Home Forums Discussions General Discussion pediatric friendly??

hello everybody
I'm new to AC and am a pediatrician about to open my solo practice.I plan to open my doors with EMR-am very confused,as I'm computer-naive, and there are sooooo many products in the market, most of them prohibitively expensive for soloists.Any pediatricians there to help me --how easy and peds friendly is AC? Anyone here in the state of NC? The AC demo that I had was very rushed, and hence is blurry.
thanks
Rachel

I am a Pediatrician and have been using AC for the last 5 years. It is very adaptable. Actually, I just came back from the AAp conference in Boston and looked at a number of programs in a EMR contest.

In my biased opinion (and I am VERY biased) AC was the 2nd best product. There was one that connected to the all the AAP protocols, healthy kids, etc but was over 20K, they did not want to discuss the cost of maintainance. It was still more clunky to use than AC.

Some of the other products have you go through a protocol where you click click click to get what you want and scroll through pages and pages and don't see your final document until the end.

With AC you create your own templates. There are templates for development in the base program (Jon puts them in ROS, I put them in SH) you can easily cut and paste from a number of sources to get what you want. Some of it is included in AC.

Immunizations need some help. You have to enter enter in the vaccine and then pull down scroll boxes for the lot numbers and such. Currently it will not produce a shot record directly (you can get a summary by date of shots on the summary page) but I know that Jon is working on this.

You can download a fully functional version of AC from this website and use if for about 3 months. No need to hurry, you should feel comfortable before plopping down your grand. As the saying goes, "Try it, you'll like it." They only way to know it is to play with it.

With templates, you can create a detailed note just as fast as writing it (if you actually did a complete note, which I knew I was lacking before). Scheduling is great. Since it brings up the old note, you do not have to put FH or PMH in again, and you can easily review them. Prescriptions are a breeze, although the Rx database could be somewhat better (Bert, a moderator and Pediatrician, has a better one available here).

There are a number of pediatricians using AC, but we are a definite minority. This has not been a hindrance though.

Finally, your database is in your office, not on the net. If your internet is down, no problem.

Wendell,

Excellent post! Thanks for the kudos on the medication database. Brian has an excellent one also for all aged patients.

I haven't seen version 4 yet. It will be interesting to see how it handled vaccines. I may begin to promote Viper again if it is lacking in that area.

Also, while on the topic of being in the "minority," due to the "kids are just little adults," theory; it would be nice if we could change parameters on vital signs, i.e. 120/80 may be normal for a 25 year old but not so much for a six month old. Same with RR and HR as well.

But, as you said, it is still the best. I would place it number one. The drill down method has some advantages for data tracking and coding assistance, but it takes forever. And EMRs such as Logician, produce a six-page progress note which could be done on one page with AC. The only other EMR I have ever really considered was Praxis but only because the concept was so unique. Still don't know as I haven't used it much. I had demoed the version prior to 3.0, and I believe 3.0 was a HUGE improvement, but I never played with that one.

I am also new to AC. I have a solo pediatric practice in rural Georgia. Is it possible for any pediatrician who is using AC for a while to discuss their work flow and share their templates with newcomer like me. I plan to continue using lytec for billing/scheduling. Is Xlink interface worth the money? Thanks.

Nand Chainani
Kids Care Clinic
Tifton, GA

I have seen version 4. I played with it at the AAP conference in Boston. As it will probably start out, the immunization section is only a mild improvement but Jon says better is just around the corner (is that like the economy, no... it's going down the toilet.

nch: My MA puts in vitals, adds CC and HPI and initial FH, I usually do the rest. I use the developmental questions to remind me of the proper items in each age range. I know most of the rest. I have been usng it for a long time, it is time neutral.

I have been planning on posting my templates here. They have to be done one at a time (I discussed this with Jon as well) but they work well for me. I think the best ones are ones you are comfortable with, and alt R click you are there.

I'm confused about the PM- does it come with AC or do we have to purchase a separate one? from the demo I can see that we can schedule the patients , but do we need a separate PM via an interface? If so, what are the PMs out there that integrate with AC? Also, abou the billing? do we have to go thru AC billing company or go thru a clearinghose?
Can Bert or Wendell please clarify? thanks a lot for your help.
Rachel

kidsdoc,

Welcome to AC on behalf of all of us. It would be nice, though, if we could call you by a first name. If you want that, please sign your name or better yet, go to the preferences and choose profile and put in an auto signature. You could even make an icon.

My understanding and I emphasize understanding, is the that the PM, Version 4.0 and SQL Server (MySQL or one of the free ones) will all be coming out at a different time. That is confusing. Jon can correct me on this.

The current version has no PM. You do not have to go through any billing company -- in fact most go do their own or Practice Ally or whatever the name is -- sorry -- someone can correct me on that.

As for what PMs will interface with AC, at the main screen, select CTRL - A, and then choose user interfaces in the admin screen, and there are many that Jon has already linked up. I think most have a charge. You can also use a drop down menu from the main screen to get to the admin section.

If you have not done so already, you should peruse the entire admin section.

I havent played with the admin section yet.but thanks for the info.BTW, I've changed my preferences and have added an icon!!!

There are a lot of aspects to practice management. There is billing, and there is info gathering.

A lot of info gathering can be done by searching.

You can do superbills and outside billing, you can do billing through MTBC directly from AC, which I use and the jury is still out.

There are a number of other options.

Office Ally is the one that Bert was trying to think of, it did not work for me because of problems with IL medicaid. But they are free for electronic billing and do interface with AC.

There is EZ Claims which is fairly basic form practice management but will also get the bills out.

Ultimately it depends on how you want to do it. Start simple and just to charting and I would add billing as I go along, would be my suggestion but integrating from the start isn't a bad idea either.

I have been using AC for over 3 years now as a General Pediatrician, and it has been a Godsend for my throughput, and for getting paid for my work. It is not perfect , but pretty close considering its cost. I am using the Peds Med Database that Bert worked on , and I have further modified it for drugs that I use. The Consult letters are great and I have made templates for requests for consultation, although I do not consult for others. I dont worry about the vaccine part of the program at this time as I am using a Web Portal for the state of GA that manages my inventory, shot certificates and recommendations for vaccines. I merely created templates in the Asses and Plan areas for the appropriate vaccine ICD codes, and the CPTs in the Plan areas for typical vaccine schedules that I use w/ a given age. I usually state that the parents have been councelled and that questions were answered, and the VIS was given to the parent to satisfy the legal aspects. I use a separate PM called Medware that I have been using since 1992, w/ electronic billing and is able to transmit to all venders including Mcaid. It does not integrate w/ AC, but my staff is so used to its ease of use, that we just generate a paper superbill which I code, and my Insurance person enters the details and ICDs from AC into it and transmits. So essentially the clinical portion of note writing is handled by AC, and the business end is handled by Medware. My claims have never been audited, but I feel that they will stand the test of review w/o any problems due to the detail of my notes. An average WCC takes 3 min to write, and the average Sick visit takes 2 minutes. My time is more available for patient contact, and hence higher turnover.
My MA enters CC, and a line of HPI and Vitals, She sends me the chart, I have a paper "cribsheet" that I use to jot notes on as I examine the pt, but transfer any PE findings and adjustments to the Hx to the electronic record when I exit the pt room to generate Rx's . I have 1 touchscreen PC or Tablet computer per every 2 rooms I use in a small "cubby" alcove or station where my Laser duplex printer is. The printer has 2 drawers, 1 for Rx paper, and 1 for plain paper. I return to the room w/ the Rx for the pt and they leave. I message my Triage nurse to arrange for consultations as needed, and the request is written at the conclusion of the visit along w/ my most recent note. The visit is coded on a superbill, and given to the clerk for entry into the PM. It doesnt get any smoother than this.
I had a horrible experience w/ another EMR some years ago and it cost me $54,000. I used it for less than 2 years when they went out of business, and they never delivered what they promised to me. They went bankrupt, and I almost did also. Pediatricians have to be very lean and mean to survive, and I suggest you dont spend over $5,000 in software. I am excited to see what V4 brings to the table, but am very happy so far. I agree that there are some Peds specific products out there like Office Practicum, and I considered Medtuity, but the former is too expensive, and I am afraid of the risk. The latter is too "granular" , ie. specific, and will take too long to complete a simple note and based on my volume of patients will cost between $5 K and $10 K per year to implement, not to mention it requires a dedicated server, which you dont presently need in AC.

Office Practicum was the other program I referenced in an earlier post that I liked at the AAP conference. But it was very expensive. Ultimately, I think AC is more user friendly.

Where is this peds med database. I would love to use that!

Ron

Hi Ron,

Here is the good news and the bad news. I think for Neil as well.

The two download sites for the medication databases are here:

Full version by Brian:

http://tinyurl.com/all-medications

Pediatric version by me:

http://tinyurl.com/peds-medications

It's rather easy. You download either. Unzip it. Go to your AC folder. Rename the original AmazingMeds.mdb to AmazingMeds.old. This assures you that you have the original if you want to go back, but I don't know why you would. Then, simply copy and paste to the folder. Open AC, and you are good to go. You can edit freely. There is one small trick to editing that anyone can tell you on here that uses them.

Brian found a great government site with a free database that he converted. Probably took him around three or four hours. Brian is MUCH smart than I am.

Given, I couldn't find that one, I made mine from scratch. Literally took me two months every evening -- one hour each night. I used Harriett-Lane and Pediatric Lexi-Comp and entered Brand names and most chemical names.

Try them both. See what you like. It's nice to know if they help you.

The bad news:

When Brian and I made these, we stripped the databases down to its simplest form to work. And, they work great in V3. With SQL, I converted mine to SQL, and it worked great. The only problem was it created a weird bug where when you try to go to admin, AC crashes. You can get around that by swapping it out with the version that comes with V4, but that, as you would imagine, is a pain. I am working on it, and for those who know me, I will continue to work on it until I fix it.

Jon may be coming out with a new medication database with the full version of V4.

If anyone wishes, you can PM me, and I will email it to you.

Bert you are a pioneer. Few appreciate what you are doing. It is really pioneering in every sense, just like a trapper heading into the uncharted Western territories. Your work makes one piece of this whole system work a lot better. When it works better more people can begin to appreciate the potential and when more appreciate the potential then more buy into the system. When more buy into the system Jonathan is able to invest more into the development. And so forth. And so,.. Thank you! I have used Brians list for some time. I don't do enough pediatrics to use yours, but if it works in Ver 4 and Brians doesn't, you can be sure I will follow you in. Thanks again.

Martin,

Thank you so much for those nice words. That certainly makes doing it worth it. I suspect there are many who I appreciate those on here who make contributions. If you look at how many people have downloaded Brian's database - 201 - (I could have sworn it was around 180 yesterday), that means quite a few have benefited from his database. But, in 5 1/2 years, I don't think I have seen 200 people on here.

I only wish my programmer could work directly with AC.

Given that Brian structured his database after mine, they are identical. So, if I fix mine, I will fix his. That is, if he lets me. After all, it's copyrighted, lol.

Thanks again.

PS Given I want to use V4, I will HAVE to come up with a fix. I simply can't upgrade to V4 if I have to use the medication database that comes with it. (Jon did say he was working on that)