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

I am really amazed, Bert, at the amount of time you put in for the benefit of AC. I really do appreciate the "family" flavor of AC as opposed to most software, but I agree that the company seems to rely on the goodwill of its users to an excessive degree. It really should be their place to create a good users manual, for example.

And, Steven, I really disagree with your perception of how easy it is to jump into an EHR, even AC. I've been using computers since I had to program one that i built on a breadboard in hexadecimal 35 years ago, but this was a big step. Sure, if you consider typing the history and physical into the appropriate fields and finding a diagnosis on a standalone machine as having learned the program it can be mastered in a couple of hours, but that is the trivial case. The reality is that a lot of us operate in a multi provider environment, the EHR totally nukes our accustomed work flows, there are new network issues, and scanning, faxing, and add-on programs that all have to be mastered at once. Otherwise, you might as well type everything into Word and pretend you're using an EHR.

When I posed the question "is it just me?" on a thread a few months ago, I was struck that many responses made it clear that those that insisted this was easy started with an early version, just filled in a few fields, then were all proud that they had it mastered in a day. The reality is that to integrate AC as it now stands into an existing practice is like having to learn all the bells and whistles of Photoshop or the Microsoft Office suite. Yes, Bert, we're bright, and yes, we can do it. But please don't belittle those who are telling you it's a difficult step. If you think it should be easy for them, then I suspect you don't understand the question.

OK, I will probably lose all the accolades I have earned over the years with this statement. But, I really don't care. My mind is open, I just don't like what it is open to. I will do as much as I can to enhance the board but only to be helpful.

It is Jon's responsibility to provide support, not ours. The board, with all due respect, is not to provide support. If a person asks a question, I will do my best to answer it, even if 25% of those don't even acknowledge my/our work and even have the courtesy to reply with an answer. If they PM me, I PM back. If they email, I will email them back. I will remote into their computer as I have many times. I will call them back on the phone. I would even travel to Portland to set up someone's system. I do this because I want to help. Not to provide support, and I certainly don't do it to recruit prospective users. I couldn't care less if a user purchases AC. If they do because of my posts fine. But, I am not going to spend my time turning the board into a blog. It just can't be. And, if AC crumbles because no one purchases it, well I will go buy another EMR, learn it, and help out on that board.


My statement is completely relevant in that it responds to what Deborah said. Again, at the risk, of pissing people off, I don't care that doctors are petrified of an EMR. They can stay with paper. If they are intimidated I don't care. AC is the easiest EMR to learn. Steven and I say that, because, speaking for myself now, I am tired of hearing how difficult it is. I use AC. I learn AC. I teach AC. But not so other doctors will get over their intimidation and purchase it. It is because I enjoy helping people.

Again, I will look at organizing posts. But, the user board is not for support. It simply has, by default, become the only form of support.

David, I don't belittle anyone or that is not my intention. I am simply saying the board should not be the support for them. It already helps many users.

And,I agree with Steven. I downloaded it on Friday and the MAs and receptionists walked in on Monday and we started right then. Everyone can decide on their workflow. I guess that is the difference. It mirrored ours completely.

I guess I should bow out of this thread as I am getting too frustrated.

Frankly it comes down to this: There are two camps. One camp wants to take on all of the support lacking from AC by reorganizing and turning the user board into one large encyclopedia of knowledge so that all new users can learn AC effortlessly. The other camp wants to continue to use the board as 1) to help others and give opinions in threads as to how to make AC better, bitch and complain and generally have fun. That is its only intent. I am firmly in that camp.

Let me reiterate that I do not think you can master AC overnight, but if you start with Version 5 and not having used older versions you should be able to get it turned on and start integrating it into your workflow very quickly. Getting the network up and running is the first step - then starting AC and entering new patients, using the scheduler should be second, generating notes (with or without templates - I type fast and really use very few templates) next and then adding labs and imported items. If you start and add one step at a time you can always spend more time refining things - I think if you did not have an EMR before then you shouldn't need all the nuances on day 1 - I used AC a long time without using advanced search capabilities, lots of templates, etc - now as I find and refine something I think it is great - being able to find all patients on Avandia (or whatever the media hypes that week) or figuring out when I last saw patients with a particular diagnosis is a great ADDITION, but when I used paper charts and sticky notes it was much more disorganized.

I started AC back in 2002 - just used it to generate notes and just evolved.

Yeah that.

I am a computer geek at heart, but I also have helped other practices with virtually no experience learn the basics of AC. I am amazed that some offices still have no electronics (maybe one computer) - I think the hardest part of starting with AC as a very limited use is getting your network up and running.

I have worked with many versions of Amazing Charts including some that are very buggy and have survived - the program could definitely use a manual and I hope that someday they get one, but I almost never used a manual for Microsoft products like Office as they usually are unintelligible and disorganized.

Don't get frustrated Bert. I have to be one of those in your camp on this. It's AC's job to provide docs with the basic workings of AC.

This forum is great for learning different ways of workflow (thanks Leslie), shortcuts of the program, what hardware some people like and don't like (we definitely know Bert hates Brother), and simply asking a question where the answer isn't so obvious. Ah hell, sometimes I ask questions that are obvious, just not to me.

I think the only real thing the forum needs is a better search function. That's it.

Bert,
I won't tell you not to get upset b/c you usually fly off the handle, get passive-aggressive for a day, and then you're fine. You have put in more volunteer hours than (I would presume) some of A.C.'s paid staff. NO JOKE. You helped more people than can be counted, including myself. I find it EXTREMELY irritating that sometimes you help someone in a post, and a person NEVER replys w/ a thank you! Don't take me the wrong way, most people on the ACUB love you and appreciate you and MOST show well earned respect to you. But some don't thank you, and some don't always demonstrate respect for you. You are an iconic figure in the HISTORY of A.C. If there are credits that play when the A.C. story is told, "Alert 'Bert' Adams, MD" would be near the top of the cast of players.

I will say in support of the ease of AC, it's ridiculously simple. The best way to learn is to do what I make my medical students do every month, just start using it.

Steven, you are right about integrating AC as much or as little as you want. Transition into it. Isn't that what we tell our patients every day? "hey doc, I want to start an exercise program." [OK, these ease into it.] OR "hey doc, I want to quit smoking." [OK, then wean off the cigs.] OR "hey doc, I want to start zoloft." [OK, start low dose and titrate up slow.]

We don't HAVE to learn all the features and use them all at once. If you were using paper before, then keep using paper for certain things, then learn more and integrate more, then use less paper.

Here's a tip: setup AC, and practice on it for a couple of days or weeks simulating office calls, ordering tests, setting up a fake patient and entering fake office visits. Let your staff play on it, you play on it. Try to break it. See if you can fix it. Press random buttons and see what happens. RIGHT CLICK on EVERYTHING and see all the hidden features to discover. Then set up your network, get everything in place........ready.......set.......GO!!

I am not screaming, just emphasizing the following::::
THANKS FOR ALL YOU DO TO HELP US BERT. THANK YOU FOR YOUR COUNTLESS HOURS SPENT HELPING THOSE IN NEED. YOU ARE TRULY A TOP NOTCH INDIVIDUAL AND MAN OF GOD. THANK YOU FOR ALL YOU HAVE DONE FOR ME, (EVEN THOUGH YOU ARE 1.2MILES AWAY I HAVE NEVER REQUIRED YOU TO COME INTO MY OFFICE TO HELP INSTALL AC B/C IT'S SO EASY) YOU HAVE TALKED ME THROUGH MANY SCENARIOS IN WHICH I NEEDED HELP. THANK YOU FOR CONTINUING TO REPLY TO PEOPLE'S QUESTIONS EVEN THOUGH SOME NEVER EVEN SAY "THANK YOU BERT." THANK YOU FOR BEING A GREAT FRIEND (I HAVE THE ADVANTAGE OVER ALL AC USERS IN THE WORLD B/C YOU ARE MY BEST FRIEND......AND I AM YOUR ONLY FRIEND......HAHA). THANK YOU FOR PUTTING UP W/ OCCASIONAL INSURECTIONS ON THE ACUB. THANK YOU FOR MAINTAINING ACUB FOR WHAT IT IS, EVEN THOUGH I RARELY POST ANYMORE.

I hope AC never makes a users manual, I've never read one by any manufacturer that was good. It's a waste of their time to make one, time better spent getting AC accredited by Medicare so we can participate in the big bonuses next year. ACUB isn't a user's manual, it's a user's forum. Let the user's vote on what they want. My vote is: keep it the way it is.

Hi folks,
Haven't had much time to be on the boards recently, but was excited to see Adam's name on there-it had been a long time.
Not sure what the conversation is/was, but wanted to say thanks especially to Bert. Bert has been an incredible resource and friend-going way above and beyond what anyone would ever expect. You presence on here has truly been gift!!

Adam, it has been a while since I have seen you on here and am glad to know you are still there in AC land. I really value you as a friend and invaluable resource!! Thanks also for being a prayer partner at different times.

Steven,
Thanks for your help with Version 5. It is an incredible upgrade with so many new features. Thanks for your help along the way.

Thanks to all the AC community. It is the community that is the richest part of AC. Most of us are in small or solo practice. It's nice to have those AC buddies out there who know what we are going through.

With deepest respect and gratitude.
Vicki

I also appreciate the user board. But I have to come down squarely on the side of those who want a users manual also. For late at night when I have done something stupid and I'm scared and most of you are asleep...

OK, my turn. First, I am not thanking anyone or this will get way too sentimental. I say, you're welcome to both Vicki and Adam. That was an incredible post Adam. And, he isn't kidding when he says he is my only friend. For the most part.

I would like to make two observations or two statements or whatever. First, I have commented to a few people on here via PM that AC hasn't seen such a large, enthusiastic, motivated group of new users on the board, well since I can ever recall. As I posited, it is probably a combination of v5 (with more questions from new users and old that has revved up the 'economy'), the ACUC and all of the stimulus stuff. But, it has been great to the influx of new ideas and having new people to challenge the older user's hard held beliefs. But, then for me, that changed. It suddenly became this movement of how difficult AC v5 is, how everyone must do their part and help the new users, hell help the person even considering purchasing AC. Fill in where AC doesn't. This isn't to say that we have seen the board for years, and we don't want it to change. In reality it can't. But, for those of you have haven't seen the age of giving Al Bourgues EMR asylum during Christmas two or three Christmases ago, the EULA wars that lasted longer than the French and Indian War, the Paul blogs that were extremely well written, but took an hour to read (God bless you Paul), the double log-on, your post didn't take days where this became the number one issue ever on AC (I forget who found the fix for that, but I had a lot of fun stretching the solution over 24 hours. There was the next huge issue of finding a solution to the horrible medication databases (sorry to sound like I'm bragging here), but I made the pediatric one, and Brian Cotner made the FP one. But, this board continues to be the voice of AC users, and it probably always will be, and I don't think we can change a user board.

Finally, to comment on what Adam said, and I appreciate what he said about the thank yous, I do think I get thanks for everything I do. Frankly, what bothers me is not that (because it rarely happens), but when someone asks a question, and either I or another user either quickly or with a great deal of research puts for an answer and never hears back. This doesn't help anyone and, frankly, it does feel as though that person didn't care at all about the time you took. Personally, I just want to know did I make a difference. And, I want to learn.

I am definitely on the side of a user manual. I am not on the side of change the board so it becomes one, or being made to feel as though I need to be mentor or do things so that doctors who are afraid to make the leap will leap. And, no offense to anyone promoting mentors or using that idea differently.

Short of a user manual, how about if AC simply is brutally honest and says which features in a version are not ready for prime time. I spent a huge amount of time trying to use 2way pharmacy communication until I finally realized it is better to wait for the next version. I also tried to work with minimal hardware on version four before coming to the conclusion that Microsoft basically forced me into a server. Had I not had those problems, my transition to EMR would have been textbook easy. AC needs to catalogue things NOT to do, or things that can't be done 'yet' so the forum can guide what needs to be done to improve the program. I was helped by an afternoon at a Kansas City pediatric office seeing how they implemented AC. Without that help I would have been even more lost starting. I hereby publicly volunteer to do the same for anyone wanting to visit Nebraska. Bert, thanks for all you do and in the event I may have forgotten to thank you in the past...I sometimes get caught up in reading the forum and may drift to other posts before getting back to my questions.

I think I went to Omaha once to interview at Creighton. I guess one of those 12 medical schools I mentioned above.

I hear you on all of your ideas. Reading between the lines, I think you are saying there should be "minimum requirements" like a lot of software programs do. Such as this much RAM and this much hard drive space, etc. I am sure there are still a lot of people out there still running with 1GB on workstation. I was until I upgraded to 2GB RAM which is the max on the workstations. I, of course, have a lot more on the server. But, if someone is running WIN7 or even XP plus SQL Server Express that is way over 1GB. So, rather than spend weeks trying to figure out why everything is slow, you could have started with 2GBs. A lot of those minimums will say minimum of 2GBs for the main computer. We recommend at least 3GBs.

I think of lot of my frustration stems from the fact that we have this incredible EMR designed by a physician that, due to government regulations and a PM (that a lot of people want) is going to be neglected. There is simply not enough time.

Speaking of new users, I feel terrible having to tell them, sorry, the letter writer is not going to improve, etc.

I guess I don't understand business and Jon certainly knows more about the direction of AC than I. It just seems like there must be two schools of thought. One would be that you already have your niche market making AC the fastest growing EMR in the country. So, you could go back and just tweak it until it is near perfection. The other would be that if you don't continue to evolve you will get left behind. Don't know.

The best school of thought is a combination of both. Of course, that can get expensive and need a larger crew of programmers to get it done.

You have to rooms. One room is perfecting AC on the EMR side. Make the letter writer more robust, make orders a little more seamless, enhance the abilities of the scheduler to match competing EMRs. These people should be testing other EMRs that people like and figure out ways to bring AC to that level in the weaker areas. Go to several docs offices like Bert's or mine and watch how we use the system, where it slows us down, where it can be better, where it shines.

The other room is the room to keep you from getting left behind. Its the PM developers. These people need to have a hang out with actual billers in various specialties offices to see what is most needed from a great PM system. AC will find out that there is no perfect PM system in existence and I doubt they nail it on the first go-round.

Both rooms need field experience in more specialties than just family practice. On these boards we have general surgeons, ENT, ophthalmologists, peds, IM, GI, FP, Nurse practitioners, ortho, PM&R, etc. So a broad range with broad needs. In the end, we all need a good documenter, report keeper, scheduler, orderer, letter writer.

Good post. To be at the ACUC, you would think there were no other users but FPs.

So, I take it you thought my Word document system was too convoluted, complicated, crazy or too cool? I am using it now pretty much exclusively.

Thanks Vicki,
You are likewise a friend and I'm still alive and kickin'!! Haha. I don't hardly have time to post, but still lovin' AC.

Well, it looks like I need to clarify a couple of things here.

1. At no point did I have any intention of criticizing Bert or minimizing his contributions to the AC user community. In fact, the opposite is the case. Most recently, I said “There is no question that saying you ‘do your part’ is a gross underestimation. What you do is miles beyond what anyone would expect.” Bert, your response, and the fact that others felt the need to come to your support, suggests that I came across as being critical. That was not my intention, and if I did so, I apologize.

2. My goal in initiating this thread was to call attention to the challenges I perceived to be faced by new and prospective users of AC, and to see if others shared that view. I also wanted to see what could be done to reduce those barriers, with particular attention to what we, as a user community, could do to help. One of the initial ideas I floated was to create a new forum, so that in addition to “General Discussion”, “Tips and Tricks” and “Tech Talk”, there would be an area with information that new users might specifically be looking for. My thought was that after a thread went “dead”, if it had such useful information, it would be moved to that area. When that idea didn’t get much support, another concept was “tagging” those posts or threads so they could be more easily identified. If that is not popular either, then so be it. At no point did I suggest eliminating or somehow limiting what has been done on this board.

Bert said “the board has always been very helpful just that way it is, and I don't want to discourage people from using it the way we always have. Questions, answers, comments and fun.”

You will certainly get no disagreement from me on that…everyone who has been enjoying and benefiting from the board should continue to do so! I was talking about an addition- no subtraction was intended.

3. Support for new and prospective users of AC is an important issue to me. For altruistic reasons, we all want to help this community grow and prosper. It really goes well beyond that. Although I am not really concerned about Jon’s profit margin, the success of his EMR does matter to me. Even looking at it from a selfish standpoint, the user base must grow for the program to remain successful (or even to remain in existence). I think it is in our own best interests to help bring new users to the program and to ease that transition. So here is where we do disagree.


I don’t want to be forced to make the transition to an expensive, bloated product because AC isn’t around. I would like to do what we can to expand the user base. Providing help, and yes, support, to new and prospective users is one way we can do that. And I believe that we should.

Time to put my foot in it again, I guess.

1) Yes, AC ITSELF is easy to learn, at least for the big, basic functions. If it had been just me and a standalone computer starting a practice it would have gone very easily and quickly. However, it is the permutations and combinations of users, networks, work flow, patient re-education, faxing, importing, patient notification systems, etc. that is daunting. And, no, it doesn't always work to do just a little bit here and a little bit there; once we pulled the plug on our old semi-automated system we HAD to get the new system up and running to fill its place, and we had to pull the plug to start with AC. You can't always jump off a cliff in easy steps. And, it does somewhat discourage me from sharing my problems here when, after yet another session with my IT folks or one of the users who has just had some function crash there is yet another posting on the board telling everyone how EASY this all is, or how grateful I should be that it is not lots worse.

2) I can't imagine how Bert can do what he is doing. Somehow "thank you" just is not sufficient.

3) Even a poor manual is better than none.

David,

Good points. Very good. I guess I forget the benefit I had. I worked for another doctor and we had what I would call client/server without the domain. We had a bad EMR, but I cut my teeth on networking there. When we added AD, there was nothing to learn about the computers. We never faxed to PC or PC to fax and didn't use Imported Items; still had paper charts for that.

Then, I had two months to set up my office, and I set the network up just how I wanted and set up my Muratec --> Toshiba --> Xerox and fax server. All with server and backups. So, it was simpler, all the patients started fresh with AC.

THIS IS WHY I want to jump through the screen and help set it up. I have helped a few people with that. I will say it is that group that tends to take the information and never come back. But, a lot of gone back and forth and appreciated it. Again, not the thanks, but the feedback.

I totally disagree with others about a manual. I have had to install ESET antivirus, Trend Micro antivirus, SBS 2003 and 2008, two Fax servers and many more things. And, all had manuals that I either read verbatim or referred to them.

When we set up AC in our office in March 09, we often came to the user board and searched on a topic. My computer guy husband did this for any issue we had and actually he always found the answer to his questions without even asking a question, just doing a search. He used this board like a user manual. We also have a neighbor who is a lantech for a school district who answered some hardware questions and such. So we went from nothing to pretty much paperless and eprescribing just using this board, ac tech support and "networking for dummies" without much difficulty at all. It is my feeling that Bert did pretty much jump through the screen and help us on our way.....and thanks Bert.

You're welcome.

Thank you for your post and for clarifying things. I am not the least bit upset by anything you said. In fact, I would like to thank you for starting this thread and keeping it running. I agree with 90% of what you are saying.

I, too, would like to see AC remain solvent. I just don't see my role in that the same way you do. I think the more that buy the software the better, but I just don't think I/We should shoulder that burden. By that, I don't mean not help. I can't help but bring people to AC, because I simply try to help so much. It just is not a mindset.

I guess I feel differently about things because my perspective is different. I have been using AC about as long as anyone. Jon appreciates everything I do, and I feel guilty every time I say something critical. AC is on the precipice of being something great, but I think getting there and staying there are much more likely if Jon and AC do what they need to do than what we do. I should preface this by saying 1) Jon has built the company, and I have written not one line of code and, 2) Jon continues to sell the product. I think this is one of those cases where the company won't necessarily get better by moving straight ahead but maybe changing to the original tenets and core beliefs of a small, efficient and inexpensive EMR. Boston Market is a great example of a fast food chain that nearly went under, because they became successful and then expanded too fast.

What is frustrating to me is that we are supposed to fill the gap where AC has not. I/We have made it known over and over of the little fixes that we as users and doctors, etc. find helpful. We have talked about the letter writer and the ICD-9 codes and other things that have never been changed. I think we could do more to help AC by using it and ALL of us being beta testers everyday so that collectively it continues to be more and more a part of each provider's work flow.

Now, that is not to say that making the board a better place to learn is not a good idea. Many don't know what I can and can't do as a global mod. If I had admin powers, maybe I could do more. Trying to find ways to make the board a better avenue to learning is fine. I guess I chose my side of this issue (not that there is an issue here) when there was talk of having two separate boards. Or ACUC for new users, etc.

Finally, I will (as those who know me know), try to help anyone and everyone. This, by definition, will help new users and prospective users. But, I am not going to mentor someone or spend my nights worrying about doctors who are scared to purchase an EMR or get their feet wet. If I were, I would write a book.