Home Forums Discussions General Discussion Starting up AC

We are a 4 provider family practice in the process of choosing our first EMR. What was your experience getting started with Amazing Charts? Did you use an IT professional to get set up or do it yourself in-house? How long did it take you to go live from the time of installation? How did you do your training for providers? For staff? How many peripherals, such as Updox, do you use? Did you install your own interfaces for Updox, labs, PM software, or did you need an IT person to do it for you?

-- Went live three days after I downloaded it, but it was simpler then.

-- If you are going to use a Server/Client domain, then get an IT and get it set up right the first time. If just peer-to-peer, you can likely do it yourself.

-- All interfaces are rather straightforward. If you had issues, you would probably be better off on here.

4 physicians is a medium-sized office. But, you would want a fairly robust network. You still need to decide client/server domain vs P2P. This is probably the biggest issue on here. But, the initial setup is the most important. May even want to use SQL 2008 Standard instead of Express, but then you would need someone who has expertise in SQL. If they have expertise in SQL, they likely know enough to set up a network.

My suggestion: just download AC as a trial on any computer(s) in your office, and test drive it with a patient or two. It functions just like a paper chart, so you don't need anything except a quick review of the tutorials on the website. You have a 3 month free trial, so start up at your comfort level -- you can print out the encounters you create on Amazing Charts (AC) and put them into your paper charts, so you really don't have to "go live" (all or nothing) as you do with most other EMRs.

I'm using it with a peer-to-peer network and very happy with being able to handle all the IT tasks myself, with the help of a lot of smart people on this user board. You do have the option of setting up an appointment time with the Tech Support unit of AC, and they will walk you through the setup.

And post back here with any questions. We'd be glad to share our experiences.

We already have a client/server network set up, so we will stick with that.
We have downloaded the 3 month free trial for three of the providers. Comments I am getting range from "not as intuitive as I thought it would be" (from the youngest, most tech savvy member of the group) to "I feel like I am wasting a lot of time exploring/looking for the features, rather than having someone show them to me". Maybe the do-it-yourself model is not for us?

If you think AC has a steep learning curve, then I would hate for you to try NextGen, eMDs, eClinical Works, Centricity, etc. I remember being in a huge hospital-based group of about ten practices. They would roll out Logician, and the groups would literally take two to three months to learn it.

AC is simple and can be learned in less than a day. Sure, the bells and whistles take a little longer and learning the orders and ePrescribing is a bit more difficult.

But, if you enter a patient, pull that chart, and then go through CC, HPI, ROS, PMH, FH, Meds, Exam, A/P, then sign the note, it is simple. You can add templates, orders, etc. within a week. It has to be do-it-yourself. IT is for the network. There is no IT for learning AC.

Your network may or may not need grooming to serve AC to each client with acceptable performance, but it sounds like the real issue is getting the providers/staff up-to-speed with minimal fuss.

One way to go is to spend a little time with a Provider who is successfully using AC - I know that several on the board graciously make time to let other Docs come in off-hours to see how they use AC in their practice.

I know that there are a couple of options coming in the future, but that is your best bet right now.

The fall-back would be to get one of the folks here to spend some time via join-me to see how they do it remotely.

Part of it is finding your rhythm - which can be challenging. See: http://www.youtube.com/watch?v=6Va7wYcjz4E
Note Bitte: the dudes in particular.

Dear MLH:
The beauty of AC is it's simplicity. The recent encounter tab has the appearance of a medical chart. It is straight forward. Once installed, you can be on it and using it for patient visits in no time at all (minutes). A friend of mine in a large internal med practice had a more expensive EMR thrown at them and they were told to expect a 50% decrease in production over the first year of use. It was described as a learning curve!

The newer versions of AC do more and are more involved than prior versions. Learning all the Bells and Whistles will take using the program and trying to jump through the Meaningful use stuff.

One of the best features of AC is this users forum. A great resource.

Good luck in your transition!

Tom

MLH:
You ask a lot of (appropriate) questions, and the answers are not always straightforward. I will give some abbreviated advice.

One request is that you give us your name (that just makes it more comfortable to converse) and if you are comfortable with it, your location (as Indy said, there may be someone nearby who can spend some time with you and that can be tremendously helpful to your process).

1. Regarding your network: There is an ongoing debate here on the merits of client/server vs peer to peer. You can probably be successful with either. On the other hand, the folks who have responded so far are (like me) in smaller practices than you. Also, as AC gets more complex, the hardware and network demands seem to be increasing. Many are DIY'ers, but plenty here pay for IT. So, despite having minimal information on your specifics,I would suggest that you continue as you are doing now and consider changing as you progress.

2. Don't underestimate the extent of what you are about to undertake. The migration to an electronic record is far more than just creating notes on a computer. Be prepared to deal with a re-evaluation of essentially all of the work flows and job descriptions (even your own!) in the office. Also be prepared to devote a lot of energy into engaging your staff in the process. Document management, messaging, prescribing...all will change dramatically. In the interest of brevity, I will not get into this further, but please be prepared! I think that AC makes the process easier than many other EMR's in some, but not all ways.

3. The first step I recommend is creating dummy patients and having the docs play with the program first. Look at the online tutorials. There are only a few, and you may look at them several times. This work should be done outside of scheduled patient hours. IGNORE everything related to meaningful use at this point. Get a sense of how to create a note and use templates.

4. I agree that AC is far more intuitive than most EMR's. On the other hand, it can sometimes be frustrating to look for something that ultimately proves to be easy to find- once you know it is there. For that reason (and based on the comments you heard above) you might want to have one doc- maybe you- develop a baseline level of comfort with the program before having others in the group look at it.

5. Once you have played with a couple of dummy charts, then continue to "play" outside of regular clinic hours. Try creating a note based on real patients that were seen in the office that day or preceding days. This may seem like duplicate work, but I think it is a worthwhile step. Do this for a few notes.

6. Then try the program on real patients during regular clinic hours. You will see lots of talk about loss of productivity during implementation. In my opinion, your productivity will ultimately return to baseline or increase slightly. I also believe that you are asking for trouble if you try to maintain your same schedule as you convert. At the very least, try to do your first notes on real patients when you have a light schedule, or using no-shows or cancellations to give yourself some extra time. You won't need that forever; in fact, you will need a lighter schedule far less with AC than with other programs, but give yourself (and the EMR) a chance by scheduling appropriately.

7. The program is somewhat modular. As I said above, ignore MU at first. You can look at orders, e-prescribing, scheduling, etc. later. With the concerns about trouble learning the program you mention above, those things should wait until people know how to create a note. As John says, just print those notes and put them in your paper chart for now.

Keep us updated and ask more questions. There are plenty of people here who share your hope that you are successful in this undertaking.

Great post Jon!

MLH: I've been using AC for 6months. I'm not very tech savvy and it was hard at first--but that's to be expected. One of the great things about AC, as Jon said, is that you can ease into it. We started just doing simple patients, 1 or 2 a day. As my staff an I got comfortable we started using it for more patients each day and using more features (eRx, Health Maintenance, Imported Items, etc).

I'm a solo doc and have had to take a lot of time to set things up and get them going. I have an IT guy I can call, but he can't help with AC itself. It's taken a lot of time and effort to learn the system, but I have a sense of control. I am not totally at the mercy of an outside vendor. That's important. In a larger office with a couple of docs like yours, it might not be you that would have to manage everything. You might consider having one of your office staff persons be your in-house computer guru.

Be flexible, be persistent, be patient and you'll get there. But remember to smell the roses along the way. :-)

I initially downloaded AC on a Saturday afternoon, and spent several hours figuring it out. I had to call tech suppport for one question on Monday. After that, I just had to get a laptop and get Dr C to try to use it. It was that easy to figure out.

Jon, I just read your post. Those are classic (and very good!) insturctions for transitioning to any EMR. The process can be longer and/or more detailed, but those are the essentials. Good Advice!

Jon, Yes very nice post!

If your tech savvy doc felt it was not intuitive there may be issues. You need buy in by the providers.

When I have residents in the office, I sit them down and have them run through a couple training videos. They then follow me for a day anyway. I then turn them loose and they do OK.

I agree you should start with dummy charts, I also agree for couple days of lighter schedule. Ignore the orders, Rx and stuff and concentrate on basics. When that is done move up to Rxs since that is one of the nice advantages of the program. (Can't do electronic Rx in trial version.)

Workflow will likely change. Your assistants will be putting things into the chart rather than just putting vitals on the paper. You may need to go to the chart to find results. Who will be scanning papers that are brought in? You need to look at how things will work most fluidly.

First, thank you to all who have responded. What we have needed most was a chance to talk to other users. Had tried through a couple of other routes, but no one was responding to our inquiries. I will share your comments about a gradual transition with the providers. Although we have an in-house person who is pretty good with computers, we should probably factor in some time for our IT person to help, just in case.
For the record, my name is Martha Herold. I am the office manager for a family practice in Mechanicsburg, PA. If anyone out there is close enough by to give us a "tour" of the setup in their office, that would be greatly appreciated. In the meantime, I know where to bring future questions!

Martha, I remember back when I first researched this and transitioned us. An old benchmark that we used was for the Dr to only try to use the EMR on every 3rd or 4th patient (maybe) once you actually decided to "go live" with the EMR. So even after the basic training and some fooling around with it, you would gradually phase it in. Granted, this was in 2005 but the prinicple is still likely the same.

I am completely with Wayne on this one. Very simple to use. I wouldn't over analyze it. Especially, if you are going to play with some test patients.

Most EMRs force you to do what it wants to do. Don't get me wrong, once you figure it out, they can be very good. But, really, AC is just typing a progress note except you tab.

Martha, thanks for the name. If you go to your profile or preferences and scroll to the bottom, there is a place to put a signature or even something witty like Wayne's.

I just want to go on record agreeing with all the above and seconding these points.
1- "Just Testing " as the first patient, play with notes, orders vitals, pass the chart around the office, let everyone work out the WORK FLOW issues for themselves.
2- When you "go live" start with just filing, this is very quick with a good scanner, but is double work, since you are still working with the paper chart and need to put the paper in there as well. But when you have a month's worth of Data scanned in, even the least "tech savvy" Dr. will turn to the computer first when looking for that x-ray report, knowing he or she can lay hands on it immediately. At that point we set a box on the floor and put the scanned items in the box, "just in case" we decided to give up on AC. We sent the box to the shredder a few months later.
3- Start recording vitals as soon as the staff can do it but to keep those as part of the database someone (Dr. is best, but staff could also) will need to code the ICD-9 and then the Dr. can sign the note. I used a generic statement" This entry is only to record the vital signs, please refer to the paper chart for the record of this encounter."
4- Then we started trying to do one note per day, (the last of course) and later we did one at the end of the morning and one at the end of the day in AC. In order that ONE data base would remain complete, we then printed the note, and filed it in the Paper chart. That lasted only a few weeks, and then we were realized we had gone live.
5- Leave all the bells and whistles, even e-Rxing until later. Templates are great but you don't need a bunch to start. You need to start in order to find out what templates you need.

Good luck.

On work flow for example, I could NOT function without charts waiting in a rack to let me know how far behind I am, and a chart on the door to tell me where the patient is. It has been four years and I finally gave up the rack of "charts" (actually single sheets of paper to record vital signs and so forth) but I still have a "face sheet" to allow me to jot down a note while waiting for a lab to load or whatever. The work flow fix I needed to replace my "how many charts are up?" turned out to be simple having the front desk collect the copay and forward the chart, with a note re: time arrived to the MA who rooms the patient, and a copy to me, highlighted in blue, so I can ignore them, but tell by the volume if I am in trouble or not. My two partners do not bother with this.