Home Forums Discussions General Discussion Down with CCHIT

Here's mine --

Dear Secretary Leavitt:

I am not a highway patrolman, and I don't work for you.

I am a private physician who is working harder and harder just to make ends meet. I have cut overhead as low as I can and I am looking at creative ways to limit expenses, let alone give raises to my valued employees.

I have already had to cap my Medicaid patients, in order to keep my cash flow from further dwindling.

I, therefore, get to feeling extremely resentful when someone hands me an unfunded mandate from on high, and tells me "Son, if you want to work here (America) from now on, you'll have to pony up some extra cash, and do it *my* way."

Great letters folks, but have you posted them in your waiting rooms like I did mine??? Have you sent it to the mass media outside of this inner cicle of medicine??? Those on the inside already have taken sides for the most part. The only way to take care of this is to do the old, "One if by land, and two if by sea"; "The British are Coming!!!"

Warn your patients and write your papers, TV stations and other talking heads, this is the only way to take back control of issues such as these. And again a good number of your patients will love you for this, that you actually care enough about their privacy to warn them to action. Keep up the good fight...
Good Night and Good Luck,
Paul

My post at the blog:
http://secretarysblog.hhs.gov/my_weblog/2007/11/health-it.html#comments
Dear Secretary Mr. Leavitt:

I am glad you have this blog asking for public input.

There is no proof that CCHIT certification is scientifically superior to non CCHIT certified EMRs in providing better care to the US population. CCHIT has been a self proclaimed, pop up agency, which is trying to promote itself with no basis. If you or your staff know of a study which compares certified EMRS to a "control group" of Non certified EMRs to show who is providing better care please enlighten us.

Many of us Physicians had EMRs from time before CCHIT came into existence. Now forcing us to switch to a expensive CCHIT EMR for no reason is a draconian measure from powers would be.

I wish you a Merry Christmas and a happy new year.

Best Regards.

Great post, Joseph. Smart and well-mannered.

It made me regret my earlier post's peevish tone. I went back and posted again.

Then, I actually downloaded Al's PowerPoint presentation and watched it, beginning to end. It was very enlightening.

Thanks, Joseph, for the cross-pollination with emrupdate.com.

Merry Christmas!

You know, I would be very interested to know what Jon's take on all this is. He can't be happy with all this CCHIT business.

I would describe Amazing Charts in its present form as small, fast, simple, inexpensive, surprisingly powerful. That is what I wanted from an EMR, and I assume most people here feel the same.

The CCHIT wants to load Amazing Charts down with requirements and expenses that will make it larger, slower, more complex, and more expensive.

Nobody is going to want that product!

Those of us who have bought the product already are going to become less satisfied with it. The people who want big, expensive programs are going to buy the biggest, most expensive ones they can find!

To make a holiday analogy, I think of Amazing Charts as Charlie Brown's Christmas Tree. You hang a bunch of glitzy decorations on it, and it's going to fall apart. Keep it simple, and give it a lot of love, and its going to earn admiration.

Not to put too fine a point on it, but:

Glitzy decorations = CCHIT requirements.

Lots of love = Eliminate bugs, improve existing functionality, clean up databases.

The more love Jon gives Amazing Charts, the more it will succeed, even while the CCHIT-certified EMRs are struggling.

Here's the point that everyone in this CCHITTY arguement doesn't get or is sort of going around or half getting too but not stating directly enough, So here it goes.

There are standards and then there are standards. I used to be a tech in theater and TV and without standards in such places we would be lost. But standards shouldn't get so out of hand as to basically say, everybody basically has to make the same exact product. In their present CCHIT model, they may as well pick one single EMR, and then hand out quantities that the few inner circle companies can produce and sell. Much like when the Bantam Car company designed the original 1/4 ton 4X4 vehicle for the army back in world war II. You all know it as the original JEEP. Then the gov't took ownership of the design with it's all powerful powers and handed out contracts to produce it to Bantam (who got screwed) Ford and Willies.

Take TV broadcast standards and the recording standards of such. Old NTSC standard def is 525 lines of interlaced resolution at 29.97 frames per second, and when recorded whether on tape (VHS let's say) or DVD there are certain standards for that as well. Now that data can work in any machine in the country. But SONY can make a "Cadillac" or Bemmer type TV or disc player while some chinese company can make a leaky row boat. They all talk the same language and this is where things should be working to. My NTSC DVD will play in either machine, be it that the SONY may have a higher fidelity or clearer picture with less jitter and better solid dark areas while the other one kind of looks like CCHIT. But to tell everybody that they must have all these bells and whistles, as well as all these taxing features that may or may not pay off that is just insane.

Anyway, one makes standards so everyone can work or talk together and then step back and let the market do what it does best. Lastly, I don't think we have had nearly enough "incubation time" here to allow the market to shake itself out no less finish creating new ways and methods to accomplish things we need them to do. By setting this all on stone tablets so early, basically freezing all major changes or standards that are yet to even be realized, then we are really screwing ourselves no less the many brave souls who stepped out on that ledge (Like Jon and AC) and took that freemarket chance to design and produce a decent working product.

As much as I have been a thorn here at time, it is because I sincerely want AC to be the best that it can be. I believe in my heart that if Jon and AC stay of target and stick to the game plan (while polishing and evolving it too) that AC just might become one of the dominant products in this market. As I have called it before, the "QuickBooks" of EMR's for small and medium sized practices. There are now multi-million dollar companies that basically run themselves on QB's, so why not AC for us in our business. What we want to do is let the physicians and providers have a real say in this matter simply by letting them, like us vote with their dollars and their practices. Just look, if the stats that have been thrown around here lately are correct, AC is one of the few "growing" products out there that seems to have a real loyal following. Why shouldn't that kind of "voting by committee" be better respected then this CCHIT we are having shoved down our throats???

Funny how "freemarketeers" are never really freemarketeers... Blackwater, Haliburton, No-bid contract handouts, CCHIT, Reading Kits for Schools, Medicare Part D without negotiating prices against big Pharma like they do to us, Medicare Advantage plans that allow for "open hunting season" on our seniors while we pay UHC approx. $1K more a year than if folks were back in old fashioned fee for service Medicare. They simply use the cover of freetrade so as to better assist their friends in picking our pockets and CCHIT is no different. Energy policy written only by big oil and coal, EMR requirements only written by GE and a select few, it's all the same. Well screw that CCHIT.

Good Night and Good Luck,
Paul

You guys should also write to your senators. Check out my thread on this here:

http://www.emrupdate.com/forums/t/11833.aspx

Can any of you guys help me with this thread? I'm being viciously attacked by the pro-CCHIT, pro-P4P emrupdate lobby:

http://www.emrupdate.com/forums/p/11907/76255.aspx#76255

Ironically, there are no American docs other than the one (who owns eCW) doing the attacking. His helpers include the vendors for NextGen, eMedRec, and medtuity! I have to warn, you, though... there are nasty pictures and even an R rated version of "Forrest Gump" at the end. I'll probably get kicked out of emrupdate forever after this...

It doesn't look like you need any help, Al!

It looks like you're kicking all their butts single-handedly.

This is my latest, more serious note which puts the situation at emrupdate in perspective. Sadly, it's just a small microcosm of what's going on in Congress with CCHIT/P4P/ePrescribing:

Now let me get serious for a second...

The reason why this thread is not bumped to an "inappropriate section" or to a wastebasket is that there are 2 moderators that are behind it- Lowell Kleinman and Bob Larson. Yes folks, they are MODERATORS and as such are abusing their moderator abilities to manipulate the emrupdate threads to try to harass a poster (me) that they disagree with. These 2 fellas are markedly, viciously anti-CCHIT and they want everyone to get out of the way so as to allow the legislation before Congress to go through. Speculation on the pending P4P/CCHIT legislation is what is thought to be bolstering the price of these public "big boy" EHR stocks at this time, including QSII (NextGen). If docs get their 10% Medicare pay cut rescinded, without any such HIT legislation added on, you'll see their stocks tumble again.

In fact, I would wager that in 2008 Lowell will most likely switch to NextGen from eCW and will get it either free or at a markedly reduced price for helping Bob Larsen out in harassing me in the manipulative manner that he did yesterday.

Now, you'll see this thread on top for the rest of the year, since it seems that other moderators cannot move it, even if it gets ugly and annoying. I doubt that Lowell will publicly apologize for starting it... that would be out of his character. So it'll be "on top" or in the "inappropriate section"... it is up to "moderator" Lowell to decide.

Right now I'm just calling it like I see it... and I'm rarely wrong in my intuitions.

Tomorrow is Sunday, a day to do more posting, including of course discussions on more reasons why CCHIT / P4P / ePrescribing are wrong.

Well, Nick Harrington has banned me from emrupdate. <sigh> Now NextGen's Bob Larsen, the new moderator can help him run things and no more CCHIT/P4P/eprescribing discussion will be entertained. I just don't have the money to fight/buy out Nick compared to NextGen.

On a happy note, the vendors are beginning to complain that NextGen is given preference at this "impartial" website. If anyone still wishes to download my controversial Powerpoint presentation, and can't get it from emrupdate anymore try this:

"What Has Gone Wrong with the Direction of the HIT in the United States?"
URL: http://www.emrupdate.com/files/folders/al_borges/entry75428.aspx
alternative download site- http://www.box.net/shared/static/ceebmf946k.ppt

Cheers,
Al

Al,

I have posted your link on a local health blog. I'll be anxious to see if any non-physcians have any comments.

Leslie

It's a mess over at emrupdate.com right now.

I watched it unfold yesterday, and posted about it today:

http://amazingcharts.com/ub/ubbthreads.php?ubb=showflat&Number=4230#Post4230

There is need for legislation for protection of our patient data.
There is a need for government to investigate CCHIT as I beleive it is now used as a way to inhibit fair and free competition. Why is CCHIT given such importance?
1st step is to get AAFP to recant its support of CCHIT and remove those individuals from the organizational leadership who support the eavesdropping/medical record theft by insureres and government agencies.

(error- sorry)

<sigh> Not so. You were given a 24-hour temporary ban to bring you to order for stamping CCHIT across every thread. Something I fear that may happen here. Further I asked for us to have a telephone call to resolve this amicably. You have my US # and are still free to call me to discuss. I'm a little disappointed that you feel unable to make that call.

As a function of the CommunityServer platform your files become unavailable during your period of temporary ban. They are now available.


Not true. All these subjects are welcome provided that some simple Forum etiquette is followed. That being that you stop hijacking threads into a CCHIT discussion. ePrescibing is a new one that you now champion. Same applies to this; very welcome discussion points BUT be nice to the existing forum thread and flow.


emrupdate.com isn't for sale and isn't mine to sell. It is sponsored by a number of EMR vendors. These are openly published within the site-wide footer. NextGen do not act as moderators. Bob Larsen acts in a personal capacity to help out with some moderation and doesn't interfer with any vendor-based forum topic.

There is no grand conspiracy here. This is just Al Borges being pulled up for acting without consideration on a number of threads. Being a prolific poster does not mean he is above some very basic rules of engagement.

Nick Harrington
for emrupdate.com

>>> All these subjects are welcome provided that some simple Forum etiquette is followed. That being that you stop hijacking threads into a CCHIT discussion.

Nick- why are you doing here? Are you now stalking me outside of emrupdate? Leave me alone if you don't like me or disagree with me.

Threads become hijacked all the time. Do I participate in the discussion? Yes. What is happening at emrupdate is that I was being singled out because I disagree with 2 of the moderators over CCHIT/P4P/eprescribing.

Bob Larsen, the NextGen rep, hates me because I mentioned the truth- that QSII stock has lost 40% of its value in 2007 and they offer not as much "assurance" as CCHIT leads folks to believe. He was also angry at me because I mentioned that were it not for Secretary Leavitt/HHS backing CCHIT the way they do, CCHIT would be in violation of the anti-racketerring laws (RICO). I also posted the financials for 2 of the other "top" enterprise CCHIT certified EHR companies- Allscripts and Quadramed, and they each lost 40% of their stock value since 2/2007, even though Dr. Leavitt, Chairman of CCHIT stated that sales would go through the roof (in 2007 sales for Allscrips dropped by 20%). The Motley Fool on 3/2007 stated that the future sales of new EMR units for QSII/NextGen was limited going to the far future... that the QSII stock was thus overpriced.

EPrescribing is a big one for the USA- just read my PPT presentation that I posted last week, or simply read any USA paper, Nick. Congress may be mandating it this week- forcing this technology on everyone, including all of us physicians on this website. AC for example would not do- it would need to be CCHIT certified. I asked Bob Larsen to debate me on these issues from a NextGen point of view and all he could come up with is adhominum attacks. No data, no citations, nothing...

Nick- you have chosen a set of moderators that now include 2 people that vehimently disagree with me on many political and technological levels. You are now interjecting yourself to try to keep NextGen as one of the emrupdate "sponsors". Don't deny it as darn it- you post it right there on your home page.

To come back all I asked was that you in one way or another remove these 2 moderators from emrupdate so that I can argue with them on a level playing field. That's all, and it is critical that you, as the webmaster if you are not going to support me, then stay out of the way or join in on the discussion. To "castigate" me in any manner or form, well, is childish, and worse yet, bad etiquette.

That's just the way I feel. From what I've seen just about everyone else who has chimed in on this issue at emrupdate over the past 24 hours feels the same way about these 2 moderators, especially Larsen, the NextGen rep. I wonder how many "valued sponsors" you'll be able to keep now that the truth is known? BUT it is your website and you can do as you please, even if you run it to the ground.

After more than 3500 posts, you have now labelled me a "problem poster" now both inside and outside emrupdate. Maybe YOU need to retract some of your statements to begin to put out some of the fire and anger. Notice that although I am royally upset- I have yet to trash you or your personna.

BTW, the reason why he came here is because he locked me out (not that I was going to post there anyhow with the 2 moderators in question still working). I apologize to all for his attacks on my character, and most of all, for his stalking behavior.

Al

There you go again. You're trying to blame emrupdate.com for every problem caused by the current US Administration. You know full well you invited your own temporary ban by your persistent thread-bashing activity. As you are aware, you can post at emrupdate.com but please follow some simple rules.

Are you seriously suggesting I'm being bought out? Who by? Careful. You're posting accusations that could get you into trouble. I'm just shaking my head in bemusement & disappointment.

What a tragedy for a respected poster to throw such a reputation down the pan with these sort of comments. Sad.

Nick Harrington
for emrupdate.com

>>> Are you seriously suggesting I'm being bought out?

YES.

Let's analyze the situation-

1) NextGen is your biggest "valued sponsor" as listed on your home page.
2) You've warned me never to cross NextGen because you were afraid that they would back out of sponsorship of the site.
3) Here comes Bob Larsen with less than 200 posts at the time (you did not know him personally earlier on) and you offer him a post as a moderator immediately... why did you not choose another vendor poster with more experience at emrupdate, and with less bias?

Thus I'm left to choose any 1 of 4 possibilities:

1) You are not a sane person. (NOT SO, or you've had me fooled)
2) There is some sort of gay relationship. (DOUBT, or you've had me fooled)
3) You suddenly developed a keen hatred against me. (Doubt, since you tried to pay me to improve the emrupdate medical section just 1 week previously.)
4) You got bought out. (DING, DING, DING, DING!!!!)

Through my acute ability of deductive reasoning I narrowed it down possibility # 4, since I pretty much know you enough after almost 4 years of constant, daily discussion, and even meeting you in England and you coming to the USA to stay at my home. I would definitely go for you being bought out.

At least Lowell was obvious on how he was rewarded; today, less than 72 hours after he performed his stunt to kick me off the site he's now "demoing" his NextGen license for all the world to see. It reminds me of the scene in the movie "Goodfellas" where after they make a heist some of the members went on a shopping spree, buying fur coats and new suits almost immediately with the illicit money.

Well, given that I am the postmaster general here, I feel compelled to add to this foray. First, the above will never happen, because most of here are anti-CCHIT, anti-big and expensive EMRs which take two months to learn, and anti P4P.

I am not sure what "hijacking a thread" is, but I think I am viewing a good example here. You are perfectly welcome to post here, but since Al is now unbanned at emrupdate.com (may I say that no one has been banned here either because our moderator would never see fit stifle any discussion here that is not rude or obnoxious) I see no reason why the others at emrupdate.com wouldn't benefit from your conflict.

Nick, what are the rules of engagement over there? Is there a list? Is there a definition of hijacking?

My other question is why is so much emphasis placed on how many posts? It seems quite arbitrary to me.

I am rather nervous given that although I have nowhere near the amount of posts as those on emrupdate, I am the highest poster here and that may make me a hijacker. Hello bmcd and Roy and Paul, et al; do I hijack threads? And, remember I am a moderator. I may not be the powerful one who is Vinny and very deservedly so, but I still have some Harry Potter type magic.

But, who knows, maybe our moderator will become bored with this thread and stop it altogether. To quote him once on the one thread that did get ever so slightly intersting, "We are all on the same team." Sounds like a pretty good quote to me.

Not true. Most of our sponsors pay $1,000 p.a., a couple pay less because I know they're not "NextGen" or "eMDs". So things are generally quite equitable.

Not true. I've never "warned you not to cross NextGen".

Choice of moderator. None of your business. Got a problem? Start your own forum (well I personally setup 2 web-sites for you!)

The rest of your post and new posts at emrupdate are just insulting. Worse, to imply that anyone is on the take is libelous. To compare Dr Kleinman to a Nazi is unforgivable.

Good bye Al -- Welcome to your new home at the AC Group.
(Good luck AC Group -- you're going to need it!)

Nick
for emrupdate.com

>>> but since Al is now unbanned at emrupdate.com

Bert, I don't think that I can post there anymore again. <sigh> Lowell has stated that "I crossed the line" again since I've asked politely that they please step down and that Nick selects neutral moderators that everyone respects and admires. Nick is upset at me again. All I did was place 3 posts, and again I'm banned. Dang:

http://www.emrupdate.com/forums/t/11907.aspx?PageIndex=3
http://www.emrupdate.com/forums/t/11951.aspx
http://www.emrupdate.com/forums/t/11946.aspx

Bob and Lowell don't like me, even though I've been a humble servant, a lowly poster whose only sin is to disagree with their political agenda. Nick is their captain and as you can see above, he's on their side all the way.

I guess I'll be doing a lot more physical exercises this winter, since I'll be writing less, which at the end is good! (I'll get rid of my pot-belly.)

Nick:

I apologize at placing you in this predicament. Your friendship has meant a lot to me over the years. I simply don't want to write while Lowell and Bob are moderators. Period.

If my new-found energized notes came off a bit mean-spirited, I apologize to both Bob and Lowell too. I don't have anything personal against either of them- I just don't respect their authority and what I perceive as their abuse of the power that you have given them as moderators.

I NEVER BTW compared Lowell to any Nazi group or dress or whatever, Nick. He's the one that ***wanted*** me to, but I never did it:

Lowell: "I will await your answer but anticipate a flurry of pictures of me in a Nazi uniform..."
All I did was to post an empty German uniform with the title: "don't know what to do with this thing yet... Lowell wanted to try one out."

(This came out of the thread where he chastised me publicly- as you can see, I used a lot of restraint!)

So be it. I can't fight against 3 guys that seem to want to moderate a website into another direction, demeaning me at every turn, AND following me around the internet.

I'm worn out... signing off.

Cheers,
Al

To emrupdate.com:

Have you seen our cool Wikis?

(please don't delete this last note)

Nick, Bob and Lowell are royally upset, so I would like to set the record straight so that hopefully we can all find eventual peace:

Nick, Lowell, and Bob-

I apologize to all of you for the past few days. I would like to part with the memories of past better days and forget the stupid, foolish things said by all. I especially feel that I am guilty of continuing the fight longer than it should have gone and for saying things that upset you so much.

I do hope the best for all of you and that emrupdate continue to sail the EMR seas without any more storms.

Al

Nope -- had a quick hunt around but curious. CommunityServer.org were talking up a Wiki component, but that looks dead in the water at the moment. They don't always "get" what forums need, focusing more on Blogs. Got a link?

Nick

They just started. It's a debate over whether they will work or not. On one hand, you may get this great FAQ that morphs into something better; on the other hand, you have a newbie building his whole network around the Wiki only to find it change.

Hey, later on guys, I will send you all a link to a site that, if everyone reads, we will all have a good laugh. We all need one, I think. As our moderator once said, and I believe it was in reference to my transgressions, "We are all on the same team." Of course, there may be a few TOs (ref to the Cowboys wide receiver)

http://www.amazingcharts.com/wiki/index.php?title=Main_Page

Doesn't surprise me. My partner and I were pretty mad at Jon last year, and got a copy of Medtuity to try. We installed a live copy of the software (enabled with 35 encounter tokens) and the damn thing didn't work worth a darn. Was way to cumbersome to use, even if it WAS pretty, and we could never check a patient OUT and have them LEAVE THE BUILDING. They told us "oops! we fixed that.. " yeah, well, it shows that the program is near impossible to run a real practice on. Jon's got close to 1500 users and AC is growing every day. After looking at about 15 other products, we reached the same conclusion we've reached three times in four years - the program works and does most of what most of us need it to do. Jon and I worked out our issues, and we all moved on. BTW.. there's a reason most of these companies won't give you a live copy of their software to pound on.

Why bother debating them? My feeling is walk away and leave the emrupdate people to play in their own sandbox, while we run our practices.

Is nice that the VENDORS have all this time on their hands for forum posts.. maybe they should fix their products instead of wasting their time blogging. You'll notice, btw.. that Jon rarely makes an appearance here - not because he doesn't care, but because he's busting his BUTT to get the updates out and the bugs fixed.

I'd ignore 'em and walk away.

Regards,

V.

Matt Chase is a very knowledgable guy. I've disagreed with the "granularity" theory of his in that I find that such systems in general are very clunky. I like freehand, scanning, dictation- i.e. I like the EMR to be a tool, not an object for P4P and for other forms of government interference. It has to PROMOTE workflow, not hinder it. AC is such a great product- I was the major debater for AC for years against Matt, who considered a Jet 4.0 backend awful. The fights were heated, not as much as this week's fights, but they got sticky at times.

I think that a Jet 4.0 backend is a great, cheap, easy to maintain software, and is more than enough power for the small physician office. I look back to these discussions- they were classics. It highlighted the fact that sometimes the "anything but the best" mentality is not always good and will come at a price.

I have been a lurker at emrupdate.com for a number of years. When the CCHIT debacle first began, Dr Borges was in the forefront championing the physician cause. Vehement debates were waged between the vendors (Holt el al) and Dr Borges. In the end they won and Dr Borges was right.

We are at a nexus of patient information management. Granular information helps epidemiologists looking for work but not me in day to day clinical medicine. An EMR should be a tool to practice good medicine. What next, my stethescope needs CCHIT certification.

I am using AC as a hybrid. Database function for PMH, FH, SH, and Continuity of Care Record (CCR instead of CCHIT) I still write my notes because I like to script and have been trained to think that way. Which is another reason granular data collection becomes an obstacle to my delivery of care. It is a distraction rather than a tool.

I look forward to the added spirit of the forum. It is time for medicine to decide what works, not business.

Gary DeCrona MD
Solo Practice
Family Medicine

Welcome, Gary. Very glad to have you aboard. I started using AC as a hybrid (office scheduler, script writer, ICD/CPT code reference, intraoffice communications) and then started using other features (medication list, PMH, FHx, social history) which I printed onto my written notes to make the notes complete for coding compliance. Hope you will find the userboard a good resource (in addition to it being a pleasant distraction).

Hi Gary,

Thanks for your first post. Since, we are talking about the beginning of AC, I recall my old office where I had been doing a very labor intensive search of all the EMRs for over two years. Had sales people in the office. Drove to Boston and NH to look at some. Tried Praxis which was cool, but had a very steep learning curve and 2.19 wasn't 3.0. I recall in August 2003 finding AC's website on a Friday night. On Monday morning, the staff walked in at 8:00AM and we went live at 9:00AM. Never looked back since. Well, I did leave that office to set up here. And, started the very first patient in AC. It's great to have every note in one place.

The only thing I liked about granularity (if I am using the word correctly) was the ability to have the computer code. Way back when Logician Internet before it became Medscape Encounter and bought by GE, the coding feature was extremely useful. You can't have that witout a drill down approach. But, the trade off is the speed. It takes forever to chart like that.

Good to hear from you, Gary. I would be interested to hear the specifics of how you incorporate Amazing Charts into your practice.

All I want is an EMR that helps me to do my job every day. I am a struggling solo FP, and Maslow's Heirarchy of Needs is dictating my EMR choices.

Therefore, I am indifferent, if not opposed, to any EMR that fulfills someone else's lofty vision of "21st-Century Medicine" at my expense.

There is a lot of scorn at emrupdate for EMRs that are perceived as "only a note-maker". However, I think that is all that most doctors want.

The overwhelming majority of doctors right now are fulfilling that function with hand-written notes, forms and transcription.

I am no technophobe, having used Mac and PC platforms for probably 20 years before I started my own office, but decided to use paper forms and then transcription when I started my own clinic because of the expense of starting up an EMR (I had never heard of Amazing Charts until this year).

Amazing Charts allows me to create notes nearly as quick as I could dictate them, with immediate access to the final typed report, and adds a number of auxiliary features that simplify other aspects of office management.

We had been a paper-only practice for four years, and my staff got beside themselves when I brought in Amazing Charts, for crying out loud. I tried to switch too abruptly for them. I had to give up my plans temporarily, and then re-introduce elements that could be absolutely demonstrated to save them time and energy, as quickly I thought their nerves could handle it.

After a couple of months, we are working two-charted, paper and electronic, but everybody likes Amazing Charts, and they are showing me new ways they have found to use it. I am still charting my course to a paperless office (pun unintentional).

Currently, I am figuring out the best way to use the LabCorp interface, which is basically going very well. Next, I want to look into ways to tame the fax machine, and the lab results from the hospital.

Folks,
Our local Med Society just sent us an attachment from the AMA about congress only "solving" the Medicare Fee Schedule for 6 months!!! Now these idiots can't even fix the f'ing thing for an entire year at a time??????? Don't try and tell me that this is not all too intentional to keep doctors limited funds and time focused on this CCHIT every year so we have less resources to use and apply to other equally if not more important issues, like trade rules that level the playing field between providers and carriers. This is a payback for their friends in the insurance industry for sure...

Smoke and mirrors, watch this hand over here while I pick your pocket with the other one over there..... BullCCHIT!!!

Vinny,
With the email I just got and I forwarded you a copy, it came with an attachment. Is there anyway to allow us to post and import, documents, pictures and the like so important stuff like this can be shared with the whole group? And like I said before, sometimes a picture really is worth a thousand words.

Read and Weep people.
Good Night and Good Luck,
Paul

Hi Paul:

It's the Congress vs. President Bush and we're all stuck in the middle. I don't think that they will continue the pay cut after June- if they do, it'll really kill off Medicare as we know it as large numbers of physicians will stop accepting new patients and may opt to cut out old patients altogether.

What they've done as a compromise, though, is to disenfranchise the Pay for Performance (P4P/PQRI) initiatives which were going to be a real big pain in the rear for all of us. They used that money to pay for the 10% pay cut fix. It is really incredible that they did this, and in this manner. Bush had threatened to veto the measure if it didn't have a EHR component tied to the final legislation (note that by not dismembering it completely, they avoided the Bush veto; defunding it, though, was OK it seemed). Would you REALLY be happy had you been given the 10% pay cut, but only IF you close down your non-CCHIT certified AC and have to buy a GE or NextGen EHR in order to see Medicare patients? THAT was what we were looking at- like looking down the wrong end of the Medicare shotgun barrel.

As probably the biggest, loudest, banned from emrupdate because of this issue lowly physician lobbyist I'm more-than-delighted with the bill the way it's come out. The only negative is the 6-month issue, but it'll get fixed. THIS IS A BIG WIN FOR ALL OF US!!!

Here's where the actual complete bill language resides:
http://www.govtrack.us/congress/billtext.xpd?bill=s110-2499

Note that at first it looks like they established monies for the PQRI (Physician Assistance and Quality Initiative Fund)here, including the eventual almost-5-billion a year earmarked for the future:

"`(i) IN GENERAL- Subject to clause (ii), there shall be available to the Fund the following amounts:

`(I) For expenditures during 2008, an amount equal to $150,500,000.

`(II) For expenditures during 2009, an amount equal to $24,500,000.

`(III) For expenditures during 2013, an amount equal to $4,960,000,000."

But then they seem to have taken it away, at least for now:

"(C) TRANSFER OF FUNDS TO PART B TRUST FUND- Amounts that would have been available to the Physician Assistance and Quality Initiative Fund under section 1848(l)(2) of the Social Security Act (42 U.S.C. 1395w-4(l)(2)) for payment with respect to physicians' services furnished prior to January 1, 2013, but for the amendments made by subparagraph (A), shall be deposited into, and made available for expenditures from, the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t)."

Whatever we end up with, you have until 2/15/2008 to make up your mind whether to stay a participating provider or not. I'd give the process a chance to finish, though, before becoming a NONPART provider just yet.

Al,
You are certainly correct about the CCHIT EMR component of the original that Bush and his henchmen wanted and we are certainly glad that such was dropped and not part if this stupid thing. But 6 months???? Come on. How much money and resources should we all be expending just to save medicare for everyone's grandparents??? This is not just us, this is the entire country for crying out loud. My mom and your dad, his disabled brother and the like.

By making us all focus so much of our limited resources on this CCHIT, we never get to have an honest conversation about the larger picture and that was my real point in the last post. And yes because of the CCHIT, cchit, that is why I posted it here instead of some other thread, althought I did sort of forget to add that very important component and thanks for bringing it to light.

But, every year we fight like dogs just to "save" the stupid thing and never get any real increase to keep pace with inflation so we can afford new equipment, health insurance for ourselve or our employees or just to keep pace with our own real ever rising costs. Meanwhile by holding the medicare fee schedule down, this becomes real price controls on our supposedly freemarket (that is why we can not talk shop among ourselves right?), and worse it is a BIG windfall profit for the major insurance carriers by acting as the forementioned price controls. Tell me this is not payback for campaign contributions and other perks of the job??? Price controls combined with laws and agencies that hand out rulings that say we are still in a freemarket that then act to totally emasculate us. Now that is pure and utter BULLCCHIT! Gov't bought and sold right in front of our eyes.

How can we fight for the bigger picture, for both ourselves and our patients, when they keep us tied up in knots wasting our few resources on this intentionally recurring theme??? This same stratagy even keeps the seniors' groups incorrectly wasting thier resources and time on this issue as well. Keeping people worried about their daily exsistance, and working in a mound of debt, separated from those in like situations, has been a stratagy used for the powerful for just about all of time. Doctors are no longer highly respected professionals that are different or separate from the rest of society. Instead you guys are just more oppressed labor to keep controlled under the thumb of well thought out stratagies of the insurance industry via well purchased gov't and their henchmen. It is part of a great plan and I for one hate it as I tip my hat to "them" for getting it so well planned and implemented.

BAAAAAA, BAAAAAAA......

Good Night and Good Luck,
Oh and Happy and Merry too,
Paul

Please write to your medical society(ies)to take a stand against CCHIT. CCHIT is not physician driven but shareholder driven. Somehow, AMA, AAFP and other organizations have bought into this organization's mission-- It is our medical society's endorsement of CCHIT that gives it legitimacy.

Send them a message, "I'm not taking this CCHIT any more!"

Folks,

I'm not willing to open up attachments in a non-moderated forum, as the LAST time we had that we became SPAM/PORN Central. Seems that once the bots find that we can take attachments, the spam comes fast and furious. :-(

That being said, I guess we could bounce those to entries in the templates forum, with a link, or something. I'm open to suggestions.

V.

Don't just WRITE to your medical society, people JOIN IT. Contribute to the PAC. Go to the damn meeetings. PARTICIPATE!

Julia and I are delegates to the annual MSSNY House of Delegates meeting. We're active in the society. We call and write to politicians, and participate in lobbying efforts, because in the long run, our survival depends on it.

I have resigned my membership in the AAFP because they do not have a single clue what it is going to take for the practice of medicine - and most specifically FAMILY medicine - to survive. They've stopped fighting for the well-skilled generalist, and have embraced this outlook that lots of government, lots of mid-levels, and lots of computers are going to "save" primary care. Makes BLOOD shoot out of my eyes!

What's going to save our profession, quite frankly, is those of us who PROVIDE the medical care competing in the same political arena as those who want to squeeze us. Can't fight if you're NOT THERE.

It's also going to take EDUCATING the patients that not everyone in a white coat is the same! The pharmacist should NOT be prescribing for your child's "ear infection"! Your shopping-mall optometrist should NOT be writing you prescriptions for oral medications! You do NOT need a specialist for EVERY FREAKIN' ORGAN SYSTEM if you have mild hypertension and hyperlipidemia, uncomplicated diabetes, or any one of the many common problems we deal with 50 times a day. Health isn't something the government "gives" to you.. your body is YOUR responsibility. Take care of it. You pay for oil changes for your car, suck it up and pay for doctor visits for your body ! Free care is NOT a right! NOR IS IT FREE!

We have some of our patients on one side (bless their dear little hearts) thinking our services are a "right" that has no cost OR value, the politicians who are encouraging this mindset to keep themselves in power, and the insurance companies who's job it is to keep as much of the money as possible. We have to STOP behaving like we're above it all, and get freakin' active.

Me? When we get socialized medicine and $25 an office visit I can always go back to engineering. How about the rest of you?

Sorry for this missive on Christmas.

V.

Right on!
I'm involved as a board member and delegate in our county medical society, on key committees in the hospital, and I write letters to our representatives weekly. Someone is reading my letters (perhaps it's a bot) as I get replies (sometime personalized and sometime with tangential replies). I don't belong to the AMA as I see them as the source of our misfortune (they are not generalist oriented) and spend that money on direct contribution to our state representatives and state senator and other worthy candidates. I agree that the AAFP is misguided by ivory tower folks that don't have a clue as to real medicine. AAFP's new campaign as "STRONG MEDICINE" gives us an opportunity for them to walk the talk. I hope that there are others that will send brief letter about your discontent with their support of CCHIT, and "evidence based" medicine. The "medical home."
This year, instead of writing New Year's Resolution, please try writing RESOLUTION for your HOUSE OF DELEGATES. If there is no prohibition against this (and I see none in the EULA), I'll print out resolution for ACville's review (need your feedback). If the resolution passes the House of Delegates in all 50 states (and a majority of well thought resolution do pass), then it will have the exposure and momentum to pass at the AMA. This is the fastest way to reverse AMA's, AAFP, and AOA's policy.