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Out of curiousity, what EMR programs come with instructions? Most sotware has online manuals, right? It used to be that you actually got printed manuals, but with cost of paper, they are usually online with the program. Word for windows, word perfect... yes, they all have online help manuals. Of, for 20 to 30 dollars, you can go to your bookstore or Amazonn and get a 3rd party book on the software. (Not likely to happen for an EMR, for sure)
Do you have documentation help with your EMR?
For OncoEMR there is none.
No printed manual, no booklets, no help sheets and no on-line manual / instructions. It's like... you get a week with the proctors and then you are pretty much on your own.
And given that a lot of what the software can do is best demonstrated on patients who have had their records inputed into the EMR for years, you wonder how to use these special tools in 2 years when you want them.
Does your EMR software come with instructions?
Most EMRs don't come with manuals.
Would you write manuals when you can charge alot for "further training" ?
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.
My sentiments exactly!!
Why not charge what you can get by with?
I asked if there was a forum with OncoEMR and the rep thought I was talking about some meeting that you can go to. I'd like to see an internet forum for our EMR so that users can discuss problems, new feature requests and work-arounds.
I actually did find a forum... I joined and saw that I was the second to join and it was started a year ago.
It's dead.
http://oncoemr-support-forum.994070.n3.nabble.com/
:)
Yea, it'll be hard for people to find that forum.
Well, start your own !
Make some videos (screen recordings) of things you've learned ... upload them to youtube and embed the videos in your forums.
That'll bring people to your site.
Costs:
$140 forum / website software.
$10/month hosting
$10 website name
+ a bit of time managing the forum.
Under $300 for a year "experiment".
$300 = cost of 1/2 hr of training !
Your goal would be to be the ecwusers.com of OncoEMR.
Note: don't pick EE (Expression Engine) for the site, IMO.
http://ecwusers.com/
But OncoEMR is the "first EMR to hit $3million in MU incentive dollars".. Tell me that isnt some kind of marketing spin.
Who are these guys and why did you buy them?
There are only a limited number of EMR's for oncology. Aria, from Varian is the most expensive, 50 grand per doc to buy. There are also many things that Aria can't do, so it was out. Then there were a number of other choices, none sounded wonderful. But you ask question after question when they present the software and "yes, it can do that" is what you get for every question. You know that it is not true so you do your best and hope that you can find work-arounds. Most oncologists don't like their emr software. OncoEMR was the first to be CCHIT certified. By the way, how do you pronounce "CCHIT"... is it how I think it is pronounced??
OncoEMR was expensive but no more than the others. After using it for 8 days I would say that I can make a progress note close to what I want and with a few minor changes in the template, I will be even more satisfied. There is no manual nor any documentation by my partners and I are quickly figuring it out on our own. To some extent the company is making some changes in the templates to make them work better for us. In other words, it could be a lot worse. A few aspects are really quite good, in a way. Still, there are a few things missing that I would like that I will never get, I am thinking. I am not trying to endorse it for any other oncologists here, but I am not saying that it is bad software.
I wish there were documentation and a better ability for us to make our own templates. Maybe that will come.
I am considering starting my own forum.
But hey, this is a great forum!!
davideyoungmd: There are only a limited number of EMR's for oncology
Indeed.
OncoEMR was expensive but no more than the others. After using it for 8 days I would say that I can make a progress note close to what I want and with a few minor changes in the template, I will be even more satisfied. There is no manual nor any documentation by my partners and I are quickly figuring it out on our own.
I wish there were documentation and a better ability for us to make our own templates.
email me if you get serious about this.
I can save you lots of time and energy in terms of what software to get and why.
my email is my forum name @cogeco.ca
I'll guarantee you ROI in year 1 (expense of forum vs. reduced training costs) ... I don't think it takes a rocket scientist to expect good treatment from OncoEMR if you are running a user forum about their software. More importantly, misery loves company. ;)
Yes, thanks. It really is a good idea. If I were to do it, it would be in about 2 or 3 months.
I need the time now to get accustomed to the EMR. I would say at this point that it has a lot of promise. A forum would do it a lot of good as well as the users.
I am a yearly beta tester for Finale, a music notation program and I am on their forum every day. I know a little about new feature requests and bug fixes and what people want and expect from their software.
David
Our Support Staff nearly always require that we provide a on-line manual with our software. That being said, with all the resource costs and pressures vendors are having because of the Government Initiative for Meaningful Use it would not surprise me if a great many, like us, had to take shortcuts just to try and cool the pressure from the end users a bit.
I would like to address your issues, regarding cost. I don't want to come off as a person who does not sympathize, but in reality a vertical within a vertical market for any industry adds an additional set of costs. I am sure all the Oncology based EHR's have strict rules they need to adhere to for the management of patients with Cancer that are not in the mainstream market.
Another vertical like this is Endoscopy ASC's mixed with Gastroenterology practices. They only have two major players, GMED and Provation, both were built on the ASC but not the EHR. They have rushed to get out "Certified" and "MEaningful Use" EHR's but this in turn has been like a watered down version. In terms in the vertical, however, this is still something that requires many resources for device support, regulatory requirements, etc... that don't exist in standard EHR's based on the good old Logician Template System everyone copied (Thank you Mark for your contribution before going to GE and Heading CCHIT).
Plus you have to remember the market for End Users buying a EHR for Oncology is relatively small. Considering many practices are still in the process of deciding, the long sales cycles to close a deal, make demos, etc... I think the cost is reasonable. This market has way to long a sales cycle and very demanding end users, it is not like many other verticals. It would be different if it truly was a consumer application or primary business application that is not limited to a vertical market. Further, those products are not always as cheap as they seem over time either. There does exist now consumer level products that work for Doctors but they have issues, but they are free or low cost initially. I believe nothing in life is free, but only time will tell, hate to see what happens when one of these big boy free EHR's runs out of funding and closes down.
In any case I am sure you will get great use out of your EHR considering your posts and the fact that you seem relatively happy with its flow in your office. This is not always the case with many of the EHR's being deployed by hospitals and other stake holders these days.
Dr. Murdoch,
I don't think this is a case as much about misery. Many EHR's are being implemented, the main problem is the majority of the response is still either extremely negative or neutral. The result is traction is being forced, pushed as they say in the software industry, rather then demanded, or pulled.
Doctors are not as afraid of technology, just EHR. PMS went from less then 5% utilization to over 90% utilization in under 4 years. EHR has been around for 20+ years and yet no Doctor is saying "Hey I just can't wait to get my nice new shiny EHR".
Regards,Brendon
As a patient, I have started to enjoy the end-benefits of my doctors using EHR. Currently, the medical organization which I frequent is using the Nextgen system, and I am informed they will soon convert to Epic.
What I like about EHR is that I receive a paper printout of the exam, all my current prescriptions, and a concise description of the visit. I never used to get any of this information. Now I do.
I should also add that the medical staff says they don't like using EHR, but they do it anyway.
The power of the printout. Oh, it's real. It's damn real.
Robert Gleeman, Medical Journalist for EMR Update.com Email: robert@emrupdate.com Tel: 1-650-968-6359 Skype and ooVoo user name: robertgleeman EMR progress is a matter of fact. EMR Update supports your right to know.
I had some experienc with Epic about 7 years ago. Our oncology group didn't use it, but all the primary care physicians that referred to us did. Now, the capacity to viewing labs and making graphs regarding changes in lab test results was great (except for one amusing point). However, the clinic notes were horrible.
Epic is a scrolling medical record. So a visit with the primary MD would cover about 7 or 8 pages, but not really pages since it is just a scroll from up and down. Of those 7 or 8 pages, about 90 percent was information brought over from previous data gleaned from previous visits and demographics. The physician's note was canned. And the reason that I was asked to see the patient in consultation was hidden in one or two sentences somewhere on those 8 pages. Sometimes is was impossible to figure out what I was suppose to see the patient for. And in almost every case, it was impossible to tell just what the primary care physician was thinking.
In other words, 8 pages of trash.
To me, Epic was the making the case for being the worse electronic medical records. Now, I realize that most EMR's are that way. You acquire page after page of unhelpful information and bury the important information in it.
I have been on EMR for a month now and I am making a difference. Every one of my notes are in pdf format (although the program does not deal with "orphans and widows" very well. I bold, or italicize or bold/italicize or bold and increase the point, but I always to something to make sure that the important information is conveyed to the next reader or to the referring physicians. You have to work to make the EMR good and the software doesn't have a clue to how to help (although I am begining to like OncoEMR)
By the way, the problem with EPIC's lab graphs is that one cannot change the baseline. If someone had a series of CBC's with the hemoglobin fluctuating all in the normal range like this:
13.2 13.4 13.1 13.5 13.0 13.4 the graph would give you the idea that the hemoglobin was fluctuating wildly since the graph is created with the highest number being very high on the graph and the lowest number being very low on the graph. I had great difficulty telling some patients that there tests were all normal. Another example of software created without a clue as to what they were doing.
davideyoungmd: I had some experience with Epic about 7 years ago. Our oncology group didn't use it, but all the primary care physicians that referred to us did. Now, the capacity to viewing labs and making graphs regarding changes in lab test results was great (except for one amusing point). However, the clinic notes were horrible. Epic is a scrolling medical record. So a visit with the primary MD would cover about 7 or 8 pages, but not really pages since it is just a scroll from up and down. Of those 7 or 8 pages, about 90 percent was information brought over from previous data gleaned from previous visits and demographics. The physician's note was canned. And the reason that I was asked to see the patient in consultation was hidden in one or two sentences somewhere on those 8 pages. Sometimes is was impossible to figure out what I was suppose to see the patient for. And in almost every case, it was impossible to tell just what the primary care physician was thinking.
I had some experience with Epic about 7 years ago. Our oncology group didn't use it, but all the primary care physicians that referred to us did. Now, the capacity to viewing labs and making graphs regarding changes in lab test results was great (except for one amusing point). However, the clinic notes were horrible.
Thanks for the great story. We've discussed this problem (canned notes are junk) and Epic is a perpetual offender.
I feel obligated to inform you that you have made a classic error in your assessment of your situation. I've seen this error before.
You assumed the referring physician was speaking to you the consultant.
He was talking to his patient's insurance company. You just got CC:d.
In other words, 8 pages of gold.
@David
Great post, it is ironic, I was just at a Physicians Office in Southwest Florida where Epic was forced down. Nearly all the providers are not happy with the implementation, cost and more importantly the overall drag in productivity they have been forced into by this large Hospital System. The problem about Epic System was it was built for the Hospital and Health Care System to capture data, and it self generates so much. It looks like something a Hospital would build from all the data it captures.
Hospitals are not specialists, they don't deal with only certain diseases and only want to communicate that information to the concerned parties: Patient, Referring Physicians, etc.....
We have decided to keep our free forming notes and just make it work for the specialist we are with. The paper note Robert gets come at a great cost. All of the data points are not always captured completely at the time of the visit, unless you have a point and click and click and click EHR Template System. If you use a note generated after the visit in more free form with Dragon or via a Transcription Service this does not exist.
It is easy to provide a printout of the patients Subjective and Objective information (HPI, Existing Problem List, Medications, Vitals, etc...) that pertain to the visit only (Clinical Summary). It is less easy to add pertinent information like in the Assessment the actual Problems Addressed and the plan. The issue at hand is that the assessment and plan is often received back by specialist after the patient is ready for discharge and many doctors use internal transcription within the EHR, External transcription company, and Dragon Note System with free form Assessment and Plan.
If the doctor does not change the way they work completely to fill out complete Orders in the Plan, work with a Diagnostic List and dictate all his findings or click his way through them at exam time, then this clinical summary does not exist. Patient Portals may be the way to go on this matter, as it gets it to the patient within 72 hours but at the same time lets the physician still choose to Dictate, use a internal Transcription Service, and still get the information into the EHR.
In other words, Doctors can still communicate the Assessment and Plan, the relevant part for specialists to the required parties without having to totally trash there workflow and method of communicating there thoughts about the patient.
@Robert
If you like your doctors office discourage them from making the change. Epic is nowhere near the EHR that Nextgen is. Nextgen is a innovative company that invented technology to build a note and forms, really cool stuff. Epic is just another copy of the Logician Note Template System most EHR is based on, and to say it could use improvement is a gross understatement.
Brings up images of "the golden dustman" from Dicken's "Our Mutual Friend" digging through piles of trash trying to find something valuable.