Home Forums Discussions General Discussion V 6.0

I just want to reiterate what Bert said. I know many are impatiently waiting the "promised" features (not all are awaiting PM). The reasons for the delays, in my opinion, are 2 fold. First, the Federal government has mandated all of these requirements which, to be competitive, Jon has been forced to implement. No one had any idea even 3 years ago that our beloved EMR would have to change so radically. I know from the source that Jon has not been happy about the metamorphosis his EMR has had to endure because of it. Secondly, Jon is very committed to not releasing a program that is crappy. Granted, he was forced to release some features such as HM and MU in order for us to be paid. He knows those are not what they should be and they will be worked on further. Things such as the PM which are not mandated can, I believe, wait until he is comfortable that the product is what it should be. For one, I prefer to see a great product at the start rather than a half-assed one (although I love half-asses). I do not think anyone is more frustrated about the delays in fixing issues than are the "old" users and Jon. For those of you thinking about coming to the ACUC, I believe just meeting Jon and understanding how he feels about his product would be worth the trip.

Leslie, a non-compensated spokesperson

Leslie,

You may not be waiting on a PMR module , but I am.

When I first started using AC (November, 2007), I was told that a PMR was likely due out July, 2009.

I feel that I have been more than patient. I have been part of beta testing on a few occasions and have spent more than a few nights with support rolling back and rolling forward beta updates.

I will be part of beta on PMR and 6.0 to help the process along.

None of us are happy with the "changes" we have had to go through, but we all deal with it.

I spent 2 hours with the IT guy from our local REC(University of Central Florida). They aren't even close. THey came into my office to sell me a EMR and show me how to get my stimulus money. They want me to help get other physicians on board. They got federal dollars, I did not. We are ahead of them in all regards, except for getting federal dollars.

By the way, they started talking to me about a RHEO, fagetaboutit (slang spelling??)

Being a cynical New Yorker, I wouldn't be surprised if CMS did not give us the money in the current state of finances. I'm not waiting for the check to show up. But I will continue to see my patients and run a small business.

So let's work together for all our needs (PMR and MU). I will continue to support AC, but I can also express my needs and frustrations.

I'd love to go to ACUC, but a feel a central location (or alternating parts of the country) would be better.

Frank, a non-compensated user, poorly compensated physician, loving father and husband, die hard New York Yankee and New York Jet fan and just a squirrel trying to get a nut.

Frank, do you know when all of the CCHIT stuff started?

Sorry, I don't have a date.

Me neither. I don't want to speak for Leslie, but I think part of the reason we don't have the PM is that every time he starts to work on it, a mandate comes out.

Sorry for the delays. It has to be hard.

I was thinking about this last night coming home from work. The "big brther" or " Uncle Sam" is more maddening than the most manipulative bully in the middle school playground. Sets the rules ( CCHIT, or whatever) and then changes them ( I don't remember the name of the new hoop AC is supposed to jump through). No wonder we don't have a new PM module yet.

How come the government takes our money ( taxes) and then jerks us around in order to ( maybe)give some of it back? Last year I honestly never expected to get any of the promised incentive, for awhile I thought maybe I was wrong and we would actually receive what has been promised. This type of scenario is what generate pschiatric disease. I think Frank is right......fagetaqboudit.

Totally agree. What is frustrating is that the 14% of us that went out a got an EMR will likely be the ones that don't get the stimulus money. The government should have seen this coming 15 years ago. All they did was allow us to use the VFW EMR, which, of course, was horrible.

From my perspective, the government should stay out of the EMR business and put all their time and money into a communication system where any doctor can communicate with another doctor at any time.

And, make it mandatory that every office precept a medical student so that said medical student could teach the doctor who has no computer skills has to use the communication system.

CCHIT was founded in 2004 as a nonprofit 501(c)3 with a goal of promoting adoption of healthcare IT.

If I may throw in a few words.

First, regarding software development. How many of you docs remember your med school years? How many of you remember your residency? How many of you would say being a doctor is easy? Being a developer, like being a doctor, is hard. Writing good quality code is hard. And nothing is ever as simple as it seems. Let's look at an example:


Here we have a simple function that adds two numbers and gives the answer. Wow! That's so simple! It's simple until you stop and realize how utterly useless that function is. First, notice that it can only handle integers. What about numbers with decimal? Well, that's easy.


But now we have a second problem. First, all answers, even those that are just integers, will be in decimal format. You now have to worry about how many significant digits you get back. How many of you want an answer such as 67.530495794757 returned? What if you are adding currency? And what if the user accidentally types in a letter or other character instead of a number? In this function's case, it will crash the program. You'll get an unhandled exception error or a type cast error depending on the language being used.

I could easily go on, but as we can see what is supposed to be a simple function is actually quite useless. There are too many situations it simply cannot handle without giving a wrong or undesireable answer or just plain crashing. By the time you add error checking and the ability to return an acceptable answer despite whatever kind of number is passed to it, I can promise you this function will become several lines of code long. In fact, you may end up with an entire math library of several functions to handle all the different scenarios adding two numbers entails.

One other factor about software development is do not allow yourself to be fooled by the 80/20 rule. 80% of an iceberg is underwater where you can't see it. You only deal with the top 20%. Software is the same way in that the user interface is only 20% of the program. The other 80% is data access libraries, error checking, and so forth that you do not see yet nonetheless must be there and work for the user interface to present you with meaningful information. These little hiccups the government keeps throwing at Jon really do cost. They cost development hours and they carry a heavy opportunity cost (refer back to your Economics class for the concept of opportunity cost). Instead of working on the PM part of Amazing Charts, Jon has to work on the latest government mandate. It's like running a marathon. If you allow yourself to get a mere 5 feet behind the lead runner, you will have to bust your [censored] just to catch back up - perhaps running a whole third to 50% faster than you were. Nevermind actually passing the lead runner. The situation Jon is in with writing code for government mandates in lieu of writing new features for AC is just such a marathon.

Secondly, government.

Believe it or not, I think what the government is doing with HIPAA is, overall, a good thing. I see more records electronic now than I ever dreamed possible. I'm sorry to say this, but doctors are slow to change. Most of you HATE computers and if left to your own devices would stay on paper doing what you are doing now the same way you have been doing it for the rest of your natural lives. None of you would change. It would also be impossible to switch doctors just like it was back in the 80's when, if you did switch, the new doctor would re-do all the work the previous guy did instead of trying to read his notes. Of course, that is expensive.

Is this to say the governent is doing a bang up job? Of course not. As usual, too many people have their hands in the pot, and rightly so since they all have a stake in whatever comes out of the situation. The government isn't to blame for this. Your next door neighbor is since he/she probably voted against you in the last election. That person told their senators that they want cheap healthcare and the ability to have their stuff securely moved from one practice to another so they could have choice. The problem, of course, is you have to buy a system that can do all that. The government does what the flavor of the month is and has no 15 year outlook. The reason, of course, is that voters do not have a 15 year outlook. We vote for people that will do stuff for us NOW. To hell with 15 years from now. Besides, who knows who will be in office by then, anyway.

I know many of you are frustrated and I empathize. I truly do. Please be patient and understanding. I'm sure Jon will come through. Unfortunately, for the time being he can only promise you blood, sweat, and tears (Churchill).

Thank you all for your time.

JamesNT

I would only disagree with two ideas:

1. Most of us don't hate computers. Most of us love them and love EMRs or we wouldn't have sought out AC. It is a lot of other doctors, that high percentage I cannot quote, that needs the lure of stimulus money to buy an EMR. Or it is that doctor who works for the hospitals and FQHCs if have no choice, that hate computers. We don't.

2. Our nextdoor neighbors voted for congress to do the right thing. They aren't. It is the government's fault. And, insurance.

Bert,

Seriously? I would have thought the Churchill quote would have impressed you!

JamesNT

Churchill and the British government impresses me. The U.S. government, not so sure.

James,
It goes without saying that we are well into the ?subjective? area; these are just my opinions, and understand that I don?t speak for physicians, AC users or really anyone but myself.

1. This is not an issue of ?doctors vs. programmers? or who has a tougher job. No one is saying that this is easy. Users are stating that we are anxious to have the promised upgrades to the program, anxious to have them within the promised time frame, and anxious to receive information about delays as they become available. We would also like to make our priorities in the area of program development known to the company, and have an impact there. Although AC is not perfect in these areas, I think they are significantly better than most of the ?big guys? in the software world. But EMR development is a fast moving target, and while there are some terrible products out there, other companies (e.g. Practice Fusion) are setting a high bar with regard to development speed and customer responsiveness. As I have said before, we all have a stake in the success of AC, and I think we should keep pressure on the company to continue to perform at a high level.

2. With regard to government intervention, in my opinion the issue is not so much ?bad ideas? as it is ?bad implementation?. I think physicians are slow to move to electronic records for many reasons. Just one reason is the high cost of doing so. A ?stimulus? program (really, a ?partial reimbursement? program) is appropriate to encourage the transition. What followed enactment was an ongoing series of mandates and requirements, many of which are still to be written and many of which are worse than useless. I am probably in the minority of physicians with the view that the government does have an important role to play in this process. I just think they are continuing down a road of very poorly implementing some good underlying ideas. And yes, the software industry takes some blame for this as well. Overall the quality of their products in this area is poor; I am not speaking of AC now, but most EMR?s are inadequate. Plus, they are taking advantage of the situation: the software is a relatively small part of the cost of EMR implementation to the physician. But these companies greedily price themselves close to (or exactly at!) the level of the stimulus rebate, hoodwinking many of our colleagues into thinking ?well, we are getting it back anyway?.
At the end of the day, we (and AC) are left to work our way through this.

Who says I am slow to change? My 1816 stethoscope works just fine!!

James, also remember some of us on this board have "technical" backgrounds. Like Bert. Like myself. So we know what's involved in writing software. I used to write real-time control software. Languages like C (not C++) were New! Really. We know it isnt "just software."

Thanks Wayne. So true.

Jon that was a brilliant post. You never cease to amaze me.

I agree with Wayne completely.

I think, though, that James means well and his grammar, syntax and spelling were a thing of beauty, but like me, it doesn't always come out right.

Alright, where to begin...

Jon,

First off, thank you for once again showing me that I have a lot to learn about the people that hang out on this forum. I am quickly coming to the conclusion that the doctors that I see here are a small subset of the population that does indeed rise above the rest. I am seeing much more technical expertise, willingness to be open minded, and a more in-depth of understanding. I respectfully request that you and others here consider the fact that this is not what I am usually exposed to. On the front lines I continually see practices that are poorly run, with crappy IT, and doctors that seem to be utterly clueless. Mind you all, not all of the docs I know are that way, some are downright fantastic, but they are in the minority.

Wayne,
Real-time control software? Impressive! Sigh...you have me nostalgic for the days when I used to draw on paper all my little boxes and arrows that represented all my little pointers in whatever C program I was hacking on. And I do miss doing my own memory management.

NOT!!

Bert,
Thank you for coming to my rescue and for the complement on my writing skills! You are quite correct, sometimes what I say does not come out the way I meant. My forever curse.

Everyone,

My sincerest apologies. It appears I have once again turned left when I wanted to turn right. As Bugs Bunny would say, "I knew I should have taken that turn at Albuqurque." However, it appears everyone probably knows where I am coming from. It's all, as usual, a matter of giving everyone a chance and realizing what kind of backgrounds and past experiences we all have and that those backgrounds and past experiences can be vastly different.

Thank you all for your patience and understanding.

Regards,
James Summerlin

Don't be too hard on yourself. What you wrote made perfect sense with just a few detours to Albuqurque. I have always said that Jon's mistake has not been not meeting deadlines, but rather making them.

As does Bill Gates.

First this is a great thread with a lot of good points.
I just want to add one observation for Yankees fan, which goes with Bert and Leslie on this. At the First ACUC in Branson we were all excited to hear Jon roll out his first parts of the PM module. I personally was overjoyed to hear that the first thing he had done was dump the usual format in the trash and start with something which much more clearly would show a simple Doctor, what you charged, what was paid (on what) and what is owed! No debits and credits etc, just plain English served up on a bun of common sense. Then a lady in the audience that was the biller for a large group asked a pertinent question. She said she didn't care what you want to call the debits and credits, (which they will of course remain, no matter what you call them), but she hoped she did not understand him correctly to mean that his item entries would not be posted in a ... (vertical column? I don't remember exactly this part). He said, yes why not? She explained that all of the posting is done by a ten key and the enter key, his plan you would need a mouse click for every entry. The room went dead silent. Afterward he turned back to address the room and said, Oh my God, I am making the (blank)(not e-clinical works, but some other retarded EMR) of billing systems. Then he said, OK this will take some work. I know for a fact that since then he has sat down in focus groups with some of us and taken extensive notes about how we want to capture the data, (AND WHAT DATA WE MIGHT WANT TO HAVE AT HAND AS WE WORK). If he can do one tenth of what was discussed, it should be awesome, and I believe well worth waiting for. At least well worth waiting a little longer. (lol)

James,
No need for apologies. Sometimes we agree, sometimes we disagree, and sometimes we are just speaking in slightly different languages. I think that Martin is making a point similar to yours, just in a different way.

Martin,
Thanks for letting us know that Jon is regularly meeting with focus groups to get input about this. That is reassuring.
But really, did you have to call Frank out like that? We all silently agreed to ignore his confession of a character flaw, and then you had to refer to him as a Y**kee fan!

James, I wasn't offendd, but I did want you to be aware. I think I have a hunch about the technical backgrounds of who you are used to dealing with.

Oh, I cant write much software NOW. Have a hard time with an excel macro, but I think its just a mental block since deep down I really dont want to.

When I look at the list of users want in the way of fixes and functionality, and I look at how Updox is a useful extension for several practices, I wonder if it wouldn't make sense for AC to focus on the core system, PM, and integrating with third parties that can move the ball forward on the functionality outside of the core.

James,

Having met some of the folks of the board in person, there are folks who started out in engineering, business, technology, MBAs, who then turned around at various points and became doctors. Some of the sharpest folks I have ever had the chance to rub shoulders with since my boat school days.

For a variety of reasons, there is nothing average about this crowd.

Hey, Indy, you forgot to mention those of us who started out as mule skinners!!

Once again, I think we need to cut James some slack. I think what is important here is remembering what everyone's personality and style here is when they post.

For instance, I knows that Indy is technologically brilliant and his posts are generally so far over my head, I need a hot air balloon to understand them. But, his contributions are immense, and he is not afraid to dumb down his statements when I ask.

JBS always has something incredible to add even if it is at the expense of me, lol. (And, no, you don't need to compliment me on that one.

And, John simply can't write a bad post.

As for me, I either am very helpful and add a post and a download that took hours or I am so opinionated that I have to correct the same premise in the same thread at least five times to the point where I am sure each poster wants to ban me from the thread.

I have stated at least a million times that coding can take a lot longer than even the author thought and that Dr. Bertman should come on and say so. I have also stated that it is not missing the deadlines that get Jon into trouble, it's stating them in the first place. But, I don't think my thoughts come across sharp enough.

Then James articulates why code can be so different, albeit it comes across a little self serving, but all in all, it shows us average users how difficult coding is. Hell, it takes me a day to write a script.

So, I look at James and think, OK here comes a post that may be a little self serving, but 1) that is not intentional and 2) it is very helpful. James does something that a lot of us don't do. He goes back and reads his posts and reiterates what he says if the feedback warrants it. He also lacks the perspective of using AC and, therefore, being less frustrated than the rest of us.

I, personally, take some of his posts with a grain of salt just like I imagine most of you take mine with the entire Morton's salt container.

Personally, I am going to one day ask James for a batch file or script.

So, let's go easy on him, realize his intentions are good and not be so judgmental. I will still pick apart his posts when I find them to calumniatory.

I started out in social work! Anyone want to talk feelings? Well forget it! I'm not a social worker anymore. (or am I?)

I like AC, it does the job, especially with this input of this forum. It is like a good performer...always leaves you wanting a little more. They (AC)will deliver in time.

I once worked on a computer that was the size of a city block. Does that get me any points? I love computer and especially love my emr, Amazing Charts. Would like the PM module most of all.

Okay I can't stand it - looked in my junk room - Commodore Vic-20, Commodore 64, TI-994a, Sinclair ZX-81, Apple II+, and the CPM machines and TRS-80s went back to my uncle ..... seems not that long ago.

What about your Atari?

I had the Atari 2600 videogame and actually had the BASIC programming cartridge although I was on EBay recently pricing Atari 400/800, Commodore Pet Computers and other 'vintage' computers until my wife told me to move on....

I started out on a mainframe in the early 70's that I accessed via teletype and yellow paper. We didn't have to do card backups, we used paper tape for backups.

Somewhere in storage I have my original slide rule, 2 ataris, 2 commodores, an original Mac(with signatures inside the case), and variety of now museum pieces.

All said, I am loving being back in the development business after all these years.

Two words: punchcards and Fortran.

i remember those darn cards. and fortran

You are sooo right!

The Government and the Insurance Companies ARE the PROBLEM .

Solutions: Government - go to GOOOH.COM and bring REAL CHANGE .

Insurance - All Medical Providers Quit Taking Any
& All Insurance

The media will cover it immediately and with great vigor.At that time ALL providers should advertise and get on camera as much as possible and explain that if you take all of the money paid to Insurance Companies for what they call "Healthcare" it will pay for the actual medical care for the entire American population.

I'm in!

Oh I forgot - Fortran, Cobol, Pascal, and a really rare Apple Logo.....

Started with COBOL, IBM basic, PL1, Beta of what became FORTRAN 84 then spent some time in the wilderness with Unix and variants. Eventually things like dBase, then OMNIS5, OMNIS7, SQL Server (before M$ bought it from Sybase), Oracle, etc.

That's enough, I'm starting to feel the miles.

OK, even though this thread has been hijacked at least five times, I say we go with either 6.0 or healthcare as in BTMRMOM.

Since this an <authorized> topic mod, let me ask how we (as citizens) might go about displacing 'insurance" companies?

No love lost there, but to use the technology term, how do we go about dis-intermediating such companies who are not providing medical care from actual providers?