clunky’. So, I actually worked with a programmer, using a third party software application called PaperPort, a Nuance product, Nuance of Dragon NaturallySpeaking fame. (See: www.nuance.com/paperport/) PaperPort is very good because it will interface with a lot of different software platforms—like databases, for instance. We simply wrote an interface to link PaperPort to NextGen which we called ChartPort, since sold to another company (Link suspect: www.chartport.com/cpdesc.htm). I also use that linkage to incorporate the data from various pieces of ophthalmic testing equipment into the NextGen EMR database.”

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William H. Constad , MD

“So,” he continued, “I don’t have to purchase the various interfaces which NextGen develops for that purpose. My own interface works generically with almost anything. However, we do own NextGen’s Optique Module as well, that’s the optical shop sales and inventory program.”

Is NextGen sophisticated enough, with enough medical content for his specialty?

“Yes,” he answered directly, “NextGen is sophisticated enough for most specialties. They offer a lot of ‘deep programming’, meaning that, for instance, in the EPM part of the program, you can, on the fly, alter the ‘scrubbing process’. If you follow this business at all, you know that insurance carriers like to ‘screw you up’, so they will say ‘OK, we don’t want to see an X in box 34, we want it in box 153.’ So what happens is, all your claims ‘go dirty’. NextGen allows you to edit the format for that particular company, then alert you of any out-of-place information before you send in the claim. We go direct electronic billing to MediCare, and we use an electronic medical billing clearing house for the rest. There’s nothing that goes out primarily on paper.”
Obviously pleased with NextGen’s billing software, was that the main reason Dr. Constad chose NextGen as his EMR?

“The main reason we chose NextGen,” he replied, “was that, at the time, there was not another EMR that offered true integration with the EPM, the billing portion of the software. There was nobody else that did that. In fact, they were actually using two databases, one for EMR and one for EPM, and they had an interface between the two databases, but they were the only company that had an effectively running interface.”

I asked Dr. Constad if he has used any other brand of EMR. “Yes,” he answered, “I was a user of Ivy EMR, marketed at the time by Alcon Laboratories. (See: www.alconpharma.com) In the late 80’s, early 90’s, Ivy EMR had 1400 offices installed, which at that time, was huge. Once they got to the mid 90’s, they realized they had to ‘go Windows’ because Ivy was a DOS product. They started to develop it, and I was a beta tester for them. We were getting ready to convert the data when Alcon ‘pulled the plug’. Nestle, who owned Alcon at the time, decided to drop the product, because they didn’t think it was going to be a money-maker. Alcon announced that tech support for Ivy would be offered only for the next five years, then not at all. That’s really what pushed me to start looking. That was in 1998.”

Dr. Constad further explained why he would mention the product details of Ivy, now out of business, and a DOS EMR:

NextGen® — Electronic Medical Records

“Ivy was an integrated EMR/PM software product using one single database for both EMR and billing. The EMR side was weak, but it did allow searches and queries, but it wasn’t a true database. I wanted a true database, but I liked the idea of Ivy, which allowed a single call for all possible problems. I don’t have time for long or multiple tech support calls.” As one of our EMR Update Forum members once said, “I like having one neck to wring.”

What brought Dr. Constad to the NextGen Healthcare software products?

Dr. Constad told me, “I sat down with Pat Cline, the president of NextGen, and he told me they not only had an integrated product, but within three or four years, they would have it all in one database. He stuck to his word. Today, NextGen offers exactly what Pat Cline promised—a single integrated product and database.”

I asked Dr. Constad what finally happened to the Ivy EMR/PM users such as himself. Were they ever helped to convert their EMR data?

How about NextGen as a support organization? Does Dr. Constad think they are good?

“Yes, NextGen is good, now, but there was a time, right after I purchased it, when they were not so good. I think they just grew too fast for their own good, grew too fast for their own tech support. They made a lot of sales, their product looked very good, but they couldn’t keep up with the whole support issue. So people got down on them all the time. To their credit, NextGen came around. It took them about nine months. They hired a bunch of new tech support people, and they changed their methods of providing support to include fax, phone and email. Their response time became quite good, and they started using triage techniques so that the most serious problems received priority.”

“Right now,” continued Dr. Constad, “if I email NextGen with a support problem, I generally get a response within one hour or two. They use Web-X to interface with my servers and usually solve most problems that way.”

Why, I asked Dr. Constad, are EMR Update Forum readers so hard on NextGen in all matters concerning tech support, even though user complaints are always handled to the clients’ satisfaction?

NextGen® EPM — Claims edits & scrubbing

“They ARE hard on NextGen,” commented Dr. Constad, “and I’ll tell you why: What NextGen offers is ultimate flexibility. There is no other vendor that offers the depth and degree of flexibility that NextGen does. I recently spoke at the TEPR Show in Baltimore, and I went around and looked at the other EMR products on the market. I saw some nice-looking products, but nothing I could customize in an unlimited way as I can with NextGen. This cuts down documentation time when I see a patient. But because NextGen is so flexible, it requires work on the part of the user. You can take the product as ‘turn-key’ and they will give you many templates and medical content. But if a doctor wants a set of ‘triggers’, it is very complex to set it up. I am a programmer, so I don’t mind sitting down with some math equations and building these equations into the templates. But I am not typical.”

I would suggest that anyone looking at an EMR product should ask themselves what they are trying to accomplish. Don’t under-spend on the EMR, because a $300 system can’t do the same thing as a $30,000 system. And don’t simply put all your trust in a slick demo. Go see the product operate in another office. And don’t underestimate the advantages of an integrated EMR/PM product. EMR and PM are intimately related—the EMR determines what the PM will charge. The software can’t tell you what to charge, but it can support the coding the doctor has chosen, and that can make the difference between getting paid for the level of visit you have earned, and not getting paid what you deserve. You need to document what you have done in such a way that the billing software can take full advantage of what you have done in the EMR. NextGen does that for me, plus it gives me unlimited room to grow.”

But is NextGen worth the money? I asked Dr. Constad if, after using NextGen’s products for six years, he is still glad he decided to go with NextGen?

Without hesitation, he answered, “Yes, absolutely. They are worth a much higher price than any of the other products I have seen to this date. But are they worth as much as they charge? That I don’t know.” He laughed, “I wouldn’t mind if they charged less. But after looking at what’s available, I would have bought NextGen all over again. I look to use the product as completely as I can, because I firmly believe that using EMR helps me practice better medicine.” How many ophthalmologists are currently using EMR? Dr. Constad feels the percentage of EMR users in his specialty is “far fewer than should be using it”, or currently, about 10%.

Since ophthalmology involves the use of retinal drawings, I asked Dr. Constad how NextGen handles this requirement. Regarding the NextGen drawing system, he stated:

“This was a weakness that NextGen had, but this month, a new update is coming out which has a totally re-designed drawing package. They made it much better than it was. And you’re right. Not only are there drawings, but also many photographs of the retina which are provided by various instruments. Ophthalmic test equipment often puts out image-based test results. This all has to go into the EMR.”

Hudson Eye's Technical Staff: (left to right)
Ingrid, Maria, Esperanza, Charlene, Kristine, Jamie and Sandy

Are the eyes more than windows to the soul, but also, windows to the general health of the body, I asked Dr. Constad?

“You are right,” he agreed, “the blood vessels seen on the retina can sometimes give us early screening for diabetics. The images of the inside of the eye are some of the most intricate and detailed images in all of medicine, and NextGen is committed to faithfully capturing these images, in high quality, in their EMR database. When I ask NextGen for something, I really try to make it something useful for every ophthalmologist out there, not just for me. As far as how much I have helped NextGen, well, you’d have to ask them that question.”

What advice would Dr. Constad give to NextGen?

“They need to continue to listen to their users. This year, NextGen actually had an ‘ophthalmology focus group’ for the first time. They selected seven or eight ophthalmologists from around the country, what they call their ‘power users’. They brought us down to Atlanta, put us up in a nice hotel, and showed us what’s coming in the next release. This was useful for NextGen because they got our feedback, but is was also useful for us because it put us in touch with each other. We could compare notes and share some of our favorite techniques with others in our specialty. It was well worth the time and effort, and NextGen paid for everything.”

“It is a tough one. A lot is required to document ophthalmology visits with an EMR because of all the equipment that we utilize. One of things I lecture on is how to reconcile the databases inside the test equipment with the EMR database. You want an EMR record which is complete, and I am fighting for increased communication and security between the hardware and the EMR. Some doctors are using the test equipment to store retinal images, so when the device breaks down, the images are lost. The EMR should capture all these images where they will be backed up with the rest of the EMR database.”

What would Dr. Constad like to tell doctors who are thinking about purchasing NextGen?

“If your main concern about EMR is the price—which I don’t think it should be—then stay away from NextGen. It’s not the cheapest by a long shot. But I spend more time in my office than out of it, so why would I want to buy ‘cheap’ equipment? I’d rather drive a Chevy, and have Rolls Royce-class equipment in my office. I have found that many doctors do not see computers and software as medical devices. I do. I want the best money can buy when it comes to my practice of medicine, and the best is what I have found at NextGen. It’s as simple as that.