Home Forums Discussions General Discussion AC survey

I got an e-mail asking me to respond to a survey about AC and future features desired. I was eager to respond, but I'll be darned if I could figure out what many of the questions were asking, and many of the possible responses didn't seem to be appropriate responses to the question posed. If I am not alone, I worry that the survey will give inaccurate direction to the AC developers. Did others have this problem?

One of my answers was that I didn't understand the question. It is almost like they want to make it all harder than it needs to be.

I did the survey this morning. It doesn't appear to be a survey about amazing charts. It seemed to be a marketing survey mostly concerned with what kind of Practice Management software would be marketable. More charitably, perhaps, what would be most useful to AC users. I agree that it was a little off-putting to have had a range of choices that went from 'Essential to have' all the way to 'Nice to have.' It's the kind of survey design that results in Board-of-Directors powerpoint presentations showing that 95% of AC users thought that such and such would be Nice to Have or Important. It often results in bad business planning. Something I saw in business school.

Wolffe Nadoolman MD MBA

Yes, Wolffe, exactly. The lowest response possible for many was "nice to have". Needed to have a box for "totally worthless, don't waste your time."

They would do better and get more information if they simply looked at the survey that has already been done by Bert....the list of 81

I felt lost filling it out. There was no effective way to try to explain what I wanted to say. Also, most of the questions I did not understand. Once committed I either had to fill out the survey or not at all.
JUST DO NOT GET RID OF UPDOX.
DITTO LESLIE

Sounds like a marketing survey made by someone who doesn't really have a background in marketing research. To do those surveys properly and have the resulting data useful and actionable is more difficult than most people think.

For those of us that don't get asked, would someone post the questions - curious now.

I'm pretty sure that Fixing Orders was on the list of 81; I hear it regularly.

Once you complete the questionnaire, you cannot retrieve the questions.

The survey was from Chris Tremblay, the new "Director of Product Strategy". It was primarily about Practice Management; perhaps a couple of questions about portals, mobile devices, and about analytics.
It did not ask about anything else (no orders, imported items, etc., etc).

Charting a new direction for AC's PM efforts seems to be a focus right now. Hopefully all of the other issues will be evaluated soon.

The questions were multiple choice and the least favorable descriptor you could choose was generally "nice to have"; there was no option to say something like "not desirable at all".

It also seemed like a survey designed by someone who was not very familiar with how AC is used by most practices. They spent several questions asking about what features we want in a patient portal. They seem not to know that we already HAVE a patient portal in UpDox, it works very well, I think most of us are very pleased with it, accustomed to it, and have no wish to change. AC is clearly way behind the power curve in developing features that we really DO want, so why dilute the effort re-inventing the wheel? It gains them nothing in market share.

It would be interesting to hear a clear statement of AC's priorities; increased satisfaction [fix things on the 81 list or other know bugs], increased market-share [marketing/sales function but doesn't do anything directly for the installed base], or increased revenue [more sales or more add-ons, this benefits the installed base where functionality is added *QUICKLY* by integration with third party solutions]

It is obvious from the board posts (and off-line conversations I am hearing) that the natives are restless, and increasingly so.

Here are the questions, I copied and pasted as I went through the survey:
1. Would you be interested in a Practice Management solution from Amazing Charts? Yes/No
2. What Practice Management solution are you using today for your billing needs? I outsource my billing/Other (please specify)
3. Do you have an interface between Amazing Charts and your Practice Management Solution? Yes/No
4. Are you satisfied with your current billing solution? Yes/No
5. I am dissatisfied with my current solution due to: Cost/Lack of features/Product support issues/Lack of interface with Amazing Charts/Interface with Amazing Charts does not work as well as I would like/Other (please specify)
6. Please rank the importance of the following Practice Management features: Critical/Very important/Important/Nice to have
-Eligibility & Benefits
-Electronic Billing via Clearinghouse
-Patient Portal
-Electronic Payments / Remittance
-Tracking of referrals
-Tracking of payer authorizations
-Billing templates for commonly billed visit types
-Support for hospital billing
-Skilled nursing facility billing
-ER billing
-ICD-10 coding help tools
-Revenue reports
-Configurable practice 'dashboard' that allows you to see info at a glance: schedule, billing, etc.,
-Practice workflow tools: task assignment, secure interoffice messaging
7. Is your office currently using a Patient Portal solution? Yes/No
8. Please indicate how likely you are to adopt a patient portal solution in 2013: We are definitely going to implement a patient portal/We might implement a patient portal but haven't decided/We will not be implementing a patient portal this year
9. Please rank the importance of the following patient portal features: Critical/Very important/Important/Nice to have
-Appointment scheduling
-Secure Messaging
-Delivery of Lab Results
-Rx Refill Requests
-Patient Bill Presentment
-Online Payments
-Online Clinical Visits
-Fax Management
-PHR Updates
-Release of records requests
10. Please rate the importance of accessing Amazing Charts via a mobile device. Very Important/Important/Moderately important/Don't care yo access on my mobile device
11. What mobile devices would you / do you use in your practice? Check all that apply; Windows smartphone/Apple iPhone/iPad/Blackberry/Android tablet
12. Is your practice participating in an ACO or other outcome based reimbursement programs? Yes/No
13. Are you currently reporting clinical measures that assess patient health outcomes?
-We are currently measuring & supporting clinical metrics utilized to derive health outcomes
-We plan to measure & report clinical metrics in the next 12 months
-We plan to measure clinical metrics in the next 12-24 months
-We have no plans to measure & report
14. Please indicate the level with which the following are challenges measuring/improving healthcare outcomes: Major problem/Somewhat of a problem/Not a problem
-Access to structured data
-Access to analytical tools
-Access to clinical and other related tools
-Correlation to clinical & other content to patient needs
-Time
-Other (specify)
15. Please indicate the value of the following to help you improve patient care: Very helpful/Somewhat helpful/Not helpful
-Ad hoc reporting tools to query & analyze your patient data
-Automatic identification of gaps in care at the individual patient, panel & practice level
-CME and other clinical resources aligned to your individual patient or practice panel needs
16. Are there items that would help you identify clinical care gaps in order to help focus your clinical strategy to improve patient outcomes? If so, what are they?
17. Does your practice plan to submit PQRS reporting to CMS in 2013? Yes/No
18. Did your office attest to Meaningful Use I ? Yes/No
19. Did you receive a check? Yes/No
20. Do you plan to attest for Meaningful Use II? Yes/No
21. ?If you would allow us to contact you regarding your answers, please give us your name and info here:

Why am I suddenly feeling like I should be looking at other EHRs?

Thanks John,

I thought it was a good survey, better than I could make up. If they are going to go shopping for an established PM or expand their team of coders, it helps to know the relative importance of different goals.

This forum is excellent for specific feedback, and I am sure they will get some.

My advice is that in the short term they need to get to something that looks like a final product that can be fine tuned and improved with time, because they are behind the major EHRs. In the long term, they need to have an excellent skeleton or database design that will allow for the improvements and requirements that will come when the industry gets consolidated and there is a consensus on what an EHR should be able to do.

Hi Bill,

I have had that feeling quite a bit recently, but I have not actually done so.

What we are using now works, overall very well, and is a huge bargain. So what ain't broke, I'm not going to fix.

What happens 6 months, or 2 years, from now is the great unknown. IF AC messes up what we have, THEN it might be time to look elsewhere. I'm not even sure where I would look, I'm not sure that there are a lot of really good products out there. I do know that there are a lot of much more expensive products out there.

So don't panic yet!

Gene

There is also an undercurrent here that disturbs me.

As you may remember, after years of complaining about the letter writer with no results, Lawrence Burris began work on a letter writer plug in for AC. He had the initial encouragement of AC, and several of us here supported his efforts. Then, rather suddenly and with no notice, they announce their OWN new letter writer for version 6.5. A lot of work and some money went down the tubes because AC finally decided to get off their B*** and do what had been asked for years. Now, they are "definitely going to add a patient portal", after years of having UpDox support AC and doing a fine job, with features that AC will not be able to approach. In short, they are no longer acting like the product for the little guy, nimble and responsive, but are now starting to swagger like the bully in the room.

I don't like this. If I want to be bullied, I will go to some huge corporation that has every feature I already want and does not ask for years of patience while they develop it. I will not have to worry if e-clinicalworks is going to fold next year. AC has always been nimble, fluid, and reasonably humble. I don't want to stay if they change.

I do wish we had been included in the survey. Well, too late now.

Can't say that I think it is a really good survey, but I can say I think it is good that they are trying to do this. Unfortunately, I'm not sure if it addresses the issue of the features that are already in AC (or almost in) but that don't work properly or in such a way as to be truly useful (e.g., order reconciliation)

The question about portal does not say that AC is definitely developing a portal they are asking practices to say - I would definitely use, etc.

I have talked with AC and they are trying to figure out what users need - we have discussed updox and they are aware that it is a good product and many use.

Just wanted to add my vote for updox portal being everything I need so would rather AC focus on improving within their current niche. I'm new to AC but have had lots of experience with lots of EMRs and what I have noticed is each one has its strong point and weak points but most try to do too many different things. One of the attractive features of AC is that it does not try to be everything. It leaves the fax/patient portal/online scheduling to other companies. It leaves the PM to other companies. It does a good job at being an EMR/EHR. It also appears to have a long history of being responsive to the needs of its users. I agree the survey will yield very little useful data. I think the user forum is a much better place to find out how people actually use AC...but it's hard to put into a pretty powerpoint presentation. :-)

Hi Robin,

You make very good points but there are two that really stand out. I agree that the best part of AC is that it does/did use a lot of 3rd party issues to others. But, not all of us use UpDox, and it would be a big step and cost to use it just to have the patient portal.

As to the PM thing, it used to, but that is the major issue between users and AC right now as everything is on hold until v7 (practice management) is built.

Bert-

Updox is a bargain, considering what it can do. Why should AC try to re-invent the wheel? The other undercurrent, elephant in the room, or whatever you want to call it, is what is going to be the cost of updating if AC rolls out a PM, portal, or whatever. I think that most of us AC users are very thankful that AC has been a tremendous low cost tool that has allowed us to get an EHR up and running. The last thing I want to see now is a piecemeal upgrade that does nothing well and costs double or more of what I am paying now. I realize that there is no free lunch and we have to expect to pay for what we get, but I for one don't want to get screwed over with AC trying to make people happy with a half-assed upgrade.

Mel,

I don't think you have read many of my posts. I don't think there is anyone other than Leslie that wants to go back to the lean and efficient AC. I abhor PM to be honest and couldn't care less about double entry. I don't do the entries. But, I don't think you can also just leave certain things out just because there are 3rd party programs that would work for certain people. That is the key. It has to work for everyone or there needs to be an UpDox 2 for others. I, personally, cannot use UpDox for certain reasons. Now, my programmer and I developed F.A.P. for managing incoming faxes. It's a little complicated to set up and can only be used in solo practice so it didn't get used as much as VIPER or Amazing Labels. But, if you use the first two, then you could say there is no reason for a solid immunization setup, and there is no reason for Imported Items, which takes us in a circle since UpDox integrates with II. I'm happy where AC is right except add the 100 or so tweaks that everyone wants. I just don't think UpDox is the answer for everyone, therefore are we to be left out in the cold. The difference with the PM is that everyone already has a billing/PM program in place.

How can there eventually be more than several EHRs? Since the consolidation is just starting, how do you think AC will end up?

AC has moved into stronger hands, and the founder has been able to take money out of his investment for his family's security and continue to contribute. All good, but there are many rounds to go.

The first problem is the wasted time trying to develop a PM unsuccessfully. While it is good education for helping to purchase or make a PM, the time and talent could have made much more than 6.5 by now. The list of 81.

The second problem is that they have to spend so much time connecting AC to a new PM to make it seamless. That may be very difficult too, but it will take a lot of time and talent to do it. My MediSoft transactions file is 20+ GB, so we will need a very robust database.

The third problem is the transition to new management and the time it takes to get people in and out, and then everyone on the same page. Does this sound like falling down in a race when you're ahead of the pack, and getting up and trying to get up to speed when you're behind? Fortunately, there are more laps ahead.

The EHRs of the present don't have to have a PM, because almost everyone has a PM already, and who wants to put the whole office through transition hell at the same time. But, the next step for everyone is to integrate front and back office.

The EHRs of the future have to have every bell and whistle that is required for the target physician market to take care of patients, and interact as needed with the government, insurers, hospitals, other EHRs, other members of the home model, and the patient. I would imagine that committees of appropriate experts and specialty reps will meet so that every ICD-10 diagnosis will eventually be associated with a list of data that have to be entered by whatever method you prefer to qualify for each of the different levels of E/M charges. The EHR will prompt you for answers and do the coding. An effective EHR will get most of the questions answered directly by the patient before they come to your office or while sitting in the waiting room.

An effective EHR will have scrubbed the chart to make your office look like you are good at dotting i-s and crossing t-s, or warned your nurse of a problem 3 days in advance of the appointment. An effective EHR will prompt prevention issues and treatment options, and provide resources to help the patient come to a better decision, either today or by the next visit. An effective EHR will allow patients to make appointments online, remind them, and contact them 15 minutes before the appointment to verify they are coming on-time, or reschedule and charge them. I'm sure I can't think tonight of the eventual requirements.

Most of all, however, it will have to save and cut personnel expenses if payments for our work aren't going to keep up with inflation.

and all that and less mouse clicks too!
I fear until EMR nirvana is reached it will be more than a 1000 mile journey.

Maybe AC will focus on the basics that need to be fixed...like some very very simple things before trying to take on too many big time tasks...oh wait..yeah right

For what it's worth, PM is bloatware for us. Our business model doesn't use complicated billing algorithms that require elaborate and expensive software to calculate and re calculate and calculate different ways of calculating the same encounter to get more money out of it. That's the way it's usually done and that's fine for those that use to that method. At the same time I resent the prospect of having to pay for that level of software engineering when I don't use it or want it.

If AC wants to run with the big fish then let them develop a bang up PM package and offer it separate from the EHR. An EHR should be just that, a health record, with functionality built around patient care.

I am probably wrong, but I think you can get it separately. I can't recall. Maybe someone else can.

But, I agree with you completely. AC was and hopefully will be again, the greatest little EMR ever. Then three things came along that changed all that. Two of those three were not the fault of AC. CCHIT and Meaningful Use took huge amounts of time and resources from AC's vision. Unfortunately, the PM is going to be a large albatross around AC's neck.

It is sad but AC keeps putting the real problems with its EMR to the side...it is the little EMR that could and they culd make it so much better with tweaks here and there...

i mean seriously, should we have to wait for yet another version to be able to delete the extra insurances in the list...

why is it so hard to edit templates with a tiny freaking box that only shows 3 lines at the bottom of the screen?

when writing a letter to doctors you can't type in the doctors name...you have to type in the first letter and then scroll down or up to find the name...yet in the rolodex they have already implemented the simple type in the name and it pops up...

the fact that with the current ICD-9 system you can't assign two different names for search for one icd-9 code...and don't say well 10 is coming out..because i bet you they don't fix it for icd-10...for example...i use low back pain and piriformis syndrome a lot...now i can assign 724.5 or whatever the code is either one name or the other...but i can't have it in there twice be searchable...and then if i cahnge the name in the assessment after i put it in, and then i write an order, it goes back to the original name that i saved in the search part...

i meant thesd are jsut the start..i am sure all of you have a lot more out there...these are just ones i dealt with today...i am a former programer and theese are very gbasic edits in my opinion...but you know who am i? just a pion user

Okay i am done venting

Had a patients son send me an email about Kareo(the son is one of the original investors in it) a complete package EMR with built in PM with a reasonable subscription cost, it is web based so I will stay away I'm too old fashioned like to keep my database with me but does bring up the question of what is possible/affordable/easier to use with EMR/PM integration and where and what will AC need to do to stay up and relevant

"What will AC need to do to stay up and relevant?"

Do what Ketan suggests. Go backwards. Go back to being what they were. Not a day goes by that I don't find something that could be changed. (many times the same thing). But, every day I find myself re-checking the top two boxes on the prescription writer so my DEA and License number show up on the script. But, my frustration is not nearly as much as the patient who is told by the pharmacy they can't get their Concerta without a new script.

Going way back, I think the survey was to get a sense of where AC users are. Many of the things in the survey are future requirements of Meaningless Use. As they raise the bar and increase the complexity of the reporting, they decrease the reimbursement. At some point, it just ain't worth it... but then again, once enough people drink the kool aid, it will make it mandatory.

So the goal should be to include those that are needed to get MU without changing the overall program. Some things such as portals are a major change (they would require external to internal linkages - much easier if it were simply a hosted program than a stand alone.) Again, what do you develop internally and what do you either link or merge?

From talking to the people at AC recently several things became clear:

There is NOT a major change in the management structure. They are refocusing and looking to the best direction, but they are poised to move aggressively.

They did feel it was better to outsource PM, but that PM should be an option for AC. Now it could be argued that there are already links for PM but I would suspect that a more closely linked PM is a goal. AC wants to offer a complete package and PM should to be in that package.

They are dedicated to fixing a lot of the problems that have been on the back burner.

They are interested in input from the AC community. They value the support and the wisdom of those in the trenches.

They are exploring ways to make 3rd party linkages easier.