Request input on AC and other options

 Hello,

     I represent two clinics doing family medicine that share management and are looking into moving to an EMR system, at first only one clinic will act as a pilot.  I’ve initially been pointed in the direction of Amazing charts and it looks like a fine system.  I’ve gone through the AC website and have downloaded the software and will be showing it to the owner and NP running the clinic. The things we find attractive about AC are the price and its interoperability with medisoft which they have been using for nearly ten years.  The owner is concerned that Amazing Charts is a small enough company that is might be bought out and the software might get sidelined.  I’m concerned that Amazing Charts uses Access as its database. I ran across a forum post complaining about slow tab flips and it was suggested that this was due to Access having a maximum database size of 2 GB.  If this is correct then won’t that be inadequate, after seven years won’t at least one of the clinics have outgrown the database?  As one member of this forum put it, “It isn’t getting into an EMR that is costly, the real cost is getting out.” or something to that effect.   It just seems that one of the open source SQL databases would have made a good, fast, cheap fit.  I don’t see anything on their website on the choice of database so maybe I’m mistaken.

     Still, I’m drawn to AC, it seems simple and straight forward enough that it would not add any time to the charting but would save time on the billing and money on paper and record keeping.  I’ve become interested in e-MDs in part because of Dr.Winn’s good words for AC. Oh, and they’re Texans thats good.  But, they’re quite a bit more expensive and are probably more than a three to eight room clinic needs.  Also, and I haven’t spoken to the local sales guy yet, but they don’t seem to interface to Medisoft, and that is pretty important.

     So now I have SOAPware to look at, and Meditech and Meditalk were suggested to me to consider.

Any suggestions? Have any of yall used Amazing Charts with Medisoft? 

Is there a chance AC might  be bought out or is it stable and unlikely to be bought?

Is AC slow after you’ve entered a lot of patients?

What about SOAPware does it have a good reputation? 

Last and most important, are these the right questions to be asking?  I know computers better than I know medicine and I want to be sure I make the right recommendation for this situation.

 Dear Benjamin,

You will see a ton of demos before its all said and done and so many of them have the same features and functions that they will begin to run together.  The thing that I tell my clients to concentrate on are:  Decide what you really want out of an EMR; exactly what functions are a MUST and what functions would be nice.  Second, decide on costs that you are willing to put out.  Sometimes, you get what you pay for if you know what I mean but there are several out there that are way overpriced!  Last, look at support because even if you have the best EMR in place, it will mean nothing if you do not have good and fast support afterwards that wont charge an arm and a leg.

That being said, AC is a good company indeed.  You will need to decide if they truely offer all that you want out of an EMR and if they will be able to handle growth and expansion that you may need to contemplate for the future.

There are so many factors to look into though.  SOAPware is also a good software but they do not have a PM system YET...but it sounds like you have that already. 

Do you want a system that is ASP (web based) or a system that is server (in-house) based? 

How much are you wanting to spend initially and then yearly?

Web-based systems will charge more and more (generally) as your storage increases which may end up being a large cost to you in the end.

Make sure that your EMR will interface with your PM system and if there is a cost to the interface and how long it will take to interface.

I could go on.  Let me know if you need more help!!  Good luck!

 Amazing Charts is very competitive.  I would give it the "Best Bang for the Buck" for low priced EMRs.

Its simple. Highly intuitive, and inexpensive. 

I would not hesitate in recommending it to offices.

They are moving off the Access backend and onto an SQL backend which will speed it up.

I've followed both AC and Soapware developments over the last several years.  In my opinion, AC wins.

Jon, the developer is a champion of small enterprise.  If it ever did get bought out, I would trust him in making sure

the deal was good for his clients. 

I agree with Layne 100%. Heck, I use a MS Access program that I developed myself and even programmed an add-on to AC, so I pretty much know the program well.

The best thing of all is not only Jon, the developer, but the many loyal users who preside over their open forum. Heck, they even put up with the likes of me going by there every once in a while.

BTW, if you are interested, why don't you go on over and participate in their ACUC meeting next week? See here for more information.

>>Its simple. Highly intuitive, and inexpensive. 

I would not hesitate in recommending it to offices.<<

For the life of me, I cannot understand why you would not hesitate to recommend it but you have not installed it yourself, to the best of my knowledge. I have heard you say good thing after good thing about AC but you chose to start your practice being paper-based and continue to do so. Have you made an upgrade to an electronic office since opening?

Can you describe your IT setup? If I came to your office what system would your staff use to check me in? How would you know I was in room 2 and I just wanted a basic physical for a late twenties male? How would you order the lab work for me? How would you receive the labs and input the results into the system? If you were to write me a prescription, would you get out your script pad? Or, would you write the script in your EMR? On my follow up visit, could you review my last visit, meds (update the ineffective meds) and look over my previous labs before initiating the new exam (assuming you asked for a follow-up visit from my initial visit). How would you write/schedule the follow-up? If I was referred to a specialist how would you write the referral?

Using a "no follow-up required work-flow" with AC, how could you quickly and easily send me a letter telling me my labs were normal and no follow-up visit is required? How would you even be alerted the lab had come in?

I look forward to the responses.

 I know I'm a clown !  I've been here so many years and still using paper!   I had it narrowed to Soapware and AC.  Then narrowed it to AC but wanted the SQL database which is taking longer than expected.  Then am also interested in eMedRec !

My current office setup.  Its me and one MA.  I run a small practice.  I am seeing 7 patients per day.   I see patients in two exam rooms.   My monthly overhead is $5k. 

My MA checks the patient in and I say hi to them when they walk into the waiting room.   I would know what room you would be in because I would walk in with you talking about fun things going on in your life while my MA did her stuff.  I order labs by circling them on a paper form I created.  I recieve them on a fax which I check throughout the day.  Based on the results either me or my MA gives them a personal phone call right then to review them and schedule follow-up if needed.  The labs are paper so are filed on top of the chart so i know that is the most recent thing to see when they come back.  I write Rx on a pad while joking with the patients and reviewing side affects.  Every office note gets its own paper.  I can quickly scan with my eye as I thumb through multiple visits in about 10 seconds.   If a referral is needed, I call out to my MA from the patient room to get it done.  A phone call is instantly made and the referral is aranged by my MA while I'm visiting with the patient.   For follow-up, I walk with the patient to the front of the office chatting with them.  Then tell my MA to schedule them for a follow-up.  She uses a free scheduler that keeps track of their names, reason for visits,phone and insurance. 

This week I've recieved 4 new patients.  I asked them why they are not seeing their old doctor and each said the exact same thing.

"He got a computer and all he does is look at the screen and ask questions from it".  

I'm a young doctor practicing medicine the old fashioned way.  A personal touch.  I'm the doctor who patient's pay cash to see me if I don't accept their insurance because of my style.   I'm excited for the summer because I wear shorts, slip on sandals and a t-shirt.  My patients relate to me, and I to them.

FPdoctor:

"He got a computer and all he does is look at the screen and ask questions from it".  

I'm a young doctor practicing medicine the old fashioned way.  A personal touch.  I'm the doctor who patient's pay cash to see me if I don't accept their insurance because of my style.   I'm excited for the summer because I wear shorts, slip on sandals and a t-shirt.  My patients relate to me, and I to them.

Great comment.  This is the issue of EMR, plain and simple.  I would recommend AC any day for a practice this size.  We are a bit more keyed towards the busy office, but of course we work with Medisoft.  We built bridges for two Medisoft Systems this week between eMedRec and Medisoft.

I think every vendor that is not EMR/PMS but just EMR/EHR has at least double digit installs or more in Medisoft customers as the PMS.

Hi Benjamin,

Please consider DescriptMed (http://www.descriptmed.com/).  I have use Dr. Ellis program for over 3 years now.  I have about 2200 patient's chart on the system.  Three years ago, I was looking for a low cost EMR option.  I was down to AC and DescriptMed (The Chart!).  Although I liked both products, I was concerned with AC Access database...  I downloaded and try out both products...  I spoke to Dr. Ellis and suggested that he changes/add a few things; and, he did!!  At that time, I was happy with my practice management software (Visionary Med).  I just needed and EMR to replace my paper chart systems that I had used for about 8 years.  I am still using Visionary Med for scheduling and billings.  I use DescriptMed for my EMR.  I am in solo, internal medicine practice.  I have the equivalent of one full time staff.  I can see up to about 25 patients per day (even if my secretary did not show up for work)...  I have the EMR installed on 5 computers and it works wonderfully...  All incoming faxes are capture as PDF.  All hard copies reports are scanned into each patient's folder as a PDF file.  All labs are downloaded from the labs as PDF files.  All of my old paper charts have been scanned and shreaded...  I use XP pro remote access from home to pull up any patient's chart if I get a call...  I suggest that you download and try out Dr. Ellis program; also, give him a personal call.  He'll be happy to discuss the software with you...  If you are in San Jose and would like to come by my office for a demo; I'll be more than happy to show you the program in action...   My email address is lamdomd@sbcglobal.net if you need to contact me...  I have no financial interest in DescriptMed...

Thanks for the prompt reply Deborah,

I want a client/server setup. We have a server setup already and an IT company on call. Each room is wired and there is 802.11 a/b/g set up. Also, I don't like the thought of having another company controlling our data. If something goes wrong it just makes moving on harder. And it's nothing to add a new disk.

Both AC and SOAPware link to Medisoft through x-link so that isn't a problem. I would like to ask if you have heard of anyone complain those two programs increase the time for charting?

Alborg: Thanks for the invitation, I won't be able to make it though.

FPdoc: I appreciate the enthusiastic support of AC. May I ask what you don't like about SOAPware?

bbchase: Thank you for the criticism.

"Can you describe your IT setup? If I came to your office what system would your staff use to check me in? How would you know I was in room 2 and I just wanted a basic physical for a late twenties male? How would you order the lab work for me? How would you receive the labs and input the results into the system? If you were to write me a prescription, would you get out your script pad? Or, would you write the script in your EMR? On my follow up visit, could you review my last visit, meds (update the ineffective meds) and look over my previous labs before initiating the new exam (assuming you asked for a follow-up visit from my initial visit). How would you write/schedule the follow-up? If I was referred to a specialist how would you write the referral?"

As I said above we are a three provider clinic with a doctor that does consults. We have a server for our Medisoft billing office, we have eight wired rooms but usually only use four. We know who and why you are here because this information will be written down for the nurse who takes you back. We have a LabCorp office in the back so we just write it up and walk it back, using an EMR we would plan to interface to LabCorp and I don't believe we see enough patients to ever overlook a lab coming in. I believe we will choose to write up the script with the EMR. All in all we're a neighborhood clinic and small enough that these things shouldn't be major obsticles. I'm still thinking over some of them.

lamdomd: I will look into it. We're in Dallas but I would certainly take you up on that offer if I were nearer.

I want a client/server setup.

Good deal.  AC has backup services I believe but I would set up your own and save $$.

We have a server setup already and an IT company on call.

Are you using a local IT company or are you using an IT company that is familiar with EMRs?  This is an issue that I run into with our clients...they use local IT companies and they have no clue about the EMR systems so, they end up paying for the local IT and the EMR support when most of the time, the local IT calls the EMR support for help anyway.  Be sure to work with an IT company that is partnered with AC and/or soapware and can provide IT and software support is one..saves LOTS of $$.

Each room is wired and there is 802.11 a/b/g set up. Also, I don't like the thought of having another company controlling our data. If something goes wrong it just makes moving on harder. And it's nothing to add a new disk.

Agreed.

Both AC and SOAPware link to Medisoft through x-link so that isn't a problem. I would like to ask if you have heard of anyone complain those two programs increase the time for charting?

I have not heard of any complaints but, I only have a few clients on AC and one client on SOAPware.  SOAPware is a good company but most of my clients like to have a PM and EMR in one so, that has been the issue.  AC clients have been good so far and it is a stable program.  There are many out there though so be sure that you are getting what you need to make your workflow change as little as possible.

BenjaminSerrato:

FPdoc: I appreciate the enthusiastic support of AC. May I ask what you don't like about SOAPware?

I find Soapware cumbersome to use.  You don't find many here talking about it compared to others, I think for this same reason.  It use to be more popular, but then it faded as complexities were added.

AC allows you to use the software for 3 months.  Try it out.  Have the doctors invent fake patients and make chart notes, etc.  Intuitive and fast.  Their back-up service is very inexpensive.  They're yearly fees are inexpensive.  They interface with LabCorp. 

I agree that AC is the best bang for the buck today.  It is clean, simple and gets the job done - all of the incredients that I think the next wave of EMR adoption will require.  The only think holding Jon back from the bigger deals, IMO is the client-server architecture - that and the perception that many offices (and pundits) have that one must have a CCHIT certified EMR.  Who would like to see AC and e-MDs join forces?  Who would like to see Soapware join us?  I know competition keeps everyone honest (in theory anyway) , but I think Jon, Randall and I all have the same vision of improving healthcare thru affordable, easy to use EMRs.  e-MDs pricing has certainly been higher than most, but part of that is driven by the higher end requirements that large medical groups and consultants expect from us.  I'm not certain all of the fluff is necessary (certainly most docs do not use most of it), but we play the game to stay in the big deals.  The future will be the web native, inexpensive basic EMR that is totally addicitve, that leads physicians to escalate their habit to the larger systems.  The challenge will be to offer enough 'value 'add' in the way of improved revenue recogniton, embedded clinical decision support, automated DM and quality tracking - among other things, to convince doctors to 'upgrade'.

>>The future will be the web native, inexpensive basic EMR that is totally addicitve, that leads physicians to escalate their habit to the larger systems.  The challenge will be to offer enough 'value 'add' in the way of improved revenue recogniton, embedded clinical decision support, automated DM and quality tracking - among other things, to convince doctors to 'upgrade'.<<

I wonder if the online experience will ever be as, "Rich or Robust," from an doctor end user perspective. Speed has always been and issue and will continue to be an issue,  but what about programming tools etc. that will allow friendly and rapid charting.

You just need an EMR designed for this ... I know of at least one that provides a rich experience which is similar to whether being used in ASP mode, or client server.

eMedRec is getting more aggressive towards pricing for these smaller solo docs.  eMedRec is not really designed for EMR/PMS but it is designed for Paper Automation and with our Dragon Note System and soon, within next few weeks, Active Ink forms support we are very competitive price wise, considering it is SQL Server based and includes Enterprise Document Management and Dragon in the price.