Home Forums Discussions General Discussion Switching to another EMR question

Second day of trial, so no plans of switching to another EMR. But, I would like to know what AC will provide for the fateful day that one should leave AC.

How granular is the data provided by AC?

Is it PDF images of encounters, or will there be tables that could be queried?

Dan

While it is granular, the database is locked, so access would require AC central to export the data.

You can export patient encounters and demographics to xls format in the admin section.

Thank you Wendell,

That is great news that the patient data could be queried and transferred to another emr.

Do you or anyone know if there is a significant charge for the patient data on exiting AC.

Dan,
I've looked at the reporting function in AC. The export to Excel is a way to get data OUT of AC in a somewhat granular format. It would be a Kludge, but it could be done. I know you have some DB experience, and I have a VB routine that can connect to resultant excel files as a DB Table.

Thank you Roger,

"some" is an overstatement. I have a lot more experience, as in hours struggling, than knowledge.

Dan

Dan,
I think you bring up an important question, albeit a challenging one. Psychologically, it is tough to think about leaving an EMR, just at the time you are becoming enthusiastic about it. (Pre-nups are pretty rare, though they may seem prudent to some ). It is especially difficult because you have no idea which EMR you transitioning to, and what it will be able to import. A generic .csv may be the best we can hope for as a bridge between the two.
AC gives you the option to create a .csv of all encounters, demographics, your contacts, and templates. You can also create a continuity of care record for all patients in CCD or CCR formats, which at least may be easy to get into a new EMR. While I have never done this, I don't understand what portion of that would require help from AC, as Wendell reports.
Your imported items essentially exist as pdf's now, and can be copied and accessed independently, if you choose.

Ah, and there is the rub.
I remember more than one slick huckster sales pitch where vendors were trying to displace AC in a practice with several thousand patient records - the train always jumped the track when I asked if the pricing included converting all of the patient data.

And on the nightmare front, think about going from this in 2010:
"Centricity Ahead in the Cloud"
"Dr. Desiree Butter has always had an interest in technology and its ability to provide easy access to patient information. But it wasn?t until she opened her own practice in 2004 that she was able to make the best use of electronic medical record (EMR) technology.
?If you're low-budget like I am, it makes a big difference,? she says."

to this in just 18 months:

"Centricity to Shutter Advance"
"GE Healthcare has announced it will discontinue its Centricity Advance electronic health record (EHR) application for small practices as of June 30.

Centricity is GE's EHR platform used by both physician practices and hospitals....GE will allow physician practices to upgrade to Centricity Practice Solution, the company's flagship EHR and practice-management software.
After June 30, doctors will be unable to post data in Centricity Advance but can access information in read-only format until Dec. 31....
GE decided to shut down Centricity Advance because Centricity Practice also addresses the needs of small and midsize practices, Michael Friguletto, general manager and vice president for clinical business solutions at GE Healthcare, wrote in an email...the company formerly considered Centricity Practice as software primarily for midsize and large practices. (emphasis added)

Here is one comment:
"Discontinued with no warning and very little time to transition. They are offering Centricity CPS, but at $1,500 it is too pricey for the small practices that used Advance. Even their own VARs can?t guarantee a transition within GE?s timeframe. Practices that went live with Advance in January 2012 have to pay in full for implementation of dead software. GE is really out of touch.?
http://histalk2.com

RE: Centricity to Shutter Advance.

GE did the same thing with Medicalogic Encounter around year 2000. They gave us a disk with XML files of our patient data. It was useless for importation.

I may be thinking of the same thing. Not sure if we have the same wording. But, you had XML files so you probably know better.

But, there used to be a Logician (expensive) and Logician Internet ($100 monthly and still to this day produced the best formatted progress note ever) -- I know I say that every time.

Then Medscape bought them out, and it became Medscape Encounter. I have to blame Medscape as anything they touch turns to garbage. Just look at eMedicine. AARRGGHH!!.

So Medscape Encounter went bottom up and Logician changed their name to Centricity, which made no sense.

I have not looked at or demoed all 200+ or how many there are EMRs, but Centricity is EVERYWHERE here including the EDs, and it has to be the worse EMR of all time. The notes are so long and hard to read, you may as well let a four year old use finger paint. It takes six pages to document an ear infection.

My God!, man, do you know how long its been since I've heard (or seen) that word used.

Crap, now I've revealed my . . . Uh, experience.

Funny, Wayne...I had a momentary college flashback when I saw it.

@DanWatrous @Wendell

Actually, you can copy the SQL Server databases out of the Amazing Charts folder to another folder and mount them in another instance of SQL Server to have full access. However, you obviously have to know your way around the tables in the database to find what you are looking for.

To this day, I still completely disagree with Amazing Charts "locking down" the database, as it were. Upon installation, Amazing Charts removes the local administrator from the SQL Server SA group and then changes the SQL Server SA password to an unknown value.

The data belongs to the practice, not Amazing Charts.

JamesNT

JamesMT.
I think the lockdown of the database is due to the concern that if a malpractice suit is filed against an AC user, and if the user doesn't keep paper records, the AC user needs to prove they didn't change past medical records? If the plaintiff lawyer can imply this it is game over, doesn't matter how right the doctor was.

A DB designer can allow read only access ("views") do that we can SEE and USE the data outside of AC without being able to change it.
THAT is rub for me. Why NOT allow me to generate my own reports, while protecting the integrity of the data? (and the legality of the record)

I suppose if an evil one had the read only key, you could load the database, change the name, then alter a record, then save it again under a different name? I don't know (obviously I don't know much about databases, but I know more than the juror that stayed at the holiday inn express last night).. This just opens up too many issues: support by amazing charts, data changing concerns, and also competitive issues regarding the EHR. It doesn't matter if one is right, it is a matter if the jury suspects that you have been able to "fiddle" with the database.

The original database (AC) remains intact, even in your scenario, so if the courts allowed the SQL database to be supeona'd, etc.
It would be easier to produce the "paper records" (copy of the chart, which is usually what the lawyers want) and alter them (altering PDF files is easy, just be sure to "flatten comments").
I sent out a query on Sermo.com: got 1 hit back:

Posted via iPhone February 17, 2012 - 08:30PM EST
The short answer is yes. I have heard rumors of lawyers looking at the meta data produced by the EHR.

But that refers back to the fact that the orginal database (AC) remains unaltered.

Everyone,

While I do understand where you are coming from, do consider the following:

1. If the database has been tampered with by an outside force, then the network of the practice in question is not HIPAA compliant and has little, if any, security safeguards in place. The practice has bigger problems.

2. If a doctor of the practice fiddled with the database, then that is what's known as fraud. Not to mention that, if being sued, we are probably talking about one patient or a small number of patients. Most doctors will use the Amazing Charts user interface to make changes rather than execute SQL commands in a database since few doctors would know how to do that.

3. The procedure I gave to mount the AC database in another SQL Server instance to allow editing through the back end is more than easy enough to do for someone with the skills to find what data they are looking for and execute the correct command to change it using SQL Server Enterprise Manager.

4. It's easy to see Amazing Charts' point now, whatever it may be, until you really do need your data out. I hope that day never comes as I truly do like Amazing Charts and so do my clients, but we have plenty of precedence with other EMR's to say the possibility, ever how unlikely now, is indeed real.

JamesNT

Before I get lynched, I have only advocated a read only view to data for use external to AC == we do this all then time, chart summation/extraction, reporting/analysis, and studies.
I have had commercial dialysis facility EMR vendors give me views into both Oracle and SQL Server DB's for quality reporting functions, so I know it can be done.
The database remains both intact and secure.
That's all.

Roger,

No lynching intended. And your approach is reasonable and is exactly one of the reasons database engines like SQL Server support the concept of views. It's a question of will AC build them and then document them.

And please do understand my point of view. I have been on the phone with a doctor DEMANDING that I find a way to get his data out of an EMR software he had stopped using some time ago but now needed the data from as he was being sued. He had a very difficult time accepting my explanation that there was nothing I could do as the software was online and there was no way to get to the database (the EMR company in question was utterly uncoorperative and even said they had no such account). Since we could not get the data, the doctor lost the case and is now bankrupt. A shame, truly, as he was one seriously good doctor.

JamesNT

James,
Wow, bummer (oops, dating myself again).
What egregious behavior on the part of the on-line vendor. And another reason to have control of your data and records!

But, you have to have malpractice insurance in order to practice.

I am employing my teenagers in scanning old paper charts to get it done, and to teach them that education will lead to work that is not so mind-numbingly repetitive.

What is the difference in court between a pdf scanned from a patient I last saw in 2007 and a pdf from a chart note made in 2012? Unless there is suspicion to suggest altering of the pdf, I don't see the court system wanting to have everything clogged up arguing over altered pdfs.

Retaining a personal pdf image of every document generated going forward seems just as good as keeping pdfs of all my old paper records which will be shredded eventually, and probably before a court case needs them.

I assumed that AC's position was to prevent stealing the software. I would like to manipulate the text for a fancier looking progress note, and I would like to eventually have access to all the data in a queriable table.

Eventually, won't there be a seamless transfer from emr to emr, cause at a basic level we want to know the subjective, objective, assessment and plans.

What am I missing here?

Dan,

You aren't missing much. Maybe just a little. First, I agree with the PDF argument. Sure one can alter a PDF. But, go back a few years and one could trash an entire progress note and make another one. Hell, we did it in the hospital all the time.

I don't believe AC's intentions though are to do with stealing the software. The software is the code not the database.

The issue is that if you have access to SQL (as the database), then it would be easy to change a 104 degree fever to a 99.9 degree temp. Huge difference. Imagine sending a record to one lawyer with 104, forgetting that you did, then sending another lawyer the 99.9. That isn't just the lawsuit, that is your license.

Also, you can't change your formatting via the database. You have to do that via the code. Wherever you enter data, that goes in SQL. The structure of how the program works is due to the code.

I have a similar question:

My associate decided to leave and will be also using AC at his new office. I am willing to give him an electronic file of the notes for patients he has seen in my office (he has a separate patient panel). Is there an export function to accomplish this from AC? Can the CSV file approach work ? If yes, how is it done? Thanks

Rene

Wow, that is a tough one. First, let me applaud you for doing this amiably. My former employers always told my patients that I just quit and move to Kansas. I think they chose a new state once a week.

I am not sure, but I doubt you would be able to do this by yourself. I don't see how the program could parse out the data.

I would call AC and see if they could do it through the actual database.

Wow Bert, That was quick! Thanks.

No use being adversarial about it. It will likely be more work for my front office staff to print quite a few patient notes than to export electronically if this was possible not to mention more than enough patients, different panel and most importantly, I can't see them all anyway.

Yes I will call AC and see what they recommend. I have semi-independently worked on my systems (2 raided servers and about 20 workstations)and you're right, in the past few years as it has grown in complexity I almost always work with an IT person beside me. I know we used a CSV file to transfer all demographic data from lytec when we converted from another system to AC a few yrs ago. I did not find an easy way to export patient specific notes from my old system then. Fingers crossed that AC support has something up their sleeve.


Rene

Rene,
So exactly how amicable is this? You could of course just give your former associate a copy of your enc file. I understand this would be a VERY generous and trusting way to handle the situation...but it would also be by far the least labor intensive.

How do you propose to identify these patients? Will you provide the records for all of the patients seen by the associate? Will you wait until each one has been requested?

Do you have Updox?

Wow, 20 clients. That would take a full time IT or at least part time.

Jon, while your idea sounds intriguing and the simplest way, even though her associate had complete access to her/their patients at that practice, I think there would be confidentiality issues if an entirely different practice had former patient records.

Speaking of CSV files. (and since my post slid off the "recent board") anyone know the format of the Quest-Appt CSV files for import into AC (an import menu item).

My associate says he called AC and they suggested basically as Jon suggested giving access to the entire AC file (the enc files) and then simply inactivating the patients that were not his. I objected as this would violate HIPAA as Bert has pointed out. We have separate panels and reactivating the inactivated patients is easy. I was hoping there was another solution (even a manual electronic export per patient is not as bad as it sounds).

Rene
btw, full name is Renato, male
IM/Pulm