Home Forums Discussions General Discussion New User Support – ACUC and Beyond

This is a bit long, so let me start by getting right to the point: I think that for all of our benefit, the resources available to new users of Amazing Charts need to be expanded.

This is not to diminish the value of the AC support staff, nor of this forum, both of which I have found to be tremendous assets in the ongoing process of converting to an EMR and a paperless office. Two providers from our office attended the ACUC and we both found that to be a valuable and enjoyable educational experience. We had a list of questions, many of which were answered (whomever told the group to use “tab-enter” to go from screen-to-screen in magnified mode; you saved me literally thousands of mouse clicks. Thank you! Even Jon Bertman had no idea how to do that). We got lots of answers, but we are only a few months into our use of AC, and we still have many unanswered questions and a ton of learning to do.

On the other hand, comments made by some attendees at the conference and some posted here remind me how far we have come from true “new user” status. I distinctly remember those first few weeks when EVERY aspect of the process was a question. Using the program is probably the best way to get comfortable with it, but at first that is a challenging proposition. I hope I am not insulting anyone here, because I know significant effort has been expended in this area, but we need more. There is no user manual. The wiki is incomplete and is sometimes outdated. Searching for answers on the board here may be helpful, but the “search” function is not great. Besides, why use resources (space, time, etc.) on answering simple questions over and over on the forum.

Why is this important? Of course we all want to learn how to use the program quickly and easily. Naturally, Jon Bertman wants more users; I would bet that some significant percentage of trial users are turned off by their inability to do things that we now see as second nature. Jon said (and I believe him), this is not just about getting more customers: it is about changing medicine. This will only happen if thousands more people use AC. And as Martin pointed out, we need to be sure that the 3500 users continue to expand in number to be sure that AC isn’t relegated to the dustbin of history (ok, maybe he didn’t exactly use those words). It is in all of our interests to try to insure that everyone who downloads a free trial becomes a user, and everyone who buys it STAYS a user. Towards that end, we should try to smooth the transition for those new users. That is exactly what many of the “answer-men (and women)” here have already been doing (you know who you are). Of course some of this may fall to the AC company itself.

Here are some suggestions:
1. A forum on the board specifically for new users (with threads about “how to….”). There is lots of room for input here since so many people do things differently (how many different ways are there to pull a patient’s chart, import a document, etc; I would bet that no one knows them all). Keep all this information organized well, in one place that is easily accessible.
2. Changes to the next ACUC, with more emphasis on truly “new” users. Wendell and others have expressed useful ideas in a couple of threads.
3. A user manual.
4. Updating and expanding the Wiki.
5. Creating instructional video tutorials of common tasks, expanding on the handful on the AC website.

For starters, we are going to create some video tutorials which will be used within our office to orient new staff coming on board (now and in the future). We will look for a convenient way to post them and share them.

So am I out in left field here, or does this strike a chord with the brand new users out there who are first exploring the program? How about you old-timers, trying to remember back to those prehistoric days (or maybe yesterday) when you tried to do something new with the program?

That's a great idea Jon. I just watched a tutorial that Ben Serrato did about getting into the mailboxes from the back end. It was great. Now I can do it. I was a blue dot but there are tons of things I don't know. Eg.this am reading Leslie's instructions on how to make the schedule a week instead of a day. It took me a while to figure out but all these little clues to working the program add up and make things so much easier. Now what was that again. Tab enter takes one from box to box in the encounter? I'll have to try that.

Jon you are absolutely spot on. When this first started it was A LOT simpler and therefore, more intuitive. The more complicated it gets, the more you will need to be trained. Two years ago Leslie and some others were arguing passionately that everyone, (including Jon Bertman) should leave AC alone, don't change it anymore and don't make it so complicated that it becomes to expensive, and slow. I like the new features and that especially includes the health maintenance, (where I am learning about hemosiderosis!) but I also fear the fallout from over complications. I admit that there should be training, I just hope I won't have to pay for it, (through higher fees) after all, I already got mine, the rest of you are on your own! :-)

I agree. I really believe those who still think this is a simple, intuitive program that a new user can just jump into have come here through many iterations and simply don't see just how complex it really is for a new user. I consider myself technologically sophisticated, but getting started left me floundering in the dark for quite some time. I know they are expensive and become outdated quickly, but a real written manual would be a great place to start.

I think that all these ideas are good.

I have found the AC Wiki useful, but incomplete and often outdated. I went through the "How Do I..." page and organized sections, but many of the topics are incomplete. If anyone on the boards can contribute, please look at the Wiki topics & complete any that you know something about. If you are a "guru" on certain topics or topics, consider "adopting" them and periodically reviewing and updating. Sort of like Wikipedia.

Also, if Amazing Charts folks are listening, the Wiki needs a more prominent place on the Support section of the website, and a brief explanation. Some people don't understand what a Wiki is useful for. And the there is no way to directly hyperlink to a specific Wiki topic, only to the main support page (which is itself a big undifferentiated list).

Also, regarding the boards, there are excellent posts by various of you geniuses out there which really hit the nail on the head. Unfortunately, it often takes me a long time to search for them when the question comes up again. Many support boards have "stickies", linking to the most helpful answers. Another suggested task for you, Bert!

Well, actually,

http://www.amazingcharts.com/wiki and http://www.amazingcharts.com/wiki/index.php?title=How_Do_I...#Administrative_Tasks

but you're right. There's no obvious way to link to the wiki. I'm guessing blindly that the wiki will work a little better after AC's site redesign. Hopefully there will be a page documenting how AC sees use of the wiki for documentation. i.e. Is it separate from the included help file, or supplementary, and are changes to the help file by AC staff automatically updated to the wiki?

Thanks, Benjamin. I stand corrected.

I thought it was hemochromatosis.

I think adding to the video tutorials will help. The ones currently listed here are just the basics.

http://www.amazingcharts.com/demo/index.htm

When I upgraded recently to version 5, I used the new features video to show our staff what would be changing. I think if you expand on these videos in more detail, more users can use AC to its full potential.

When we started AC, we reviewed all the new features videos in sequence several times. With no background in AC they were pretty rapid fire, and I had to go over them a lot to get the gist of them. I agree that expanding on them and having a collection that assumed no prior knowledge of AC would have been extremely useful.

I guess I will be playing Devil's Advocate here, so feel free to throw stones and yell at me.

I don't think a new user forum will be helpful. It just isn't the place to put How to subjects. It will soon become just a regular forum as users both new and expert will comment. For instance a How to on how to fax from the PC will soon bring a slew of the same comments as old. Maybe it is the organization of how user board compared to others I have seen. I just see the user board as a place where everyone posts whether its questions, answers, solutions or just gripes, etc. about medicine.

As far as putting more emphasis on the next ACUC on new users, I felt like this year, the "newbies" taught the experts much more than the other way around. Those who put on the ACUC have had many discussions as to how it could have been done better in the future. This is nothing against new users, but I guess I am opposed to creating a whole group of new users, medium users, long time users, etc. We have talked about taking certain sections of AC from installation all the way to progress notes, orders, ePrescribe, etc. with each speaker becoming a super expert on these sections.

As I have stated before, and I am sorry for my pessimism, but I am 100% dead set against the Wiki. I just feel that the users shouldn't be building the "Help Section" and manual. What if someone writes that to move AC from one computer to another, you copy and paste it. Maybe it gets corrected, maybe it doesn't. How much is Jon liable for this?

THE MANUAL: Yes, that is the key. There is no comprehensive user manual. Most software I use has a User Guide, which is short and to the point, an Administrator's Guide, which is 100 pages long and comprehensive. The support section also has a Knowledge base and FAQs. Finally, the user board rounds this out.

Instructional videos are an excellent idea. I still prefer the last paragraph.

Sorry, just my opinions.

In reverse answer to your statements.
Yes to instructional videos.

Manual: Few people actually read them. Wiki, sort of, is the new manual. I think there should be some basic structure set up by AC central and allow modifications from there. Perhaps overseen by a AC rep or caveat emptor. You could make a manual by reworking the wiki for those who cannot live without a manual.

ACUC newbies: There should be a track for them. The problem is that the interaction between green dots and blue dots goes both ways and if they are separated both loose.

Separate forum: Agree, couldn't have said it better

When you say separate forum, do you mean on the same user board? I just see it just merging with all the rest. New users are going to post in the other forums as well as the forums for new users. When a new user posts a question like how do I import, it will be answered. Maybe I am missing the concept. Are new users with new questions going to post in the forum for new users? If so, the older users will reply, and that thread will become a non-new user forum.

The wiki: I am sure one can never say never, but I have never seen another software program where a wiki is the main source of information. If you look at Jon's Help list, it is full of "to be dones." It is really up to Jon to come up with:

1. User manual -- if they want to read it they can, if they don't, they are on their own. Chapter 2: How to move AC and SQL to a different computer. Chapter 3: The AC backup and scheduling.
2. A knowledge base where information can be searched.
3. An extensive FAQs.

Instructional videos are a good idea. I am simply not trying to re-invent the wheel. Almost every other software application I have seen or purchased has the above and none of them rely on a Wiki. There will always be several key areas that are not covered.

I have to agree, but then this is not a typical software program. I've been using Amazing Charts since 2006, and no manual during that period. In fact, some of the information on the website is now outdated for the new version.

I guess my suggestion is just to utilize the already available and constantly updated information present on this board in some useful way that could be searched and updated. Whether that is a Wiki with edit reviews or oversight, or saving useful threads in a section of the board (ie: "stickies") where the info can be easily found.
I would love a Knowledge Base or manual, but it hasn't happened.

I understand, but even with stickies, it will be difficult to search. And, who is to say which threads are more helpful than others?

Amazing Charts is a different program, and it is great because of that and its users and Jon. But, at some point it can't be left up to the users to have an organized support section on the website.

AC has grown and so has some of the supplementary aspects that go along with that. Compare the first EULA with today's version (and I am all about the EULA -- no complaints here), but it has moved forward. It is time for an organized support section SUPPLEMENTED by the user board.

We REALLY need something better than we have for instructional material. I really believe there is a significant underestimation of how complex this program has become among those who have used it for some time as well as the developers. When we got it, we asked about online instruction, and it was provided, but we were sort of made to feel like the slow kids in class because we asked for it, like everyone else just sat down and ran with it. Well, I really don't think I am dumb or technologically challenged, but it was not simple. I have written a lot of software for our office, and I do understand the concept of "mission creep" and how it sneaks up on you, and I think that happened here.

As a dinosaur, I still do best with a printed manual. I can kind of skim it, look stuff up, paperclip a page to go back and forth, take it along to read while waiting for my daughter to finish a lesson, etc. There are lots of things that are hidden in AC that I would never know to search for in a forum ... like the %LName placeholders. I happened to see that when I first signed on the board, but otherwise have not seen it referenced anyplace, so how could I know to search for it?

We all have our hands full with the big basic stuff for the first several weeks. Then we want to add goodies. Whatever form the instructional material takes needs to be organized to not overwhelm at first, then to show what sorts of things are possible, then to go into them in detail.

As an expansion on the above, I have now been involved in a fair number of threads on this board, and there is a lot of information in them that I am implementing. However, the search function only goes so far... like, trying to remember the name of the program Bert developed for printing labels. If I search "labels" it comes up with a huge bedlist of hits. I did locate it, but it took some time. An index in a manual would have led me to it quickly, along with pictures and screen shots.

I completely agree.

I think a new user forum could be helpful, but the problem is if you had a new user forum other people would have to check - start a thread like HOW TO DO E PRESCRIBING FOR A NEW SCRIP and then the important issue is that after 5 replies it would start being a talk about a new printer or LOGMEIN for Iphones...I am being facetious but people here have a hard time staying on topic.

I really think AC needs to devote some time to a USER MANUAL and Jon has told me that he wants to do that, but I think new features and fixes preoccupy them. I know places like Microsoft hire someone only to do manual development and often it is clear from reading them that the people do not necessarily really use the program.

As far as the different ACUC meetings maybe we need to have 2 tracks - one with advanced topics and one with really beginning topics. Maybe even we could convince Jon to devote 1 or 2 employees to doing beginner training (I wasn't there and maybe they did this), but it will be hard as many of us who use AC daily have forgotten initial things like setup, etc - I know I originally configured mine in early 2002 and don't even think about some things any more.

I know this is longwinded, but I think the first thing we could all do is when we start to go off track.....START A NEW THREAD. That way when someone wants to search for "IPHONE" they can isolate threads that are about the Iphone.....Sorry for ranting.

No PMs on this.

I suppose there are lumpers and splitters. I will have to be a lumper. I lean toward everyone staying together.

v5 has a higher learning curve because of four reasons:

1. ePrescribing (which is easy) it is only the codifying that makes it scary at first.
2. Immunizations. Pretty well done, but the migration is horrifying until you do it. If you are setting up from scratch no big deal. There are three windows, one of which is sandwiched between two others. This could have been simplified and, personally, I kind of want where I put in immunizations to be the same page I can see them.
3. Health Maintenance
4. Orders

I turned off HM on day one. Orders are going to be redone. I hope. I pretty much use the Other section with the free text and send everything to myself.

The other two with good manuals wouldn't be that bad. In fact, and don't make me do this, but I could write 2 two-page documents on them. Maybe change the word from codify to conversion.

What I am saying here is, right out of the box, it isn't that hard to use. Sure, I started with v1, and it was simpler. But, I still think it is like Word. Install it. Open it. Type. If you want to learn mail merge six months from now, great.

I'm telling you, while we taught the users stuff about AC, in general, they knew far more about v5 than we did, to a point.

One must keep things elegant. When you are forced to turn off drug allergies and interactions because if you don't, it's like Christmas in NYC, then it needs to be simplified. I think way too many times, AC buys or subscribes to a feature and then is happy with it. Sure, to be fair, they are working on New Crop and ePrescribe, but I simply would not be happy with the way the allergies and interactions are displayed. And, of course, we should be able to do allergies only. Other than actually sending it by ePrescribe, what good is the conversion process, uhh... codification process, if the interaction and allergy outcomes is horrible.

But, I will say, if I first installed AC and saw those orders, I would freak. I don't see what was wrong with the old ones. What has made AC much more difficult is CCHIT. Having to change a beautifully designed and streamlined program into a different mousetrap but not necessarily a better mousetrap, is a shame. It's just like the state of Florida mandating that you need to stamp a picture of yourself and the patient followed by smearing a drop of blood over the script before it is legal.

OK, so I did in one post what you talked about for an entire thread. I got a bit off topic even in this post.

I guess at the risk of being arrogant, I still don't think AC is that hard. Still, if you compare it with Logician or NextGen which take a staff of four and $10,000 to teach you, it's cake.

When I was learning Praxis 2.7 (which has a learning curve like the Mercury's orbit, part of the purchase was about 20 hours of training over the phone.

As each sale happens (and I don't know how quickly that happens), a support tech could spend 12 hours with the staff over the phone. Four hours on a Monday, let them play with it and use it on Tuesday, four hours on Wednesday to answer the questions that came up, user by him or herself on Thursday, and then four more hours on Friday. Just a thought.

Excellent thread. Jump in Carolie. I still stress we all must be careful what we wish for or we will end up with a program that looks a lot like NexGen or some other useless piece of poo poo. Version 5, I do not really believe, was Jon's dream EMR...most was mandated in order to acquire the blessings of the government for "meaningful use". I still have not updated, really do not want to, except for a very few features which I think might help my work flow. Martin is almost correct in that I have stated often about leaving AC basically alone. But, I have not actually espoused making no changes. I have argued to change the things that need changing, like the letter writer, fix the bugs, make the work flow flow, etc. It was the simple, intuitive, no nonsense, lost cost features that drew all of us to AC in the first place.
As most of you know, I do not really cotton to change unless it makes darn good sense or benefits my bottom line without compromising my principles. I am not afraid of technology but I am not enamored by it either. I like to touch and feel and see and smell and interact with my patients. I still use a stethoscope even though there are much more techier things out there now. I believe in the healing/reassuring effects of chiropsia (the laying on of hands). I still pick up Harrison's Principles of Internal Medicine and read about the differences between hemochromatosis and hemosiderosis. So, my EMR should assist me in this...not replace it. I like simple. After playing around a bit with V5 I agree with David. AC is no longer the program it once was. It would certainly be a lot harder to jump in like we did years ago and learn it in 1-2 days. Definitely more thought needs to be given by the AC team regarding instructing new users. And, once the PM module comes out...look out. The learning curve will go up many, many notches.

Leslie, the crotchety old grump who likes Martin anyway

What's a stethoscope?

Extremely well said, Leslie. And, as a caveat, I can't blame Jon for this due to the government intervention. We 17% of all doctors using EMRs were doing just fine.

I love technology, but I am certainly not in favor of where AC is going. Definitely, Jon is feeling the pressure from all sides. Those who want PM and those who don't. I guess you can't be all things to all people.

I remember one day sitting down with Ed. I was still like, "Let's add this, let's add that." He got up, left for home and told me, "When you're ready to get the bugs out of this version and make it perfect, call me. Until then, I will be in my trailer watching Dukes of Hazard.

From my perspective and I think Leslie's, I just want the old, no frills and quick program. Like the iPhone, each version should build on the rest, but only after the bugs and suggested improvements are put in.

When you go back over the board back in the v3 days and the v4 days, you see a lot of suggestions/whining/complaining(Bert) about things. But, they were usually about small tweaks or issues we already had such as the letter writer or lack of auto-refresh. We weren't clamoring for super new things.

I am frightened beyond belief of the PM. For others, they can't wait. I just see an entirely new program that will rival the amount of code and time.

The worst thing I have seen with AC as far as its effect on people is when it has multiple crashes throughout the day. Even then, until a fix is found either by AC or a user, you can get through the day either via perseverance or frustration or even paper. If the PM/Billing system has a major issue, it is going to produce major problems with the influx of money.

Just my two cents.

Just remember, if Brian were here, all of these things would be addressed in an extremely elegant fashion. This is no reflection on Leslie's comment, which was excellently put.

OK... time to flaunt my ignorance yet again.

What is the "Practice Management" program that is looming out there? Is it just an integrated billing/accounting module like the Medware program we currently use, or is there some dark and loathsome Orwellian set of functions involved?

I believe it will make AC into:

An electronic medical record
A scheduler
A full fledged coding and billing program

All designed to work seamlessly together.

We use Medware, and I would think it would take a lot of time and code to develop it.

I believe the plan will be to use some parts pre-existing billing software, some parts new and then somehow merge them into a new and improved billing module.

It will also cure cancer and end war.

No, that would be too "meaningful."

When I started this thread, I hoped to get input from various sources, and then try to "organize" them. That is still my intent. Lots of AC veterans have expressed truly worthwhile opinions, and in no way do I want to slow or impede your flow of ideas.

BUT...I did also want to get input from truly NEW users. So any of you out there who are truly new to the program (by that I mean, still in a trial, or in your first couple of months of implementation)...and who somehow managed to read this deep into the thread... what are your thoughts?
Are you satisfied with your ability to find what you need? If so, what helps? If not, then what would be useful? I know you are out there; don't be shy.

maybe I'm a "toddler"

July is my 1 yr anniversary with AC and running my practice.

the first few months learned enough to get by - not what I should do or could do. E.g. I accepted as normal 10 hrs to backup ... only when i clocked 30 hrs did I scream enough!... now I know re import files and not scanning at 600x600 resolution, etc. This mistake handicapped me for months. You miss things learning ad hoc.

Jon's videos are commercials - only Morgan Freeman could do a better job of selling with voice alone - but they are not training videos. I needed a "how to implement AC in a paperless office with 2 assistants and not screw up" - instuction sheet with hyperlinks. I'd like to write one, yet one yr later I don't know if i can ... the ACUC helped a lot.

The userboard is a treasure chest - ... great for problem solving ... not too inefficient a means of getting the basics -

E-MDs was going to charge 7k$ for on site training and promised access to "online self directed training" - ridiculous price and no need for a warm body in my office - but an overview followed by self directed review is what I wanted. Online media would allow me to direct my staff to specific learning objectives.

imagine if the number of users doubled in the next 2 yrs... would existing wiki, videos and the userboard make sense to get them started? why waste helpdesk resources - I think an online manual of the "essentials" with some video instruction would be very helpful.

Users should write it - AC direct and coordinate it - I am no expert but I'd be willing to contribute. Perhaps we can define what the essentials are then recruit contributors then have AC edit? We could ask everyone "what do you know now that you wish you knew then?

Gino

Gino,

Thanks for the great and informative post. I agree with almost all of it. I definitely agree that there has to be, needs to be an online manual. Jon mentioned revamping the site, which also needs to be done.

I sometimes wonder how much control Jon is willing to give up. I know when I have priced a professionally designed website, it could get up to the $1,000 to $3,000 range pretty quickly. I don't have a site, but that is just because I didn't want to do the cookie cutter ones (and I hope I don't offend anyone -- they are just fine to get a site up and running), but mainly because I couldn't come up with the content.

But, a website is basically your store now, and it needs to be very good. If I were Jon (and a lot of us start out our sentences that way -- obviously, if I were Jon, I would have the number one EMR)I would pay someone a lot of money to build a very good and cohesive site.

On that site, there needs to be a support section. Basically, on the side or wherever, it would say:

User Guide
Admin Manual
Knowledgebase
FAQ
User forum

Support:

By phone:
By email:
By chat:

The only place I would differ would be in who writes the manual. I think it would be logistically difficult to have a lot of users write the manual. The timing would be wrong, and the editing would probably just make it start over. Essentially, you would have 100 Wikis combined into one.

Someone from AC needs to write a manual. Maybe it would be one of the users who knows it well and works with an editor. Maybe the developers who know certain areas well. Of course, they don't use the program. Don't reinvent the wheel. Jon's a big time entrepreneur now. He should be able to pick up the phone and call a company like Backup Assist or Acronis or whatever and ask them how they did theirs. Find some really good online PDF manuals and talk to those who made them.

But, we who are using it, have pretty much figured it out. The new users will hopefully do so. As far as the new customers that will lead to doubling of the customer base, that is up to Jon. If he is smart (and of course he must be), he will step back and look at exactly what you are talking about.

Thanks Gino. Keep posting.

AC needs a downloadable .pdf user manual. Period. Screenshots and directions on taking a new patient all the way through an encounter. I'm not a big fan of demo videos because they are SOOO time consuming. I need a quick reference. Especially if they add a PM module.

On to a gripe session:

I'm with Leslie on this. I haven't upgraded to v5 and honestly, I see no reason to do it now. There is nothing in v5 that will improve my workflow or practice. Nothing. Not even eRx. It's just more crap that I have to figure out and teach my staff. It's bulkier. It's slow. It's closer to all of those EMRs that I skipped over. I hate where it's headed. More time out of my day upgrading every computer. More chance of having some unknown bug come up.

$44,000 is a good chunk of money but with the current rules, even if I upgrade to CCHIT v5.31415926 or whatever, I may not show meaningful use. Fine. I'll survive. I may stay with v4 forever...not really but it sure has been great for my office and its stability is unsurpassed for software on my computers.

I love AC. I love computers. I actually don't mind change. But only if the change is for the better. Not to better comply with the government regulations. Not to better comply with marketing forces. But to the betterment of a physicians practice, workflow and patient care.

yes, CCHIT/government makes me bitter.

I suppose Leslie, you and I should make an offer for the company.

I can't agree with you more. On every single point. Except ePrescribe. It's incredible, although we probably send a lot more scripts.

I suppose it's not fair for me to second guess Jon, because maybe he has to do the government thing. But, short of their actually not allowing me to be licensed unless I have HITECH, HIT, CCHIT, etc. I don't really need it. I never cared about HIPAA. Still don't. It's not like I published patient records in the newspaper before HIPAA.

I completely think Jon would be OK without trying to make changes to keep up with the market. He already found his market. The little EMR that could and was very, very good. Unfortunately, with each new edition, it does get closer and closer to NextGen, etc. And, I guess I am one of the 50% who really doesn't want the PM.

I really am sad, though, because I actually Googled Pi to see if that were the version number you used.

Oh, Travis, you sound so much like me!! Coming from me, take that as a compliment And, Indiana is much closer than Maine. Do you like corn? How about soybeans? Would the three of us (Bert, you and me) not make an awesome group practice? Only Bert would have to pay more of the office expenses since he would be living there.

I like version 5.
It is stable, we are not having any issues at all. It doesn't crash.
Eprescribe is literally fun and makes workflow smoother.
I really like the new orders section and the tracking feature is a huge improvement over our previous sytem that used index cards and clipboards with the lab slip duplicate ( think of the staff hours spent alphabetizing, sorting by date, and shredding).
I have played with the HM section but am not using it. If some of us like it....great, we can use it. If you don't like it, you don't have to use it.
Very flexible and user friendly EMR if you ask me.

Unfortunately, I was not able to remote in at the conference to show you V1.25 in action (I actually meant to bring a copy but...) It was amazingly similar. It was what hooked me on AC.

Like Deborah, I like V5. It is not slower, it is quite stable. Eprescribing and functional searches have made me happy. I had issues with prescribing and searches in V4. I feel V5 continues along the lines of AC without being nextgen or such. Yes there are some complicated sections but you do not have to use them.

Really V5 is V4 +fixes +HM +eprescribing. (2 out of 3 ain't bad). You can use it the same as V4 if you wish, or you have more. (OK prescribing is a little different, but once you start eprescribing you will like it)

I actually think HM is a good section and has potential, but is overly complicated. It was rushed out but needed to be there. PCPs may find it helpful, it's nice to have somewhat to remind you of all the little things. (it would be nicer if it were better integrated)

Jon needed CCHIT certification. Although it is not the final standard, it is currently the one that others are measured by and will position AC for the future. Anything less and people would have stopped buying the program and drifted away both because of external requirements (group demands) or the lure of better bells and whistles. AC needs to increase it's user base, even though it has more independent practices than most other systems.

@Leslie Hilarious. Except from the looks of things, Travis spends as much time at the office except he gets called out more.

@Deborah and Wendell,

Appreciate your position. I agree ePrescribe is awesome. Immunizations are better. And, I also agree that you can turn off HM.

I hate the orders section. I now just use the blank one on the right and write in the diagnosis later. I send them all to myself. I see no advantage of sending them anywhere else. But, I respect that you like them. That's what makes the world go 'round.

I am glad Microsoft stopped just adding features to Outlook and finally came out with a version which is five times better than 2007. It is kind of like XP to WIN7. Why did they even do Vista?

I completely understand what Wendell is saying, and Jon has to run a business and may have his EMR lose market share if he doesn't keep up. I just wonder what would happen if he said:

-- The government wasn't CCHIT and meaningful use: I don't care.
-- Other big programs have billing programs (PM): I don't care.
-- We have to have HM: I don't care.
-- The orders have to be more complicated: I don't care.

Part of this works because of the YouTube videos on other threads. The "I don't cares" just work better after you have heard it.

So, my thought (which is probably not sound business practices) would be: What if Jon said, "Hey this program got to where it is BECAUSE it doesn't have HM and fancy order sets and PM. It got to where it is because it is inexpensive, lean and fast. I will take this great little product and continue to make it better by improving the little things."

Would it sell more because the same type of people who bought it because of that would continue to buy it. Or would it fall apart, because people wouldn't buy it because it wasn't meeting government standards and doing all the things the eMDs does?

I know this probably doesn't make a difference, but do studies show that a change in the Graphical User Interface makes a difference? I would think that changing the look (not dramatically), but a few things would psychologically increase marketability. The only thing that has changed has been the icon. Look at iPhone 4. Sure, there are a lot of changes, but they changed it from a phone with a rounded edges to a thinner phone with square edges. There must be a reason for that.

Caveat: I completely respect the opinions of those who want the PM and like the order section and HM.

Jon and the AC team have some unique challenges because their audience, especially the next wave of adopters, are coming from a very different perspective.

The next wave of prospective users and eventual adopters will probably have less interest in the technical details, and will judge the 'system' [EHR, server, fax solution, scanning, security, network, updates,OS patches, etc] by stability, usability, and output. They are just wanting it "TO WORK", and don't want bothered with the details of how or why. I come to this conclusion from talking to several folks at ACUC 2010, and my experience with the different waves of users who adopt technology solutions.

The challenge for Jon and the team is to keep improving AC while keeping the newbies and the long-timers (make no mistake Gino, you've earned your spurs) both satisfied.

Some of that may be by making the GUI more modular so that each user/practice can hide or display functionality they use more frequently. Please know that this is a *significant* undertaking, as it means tracking the dependencies of functions and the related data model, managing dependencies in memory/controls/flags, and adds exponentially to the time required for full testing. It still may be worth it, but it doesn't come cheap.

Several folks gave very generously of their time to suggest several concepts to me, and I want to thank them for their time and amazing insight. One is that some existing practices, but most of the new adopters need help in implementation of the systems that make up the whole. This community of gracious folks has functioned as a 'committee of the whole' to help each other in the past, and it is an awesome thing to behold in action.

One area that is significant, and that several have commented on,
is the knowledge transfer between different practitioners (new and old) of tips & tricks for how to use the tools to practice medicine. That is the single greatest gift of insight that this community can give each other, and I hope that DocMartin and I can capture that interaction as we kick-off some MeetUps.

In the area of documentation, there is a need for precise electronic documentation, but I also see where rich media can provide value given the proper application. More on that once I have a test case.

Spot on, Indy

Early on are the adopters who think it is "cool". By the time we talked ourselves into an EMR, we wanted it to be a toaster; plug it in, and push the "on" button.

That said, AC is clearly closer to the toaster mode that the others we explored. I really love this users group as my instructional interface. However, it is a somewhat unusual approach to support. We have grown used to a service contract and a harried tech support person in our software purchases. The tech support we get from AC directly is good (and I'm not about to drop my contract), but honestly the insights I get from you folks are much richer and more helpful as regards the actual use of the program. I'm not sure how I would go about marketing this paradigm to someone who was shopping for an EMR. Until you have experienced it, it sounds like a flakey approach.