Home Forums Discussions Problems What's Up with Tech support ?

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I am a big booster of AC support. I also understand that there were issues related to Hurricane Irene and loss of power earlier this month. On the other hand, I have to agree that in recent weeks it has been far more difficult to get through to someone on the first attempt. This is especially frustrating since we regularly receive a "bounce back" message on the emails that we submit, similar to the one that you sent.

Of course, messages to the users board never bounce back! Your message above included your issue, and here is the answer, mostly courtesy of Wendell and Wayne from a past post:
Do a search on the incorrect insurance name. That will give you a list of all the patients with that insurance. Then on each individual patient's demographics, change it to the correct spelling. Once there are no more occurrences of a particular incorrect insurance, it will disappear from the list. You will likely need to shut down AC and restart it to have the change take effect.

Again a simple notification on the board about why the email system isn't working would be fairly sufficient.

When the Live Chat system and the email system isn't working, there is essentially no tech support.

But there are always folks like you, John and Bert, who are incredibly helpful!

Same exact thing happened, I also tried emailing them directly, absolutely no answer, although I did receive a read receipt.

Quite unusual for them.
It would be nice to know that there are "technical tech difficulties" if they are experiencing them.

I also have been finding contacting AC a nightmare lately. Phone yields no results or return call (just message). Chat not available. I have emailed Jon FOUR times over the last three weeks requesting a reply to my email (answer to his with questions) and I have not had the courtesy of a return email, call, etc.

I am getting quite concerned.....

James P. Clayton, M.D.
Red Hook & Yacht Haven Family Practices
US Virgin Islands

I was able to chat today. Vance told me "You know, I have not heard of this. However, recently I have sent a few E-mails to clients that I know have been valid E-mail addresses, and I got that message sending an outbound E-mail. There may be a problem, I will let the higher ups know.

Because they never (or almost never) look at messages on this board. It really would be worth their effort. Imagine how many emails and tech support chats they could have headed off by an official response to several recuurent issues posted here.

Thanks for letting us know, NY2GA! It appears our email server was bouncing back support requests when "all agents are busy" rather than delivering them to our agents. Thanks for alerting us - we have now determined where the problem is, and will have it resolved within the hour.

Hopefully this will explain the unusual experiences reported by some users above.

But as much as it is frustrating to not be able to reach us when you need assistance, keep in mind the bigger picture:

1. Every one of our > 6500 clinicians has paid less than $1000/year for support, maintenance, and other features, compared to the common $1000/month that users of other EHRs pay to their systems (and/or allow their EHRs to sell their patient and practice data to pharma companies and God-knows-who-else in lieu of money from the clinician).

2. We are consistently rated better than other EHRs in terms of support, usability, and overall satisfaction, in multiple studies.

3. Emailing me personally is the riskiest way to get a timely response because I get so many emails, and frankly because I have been spending nearly all of my time working to ensure we get our Practice Management module complete and into beta release this year, and get the other fixes discussed on the board and at ACUC into the program ASAP. I will eventually get back to a personal email to me, but if you need immediate assistance, email our tech support department.

4. Of the many thousands of unique practices using Amazing Charts day in and day out, here is the current tally of outstanding tech support issues: 190 open (aka unresolved) support tickets. In other words, far less than 0.1% of our customers currently have an outstanding issue (although 190 is still a lot, especially if you are one of them).

As of this moment, there are 36 clients that have not yet gotten a response from us (granted, since we weren't getting the requests as noted above, there could be a significant number more who submitted for help, and didn't realize that their request didn't get to us)

(This doesn't include 180 clients who are scheduled to have us assist them with their upgrade to V6).

While there is room for improvement, all things considered, I would say we are doing a pretty amazing job - especially when you consider we not only rank better than othe EHRs, we are markedly less expensive. True, it isn't easy doing so much with so little, but it is what we are all about. So thanks again NY2GA, JBS, and others who provide us constructive criticism, their support, and the benefit of the doubt when problems do occasionally arise.

Jon

Jon,

Thanks so much for your post and explaining the issue with the email and the amount of support requests. In fact, I think I speak for others when I say that while the support issues you outline are important, the president of the company coming on and communicating this has a larger impact.

I think more communications such as these explaining how much Amazing Charts knows about very difficult bugs and what they are doing about it goes a long way toward user satisfaction.

I know this paragraph will be controversial, but there are likely many users that would not be averse to paying more per year to increase support especially if the extra weren't per doctor. I think that the two most important things which make a company successful are the product and the support. Especially when a product is similar to another, e.g. Dell vs HP or Backup Assist vs Acronis, the tiebreaker is usually support. Dell has excellent support as does Backup Assist which uses a unique style of support.

You are more than correct when you say that AC has always been a great product and an incredibly low cost. But, as the product becomes more complex with MU and ePrescribe and the upcoming PM, along with the increase in users, which, by definition, are new to the program, the need for support grows exponentially.

One thing which may be helpful would be a Survey Monkey survey asking users about support, their thoughts on any type of increase in payment to offset adding more support techs or what mode of accessing support they prefer. I know that most of us prefer ping/chat as it tends to have a quicker response and is extremely helpful with the support tech quickly remoting in if necessary.

It may also be helpful to use a strategy that other companies use whereby instead of just using an email, but have the email auto-generate a response letting the user know that AC is aware of the request. It would also generate a ticket number.

I am sure you already know this, but it may be helpful for support to increase when new versions are released as that is when the most users will require support.

I hope you find some of these ideas helpful. And, again, your to give the "state of AC" is very well received.

Having said that, it certainly does not need to be the CEO who updates us. Having a high level tech support person or developer come on once a week to inform us of where AC is, where it is going, and what is being done about any major issues such as the prescription writer would be immeasurably helpful

Thank you on behalf of all of the many AC users.

I agree with Bert. I think it is risky, however, to imply that "you got a cheap product, so you should not gripe when you can't get prompt support for it". I did not perceive that I bought this at Wal-Mart or the second hand shop; I paid a significant amount for what appeared to be a streamlined program that would do exactly what I wanted. I expect it to work. If I buy a Subaru instead of a Rolls, it does not mean it is okay if the door falls off and I can't get it fixed.

To add to David's comments, I think it is common practice by all software developers to acknowledge & notify users of known bugs and software issues. This can only help the tech support providers, since it will allow users to avoid repeated tech support calls.

Great post David.

I agree c David. I didn't get AC just because it was inexpensive. I got it because I thought it was as good as many that were priced higher. If that does not continue to be the case I, for one, may well look for a superior product albeit at a higher price. I am sorry but I found Dr Bertman's post to be a bit on the defensive side. If you need to charge more to continue to provide a quality product then do so. But to suggest that you might not be able to provide that because of the price we pay seems like a risky way to present AC to the public. As far as the past studies are concerned, I would predict AC will slip a bit in future studies due to the recent frustrations. Amazing Charts is experiencing growing pains and I think that is beginning to show.

Thanks for the answer.

My 2 cents.

Tech support is extremely important to be available when I need it. My patients sure do not care why my 'computers' are not working properly. They want to get in and out of the office. I too suspect that AC may fall in ratings if these tech support issues continue.

I am in a very busy solo pediatric practice and began using AC in January 1, 2011. I have worked hard to focus on how to use this very flexible and very intuitive program. Every day it is improving my life by making my office run smoother and improving the quality of my medical care. Since downloading and installing AC in Nov 2010 I have called tech support about four times, mostly to do with the initial install. Otherwise I have been amazed at the reliability of this software.

Now I know we tend to expect this software to be as reliable as a hammer and nail. However, after about thirty years of writing and using software in medical practice I have learned that it requires me to pause and to think carefully on how to implement and use a peice of software. I have also learned that it makes a world of difference how one maintains your hardware and operating systems. As you know, it is a miracle that Windows works at all!! I see physician's offices all the time where computers are loaded up with all kinds of bloated software, people doing all kinds of crazy email, and people working social media. Complexity courts disaster in Windows systems.
If you can't take care of your computer then it is important to get your own tech consultant who knows how and has a proven track record of careful and thoughtful maintenance....and pay for it. If your hardware and OS are well maintained then you at least have a decent chance that whatever EMR you use might acutally work and be reliable.
All Windows software today is buggy and fragile and requires great care to use properly. It saves time but also requires some of your time to learn it's complexities. Tech support is necessary at times, but I beleive that we tend to cry help too soon and too frequently. Most computers you see in homes and offices NO NOT WORK because users have not put in the effort to learn the pitfalls of this new tool.
No matter how much you spend on tech support or what EMR you own, reliability will not be acheived unless you pause, take a deep breath and focus on computing. Someday computers and software will be bullet proof but we have beeen Microsoft's beta tester for thirty or more years with no end in sight. So get used to it.
It warms my heart that Jon is busting his ..alls on the Management Practice part of AC and it will probably will work pretty good someday. In the mean time I'm going to bust mine too to make this program continue to make my life better. I might even give tech support a try. You all are pretty good support most of the time and have a good sense of humor. Three cheers for Amazing Charts, a small company with a heart.

@BudDC,

I don't even know where to start. I am glad you are happy with how AC works and that people at AC are busting their a... But to blame the current state of affairs with how AC is working...ummm...not working on the fact that 1) we don't have good enough computers, 2) we cry for help too soon, 3) Microsoft, 4) we need to learn its complexities, 5) that all Windows software today is buggy and fragile and requires great care and 6) we are not focused on computing is ludicrous.

All Windows software is buggy and fragile? When was the last time you opened Adobe and it crashed? Outlook? Almost any antivirus software? Firefox, etc. Hell, it even apologizes if it crashes and can't open up with the same websites.

Are you really saying that if I hire an IT professional and keep off the spyware, I may have a "decent" chance that my EMR will work?

I know this may sound like I am bragging, but it is necessary to brag to refute your post. I just happened to two months ago purchase all new computers for the office including the one in my office. I upgraded my RAM to 24GB and have SQL Server 2008 Enterprise utilizing 12 of those GBs. The computers all cost over $1400 using OCZ SSDs with SATA III connections giving them 6Gb/s throughput. They ALL run Intel i7 2600k processors. They ALL have 8GBs of RAM. They all run WIN 7 Pro. They all have WEI scores of 7.6. (7.9 is the highest). My computer is $2500 and that is at a 40% discount. I won't even list its components. We use CAT6 cable, an extremely high end switch. The computers are locked down so that no staff other than me can download ANY software or surf anything on the net other than what I deem necessary for the office to run. It is all protected by ESET NOD32 Antivirus. Oh, and the server is a Windows SBS 2008 running on a Dell 2900 Edge Server. My computers boot from BIOS to CTRL + ALT + DELETE between 9.3 and 11.4 seconds.

OK, so that is the bragging of my network. Now, let me embarrass myself on the board and, WORSE, in front of my patients. My average wait time for my prescription writer is 8 seconds. Quickest, less than a second. Longest around 30 seconds. This is still faster than a lot on here. When I choose my TSP 800 print driver, I don't know if I will get a perfect 4 X 6 tamper-proof script for 30 inches of postage stamp scripts. There are other bugs, but I won't go there either.

I have been using AC for over eight years. I started with v1. Yes, there were bugs. They fixed them. By version 3, it was rock solid. Version 4 and SQL and no issues. v5 was still rock solid and provided free ePrescribe. But, AC is not going through growing pains. It is growing too fast. And, support can't keep up with it. When there are more bugs times more users, you get more calls to support.

Please don't take this personally. I am not attacking you. I just couldn't read that post without responding.

Gee Bert, my P4s can bring up the Rx writer in 8 seconds. Guess I don't need to update. (Not true)

AC is growing fast, but it needs to run to stay competitive. Hopefully with V7 it can step back and fix many of the things that have been left to flounder. Many of them have been corrected, but I agree a lot of things need to be fixed.

The problem with the Rx writer seems to only affect a small (possibly 20 or 30% I would guess from reading the forum) percent but it is a major headache when it happens.

It was a problem for me and I went the hardware route and bought 4 dual core computers that solved the problem. Later I found out about the other solutions, but that was OK, the ones I replaced needed to be replaced and the 4 I did replace came to less than $500 total.

One of the other big problems is that the users now have less computer skills. More are docs who are jumping on the AC bandwagon for the Government money and have no interest in computers. Before I feel many of the users were more techo savvy. Techo savvy means calling support less. This, I am sure has put a big strain on tech support.

Bert, I agree with you, but I do understand BudDC's point.

I remember part of the permutations formula from statistics which involved N! (N factorial), and remember just how huge that number got very quickly. I believe that the best bet in keeping some mission critical piece of software alive is to keep N to the smallest possible number. My staff are not allowed to use the AC system for anything other than AC and UpDox. We have some Macs on the network that they are free to use if they want to check Expedia or whatnot. Our system is maintained by IT professionals, and we did not scrimp on hardware.

Now having said that, I feel we have done our part. When at this point AC does weird things (and we are still on 5.029), I am really sure it is not our fault. I feel that the fact is, AC is buggy, and version 6 sounds even buggier. I feel stability and cleanliness issues are getting glossed over in the rush to greatness. I fret that this is going to be its undoing. "If you can't find the time to do it right, when will you find the time to do it over?"

Good quote. But, I have to say I do not understand Bud's point at all.

The only time I think that users blamed AC unfairly was when they continued to blame AC and SQL when it was more than likely their networking issue. 22 users with wired and wireless patched together with chicken wire.

I agree about the future of AC. I suppose there was no way not to do MU (unfortunately). I say that not because I am not doing it but because it caused Jon to spend a LOT of time for that version rather than continuing down the road of the EMR.

I don't know that much about business, but I think there are times you have to try to keep up with the other companies and times that you don't. I think what Jon doesn't realize (and I must keep in mind I am referring to a person who has who built a successful company by teaching himself VB all while working full time in a practice) is that he needs to keep up with the EMRs in his class. There basically are none. So, AC doesn't need to keep up with eMDs and NextGen, etc.

That is my point exactly. It doesn't seem to have any rhyme or reason. Adam has awful computers, and he states all of his prescription writers pop right up.

This is where we have to agree to disagree as I just wrote above. I am sure there are some more inexpensive EMRs given Jon's success, but he is competing with them. Not NextGen. Even Praxis, which is significantly more sophisticated and expensive (well probably not that much more expensive) has decided to not go down the PM route. And, I just don't see the little things getting fixed after V7.

Exactly. And, that is why you need to foresee that. If more users mean more calls, then you need more support. How do you pay them? With the more users.

Ho Hum.....said it long ago, I will say it again. Sometimes it is better to be a big fish in a little pond rather than a little fish in a big pond. Even my mules refuse to go down a trail that is too difficult for them or one with which they are unfamiliar. Stick with what you do best, Jon.

I say this with utmost respect.

If I took that advice, I would not know:

* Object oriented programming with proficiency in two languages.

* Database design and theory

* Active Directory

* Sharepoint

* Business Intelligence

* Exchange Administration

JamesNT

But, James, here is the difference. Knowing all of that, you still are most proficient in one aspect of IT. I am sure you have your special niche, something which you and your company do best. And, I am sure you have a client composite based on billing software. I doubt your boss would also ask you to run wire, write prescribing software, or launch a satellite.
Previous versions of AC were perfect for the small to medium-sized office. Just enough bells and whistles to make it useful and intuitive. But as time has gone on, it appears the push to compete with the Microsofts of the industry, the need to be the everything to everybody, has lessened the usefulness of the program and, I believe, will drive away those for whom it used to be perfect. Here are just a few of your many past quotes....taken out of context but still telling.

"You should look for a networking consultant in your area that specializes in 3com or other name-brand equipment that can get you set up with a much more professional class wireless setup."

"You may wish to speak with someone who runs network wires for a living to see if there is something going on you do not know about. I am no expert, but it would be nice to get confirmation that running these wires really is ok and there is no technical reason for them to say no."

"I cannot tell you the number of times one of our clients will do something themselves when they have no experience and no knowledge of how to do the task and are going against all of my recommendations. "

BudDC,

I find myself agreeing with much of what you have said. Bravo! Unfortunatley, I don't agree with it all. Let's take a look.


Correct on all counts. I spend a great deal of time, when I'm writing software, asking myself how a feature shoudl behave for the end user. In almost all cases, when I spend a few extra moments pondering these things and tweaking our program, the users who end up getting the software in the end get a better program that requires less time and effort on their part to use. This means, by definition, that a little extra time on my part saves more money for the company. My boss gets infuriated with me on this sometimes as he wants everything right now, but that's fine because I would rather have him a little upset now over deadlines than way upset later when something doesn't work and clients are getting peeved. Not to mention the fact that his getting infuriated is actually half the fun.


This is where we begin to part ways. You are quite correct in that most offices do not maintain their hardware and software as they should. I constantly see offices with 6+ year old computers and software that hasn't been patched in years. I see copies of Windows XP still on service pack 1, anti-virus software that is 3 or more versions behind and the subscription lapsed years ago. I also see all kinds of crapware because the office bought cheap home computers instead of business class machines. The list goes on. On these points, I agree.

The divide occurs when discussing Windows. When considering the millions combinations of hardware and software that Windows must support, and it has to support it all securely, I think Microsoft is doing a great and totally fantastic job. This isn't to say Windows doesn't have its little issues, it does, and I'll totally agree that back in the Windows NT 4.0 days Microsoft Windows wasn't much good at all. Believe it or not, back in those days I was a Linux guy. I actually hated Windows.

But then, things began to change. With the release of Service Pack 4 for Windows NT, I noticed a substantial increase in quality. Also, instead of just bitching about Microsoft, I started actually analyzing blue screens to see what was causing them. In truth, I was just looking for more ammunition to fire at Redmond, but I found much to my surprise that the vast majority of blue screens I was experiencing were due to faulty NIC drivers - especially from Intel.

When Microsoft released Windows 2000, and upon seeing the divisions and horrific issues growing in the open source community which are a different story entirely, I made the switch. I completely dumped Linux and open source and went full on Microsoft. The quality was there at along last - at least better than any Linux I saw - and Windows would finally run months instead of just days without crashing.

Things really took off when Service Pack 2 for Windows XP was released. Service Pack 2 was, for all intents and purposes, a complete re-release of Windows that everyone got for free. Security vastly improved as did stability. I started doing more research into application vendors of the time that complained about Service Pack 2 for XP and discovered why they were complaining - their poorly written application(s) broke all kinds of rules, many of which were inexcuseable. These were, after all, commercial apps that people paid good money for. What got me started on this "crusade" was when I tried to run a user as a standard user and got this error from Quickbooks:

You must be a member of the Power User's Group or Administrator's Group to run this software.

That error, along with many other things I kept digging up, further drove me to the conclusion that much of the problems people blamed Windows for were actually the result of poorly written applications that, in many cases, cost way more than Windows.

With all that being said, I encourage you to check out the following blog posts from Raymond Chen and Larry Osterman. Raymond Chen is a developer on the Windows Shell team (the explorer shell which is the start menue and desktop) and Larry Osterman is a programmer on the Windows Sound team. Both men have been with Microsoft since before Windows 95. I think you'll find these interesting.

Raymond Chen: Why is there no programmatic access to the start menu pin list?
http://blogs.msdn.com/b/oldnewthing/archive/2003/09/03/54760.aspx

Raymond Chen: Why does explorer eject a CD after you finish burning it?
http://blogs.msdn.com/b/oldnewthing/archive/2005/06/10/427696.aspx

Raymond Chen: The Decoy Control Panel
http://blogs.msdn.com/b/oldnewthing/archive/2006/01/10/511201.aspx

Larry Osterman: Why does Microsoft Time Bomb its Beta Releases?
http://blogs.msdn.com/b/larryosterman/archive/2005/08/10/450173.aspx

Larry Osterman: The Last Consumer Operating System Written in My Lifetime
http://blogs.msdn.com/b/larryosterman/archive/2005/11/17/494007.aspx

Do read those blogs at your leisure. They are chocked full of useful information that will explain many mysteries to you, as they have me.

JamesNT

Leslie,

What we must realize is that we are both correct. Obviously, I am better at some of the things on that list I gave you than others. However, I am proficient on all those items nonetheless. But then again, I know nothing of physics, podiatry, chemistry, or politics. So from that standpoint, what you say holds true.

What we have here is a pendulum. Swung to far one way, people will probably know one and only one thing. Swung the other way, people must be experts in all things. Both extremes, in my opinion, are equally unacceptable. One can't know it all, but at the same time one must be adaptable in this economy. Someone who is proficient in SharePoint should also pick up a secondary skill, such as SQL Server, and perhaps branch out into Buisiness Intelligence. The beauty is that all three work together. You can, for example, publish reports made in SQL Server Reporting Services through SharePoint.

Refering to your quotes, you are correct in that I did say those things. The problem is that most IT guys do specialize in one and only one thing. Heck, most of them don't even keep up with new developments in their area of expertise. This is why most of the IT guys I knew back in 2005 aren't around any more. How many new guys have you seen in your area and how many of the old guys have you not heard from in a while?

I agree, you can't know it all. But one cannot overly limit one's self, either. Agility must be maintained.

By the way, I can run wires.

Regarding Amazing Charts branching out and becoming less useful, this is the natural evolution of software. Consider your post:


For one thing, this is your opinion. You cannot speak for the entire user base. The addition of new features was the result of:

1. User requests.
2. Making an effort to be innovative. Who wants to pay yearly tech-support for a program that hasn't seen a new release in a long time? Lack of user requests is not an excuse. People expect to see new versions of software every so often to get a feeling of getting their money's worth.
3. To attract new customers.

Do not underestimate number 3. New customers are a must. After purchasing Amazing Charts, how many people do you honestly think renew their tech-support every year? Far less than you may think, I would wager. The average provider I work with is around 2 - 3 years behind on tech-support for their EMR and/or PM system. In their minds, they haven't had to call tech-support in a while, so why should they pay it? The latest version doesn't have any new features they want, so again, why pay it? So, the last resort of trying to keep some semblance of decent cash flow is to get more clients - bigger clients - to further ensure a steady revenue stream of not only sales but tech-support dollars.

Amazing Charts has no choice but to go after bigger fish as it simply cannot rely on the little Leslies and Berts of the world to pay the bills. True, they may lose a few of you on the way, but from a purely economic standpoint that is an acceptable loss if they just signed up that 5 doctor podiatry clinic. I realize that sounds dismal, but economics is the Dismal Science.

What would you do if you were Amazing Charts?

JamesNT

Addendum to previous post regarding adding more features to Amazing Charts:

1. User requests.
2. Making an effort to be innovative. Who wants to pay yearly tech-support for a program that hasn't seen a new release in a long time? Lack of user requests is not an excuse. People expect to see new versions of software every so often to get a feeling of getting their money's worth.
3. To attract new customers.

4. The advent of further government regulation.

We'll save that one for another time.

JamesNT

James,

The problem of "mission creep" is inherent in all projects. Did anyone ever build a house and have it come in under budget? No... there is always the expectation that "well, as long as we are at it , we can just....." One of the big responsibilities of an architect or builder is to reign this stuff in, and be able to tell a client "yes, this can be done in principle, but it is not good for you and you would not like it."

My experience with software designers is that they are much less good at limiting their imaginations than many other trades. Software design is cool, it attracts very bright and creative people, and the urge to strut your best stuff is overwhelming.

What Leslie is saying is that some of the "cool" things that have crept in, to make the permutational N! so much bigger, are the result of lack of restraint. Someone should remember the Talmudic saying: "The wealthy man is satisfied with his lot."

There is a basic piece of business and marketing that isn't being said here. Well, actually Leslie kind of says it. That is "Know your nitch." Others may use the quote "Stick to the knitting." The issue here is knowing what you are good at, what you are not so good at, or what does not play to your strenghts, and stick to those things that play to your strenghts. There may be some occassions where you have to go outside of it, but you really want to emphasize your strengths.

I think what Leslie fears about AC is the same as what I fear...that they may have forgotten this tenet. They are trying to compete directly with the likes of Centricity(?) or other big-named EMRs. But we also have to allow for what may be necessary for AC to do (some way) even if it isn't currently their strength (PM Module maybe, other bells and whistles.) just to be a viable platform.

Now alot of things have been rushed into AC by MU & CHITT. Those are things that AC had to have to remain viable. I also feel that an integrated PM module is needed for them to remain competitve even in the small practice nitch. Whether they make it from the ground up, buy someone else, whatever. Unfortunately, due to what I have seen of the integrated EMR/PM systems, I don't feel confident that the PM will be that great. I would of course prefer to be so wrong I am dubbed the village idiot. But it seems that either you end up with a good EMR and so-so PM that is at least integrated to it, or a good PM and so-so EMR. And AC has the good EMR already. Additionally, so many things were added to AC so quickly, and seem not to work or work well (Orders, or even the risk factors/health maintenace sections.) And Jon and his team need to understand that the presentation of the medical information can be as important and the ability to record it. So we need to be able to print out a decent-looking vaccination record (We still can't as of 6.0.9, but I don't know about 10 yet.) We need a consistent and set way to record PPDs...and print it out to give to patients for their jobs/schools without us entering it twice, or having it come out with a lot of other undesired information. Plus there is all the the myriad things that had to be added and need to work well just for MU. 'Cause if AC wasn't MU qualified, it would be needing to plan on shutting down. But I think I really understand Leslie's point. Maybe it just seems that AC is losing focus because there is suddenly so much that must be done in too short a time period. I sure hope so and hope that Leslie is wrong. But she might not be.

I can see both sides of this argument, too. Companies as big as Yahoo and HP were tremendously successful, but lost their way as they tried to expand and cover too many bases. On the other hand, Apple was practically on CPR until they diversified and came up with iPods, phones, etc.
I am certainly no expert (though that doesn't stop me from expressing an opinion). It seems that to stay ahead, a company needs to follow certain tenets. These include: start with a good product and improve it as you develop new ones; provide strong customer support; and pay attention to your customer base as you expand.
So if Jon made the judgement that he could do the above as he developed a PM product, then it made sense to go for it. On the other hand, if someone said to Jon in 2008, "we can get CCHIT certification and develop a practice management program, but in the interim years, the quality of our support will take a big hit; we will have little time to communicate with customers and solicit their input; and the program will be more complex and buggy but we will only be able to devote very few resources to fixing old and new issues with it"...well I would imagine that Jon would have said to forget it.
Some fear that the latter scenario is being played out. I think we are seeing some signs of it; hopefully they will be temporary and short-lived. After PM is completed, I hope the company can get "back to basics" and address these issues.

With respect, if AC is to "stick to the knitting" and do what they are good at, they should dump the PM idea as PM is a different animal from EMR.

JamesNT

WOW!
OW OW OW
What a great flow of ideas!
I found alot of passionate users at the ACUC conference in June and I can certainly see the heavy energy of you all. I guess we all have a great desire (and need) to make this program really work and hopefully be part of a small company that might whip the great IT companies. I remember IBM trying to sell me a system for $5000 back in the 80's and I'm sure it would have done nothing more than make me poor. Even though AC Inc is preoccupied with getting the product out right now, I'm sure they are listening to the clatter from us users, and they know that their and our success are tightly bound together.

I do beleive that the EMR is a finite problem and that we are in early adolescence and feeling the anxiety of growing. It is really quite scarry to commit all of your medical life to a spining magnetic disk. As you all know you can carry all of your life around now in a thumb drive ... makes a lot of physicians say "huh" and feel quite uneasy. I think AC the program and AC the small company are our golden opportunity to produce a truly usefull, flexible, and controllable experience for phyhsicians in private practice. It will give us the power to really do the job we have been trying to do with paper records and our good and above average memories for the past fifty years. Having an EMR is a very heady and empowering experience for me. When I answer my calls I no longer guess and relive old problems with the party on the other end of the phone. It produces a much more productive physicain - patient relationship.
When it doesn't work GRRRRR.
I'm sure we can beat this problem with a group of user Docs we have here and I look forward to contributing my 2 cents worth of sweat.


One thing I would like very much. A two page description of how AC program works as it sits on top of the data base. A simplitied flow chart would be just fine, with a little wire going out to the side for the internet connection.
It's my impression that the Rx Writer uses the internet to complete the drug interaction process. Could it be that we might be having problems connecting to servers that might be slowing down the program.?? I surveyed all the DNS servers and by changing my DNS URL's in network connections I improved my time to connect speed quite a bit. Maybe I'm dreaming but the big change in AC recently has included a more intensive exchange with the internet. I know that's going to be a factor in the queries for insurance status that are coming in version7. Good fast communications with important servers at insurance companies should take some carefull investigation and thought. Of course it would be nice to know how the program acutally works, since this impacts significantly on how our local networks, routers and modems do their job. I don't want and don't have the skills to hack this thing ... I just want a road map of the major throughways.

James,

I am really in for a flame war. James, everyone knows how smart you are with Windows and SQL and all else computing. But, you are not a doctor, you do not use Amazing Charts, and you certainly aren't as knowledgeable when it comes to where AC should go than "little Leslie and me."

I could not disagree with you more on every statement you have made. So, maybe AC will not make it if it doesn't grow, but how do you think it got here. It got here BECAUSE of the Wendells and Leslies and Jon and Johns who have used it for years and do pay their support.

"The addition of new features is due to:

User requests: Where did you get this. It is exactly BECAUSE user requests are NOT put into the program that we are frustrated. I have been using AC for well over eight years, and I doubt I could list ten ideas that made it into AC. BUT, the ability to record the time of birth got right in.

Making an effort to be innovative: This does not hold true in all software. Sure, its exciting to see the latest Windows OS, but I couldn't care less if ESET has a new version every year or not. I will still purchase a subscription each year. Sometimes new versions make the product worse. You left out a key adjective. People don't expect to see new versions. They expect to see new and BETTER versions. From 5.028, each new version has been buggier and buggier. What Leslie is saying, and I pretty much always agree with her is that as AC "grows" it doesn't experience growing pains, it experiences a turn toward mediocrity. We do not feel we are getting our money's worth.

To attract new customers: Yes, new customers are vital. But, the problem is AC is not going to continue to get new customers if they continue on this path. There was a time when a prospective customer would read the board and be swayed to purchase the product. Now, as they say, not so much. If a prospective customer read all the threads today, I don't think they would save this website to their favorites.

"How many people do you think renew their tech support?" My guess is a lot of people did. But, why renew when your emails bounce back, you can't get anyone on the phone and your issues aren't fixed.

There are two things that sell ones product. The quality of the product itself and tech support. Both have gone downhill. What most of us are saying is slow down and remember your roots. Fix what you had first.

"Amazing Charts has no choice but to go after bigger fish."

Isn't that what Leslie said? Big fish/Small pond.

You think that good business is to attract new customers at the expense of "an acceptable loss." I think good companies try to gain new customers while keeping their "customer base" happy. As they say, an upset customer will tell ten people, while a happy customer will tell one. You build on your base, you don't dismiss them. If I were a company, I would listen to my long term customers, not alienate them.

"What would you do if you were Amazing Charts."

Well, the first thing is I would change the GUI. Second, I would scrap the PM. You can't be all things to all people. As noted, CCHIT and MU has really slowed down AC. But, the PM will grind it to a halt. They will work on it until first quarter of 2012. And, I will not be convinced that the EMR and the PM will be Netflix and Quikster. They will overlap, and their will be a lot of support time going to PM. We yell and scream over the letter writer, but I imagine when a major portion of the billing module isn't working properly and practices can't bill, their will be issues.

For sure, there must be a balance between sticking with your past and what works and growing your product. I think the difference here is that AC isn't improving to compete with the same size EMRs, it is trying to joing the NextGens of the world. Jon has/had a niche that few companies enjoy. He owned the inexpensive, no frills, it just works, faster than any other EMR. That is why we all bought it. That is what we all want to keep.

IT techs aren't like drug reps. We don't see them come and go.

James, I did address this in my post. Additionally, I'm not sure AC can compete long-term without having some type of integrated PM. But as I said, I do hope its better than some other integrated solutions I've seen, like AltaPoint. I'm not sure how good AP's PM is, but apparently others like it. But this was also the system where I literally could not figure out how to open a chart. I had to call them, and it was not intuitivley obvious. An example of doing one thing well, but not the other.

I am not sure if it can compete long-term WITH an integrated PM.

Bert,

On user requests. I find it odd. So many things are mentioned here, I for one have sent in suggested improvements. Mainly for small things that should not be too much trouble. And it seems many request don't get implemented. But I also remember going with Alice to a Pri-Med conference, meeting Jon, and asking him to add a few improvements to the AppointmentQuest interface,which he did. I'll also never forget when we first got AC and I was having some difficulties. I was on with tech suppport at 8 am or so, when my phone rang. It was Jon asking about the issues I was having! I will never forget that. Of course, he's got a bigger company now and I don't expect him to do that in the future. But the memory always makes it hard for me to criticize AC.

But I really don't see how some of the smaller requests don't get done, or when they do are done poorly. Take the issue or printing an entry from the Rolodex.

I'm not sure exactly how difficult it was to add the print feature there, but I wouldnt expect it to be too much. Or to add the option to include the phone/fax numbers on a letter. For years neither was done. Then when they did do it, it prints out as a letter, addressed to the wrong person (to the entry), does not include the fax number, has a signature block with the entry's name (so it is both to and from the person in the rolodex), and can't be modified. That was ridiculous. Who was assigned to that? How about just print the entry!
And I think this is one example of what Leslie and you (and me)are afraid of. It's not even the biggest one. But I like it as an example precisely because it is a smaller item. Or another small one...please add the patient ID number to the Orders sheet. Everything else is already there, just add it for those few people who need to input it into the Quest system to bridge demographics.

I feel Jon should have one or two people that are dedicated for the next year to fixing these small things that have been around. The rest of the team to continue on the major stuff.

Bert,

I couldn't agree more with everything you said in your reply to me. In fact, you and I are on the same page. The problem is the point of view we are looking at this from. You are looking at this from the point of view of a paying customer who expects to get his money's worth. I, however, and not a paying customer. I am, as you pointed out, not a doctor. Therefore, I will never be able to look at this from the standpoint that you are now.

My point of view is that of simple economics, computer science, and what I have seen so many other companies do in the past.

I'll respond more in-depth later. Right now, I just got done raiding the Firelands in World of Warcraft and I'm tired. For now, know that my post was not intended to start a flame war and certainly not intended to offend anyone. There is a method behind the madness and I probably just did a poor job of explaining my side of the story.

JamesNT

As for me, I have played with computers since they filled rooms and used FORTRAN. The excitement of the next coolest software release has long since worn off. Unlike WOW, James, I don't get bored when I have mastered a level. my computer is just another small appliance. I don't get excited about the next version of my microwave, nor is Sears in jeopardy if they don't change the controls annually. What brings me to purchase is a record of simplicity and reliability. Drooling over upgrades is for kids.

Thank you all for the great posts. As a solo doc, having a clean, precise, intuitive and inexpensive EMR is paramount to my success. Heck, the current prediction is that I (being solo) will not last 5 years. I am the only solo primary care left in my area (those who jumped ship could now kick themselves but there is no going back). I have succeeded I believe because I have my own patient base that likes the way I do things. They stick with me because we "match". I strive to keep things down to earth, personal, simple and fun. I lost some patients when I gave up hospital practice but I have gained far more who are sick and tired of voice mail and having to see a different "provider" every visit. Sure, I have had to add a few ancillaries in order to remain profitable (things I swore 10 years ago I would never do) but they really have not changed the overall complexion of my practice. That is why I am so disappointed with the direction I see AC heading. I do not want to have to change but, if we no longer fit, then I will have to find something that does. I personally do not want the PM. I have a PM program already, do my own in house billing and feel it is a trivial thing to have to enter info twice (the majority of it is only re-entered once, when a new patient's info is first gathered.) The time that has been freed up for my office staff in other areas more than makes up for the time it takes to do a duplicate entry.
My PM program now has an EMR side and it sucks. But, they are separate programs. I can still just have the PM without it being all bogged down by the EMR which I would not use.
And, James, how many of those new users to which you refer, who were swayed to purchase AC because of the upcoming PM, are now those on the boards complaining about Eprescribing, having to purchase new hardware, having trouble with installing, system crashes, etc.? I have never ever seen so much negativity and complaining on the boards as I have this last year. It used to be people came on and got their questions easily answered, made requests for simple additions or fixes and extolled the virtues of AC. Not anymore. I understand how the government forced many of the changes. I too have to deal with these changes everyday. They bog down my practice and force me to practice a little differently but they have not led to patients leaving my practice. Somehow, some way, there has to be a middle ground. There has to be a point where AC simply says "just because everybody else is doing it, we are not". There has to be a time when AC mans up and says "we are not doing that to our loyal customers".
I will now shut up.