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I lost a chart today, but why worry. A chart's just a chart, right. Life is so grand and AC is the best. What else could be better?

Losing notes is perhaps the most frustrating part of using Amazing Charts in our office.

We first had the issue when the wireless connection was dropped and more recently we had a mystery case of disappearing notes that the tech support team is still investigating. I cleared out all messages in the queue and it has temporarily halted the disappearing notes but this has been a real concern for our office and our productivity.

The clumsy billing procedure, with CPT code and ICD9 code entry, is our top concern at the moment as we just haven't been able to keep up with the chart signoff and subsequent billing using the current software. I'm looking at alternatives with ezclaim, office ally and our own custom msaccess tables. Still not resolved or decided but we certainly share this concern.

Thanks for the input and sharing some of your ideas.

Vicki -- just a thought. If it is crucial for you to be able to generate your superbills before signing off on the note, consider abandoning (for now) AC's superbill function.

At my clinic, I didn't use AC's invoice/superbill at all.

I had printed superbills, and each morning, we would load a stack of them into the printer and select...

File -> Print Schedule Info -> All Encounter Sheets for this Schedule

and the patient info would be automatically filled into the printed invoice. We would then print any work-ins superbill when they arrived.

Note that this is something Jon is planning to fix, but it will probably be many months from now.

Thanks Brian-
I am going to have to figure out some other way of dealing with the billing. I appreciate hearing about your work around. What kind of PM software do you use?
It is also good to know that this will eventually get addressed. I would hate to have to change EMRs, but I need the revenue as well as the documentation.
Thanks-have to get back to that stack of notes and the one that went missing, LOL!!

I used a billing service, but I was looking closely at Office Ally (free).

As far as lost notes are concerned, remember that when you open notes and delete the one in your Inbox, it remains in Deleted Items. You can sometimes go back in there and find a partial note, especially if you saved the note or forwarded it to yourself previously, in an incomplete state.

Thanks Brian-

It happens most frequently when I am signing off on scanned items. When the window closes, the entire disappears into cyberspace w/o anything in the deleted box.

I will be glad when the default option for notes is to save, not delete.

Vicki I have lost a few notes myself. Very upsetting. Most all of mine were when I was forwarding a note to the MA for them to add things to the note before I sign it. Of course no one who has made a mistake, knows that they did, so they all deny responsibility for the lost note, (the same as I do when I lose a note all by myself).

There are two tips:

1- the "deleted notes" will allow you to recover the note IF you figure out it is lost, before the day is over. Most of us have had this frustration, you are behind because you are not running at full speed yet. When you get the hang of it, you will also realize right away when a note is lost, because your inbox will no longer have 300+ messages! (OK, some days it will, but not most!)

2- If you use a scrap of paper, (we do, it is used to record the vitals, and carry any information regarding co-pays to the biller) The scrap of paper will have a little real data on it. Ours has the vitals and a few words of the chief complaint. Now if you go to the chart where the note was lost, some data is still there! If an Rx was written it will remain in the RX box even if the note was not signed! Likewise the Dx will remain in the summary and in the drop down list IF you coded the chart during the visit.

At one time I had several of these, so I just made a template:" This is a reconstruction of the office note on this date" "The original note was lost during the early days of our implementation of an EMR and all of the data here was re-entered from factual written documentation that we had." Then I reentered the vitals, the DX if I could, the Rx if there was one and NO PHYSICAL EXAM since I could not provide any reasonable assurance that I was not just making it up. IMHO this is the best you can do, and you should just move on. It is lost and there is nothing else you can reasonably do.

My associate still sends her charts to the staff, and they send the notes back and it all works smoothly. I do not choose to do it this way. (Just chicken I guess!)

Hope this helps.

Well, I will "tell all" now.

When the patient comes in, we take notes on a yellow slip of paper, which I dictate from. The "yellow sheet" then stays with the chart until the dictation is signed, printed and filed. (I sometimes fall a little behind).

If somebody runs off with a chart and the note is lost, we can still reconstruct the note (mostly).

I have several notes that are completely lost and will end up refunding copays because I can't honestly remember enough to redo the note. These suggestions will help prevent this in the future.

We use a full page flow sheet that follows the patient from begining to end of visit with lots of places for the girls to enter lots of simple but great data including copay info. This stays with the encounter until Nancy is done charting everything and has created an invoice for me to then do my thing. If she gets behind or something goes stupid, we still have a good set of basics to create what we need... It started more as a thing for prior auths and for me with the payment issues but it really serves these and many other purposes. Still using some paper....

Just made us a form with vitals, a place for written orders, and a table for cpts and icd9s. The nurse can enter he lab work/injections etc., I can enter mine then it will go to the office manager to manually enter it into an AC superbill.

I am talking to Office Ally. Will not be able to make the switch till next year because of a contract with a billing service. Maybe this way I can get superbills to them more promptly.

It would be really nice (and reassuring) if problems like these could get some kind of follow-up.

Did this software issue get resolved? or is it still a problem?
There are other threads like this where I'm left wondering whether and how they were resolved.

Lost notes and lost messages are, in my humble opinion,a SERIOUS unresolved software problem.
It seems that the programmers have a very difficult time fixing a problem that occurs erratically. On Friday my MA sent a message to me querying a treatment protocol for a patient. The whole message which included a question from her, my reply and her second question was lost. It wasn't in the outbox, deleted, any of my boxes...it was gone. I lost an entire note from Friday and realized it yesterday when I tried to retreive it and send it to the hospital EMR for her admission on Monday. I had signed it with out attatching a billing code because it is a preop visit and included in the global service. Fortunately I did not have any difficulty recalling the necessary information and simply did the note over again.
One work around for the lost note is to assign someone in the office to double check the appointment roster from the day before to make sure that each patient has a note in their chart, but that assumes the doc is doing their charting basically "real time" ( a valid goal of EMR) and also increases the work load for the staff ( not a goal of a good EMR).
Billing is a separate issue. If you ask me it is worth the "expense" of a good billing software which pays for itself easily by simply doing a good job.It costs a bunch in lost revenue to use something that doesn't work well. I use AdvancedMD and the X-link to AC.
I think the lost note and disappearing message problems are much higher priority problems than enhancing the practice management side of AC.

I agree. All of the Wish List and enhancements should take a backseat to correcting ongoing critical bugs. And we should take care to keep threads regarding such ongoing problems alive and in the spotlight.

ATTENTION: AC Programmers: FIX THIS PROBLEM!

Yes, it IS more difficult to correct programming errors which are difficult to replicate, but it is not impossible. I do think using wireless may be a bad idea because of increased risk of lost data. My IT guy also pointed out to me that a CAT5 connection is at least an order of magnitude faster than the fasted wireless connection, so that is another reason to give up wireless (except for truly portable machine needs).

From reading here, it sounds as if most of the losses occur when notes are being forwarded through message boxes. Luckily, having no staff, I have no need for using the message boxes and hopefully lost notes will not occur to me. Still, this needs to be fixed.

I too am solo Peter and often do forward to myself. And yes I have had notes lost too. I have even had addendums that I know were written, saved and actually reviewed at a later date that have gone missing.

Are you having lost notes/addendums even recently? Since 4.0.73? Even if you didn't care about the quality of care problems created by this, missing notes and messages create a real liability issue.

That's the whole point of EHR isn't it? besides quality of care, yes, but many many people are adding it because they HAVE to. Lost notes leave no "paper trail" and would seem to put you in a most vulnerable position.

If you make a backup everyday, maybe the lost note/addendum (at the very least) can be found in a previous backup? I would like someone to check that next time he/she loses a note.

Also, am wondering whether notes are lost on the "main" machine or just from client machines? It would probably be useful to those who are trying to fix the bug to know the exact setup and circumstances under which this occurs.

I noticed that today when I added a new patient on a network computer and wrote up an new patient note, this was not reflected in AC on the main computer. I had to get AC to refresh/reload the database on the main computer to get the new data to show up.

Has anyone noted this problem of lost notes to occur with wired networks?

A few people i discussed wireless networks with, informed me that with $50 worth of equipment they could basically hack into my network and my patient data would be at risk. AS such, we decided to have a hard wired network through out. That being said, I have not yet implemented AC in my office, because i have other technical issues I am attempting to resolve currently.

For me, wired is always best and will always be more secure. But if you are using WPA encryption AND setting up your wireless router and access points so that they only accept the MAC addresses on your network. You can change SSIDs from factory defaults and disable SSID broadcasting. Make your passwords at least 8 letters with one capital and one number, and you make up the passwords and not your users so you don't get lotrfrodo.

A very smart networking IT person once told me, "Are there computer hackers out there that can get into your system?" Definitely. But, are there computer hackers out there that want to get into your system? Doubtful."

Think about it. We all worry about protecting our data, but you can only do so much. If someone broke into your old office and took your paper charts, is that your fault. If you had an alarm, and they still got in, what can you do. Unless Anthem hires hackers, not too many people give a damn about your data. Much more important things are:

1. Backups. Lose your patient's data, and that is your fault, and you are screwed.
2. Antivirus and malware. You don't want viruses on your system.

And, if you really don't want people to take your data, you will need to put your server in a locked room, make your permissions flawless, don't give keys to any of your employees, don't have a cleaning service. Walking into your basement or your office and grabbing the server or the hotswappable hard drives is a lot more likely than someone hacking in to your system.

You need really good passwords. Period. I mean what is the most likely schedule for usernames. First initial, last name. Or first name period last name. So, if you are trying to get into SBS via RWW, you simply use your IP address which is everywhere, type in asmith and then try some passwords or use a password software program.

Here is a great example of losing data. I took home a hard drive as always on the weekend to battle against fire or floor, neither of which is rather likely. Then, my house was broken into, and they stole a cell phone, which was on TOP OF the $200 SATA hard drive. I guess they didn't know how much a good hard drive is. That had every bit of data. Yes, it was encrypted but still.

This is why it is so important to make backups that go back days to weeks. If you don't notice you lost the note until three days later, having one backup will do you no good. In fact, I am willing to bet that having multiple backups for this kind of issue is more important than for a crash.

I should never say never, but notes can ONLY be lost from the main machine. It is the main machine, because the database is on the main machine and anything you save is saved to the main machine's database. You shouldn't even have SQL Server on your clients, so you have nowhere to save your data locally anyway.


Peter, can you explain step by step what you are doing? When you write up a note or add a patient on any client computer, it is saved immediately to the main computer. You can't save a note to your local client computer unless A) you have installed SQL Server's database on that computer and B) your AC client is incorrectly pointing to that database in which case none of the data from that computer would be on the main computer whether you refresh or not. I am confused.

"never say never...": Except in one instance I can think of. You are assuming that the note in question is saved on the main computer. But the note may be lost on the client computer if it was never successfully sent to the server machine in the first place. (A-HA!)

"Peter, can you explain...": Yes. I am distinguishing between saving to the database (which should only happen on the main computer) and the user interface being updated. I can add to the database all I want; that does not mean that the user interface reflects these changes.

I had AC UI open on the client computer, and open also on the main computer. I added a new patient to the UI on the client computer and added a new patient visit note in the UI on the client computer. I do not know at what point these changes are saved to the SQL database. I finished my note and was at the schedule/search screen on the client machine. I then went over to the main computer and looked at the list of patients and this did not include the new patient.

Now, in retrospect, I can understand if you are now to tell me: well obviously he does not show in the list. That was a search done previously. To see the new patient you have to refresh the search list (of all patients).

and that is what I did. I refreshed the search list on the main computer in the AC window and the new patient popped up.

I guess it would be nice if any changes to the SQL database from one network computer would signal the other machines on the network to reload the database. On the other hand, one could argue (true or not, I do not know) that this may slow things up too much.

Chew on that and tell me how it tastes Bert.

While I am at it. It seems as though I cannot call up a patient's chart by clicking on patient's name in the schedule. It appears that I have to call the patient up in the search window to open the chart. I guess not a huge problem, just extra steps needed.

We are using AC with 5 providers and have not been having problems with lost notes. We use a totally wired network.

SoloMio,

First, I was trying to help. If you took it any other way, I apologize. You can use all the emoticons you want, but it does not change that your statement was and is rude.

You are completely wrong about how you are seeing things and doing things. In other words, your setup is completely wrong. You CANNOT save a patient to a client computer and not to the server. Can we use the word server to mean main computer. You cannot save anything to the client computer. The only thing that gets saved to the client computer is the spell check information.

You ask how fast it gets to the SQL database. It takes 0.938 seconds on a network set up in a 1GB configuration with adequate processing speed.

Now let me tell you what looks like it is saved on the client. If you write a prescription and close the prescription writer and reopen it, the med will be there. But, it is ON the server not the client. If you send a message to someone or to yourself and save it, it is on the server. Addendums save and may appear to save to the client, but they don't. Nothing other than spell check saves to the client.

But, let's look at the proper way to set up a system and I should warn you that AC support will argue with the server set up. I install to the server, move the databases to the data drive and delete everything else. They would tell you to install to C or D or wherever and leave everything in one folder. I would recommend that to the non-advanced. But, I would never have the AC executable on the server. This means I NEVER open AC on the server. Of course, if you are peer to peer, then you do have to on the main computer if you use it.

Now, when you first install to the server/main computer, you will see a window which says, "IS THIS YOUR MAIN COMPUTER?"

If it is, then you choose the top radio button and, thus, install SQL Server Express. You must have SQL Server installed on the computer you wish to use for the main computer.

Now, when you go to install AC on your clients, you choose the second choice. This choice states that this isn't the main computer and, therefore, there is no need to install SQL Server, there. You simply want the client there and when it opens it will want to find the database on the main computer, and you will browse to it. You will access the databases using the .xml file. You wouldn't be able to connect to the client computer even if you wanted to. So, ALL data (as it should) including new patients and new notes are saved to the SQL databases which are controlled by the SQL Server engines you installed earlier.

NOW.....sure if one were so inclined to install SQL Server on his or her client computer, then yes, you could indeed connect that AC program to the databases on the client. But, then it is obvious that any data saved on that computer would be on that computer and, therefore, not on the main databases available for sharing to all the clients.

I doubt this is the case, but given I have never lost a note in six years (and this doesn't mean I doubt others have), maybe some users have some clients connected to the client computer.

So...in short...when you save a note it goes to the server. When you add a patient, it goes immediately to the server (again if you have your client connected to the server's database). And, you don't have to refresh. Simply backing out of the patient name field will allow you to then enter the new patient and find them on any computer.

I hope this helps. I reread my note from above, and from my perspective, it is nothing but an attempt to help. I really don't know where the attitude comes from. I am just explaining to you how Amazing Charts and its database works in both a client/server and peer-to-peer environment.

I'm going to comment as a moderator about Bert's and SoloMio's recent dialogue.

Sometimes when a person is having a problem w/ their computer system, it gets frustrating. What should take 3 seconds to fix can sometimes take 3 hours, and that can lead to elevated BP and emotions. When someone is trying to help on the AC User Board, those emotions can sometimes carry over and be inadvertently unleased upon the helper.

SoloMio, it looks like Bert has taken a lot of time commenting on your questions and has been trying to understand what exactly is going wrong w/ your system. Besides the inventor of AC Jon Bertman, Bert Adams is the most experienced user of AC. He is user number 4 and the longest continual user of this program. He knows it better than anyone on the message boards. I think he is trying to say that there is more than likely something wrong w/ the installation of AC on your network. It is literally impossible to be experiencing these types of "lost notes" repeatedly on a properly configured system. I would agree, it can't happen. I've been using for 20 months and it's never happened to me. So he has deduced that the problem isn't AC rather something in the configuration of your system or installation of AC. He is trying to get you to describe what that is.

Admittedly, I had trouble installing V4 and it took a few installation attempts and about 4 hours to install on 10 office computers. It should have taken 30 minutes. i was frustrated and called Bert to help me. He guided me through and helped me troubleshoot a network problem I was having. He knows a lot about computers and I can highly recommend that his advice is always sound.

Telling someone to "Chew on that and tell me how it tastes Bert," could easily be misconstrued. Maybe you were just caught up the moment of trying to prove you know what you are talking about or maybe you were joking around. I don't know. Clearly that comment offended Bert. And perhaps you might consider appologizing to him.

In Bert's second sentence of his reply to you, he appologized. In his final paragraph he stated that he was just trying to help.

Thank you for considering this.

I would like to apologize to Bert and to anyone who felt my post was rude. I cannot fault him for reacting that way, as I recently also mistook a member's post as a slight. I was not frustrated or upset in anyway. My "chew on that" remark was just a way of saying "wow, I can't believe I typed all of that; hope it's not hard to swallow!" but it came out the wrong way.

Nevertheless, my comments were not meant to offend anyone. I am just a clown at heart.

Thanks Peter. I know Bert will appreciate your sincerity. I do.

P.S. we all must be really bored if we are on AC UserBoard at 11:40pm. <<joking,, but not really>>

What's a user board without a good flame war once in awhile. The problem here is everyone is too nice to let a war even get hot, lol.

Apology accepted and again, me as well. And, hopefully, we can get everyone's notes going in the right direction.

Thank you Bert. Everyone is friends again.

Yeah, but now I am friends who Dr. Who.

Back to the original problem about lost notes and messages, thinking about it, my office system uses two wireless( myself and the MA to take to the exam rooms) and three hard wired computers. I think that of the users in my office I am the one with the most lost charts/messages and the MA who uses one hard wired and one wireless computer is next. I don't think the other users have lost anything they have sent. Reading back through this thread I think that I am seeing no problem in the offices that are hard wired and problems in the offices that are using wireless. ? Yes?

I will have to think on that one. Ask Adam in a PM. He has both wireless and wired and has a ton of experience.

What? You don't want to continue in the fun flame wars? LOL Or, like me, you probably have enough of them at the staff meetings at your hospital, lol.

But, really, PM Adam.

(for it to be a war, I would have had to intentionally made flame, which I was only being silly and thought to make Bert giggle. so no wars to my knowledge). also it would've been nice to have an opportunity to explain myself.

Peter,

Do me a favor. I hope it doesn't seem too obvious or anything. But, based on the answer it may indicate whether I or anyone else can help somewhat.

Please go to all of your client computers. First, look on the Start menu and see if SQL Server 2005 is installed on the machine. There may be other things listed like SQL Server Client, but I am talking specifically SQL Server 2005. You can double check by looking in Add/Remove programs and seeing if it is in there. It will probably be listed there as Microsoft SQL Server 2005.

The next thing can be done a couple of ways: But, maybe we can stick with one method: Go to each client and either "Log out" of Amazing Charts from the File Menu, which will take you to the logon screen or open Amazing Charts and stop at the logon screen. Either way, just get to the logon screen.

Once there, put the mouse cursor EXACTLY between the name of your practice in all caps and the phrase Electron Medical Records System in lower case smaller font. Now right click.

The window which pops up will show the current database path. It will say, Currently, the main computer to which you are connected is YourComputer (where YourComputer is the name of the computer you are using for the database). (Port: 61067)

The path to the main database is:
\\(yourcomputer\amazing charts\AmazingCharts.mdf where "yourcomputer" is the name of the main computer you are using on your network.

Do you want to reset these settings and browse for a different main computer. You would say No unless the path shown is not the path to your main database.

Please do this, and let me know if every client computer's path is the same and shows that it is connected via Port 61067 to \\Server\amazing charts\Amazing Charts.mdf Again, replace the word "Server" with the name of your main computer.

If they all go to that database path, then we or you have more troubleshooting to do to figure out your issues. If they don't all point there, then that would be the problem.

I only have one client computer. SQL server 2005 is installed. The reason, if i understand corrently is this: when you call AC support and say you cannot get an install on a client machine, they adivse you to choose the "halfway" option during the install (not the 'yes' or 'no' response to 'main computer?' but the "kind of" option). That is the type of install that I did.

Now, as for checking path, I did as you said and it checks out correctly: port 61067 pointing to server AC...mdf

and it is updating the main database, because the changes are seen after refreshing the search on the server machine.

I just assumed that this is how AC works. Other folks don't get the same thing?

Thanks, well the only reason they would tell you to take the middle option is so you have more flexibility. I think it's wrong to tell you that because that is not what is recommended on that little window. You only need the SQL Server on the main computer. It won't hurt to have it on the others, but it just takes up resources IF it is running and makes it more likely that others (if you do get others) would save to the wrong database. The only reason that makes sense to have SQL installed on a client computer is just what they say: In case it is a laptop, and you need to have a database when you take it with you and then sync when you come back.

I guess one thing I could say that MAY be helpful is not to look at it so much like it has to refresh on the server. In your mind's eye, forget there is even an AC on the server (even if you do use it). Basically, when you save information to the database path you mentioned above, it is just stored on the database, and your client computer should be able to retrieve it instantly just as if the database were on its computer. (I know you probably know that).

I would say that other folks don't get the same thing, but it's hard to tell, because we are both probably saying similar things, but there is just one little thing that is different. If you continue to have any issues, and AC support can't help, I definitely don't mind trying, but you have to keep writing what is happening. I hate to use the cliche`, but it is history, history, history. You know, it's kind of like patient with joint pain, etc. who on the 5th visit says, "Oh yeah, you asked me if I could have been around ticks, I forgot to tell you I was at a Lyme tick deer farm two months ago."

that is true, it should only be needed for portables but at AC support they found that it also resolves some install problems much quicker than actually finding the real problem.

I am thinking that probably the things I am seeing are not really problems, but just getting used to how the software works. As I become more proficient it'll be much smoother.

Wow, that was a long time ago. I am slowly getting all my laptops hardwired-it is the way to go.

I have also have a nice system for dealing with billing. At this point, a functional PM will be gravy. I am so thankful for AC-All in the customer service is very good. The user boards are the real gift for AC users. Bert and Adam and Leslie and many others have been there so many times and saved me (even when I was cranky, like when I wrote this).

I wish I had more time for the boards right now. I learn so much from other users and the generous responses that folks freely give.