Home Forums Discussions General Discussion Blog of a newbie. A doctor's AC beginning.

Hi everyone. My good friend, Adam Lauer, a solo family practitioner from Brewer, Maine has purchased Amazing Charts as I write. Approximately two years ago, standing outside of a Chinese restaurant in downtown Bangor, I encouraged Adam to purchase AC. Adam has installed what I would call a state of the art network in his office and is ready to move from paper to the great digital world.

We thought it would be interesting for him to write a blog chronicaling his setup of AC and a bit of his path. As blogs generally go, it should go pretty much uninterrupted, but if any of any brilliant thoughts to add, please feel free to do so.

Thanks for volunteering me, my good friend.
I'll try to chronicle my journey as best as I can.

2-1/2 years ago, I started my solo FP office. Cost was an issue and I couldn't afford a complex computer system. Bert suggested I start off with AC. I argued stating paper was cheaper, and I was influenced by a practice consultant who felt paper was a better "guarantee" that nothing would get "lost."

Boy was I wrong!

For the 1st 2 years of my practice, I slugged away with paper. I dealt with missing paper charts, staff time filing papers, signing papers, faxing papers, printing papers, and worst of all was staff LOSING PAPERS. Paper, paper, paper!!!

Ugh, I'm hating paper (but I still use a paper personal organizer/calendar), ironic?

Do you know how much I spend per month on paper, copy toner, and associated fees in dealing with paper?
My cost is:
$250/month raw paper
$179/month toner
$400/month staff time filing (estimate based upon one staffer at $10/hr, 40 hr/wk, 25% of time spent filing)

$600/month miscellaneous staff time (finding charts, writing sticky post-it notes, putting away referenced charts)

Medico-legal risk for poorly documented phone notes, prescription refills, and staff advice to patient: PRICELESS

So in summer 2007, after much pressure from Bert, I bought a server. I configured it myself, installed Small Business Server 2003 myself (he helped me), and connected my client computers myself (again more help from Bert). I got the server online by August 2007.

I simply waited and tweaked, getting my server into peak performance nad patiently listening to Bert tell me how great AC was. I would have gone to AC sooner, except for the following:

My wife (and office manager) is extremely ill with idiopathic gastroparesis and was hospitalized 5 times at our local community hospital and was admitted once at Mass General for 5 days. She had a J-tube and Port-a-Cath placed in order to maintain nutrition.

So we fast forward to end of December 2007...

December 2007: I downloaded AC for the 1st time. I was not able to play with it for about a week. Around Christmas, I started using it on my computer at home.

I needed instruction from Bert in order to get started. Within a couple of hours, I was navigating nearly all features and configuring it to my office environment.

I spent a great deal of time on templates. I did not like the ones that come generically with AC. So I basically deleted them all and made new ones. This took a few nights.

I played with the databases and learned some of the strengths and weaknesses of them.

One word on Backups:

I am now considered extremely anal retentive about backups, by my own standards. I used to backup only to a re-writable CD, the practice management software/data base. I didn't know the inherant weaknesses of single backup systems.

After a Vista failure on my billing/scheduling software (Emedware by Sage......NOT AC), and a NEAR catastrophic failure of my backup system, I learned a better way was required.

I emulated Bert's system. Here goes...

My back up system:

6 external hard drives, connected to the server. They are labelled Mon, Tues, Wed, Thurs, Fri, and Weekend. These backup my practice management software (Emedware) and the entire SBS server, daily. Therefore, Monday's backups go only to the Monday drive. Tuesday's backups go only to the Tuesday drive etc, so on and so on. I use Backup Assist, a comercial program, to schedule these backups automatically at night.

DVD burner, I copy the weekly backups and take home for archiving.

Pocket sized external portable USB hard drive to perform daily to every other day backups of the practice management software only, to take home and remove from the office every night in case the building burns down.

Mirra Personal Server, is a real time backup onto a small computer device (the personal server), which backs up in real time and allowed for file recovery in the event of deleted files.

To those whom I've read that back up their entire systems onto USB drives (thumb drives), STRONGLY CONSIDER CHANGING YOUR WAYS! Multiple backup media helps to ensure that your data is recoverable in the event of disaster or computer failure. The more backups you have, the less likely you are to have an unrecoverable disaster.

Remember, disasters are not typically floods or fire, rather staff errors/computer failures/hard drive failure/internet acquired viruses.

I'm signing off for tonight, and will post more later. G'night all!

I bought AC today, $995 plus $500 Angel Guardian Support, and registered my copy. What a bargain!! Compared to the other EMR's on the market in terms of cost, portability, and ease of administration....AC is still underpriced. But thank God J.B. maintains the promise to be a doctor 1st and a programmer 2nd.

Congratulations, and welcome, Adam!

I have gotten a lot of great tips from this forum, which have really helped with my startup. I have appreciated the diversity of approaches and opinions.

New voices and perspectives are always welcome. Thanks for taking the time to share your experiences with us!

Today, I installed the registration code on my server. I have a number of "faux" patients for staff to play around with. I have also converted the "real" patient demographic database flawlessly into my test version of AC.

Since I'm in court with the ex-wife tomorrow, staff are instructed to press every button, drag and drop all that they can, and right/left click every region of AC so they can become fully trained by experience. I think that's the best way to learn.

More to come, for those who are interested.

Welcome Adam!! Your blog was interesting, but what we really want to know... What is Bert really like?? Have you met his "domestic partner"? Should we be afraid... very afraid??

There is nothing domestic about my partner!

Welcome Adam !

So, how is it that your are handeling the documents THE EVIL PAPER.........
Are you using AC Imported Items or are you getting the hell away from it, as probably Bert has suggested.
Believe or not after 21/2 years with AC we still use paper records and print out our notes.

GAMA,
Since I'm not yet live with AC, I can share my PLAN. I have played with the Import Items tab quite alot, and find it very easy to drag and drop items into it. Right clicking to rename the folder ONLY (not naming the files individually for time saving). Thus files are entered sequentially, filed under proper heading/folder name, and that will be better than my existing paper filing (everything is just piled in sequentially, NO DIVIDERS!)

Here's the real trick thoug to make this easy for my office in handling faxes with minimal scanning. I do not have a traditional scanner, rather a printer/copier/scanner/fax machine. Incoming faxes are directed via my network to a shared folder on my computer server. From here, a link on every staffer's computer allows ready access to incoming .PDF formatted faxes. This is 90% of all incoming media to my office. From here simply open the .PDF, delete any cover pages, drag and drop into the appropriate patient's Import Items folder, relabel the folder, and voila! it's all done. Believe it or not, this takes less than 1/3 the time of standard filing (printing labs, pulling charts, alphabetizing papers, punching holes, lifting those stupid metal tabs, and puting chart away....not withstanding time searching for the dreaded MISSING CHART).

GAMA,

We at least have to get you to stop printing out the notes .

As soon as you go paperless or at least printless for one month, Adam and I will come down and take you to the nicest restaurant in New Jersey. Well, at least one we can afford. <G>

Bert and I can't take you to any restaurant in N.J. We don't like N.J. We'll take you anywhere else in the country.

GAMA,

That's not true. Adam didn't mean that. NJ is awesome.

@Adam, yeah the dread missing chart. I think that stastics show it is cheaper to fire the patient than it is to spend days looking for the chart. You have have to get their address...oh wait, it's probably in their chart.

Hi Adam,
I am a relative newbie to AC as well. Brian and Bert have been invaluable.
I have not always followed their advice and have regreted it most of the time.
I have been in pracitice for thirty years between emergency medicine and family practice. I currently hold a contract with a community college and take care of 460 full time employees and their dependents for a monthy stipend; it is the best job I have ever had. I began AC in September 2007.
I currently have my desktop server and three client laptops (one for my wife/receptionist/office manager and two for my two exam rooms). Each patient receives a printed "Summary Page" from AC as they arrive for their visit. The Summary Page includes everything from their picture to their diagnoses and current meds along with preventive items such as last colonoscopy, paps, mammograms and even cholesterol complete with values. I keep all of these under the "Directives" in the Demographic Page.
The patients love this and it gives them the opportunity to update their Summary Page with each vist (which keeps me current as well).
I initially dictated everything with Dragon Naturally Speaking (Bert had encouraged me to do everything in the patient room, but I ignored him initially). I have recently been completing my charts in the patient rooms with the patients peering over my shoulder and I forward them to myself to sign later. This is much quicker and my patients and I both prefer this procedure. I complete my Rxs in the exam rooms and print off the typed Rx and hand it to the patient. My receptionist can then fax it to the pharmacy for them or they can take it with them.
I am becoming more adicted to AC daily.
Welcome aboard!
Best,
Jim

Thanks Jim.
I appreciate the welcome.