Home Forums Discussions General Discussion making the transition to amazing charts

I am an internist in an 8 physician group, 7 primary care and one pulmonologist. We have around 15 K patients, but are essentially solo providers sharing common overhead with our billing done with lytec which we just upgraded to lytec 11. We are seriously leaning towards AC EMR considering utilizing xlink to interface lytec with our EMR and we utilize Quest as our lab. We have an on site and off site server and are all hard wired, and each "pod" has one physician with one nurse and two exam rooms which will have encrypted wifi so have the capability of using lap top or tablets. One FP already using eclinical but seriously thinking of switching as well.
Just purchased a fujistsu scan snap s1500 scanner and 2 HP elite book 8460 notebook PC with 8 GB i5 2520m processor. I currentlyl have been using dragon and have 1500 plus pseudoelectronic records--still have a hard chart but also keep the dictated notes on my HP PC.
My main question is how would one best utilize what i have described thus far in seeing about 15 patients a day, with two exam rooms, and one nurse. My thought wouid be to have my nurse do intake, vitals and short history with her notebook pc and i follow to complete the encounter with my notebook pc and possibly dictate using dragon on my hardwired PC in my office.
My other question is how AC interfaces with the upgraded lytec ll with xlink, anyone currently doing this and do they play well together. Also is tracking data for meaningful use made any easier with xlink to lytec where all our demographics are currently held. I am hoping all data can be transferrable from lytec to AC, according to our local IT man it will, still waiting to hear answer from AC IT person. Also is our group size too large for AC to accomodate. Any groups as large or large currently using AC and does it work?
Thanks for your time--first time on this post but I am fascinated and thrilled to have such a forum to seek answers as this is new territory for most of us in our group, myself included.

Do you wall want to store your charts in one database ? It becomes muddy when you do this - I assume if you are using Lytec and "having common overhead" that you all bill under one tax id. That being said if you do that then I assume you share patients - cover for each other, etc. If you do not bill under one tax ID I would recommend thinking about if you all want one database as that muddies the water when it comes to who owns what chart, etc.

I do not use xlink as I saw it very costly when I could just double enter data - use paper superbill anyway and my billing person is responsible to make sure billing data is entered correctly so billing is done right. It sounds like you can export pt. data to populate AC the first time so that the patients are all in AC, then enter both places in the future.

Steven,

We are an LLP, not a corporation so each have individual tax id's--as I understand it we will each purchase the software and like now have our own individual charts. 5 of us are out patient only and take phone call coverage for each other. 2 of the FP's still do in patient as well and cover one another. I don't think we want one common data base but rather run it such that we will all link indivually to one common server but on the server have different domains for each physician. I am not sure if this is the proper terminology.
As i understand it i will purchase AC for my patients, and each of my partners will purchase AC for their patients, but will interlink with our lytec so the two softwares can interface and exchange data--currently we are using a paper superbill and I was hoping to do away with the paper superbill and electronically bill based on the encounter on AC interacting with Lytec. It may make sense to export the data from lytec and continuing using a paper super bill. From Jim-thanks

I think the cost of x link is high and from what I hear not going to be a great fix - I think the paper superbill is probably cheaper and really going to work well. You will need to talk with a network guru about installing AC in the way you want as I am not overly familiar with how this works - you might try PMing someone like JAMESNT on the user board as he could answer if this is possible. I think you are on the right track and it will work well if you each have your own AC - I think it would be a mistake to try and put all in one database.

In our office, we keep the PM software totally separate from AC. It means duplicating demographic entry, but reduces risk of corruption overall. What you are suggesting sounds pretty complex, and AC is not really designed for complex practices. There are speed issues with even one or two providers operating off a server, and sharing that many separate practices on one server may prove problematic. If you have the hardware already, I sure would take advantage of the free trial, and print out the encounters during this period in case it does not work out.

I agree with David. What you describe is the most complex setup I have heard in the eight years I have been on here. There is really no way to combine databases of separate practices whether on a server with one domain or seven domains. If you have a separate tax ID#, then you have a separate practice, and the databases will not work together. I don't even know how you would do it with an EMR. I am not understanding how having separate practices link to one server will help share data.

You would be better off incorporating under one tax ID#.

Thanks for your responses. I will let you all know after talking to AC IT and my local IT--sounds like it will be best to keep the AC separate from the lytec PM. That is if AC is even an option, as our practice size might be too large/complex for the AC software. jimmie

You could have separate logins and each pointing to a different database. When you do this x 7 the likelihood of mixing data (i.e wrong provider linking to a particular database) or not being able to find the database becomes more likely.

Then the issue of who will do updates and update all 7 databases. This is getting more complex by the minute. Could be done but...

I don't think it could even be done.

The next question i have are there any practices out there similar to our makeup. A limited liability partnership that utilizes AC with 3-5 physicians and how do they utilize server and connections to each physician utilizing AC and also how do they integrate with their practice management?
jimmie

I simply don't see how five different practices can share one database or several databases whether on a server or not. This is the same as having five different practices at different locations.

I am not even sure how you would have more than one Amazing Charts instance. The PM would be doable.

The best bet, I would think, would be for everyone to incorporate under one tax ID# and have one database.

Given the right hardware and SQL Server AC could handle that size practice as a single DB, but that isn't the goal.

Given what you DO want to accomplish, I'd get some redundant server hardware and run a Host server [with redundant hardware] that houses a Virtual Machine for each practice. Then each practice has their own DB, and yet it is centrally located and each Doc can cover by logging into the correct instance (and DB).

There are lots of details to how you do it, but it is effectively what we are doing now, just Docs are not [currently] covering for one another on the platform.

So are you saying to change the path each time you wish to get into the other database? Which sounds doable I must admit.

Why didn't you adopt Practice Partner if you had Lytec already? We had Lytec but bailed as it was expensive for a private, solo practice.

I think Indy's idea is brilliant. Indy, I wonder if you could do they virtual servers, then use terminal servers so each doctor could simply use the other ACs on each virtual server?

We are looking at Lytec MD, and Praxis and eclinical, but the AAFP article is pretty convincing at putting AC ahead of the game. But I think it has to be the right fit, and I realize most users of AC are solo or less than 5 docs.
I am pretty tech/computer naive but I don't quite follow Indy but I have contacted Netgain to support and maintain a virtual server, but feel it best if we can keep the server under our "roof" if possible. Maybe need to rethink this. Thanks again. jimmie

I know this isn't for everyone, but we use Redhat Enterprise Linux as the host/virtualization platform, then run the VMs on top of that platform. How we implement the detailed security architecture is part of our 'secret-sauce', but the goal is a well performing user experience with maximal security in layers. [disclosure - we are RH Partners]

It can be done in your office Jimmie, but if you are talking about that many practices, full redundancy is essential - but that is a whole other discussion.

I think what Indy is proposing, and this is a big assumption on my part, is having one server, with five Virtual Servers on it. You can run as many as you like as long as you have enough RAM, etc.

Then each doctor could have their databases on each VM, therefore keeping you from having to purchase five servers. I don't see why each doctor couldn't log into each doctor's database when they need the information. Technically, each doctor would need a license for each database, but it seems like it would be a wash in the end, so that AC may (may) allow five doctors with five licenses to each have their own Amazing Charts system but cross reference to the other databases.

Jimmie,

I also agree with Indy. You can get one Dell R710 (or T710 if you want a tower and not a rack) that can pull all the virtual machines they are talking about. You will need a copy of Windows Server 2008 R2 Enterprise Edition which will get you four virtual machines. You will then need two additional copies of Windows Server 2008 R2 Standard to get the 5th virtual machine for another Amazing Charts and the last one for the domain controller (assuming you don't already have one).

BackupAssist (www.backupassist.com) can do all your backups for you.

The server will need the following minimal hardware specs:

Processor: TWO Intel Nahalem quad core procs with hyper-threading.
RAM: 32GB.
Hardddrives: Two 136G drives and four 300G drives. All drives will be 15,000 RPM. The two 136G drives will be in a RAID 1 array and will be for the host. Two of the 300G drives will be in a RAID 1 array and will be for two guests. The last two 300G drives will be in a RAID 1 array and will be for the last three guests.

As far as interfacing between the 5 Amazing Charts and Lytec, this can most likely be done (I would have to look into it) but it would be a totally custom interface using SQL Server Integration Services. Although this most likely can be done, you will need to find someone to develop it and maintain it. If the docs don't have too many demands, maintenance costs should be fairely low - as in going months a time without making changes. If the docs are demanding, maintenance costs could be high making this cost prohibitive. If you decide to go this route, you will need a copy of SQL Server 2008 Standard Edition which will drive up the cost of your server. There are other options that your IT guy may have in mind.

Please note that these are my recommendations. Others on the forum are more than welcome to weigh in with their recommendations. Obviously, there is more than one way to skin a cat, peel a banana, etc.

One other thing, if you don't already have a domain controller, consider SBS 2011 for your 5th virtual machine.

JamesNT

Call sales. They will tell you the number of practices of different sizes. We are 4 without much issue, although not really complex like yours.

Thank you all for your time. I will talk to my partners and let them know of the ongoing discussion as well as my IT guy.

Will try the 3 month free trial of AC and see if we can make it work in our office-but will keep you guys updated. jimmie

Why don't you each have a laptop to carry in the rooms and a desktop in your office to function as your server and have you database (separately) on your desktops?

Thanks for your suggestion. I am going to be the guinea pig for our group and the others will be soon following, but am working out the details with my local IT guy, but we may end up doing what you are proposing if the main server doesn't pan out. will let you know what we get figured out. jimmie

Boondoc has a good idea. The only issue is backup. Each doctor would have to make certain their desktop was getting backed up. 5 doctors means 5 backups that have to be maintained and we all know that probably will not happen. Furthermore, that would mean additional licensing for any backup software that would have to be purchased as well.

With my recommendation, one copy of Backup Assist for $450 does it all.

JamesNT

Which includes Exchange, SharePoint AND SQL Server backup.

But, I think it only backs up servers.

How will all five desktops use Lytec?

Backup Assist backs up workstations as well. With Boondoc's idea, the office has to purchase a copy of backup assist for each computer at $450 a pop. The SQL Addon for Backup Assist cannot be used in this case because the SA password for SQL Server is not known.

JamesNT

As soon as the encrypted wifi gets installed will then download AC software onto my PC as server and use the 2 HP laptop notebooks with fujitsu s1500 scanner, and wireless printer--so will see how it goes--will keep you updated--the lytec interface will be another step in the future. will also have to consider the backup assist idea as well. Once again thank you all for your input! jimmie

Jimmie,

If I may, and I mean no offense whatsoever, you should really sit down and think this through all the way to doing the interface before spending one dime. Interfacing 5 different Amazing Charts with one Lytec is possible, but it will require serious skill. This isn't something you are going to do with X-Link. If you want more information, please ask.

Bert,

Apologies for not answering your last question.

Lytec is client server like AC. Each desktop will have the Lytec client on it.

JamesNT

My idea of how this would look.

Lytec would be installed on the SBS Premium w/ SQL Server.

JamesNT

NP James. Thanks for the info.

James NT--no offense taken, I will share your thoughts with my IT guys and we will likely getting back to you-- I feel like I do when I carry on a conversation with my mechanic (I'm not a mechanic). Alot of this terminology/computer stuff is a bit daunting. once again thanks to everyone. jimmie

Hi jimmie,

90% of the stuff I learned was from Google.

Jimmie,

When you get a chance, please look for the private message I sent you yesterday.