I had hoped this thread would solve itself, as the thousands of other users who have had consistently great support would chime in and Osler’s issues would get resolved, but alas it is not to be, and I guess it is well overdue for me to address these concerns.
You are correct that we are in the throes of a “perfect storm” of (1) migrating to the markedly more robust - but markedly more complex - SQL Server database, (2) a “rush” on EHR systems due to all the recent hype surrounding the HITECH stimulus funds, and – most importantly – (3) our dedication to providing a truly affordable and usable system with no hidden fees or surprising charges.
The first issue is improving as we continue to learn from the unique issues of using SQL Server on various operating system platforms. We have over 3000 practices and there is many times this number of computers running Amazing Charts, each with its own programs, tasks, networking, viruses, anti-virus software, firewalls, etc. Yes, supporting all this is difficult and complex to say the least and we are constantly facing new problems related to Windows updates and software and hardware conflicts – but we work to solve each one, and are continually building on our experiences to facilitate solving similar issues more rapidly.
Add to that the recent rush of new clients, often much less technically savvy than the first wave of “early adopters,” who not only need help with learning basic Amazing Charts functionality, but also require help networking computers and configuring routers. Rather than do what most vendors do, and tell the clients they need to contact their hardware or software vendors from which the underlying problem emanates, our support people roll up their sleeves and dive in. We help everybody fairly, and only stop helping to assist “emergencies” where a practice can’t access Amazing Charts at all. Otherwise, we help our clients equally, even when a client yells louder than another or has issues that aren’t caused by Amazing Charts but rather effect Amazing Charts. As has been noted here – most of the issues aren’t Amazing Charts problems per se, but rather due to the complexity of Windows, SQL Server, and the myriad of hardware and software products being used. Yet we still take responsibility and strive to solve the problem, even though this sometimes can take time and multiple contacts.
Which leads to the third issue, cost. Despite striving to support our clients with whatever they need help with, we have also struggled not to charge any extra for this support. Keep in mind that our $500/year charge for “support & maintenance” pays for all our software improvements and enhancements. The CCHIT Certification we have completed as part of V5 is included. The Health Maintenance module that is now in alpha testing is included. Even our e-Prescribing has been reworked for usability and will be included in V5 at no additional charge to our clients even though we have to pay our vendors for access to the data, updates, etc. We do this because we feel it is not fair to charge physicians to write scripts. We do this because most of our clients don’t require us to spend hours sorting through unusual networks or configuration issues and so we can afford to do it.
And despite our low cost, and the impression from this thread that our support is lacking, our support is consistently rated higher than the vendors who not only charge ten thousand dollars per physician for a license, but also charge thousands a year for their support. In fact, a 2008 study of EHR users published in Family Practice Management showed that EHR users asked their “Overall Satisfaction with Support and Training” rated us higher than eClinicalWorks (eCW), eMDs, SOAPware, Healthmatics (now AllScripts), Centricity, Misys, and others. The ongoing AAFP Center for Health IT survey also finds that we are rated above EVERY OTHER EHR for quality, price, support, ease of use, and impact on productivity. And the October 2009 Medscape survey of EHR users also rated Amazing Charts higher than EVERY OTHER SYSTEM on 12 areas of performance, including vendor customer support. So for those considering Amazing Charts and reading these posts, please don’t mistake the fact that we allow our users to share their frustrations on an uncensored user board as meaning our support is lousy. It isn’t, and when the vast majority of users are asked about their experiences, it becomes clear that not only do we do a great job in general – we do it without gouging our clients.
All this may be terrific, but unfortunately it doesn’t solve the real problems that Osler and a few others have reported here. And while these experiences are not those of the average user, and while I also suspect there is a lot more going on with Osler’s set up than the average practice (since the vast majority of our users have never experienced anything like this), I do agree that the experiences he relates would certainly frustrate me too. So we need to find a solution for those clients who require a level of access and support beyond what the vast majority of our existing practices require. As dklehmannmd noted, she would be willing to pay more for an increased level of support, which is not currently an option.
So why haven’t we increased our annual charges? First off, as noted above, the vast majority of our clients never have support issues, or when they do they are immediately solved rapidly and well (it would be great if some of our users would actually chime in here). It has not felt fair to raise our prices across the board to support the relatively small (but outspoken) number of clients who have experienced something unusual.
I have also resisted instituting a “two tiered” system as I am concerned that most of the people who should have this additional service won’t purchase it outright, and then will get upset (and more outspoken) when they are advised that their expectations or problems aren’t “normal” and are required to pay more. But it sounds like that time has come and we need to offer a more intensive technical support option for people experiencing situations like Osler and dklehmannmd.
And while you may get the sense that I’m shooting the messenger with this post (and I guess I am a bit – sorry Osler and dklehmannmd), the bottom line is you guys are not thrilled with Amazing Charts. And that is not acceptable. Period. So the question is, how do we get there? Do we raise prices for everybody to hire and train more support people so our average “time to resolution” goes from under a day to under an hour? (Of course, as this thread proves, there will always be situations that are not easily solved, no matter what we charge.) Do we offer two tiers of support and require clients needing more help to pay more? I’m not sure of the correct approach and would really like to hear from other Amazing Charts users before making a decision.
Jon
Hi, Jon. Thanks for taking the time reply to this thread. It's almost unheard-of for a CEO to engage in completely honest conversation with their customers the way you have always done. You're clearly a class act and your ethics put all other EMR vendors that I'm famiar with to shame. First of all, I'd like to say that I have been a
huge supporter of Amazing Charts over the years. You've almost single-handedly been responsible for keeping the other EMR vendors honest by providing physicians with a great product at a fantastic price. By offering physicians 90% of the functionality for 10% - 20% of the cost of many other EMRs you've allowed hundreds of your colleagues the opportunity to move their offices into the 21st century. The fact that almost no other companies besides Amazing Charts offer downloads of their software to permit extended evaluation is quite telling.
The simplicity and intuitive nature of Amazing Charts version 3 appealed to me because I knew that it would be easy to set up and run in my office and my staff would be able to pick up on how to use it without requiring any formal training beyond the time I spent explaining the EMRs features to them. It actually took less than an hour for me to review all of Amazing Chart's features with them and get them to the point that they were comfortable doing everything from registering patients to scanning in and filing lab reports. I've been using EMRs for a number of years and my office currently has a different EMR as our primary system. I use Amazing Charts mainly as a backup charting system and for charting on out-of-office consults. I was always secure in the knowledge that if ever our main EMR went down, Amazing Charts would be there to back us up. Unfortunately, as a specialist even if I wanted to it would be impossible for me to use Amazing Charts as my sole EMR because of the lack of a usable method of generating consult letters to referring physicians. (I had spoken to you about this last year and would request again that you include the ability to easily generate editable consult letters in version 5 of Amazing Charts. By not fixing the letter writer you are actually making it essentially impossible for most specialists to use your EMR. While I have your ear, my second request would be that you include the ability to save a list of editable favorite prescriptions that can easily be chosen by the physician.) Even with just using Amazing Charts as a backup EMR the money spent licensing it was probably the best software investment that I've ever made. In fact, we purchased some extra licenses for our clinic - even though they were not needed - just as a way to say "thank you" for providing physicians with an alternative to the ridiculously expensive EMRs that dominate the marketplace.
We held off on upgrading to Version 4 until a few weeks ago because we wanted to make sure that all of the bugs had been worked out of the current release and because version 3 still is quite functional "as is". Our main EMR is currently being updated, and we took the opportunity to do a server upgrade at the same time, so we decided to use Amazing Charts as our primary EMR while we were waiting for things to be sorted out with our main EMR. Because in the past when I used Amazing Charts version 3 I had experienced periodic crashing of the software (which I had attributed to it running on the Access database) I felt that this would be the ideal time to make the upgrade to the SQL-based version 4. And thus began the unfortunate saga chronicled in my original post to this thread.
Jon, as much as I like your software and your company, I was
appalled by the complete lack of any timely response to what must have been well over a dozen messages left for Technical Support over the period of one week in mid-October. I'm sure you can imagine what it must feel like to be in the middle of a busy clinic depending on an EMR, only to have it not working and at the same time having Technical Support neither answering the phone nor responding to multiple urgent messages that have been left. To make matters worse, the failed installation of version 4 somehow prevented our Practice Management software from running, resulting in our receptionist being unable to even book, confirm or reschedule appointments during the time that Amazing Charts was not working.
Despite the extreme difficulty in reaching Technical Support, I must say that every time we have been able to actually get someone to help they have been
phenomenal. Your techs are easily the most dedicated and helpful techs that I have EVER dealt with. "Joe", in particular went so far beyond the call of duty trying to help us that I was amazed. You need to find a way to clone him! After dealing with the third day of post-installation crashing, I sent an online request for "chat help" via your website a few minutes after your office would have been closed. Joe not only answered the call but he also stayed two or three hours overtime, trying to help resolve our problem so that we would have a usable chart system for the following day's clinic. In our discussions I mentioned the problems I had experienced getting a scanned signature sized properly to fit the signature box for prescriptions. No one in technical support had replied to any of our messages that had been left about this, so I had decided to remove the (poorly-sized) signature. Unfortunately, Amazing Charts actually does not provide an option to delete a saved signature. With no response from Tech Support expected, I had checked this forum and discovered a post explaining that the signatures were saved in the Data001 folder and can be made visible by changing the file extension to e.g. .bmp. I did this and deleted the signature. Only problem is that by deleting just that one signature file it's possible that I may have corrupted my database, resulting in the constant crashes that I was experiencing. Joe manually went through my databases, looking for where the structure may have been broken. All told, he spent several hours trying to help me, including the next morning when the database was fixed.
The crashing improved immediately, and Amazing Charts now crashes 2 or 3 times a day instead of every 5 minutes as it was doing immediately after the upgrade. I had experienced daily crashes with version 3 and had assumed this was normal, but now have been advised that it isn't. I suspect there was a problem with the database dating back to version 3, so perhaps these problems were carried forward with the upgrade to SQL.
Most days I don't even have time for lunch, much less calling Technical Support, so I haven't tried to get the current crashes resolved. I'd love to see someone fix the crashing that we're still experiencing, so that I could know that the next time we need Amazing Charts it won't let us down. I'll try emailing tech support and see what happens.
I hope no one reading these posts who was considering getting Amazing Charts changes their mind because of anything that I've written. I believe that the vast majority of Amazing Charts users seem to be having no major issues with the upgrade to version 4. Furthermore, if you're looking for a well-written, complete, well-supported, inexpensive EMR, then Amazing Charts is really the
only EMR that you should even bother considering. I've been using EMRs for a long time and have no qualms about saying that
Amazing Charts is easily the best low-cost EMR that I've ever seen. The only way to get a significantly "better" EMR would be to spend at least another $5,000 getting a program like e-MDs. And once you commit to buying a more expensive mid-level EMR then you're stuck with having to pay annual "support" fees that cost more than the purchase price for Amazing Charts.
As far as to your question on how best to handle the support of your customers, I have a few suggestions:
1) Ensure that you have hired enough technicians to handle the typical volume of daily calls that you receive in a timely manner. All calls should at least be answered by a live operator who knows enough to triage the calls appropriately. Customers experiencing disasters like the one I went through should be prioritized, with every effort being made to at least get them to a state where they have a functional EMR on one computer. For example, in my case when I had called on the morning after the installation when my receptionist found that Amazing Charts was continually trying to install itself under her profile and had somehow inactivated our scheduling and billing software, this brought the office to an essential standstill. I gather from reading posts here that others have experienced similar issues with Amazing Charts trying to reinstall itself and also somehow inactivating Practice Management software that also use databases. Had someone triaged our call and realized that the situation was a disaster for our office, a senior tech could have been assigned to deal with things immediately. They would probably have been able to solve the problem in less than five minutes by reinstalling the missing DLL files that apparently caused the problem in the first place (I gather this is a known issue with Amazing Charts). By at least having one computer up and running our office could have limped through the rest of the day and dealt with getting the rest of the office up and running at a more convenient time.
2) Along the same lines of suggestion #1, even if you don't have enough technicians to deal with all problems within 24 hours, at least let customers know that you have received their request for help and that you will be getting back to them within a specified period of time. To have no one answer the phone, be forced to leave a voicemail, receive no acknowledgement of receipt of the request for support, and then to not even receive a call back several days after an urgent message has been left is in my opinion
unacceptable. I
still can't believe that our calls indicating that the chart system was completely unavailable were ignored in this manner.
3) It would be helpful if you could assign a technician to spend one hour a day reading through the posts made on this message board and respond to questions or give advice. It seems frequently that the posters here are left to fend for themselves, with one or two people like Bert altruistically doing an incredible amount of work attempting to troubleshoot problems and come up with solutions for those of us posting here. To see an official representative of Amazing Charts in the forum helping out daily would be rather reassuring and would alleviate the nagging feeling that some of us get that we're "on our own". Having said that, I really commend you for having the confidence to keep an uncensored message board on your site. I don't think I've ever seen another EMR vendor that is so confident in the quality of their product that they would be willing to support an uncensored message board like you do.
4) As far as to what might be the best option to keep prices down, yet ensure proper support of disasters, I think a compromise solution would be that for the current $500 annual support fee you would offer 30 days of telephone support/disaster support after the initial installation (or perhaps after the initial call), followed by (up to) 11 months of e-mail or "chat" support, as well as all software updates. After the initial 30 days of telephone support/disaster support any calls requiring/requesting immediate telephone support would be charged a flat fee of $50 or $100 (or whatever you feel is a realistic amount to adequately cover your costs). These per-incident support calls would be triaged to experienced technicians who hopefully would be familiar enough with common problems to rapidly diagnose and fix these issues. Since most of your previous users probably haven't needed to call technical support I suspect there wouldn't be significant resistance to such a pricing model. The flip side is that as you start selling to less computer-savvy physicians you are inevitably going to be finding more and more demands being placed on technical support. If you are not adequately compensated for these calls then you will quickly be put in a no-win situation. (In my case, I'm fairly knowledgeable about computers and I would estimate that your techs probably had to spend at least four or five hours working hard trying to sort out the various issues that had cropped up after the upgrade to version 4. While our situation was obviously atypical for what happens after upgrades, if even 1% of your users experienced similar issues, this could easily overwhelm your Technical Support department. I would expect that the more features you continue to add to Amazing Charts, the greater the demands will be placed on your Technical Support department. If you introduce version 5 without first significantly ramping up the number of techs on staff, I would not be surprised if you quickly start to hear from a lot of unhappy physicians who feel as if they've been abandoned. By charging a per-incident fee, at least you would be recouping some of the expenses incurred by these support calls. The benefit to your customers would be that hopefully such a tiered system of technical support would guarantee that immediate access to advanced support was available whenever indicated. I don't know about other people, but I would gladly have paid $100 to quickly end the nightmare that we had experienced in clinic the morning after the upgrade to version 4.)
5) One of the best ways to improve support is to do everything possible to obviate the need for such support in the first place. You've actually done a fantastic job simplifying the SQL installation, as well as providing users with the tools needed to perform some basic troubleshooting. If there is any way that you could figure out how to prevent some of the more common problems that people have been experiencing then this would probably alleviats some of the load on your techs. There are known issues with DLLs having to get reinstalled; is there any way to avoid this problem? Also, Amazing Charts seems to conflict with certain Practice Management software, presumably because of some bizarre interaction between Amazing Charts and the PMS databases. I've never seen this kind of problem before, but surely there must be some way to avoid it.
Jon, you did a great job providing physicians with an intuitive, sub-$1000 EMR with version 3. The update to version 4 gave us the industrial-strength stability of a SQL database, yet somehow you did not raise your price. Incredibly, you're now planning to introduce a CCHIT-certified version of Amazing Charts - which I thought would be impossible to do at your current price level (since most CCHIT-certified EMRs sell for over $10,000). Health maintenance, electronic prescribing and practice management are all features that you are planning to implement in the near future. While I completely understand (and for the most part agree with) the business rationale for moving Amazing Charts in this direction, my main fear is that by widening scope of your software you will lose focus on improving what should be the core element: the EMR. If EMR usability remains your primary focus I would have hoped that your first concern would have been to maximize the functionality of simple features that are used on a daily basis before you directed all of your resources towards "features" like achieving CCHIT certification (especially since - I'm sure you'll agree - CCHIT certification is something that you're being forced to add solely for marketing reasons, as it adds very little functionality and historically, CCHIT-mandated "featureitis" has actually both detracted from EMR usability and increased costs). The two features that I had spoken to you about last year (
fixing the letter writer so that at the bare minimum it would default to opening up WordPad as the text editor; and adding the
ability to save "favorite" prescriptions) are features that have huge impact on EMR functionality and (in my opinion) should have been very easy to add to Amazing Charts. I hope you'll add these features to any upcoming versions of Amazing Charts and ensure that improving the actual EMR
never takes a backseat to the race to add less critical things like e-prescribing and PMS.
Keep up the good work.
