Home Forums Discussions General Discussion EMR dissatisfaction

I am not sure how much I trust the KLAS surveys, but this one suggests that so many people are unhappy with their EMR's, that about half of the people looking to buy are actually looking to replace the EMR they already have.

And, in good news for AC, "60% of EHR buyers in 2012 are considering a small vendor."

Jon,

Thank you for the article. Very interesting. I won't belabor you with my rationale, but have decided not to pursue MU because of my extreme satisfaction with AC/Updox and my improved efficiencies in the office.

If any one reading this is in the market for an EHR, I can not say enough good things about AC.

Jimmie,
I would be interested to hear about your decision not to pursue MU; I know you were grappling with it. Maybe in DC in November...

This doesn't surprise me in the least. Most of the EMR's are outrageously overpriced, their sales reps are horrific liars, and they rarely deliver on all their promises. Furthermore, once you get your data in you can't get it out. Agility simply isn't there.

I'm also really beginning to believe that many EMR softwares were developed by someone deciding they wanted to start an EMR company who then hired off-shore developers to quickly stand up a software for them. This explains why so many have not been updated in so long and why user requests never get done. People are literally giving their money to someone who is riding a wave.

People are going for the small companies because those companies, like Amazing Charts, were started by someone here who is trying to solve real problems. Not just ride a wave.

JamesNT

Jon,

I have not made any formal plans but hope to make it to DC in November.

I have been struggling, no doubt, with the decision.

I have come to realize that with AC, I do have a choice to pursue or not pursue MU.

I also have realized, it is an individual choice, and my rational/intuitive slant may not mesh with others.

I do not have an issue with others pursuing MU, and in fact would encourage others, if it is in their best interest to do so.

To understand my decision, I will try to keep it simple.

I am half way through my career, and plan to work till I am 62-65, at least, and soon to be 48, no debt, and lucky enough to have the house paid off. 2 kids, 9 and 12 who will likely go to college and stuffing away their college fund.

I went live with AC 11/11/11 and have things running smoothly with Updox and essentially as paper free as can be. I have about 8 grand into the process to get me to this point. (software, hardware, printers, scanners, etc.)

My overhead percentage has gone down (but has remained fairly constant)because charges have gone up and my collection rate has stayed the same--mid 90's. Since January 2012.

My increase in take home this past 6 months has more than paid for my investment.

I think I have some improvements that can be made to tweak my efficiency as time goes, and can stomach not taking the 44K (minus taxes) and the upcoming penalties for not pursuing MU.

AC/Updox has afforded me the ability to at least have a choice in the matter, and at the beginning of the process, I did not realize I even had a choice.

I am going to spend another 1500 dollars soon upgrading my desktop and mirroring the drive to minimize downtime when and if my hard drive goes out.

I have revealed some personal details, only to give those still struggling, some pertinent facts as to why I made this decision.

This transition has not been without stress, but I get a hint of what Joseph may have felt like when he told his brothers not to beat themselves up for selling him to the Egyptians. I am starting to see some light at the end of the tunnel or is that just a freight train coming my way?

Jimmie--

I am 69, still active in my office and happy with AC.
It is the only program that I have seen out there that--

1. makes sense on its own merits as a paper replacement. (I was never really unhappy with paper!)
2. Is inexpensive enough to pay off in the time I expect to remain in practice
3. Allows me a lot of control over hardware, and runs on pretty much anything, though better since I switched to SBS-essentials.
4. Has a spectacular user base that share all kinds of information. I have not yet had a problem that couldn't be solved by the user board, almost instantly.
5. Can produce clinic notes that are readable by human beings.
6. Allows me total control of my own data.
7. Continuously updates in meaningful ways -- every update is a real improvement.
8. Allows for "meaningful use" without a lot of hassle. I qualified the first year, and in the second, I think I am doing much better at using it "meaningfully".

It still isn't as efficient as paper for me -- but getting closer.

Thanks for the feedback Tom.

I have to give Gene from Cumberland credit for his inspirational quote about the light at the end of the tunnel, but I likely marred it a bit.

Jimmie and Tom,

I appreciate your posts. I am 67 with a kid just starting High School, so I figure I may as well keep working for a while. Besides, I really like my job, and it provides my main social contacts. So, the implementation decisions are made with a window of at least 4 years.

I find as I go along I have gotten more and more hardware intense. We have had rare failures in a part of the system that represented a "single point failure" and shut us down for a few hours until it got resolved. It really throws a grenade into the works, with scheduling repercussions lasting days or even weeks. So, I keep stuffing more and more redundancy into our system. It does sometimes feel like a very expensive game of Whack-A-Mole, and every new item is another item that can break, but with less and less impact. Every purchase is weighed against the memory of a half a day of non-production, and every time, the new gizmo looks cheap.

I do worry a little that AC is still a relatively small company, and very dependent on one person. I figure with a 4 year window, even if the company disappears tomorrow I can keep using what we have for the duration with no support or upgrades. I would frankly be a bit more nervous if I had 20 years to go.

I found the article interesting, and while I did not post it to gloat, I am surprised that people keep flocking to bloated, expensive EMR's which provide little in the way of useful functionality. In fact, some practices are on their second or third iteration, and still have not learned a better way.

While no one thinks it is perfect, AC is clearly working for many of us...

The question of MU participation is not always straight-forward. Some even call the economics into question; they argue that the costs of obtaining the incentive exceeds the payout. Then there are the quality and "moral" issues that Jimmie and David have described. While many of the requirements are a pain, MU is not just a series of roadblocks that are incompatible with practice improvements. One challenge now is to find ways to use AC and some aspects of MU to practice better medicine; personally, I think that is possible.

David,

Thanks for the feedback, and you have identified the Achilles' heel of my current setup, but in my opinion it is also my best asset (AC).
I do not have any personal experience with any of the horses in the race, just paper charting 19 years/pseudo charting with dragon for about 8 years.
However, your observations have not gone unnoticed, but currently I have put all my money on this horse and can't complain yet, ask me in 20 years and I may have another answer, but for my current set up all the other horses aren't as appealing, short or long term.

Jon,

Thank you, and I do owe you and your wife a coffee or beer, I have not forgotten.

I think this is classic "big practice" behavior. Everything that doesn't require a clinical decision (and some things that do!) gets foisted on the non physician staff, with money no object (at first) and the staff needs a lot of handholding (or "EMR training"). If the docs don't like the results, the office manager goes, new OM, new EMR, same cycle. I have watched a local cardiology group go through this 3 times.

John,

Last week I had a conversation over lunch with a cardiologist from Burbank, Ca who was helping peddle Bystolic, and actually had a very cogent presentation with the "sell" job. But during the encounter he had mentioned his cloud based EHR and how extremely unhappy he was because simple documentation was quite burdensome and asked what I was using. So I was trying to tell him, so instead I just took him to my desktop in my office and created a fake patient note with dragon/templating and printed up the billing slip, and he was quite impressed with the difference in documenting/ease of use. He asked in a round a bout way of the cost and I could literally see the blood drain out of his face, and I did not have the heart to ask him what his cost.

For what it is worth, I need to correct a mistake from an earlier post. Joseph was actually picked out of the pit by Midianite traders and sold to the Ishmaelites who then sold him to Potiphar, an officer of Pharoah.

I wish I had a dollar for every time one of the salespeople for the big name EHRs says "Our EHR lets you do what you do best, while we take care of the details!". What BS -- if you don't watch their every move, and make them produce results, you will spend thousands and have to do all the adapting & customizing yourself anyway.

So, if you have to do it all yourself anyway, why not just use AC?

As I was wandering through KevinMD, I saw this post, about much of what we are discussing here. Do any of these comments seem familiar?
-- "in our first year in the Meaningful Use era, our focus changed in a very bad way. We started talking more about our EHR complying to criteria than maximizing quality and efficiency."
-- "Our vendor jumped on this bandwagon, ignoring the fact that they were stuck in a pre-Internet, office-network design, and instead put all of their resources into letting their users meet Meaningful Use.?
-- "these criteria become more important than the patients they were meant to serve"

As the author says, Meaningful Care has become Meaningful Use.

This is just another instance in which the singer is worshipped instead of the song. It happens all the time; look at all the regulations of all different types that are enacted in a real effort to enhance safety that then just become objects of veneration in themselves even though the original need is long past. It is, after all, only human to be unable to say "The thing that I have committed my life to is now seen to be pointless, and should be allowed to fade into obscurity." It is depressing to watch, and seems almost inevitable.