How modifiable is NextGen really?

We are a small practice of psychiatrists who have now spent almost 18 months trying to implement NextGen. The journey started with a promise that we could easily customize their templates to suit our own practice. Which to me was the main selling point, outside of e-prescribing and e-Lab interfaces. Based on the out-of-the-box package for behavioral health there was a great deal of input needed to make it usable for Psychiatrists. After the initial substantial cost of the system, I have since spent over 40K in developing the templates that supposedly were easy to modify (including remote training, and many many hours of webex). Our main problem is that we rely heavily on free text fields in psychiatry and the printed output from NextGen has been dismal. I have to be able to type something in the social history not just use radio buttons. We have worked with multiple different people in NextGen and I am not saying they aren't nice or aren't trying, but the patches they send us are imperfect at best. I cannot tell you how frustrated we are to continue this far into the process and still not have an acceptable output. The last "patch" we received worked in development and then didn't in test. I am now concerned whether they will ever have full output control. We are a small practice that has spent over 100K on this project and still has no usable output. With all this time, effort and expense, there is no way that this has been a reasonable purchase. Truthfully I am unsure whether their platform is really capable of managing the output of a free text field. Is anyone else having this problem with free text fields? Is there something that works? We are at the end of our rope and certainly our budget.

NextGen Complainant #24601.

Please take a number in the long line.

 

PsychDoc:

We are a small practice of psychiatrists who have now spent almost 18 months trying to implement NextGen. The journey started with a promise that we could easily customize their templates to suit our own practice. Which to me was the main selling point, outside of e-prescribing and e-Lab

 

If that were in the contract then you may have some legal redress.

 

What have other people done to address this concern? Legal or otherwise?

Never mind the legal stuff.  That won't help. 

THE SOP (Standard Operating Procedure) is this:

(1) post here.

(2) Bob reads it.

(3) he contacts you via email.  Probably says dont post here.

(4) He cuts you a deal.

(5) you go away.

 

It's the NextGen way (TM)

 

A better EMR for you would be either eMedRec or Medscribbler.

Psychiatry doesn't suit EMRs.

IMO.

 

Perhaps that's the case for a single psych, but for a group, they may be doing drug trials, or doing outcome studies.

How amenable to this are your two suggestions??

 

>>Is anyone else having this problem with free text fields? Is there something that works?<<

Text Field output can be a real grammatical hairball in any EMR,  especially when sentences concatenate, because text output from controls  can be contingent on pre and post output as well as blanks from not answering certain field choices. Can you customize the text output on the fly and view it before generating the finished note?

Can you post some examples of where the NextGen output is failing ?

 

You should take a look at our site www.doctorsinperil.org and consider submitting your contract to our email address for legal review. Our probable filings at this point are confidential, but we may really be able to help you.

Sincerely,

James Edison

p2p4docs:

You should take a look at our site www.doctorsinperil.org and consider submitting your contract to our email address for legal review. Our probable filings at this point are confidential, but we may really be able to help you.

Sincerely, James Edison

I'd advise against that.

Speak with Bob. He gets results.

 

Interestingly I have just been asked to speak at the national meeting for Child Psychiatrists this fall about my experiences with technology including EMRs. I am trying to get together something that will show everyone where the output failure is happening and will post that soon.

I could see that speach.

Here is a Microsoft Word template, use it to store your free text with Dragon anyway you like.  Integrate the Floating Tool Bars and click on them as you need.  Don't spend to much unless the deliverables are well understood and you have test driven the application....... 

I would love to see your speach put up on EMRUpdate with a video link.

We just picked up a Child Psychiatrists in Florida Here and we have to rewrite our Prescription Writer and some of our Note Module just to get him happy.  There is a lot of little nuances that are different in your practice then General Medicine or even that most EMR's have to deal with.  For example our prescription writer does not handle well the ability to write three scripts for the same drug with a comment field on the prescription, Do Not Fill Until @@Date when writing for the same drugs over time.  We had to modify this and of course we are trying to get the notes module working and he is waiting on Hand Print Recognition, because you are in front of the patient and you don't really want to use DNS in front of the patient and you are over booked.  Further, you need clicking on templates, but they have to be free floating Text Macros not just codified structured data output as you alude to because you want the note to look a specific way.

In the case of Child Psychiatrist we are dealing with he is a bit nit picky on the note format, we don't mind we are working on it.  I believe if you get to Bob Larson he could possibly get you in touch with development to make your note work much better for your needs in your specialty. 

Regards,
Brendon

 

I agree that there are some specific things about psychiatry and I wish we were to a point where we could even look at the issues you bring up. We don't even have a note we can print and we haven't gone into production! I also appreciate your optimism - however we have been working with NextGen extensively and are concerned that they may not be able to make it work. We have had multiple "patches" that have provided only partial results and even lost abilities to modify the templates from one upgrade to the next (i.e. we use to be able to hid fields and since we upgraded we can't -see excerpt below) I am very lucky to have a good internal IT team and have even had NextGen people ask my IT guys "if they had any ideas". I cannot imagine what it would be like without my own IT team, but I think it would have been impossible for any psychiatrist to have even gotten this far without them. To make sure these concerns remain concrete - here is an excerpt from an email by my IT about our concerns: "Our primary obstacle to the use of this product deals with output functionality. I've gone back over our notes and design effort and discovered that at revision level 5.4.28 this hide process was working. Either at the major revision level of 5.4.29.32 or one of the following patches is where it stopped working. It seems reasonable to me that the variance in the code could be identified on your end and a patch issued that would repair this issue. Getting this hide functionality back would be a first step towards getting us in a position to use this product. That said, we still have issues with the inability to manipulate the formatting of Notes fields for output. Currently the document builder process is incapable of applying any formatting to Notes fields, thus the data present in a field of this type ignores all formatting present in the document builder output and runs the text across the entire page between the physical print margins. After sending one of our staff to a week of training in Atlanta GA in July, and numerous on-line sessions with your staff in an effort to manage the output format of these fields, the final resolution we were left with was to have the Dr. initiating the print to manually manipulate the output to a satisfactory format for each and every print job. Surely you can agree that is not an acceptable solution. We finally came up with a work around on our own to create an output with a uniform left margin. That solution was to move all the elements of each document, and its associated subforms to a Zero margin, and then set the printer margin to .25". We then spent some 28 hrs in August and 45 hrs in September manipulating the output of each format required by APS. This output, however, still leaves us with no ability to manipulate indenting, tabbing or the right hand margin, which prevents us producing an acceptable format. A complicating factor in this solution is the fact these outputs are sent over an encrypted tunnel to remote printers we are not in control of. Thus managing formatting so that we get a consistent output at all times regardless of the equipment is seriously limited. This output reflects greatly on APS, HLI and NextGen. It is the hard copy impression anyone who reads, reviews or audits our system will be left with. I think it is in our collective interest to develop a very professional output." Hope this helps clarify our concerns. Also - I have not heard anything directly from NextGen or Bob about this post.