Home Forums Discussions General Discussion AC Saas started !

After more than a month of serious consideration of switching EMR to another vendor, early this morning on wake up I shouted to my sleeping wife ! AC starts Saas !!
This is a big news ! Now I may not have to spend hours a day searching for another vendor, changing billing software (from my current EZclaim)...

Congratulations, Amazing charts !
Let me tell you my story...

I always have considered myself tech savy, but how many doctors may have decent experience in networking IT technology? Each time AC network connection error message pops up, I have panic attack as I do not hire IT person. But that still is fine because now I am quite good in maintaining my own network and can troubleshoot most commonly occuring issues without downtime.

But as I am now about to purchase second office, remote access is another big headache!
- How shall I connect two separate offices? How can I improve limited AC's Template function ? How to avoid hassles of daily back up, and secure myself network or server failure. You know, even with daily back up, if disaster happens at the end of day(I just realized that I evenhave forgotten backing up whole last week), you lose whole day's job.
After struggling how to cope with this headache, I decided to peep into other EMRs. And have signed up and tried Saas EMR from practice fusion. Test running Practice Fusion every day, and have had demonstrations from other Saas vendors, my current status and opinions are:
1) Server based is obsolte, at least server + Saas hybrid must be provided by EMR vendor.
2) Saas is the way to go. It is speedy, no limit of file storage(such as imported item) to server, upload, then forget of backing up.
3) Sassi : No worry for remote access - this is the biggest thing !! No worry of staffs whining or crying knocking exam room for help with network error. People always worry of Saas downtime. I think Server downtime is greater headache than Saas server downtime. Saas downtime is noticed prior to their maintenance hours in advance, and users can prepare for that in advance. True downtime is (probably) not happening often in real world as server is maintained by experts and has back up something. But small server in my office is maintained by myself, and biggest thing is, I have to worry of power outage which happens with strong storm wind in summer season. Electricity power outage causes complete stop of server after hour of back up power to server desktop. I don't have to worry for this with Saas.
4) Worry about speed? Saas is not slow. Fast enough. And Saas provide better flexibility in programming(I guess) and template function is better than AC because they do upgrade very often at their side, not by us installing upgrades. I do not use dragon naturally speaking as I do not want to dictate in front of patient, and I finish and sign my chart at same time patient leave the exam room. To do this, template function is very critical ! Saas provides much much better templates than AC.
5) Functionality and efficiency wise, AC is the best !! All other vendors I considered provide redundant unnecessary functions that only causes more headache and confusion. Probably those are derived from 'confusion' of work flow by non-physician programmers. So far AC is the EASIEST, CONCISE and EFFICIENT EMR that any staff can use right away as they are hired ! EZclaim combination with AC is also quite satisfactory (even though AC does not yet provide full practice management module). To be honest, I do not wish full practice management software those which other vendors provide because they never seem easy to use. I set up billing myself with EZclaim without difficulty, and my zero experience newly hired staff doese perfect job of billing part without any difficulty or complaints.
6) Work flow : AC is best ! : Midmark ecg/spiro import is generally not provided by Saas. AC is perfect for interface function. Saas cannot scan files directly to charts (as AC does with scanner TWAIN).
7) Scanning and Fax/Updox : I use full function of fax management, imported or faxed lab and patient portal with updox interface. It is not well provided by other vendors. This is another big barrier switching to another vendor. I am already too spoiled by AC to switch to other vendor.

As AC now starts Saas, I do not need to start the hassle of switching EMR, and continue enjoy the great features of AC !!

Thank you

Alan Kim

Dear Alan,

What kind of internet connection do you have? I have DSL service rated at 3mbps. The actual speed when tested is: download 2.8mbps upload 0.76mbps. I wonder how fast AC/SaaS would run with this type of connection.

John

John, you seem to have same mistake I had.

DSL is no no in medical field.
I changed from ATT DSL to Cable only 1 month ago.
DSL has upload speed limit which is one of a characteristic of DSL !
Some companies (such as Comcast here in GA) provide a certain faster service, but my office is not coverage area.
The download 3 MB is quite good for DSL. Upload is usually 0.25 - 0.3mb/second at most.
We cannot blame DSL as it is how DSL's characteristic. I talked to att DSL tech support and I heard answer that my complained speed 0.2 - 0.3 actually is good speed for DSL, he said !

I switched to Cable (Charter cable) and download is 7 - 8 mbs average, peak is 10 and over mps, up is about 2 - 3 mb/sec.
As long as you have DSL, gotomypc also is slow. Big difference you may have is

1) Radiologist's group may not complain low upload speed froom my office: I have x-ray system with DICOM image reading at local radiologist's office.
2) Your gotomypc remote acccess becomes much faster, and now you may change your mind - "probably I can actually see patient with gotomypc at my second office..."
3) You may not suffer great system slow down when you synchronize bigger files with dropbox. With DSL, even simply moving big file to dropbox (and it starts sync immediately) causes slowdown - remember synchronization is uploading (and downloading) process.
4) When you use Saas, upload is very important as you are not saving scanned image directly imported to local server, but instead upload to cloud server !
After I changed to DSL, upload is almost instant.

Alan Kim

What if the internet goes down...

Alan - thanks for waiting! We get there, even though it sometime takes a (long) while.

Sandeep - yep, exactly the problem with SaaS models as they are currently designed: if the Internet goes down, you are screwed. This is especially an issue for medical practices with patients waiting to be seen (and more flowing in) - and is true for any EHR that is cloud based, (e.g., Amazing Charts in the Cloud, Practice Fusion, Allscripts MyWay, etc).

Which is why this is phase I of our SaaSy concept. Phase II of SaaSy is being designed to include your data both locally and in the cloud, so if there is an Internet outage when there are a dozen patients in your waiting room, all is well and you'll still get home for dinner.

I would hesitant to implement SaaS until the Phase II is implemented. Wouldn't want to to shutdown the office because Time Warner was having a bad day What's the ETA?

Late 2013 - though we are working to find a way to decrease this wait.

To be perfectly honest, when it comes to moving your stuff to the cloud, the main questions to ask are:

1. How much downtime can I afford?

2. How much downtime do I have now?

If you are a solo doc and do-it-yourself computer person with a disaster for IT, then you will be well served by going to AC's SaaSy. Your downtime will not go away, but it may be a VAST improvement over what you have now. People in this situation may wish to move to AC over the Cloud now and not wait for phase II.

However, if you are a practice and you have some type of Sandeep, Bert, or JamesNT for your IT person, then SaaSy may be a big mistake for you.

It all depends on whatever situation you have.

JamesNT

Jonathan,

I am essentially 2/3 "in the cloud" already using log me in on my wireless laptop remoted to my PC and using UPDOX--I have very small exam rooms and functionally had to go this way even though hard wired is recommended.
My question-will there (and I understand if there is no answer yet) be a free trial available or an approximate cost. As I am debating on upgrading from my current PC to a heavier duty PC vs getting a server. But may consider opting for this--but have to think about down time and cost issue, and have found it quite difficult not to e-prescribe or have the functionality of UPDOX when the internet goes down currently, which thankfully has not been very often and our internet speed is fairly quick 1 mb/s or so.
Also is there a good link defining and describing SaaS?

P.S.

no offense to you Alan as you did a great job laying out the pros and cons--I meant from more of a dictionary type description.

One other feature I like about having all my data locally (on an onsite PC or server) is that it is about all the power I wield these days as an internist. The power to share or not share any of my data with anyone I choose. Will a provider still have that power with SaaS?

Alan,

I am happy that SaaS will be perfect for you. But your article is biased based on the fact that you are limited in IT experience. So, yes, perfect for you. But, one, while the Internet usually doesn't go down, the users like John probably don't use DSL as a choice. They probably don't have cable available.

And, servers are obsolete?

I agree totally. The question should be, do you really, REALLY trust someone else to hold your data for you? What if you have a bad couple of months, and fall behind in your subscription payment; what then? What if AC goes bankrupt or for some reason is shut down without warning? Unless your practice is 100% acute care, you would be dead in the water.

Dependence of electronics for medical record keeping is scary. Letting someone else hold my data is terrifying.

A couple of the major issues with SaaS products like Practice Fusion (to pick a popular example) may be minimized or eliminated by AC's version. Owning an up to date version of your database and keeping it in your own office is major. It reduces the impact of internet outages and guarantees that you have access to your records in the event of a termination of your relationship with AC, for whatever reason. In addition, while Practice Fusion reserves the right to sell your data; and in fact is widely believed to do so- hopefully AC will not ask for that right, and can be trusted not to exercise it. You would still control your data.

This eliminates several of the most serious reservations that I would have about a SaaS product. It does not mean that I will sign up (I have no intention of doing so) but it does mean that I would recommend it as an option to those who are interested. As Alan and others point out, many docs prefer the option of a hosted version that frees them from many IT responsibilities.

I am wondering if AC can pull it off. Just one more difficult thing to add to their application. Are they talking in real time? Is it something that gets downloaded at night, in which case one cannot use it if there the Internet goes down.

To be fair, our Internet rarely goes down. I think about five times in five years and only for about one hour or less each time. Maybe it is different in other places. One nice thing about VoIP is that some providers will give you free Internet just for the VoIP. Or you could have an inexpensive Internet backup. Of course, to purchase $50.00 a month Internet just for the few times you go down doesn't seem like a good bargain.

1) Servers obsolete? I highly doubt it. "Real" servers are far from it.

2) In terms of speed, there is no way it can be faster than a local system. Upload speed is a limiting factor. For me to get 10 M/ 2M costs close to $300 per month (TWC Business Class, the only option besides a T1). Not exactly economical. Furthermore, I've had the internet go down for days at one point.

3) How do you have internet if the power goes out at your office?

4) The templates are different? Are you talking about the templates in AC?

I'm with David on this one. I like having my data locally. Don't have to worry about my data being held hostage if the relationship with the vendor goes sour.

I actually think electronic records are an improvement. Think about it with paper records... who actually kept copies in multiple places? Could you access a chart without having to physically get it? You can have your charts stored in a protected storage center or on something smaller than your car keys.

If your office were to flood, all of the paper charts would be destroyed. Maybe something like that happens to charts in storage. What would have done then?

There are obvious security issues. But they are manageable.

Using proper equipment often helps with networking issues. Using all wired workstations, gigabit switches, and things like that keeps things running smoothly. You shouldn't be having issues if the network is set up properly.
I wrote a little post called Networking Fundamentals. Check it out.
http://amazingcharts.com/ub/ubbthreads.php/topics/45875/Networking_Fundamentals#Post45875

I think SaaS could be a great addition. I would guess that the on site database would be synced to the main database. The question then becomes, how reliable is syncing especially with it being done to a cloud.

If totally reliable, it could be a popular option, especially those of us with 2 offices.

This then, will increase the need for someone to be able to combine the databases (hint, hint) for those of us with 2 AC databases.

1200 dollars per year for one computer with Saasy
3600 dollars per year for 3-5 computers with Saasy

still require main data base, so one would still have to have server/PC locally and maintained and changed out roughly every 5 years.

So if one has only one office and IT support locally, not worth the extra cost as I see it unless I am missing something.

Sandeep,

Our business class is fairly pricey from T-W, and we get similar speeds. At home, I pay $69.50 and get 15 down and 1 up.

I was told once by someone (kinda vague), that he just ordered regular cable and got it much cheaper and much faster.

They don't let you use the home version in commercial locations. It's crazy. We pay 45 at home and get 25/1. At the office we pay 90 to get 5/0.5. Supposedly business class packets have priority, but the backbone is the same for both residential and commercial networks.

Here is a related question:

We just upgraded to a DSL service giving us a measured 10 Meg down and 700k up, as fast as we can get on a "normal" line. We do very little uploading, almost all downloading. The service rep wanted us to buy a symmetrical 4 line service that was 1 down and 1 up guaranteed, and kept trying to tell us it would be a much faster service in the end. It was about $300/month. Now, I have an insatiable greed for speed, but even a degraded 10 Meg service ought to beat a dedicated 1 meg service for downloads in my thinking, and it is a whole lot cheaper, but the rep was really insistent. What do you gurus know about this?

You are *probably* better off with what you have for now. My guess is that the most substantial files you are pushing (uploading) are Updox files and backups.

On the Enterprise side, having done work for both national telcos and cable companies, from an infrastructure standpoint you are better with a cable modem over DSL because of the difference in the technology, and that is what limits the performance.

A while back, we needed better service in a location, and we got the cable company to extend their line because we could demonstrate enough new users for them to pull a line out and get "pole access" from the power company. The alternative was a DS3 since the fiber plant didn't extend in our direction.

The tech behind DSL is inferior, and more prone to congestion and signal loss.

After much research and planning, I am installing SBS Essentials server -- Thank you Sandeep, Bert, et. al. Not in place yet (I'm on vacation on the Big Sur), but I'm sure it will be better than my current Win7 32 bit 2G setup-- which itself is amazingly proficient and reliable, by the way.

A colleague has just decided to go with some "cloud" based solution -- I can't even imagine what he is thinking. It is costing him $750/mo per provider (there are two of them) and he has no access to data if the internet goes down, no access to his data if he forgets or is unable to pay the monthly fee, limited ability to switch to a different EMR (he doesn't own his own data, the way I understand it.)

Out here on the edge of the continent we have pretty good DSL service most of the time -- it's plenty fast to use RemoteDesktop with Dragon Naturally Speaking, for example. But I don't trust it to be always there.

Actually, we make paper backups of all our notes -- we can, and have more than once -- run our office by flashlights and a portable generator. Winter storms are major problems sometimes.

Maybe I am missing something or not understanding the definitions. While I am not big on DSL, especially for home use, is it not always "dedicated?"

One of the advantages of DSL is it is your own line. No one else uses it so you don't have degradation of speed based on all of the high school kids coming home and jumping on their Internet games and slowing down the cable.

I would never trade 15 down for 1 down. Is he crazy. You lose around 200 up by not changing. I would tell him to either give you the 1 and 1 for free or make the 15 and 700 (roughly) 15 and 2.

Our IT guys just recommended putting a cable line with 30 mb download and 5 mb upload which will become functional in next 1-2 weeks which should be a noticeable improvement with our current T1 cable at about 1mb speed. about 75 bucks a month for the new cable--

Lucky. I wish FiOS was more widespread. Best upload speeds around. 25/25 plan only 75/month.

Sandeep,
Too bad I can't rewire my own brain, then I might be able to sorta keep up with you.--what does FiOS stand for?

never mind--just wikipediaed it--ours is an RG8 cable--

It's a 100% Fiber Optic Network.

Also, a T1 is 1.54Mb/s.

The other speeds are just sick.

Verizon's FiOS stands for Fiber Optic Services. Just like Time Warner has Roadrunner, Verizon has FiOS.

I wouldn't be using a purely cloud service without a T1. Need that reliability. Lots of people use dual WAN with T1. Get the speed of cable along with the reliability of a T1.

Just to clarify, these things aren't actually in the clouds.

What are T1s going for these days?

Neither is my computer IQ, but compared to 6 months ago, I sure know a *&&^ of a lot more now than I did then thanks to you guys!!!
The T1 is about 500 bucks a month--around here. T3 about 800 bucks a month. Our new RG8 cable thru optimum 79 bucks/month.

I should also mention the initial install for the access point for the RG8 cable would have been more if it had not been for the allergist in the bottom floor getting the owner of the building to rewire and get the cable placed in her office, which happened to make our install easier and around 200 dollars. So the install may be more than that depending on location of access point.

T3 is 800?!?! T3/DS3 is 5000 a month here. T3 is 24 T1 lines. The pricing must be wrong haha.

I asked my IT guy and he said the T3 was 800-850 but maybe i misunderstood, and i don't know the D53 thing he just said he was at an office with T3 and asked the gal what it cost and she said 800 dollars. I'll double check I know just enough to be dangerous.

DS-3 (Digital Signal Level 3) is many times considered the same as T3, but in reality the T3 or T1 lines are the physical lines and the DS-3 is the electrical transmission through the line. It is equal to 28 T1s.

The cost is generally between $3,000 to $13,000 depending on location. So, let me know where to get the $800.

Then there is the OC3.

Bert,
Your killing me!!! I am not even going to ask what OC3 is.