Thank you for opening up this topic. I was concerned about being considered disruptive, so I have kept quiet about this issue. I am very pleased that we are able to discuss concerns about AC's EULA. This eases my mind about AC.
My concerns are simple.
I don't know how long I'll be allowed to practice family medicine as a solo-physician with the hospitals acquiring and dominating physician practices in our area. "Either you're with us, or against us." was the attitude of one hospital. "Roy, you are going to have to hitch your horse to either our post or their's" was another hospital's CEO's comment to me. In fact there are maybe 4-5 solo FPs in this community of 80,000 people.
I need to know that I will be able to use AC to access patient's records after I close my practice without having to pay a yearly license fee. I'll need access to my patient records according to state law for 8 years plus the age of majority of the patient. It needs to be in a format that is acceptable in the court of law. Data elements in database format is not helpful to use for legal purposes or continuity of patient care should I close my practice. I do want to practice for at least another ten years and I am hoping that I will not be forced out of the market before then.
I suggest that the users be allowed to use AC at their own risk for whatever edition that they last purchased. This would be like what we do with Microsoft Office. Certainly, if we have active practices, it would be stupid for us not to continue getting the latest updates. In fact, even if I closed my practice, I may be interested in continuing a subscription of if it is nominally priced (although the only reason would be to get copies of old records on an occasional basis).
I think that this issue will eventually be sorted out by the courts as I can see ASP-EMR users will be left hanging high and dry without a way to access records without a subscription. Then again, larger clinics can run in perpetuity whereas when smaller clinics close, they are closed for good.
The EULA should specify if there is a shut off mechanism in the software, if annual payments are not made. Shutting off a software will be disruptive and financially disasterous to a practice. I would think twice about purchasing a program that has an automatic time driven shut off mechanism.
"Jettisoning assholes." I felt uncomfortable reading this on the post. Jon has always treated me well and I certainly hope that my posting things about making improvements to AC doesn't make me into an asshole in his eyes. Nobody (with the exception of some attorneys) want to be percieved as an asshole or having a personality disorder.
On the other hand, if there are individuals that disrupt operations at Amazingcharts or is perceived harmful to Amazingcharts or to Jon, it is reasonable that there is a way to discharge that customer. It would be good to specify what action (steps) would be taken prior to jettisoning an AC user. Perhaps there should be language of having graduated warnings (due process) prior to yanking the license written into the EULA. I don't want to see a "user" turn into a "suer." Amazingcharts must stay away from legal issues that could take down the entire company-- there are over 1,400 small practices that depend and rely on this wonderful software to keep them from going belly up.
With regards to the medication database, I have more concerns about liability involved with a sloppy database. I realize cleaning up the FDA database is a gargantuan task for one person. I looked all over the internet to find a source that would provide the "1000 most commonly precribed medications" but I have not found one suitable for use with my practice. It would be nice to have a two-way exchange of database where Amazingcharts can find out what we doctors prescribe, what CPT codes we use, and what ICD-9 codes we use and eliminate codes that the 1400 users never use. Or... I like the idea of "commonly used codes, and medications" that we can check off. The feature to select common codes is available but does not seem to have any pratical relevance.
With the issue of someone suing Jon (or Amazingchart) for using an old (not updated) database, I have no problems signing a paper stating that I won't sue because I am at fault for being stupid enough not to purchase an update. However, if the software is somehow deliberately crippled due to not purchasing an update and that causes disruption of practice or harm to patient care, that is a different issue. IMHO, limiting access to patients' chart notes is more likely to cause legal problems.
I am generally happy with Amazingcharts. Those that come to visit my clinic find Amazingcharts extremely easy to use and very practical. I have encouraged them to adopt the program in their practices.
