Home Forums Discussions General Discussion Thinking about getting AC - have questions

Hi all,

I am an FP/Urgent Care doc in a busy practice (average 70-80 pts. per day, over 10 hours - two providers) and have been reading a lot about AC. There are 4 of us in the practice.

Currently, we use a "smart chart" template, which is very fast, since all we have to do is check boxes (we still have to write out the HPI and the assessment and plan) - but the idea of being able to at least print out an eaasily readable visit note, as well as print out/fax rxs. is very appealing.

Does everyone that gets AC use it as a total EMR system, from the registration on down? Or do any of you still use your "old" registration system and just import a pt. list each day? (obviously, this is not the most ideal way to utilize AC, but there are other issues that I won't get into about why that approach may be necessary, at least for the time being.)


Since none of us is beyond a two-fingered typist, what I have been thinking about is using a netbook, with Dragon v9 (preferred), and a dictaphone powermic (or maybe Philips speech air) - then we could dictate the HPI, and navigate around the screen by the handheld mic...

Has anyone used this setup, and what kind of success have you had?

Also, what are the capabilities of AC in terms of workman's comp forms? Can the standard DFR (doctor's first report) and Pr-2 forms be uploaded into AC?

Thanks for your help!

From foggy SF, CA,
Melanie

I use Dagon NS Medical with templates, the mike built into my Fujitsu tablet works just fine. The tablet converts what you write with the stylus into typed content just about as fast as you write it ( but I have pretty good penmanship). Between the dictation and the stylus typing is not really necessary. I love AC, I love the eprescribe.
AC can basically work as a "check the box" system, you would create your own templates ( as easy as writing it once and then giving it a label)and select the text appropriate to that patient and delete or insert as needed.
I think in order to use the eprescribe you would need to use the demographic page of the chart.
I can't tell you anything about workmans comp....I haven't ever seen a GYN problem as a workman's comp case....we won't go there!

Deborah,

Thanks for that information! It is nice to hear of some alternative ways of using AC. All of us are poor typists - trouble is, one in particular has terrible penmanship! He's been asking me about the use of AC with a tablet, so I will pass that on to him. It's refreshing to know that the system is so adaptable. I could envision some of us using a netbook, some with a tablet, etc.

Do you use AC for the registration also? Is there any user out there who does NOT use it for registration, but instead uses it to make office notes, and printing of rxs easier?

Hi and welcome

I am not sure what you mean by registration. Do you mean booking patients appointments? DO you mean registering patients in AC. AC does have a pt appointment templete. Registration is done via AC through the DEMOGRAPHIC portion.
As for AC , it is the most user friendly EMR I have seen so far.
As for entering text , I find the TEMPLATES that you create are the easiest and fastest way of entering data.Once you have created a TEMPLATE you can adjust it to your patients situation. I also use the TEXT to SPEECH feature in Windows Vista rather than DRAGON as I find DRAGON expensive.
If you can create a TEMPLATE of the WORKERS COMP form or any other for using MS WORD then you can use it for any number of patients repeatedly. I create a ton of templates for my self to track NARCOTIC prescriptions , PTINR, IMMUNIZATIONS etc.
AC also has a nice TRACKING feature where I track all my PREVENTIVE visits - MAMMOGRAM,PAP< COLONOSCOPY etc (KEEP THE LAWYERS AWAY!!!)
GRENVILLE
Solo Familt Physician
Copley
OHIO

Hi Grenville,

I'll see if I can be clearer about this... Our situation is that we are actually a very small part of a MUCH larger (over 900 partners) ED partnership. There are two offices in our area that I work out of. We are considered "ambulatory care centers" although what we do is a blend of urgent care and primary care (mostly the latter).

So, we don't have all of the autonomy that most FP/IM practices have, since we have to have things "cleared" by the compliance officer for our partnership, etc.

Our current registration system has been in place for a while. It is set up so that the two offices in our area are linked - so we can make appts. for pt's at one office from the computer at the other office.

So...I am trying to envision how we might use AC within the constraints of the above. Obviously, the easiest way is to redo the entire registration system for AC. That would entail installing AC at both offices. Not a huge issue, but we would have to have every doc at each office on board with AC, and we would have to go through the (bigger) issue of having it "approved" by the necessary people in the partnership.

On the other hand, if we were to ease our way into a "semi-EMR" system, we could (at least initially) retain our current registration system, and have one doc (that would prob. be me) begin to use AC to form pts. notes (which would then be placed into an existing paper chart) print out rxs, keep track of CQI, etc.

Or still yet, we could try it out solely for our occ. med pts. (about 20% of our total pts.) and utilize it to make much "neater" reports.

Part of figuring this all out boils down to these three issues:

1) How hard was it to change over your old registration system to the AC system?

2) What would I NOT be able to do with AC if I did NOT use the AC registration process and kept our own system in place?

3) How do the fees for AC apply when it is used by two separate offices? If I am a registered user, and work out of two offices, do I get charged twice the registration fee?

AC charges "per provider." NOt per office or per computer. So you would pay one fee for as many offices or computers as you wanted. But you would pay extra for another MD or an NP or PA.

It sounds like by registration you mean scheduling appointments and inputing the patient demographics. There would have to be an AC interface with your current scheduler to do that. For example, we use Appointment Quest for our scheduler. We download the schedule every morning. AC also imports the address and teleophone of the new patients (but not the insurance info). We type in the rest whne the new patient arrives after they fill out our hard copy registration forms.

Hi Melanie

1. You can keep your current registration on any computer you want and MAP the drive, the registration is on and you can then view it locally on the local computers on you site.
If you go off site then you can come in via REMOTE DESKTOP CONNECTION you are able to access your files or programs.
2. You can also do the same with AC and access it vis REMOTE DESKTOP CONNECTION at any site you are on but you will need WINDOWS XP PROFESSIONAL to have remote access or any software that allows you remote access.
2. AC charges per PROVIDER so you can access it from as many sites or office you want and you do not need to install AC if you come in REMOTELY.
3. So you can run both systems currently if you want- OLD registration system on a particular folder and MAP that drive so it is accesible on the network and also use AC and view it on the NETWORK locally ,but you will have to install AC on each local computer or if you are out side the office, then come in REMOTELY
I hope this helps
GRENVILLE

Jon, if you are reading this, give Melanie a call yourself.

900 partners!

Grenville-

It is great to hear that I don't have to eliminate the old registration system completely if we wanted to "try out" AC - it seems that all we need is an interface with our current system.

Not sure what you mean by "map" the drive... can you elaborate? Would we be able to use our existing registration system to sign in pts., put in their demographics and insurance info as usual, and then would I be able to take my netbook (with AC installed) and be able to see my list of pts. for the day (with all of their demographic/insurance info) on my AC screen?

If I could do that, it would be fabulous!

Thanks so much for all of your input. This forum alone is a huge plus to the idea of AC!!

Melanie

Hi Melanie
1.You can have an interface on your current system
OR
2. You can share(MAP) the Drive that has your old registration system and your AC .
3 So when you remotely connect with your netbook to your computer which has the AC and your old system from anywhere,you will be able to see and use both systems
4. I am sure you are aware that the main computer you want to access that has your AC and your other progam has to be ON all the time.
GRENVILLE

HI Grenville,

All I want to do is to keep my current registration system, and when I turn on my netbook, have the pts. in the existing scheduler show up on my AC scheduler - I don't need to see both schedules.

Would that require an interface?

Thanks!

Yes you will need an interface if you want your old registration to show up in AC
Check into the cost of the interface as some of them
get too pricey

GRENVILLE

I can think of 2 related possibilities:

1) If you can export out of your current registration system most or all of the recurrent patients, do that and import into AC. I think this is what he was talking about as far as mapping the catagories to AC.

2) Run dupicate registration systems. When a new patient comes in, the information is put into both systems. If you have many of the old patients from above, this is less burdensome.

3) Yes, you can have an interface created, but both expense and time would probably be reasons not to do that.

Another possibility is to only put telephone number in AC and all ofther information would go to "official" registration system. If you need to get in touch with a patient, having a telephone number would be nicer than having to switch systems to get info

Wendell,

My guess is he meant actually mapping a network drive so it is easily accessible to all computers that map it. I guess it's hard without his saying.

We do double entry. Medware and AC as far as demographics, etc. It's not that difficult. We used to have a script program that would automatically put all info that was entered into Medware directly into AC, but then along came S and Q and L.

I imagine with the new PM that Jon is making it will all be a moot point.

Trying to interface it (having Jon build you one) will be rather costly.

Pediatricians can have autonomy too.

It seems that the most logical solution would be to export our existing pt. base into AC and can the old registration system. Are there any AC users out there that are exporting their pts registration information into AC.

I suppose that we could ask the staff to double-entry pts into both the existing registration system and the AC, but with 80 patients a day, that would probably slow down the registration process (and the ensuing office flow) too much...

And Bert - sorry! I sure didn't mean to forget you Peds folks!!!

Melanie

I just found out that our current registration system is E-Medsys. Has anyone used this and successfully transitioned to AC?

Also, I just found a brand new DNS Medical v.9 online for 300 bucks - is that a good deal? Seemed so to me, so I bought it...

Melanie

New question(s):

I am trying to imagine the flow of things by incorporating AC into our practice...Let's say a Medical Assistant rooms a pt.- does he/she have their own computer that they enter the pts. CC and vitals in?

How do most of you use AC with the MA's? And - is the cost of AC simply per provider, inclusiveof any number of MA's/staff?

There are several ways to do it. In the practice I was in before, the MAs just logged in under the doctor's accounts and triaged the patient in the room then sent the chart to the inbox. Now, my MA has her own triage area with her own computer, printer and AC login account like the rest of the staff. This, of course, works much better for messaging. It also has the added benefit of allowing her to have one triage area with one set of BP cuffs, forms, stadiometer, scales, etc.

AC is licensed per provider. You can have as many computers and staff as you wish.

Bert,

In the first instance, did you have a computer set up in each room for the MA's to log the info?

We have two docs on, and 8 exam rooms - what we do now, is the MA rooms the pt., writes down the CC in the chart, takes the vitals and puts the chart up for the provider.

I am envisioning either a computer in each room, where they can log in the info, or a "COW" (cart on wheels) with a computer, an electronic BP cuff, and thermometer on it - perhaps two of those, one for each doc.

As far as the networking part of things - what does AC include with that? Do we have to set up our own network between all the computers? How hard is that to do?

Do you have 1 MA or 2? Or one per doctor? Assuming there is a small desk (or flat surface) in each exam room, you can assign a laptop to each MA. That's less expensive than buying a PC for each room. Of course, you would then need a laptop to bring into the room for your use, so you still need that flat surface (and maybe a chair). Now, the MA can room the patient, take the vitals and input them and forward the chart to the appropriate doctor. Then take the laptop with her to work on the next patient, or any other work she needs to do.

Setting up a wireless network to connect the laptops is pretty pretty easy. But it may be more reliable if you have cables run t each room so that you can plug the laptops into the network by cable.

In our office we have different windows accounts for MA's or me or the NP. Thus, they log into their windows account and their version of AC is up and running. They then put the vitals in and forward it to me or the NP.

We are hard wired. There is no extra charge for networking ability as was the case with some EMRs a while ago. Hard wiring is more stable and secure than wireless, but both work fine and I have used both. It may be worth the consult to have a professional examine your options if you do not have someone computer and network savvy. It really is rather easy, but little things can make you very frustrated.

First, how many MAs do you have?

I will answer your last question first. AC has nothing to do with networking and, in fact, this has always made support difficult, because probably > 50% of the issues are related to networking issues. Networking can be easy or hard A) depending on how good you are at it, and B) the complexity of the setup and whether it is Peer to Peer or Client/Server. I don't think it is all that difficult, but it is best done correctly, so I would contract it out if you don't feel comfortable.

As far as computers go, I am not a big believer in COWs. I also think that we are all making it much too difficult. This is my bias, but I am not a big laptop computer person especially when it means moving things around and carrying to and fro.

I would make it simple this way. I would put a desktop computer where they need to go. In other words:

Reception
Biller
Possible other clerical person
Rooms 1 through 8
An MA computer (possibly for triage or at least for messages -- my preference would be a computer for each MA so AC is up and running for each MA, thereby making it easier to send messages to the one you need to). If money is a constraint, then just one should suffice. If you have a triage area, then you are all set with that.
Anytime a doctor goes into a room, there is a computer there. If the MA rooms the patient in the exam room, he or she can log out and log in for the particular doctor.

The only issue you would have would be if a different doctor came into the room. In that case you would need to decide how to handle that. I suppose worst case scenario that other doctor would have to pull the chart and send it to him or herself.

Maybe someone can add a solution here. There are other workarounds such as using a dummy provider and signing off with your own name.

For our medical staff, we have one desktop on the counter (nice to have the big screen for viewing x-rays, etc) and motion computing tablets. Two of these we purchased new (expensive) and one I got used on ebay. The Doc and CRNP carry their tablets with them, as does the MA.

None of our medical crew can type well, and using DNS would involve developing a new work flow.

We did have our server and computer network professionally installed, and I have to agree with Burt. Hardwired is better. Right now our tablets are wirelessly connected to AC on the server, except when we drop them into their holders, at which point they're on lan.

Hope this helps - all in all we are very (VERY) pleased with AC. Mostly because there's no tricky crap that traps us into a contract or continuing with AC if something better and cheaper comes along (I'm not holding my breath - and they'd have to be really good to get us to switch - we're pretty loyal at this point).

Thanks all - what I am hearing is that there are a lot of ways to go about this. Perhaps having a desktop computer in each room for the M.A. to log in the patient's vitals and chief complaint. I'd love to say that I could trust our medical assistants to carry around a laptop or tablet, but there's a lot of hustle and bustle in our office and judging by how many times they've dropped the digital thermometer, don't think that's a good idea!

As I said before, there are four of us (the one of us is semi-retired) and we all have different "tastes". One likes the idea of a tablet, I prefer a net book/laptop, etc. the one thing we all have in common is that we are a lousy typists. I purchased Dragon nine medical, and I'm actually dictating this rather than typing it because it's much faster. I found a way (by using the command browser) to create templates for basic exams, like for sinusitis, bronchitis, that I can enter into AC by simply giving a brief command. The same goes for the plan for each of these. I just leave a space to fill in the antibiotic, if necessary.

I can see that Dragon isn't going to be for everyone but I think it'll work well for me.

It's good to hear that the hardwire setup is best; we do have a couple of IT people working for our partnership that I'm sure could help us out.

Melanie

I have to add, thst the more I read about AC, and the more I play around with it, the more I like it. One of the main things we will need in our practice is something that is FAST. One of our sister sites is going to be getting NexGen, because their HMO is going to help subsidize it. They are as busy as we are, and though I don't have any experience with that system I do think it may be slower than AC. I like the ability to work around things with AC, and the flexibility that that affords.

And of course, the price, and the fact that there is no other crap to put up with (as Barb said), are very enticing.

Although the CCH IT certification was probably a big pain, ours is one situation where that will make a big difference. I am certain that our partnerships compliance officer would never allow us to utilize a program that didn't have this certification!

Melanie

Uhhh..about ten times slower.

I hope you aren't saying you will have two desktops in each room -- one for the doctor and one for the MA.

Yeah, NextGen is markedly slower. AC is one of the fastest EMRs out there in my experience. Simple=speed.

I'm definitely no master of workflow as my previous thread of using the AC masters to help me shows. So takes this with a grain of salt. I would envision the quickest, most efficient process would be for the each doctor to have their own computer/laptop and each room have a desktop. If the docs didn't have their own computer, that would require constantly logging the MA off the computer and logging the doc on in each room. Too much time and energy. So let the MAs stay logged into the desktops in the room (and make sure they have a quick keystroke way of locking the screens) and put in all the info then forward the chart to you. Now you have your own computer to bounce from room to room. The major obstacle with laptops/tablets in my experience has been the speed of the wireless system. I love speed and the wired computers are at least 2x faster.

Do the 2 docs use the same rooms? Or do you both roam through all 8 rooms during a clinic? If one doc uses 1-4 and the other uses 5-8, then I would do the opposite of what I said above. I would have the docs use the wired desktops (so they can stay logged in) and benefit from the speed. I would have the MAs use a laptop/COW with a BP cuff, thermometer, etc. This would be the best option in my opinion.

What you will find about AC is that it doesn't have a lot of the bells and whistles of some of the more expensive programs. If you like bells/whistles, AC isn't for you. The lack of bells/whistles = simplicity and speed. And "amazingly", adaptable. You're getting comments from Pediatricians, Internal Medicine docs, and General Surgeons. That's pretty adaptable. Oh, and CHEAP. I just spent more money on Dragon Medical 10.1 than AC

Travis,
that is exactly the sort of scenario I've been envisioning. The two docs do not have assigned rooms, instead as you said, we bounce from room to room. So I think that if the medical assistants work on the desktop computer in each room to log in a patient and forward the information to the docs, we can take our laptop or tablet or whatever and go from room to room. I'm a little dismayed to hear that the wireless is so much slower. Does it take that long for the information to show up in the doctors' computers? What about when it comes to printing out notes or patient instructions?

If in fact we do go with amazing charts (and I'm hoping we will), it's going to be interesting to see how our sister site does with NextGen. From the little bit I've heard about it, it sounds like there's going to be a lot of keystrokes/mouseclicks involved to generate a note...

Melanie

Melanie,

Wireless isn't that slow. It will certainly be on your doctor's computer by the time he or she opens it up.

My question is given the scenario you describe, each nurse would have to be working with the same doctor or they wouldn't know who to send the chart to. If that is the case, then what is the need for the laptops? Why not just have the MAs doctor use the desktop? Seems way more logical to me.

I would second Bert's comments. They can all use the same desktop in the room, no need for a separate laptop. Perhaps using a computer at the nurses station, depending on how the layout is set up. If they know which provider is seeing the patient, they then just forward the note with vitals to that docs inbox.

Wireless speed is fine, there can be issues with connectivity but if you have a good connection you will not notice much of a difference in speed. Connectivity is a function of both layout (metal in the walls) and distance. Wireless N standard is usually pretty good at connecting with minor interferences.

I don't know nearly as much about wireless as Wendell, but just keep in mind that if it is a large area, you may need to add a wireless access point or two. I think coverage will be more important than speed.

Our office flow is...in a word, difficult. We each have scheduled pts, as well as a slew of walk-in pts. The latter are "up for grabs". We each pretty much try to grab a walk-in chart in between every (or every two) appts. It's not an ideal system, BY FAR. The appts. invariably end up waiting longer than they should. We are contracted with our HMO as an Urgent Care as well as a Primary Care practice, and so we have to take walk-ins. We also are Civil Surgeons, and do INS exams - plus we do W/C, and DMV physicals, etc. And those are almost always (unless they are a recheck) walk-in pts. The only saving grace, if you will, for our Primary Care pts. is that they know that they too can come in as a walk-in if the appointment schedule is filled up. That doesn't always assauge their frustration, but it helps.

Our current system is all paper charts. We have a rack for the appointments and another for the walk-ins. We use a "smart chart" template to speed up the charting. Some of us write more than others - I am probably the wordiest of us all. (Since I am a hunt and peck typist, that's another reason why I was drawn to Dragon).

Added to all this, we have the issue of two docs circulating randomly amongst the 8 exam rooms, including a minor trauma room which is used for lac repair, procedures, etc.

We used to have two M.A.s assigned to each doc - one for rooming and one for procedures (we do on-site CBC, chem, XRays, etc.) Unfortunately, the "rooming M.A." would sometimes just kick back and not help out the others if all their rooms were filled. So now, we just have four M.A.s circulating and doing the work for the two docs. When the M.A rooms a "walk-in" pt., since they don't know who will be seeing the pt., they will have to send each walk-in pt to both docs working that day, and then whoever "grabs" the pt. first goes to that room. Is that possible with AC (for the pts. to be sent to two docs inboxes instead of just one?)

The only thing I liked about a laptop/netbook for myself, is the fact that I may well be the only one using Dragon. To install DNS on all of the computers in each room would be unnecessarily costly, and not feasible - I think you can only install one licensed program on up to 5 computers, and even then, it can only be used on one computer at a time. And, I'd have to have a mic for each room, or go aorund plugging one in all the time. Ugh! I would rather carry around my netbook and my little stylus-sized microphone that clips onto the computer, and dictate as I go. The other docs would either utilize a portable
tablet, or (more likely) type/mouse click their way through AC on the computer in the room.

We are going to be doing a MAJOR renovation of the office in the next year, so it's definitely the right time to think ahead in terms of our EMR needs!

Regarding NextGen, back when we first considered getting AC (at $300/provider) someone on these boards mentioned that they had just dropped a big, expensive EMR to go w/ AC. When I asked him which one, he said to look in the recent Medical Economics and he would be quoted with details. It turned out his previous EMR was , yep, NextGen. Too bad I don't still have that old issue of Medical Economics.

Melanie,

Yes, it can be sent to both doctors as far as I know. I don't think we ever have. But, you can certainly Cc messages. The problem may be that neither physician would know if the other had taken it except, I guess, the patient would not be in the waiting room anymore.

Another option would be to have a "dummy physician" like Dr. Walk-in. The walk-ins could be sent there and whoever got to that patient first would pull it. But each doctor would have to sign out if they pulled one. We have superbills on clipboards, so that superbill could say Dr. Walk-in. You wouldn't have to pay for that doctor given it isn't a real licensed doctor, but I would run it by Jon first. Of course, you would want to make sure the doctor who saw the patient was on the chart. Just ideas.

Melanie,

For your type of practice, the wireless speed should not be a problem at all. You really won't notice AC being slow. It is slow for me when I complete a chart, the fax the H&P to the hospital, then fax a referring doc letter. The sending the faxes and finding the networked printer can be slow sometimes. You won't have that problem.

Your practice work-flow is a dilemna for sure. The problem with the docs and MAs using only the desktops (besides the dictation issue), is having the MAs login, fill out the stuff, send it to the doc, log-out, now you come in, log back in under you. Not real efficient if you have to log in and out all the time. That's the advantage of you having your own laptop.

As Bert pointed out, if the chart is sent to both docs, you will have an inbox full of charts of patients that your partner saw.

Hope this doesn't show up twice, but it did not show up after I thought I had posted it.

An option would be to have the MA lock windows and have the chart open under their name. The Doc comes in and forwards the chart to themselves, logs out (control L) then logs in under themselves.

Yet another option would be to assign rooms. Dr. A only goes to Room 2. The patients in Room 2 will be sent to Dr. A. If another Doc goes to Room 2 he knows he has to pull the chart from Dr. A's box. (They would have to log in under the other Doc and pull the chart or log in under the MA and pull the chart back and reforward it to themselves.

Again, neither is an ideal solution

Not ideal? It's brilliant.

I agree! I was just now typing how much I liked Wendell's first suggestion, then the program seized up and I had to end it and come back in...

Given the dynamics of our workflow, I do believe that that is the best solution. I was hoping that perhaps there was a way to tell when a pt. was "pulled" - say, for instance, the pts. name highlighted in red - but evidently that is not the case. So, I think that this is the best workaround.
It needn't be as cumbersome as it sounds - I can envision a scenario where I am finishing up the chart of a pt., see that the walk-in in room #3 will be where I'm heading next, and tell the MA to go in and forward the chart to me. The pt. will know that I am on my way in to see them when that occurs.
Even if I had to do the logout/login thing, I could always use that time chatting with the pt. about their CC, etc., in preparation for dictating the HPI. I think it's just a matter of settling in to a new type of workflow. Which is going to be an issue no matter which EMR we use!!

Speaking of superbills...How do you all handle those? Bert, you said that you put them on a clipboard. Do you then fill it out yourself after each visit?

Yes, because I don't find printing the superbills to be accurate, I just use a paper superbill. It's just simpler to circle the ICD-9 code and diagnosis, circle a CPT, circle a f/u day and write a small note if I have anything that needs to be done. This is from the self-proclaimed paperless king, so don't tell anyone.

Sometimes a piece a paper is more efficient. I like the Faulkner quote "The tools I need for my work are paper, tobacco, food, and a little whiskey."