Home Forums Discussions General Discussion Is it really just me?

We've had AC for 2 months, and have been using it "live" for 6 weeks. I spent another 2 or 3 hours today dealing with six or seven more annoying little issues from backup philosophies to planning fax modems to order group defaulting to the wrong place to wireless network issues to a laptop in one exam room that I swear to God has the cursor moving all over the screen with my hands no where near the computer. And while I can fairly say that things are getting somewhat clearer, I would not in a million years say anything like "I walked into an exam room on day one and just started using it; it is that intuitive."

So, I'm kind of curious; did most people really just waltz into AC (in which case I will take the hint and retire to my cabin in the bush, like I've been threatening), or is this just sort of how it goes, and I can expect it to all settle down eventually?

Got version four and used first in non-meaningful way simply dictating full note in physical section using dragon. Did enter icd codes and allergies soon. It allowed us to stop making paper charts. With version five started entering meds and sending electronically. Still not getting refill requests other than by FAX until five.one. Have not gone back to codify immunizations from paper yet. Still on paper superbill. Keep watching this site for creative ways to use program. Biggest problem was not buying server at first. Well worth price for good unit.

However you want to do it is fine - I started with a very old version and just did it to type my notes after pt. left and printed note - put in chart. Did this for a long time and just started adding features. Once I went paperless it just blossomed - started scanning/shredding everything, e-mail instead of sticky notes, lab interface, e prescribing, e refills,started double entering vaccines on paper (yellow vaccine sheet), entered AC and put in state registry - one day saw that one of my nursing staff had spare time and said "I want every vaccine I have ever given and every one on pt chart to be in AC".....he started doing that from the book of yellow sheets and before I knew it they were all done - now have complete vaccine history in all peds charts.

I still use paper superbill and nurse has 8.5x11 sheet to put on cc, vitals, etc - probably will get rid of that soon - hard to let go........it really does balloon on you and there were times when I started adding things and did several things at one time (staff gets nervous).

Now have fax and am considering spending money on UPDOX - could really make it easier for staff to file and cut down on lag time.

Just work at it and you will figure it out.

David,

Yes, as far the actual use of AC, I did practically "waltz" into it. The other issues you mention such as fax modem, networking, computer problems lie outside of the actual EMR. We started slowly, using only the main features at first. Once we all became comfortable we started using more and more of the features and are now paperless (except for a paper superbill). The tech issues will always be there and will always be annoying but, for the most part, AC is very, very simple.

David, even the most intuitive EMR won't let you necessarily "waltz in on day one" and start using all the features. But with AC, many can probably waltz in and do a basic encounter. It will take some time and effort to into all of the capabilities. I don't think people mean they just on day one can use everything. Just that they can go ahead and quickly do a basic chart note (hey, just type in the boxes if nothing else) and can fairly quickly build up from there. And AC is alot more complex now than it was 3 years ago.

David,
In response to your question, "yes, it's just you". We started a couple of months before you, and everything in our office runs as smooth as silk; on autopilot. How about this: send me a plane ticket to Fairbanks, arrange a couple weeks of camping, hiking, and boat tours, and I will spend a couple of hours in your office getting you up to speed...

We are right with you. I think the big "unspoken secret" about transitioning to an electronic record is the fact that the EMR program itself is only a small part of the process. Yes, it is essential to have an intuitive, functional program, and I believe that AC fits the bill (at least for us). But in reality, that is just one of a number of issues to address. Next you have a series of concerns related to IT (e.g. networking), security, document management (faxing, scanning...the whole "going paperless" thing), intra- and extra-office communication (messaging, emails, letters), and on and on. All of those issues must be addressed as you try to learn how to use the program.
What I am learning (sometimes the hard way) is that implementing an EMR really involves completely re-examining and re-imagining the work processes in the practice. In a sense, you need to re-think every little step of every staff member's job. You can try to change as little as possible, but in fact what worked before is not likely to be what works best going forward. I am fortunate to have in-house (in fact, "in family") support and management for this, otherwise I think I would be pretty overwhelmed by the process. I expect the adjustments to continue for a few more months. In a sense, though, this will be an ongoing process that goes on forever....unless I get all my answers at the ACUC.

I had signed up for a very expensive ( ridiculous) EMR/PM package a year before I started AC. A year later ( with lots of "training") it was still not possible to even produce a credible note for an encounter never mind all the other aspects of charting. Once I dumped that bad boy, starting up AC seemed really pretty darn easy.
I think the above advice is to start one aspect at a time and then add the next function when you feel more confident. The technical support on the ground is also crucial, I am not at all computer savvy and I would have benefitted from a more robust technical support option when I first started. Hang in there, paperless really is better ( but like the others I still use a paper superbill).

Thanks for the support, although I was halfway through Jon's note and three-fourths packed for the cabin before I got to his punch line. We actually had been doing EHR little bits at a time.. an e-prescribing program, with a homebrew database that stored dictations from Dragon and a practice mgt program. Then my partner said "let's just go all the way" (she does things like that.) Well, that was a substantial leap. My previous dataprocessing experiences have left me unbelievably paranoid about data loss, so our server farm got pretty fancy. Our billing person's husband is IT for the hospital, and he and his partner want to start their own IT business, so they pretty much have a cot and a toothbrush set up in my office.

You are all correct that AC itself it really good, but the permutations and combinations of the whole system start to multiply faster than bunnies. My magic computer trick (see above) I think could be traced to bluetooth and my partner's computer interacting with mine from the next exam room. Yesterday was ugly. Today was better.

I think the bluetooth from the next room could be fun with a staff member or something where you take over their screen and do bad things....I digress.

I did start using AC day one to make an office note, but that was a much older version and AC really did not do a whole lot more then......I also think those of us who dived in quickly were probably computer nerds at heart.

Debra, would you mind telling me/us what your initial emr was? You can PM me if you wish. I just keep a note of emrs that have been noted as particularly bad choices.

PM if you must, but practical experience/knowledge like this is important to many of us. Frankly, I think sharing the information is a service to all.

I can understand not wanting to slam an EMR on the internet but we all want to know, myself in case it was one I looked at, then I can gloat that I dodged a bullet.

As far as jumping in, and all being nerds..

I am the most tech savy in our office and I have NO IT skills, but I am less intimidated than my partner. We set up a 6 month schedule for implementation so that we could sort of EASE in. First the staff started filing in AC and still filing in the paper charts. That was scheduled to go for the whole six months. It was so faster to look in AC than the paper chart, that even the most un-savy were looking in AC first (as it would be scanned there before it went paper) and so we quit filing in the paper charts after just 4 weeks. WE BOXED THE FILING FOR ABOUT 6 MONTHS, we just couldn't bring ourselves to shred it, at first. After we had all patients demographics in, all appointements being made in AC and the staff began entering the vitals (for both training/workflow and to build the database) we asked that each physician do one chart in the morning and one in the evening in AC. We had scheduled to do that about the second month, but we started that in the first few weeks. Then we asked that all of the billing be signed off in AC. That would mean we had the date of the visit, a note that said "see the paper chart" and the ICE-9's (but no plan) and then sign the note with a CPT assigned so the biller could begin figuring out the work flow to move the billing from AC to EZ-Claims (which was also new for us).
During that period, the doctors realized the filing was in AC, the vitals were in AC, (and on a paper page we were using for vitals) and they had to code and bill, so we just started charting. All three Docs started using it full time in about the same week. We still carried the paper chart in the room for at least 6 months.
Our six month schedule for implementation was squeezed down to about 6 weeks.

Just as a driveby - I'm wondering what the interest would be at the ACUC to touch on how existing/impending tech influences adoption/modification of practice mechanics.

DocMartin has laid out a very systematic approach, and that may be fully sufficient.

Lots of different ways of considering this, but I, for one, would definitely be interested.

I started using ac just to document an encounter but print it. Within 2 weeks I stopped printing. Didn't import labs until about 6 months later. Then all labs were in chart in computer. Then started eprescribing with V5. We still get out the paper chart but only to look at past info that hasn't been entered yet(like an old PSA). We are fully electronic within a year. We use ac for everything and bill with EZclaim.
It's been a waltz....I really love AC and it has been an answer to my prayers. It'll be a while before Obama and his mandates drive me out of business. Me and AC.....what a team!!!

Sounds more and more like we are pretty much on track; maybe we jumped in to using a few more features right away than we needed to, but I can say all records are going in electronically. When we see a patient for the first time in AC we summarize the chart in AC, mark it as "no longer needed for an encounter," and file it nearby but don't pull it for the next visit. We are e-prescribing, importing labs and faxes, and very selectively importing parts of old records. We have not started health maintenance, and vaccinations are going into past history for now. But waltzing in? No way. More like a cannonball splash by a fat guy in a crowded swimming pool.

Yeah, I have totally suppressed all memory of the weekends when I came in and spent hours entering medical history into patient charts. It's really better if you forget that! (And we also printed the encounters and filed the printed copy in the paper chart, but only for a few weeks.=)

LOL. Martin, It took me a year to get Alice to stop wanting to print her encounter note and put it in a paper chart.

I was fortunate that when I moved my practice to a different part of the state, I decided to start brand new and go full throttle with the EMR. I had a new office manager, a new front office person, a new EMR, a new practice management system, and new town. It was an ideal situation to start using an EMR. Totally from scratch and the practice started off slowly as expected and picked up rapidly over the first few months.

I got on this board and tried to figure out how others had done it and used a lot of their ideas. I started with v4, installed my network, fax, id scanner and computers myself, and used it from day one. It was a rapidly moving waltz but it wasn't a struggle by any means. I've made some adjustments like using Dragon 10 which is pretty good for the most part on those wordy plans I sometimes come up with. I use the efax for prescriptions currently (which I didn't do when first starting) and will upgrade to v5 and use the true eRx at some point when I feel it's stable.

The only paper in my office is a superbill and the patient intake forms. Well, not exactly. My office manager/wife loves paper (or maybe she hates trees) so its not completely eliminated.

Many of your issues sound like your network/computer arrangement and not so much the actual EMR. But all EMRs have a steep adjustment from the beginning. If I was going to use it in my old office, I would have started very slowly as the staff would have been overwhelmed quite quickly.

Hang in there. It's worth it.

I am 4 + years in and still using a paper chart:^)
I was leaving a large group and probably with about a month of lead time to get AC up and running when we made the conversion.
Bought the computers and fax machine and were up and running. Luckily the group had been using a computerized schedule and so that conversion was fairly easy. I had also been using Patient Ed (still do) software to help document and prescribe from an office computer so putting the AC was not a big step.
But I still like having the paper chart when I am seeing patients in the exam room. So I print out the encounters and put them in the paper chart along with the labs and other reports which also gets imported into AC.
Yes it is double entry and some day I may give up my paper chart, but at this point I think it is less intrusive when I am seeing the patients and often things are easier to find in the paper chart than in AC, conversely at times it is easier to track down info on the chart.
Prescriptions are done in AC (and Patient Ed)and now using e-prescribing to help simplify life. Refills are all done in AC.
Greg

To add to issues "they" never told me..

In addition to a drop in productivity during the transition, there has been a significant drop in the quality of my medicine as well. Our office providers have been generally very obsessive about evidence based medicine, have held a weekly "journal club" for the office, etc. In the 12 months prior to instituting the EMR I had personally logged 238 CME hours on UpToDate. In the two months since starting AC, I have logged 7!!! Our journal club time (plus lots more) has all been spent on transition issues. All of this is recoverable, of course, but I sure can't pretend that it did not impact the care I have been giving.

I've used at least 4 EMR's including residency and medical school. I'm a little newer at this, so started with EMR from day one and never have used a paper chart. The downside is I probably write way too much, much more than any sane person would ever write by hand. (Side note: typing most important class from high school.) I found the VA system cumbersome; Logician worked well for a very large practice, but required a lot of 'clicky clicky', ECW took a solid 2 weeks of training to even get proficient, and that is for a fairly tech savvy doctor. I loved AC from the day I tried it. I could tell it was designed by people like us, that actually use it. I have the feeling as we go along that it is continually getting better. The bugs bother me, and are sometimes a real problem. But this is one company where you can actually get an American human on the line for tech support and a company that changes the program, making it better and better. I love AC - and to answer your question, it is easy compared to most!