Home Forums Discussions Feedback and Recommendations Jon, PLEASE fix the letter writer!

I spoke to Jon around a year ago, discussing some of the missing basic features that make a big difference in time spent using Amazing Charts. As a specialist, by far the biggest problem with Amazing Charts is the near-useless letter writer. I don't see why Jon couldn't just default to opening up WordPad when a letter is to be written. While the HTML letter writer may facilitate an audit trail, it does not allow for easy corrections or for formatting. The amount of effort needed to generate an accurate letter in Amazing Charts makes the program almost unusable by specialists.

Also, the letter writer should autopopulate the referring physician into the address field like every other EMR I've seen does. Having to manually select the physician that the letter is to be sent to disrupts workflow.

It would also be preferrable to be able to choose the salutation that is used in the patient instruction letters. It currently defaults to using just the patient's first name instead of Mr./Mrs./Ms. I may be a bit old school, but this seems overly familiar/unprofessional to me. Just as I expect my patients to address me as "Dr.", I address them formally as Mr./Mrs./Ms.

I know several people have already requested that the letter writer be fixed. Is there any reason that something as important as this and that should be as easy to fix as this is being ignored? It doesn't make much sense to me to have an EMR with such a weak letter writer.

Jon, are you listening?

Osler,

The letter writer is a disgrace, and by far, the weakest part of the program. It should open up in any program you wish, preferably Word. Most programs allow that.

It isn't just specialists, it is the referring doctors which hate the formatting of the letter. It is embarrassing. And, once you open the letter for printing, it is over. You can't change anything. Also, the preferences at the bottom should default to what one needs. I don't need the note to go with it and usually don't want it, where others may need it.

This is why I do not want the PM. Because as we move toward that and working on that for months and months, the little things don't get changed. I don't think the letter writer will ever change.

I agree with everything you said. The problem with trying to get CCHIT-certified is that doing so requires so much of the company's coding resources that the basics that impact real functionality get ignored. There are probably a dozen little things that could easily be fixed right now and would improve Amazing Charts immensely. Unfortunately, these are either put on the backburner or else ruled out completely due to lack of coding resources. Some of the things I'd like to see fixed before a CCHIT-approved version is released:

- Letter writer that opens with a user-selectable program (or at least WordPad) so that formatting, editing, etc can easily be done.
- Auto-populate referring physician field in letter writer.
- Allow a user-editable list of favorite prescriptions to speed Rx writing.
- Control the default salutation used for patient letters (currently defaults to the patient's first name, which - in my opinion - is unprofessional.
- User-editable list of headings for imported items to be filed under during the import process.
- Ability to sign notes without having to answer all of the coding prompts.
- Ability to remember user preferences in screens (like the letter writer, as you mentioned).
- Ability to color code appointment types.
- Ability to change default fonts within Amazing Charts screens.
- Ability to turn off templates (so that I can use the mouse cut and paste functions again - yes, I realize that you can use keyboard shortcuts instead.)
- Better control of backups (location, number, frequency, etc.)
- Easier way to add a proper (handwritten) signature to documents.

It's the little things that make a big difference.

Dr. Osler:

If it is possible, could you sign with your first name or is that not a good thing. I feel funny saying Osler just as you feel funny saying first name for patient.

As you may have guessed or seen, I think I am now the remaining original user of AC. At least it seems that way when one looks at the user list. I can recall what attracted me to AC: a fast, no frills, inexpensive program that could not be found anywhere else.

At the time and even now, there are only two unique EMRs (that I have seen), Praxis and AC. I have always said if I ever changed EMRs, I would try Praxis again. Huge, steep learning curve but a great concept.

Anyway, in the beginning AC had no competition. None. Therefore, it sold easily mainly by word of mouth. Consider how small Bangor, Maine is, and I convinced two local doctors to use it.

But, now with PM coming along, AC is beginning its quest to compete with the "big boys," something it will most likely fail at. Logician, eMDs, NextGen, etc. have 20 programmers, CEOs, COOs, etc. I doubt the president of NextGen emails his users on same day.

Obviously, there are many users of AC which can't wait for the PM module. So, who am I to say we shouldn't have it. But, I guess at some point Jon has to decide do I want to keep those users or the ones who want a GREAT emr and continually make it better and better.

How cool it would be if AC still moved forward, yet was able to take certain "modules" of the program such as the script writer, the lab writer, the letter writer, etc. and say, "This six months I want you two programmers to completely revamp the letter writer.

^^^ Bert echoes my thoughts exactly.

I do think that Jon wants to be able to continue to work on AC as well as the PM - in my conversation with him I think his plans were to have 2 programmming teams, one for PM and one for the EMR program. I think it will get better, but some days I know support seems less help than they should be - unfortunately the hours they are open are the hours that most of us are seeing patients - I usually do my installs over the weekend, but there is a great risk doing this when support is not available.

I do agree that it is much better to use the online ping - only once have I had them send me an auto answer that took a message and said they would call back.

I must admit that I have never had any major problems with any version of AC and have used it for many years. One night late at night when I did an install I ran into problems with printing and discovered it was a Windows Vista issue.

Ironically one of the reasons I think that support has a miserable job is the fact that Jon allows us to use any level of hardware we want - I have Windows 2000, Windows 2003 server, XP Home and Pro and have used Vista also - all in the same office and mixed together. That is a nightmare for any support helpline.

Don't I always, lol.

@Steven,

I don't know. I think there are issues now that could be resolved, and the PM will have issues and AC (the program) will become the step child.

I read on here once that Jon makes sure he reads every line of code. That all code is approved by him. I am not sure if that is a good thing or a bad thing. But, it certainly must take time.

One thing I have always noticed is that when updates comes out, then tend to fix bugs or add small features here and there. But, you rarely see an update or upgrade completely revamp a part of the program like the vaccine registry (thank God I have VIPER), or the letter writer or script writer. They just stay the same.

Another opinion I will throw out there that would help with support is more support on the website: User guides, FAQ, Knowledgebase, forums. It really only has the forums. I think if it weren't for the forums, many users would really become frustrated.

There is another thread going on about backing up and practicing restoring which has alluded to three different ways: Using your backup, using sync and simply moving SQL databases the correct way. Nothing against using sync, but it is not the way to move a program and neither is using a backup. Once the program went SQL, the technique for moving the program from one computer to another was made more difficult by a factor of 10. If I had to do it, I would simply move the databases. But, this information should be on the website. It should be part of what is termed "best practice."

And, I am sorry. A user-driven wiki is not a user guide or knowledgebase.

Just my opinion.

My programmer, who may be the best ever, (I have no one to compare him to) made the VIPER program. Took him about one day. Of course, V4 (of VIPER) is much better. But, from day one, when you go to print the vaccine record, it opens in Word.

If you notice when I am talking about Backup Assist and Acronis when questions arise about backup programs, what are the two main things I talk about:

How good is the program and how good is the support. Cost is an issue, but I truly think it comes in third.

I know they are both huge companies compared with AC, but then that means AC needs less support. But, when you get support from these companies (and many others), you always get one or two follow-up emails. "Did we fix the problem? Was there any way we could have fixed the issue better? Also, when you work harder on one product, it requires less support.

Support is the major reason why my programmer and I haven't to really market FAP, VIPER and Amazing Labels. And, Steven, you know how good Amazing Labels is.

I agree with all of the above - I hope Jon is able to make the leap and get more support going. Unfortunately the best way to make it easy is to do what some companies do is to tie your software to dedicated hardware (something I and a lot of small offices don't want or can afford) making support easier.

I do know how well Amazing Labels works and I only hope your programmer can make the jump to version 5 AC when it comes out - staff could get cranky if they didn't have a good label printer

If it makes a difference, feel free to call me "Ozzy". In my opinion, there's already too much personal info available on the Internet, but that's another issue.

I don't think Jon has a choice in the matter. If he wants to keep Amazing Charts viable, he simply has to get it certified (so that all of those physicians lured by the promise of "free money from the government for buying an EMR" will put Amazing Charts on their list). To not get certified in 2009/2010 would result in instantly being shut out of a large chunk of his potential market. Likewise, I feel that most physicians are looking for an integrated EMR/PMS, so adding a PMS will only serve to open up the market further for Amazing Charts. I disagree with your assertion that he is trying to compete with those mid and high priced EMRs you listed. Right now, Amazing Charts has no competition in the low end of the market, and as long as Jon positions Amazing Charts as a sub-$2000 package, he should do well. The problem is that he's trying to do everything all at once, with limited resources. While I'd like him to "fix" what I think is wrong with/missing from the EMR ASAP, he obviously feels that the time is better spent on adding features/certifying/adding PMS. I think he's decided it makes more financial sense trying to go after a bigger slice of the pie than it does to try and keep current users (who have already purchased his software and thus provide limited additional revenue) happy. I bought a license for $1000 and added 2 additional licenses for an additional $400. I could easily (and I'm sure many users do) have chosen to decline the optional "support" charge and that would have been all Jon may have potentially earned from my practice. Admirably fair pricepoint, but definitely not a good way to stay in business longterm, unless he was able to count on a steady stream of new sales. The new revenue model that Jon introduced in July, 2009 reflects the reality that his previous model was not sustainable. The cost of properly supporting hundreds of new users of the SQL-based Version 4 alone could quickly drain any profits Jon may have made over the years. (He'd probably have to sell 40 new licenses just to recoup the cost of hiring a single new tech.)

I half-expected a company like eClinicalWorks or e-MDs to buy Jon out in 2009, just to gain access to his hundreds of current users and atempt to then upsell them to their mid priced EMRs. Certainly, these companies have the resources to pretty up the Amazing Charts GUI and fix the lingering bugs + missing features much faster than Jon can. Also, they would be able to actually advertise the EMR rather than depending on word of mouth sales.

At this stage, I'll see if they can fix my installation of Version 4 and then if it proves to be stable I'll retire Amazing Charts to backup EMR duty again and probably skip renewing the technical support fee next year. If version 5 comes out in January, I'll take a look at it, but after seeing the nightmares that several early adopters went through with moving to Version 4, I doubt that I would ever install it in my clinic.

Osler - I hope they can fix your install of Version 4 - unfortunately it probably is something just a little out of the ordinary and will end up being a simple fix.

I must say that I have tended to adopt new versions right when they get released as a beta version and have never had any real issues that could not be resolved easily. The one pain in the neck that I ran into was when Jon required validation for prescription writing which I did not check until I started seeing patients on a Monday morning. I think you will find that for every 10-15 people who have no real issues with installing a version of AC there is 1 who has issues and posts on the Users Board.

At this point Version 5 is already CCHIT certified (provisionally) and only requires Jon installing it in a real practice setting - at this point he is most likely just finishing all those last minute things so he can hopefully avoid problems with installs.

I think you should just wait and see - I hope Version 5 is full of lots of new features and has fixed many of the problems we have had for some time.

I think I will stay with Dr. Osler. I have to agree with Steven on installs and problems with V4 or V5. I have never had an issue with anything except in the first month six years ago. Not one glitch or hiccup in installation or usage. I, too, think that those who did posted (and should have) and those who didnt, didn't. V3 to V4 was a big step and required a bit more tech savvy to install with SQL. And, many with Peer to Peer or even client/server were used to the ease of simply copying and pasting the folder anywhere they wanted. My guess is that 90% of those who had problems did something incorrectly. Not blaming them, but I doubt it was Jon's issue.

I think you misunderstood my comments about competing with the "big boys." I didn't mean for that to come across as he wanted to actually go toe to toe with NextGen. I just meant by even added a PM, he was trying to position himself into a different market. And, therein lies the paradox and my point. He gains more potential customers at the possible expense of losing those of us who came to AC for its simplicity and speed.

I am confused, though, because it sounds like you were saying th exact same thing I had asserted.

You state that rather than fix his current EMR, he would rather add features, certification and add the PM. I think that "going after a bigger slice of the pie" is akin to what I was talking about when I said competing with the big boys, e.g. trying to get the same customers who look for a complete package, not necessarily competing with those that cost $30,000.

Saying the same thing, just in different ways.

On a side note to everyone, and I am the most at fault of this. But, it is a bit funny where all of us, again, especially me, tend to say what we think Jon should do and where he is going wrong. He probably reads it and laughs. On second thought, he probably doesn't even read it. And, by that, I don't mean he isn't smart enough to use the feedback, it's just that I am sure he has his own course and agenda. But then, sometimes I wonder.

I had tech support do the install specifically because I didn't want any excuses of "end user error" for a failed install. Yes, your comment sounded like you were saying that by adding a PMS Jon was positioning Amazing Charts to compete with mid and high priced EMRs. I feel the EMR-only market will soon dry up, so Jon's decision to add a PMS is more about adapting to the reality of new market expectations than it is about changing the target demographic.

While Jon will no doubt follow his own instincts re: how to develop and expand the scope of his software offerings, I think he would be wise to pay attention to to comments of veteran users like you. I have found that often once physicians become programmers they tend to "go native" and start forgetting the priories of practicing physicians and and instead start thinking just like software engineers.

Agreed. But, he not only needs to worry about developing a PMS, he also needs to realize that in doing so and in adding SQL Server, he needs more tech support.

It is ironic that SQL Server adds stability yet it is causing instability for a lot of users.

The letter writer is a disgrace. I do agree that there are limits to what can be corrected and it should. Steven is right that Jon stated he was compartmentalizing the growth of AC. I don't know if he "approves" every line of code. He freely admits that V1's errors were due to his coding errors, which were corrected when he hired another programmer.

Jon has continued to develop AC into what he considers a more complete product. As such, there has both been the desire and the request for a PM section.

It may also be required to completely be compatible with the requirements for government reimbursement.

Like it or not, his business is growth by more sales, NOT maintenance fees (which would otherwise be more exorbitant.) Lack of compatibility with upcoming requirements for government reimbursement will end most future sales. This is a necessity.

One always has the ability to stop upgrading. There might be someone out there using V2. I doubt anyone is using V1. There are a number using V3. Hopefully V5 will be available soon. PM will probably be V5.5 (or 6 if he wants to get recertified in CCHITT.)

Jon has not led us wrong to date. I would love to see how V5 has moved forward, but I accept his delays to mean that it is not ready for "prime time." I, for one, am looking forward to a PM system, but realize it may be another year in the wait. Hopefully the letter writer can be done sooner.

For the record, the letter writer is fine for me. I would love for it to auto-populate the referring physician but sometimes I send a note to the consultant (who may be a GI guy) as well as the PCP. So I just do it twice. No biggie. I don't have the need for formatting either although I can see the need. I definitely don't want more programs to open up like Word. Keep it within the program That's all I need is 65 windows open doing different things.

I'm just simply trying to assure my referring docs know what I'm doing with their patients. The letter writer is definitely markedly better than the handwritten scribble I get from the majority of my referring docs. I usually have no idea why I'm seeing the patient except for what my front office person puts in AC.

I would prefer that it remember that I don't send demographics and a copy of the note to the referring docs.

I do like these suggestions and think they should be at the top of the list for V5:

-Auto-populate referring physician field in letter writer.
- Allow a user-editable list of favorite prescriptions to speed Rx writing.
- User-editable list of headings for imported items to be filed under during the import process.
- Ability to sign notes without having to answer all of the coding prompts.
- Ability to remember user preferences in screens (like the letter writer, as you mentioned).
- Ability to color code appointment types.

This thread is a downer. I, for one, really enjoy AC. I accept its downfalls as I accept the $60,000 I didn't spend that my fellow general surgeon colleague spent on eMDs (with the hardware of course).

The letter writer is a disgrace. I do agree that there are limits to what can be corrected and it should. I don't know if he "approves" every line of code.

He does approve every line of code. He stated that in a post a few months back.

Jon has continued to develop AC into what he considers a more complete product. As such, there has both been the desire and the request for a PM section.

I think what I am saying is being misunderstood. I know there are many who want the PM. And, I think they should have that option. I am just saying that I believe we are seeing the opportunity for improvements to the core product slide downward. Look at the support threads. I mean I rarely use support, but it sounds as if some are really have a difficult time with it.

It may also be required to completely be compatible with the requirements for government reimbursement.

I am not an expert on this, but I do not think a PM is required to be compatible. In fact, I think the government benefits if we are not able to bill

One always has the ability to stop upgrading. There might be someone out there using V2. I doubt anyone is using V1. There are a number using V3.

The ability to stop upgrading has nothing to do with V3, V4 or V5 being improved. Sure, Osler can not go to V5, and I don't blame him. But, I would like to see V4 or whichever program improved. It just seems like the emphasis has always been on interfaces and more interfaces and CCHIT which is required and now a PM.

Jon has not led us wrong to date. Hopefully the letter writer can be done sooner.

No, he hasn't, and that is why I said, he is probably reading this and laughing. But, I do not think the letter writer will ever be fixed. The code required to have the letter writer use the program's application and window is way more than work than writing a two-word shell command and letting it open in Open Office or Word Pad or Notepad or Word.

@scalpel, I understand where you are coming from. It would be easy to have the ability to use AC or other programs. AC already has too many windows. To have Word or whatever pop up to write and edit a letter would be infinitely better and give a lot more usability. Your letter would format the way you wish and would actually look professional. You could save in .doc or .docx and, therefore, be able to open it and edit it as you see fit. It would also crash a lot less often. To each his own, I suppose.

I really don't think this is a downer of a thread. It is a much needed thread that Dr. Osler brought up. It focuses the spotlight on an issue that AC has had for awhile and thiat is moving forward and leaving large parts of the program behind. The letter writer, the immunization record, the script writer, etc. are all close to the same if not completely the same as they were in version 1.

Where is George when you need him?

I know in other posts users have stated that when another product (I think SOAPware) went to SQL it was a disaster in the upgrading. Unfortunately big steps require big changes.

Bert - You mentioned Praxis, as though you might be tempted to try it in place of AC. I used Praxis 98 ( it has probably improved a lot since then) but then its promises way outpaced its product.
We have been with AC now for almost 4 months, and it has been wonderful, inspite of the problems some are having.
I would very much like to have the PM module become available, and will use it and the e-prescription section too. When I started AC, I was told they hoped to have both available by July or August. Obviously that didn't happen. Because of the quality of the core product, the EMR, I am willing to wait in hopes that the PM will be of the same quality.

I think e-prescribing is real close - I use the NewCrop feature which requires double entry, but I couldn't stand letting Medicare not pay me 2%....besides I can't resist a bell or whistle....but would be better to wait for new version.

Hi DocLon,

Welcome to AC and the boards. Yeah, Praxis is at 3.0 I think. I would never change from AC. Love it too much, and it works. I tried to learn Praxis back at 2.17 or something like that. It's logic processor or whatever they called it was just completely different. And, writing notes based on a bell-shaped curve was intriguing. I do recall that the owner/president is/was a bit cocky. But, maybe he has reason to be.

Exactly.

The sad part is that there are several simple fixes that could have already improved the usability of Amazing Charts immensely. I don't expect any further development of Version 3, but I would appreciate it if Jon could produce a more polished Version 4 before he stops its development completely and moves on to Version 5. A stable Version 4 that included the bug fixes and features mentioned above in this thread would be "good enough" for a lot of physicians. Version 5 is going to add another layer of complexity to the program and I feel it will be very difficult for Jon to adequately support Version 5 unless his company gets bought out in the near future.

I have to agree with both Bert and Osler that V4 is somewhat unpolished as it accomplished the goal of going to SQL.

It is like VISTA, good idea but not well executed. Hopefully, V5 will be more like Windows 7, which seems to be all things Vista wasn't. Fortunately, we don't have the same upgrade costs that Microsoft charges per computer.

I do agree that there are several fixes that should have happened to V4 that appear to be pushed off to V5, like the search problems (don't get me going) as well as a bunch of other fixes and tweaks. V4 appears to be stepping stone.

We may be on V5 for a long time since it would appear that CCHITT certification is tied to a version. That might make it probable that the PM system might be an add on.

Bert, you might consider putting one of your surveys to the board as to whether they prefer stand alone/optional or integrated PM.

Amazing Labels? Bert, what is Amazing Labels?

I really do get the jist of this thread and think its spot on. Its comparable to expanding your practice with cosmetology, botox, etc when you haven't nailed down your basic practice.

Build a "perfect" EMR with CCHIT compliance (I guess that's unfortunately necessary now). Fix the little and big things. Worry about the PM system later. A PM system is a HUGE undertaking to build a really good one that scrubs the claims and works for all specialties. Plus, it will be tough to convert me to a new PM system as I just did that and it was VERY PAINFUL.

Thanks Travis. Great post. I guess it's kind of damned if you do and damned if you don't.

On one hand, I look at Medisoft and now eMedware that we use, and it is a very complex system. And, I think how can AC's PM be anything like that. But, then you could say that Logician or NextGen is the Medisofts of the world and AC is less bells and whistles.

I guess we can only talk from our perspective. For me, I want a smooth, well running program that has no bugs and continues to improve based on user input.

But, I also understand where there are those out there who really need the PM. But, again, you have to find your niche, and I really thought that Jon had found his. CCHIT, as you say, is necessry, but continue improving V4 or V5, improve the support, raise the cost a bit and the sky is the limit.

Amazing Labels is a small little freeware program that my programmer and I built to make labels for labs and charts, etc. It can also do address labels all based on the demographics.

The only caveat is that you must have a Dymo printer such as the Dymo 400. You can talk to Steven about how invaluable it is. Our error rate on lab turn downs due to improper labeling dropped from around 7% to under 1%.

Sounds like a neat little program. I'll have to keep it in mind.

It is. But,again, talk to Steven. He could be my marketing manager. I think he likes it more than I.

How's about a petition to fix the letter writer?

Where can we download this program from?

I will need your practice name for registration. PM me with that. Do you have DYMO?

Thank you. We use Brother label printers, but will purchase a Dymo printer if you don't support the Brother printers. I sent you a message with the practice name. Why is it needed?

I think it's just Ed's way of having the registration say Registered to or Leased to Generic Pediatric Clinic...etc.