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DrMurdoch: AKnative outlined many software problems. You also raise some important issues regarding some people at this install. It also seems this group would rather have had an improved Chartlogic vs. another EMR, but was frustrated in waiting for Chartlogic to get updated. You were responsible for their Go Live date, so if they went too early, seems you could have warned them. AKnative, what are some workflow things that work better for you with ChartLogic vs. Praxis ?
AKnative outlined many software problems.
You also raise some important issues regarding some people at this install.
It also seems this group would rather have had an improved Chartlogic vs. another EMR, but was frustrated in waiting for Chartlogic to get updated.
You were responsible for their Go Live date, so if they went too early, seems you could have warned them.
AKnative, what are some workflow things that work better for you with ChartLogic vs. Praxis ?
Under advisement we moved our go-live date forward twice (totaling 2 mo delay) in order to try and accommodate appropriate training. As with any clinic with multiple users, there are people on the "team" with varying levels of enthusiasm about the project and this can be frustrating. We also attempted a second go-live after speed problems were thought to be as improved as possible. Despite realizing that speed MAY be able to improve over time and that some of our frustrations MAY be worked out eventually with Praxis 5 and other upgrades, we decided as a group that poorly designed interface and software issues would still be prohibitive.
We certainly would welcome upgrades from Chartlogic and because of the distractions with Praxis we have yet to get the latest version of Chartlogic and thus we will be working with them for the time being to regroup and evaluate our options.
Briefly: a partial list of things that worked better in Chartlogic and then I will give one detailed example for illustration purposes.
*cosigning/reviewing midlevel provider notes
*managing medications, refills
*sending and processing patient referrals to specialists, including the ordering of procedures, imaging studies, etc that are out of house
*immunization documentation
*managing patient phone calls/questions/rx refills/record requests, etc.
*Billing/coding
Heres' a few of the issues we found with medications in Praxis:
The parties have resolved their dispute and all related issues to their mutual satisfaction.This note added at the request of Infor-Med Medical Information Systems, Inc and CopperView Medical Center
Well done, that is a nicely documented workflow ! For your future demos you should walk through that and see how the vendor does (instead of letting them do their own canned workflow).
Greg--Principal at PatientOS Inc. (888)-NBR1-EMR
aknative: Notes that are modified and sent on do not stay in an inbox of someone else unmodified.
Notes that are modified and sent on do not stay in an inbox of someone else unmodified.
Certainly this needs fixing. Messages need to be patient-centric, not provider centric.
They (The nurses calling the pharmacy for a repeat) have to go to a different part of the chart to see the pharmacy, another part of the chart to see the DOB and the patients phone number.
Surely Praxis can be modified to do this properly.
Cannot prescribe 30mg morphine and 60mg morphine simultaneously (can't be done)
Very odd.
Took us an average of 40-60 sec to print a prescription, after which the chart must be closed. If a chart needs to be re-accessed for any adjustments to the Rx or additions to the plan, it will take another 30-45 sec to open. That's 2 min of wasted time right there.
Ouch.
There is not a good way to deal with Durable Medical Equipment prescriptions such as diabetic supplies or ortho equipment.
I find alot of EMRs fail here. Same with physio prescriptions, Massage therapy prescriptions, etc.
Anyone who has enough time to read all this... hope it made sense!
Very interesting read.
Your main example centers around messaging. That's really only a small subset of Workflow.
Praxis is certainly not meant for a group your size. It's a solo doc EMR mostly, with very few users.
It's clear Praxis is not designed to meet the Messaging/Communication needs of a larger group.
AKnative, I am sure your failed Praxis deployment gives you great pains both financially and emotionally but you are not without great company, the failure rate for EMR deployments in at least 40%.
My EMR is: Synapse It is what we know already that often prevents us from learning. Pioneers are the ones with the arrows in their backs.
DrMurdoch:AKnative, I am sure your failed Praxis deployment gives you great pains both financially and emotionally but you are not without great company, the failure rate for EMR deployments in at least 40%.
I believe the published number for failed implementations is 30% and that number was for one particular high dollar EMR. Praxis is one of the better EMRs in this regard.
e-MDs has a 94% renewal rate. That means 94% of our physicians pay the annual maintenance fee of approx $1,800 per license. Our CFO says that about 3% of the non-renewals are physicians that move, retire, die or join another practice, so best guess is that 97% of our physicians are happy with us. We did just lose one physician champion who had been using us for years. He starts at e-MDs this coming Monday.
Disclaimer: I am the founder of e-MDs - highest rated EHR in 5 consecutive AAFP and ACP physician surveys
>>That means 94% of our physicians pay the annual maintenance fee of approx $1,800 per license.<<
Hi Dave,
Nice to see you posting. Always your posts are informative and often sometimes provocative. I use Writepad EMR. If a user doesn't pay the maintenance fee, the program is crippled or so is the message a user politely receives. Of course no fee means no updates, and we always want updates because we always want a fix. Why do we want a fix? Because there are always problems. ( is there a 12 step program for EMRs?)
Anyway, I always pay because basically, I am happy. Who knows, perhaps if I did not, I would become sterile ;-) (Can't technology do this to me over the internet?).
Anyway, I assume e-MDs is NOT employing, "Strong Arm," tactics for the sake of stats. I've used dozens of EMRs over the last three decades and basically, if you don't pay the maintenance fees, you will suffer to the point of pay or switch.
My point is that I am sure your stats are legit, but you can see by my example, that percentages, don't tell all.
Chris Wilkerson, D.C. Carson Doctors Group TabletPCs in Medicine Editor-in-Chief www.MedicalTabletPC.com Home: www.Digital-Doc.com
digital-doc: My point is that I am sure your stats are legit, but you can see by my example, that percentages, don't tell all.
Well, the stats tell you that 94% are still using the EMR. They don't tell you if they are really happy using it, but they tell you that they are not miserable enough to try the switch to another EMR.
94% is a fantastic retention rate for any product/service in any industry, so e-MDs must be doing something right.....
I wonder how those uninstall rates are calculated anyway... Are they counting individual physicians, or facilities? Do they include hospitals? 40% seems really high....
Margalit Gur-Arie
On Healthcare TechnologyHealth Tech & Policy Bloghttp://www.onhealthtech.com/Health Tech Discussion Board
aknative: DrMurdoch: AKnative outlined many software problems. You also raise some important issues regarding some people at this install. It also seems this group would rather have had an improved Chartlogic vs. another EMR, but was frustrated in waiting for Chartlogic to get updated. You were responsible for their Go Live date, so if they went too early, seems you could have warned them. AKnative, what are some workflow things that work better for you with ChartLogic vs. Praxis ? Under advisement we moved our go-live date forward twice (totaling 2 mo delay) in order to try and accommodate appropriate training. As with any clinic with multiple users, there are people on the "team" with varying levels of enthusiasm about the project and this can be frustrating. We also attempted a second go-live after speed problems were thought to be as improved as possible. Despite realizing that speed MAY be able to improve over time and that some of our frustrations MAY be worked out eventually with Praxis 5 and other upgrades, we decided as a group that poorly designed interface and software issues would still be prohibitive. We certainly would welcome upgrades from Chartlogic and because of the distractions with Praxis we have yet to get the latest version of Chartlogic and thus we will be working with them for the time being to regroup and evaluate our options. Briefly: a partial list of things that worked better in Chartlogic and then I will give one detailed example for illustration purposes. *cosigning/reviewing midlevel provider notes *managing medications, refills *sending and processing patient referrals to specialists, including the ordering of procedures, imaging studies, etc that are out of house *immunization documentation *managing patient phone calls/questions/rx refills/record requests, etc. *Billing/coding Heres' a few of the issues we found with medications in Praxis: There is not a good way to deal with Durable Medical Equipment prescriptions such as diabetic supplies or ortho equipment. Can't print prescriptions individually, what about schedule II medications? We now use a praxform, but that requires all separate or all together (no picking and choosing so one may have 10 sheets of paper for 10 rx. Can't add same Rx twice. What about people who need a 90d Rx and a 30d Rx of the same medication at an office visit, or post-dated Rxs? What about someone that takes 30mg morphine and 60mg morphine simultaneously (can't be done) Took us an average of 40-60 sec to print a prescription, after which the chart must be closed. If a chart needs to be re-accessed for any adjustments to the Rx or additions to the plan, it will take another 30-45 sec to open. That's 2 min of wasted time right there. There is no way to use weight-based dosing or calculate weight-based dosages in the chart for pediatric patients. Here's an example of an issue that repeats daily in a Primary Care practice. Pt calls to report, as asked, that their BP has been running high. Agent sent from triage to MD1 via MD group. Another MD 2 (covering for MD 1) looks at chart and wonders if the patient has been taking 1 or 2 tab of the hctz (because pt was asked last visit to increase if necessary) Agent sent back to triage with this question. Meanwhile agent is unmodified in MD1 box and they are unable to view the above activity because it's not "saved" and sends another agent saying something different. We now have 3 agents listed in patient record, all done at different times with different information. Finally patient is called and we find they are taking 2 tab of hctz (the max) and so they need a new rx. MD 1 put a note in chart that in this circumstance Diovan should be called in, but staff can't do this in Praxis. Agent sent back to one of the docs. More agents put in chart. (Users can decide to save agents or not to the chart, but the default of save we found makes most users save these, sometimes unknowingly to the chart even when they are incomplete.) Now the doc has to start another note (can't put rx in phone note) and this is called Fast Rx. Then MD 1 gives rx for Diovan #30 with 2 refills. Then, triage gets the Fast Rx. Fast Rx is poorly designed. Once it's sent back to triage it can't be modified. The triage sees a minimal version of the screen the MD sees. They have to go to a different part of the chart to see the pharmacy, another part of the chart to see the DOB and the patients phone number. The triage staff writes all this info on a piece of paper so they can have all the info in front of them when they call the pharmacy. The patient is called back but then requests 90d supply. Then triage has to create a new fast RX (previous can't be modified and triage nurse isn't allowed to enter Rx in praxis) and send to MD to get a new rx approved and puts a note in it about the change request. Meanwhile the previous fast rx indicates that the 30d rx has been called in (can't be modified) to a retail pharmacy. By the way whenever a default pharmacy is saved to a patient the fast rx indicates that rx has been sent there whether it's happened or not yet. Now MD 2 (covering again) has to read about 7 different chart entries to try to find out what has happened. Then, the patient goes to pharmacy to pick up rx and finds that the Diovan is not preferred on their insurance and they want Cozaar. They call the triage nurse who has to put in another phone note and fast Rx with Cozaar and I hope by now you can see how confusing this all is. By now there are 8-10 notes in the chart and it's a mess. In Chartlogic this would all be one note with a couple addendums at the most. Phone notes can go back and forth between staff with additions and subtractions unlimited. Notes that are modified and sent on do not stay in an inbox of someone else unmodified. Rx can be added to phone notes and modified by certain triage staff with privileges. Simple changes that don't affect the total number of pills or drug can be made without the provider getting multiple additional requests and questions and delaying the process. The necessary information for a staff member to call in an rx is all easily accessible from the screen the staff member has in front of them. The pharmacy and method of dispensing of rx is documented explicitly. Anyone who has enough time to read all this... hope it made sense!
eMDs does all of the things you ask for: except I am not sure how eMDs handles Durable Medical equipment, immunizations, or pediatric weight based dosing since we do not do any of those in my practice. One of the reasons we chose eMDs over Praxis for my group practice.
Bryan D. Uslick, MD CFCDD (Gastroenterologist) eMDs user since 3/3/2006. Currently using version 6.1 (Prior Praxis user.)
Provation MD endoscopy report writer
To improve the ability of physicians to get a full-featured demo, here are some notes that might be helpful in pressing a vendor's feet to the fire:
--Regarding messaging, an important function is that ability to review a chain of messages regarding a single patient with a single precipitating event. In your case, patient-reported BP running high.
--The person receiving that message should be able to either generate a message to a single recipient or a group of recipients. The group might be "On call FP" when the physician actually on duty might not be known. Everyone in the group, when selected, receives the message.
--The first recipient to answer the message, disposes of the message from the inbox, but sometimes "disposal" is not what is wanted. "Forwarding" the message to a more appropriate recipient is a necessary option. So the message goes from one recipients mailbox to another.
--The chronological history of a message chain should be easily reviewed. So Sue sent a message to Dr. Jones, who initiated a new message to call the pt with a question, which prompted a new message....ad nauseum. These are all linked and easily reviewed when there are specific accommodations for it. For example, under the messaging window, we have a "Message history" tab which shows the whole chain of messaging associated with any particular message, no matter where that message was in the chain. So you can see how Mrs Jones reported her Percodan script was eaten by the dog....Dr. Smith was on call and wrote another script, but Mrs. Jones reported that it blew out of her car window on the way to the pharmacy....
-- The script writing, faxing and calling in should be available, for those with permissions, from within the messaging tool.
Some other items for the demo list:
-- For some items, messaging is not the proper tool, but rather Tele Triage is the tool of choice. As suggested by its name, it is where a mini-encounter can be documented (a croup pt who really does not need to be seen but some clinical items should be documented by a nurse after a tele interview of mother). Tele triage is common in peds and FP. Again, rx'ing should be available.
-- Though never discussed here, an "Rx-by-proxy" is a great feature. That is, a physician explicitly gives a nurse the permission to write scripts, for example in Tele Triage, and those scripts are stored for review by the authorizing physician. In our Rx-by-proxy, the script is produced and transmitted/printed in the physician's name but still stored for review. Ostensibly, it's a verbal authorization by the physician while the nurse does the leg work.
-- DME is an infrequently reviewed feature. DME is feature not used by most physicians and so should not be taken for granted.
-- Weight-based peds dosing requires some granularity in the EMR so that at least the multiple methods of getting weights (lbs; kgs; lbs/oz) allow any of those weights to carried over to peds dosing. BMI should be automatically calculated as well. Any of these values, if used for peds dosing, should be immediately available, automatically, for plotting in growth curves.
mchasemd: -- The script writing, faxing and calling in should be available, for those with permissions, from within the messaging tool.
Hey Matt, show off and show us what this looks like in Metuity ! (in another thread).
WIll do.
...........Cannot get the link icon to work. It is grayed out and I wanted to link screen shots to
http://www.medtuity.com/images/refillrequest.jpg
http://www.medtuity.com/images/refillrequest2.jpg
http://www.medtuity.com/images/refillrequest3.jpg
http://www.medtuity.com/images/refillrequest4.jpg
mchasemd: http://www.medtuity.com/images/refillrequest.jpg
So the refill request is free text - you type in the name of the medication instead of selecting an existing prescription?
I've got the new post up in a new thread. No, you pick a previously prescribed med. It's very fast. Takes about 5 sec max to do a refill.
Elana, I just want to get the "facts straight". As you recall we delayed our start up date several times to allow for traning and implementation of Praxis. In fact, I feel that my staff and physicians were "very well versed" with Praxis prior to implementation; possibly too well versed. When we actually tried to use those features of Praxis that we orginally thought were superior to our current EMR, that is when all the problems started popping up. Praxis referred us to several clinics that they felt would give us "insight" into these software "glitches". Little did they know that those Praxites were "hand-writing" prescriptions and doing a similar "paper trail" for referrals, etc that we had already disposed of long ago in our practice. Furthermore, why would we pay an additional 60 K for an EMR just like our "old EMR"? We were at one point excited about the features that Praxis could provide us that CL could not. I feel that AKnative has outlined it well so I will not be redundant. Furthermore, in response to the "positive attitude". I feel that we kept our morale quite well through this tough process. Even after the initial failure of implementation that cost us well over 250K we continued to be in discussions with Dr. Low in how to resolve these software issues and speed issues. In our very last phone conversation with Dr. Low in which ALL of the partners were in attendance, Dr. Low apologized for the software problems and speed issues, and conceded verbally to refund us our implementation costs and on-going costs until the problems could be fixed in Praxis at which time we would try and implement Praxis again. All the partners were excited and agreeable to this solution. Unfortunately, since then, Dr. Low has refused to sign any writing documentation consummating that agreement and has refused to continue communications with our practice administrator. So please do not comment on our "attitude" and being "open to solutions" until you have "ALL the FACTS STRAIGHT".
Paul Lei, M.D.
drplei: Elana, I just want to get the "facts straight". As you recall we delayed our start up date several times to allow for traning and implementation of Praxis. In fact, I feel that my staff and physicians were "very well versed" with Praxis prior to implementation; possibly too well versed. When we actually tried to use those features of Praxis that we orginally thought were superior to our current EMR, that is when all the problems started popping up. Praxis referred us to several clinics that they felt would give us "insight" into these software "glitches". Little did they know that those Praxites were "hand-writing" prescriptions and doing a similar "paper trail" for referrals, etc that we had already disposed of long ago in our practice. Furthermore, why would we pay an additional 60 K for an EMR just like our "old EMR"? We were at one point excited about the features that Praxis could provide us that CL could not. I feel that AKnative has outlined it well so I will not be redundant. Furthermore, in response to the "positive attitude". I feel that we kept our morale quite well through this tough process. Even after the initial failure of implementation that cost us well over 250K we continued to be in discussions with Dr. Low in how to resolve these software issues and speed issues.
Elana, I just want to get the "facts straight". As you recall we delayed our start up date several times to allow for traning and implementation of Praxis. In fact, I feel that my staff and physicians were "very well versed" with Praxis prior to implementation; possibly too well versed. When we actually tried to use those features of Praxis that we orginally thought were superior to our current EMR, that is when all the problems started popping up. Praxis referred us to several clinics that they felt would give us "insight" into these software "glitches". Little did they know that those Praxites were "hand-writing" prescriptions and doing a similar "paper trail" for referrals, etc that we had already disposed of long ago in our practice. Furthermore, why would we pay an additional 60 K for an EMR just like our "old EMR"? We were at one point excited about the features that Praxis could provide us that CL could not. I feel that AKnative has outlined it well so I will not be redundant. Furthermore, in response to the "positive attitude". I feel that we kept our morale quite well through this tough process. Even after the initial failure of implementation that cost us well over 250K we continued to be in discussions with Dr. Low in how to resolve these software issues and speed issues.
In our very last phone conversation with Dr. Low in which ALL of the partners were in attendance, Dr. Low apologized for the software problems and speed issues, and conceded verbally to refund us our implementation costs and on-going costs until the problems could be fixed in Praxis at which time we would try and implement Praxis again. All the partners were excited and agreeable to this solution. Unfortunately, since then, Dr. Low has refused to sign any writing documentation consummating that agreement and has refused to continue communications with our practice administrator.
Wow, the CEO promises something as important as this and renegs ?
That looks bad.
I hope this gets resolved quickly.
Praxis is the weirdest EMR, and it's getting weirder.
So please do not comment on our "attitude" and being "open to solutions" until you have "ALL the FACTS STRAIGHT". Paul Lei, M.D.
Thanks for the Update Paul.
drplei:Little did they know that those Praxites were "hand-writing" prescriptions and doing a similar "paper trail" for referrals, etc that we had already disposed of long ago in our practice
I thought you guys did your due diligence. It is a topic of debate that individual scripts could not be done and in order to do so we had to subcribe to get the feature with surescripts which 5.0 promises when it is released. But for an annual fee which the cost can not passed on.
What referrals are you talking about? Inside the note which is completed when the patient leaves or even if not completed the reception looks at the note which has the labs, which I print to give to patient and faxed by staff since our Dynacare is not yet bidirectional (supposedly owned by labcorp but does not have the same features of labcorp yet for some reason).
When I spoke to one of your collegaues it as difficult to converse and was very upset. It was my own time and I am not paid for Praxis. She was dead set it was your groups way or the highway!
I wonder truly given the extent and expectations your big group wanted for just 60K with multiple offices why your case was taken. That I think was the blunder of Praxis. Agents and the intranet originated from Praxis and it is nice to know that Medtuity also has it. Needless to say I would be on your side, to get some sort of refund but I wonder what your contract says.
drplei:Dr. Low apologized for the software problems and speed issues, and conceded verbally to refund us our implementation costs and on-going costs until the problems could be fixed in Praxis at which time we would try and implement Praxis again. All the partners were excited and agreeable to this solution.
Refund your ONGOING costs? Wow, I do not think Cerner or even Epic would do that? Would you Dr. Winn? Matt? or ECW? You sold the software for 60k and now you have to pay for even half of 250k? Is that good business? I hope patients are not reading this and get an idea? We know pathophysiology is not consistently following a course. Wow. A company sells a software for 60k and failed then pay back 250k plus 60k back plus ongoing costs? OUCH! I should have done that to Dragon, thanks for the idea.
Roger Ven Torres, M.D. http://www.wapcp.org/ Praxis user since 2000