Home Forums Discussions General Discussion Appreciation, Templates, Hardcopy

Vinny,

Thank you for taking a leadership role with the User Board. Your contribution to the board has revitalized the quality and quantity of discussions. I understand you are volunteering whatever spare time you have for the AC community.

I'm working on more templates to attach to the board. However, I have a question regarding the "download", "upload" function of the fully moderated board. I have no idea how this is done. I've been pasting my templates onto the posting form and sending it to the fully moderated section. If I would just paste my template onto the less moderated section (such as this one), then there is no need to screen for porn or other viruses (since there is no download/upload issues).

One other question (to which you may have no answers): There has been some discussion regarding the new EULA. You responded to that with a <SIGH>. I read through the EULA and it looks pretty standard. But the part that I am concerned about is what happens when we don't pay up every year? I intend to pay $500 each year to support AC as I have since I started using this software. Is there a mechanism in AC that would lock me up from using the software if I don't pay up whatever is the annual fee? I'm worried about owning medical records that I can't get ready access. That's why I won't subscribe to an ASP system. No easy access to my records will shut down my practice and will cause legal problems. And would the Guardian Angels come into my clinic and take out my hard drive to get to my records (or software)? I have started printing out my electronic medical records since I am not getting a clear answer/clarification. Needing to print out my records kind of defeats the purpose of getting an EMR.

Hi Roy,

No, Jon does not have a remote control or back door to turn off Amazing Charts (that I know of..), and my thinking is that the EULA police aren't going to bust down the door of someone's office just because someone has a falling out with Jon. If it ever went to court, as much as it's Jon's program, my thinking is that the provision that you have to remove the software would probably be found unenforcible, as access to the patients' medical records would probably be found to outweigh Jon's rights here.

Bear in mind a few things, though. First - why would it ever come to this? Jon's a sensible guy, and based on what I know of him, it would take some pretty severe provocation to ever get to the point where this would be an issue. Second - $500 / year is dirt cheap for what we're getting. Third - the cost of litigation to either get you to delete Amazing Charts or to get a court to tell Jon "no, you can't do that" would cost BOTH parties a fortune, which neither Amazing Charts or any medical practice I know of wants to throw money away on laywers, so quite honestly I see this whole saga as a "non-event"

Even so, since most of the chart in our office is still paper, the paper chart is the final word on the patient's medical record, at least for the time being. This may change once we're interfacing to the hospital's lab and radiology systems, as most of our working chart info that would need to be imported comes from the hospital, and I don't want to add the overhead of scanning all of this at the moment.

If you go into Amazing Charts, bring up a chart note, right click on an area to bring up templates, then export the template, it will create an XML file of the template. I usually shorten the file name a bit, as generally the name is the template name plus the practice name plus the date then ".XML" at the end.

When creating a template post, I would like to see the actual text posted for those that choose to cut and paste the text into a new template. The uploaded XML file is optional, but it looks like a few people so far are downloading them, which is kinda cool (and why the template discussion can accept uploads!)


Hope this helps,

V.

Gents,
Although I agree with the part about "the cost" to both sides being the possible real limiting factor let me tell you that the "request" we recieved to remove and be gone in 30 days was, unfortunately quite real.

As I'vd said before, I totally admit to being more and more in your face as things did not get resolved properly. But we also saw not fixing a beta site's data that the developer himself thought was most probably corupted by the use of a previous beta version months earlier as not very polite or AC ethical either. And so the stupid thing took on a life of it's own and just got worse and worse. I have privately and publicly owned up to our and my own 50% of what went wrong here as this is my M.O. when treated poorly and rudely. But other than pulling back from the brink and the edge and "allowing" us to stay on under restricted circumstances we have never recieved an admission or apology of the same for their 50% from AC.

As I have also stated a long time ago, I suggested to Jon that he offer an ASP model of both the EMR and PM side of the program, but to do it in a very AC, ethical way. By insisting that the clients purchase a real license to the program and recieve a copy there of, because AC will never hold your data hostage like the traditional ASP's will. You the client will always be a licensed owner of the software you purchased and so you will always have at the very least archival access to your old data and charts. As you've all said better than I have; this stuff is just way too important. These are our patients' PHI, Medical Records and our documentation there of, for all of the reasons we in this business need to do such things. There is a VAR who sells Altapoint under just such conditions and basic terms which is where I got the idea to suggest to Jon. I sent this suggestion to both Jon and Carlos I never did hear back from either one of them on this suggestion....

So here is where I'm coming from... Since the clause has been sort of just about executed at least once already, then obviously it can and probably will be used again, right? Take all the personal garbage out of this, and it's still just not right. Simply live and let live. Have a nice day, fly without a net, but you do own the last copy you paid for and have a nice life. So why is it there and why won't the most ethical software vendor on this side of the business understand or cooperate with this? Why did he put it in there in the first place? Perhaps if enough users voice their disapproval of such a clause, then maybe, just maybe, Jon might change this policy back to a more customer friendly one. And what did happen to our old EULA that us older users originally agreed to? Does anyone still have a copy of the old original one and if so would you please post a copy of it for everyone? Could you please send me one?

And yes I totally agree with Jon deserving every penny that we all pay him if not a good deal more. I was one of the first (#2 I think) people to suggest we give him an up front, down payment to the new PM to assist in it's R&D. When my credit card had trouble going thru this past Febuary to pay for our renewal, I was the one calling AC almost daily saying, "I want to pay you, what should we do? You guys deserve this money." Nancy and I have been a beta site for about a year or more now, because we want to assist in the development of this fine product. I was one of Jon and AC's biggest supporters, even offering to go the the NYS AAFP meeting this spring in support of quality small vendors like him and AC. I was asking Jon and AC to send me some sort of demo copy with false patients and data that I might be able to properly demostrate for a large audience, just what $1K can still buy you when you shop wisely. Our State medical society was working with state gov't on getting grants for small poor practices to assist us in buying big expensive programs; basically give corporate wellfare to GE and the other large vendors. I was going to try and fight, (Nancy was being offered and supported to be a delegate, and so I was going to address the meeting as her rep.) for better support of quality small vendors that practices could afford and support on their own and not throw away our tax dollars giving money to the rich and powerful.

But basically until this set of unfortunate events transpired between Village Medical of CNY and AC, Paul and Nancy were some of Jon and AC's strongest and most loyal supporters. We did not reach this point today without there being some amount of mishandling of the situation on their side. I know without going inappropriately into too much detail that Jon was going thru some pretty bad stuff personally and I wish him nothing but the best. But we never knew that such was the case until things had pretty much blown up already. AC is going thru growning pains and we found that their tech support was less than great. The ladies who were handling our issue this past winter, would just pop you on hold in mid-sentence, didn't seem to be very up on a number of important issues and new developments, and just in general didn't give us a feeling of being on top of things. This is AC's issue to deal with.

In closing I guess as a previously strong AC supporter because of their great product and extremely ethical corporate policies, all I would really like is to see a return to such in "writing" when it comes to the EULA. And I think we need to have the support section be better spelled out. What is supported, what is not. Is data coruption part of that and under what conditions and terms. What is the "covenant" between the beta's and the developer and shouldn't beta's be supported in a different fashion than regular end users, seeing that we are putting our offices and our data at a higher level of risk, so as to assist and support in the continued development if this fine product that we all really want to see suceed? I personally don't feel that such requests and desires are very unreasonable. I like Bert feel that a little more feedback from the group is critical to some of these more important issues. Please people, chime in here. Thanks so much. To AC.....

Paul

Hi everyone and to all the usual suspects. I must write something here.

Basically, I have thought a lot about this, and I, for one, see this as being most likely the following. At first, this was a small operation with a EULA probably written by the same person using C++ or VB. As it has grown due to how well it has been written and marketed, the need for an attorney or attornies to write the EULAs was necessary. Unfortunately, the one area or clause is what has everyone in an uproar.

I think the basic issue is whether we have PURCHASED the software or whether we have a SUBSCRIPTION to the software. Clearly, it has not been stated anywhere that I can find that this software is a subscription type. Their clearly is subscription software in existence which has nothing to do with ASPs or otherwise. I cannot go into detail, but there are very large companies that offer subscription software under the expectation that each year the subscription will be renewed and support continues, updates and upgrades provided and even brand new products will be shipped quarterly. However, if the annual subscription is not paid, the software must be removed from the computer and the vendor can and will cripple the software and possibly bring legal action and win large settlements as they have. Of course, this is a large company with their own attorneys.

But, that is one comparison. The other comparison or analogy is the one which applies here. It is like purchasing Word 2003 or Office 2003, etc. Once paid for, the license is yours to keep and the software may be used forever. If you wish to upgrade to 2007 you can, but you do not have to. Of course, you will not have the latest technology, but I know people still using '97. I don't associate with these people, however. <G> a joke if you don't know, lol, but close to the truth. Of course, Microsoft at some point will not supportl, say, Windows 2000 and, even more damaging, will not allow you to upgrade from it.

The EULA for the trial version clearly states that it is time restricted and it will fail to work after thirty days. (Interesting that you cannot copy and paste from the EULA) So, it is not that difficult to put in time limitations. Even if a full working copy, time constraints of say 395 days to give a month grace period could be activated if a new registration key were not inserted. I am not at all suggesting that this is the case, and I highly doubt it is, but I just bring up the possibility as the devil's advocate.

Remember, just a few years ago, Microsoft could only stop piracy by activation, but now they have Windows Genuine Advantage, a small piece of software (may as well call it spyware) that slips in through your Windows Updates if you are not watching, and checks your hardware configuration and compares it to your 25 character producty key. If there is not match, this information is sent back to Bellevue and soon strange things start happening to your OS. It starts with your Windows Media Player which is certainly hitting below the belt. Vista will be worse. If you don't believe me, ask my friend. She had an OEM version which, of course, being a copy meant for an Original Equipment Manufacture is meant to only be released with hardware, namely the PC at Dell, HP or some online vendor. So, the technology does exist. Again, no suggestion here.

It is interesting to ponder what would happen in the courts. On one hand, by installing the software, you have signed the EULA, but that is what the courts are for. My guess is the court we decide for the owner of the software, but maybe not since it can be proven that any piece of information can 1) be printed and 2) be transferred to another EMR.

I do see Vinny's point, although I do have to disagree with him on the paper issue. We have NO paper. None. So, all of our information on each patient is either a 1 or a 0. We have extensive backups, but that is a posts for a different time.

I do also have to disagree somewhat with Paul. I know basically what occurred, and I know it must have been terrible. But, Beta testing is slightly different, I believe, than he is writing. Sorry in advance Paul. I may very well be wrong. Freedom of speech and the blogs and all. But, Beta testing benefits both parties. It clearly benefits the software writer, because they get the feedback they must have in the many beta versions in order to sell a basically bug-free full version. Then comes SP1 and 2, but still. These Betas generally go to the users who are somewhat more familiar with computers and software and specifically that software. This is because they will tend to "bang" on the software harder, find more bugs, and send more feedback. The user, however, benefits greatly since they get to use the latest and greatest cutting edge software and also get a long trial before possibly buying the real product. But, almost every software vendor, especially Microsoft, Sun, Apple etc. will state that they do not support the product for the very reason they are putting it out there to test. One, there are too many bugs to answer calls for, and the tech support can't fix what they don't even know exists yet.

Finally, though, it comes down to do we own the software in question or are we subscribing to it. That is the part that needs to be more clear. I think everyone is willing and more than happy to pay the $500 per year, that has nothing to do with it. I think clarification on the above is the vital thing.

Bottom line:

I can't take the chance that there is a date-encrypted subscription key in the next update. It's not that the $500 yearly fee is a problem. It's that I need to know that I have access to the software after I close my practice (which may be forced upon me with Predatory Hospitals, reimbursement, "urgent" care centers and such). I am required to keep a copy of my medical records for upto 28 years for children (8 year discovery period from the age of majority).
What is sad is that I implemented being paperless hoping for increased efficiencies and now I will have to start printing and filing again. It's a shame that attorneys write EULAs so that other attorneys are needed to decipher the EULAs. I don't know if EULAs really protect anyone. As SirTopenHat would say, "It just causes confusion and delay."
Regardless, this whole EULA controversy has had a "chilling" effect this summer. I have cold feet. I'm going into the pool only after dipping my toes several times to ensure there's no pirhanas (not head first as before).

Thanks for your thoughtful opinions.

Roy,
No need to appologize my friend, I for one am very glad to air this out and that means there should and will be differences of opinions. Freedom of Speech, don't hold back. I do like your analogy of a subscription service, which I guess is what AC is now becoming. It would be nice to have that clearly stated and perhaps pre-warned as such changes come down the pike. I too really thought I was purchasing a software that I could keep and hold forever as long as I had an proper OS to run it on. That is really what I wanted and what I will continue to seek and advise others to purchase for all the good reasons stated previously by you, myself and others.

As for that beta site issue, I do totally agree and have said previously, that yes it is a very symbiotic relationship between beta's and vendor/developer. We beta's get to test drive the lastest and greatest and in the case with AC even have a reasonable amount of input as to what gets developed and included in the product. Absolutely wonderful. It is one of the main and many reasons I first feel in love with AC and supported and respect Jon so. I used to promote AC to almost anyone who would listen, really I did. And when it came to other vendors they better start designing interfaces with Jon for AC if you wanted my business long term as well.

But when we first stepped up to the plate and chose to be a beta site I had a long conversation with Carlos (not to put a great man who needs to maintain his job with the company on the hotseat, but this was quite real) when the NYS Rx's came out beta about a year ago now (spring of '06 I think). He promised me that Jon would not leave a beta tester hanging if the beta hurt their stuff. He said, "what do you think you are paying for the support for? Jon would never do that, I would never allow that to happen to you. We just not that type of people, Jon's a great guy. You can trust him, trust me." (I am slightly paraphasing here, but only a bit.) So I stepped up to the plate feeling a sense of obligation to assist the folks who were putting features in their product that I had been hounding them for and made Village Medical a beta site. If I wasn't willing to communially help out for items I had wanted then who would. I had nothing but good intentions and perhaps high but understandable expectations, right?

Now I have submitted a great number of bug reports, talked with Jon and tech support about a good deal of issues we have found that has assisted in the design and development of this product just as many others have. We already had MidMark Ritter ECG and Spirometry so we Beta'd that as well. And yes we got the real advantage having it in the product and getting to use it early and first, no doubt about it. But just as you now wonder about saving everything to paper I start wondering about saving all those tests in the original format with patient named specific file names, by running them on the original MidMark software that we own and then copying them back into the inported section of the patient's chart for all the same concerns.

But I have beta'd other high tech stuff as a studio level Audio and Video engineer so I have some experience with this stuff although not in software per say. The beta understands that there is some amount of risk to be "down" a bit more, but the vendor also knows that you are taking such risk for the mutual development of their product. So there is a sort of covenant that I always sort of understood between the beta and vendor/developer. We as small offices may not know how databases work all that well, so if and when the beta starts hurting our data, the vendor will assist in hopefully gettting it straightened out, cleaned up or what have you. Not all of us are Roy's and Vinny's. And developers need both types of users to "bang" on the product to get really tuned-in. You better understanding and more knowledgable sites can actual get into the code and find the bugs at their root cause sometimes. meanwhile us more average users can show the developer where and how it do or does not work for the main portion of the intended end users. As my friend David Danto used to say about designing a product whether consumer or pro level; design it with the end user in mind. "A gas peddle should always be a gas peddle and brake should always be a brake. When properly designed a new user should be able to take the darn thing out of the box and put the thing through 75% of it's tasks without ever opening the manual" So anyway us average level users have a place as beta test sites as well. Does it work for the intended end users. Office staff and providers who "Don't" know how databases work at the root levels and how to write and correct code for them.

We dropped our old EMR ChartWare for just this reason. As we were trying to get to know it and use it, tech support was treating us like troglodites and retards because we didn't understand from the get go what SQL Server was and how it works and all the other fine points of databases and their managment. All with NO help files in the help section (totally vacant I kid you not)and no user manual. Just insane and this guy was an AAFP perfered and multistar vendor!

So as an average level beta user who was requested and invited to beta test the product because it had many features that would be positive for both sides, I still would like to know, will AC and Jon help fix our data, any of us, if it proves or looks highly likely that beta testing hurt our data? I certainly can't go in there and correct things and find the causes, and repair what needs to be fixed or piece a health data set back together from various earlier back-ups. And should I have too? I wouldn't even know what caused such an issue and so I and many others like me would be at the vendor's mercy as to what caused such problems. Was it something wrong in our system or network or was it the program and it's inner workings, or what have you? This is why we fell in love with guardian angel. Just help me please, I don't really understand this stuff all that well. Thank you for not requiring me to be from silicone valley and thanks for great support.

So, how high end of a user should I have to be before I can be in on this? And then if perhaps I shouldn't be, then please let me know and I will certainly pull out. But I just got a call last week to let me know that the newest beta was out there for us to toy around with, so I guess we are welcome guests to beta around. After over a year of talking and assisting and helping me with my issues I am positive that AC knows what level of user I am, trust me. So yes I have been invited and encouraged to participate as I am and at my present level of technical knowledge.

Here's my example as I explained it to Carlos. Let's say I work for Jeep as a line employee and so they need a number of regular folks to daily drive new models to ring the bugs out of them. Only if folks like us test drive them do they get to find these bugs. We understand that on any given day that the car may crap out on us and leave us stranded goodness knows where. But we get to test drive the lastest and greatest and have input of the final product. But only under such testing conditions of cold, wet, hot and so on will they find that issue with the engine managment computer and it's harness that it gets funky, runs rough and dies when cold and damp let's say. But who should pay for the tow??? And I'm not asking for anyone to fix my bad hardware or something like that. We too are trying to go paperless so most of our charts are ones and zeros too. It's the actual data and data coruption that I'm talking about. And we all know that many times it really is hard to pin the cause down. Such foul ups can come from a number of causes. So as a paid subscriber to support and updates and an invited beta user can I count on, should I be able to expect help if and when our data gets fouled up? Is this part of guardian angel?

And I as a fellow struggling small business person I understand Jon's and AC's financial restraints. There is just so much they can provide at a certain revenue stream. But I have suggested to Jon and offered to pay him more for top quality support. Again most users can't open the hood and go, "oh, it's the fanbelt". We need and have to trust our vendor and support people to help us get such things straight. I would gladly pay AC a decent amount more for well defined inclusive support coverage. I even suggested to Jon that he set up a multi-tiered support program so people could buy what they need. High tech users could purcahse less, while us average user might purchase a bit more for the peice of mind and security. As I've said before that last thing I want to do is shoot my goose who is laying my golden eggs. Jon's and AC's continued success is in all our best interests and I hope he makes it all the way. Imagine if AC was one of only an handful of market dominant EMR's. They and therefore all of us would have to be accomidated and included as the market shakes itself out. I want AC to be a prolific as QuickBooks or Word. Then people will have to come to us...if only, right?

In another part of the EULA, somewhere it it's details is language that the program and the vendor (AC) promises nothing at all, Limit of Liablitiy. This is part of what I was told when this issue arose as well. Their is no promise that the program will do what you would or could expect to do and their is no promise that it won't misbehave and no liability if it does. I was told that all the other high cost, pain in the butt programs have such language in their contracts too and such is surely true. Now yes we all need to protect ourselves and the smaller you are the more you need to avoid expensive litigation, but this is an EMR folks. Our butts are on the line when we use and perhaps falsely depend on it's accuracy everyday for all the laws and reasons laid out in previous statements and threads. I thought I remembered a vendor who wasn't going to act like this and hide behind such stuff. The wonderful man who made fun of all the others for being this way and promised to always be there for us and to treat us fairly, because he was always go to treat us as he would want to be treated himself. As I said before when I first read the old EULA, I made Nancy and the staff read the entire thing. I used to brag about my EULA, my vendor, and my EMR to all other comers who couldn't come close to this level of customer friendly and ethical behavior. I really felt like I had found a safe harbor in this awful and ugly side of the business of medicine.

When we were having the issues with the financial numbers is when the new disclaimer came in as one logs on to the financial section. So instead of being able to depend on the program to do what it seemed to be able and was designed to do, instead we all got a new disclaimer about not trusting it or using it as such. But this was only post facto after most of us had been using it for quite some time. This is about the time that I honestly got very rude because I found that extremely offensive and not AC like at all. As I gather most of you would have too, although many of you might have been a bit more diplomatic about it than I was. I'm just a kid from the Bronx at heart. But does any of this seem very good old fashioned AC to any of you?

Until we went with AC we were almost going to try good old paper because at least all these awful games could not be played on us. It would be only us in control and responsible for our records. Personally I think in the end if the gov't wants us to all go E.charting then someone has to develop law that protects both providers and patients from all this stuff. But the laws that govern all things takes time to catch up to the needs as new things come to market. But this is probably what is needed in the long run.

Be well to all and let's continue the spirted debate. Although perhaps a bit upsetting or stressful, it is none the less very healthy I think....To AC's Continued Success!!!
Paul

I only have three things to say, which for my small group of friends on here that know me (Roy, Paul, and all) know is an accomplishment.

1) Paul -- I wouldn't know what to do if I didn't apologize to you. What is it now? Five or six, lol.
2) Roy -- I don't think you need to start printing everything out. No one is going to take your software or do anything crazy to it. Microsoft is Microsoft. They keep you from reading their EULAs by making them longer than a Bio Chem lecture. Keep a 3.1.1...something version around. Remember, even in my example of those on the trial period knew they had 30 days. And, if worse comes to worse, which it won't, you could always print it out. Roy, you're a great guy, and you deserve to use AC how it was intended. By making your day more efficient and your patients and staff happier. But, it's up to you, my good friend.
3 Jon -- it's time for a state of the union address for good or for bad. We all love AC. We all love you. We all want to continue to use AC until universal healthcare arrives and we can all retire rich.

Wow!

Where do I look to see the beginning of this discussion about the EULA?

Folks,
I gather that most of you remember just like us our old AC where Jon railed against and blatantly made fun of all the other large, expensive, bloated, unethical and greedy EMR software vendors. He even used terms like Bull$#!* to describe their policies and contract language. That was the old AC we feel in love with and were extemely proud to be a small part of. Almost a solo, small practice movement of providers and staff teamed up with this great little vendor against the ever growing ugly medical industrial complex. now today we're just standing here kind of confused as to where that all went... How did this happen and how did we get here, and is there a hope, a chance that even with all this growth and expansion (mostly good in terms of the end product) that we might be able to find our way back there? Can AC still be kind of the "Ben & Jerry's" of EMR's like it used to be, even as it continues to grow and expand??? (Nancy and I used to have to drive right thru Waterbury VT every morning on our way to I89 and work) I guess we just want AC to maintain it's "rudder" thru this growth period.

And to all those including Jon who have work so hard on the actual product I don't want to sound ungrateful. It's really come into its own over the last year or so, becoming a contender to be dealt with. It really was great to watch it from a front row seat as a beta site and it felt real good to be a part of it too. And for all those late nights and the hard work that it took for such to be, a sincere and heart felt thank-you. Nancy and I really like the product very much and it continues to improve and impress us. You'd just about have to pry the the thing out of our bloody hands now; that's how much it is a regular part of our office, work and our lives. We just used to love the company and it's corporate philosophy and policies too and now we are more than just a bit concerned as to where that company itself is headed. As of just six months ago, of all the companies out there I never thought in a million years that I would ever have a reason to be concerned that AC of all people might use the value of our data and our patients charts against us and all of the other users out there. I remember when we first got in, Carlos and I were making fun of our old vendor and vendors like them for making it so hard to import and export all of your data between different products. In the end it was just cheaper and easier for us to hand enter our old patients as they had their first, AC visit.

Should we go back there? Can we get back there? Or has something special been lost forever? I'm not sure, but I'm willing to do my part to try and get it back. What say all of you? Personally, I miss it very much. And once again, THANK-YOU for the darn best little EMR out there.

Paul

>>Wow!

Joseph, what did I say that made you say wow! <G>

The lively discussions on this user board represent the spirit of Amazingcharts. I am writing my Semi-Annual report being a recipient of the 2006 Health Information Technology Awards. Part of my report analyzes how Amazingcharts continues to be the best fit for solo-practices. Amazingcharts attract practices with less than 4 providers. I suspect in our Amazingchart universe, 4 providers would be considered a huge practice! Imagine that!!!

To use a Buddhist term, we are a "sangha", a community of individuals each seeking a path of living correctly and in good conscience (with good thoughts, intention, effort etc). We don't seek an easy superficial livelihood (join a big group punch in/punch out a time clock). We choose to earn a living that is pure and honest. I felt this connection with Jon and Amazingcharts. The way Amazingchart was advertised was refreshing-- "So, why is it so cheap? Is this program crappy?"
So, perhaps I took the EULA for a mantra. It was a symbol of our community. It disappeared suddenly and has been replaced by something we have been resisting to the best of our collective ability. The corporate structure.

The friendly neighborhood pharmacists that knew our patients have been replaced by Walmarts, Walgreens, and Rite-Aids. Now we are being replaced by Minute-Clinics, Mega-clinics, Hospital owned entities, FQHC, and the corporate practice of medicine.

Perhaps we are just trying too hard to figure out what are the motives behind the changes that we find so hard to let go.

I'm grateful for Amazingcharts and appreciate all the individuals out there that share a similar vision--- I'm really not alone.

Just a thought. To quote Paul, be well.

Roy,

That was a marvelous explanation!! I think it is pretty obvious that most of us here are docs who march to a little different drummer. I think we are the "throw-backs"...the ones who have resisted with all our hearts, to jump into the corporate fish bowl. I bet the majority of you despise voice mail, shop at your local corner markets, support the independant pharmacies, still look for a gas station where the Texaco Man in his bow-tie will wash your windows, and still hold strong to the idealistic world of Marcus Welby. Not to say that we are not technologically informed or medically progressive. The sad thing is that I have a whole practice of patients who feel the same way I do and I suspect there is a whole society out there that yearns for the way things used to be. It saddens me to realize Generation X and beyond have no idea just what a service oriented business is. But, like sheep being led to the slaughter, we have allowed corporate America to take us down this "new and improved", "upgraded", "faster, "sleeker" road and I doubt we will ever find our way back.
Oh well, we have AC, for now at least, and with good fortune, it will not metamorphasize into just another EMR, full of bells and whistles and shiny thing-a-ma-jigs....and empty promises.
Sorry for the long rant. I had a fit of nostalgia.

Vinny, was that really a typo or were you subconsciously referring to this comic?

http://www.cartoonstock.com/directory/l/laywers.asp

Sounds like there is a lot of debate and discussion on the EULA and what it all really means. Let me give you my perspective, which has over time, grown, changed, and has had to be adapted as I deal with third-party companies with contractual requirements (e.g., the AMA and their royalty requirements for using CPT codes) and with a multitude of clients of differing skills, attitudes, and demands.

Here it is in a nutshell: The EULA is meant to make it clear that there may well be multiple problems with the program that I've not been able to find, or if found, have not been able to fix due to a lack of understanding, or time, or resources. The EULA is about covering my [censored] and it should be understood that anybody using Amazing Charts does so at their own risk and that I make no guarantees or warrantees about the program, the data being saved, or my willingness to provide support. There it is. Blunt, honest, and with minimal legal bullshit. (This, by the way, is the concept of the EULA from day one, and is no different in intent, though I've had to reword it to make it clearer to the types of clients I'll describe more below.)

So why should anybody use Amazing Charts? Maybe you shouldn't. But for those who have reviewed the site, understand where I'm coming from, and appreciate my frank opinion, here is what Amazing Charts is about:

1. Amazing Charts is a work in progress. It is not complete, and won't be for awhile longer. The big features I feel are lacking are a complete Practice Management solution, Health Maintenance & more robust reporting abilities, and online Practice/Patient Services. This is my focus over the next months and years. Other user requests are also added to the development process as complexity and resources allow.

2. I provide Amazing Charts as I would want to buy and use software. Free to try the full version for well over 2 months, and then reasonably priced. The point of the free trial and affordable price is to have clients understand what Amazing Charts can do - and what it can't do - before they spend any money.

3. Because I am providing an affordable alternative, I do not have the staff or resources to offer 24/7 live support, invoicing, nor do I take responsibility for people's network issues or using Amazing Charts outside the realm of how it is designed and described. Clients can use Amazing Charts as it is. If it works, great. If it doesn't, I'll try to figure out why and fix it, but if I can't solve the problem, or you can't help me with the steps I need to identify the problem, or if you simply can't accept me not finding a solution in your required time frame, then you shouldn't use Amazing Charts. I expect clients to understand this and be supportive and appreciative for what I do offer at such a low price.

While all this may sound rather cold and harsh, most of you who know me well, understand I am trying to make life for us physicians - working just to stay afloat and make an acceptable living - better, and that Amazing Charts strives to follow our pledge: We will treat you fairly, honestly, and the way we would want to be treated ourselves. We want you to be thrilled! Thrilled with our cost, our software, and our services. Happy clients mean good word-of-mouth, and good word-of-mouth is why we are one of the fastest growing EMR companies in the country. (We, of course, expect the same from you in return.)

What I have learned as Amazing Charts approaches 1500 practices and I've had the opportunity to work with a myriad of personalities, is that this really is no different than my medical practice. While the vast majority of my patients are considerate, appropriate, and appreciate my role in their lives, there are a very small group of patients who are either inappropriate to me or my staff, or simply demand significantly more of my practice resources than is reasonable based on my compensation and the needs of my other patients. Usually these are Axis II-like patients who call every day, write long diatribes demanding a response, bad-mouth me and my practice, and are incapable of understanding another's point of view or accepting that I can't help them whenever they want. To keep myself, my staff, and my practice functioning and enjoyable, I sometimes have to dismiss these patients from the practice.

And just as a very small percentage of my patient population has these traits which makes having a working relationship beyond my ability, so too does a very small percentage of my Amazing Charts clients (well under 0.1%). Just as I need to be able to legally withdraw my medical care of a small subset of these extremely difficult patients, I too must have a way to end a relationship with an abusive Amazing Charts customer.

That said, Of our 1475 practices to date, only two clients have actually been told I was revoking their license. In both these cases, the client was either inappropriate to me, a member of my staff, or demanded so much attention that it impacted our ability to help others. These clients were not denied access to their data - in fact I went out of my way to unlock their Amazing Charts databases for them so they have perpetual access to all their data (just as I would release any dismissed patient records).

What really frustrates me is when a client now upset with how I'm doing things forgets the hours upon hours of time my staff and I have spent in the past troubleshooting various issues well outside the realm of Amazing Charts, such as their own network problems which caused problems in the first place. For me, when a client I've worked hard to help despite it really not being my responsiblilty comes back acting like an asshole - they lose my respect and my willingness to help them beyond the letter of our EULA and support services. If they then openly badmouth Amazing Charts, they get their license yanked.

The bottom line is this: I will strive to improve Amazing Charts, work to continually add features and improve the usability of Amazing Charts, and to make the practice life of my clients easier. It will take time, but I am committed to do this, and to do it fairly and affordably. In exchange, I expect clients to spend time learning how the program works, pay us on time and in the manner specified on our site, be loyal and positive about what Amazing Charts offers given the price, all while feeling free to provide constructive criticism and input.

Hope this clarifies where I stand and why the EULA is what it is. Thanks for all your support in making Amazing Charts the best it can be.

Jon

P.S. And perhaps most importantly, how would you recommend I change the EULA to address both my issues and preserve my right to jettison the assholes, while addressing your concerns about access to the program and data?

I am glad Jon was able to jump in and comment on this EULA discussion. I for one love the fact that you can send e-mail to Jon and he actually responds and tries to do the basic things you ask for. I remain an avid supporter of Amazing Charts. Keep up the good work.

Well, that was certainly a State of the Nation address. Thanks Jon. And, I don't mean that sarcastically.

Jon,

Just a suggestion or a thought. There are three databases we use everyday. Meds, CPTs and ICD-9s. As you know, I have back in '03 made my own database, accurate to the smallest detail, (not every pediatric med, but most) and like AC, a work in progress. Many have downloaded, some have definitely used as we keep in touch and others I am not sure.

But, have you considered that rather than have to pay big money to licence these databases with the AMA and FDA, let the AC family make our own. With 1500 users, you have 1500 coders, etc. We could easily get together a committee and make a more accurrate and "free" database, which, of course would need to be looked over by many and approved by you. I know, for me, since '03 when I had 1300 entries, it has been fun to add more each week. I make it a practice to never leave the room without updating the AmazingMeds database in real time.

Would love to hear from others on this.

Thank you Jon and all who make AC the sangha Roy described. You are why I chose this EMR. And I've been very grateful for all the help Bert has provided to me and others.
I would participate in creating the databases he proposes, as long as I could be given a specific assignment and had the necessary tools to carry it out. I don't have OCD but do value precision.
And yes, be well.
Lisa

Thanks!

That's a cool idea - and sounds good to me. I could post online alternate AmazingMeds.mdb and/or codes.mdb databases, which are uploaded to me and which the more technophillic users could replace, if they so wished.

I would need to make some changes in codes.mdb since it is currently locked (and need to be sure I could do this per my AMA contract), but assumming I can, it is a neat idea. AmazingMeds.mdb could be done as is - since it isn't locked.

Of course, you can imagine that the EULA will have to again be modified for protection of AC (as well as to protect anybody who gave us data to post which might, or might not, be 100% accurate. Cool?

Jon

Jon,

For starters, would you like an upload of a semi-cleaned medication database? I only took out dental, equipment, units and medications that I know are not used by physicians. I took out as many misspelling as I am aware. I took out duplicate entries (but there's a lot more left).

I think we can split up the database and them recompile them after setting up standards.

Roy

I haven't paid much attention to EULAs, up until now, lol, as I generally always click on them, given I can't install the Microsoft Office 2003 or 2007 which I just paid over for or they won't install.

I would have to guess, howevere, that when Outlook allows hooks so that companies like Sperry can provide 3rd party software, Microsoft must have in its contractual agreement that they are not responsible for Sperry. Indeed adding more than one of Sperry's programs always caused Outlook to crash and removing it would fix it.

I used to email my database and actually required the recipient to sign a waiver and now I just give it away "as is."

There has to be a way to improve on the codes database even if it meant hiring a professional coder and finding a way to make it feasible such as a slightly higher one-time fee (just a thought).

Lisa, thanks for the mention.

I think the only way to actually fix the databases are to do them from scratch. Use the format that the database comes in and add the information. Starting with the hundreds and hundreds of codes and working backwards will not be nearly as effective as starting with nothing and adding clean. IMHO

Bert,
I would have to agree with you on starting from scratch. I have spent maybe 50 hours on the medication database and feel I have hardly made a dent.
Roy

Bert:

Long ago I made the comment wow:
Not at your post-

but at the length of the entries in this thread.
This thread is the only one probably with long individual posts.
It is amazing to see such long posts. Such a open forum. Kudos to AC.

Heil AC users!

Thanks Joseph,

I guess I am paranoid. It's ironic, because I was trying to get to 100 posts on the Top 100. They do that every once in awhile on the "24" post with Keifer Sutherland. But, you made so many good points, we had to stop, lol.

To Roy and everyone. I went only and found an Excel sheet from the AAFP with 1700 ICD-9 codes which I could easily make an Access database, but that seems to be far too few. Or is it? I need feedback from those smarter than I when it comes to ICD-9 codes. I know the book our biller has is huge.

I think the CPT codes are far more proprietary.

It's not the number of codes, but which ones in particular. Suggestion although it has it's own possible flaws. Have a place for users to post the codes they use and by their specialty. Obviously we all need certain basics like office visits, CPE, and other everyday codes that are fairly universal.

But anyway, at Nancy's IPA/PO we get fee schedules with certain codes on them, but they are taylored by basic specialties. Members are welcome to send in codes they are thinking about or find a need for and they are added to the next update. But this way the list is not out of control for anyone user, but we all have almost all the codes we need. So perhaps a Peds/Family Med one, a GYN, A GI, and so on and so forth, as needed. And maybe one that is a compilation of all the codes for those who might want access to more for some reason. And again the ability to suggest and add codes is the key. But this might end up being more work than other methods, but it's a suggestion.

Paul,

I am not so much worried about the number. I was just wondering if anyone knew if that would be a representative amount of codes. In other words, would most databases contain 20,000 codes or 10 codes (to exaggerate). I ask because it would take aout ten seconds to make a database of that Excel sheet.

Bert,
I gather once you transfer it to Excel then you could edit it and add to it easily, yes? Would my idea of the specialty oriented DB be too much of a headache for all involved? As printed fee schedules it works great for the PO I mentioned. Everything you usually need and not a lot much more. I do like seeing the other codes that others in our field use. I allows me to evaluate how we are doing things as compared to others.
Paul