Home Forums Discussions General Discussion Neurologist Needs Help!

I apologize in advance for asking questions that I am sure have been asked and answered before, but I have going round and round with my decision making for an EHR and can't seem to make the final plunge. I am a solo neurologist, presently using Medware as a practice management system (finally working quite well after much work). I have a receptionist, biller and transcriptionist, no nurse. I have the field narrowed down to AC, eClinicalworks and e-md's. I very much enjoy the philosophy of Jon with regards to cost and business structure and don't look forward to paying many of thousands more for one of the other two systems, unless I am getting much more in return. I have used the trial version of AC as well as eMDs. As a neurologist much of my documentation is very descriptive, which I believe lends itself well to AC with Dragon VR, however I am concerned with what I understand is an increasing push for granular data. eMDs is very nice in the way granular data can be picked to form a paragraph that is actually pleasant to read in contrast to some other programs.

I am also concerned that some things are missing from AC that may be very useful in the other programs. I may be missing something, but order tracking (which seems a core reason to utilize a computer in managing medial data) seems to be much better developed and easier to utilize in the other two programs than AC. While it looks like I may be able to generate reports that identify patients who have not completed various studies with AC, the real time order tracking features of the other two are impressive.

So I guess my questions are:

1.) are other neurologists successfully using AC (other neurology practices in my area, are using ECW with success)
2.) are the bells and whistles of the other programs useful, or just fluff,
3.) is AC likely to improve those parts of the program that are relatively weaker,
4.) does anyone feel that paying more for the other programs results in a better payoff (increased efficiency, better quality) down the road,
5.) does the onsite training of the other programs result in a better result albeit at much increased cost. While the upfront cost of AC software is much less, the real savings seems to be in the lack of need for onsite training. When going out a year or two, the annual maintenance costs of the various programs don'y seem to be as different. Also, the other programs come with PM software included so the annual cost of Medware would be eliminated
6.) how much weight would anyone give the fact that certain programs have received favored status from the local RHIO and IPA. (not AC).

I welcome any advice.

I am not a neurologist so my comments may not be as useful, but:
We started with AC as just an interim solution while we continued to shop for the perfect emr. I believe we started with Version 4.0 (maybe 3.something?) The improvements/upgrades have been delightful and are coming as fast as Jon can manage, but never fast enough to satisfy me. They are however faster than I can integrate everything.
We sould love to have the billing, but are getting along with one girl, (for three Dr's) copying all the billing from AC into EZ claims and billing from there. That is really no different than billing from a paper chart.
The critical issue (IMHO) is can you see the patients and chart them efficiently? If you are too slow to chart in a system then the billing becomes mote since you won't have much to bill!
AC HAS been so intuitive that no training was really needed, but Version 5 has a lot of bells and whistles, I am not sure I am using every feature yet. I do LOVE the e-scripts! It is such a STUNNING improvement over the prior system.
And as for the local IPA favoring one emr over another? Our local IPA wanted e-Clinical works and I believe part of the appeal was the internet based system would allow them "the utility of doing chart audits without disrupting your practice". Uh, NO, that's a deal breaker for me. That database is an asset that I only dimly understand the value of, but I know I want to keep it in house. One example of the data I want to mine, or dole out to the IPA that deserves my business is the ability to search for who in my practice is turning 65 next year. Medicare HMO lives are a valuable asset. I'll be trying to hang onto them.

I think the PM portion of AC will be out this year and I think Jon has every intention of giving it to everyone that is paying for support/maintenance, as well as the IPHONE app/Blackberry app he is working on. That being said I currently use Medisoft and have lots of problems - annual maintenance for just the billing software if I want it is $1,400 - more than I pay for buying AC. I have had to pay for support just to install it - I once bought an upgrade for more than $1,000 and when it failed on install they would not help until I coughed up money for support as installation support is not included - they come up with a new version every year or so and charge more than AC charges to buy from scratch..I digress.

I think you can do any specialty with AC - decide what your standard reports look like whether they are a JOINT INJECTION (FP), CYSTOSCOPY (UROLOGY), ETC and put in a template with fill in the blanks (I think you need to show something different on a procedure each time or an audit might insinuate your records are just boilerplate and not real). Download it - try it to generate a few notes on one computer (instead of dictation) and see what you think - if you like it, then install and use. I installed and started using on Day 1 - when Version 5 came out beta I put it on and upgraded that day and went to work.....maybe don't be that brave.

My reaction from a 4 provider mixed specialty/IM practice is this:

The 4 of us have different styles, and even philosophies of what the different sections of the chart should mean. Personally, my HPI is very narrative as is my plan, with other sections more granular. Highly granular reports not only annoy me but offer me little useful information. If I got, for example, a long list of nerve velocity times from you with no thorough interpretation and lists of suggestions, then I think the patient is poorly served no matter how many reports you can generate.

AC mixes fairly well with Medware, but not perfectly yet. We can live with that.

At the end of the day, I want a system that allows me to generate and store a record that says what I want in common english that explains my thought processes and plans clearly. All other considerations are secondary. AC does well at this.

I agree with the notion of having a report that actually sounds like you dictated it. I hate the programs that go something like..."diarrhea, no, nausea, no, dysuria, yes...". The longer I use AC the more I find I can do a little here and a little there to improve the output from it. For example, I actually have 4 different follow up HTN templates and 4 follow up Diabetes templates. Basically in the end they all say the same thing but the vernacular and sentence structures are all a little different. So, if I am seeing a patient often for the same problem I just rotate the templates. When you send or copy or audit the chart it then does not look quite as "boilerplate".

Granular data has the potential of being helpful. Often though, the granular data can be in the form of the ICD and CPT codes. I have looked at eCW and eMDs and thought they were OK programs but took too long to chart and harder to make out what was going on from the note they provided.

The cost of maintance for a year for AC is what they charge for a month.

I prefer to have an onsite database.

I think all will ultimately be eligible for goverment reimbursement, but will it actually happen. Look at what is happening with medicare reimbursement and tell me the government is going to drop 44K in your pocket for EMRs. Are you prepared for the hit if it doesn't happen? Probably can if you are using AC.

Functionally, all of them are tools for describing wht happened in the visit. AC is the fastest and most user friendly.

AC is capable of doing billing but needs help in that area. Hopefully this will be corrected soon, but there are workarounds now that work and are affordable.

Is your IPA getting a kickback? It seems that eCW will adjust the price based on what it takes for to get the contract (can't comment on eMDs.) So what is the true value. While it may be nice to be on the same system, this is truly of value only if you are practicing as a group without walls. Are you prepared to share your database with other providers?

While I am neither a neurologist nor directly answering your questions, these are points that I think are salient in the discussion.

A couple of other more direct answers to your question, Richard,

My partner was involved at some length with a group sponsored by our state medical association who was charged with picking 2 or 3 vendors to get a good deal for its members (mostly solo/small practices). AC did NOT make the list, because it was not certified at the time, although several members wanted to give it an honorable mention. I think there is little doubt that it would have made it if it had been certified just a few months sooner. Two of our larger hospitals in the state created a deal with ECW, and subsidized 75% of the initial costs for the doctors in that area. I don't know how that made it past the Starks amendment, but there you have it. So, that was a lot of clout. Watching the process I was struck with just how many non-scientific issues went into the selection process. So, I would try not to be too terribly swayed by that.

I have gotten probably 70% of my training right here on this group. Now, that has meant that have had to be willing to make a pest of myself, and to become comfortable in essence asking a friend "Hey, Wendell, when you have a second, could you show me....." If I had been saddled with huge cost for training, I'd be more in the mode of "Hey YOU!!! I'm paying you!!! Get over here and fix this!!" Consequently, I'd be angry when they didn't hop to; as it is I am grateful for the help. It makes it a lot more pleasant for me, but then again, I'm sort of "country", and built like that.

The order tracking would attractive. AC allows you to put in a reminder that pops up at an appointed time, and that isn't half bad. I started with version 5, and I get the impression that this feature is new in 5.