Guys,
I hear you. When I did a trial on a few pts. using AC, I dictated everything. My Med. Director, who has said that he can dictate faster than anything, is the one wanting AC to be able to do what my template does. After he downloaded and tried UniCharts, he seemed to like the point and click + and - thing, and felt that it duplicated our current paper "SmartChart" nicely - and we are very fast at that.
The other considerations are that we also have a partner who is a non-typist, very computer illiterate (really!) and VERY RESISTANT to changing to an EHR system. I think he feels that my template will be easier for her to adapt to.
Another consideration is that we are all in the habit of "counting the bullets" in the ROS and Exam sections to be sure we are coding at the proper E&M level. Our major insurer, Blue Cross Anthem (California) has historically allowed us to check the "all other ROS negative" box at the top of the ROS section and count that. Soon, they will be disallowing this. They want to be able to audit our charts and make sure that we are addressing each and every bullet that we are counting towards substantiating the E&M level we are billing at. I was going to have a line that said "all bullets not marked with a + are considered negative" to address this. With careful crafting of how the bullets are written, this should fly.
If I put in a bullet saying "no ear pain" and check it, that is different that one that says simply "ear pain". My template would say the latter, and I would only check it if it was a positive finding. The former indicates that I actually addressed it with the pt., while the latter is more nebulous. Nebulous is good. If I saw a patient with eye symptoms, for instance, they might question me "Did you really ask the patient about ear pain?" and I don't want to go there. Semantics, granted - and only important if we were to be audited by BC. But, we WERE audited last year and it was a giant PIA. First, we got a letter saying that we were being audited b/c are charges were higher than 95% of other docs in our specialty (IM and FP). We were SHOCKED to read this. We knew that there was NO way that this was true. We had to get our billing company to send us figures which showed that we were WELL within the norms. We sent this is in protest, and - get this - they sent back an "oops" letter stating that their computer program had actually counted the E&M higher levels TWICE!!!! They were very sorry, etc.
Of course, they held up all of our payments during this time...
The only times I would use my template is for the ROS, FH/SH, and Exam. All of this is basically chart filler/make-our-lawyers-insurance companies-happy stuff. If I seeing one of my partners' pts in F/U, all I really look at is their assessment and plan (and occasionally the exam, if they had pneumonia for instance, and I wanted to see where the rales were heard).
The nice thing about AC is that we can dictate when we want, and template when we want, and mix and match when we want.
The other thing is, that since I was able to pull off making a point and click template, my director is closer to pulling the trigger on getting AC. I still think it is a great system for the money, and he agrees - but he wanted it to be able to do this one feature...
