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WebDMEMR is a web based EMR with features for clinical trials.
WebDMEMR's set up fee is $350.. What's yours?
Just a little friendly competition...
lroman@webdmemr.com
http://webdmemr.com/
Ironman, I'll take you up on your offer. Ours is normally $1995 for the practice, including the first provider and $795 for each additional provider. I say "normally" because we may offer a discount in conjunction with implementation of a partner PM system or for large practices that don't want too much customization by provider.
As with most things, I don't think you can judge price without knowing what is included - and what is not. So I will tell you what we inlcude and you can do the same:
Our start-up fee includes:
* Project planning. Working with the practice to develop the best deployment plan and schedule for the practice.
* Customization of the practice, including clinic settings, workflow and templates. We also include the tools for the practice to do this and train them on the tools but we do the initial customization for the practice.
* Setting up their ePrescribing and eFaxing
* Setting up/programming any desired HL7 interfaces
* Customized Web training. Typically takes 4 hours each for Admin users and 8 hours each for providers and clinical users but we don't have time limits providing the staff are actively participating in the training. Training is done on the practice's customized version of the system so it cannot be canned training.
What is not included:
* Onsite training. This is optional and is $1500/day plus actual travel. Some practices need this and some don't but it needs to be available for those that do. We often recommend that we be onsite for at least the go-live date.
C Huddle VP, Market Development www.Sevocity.com
C Huddle: Ironman, I'll take you up on your offer. Ours is normally $1995 for the practice, including the first provider and $795 for each additional provider. I say "normally" because we may offer a discount in conjunction with implementation of a partner PM system or for large practices that don't want too much customization by provider.
Firstly, it's "Lroman". Secondly, thank you for participating in my friendly competition ;)..
WebDMEMR's $350 set up fee includes unlimited providers, the information below, and many other features.
1. Project planning? deployment? It must be a client server based EMR...
2. Templates are a no no... I know most physicians who arent into typing would argue that point but the truth is that :
a). Templates are generated by other people, using their words, their judgment, and their methodology. EMR templates assume that the system knows more about medicine than you, the actual user. The makers of templates assume to know what you are thinking and what you are required to do at the point of care. b). Templates allow payers to manage you and your practice. Many third party payers are cutting costs and increasing revenues at your expense and at the expense of your patients. The manipulative characteristics of templates with structured language allow potential control by third parties. c) “Templates are legally dangerous. Your templates can actually be subpoenaed during the discovery phase of a malpractice suit. Imagine how pleased a plaintiff's attorney would be to find that your entire practice could be reduced to a series of structured statements and factoids. Suddenly, the art of medicine is diminished, and you appear as a mere technician forcing your patients into a single mold.”
a). Templates are generated by other people, using their words, their judgment, and their methodology. EMR templates assume that the system knows more about medicine than you, the actual user. The makers of templates assume to know what you are thinking and what you are required to do at the point of care.
b). Templates allow payers to manage you and your practice. Many third party payers are cutting costs and increasing revenues at your expense and at the expense of your patients. The manipulative characteristics of templates with structured language allow potential control by third parties.
c) “Templates are legally dangerous. Your templates can actually be subpoenaed during the discovery phase of a malpractice suit. Imagine how pleased a plaintiff's attorney would be to find that your entire practice could be reduced to a series of structured statements and factoids. Suddenly, the art of medicine is diminished, and you appear as a mere technician forcing your patients into a single mold.”
so WebDMEMR refuses to use templates. We do however allow users to upload thier own templates. And customize progress note print outs with practice logos.
3. ePrescribing is already available only training required (no need to "set up")
4. Training - Onsite and Web. Doesnt take very long, Est. 1:30 hrs for Administrators and about 6 hrs for providers and regular staff.
5. 24 hour customer support
6. Also included, for sites that participate in clinical studies, A Clinical Study Accounting module to manage sponsor payments, procedures and generate invoices.
It is not client-server. Implementation and deployment of an EMR is a project whether or not it also involves setting up servers in the office. You have to decide how you want to deploy it, when and what each person's tasks are.
Templates in EMR are no different than when used with transcribing. They allow the physician to indicate repetitive words with less effort but done properly they in no way prevent the physician from changing them and/or the end result of using them.
This is absolutely wrong with our EHR and most that I am aware of. Templates are created individually for each practice based upon how they normally chart. The practice reviews and approves all templates and has the tools (and uses them) at their disposal to modify and create templates. I have heard a certain vendor advocate that templates are legally dangerous but I have not heard a single legal case lost by a physician or vendor cited. If you know of one, please cite it. If too structured and not modified as needed I could see where a provider's template might make them look bad in court. On the other hand, done correctly, templates serve as reminders for the care the provider would normally give and therefore actually might prevent them from ever ending up in court to start with. Developing good, easy to use tools for template creation and modification is a lot of work and I think some vendors who knock templates just don't want to do the work.
Templates are generally of two types:
Documentation by exception (DBE)- The EMR dumps a pre-answered template into the encounter note. It is the duty of the physician to change, in the text, that which does not apply. That is, the note is generated and it must be read, dissected, and changed. This is the typical documentation method in templated EMRs. It should not be allowed. It's disingenuous documentation.
Documentation by findings (DBF)- The EMR presents an unanswered template from which the physician can point and click on the content that does apply. The template allows pertinent positives and negatives.
There are variations on this these. For example, Medtuity has documentation by findings templates and it has vignettes (preanswered templates), but in both cases, the content of the note is the result of point and click. Content is easily changed.
An attorney friend of mine won a case due to "documentation by exception". At that time, it was the largest malpractice suit won in Ohio-- multimillion $. As he explained to me, the documentation was composed of lots of negatives. Trouble is, the pt died. It would have been good for the defendant to document some positives, but documentation by exception usually is a long list of negatives-- it's too hard to predict positives in any given patient.....so just document lots of negatives to provide the impression of completeness.
1.There are many so called "smart templates". The fact is and remains that templates are not intelligent and cannot be easily modified for future use. Although template EMRs claim to allow for changes in text, the reality is that the constant editing of the template requires an approach that does not lend itself well to your patient encounter, especially under the stress of your daily practice. Also template-based EMRs allow for only one way of treating any given condition, and the choice rarely fits the variations of each encounter. As a result, making “quick” changes to templates is, time consuming, and even more complicated than simply writing longhand.
2. WebDMEMR is for all types of practices therefore we allow physicians the freedom to document their encounters in either S.O.A.P. or short progress note format, as they choose not by some predetermined template that can't possibly apply to ALL patients. Also with WebDMEMR, physicians can use their own templates IF and when they like.
3. Ok I misunderstood what you meant by project planning, WebDMEMR actually does that in it's training..
Still waiting for someone to beat $350..
"1.There are many so called "smart templates". The fact is and remains that templates are not intelligent and cannot be easily modified for future use. Although template EMRs claim to allow for changes in text, the reality is that the constant editing of the template requires an approach that does not lend itself well to your patient encounter, especially under the stress of your daily practice. Also template-based EMRs allow for only one way of treating any given condition, and the choice rarely fits the variations of each encounter. As a result, making “quick” changes to templates is, time consuming, and even more complicated than simply writing longhand."
The is a broad statement which does not apply to all templated EMRs. You are pushing too hard for your agenda while ignoring newer technology. If you don't understand the concept of "documentation by findings" and how templated systems can use this approach, it might be beneficial to do some research.
I decided to google DBF and I ran into these statements on a Dr's blog..
"Recent audits by federal agencies confirm the warnings about E/M compliance dangers accompanying documentation shortcuts introduced by many current EHR software designs. These audits are a clarion call for stakeholders to eliminate the problems they have created, however unintended."
"The templates generate multiple records with nearly identical text. This is a red flag which may cause the Medicare recovery auditor to cast a deeper and wider net."
"The templates default to multisystem reviews and exams whether you do them or not, and it takes time and trouble to edit them out. If too many of your notes are so rich in documentation auditors will look askance."
"Physicians have long been counseled that a well-documented medical record provides the best defense in the event of a claim of medical liability. The June 2008 issue of the Journal of AHIMA quoted EHR legal expert Patricia Trites on the potential danger of electronic systems that permit copying of near-identical documentation into large numbers of patient records: "From a medical-legal standpoint, what would [lawyers] do when they [see] this chart?" she asks. "They are going to rip it apart."
And this quote from a user ---
"I have personally been an expert witness in 5 malpractice case in two years caused directly by EHR's. The Veterans Agency EHR, touted by many as one of the top systems was involved in 2 of them. I counted 1012 pages of template heavy notes in one simple 8 month long chart and 157 times that this patient was supposedly screened for PTSD. Who are they kidding?"
"Templates can lead to loss of the human touch in health care. In the process of digitalization, the interpersonal aspect in health care may be lost. In handwritten hospital charts, doctors and other health care practitioners may write what they think and they feel based on their personal observations in their very own words. Templates are simply about ticking off boxes and crossing out things in electronic forms. The doctors are forced to think in categories and can seldom express a personal opinion on an individual case. Because of the lack of flexibility of many electronic reporting systems, cases of misclassification of patients and their conditions have been reported."
Maybe you could help me find some positive information on DBF in EMRs...?
You'll get no argument from me concerning the design of many templated systems. I have railed against that basic design, highlighted above, for more than 5 years. Many of the most popular EMRs use that design. Many physicians have come to equate a templated system with automatic default answers. I'm here to say that it does not have to be.
A templated system can provide choices consistent with the disease process(es), including pertinent positives and negatives, a variety of symptoms, and a variety of physical findings. In Medtuity's case, the templates are not automatically answered and all of the choices are "front and center" where they are easily picked without repetitive linking to other screens.
All templated EMRs are not the same.
What Matt is saying, if I may, is that the template does not have to come preanswered.
Looking at 2 templates for URI you would see one that is loaded with +st, +fever, +rash,-abd pain,-cough. The user then adjusts the +/- to fit the patients true complaints. so the theory goes.
The other template would have placeholders for st, fever, rash, abd pain,cough but nothing is preselected. The user must make the selection.
Both are called templates. The former's reason for being is to speed up the visit. The latter's reason is to create a record that accurately reflects what the patient is saying.The outcome is that the former creates a canned note and the latter creates an accurate note.
The irony is that with a good EMR the former is not needed. A well designed EMR cam allow for DBF if the findings can be added efficiently.
Lowell Kleinman, MD www.drkleinman.com www.old-fashionedhousecalls.com
Here is how most templates work:
A template is a a series of questions pertinent to the condition being considered.Templates are usually split into sections: HPI, Social Hx, Family Hx, Past Medical Hx, ROS and Exam. Most templates have multiple levels and sub-levels of increasingly specific questions.
Most systems come with pre-built templates for many conditions. Some systems allow users to change the templates on the fly - add/remove questions. Others have more complex processes for changing templates. Most systems allow users to create new templates, and vary in the complexity of the task.
Some systems allow the user to click on ONE button and record all negatives, or normals, for all questions. The user can then go and change the few items that are abnormal. Some systems also allow the user to save a "normal" template, where everything is preclicked with negatives and load it automatically. This is called documentation by exception.
Documentation by findings, means that the user only clicks items that he/she actually examined and found either negative or positive.
The templated system is not forcing the user to resort to documentation by exception. Usually the user must click at least one button to create all that "normal" text. One can argue that the EMR should not allow documentation by exception, but ultimately, it's the user's choice.
Margalit Gur-Arie
On Healthcare TechnologyHealth Tech & Policy Blog
lroman: WebDMEMR is a web based EMR with features for clinical trials. WebDMEMR's set up fee is $350.. What's yours? Just a little friendly competition... lroman@webdmemr.com http://webdmemr.com/
This is a joke right?
Athena Health does not show screenshots or video of their EMR either.
You know why?
Per Jonathan Bush - it does not show well = it is a terrible user interface.
I assume for $350 yours is the same - a crap EMR that you cannot show on your website because people would never demo it with your sales people?
Instead you try to trap people with talk of clouds and other insubstantial offerings?
I've looked at Medtuity - damn good looking product - what can you offer?
please, just more spam offerings from vendors
I'm confused by the previous post. http://athenahealth.com/our-services/athenaClinicals.php has a link to our clinical demo.
It's on the right hand side "See it in action"
Thomas Natt, East Coast Sales Manager, SGS, athenahealth, 617-402-1237, tnatt@athenahealth.com
Disclaimer- I work for athenahealth, the views expressed are my own and do not represent the thoughts or opinions of athenahealth.
Oh yeah I stand corrected - well it looks alright.