Home Forums Discussions General Discussion Praxis - help

I have a problem. I have been on AC for 9+ years and like it. I have 7 partners (1 office houses 6 and I work in the 2 doc office). They are not on anything but Doctor First and are finally getting around to looking at EMR's. One parnter seems set on Praxis...I dont think I like this program, I cannot get a firm price, looks like you need to buy Oracle license, and support is ? I wanted them to look at AC, so they finally did. They felt it had too many clicks (they all do). I asked them to consider moving us all to the cloud, but I wonder if I could ever recapture my database in the event that AC retires, etc. As I see it, it would cost 2k per new user (I would need at least 8 nurses to have access as well) and then support for the entire shabang. I called AC and had to leave a message. We are using Medical Manager for scheduling and Zirmed as our clearinghouse. Any thoughts out there..thanks...Todd

Todd,

I think if I read your question correctly it has more to do with getting the 7 to come on board with the most logical EHR for your 2 offices. Do you envision one commonly shared data base For the EHR? I do not think AC is designed for this, however with that being said, our office has 9 physicians, and 6 are currently using AC and quite pleased. We have chosen to individualize our AC databases per provider, so that I have my own pod and manage AC on my own server and have my 2 additional computers to fit my needs. As an office we share a server for our PM/scheduler, which happens to be Lytec.
I have invested about 10-11 grand to get my AC pod extremely functional, and just to show some perspective, had a conversation with a drug rep yesterday who majored in business, and we chatted about different EMR's and he was bemoaning his own experience with his primary care doc. It takes anywhere from 2-3 weeks to get in to see his hospital employeed doc because he has transitioned into an EMR that is quite laborious to utilize, and admittedly is less efficient.
I showed him my system, and made him realize the technology is out there to quite literally be paper free and communicate safely and securely electronically and walked him through the process, how if he were to see me he would be handled. 2-3 days before the visit his labs would be viewable on the Updox portal site. Before he gets out to his vehicle after the visit he would have the summary of the visit available on his smart phone The CXR report would be viewable within minutes of my viewing with an interpretation later that day following his CXR. In 2 days he will message me asking for a prednisone burst because the advair sample and antibiotics aren't helping his bronchitis induced ashtma flare. As soon as I send in the prednisone burst to his pharmacy he will get a message to pick it up and in a few days he will message back that he is better. All of this easily capturable and recorded in AC as part of the permanent record.

Needless to say the drug rep/ business major was quite surprised how I run my little pop sickle stand. He had not realized that the technology to this degree is not only available but currently being utilized quite extensively in pockets of areas everywhere.

So back to your question, if your partners can find a better deal other than AC/Updox for the cost and functionality. I would encourage them to do so, and let me know about it. I think you have to impress on them it is not about the # of clicks, it has to be more of the functionality and improved efficiencies over time. Those # of clicks will subside, as you know, once you get your routine down.

The other issue is that if they see the light and choose AC, then do you do it in the cloud or do it on site. I do not know what to tell you there. Crunch the numbers and see what works best.

Thanks Jimmie:
I was planning to go with one giant database and I think we can afford the cloud so we dont have to run a vpn across the net to share AC on the main server at the bigger office. We currently do that with Medical manager and it has been a nightmare recently.
By the way I think I saw you are in Montana...I love Montana, I am originally from Seattle...

Todd,

You bet, any time.
Good luck on your endeavor.
Sitting out on the deck, looking out over the Missouri, and watching the tractor/bailer pooping out big round bales across the river. We are up on a bluff about 300 feet so get a birds eye view of the farm. I think the thing that drew me to Montana is the ability to see mountains 50-70 miles off in the distance, unlike anything in central Indiana, where I was spawned. Although, I do miss the big cornfields. fireflies, and humidity effects on the skin.

Todd: now you know why I love Alaska. I have very big mountains as close to my front door as I could want them. Our church as a Peak of the Week event for us outdoorsy types.

I would highly recommend having your own databases, especially since the server requirements are so easy. Then, if you ever decide to part ways, you can simply take your practice with you. The other docs could also use a different EMR, but that would certainly complicate things somewhat.

Todd,

I agree with Chris. I have one partner who has been using e-clinical for quite a few years, he started before our office transitioned to A.C. His 5 year software cost is 35K, and mine is 6K, but he chooses to stick with e-clinical. I do not quibble, but I do not pay his e-clinical checks either. I pointed out this difference in cost, one time, but I sure as heck am not going to tell him how to run his business. But you can run a partnership with a partner using a different EHR quite easily.

Jimmie: I am interested in how this works, for future acquisition of partners. You can PM me if you want. Does each partner have a separate business? Are there different businesses under one practice name?

Chris,

I will PM you

I thought I would chime in on this one having worked with both.

Praxis is a lot more feature heavy but it has a very steep learning curve and the price tag to go with it. The demos you see are after months and months of training.
Amazing Charts doesn't involve that many clicks. Almost all of the fields are on the Most Recent Encounter Tab. You'll often have to cycle between Imported Items and MRE. Most people pick it up in less than a week.

In terms of IT requirements and cost, it's very different from AC. While with AC, you can skip out on getting a real server. That's not an option with Praxis.

Praxis Info:
Licensing
$10,000 for the first provider
$5,000 for each additional provider

That's not including the server and other software like Oracle.
You will either need 2 physical servers or implement virtualization (cost effective).
Here's the link to the official requirements:
http://www.praxisemr.com/server.html

A server that meets these requirements is in the $10,000+ range.

The workstations also need i5s.

The Oracle Database 11G software is another $5000-6000.

Then you have to pay someone to set and spec everything out. That will take a significant amount of time and money as well. Varies from person to person.

No wonder many of the older doctors are just deciding to retire instead of adopt MU!

Also forgot to mention that the support cost for Praxis is 14.9% x Licensing Costs yearly.
1 Provider - $1500
2 Providers - $2250
3 Providers - $3000 (sweet spot relative to AC)
etc.

So in terms of support, pretty close.

AC does have a sizable support fee as well. Flat rate though. No discount on additional providers. 1000/yr. This is where Praxis may be better when it comes to larger practices.

Personally, I think that is a little much considering all of the providers might have one server and one database. Should be discounted when sharing the same database.

I used Praxis for about a year way back when. Much cheaper with 2.17. It had a very steep learning curve. But, it was really, really cool. I am sure it is much cooler now. But, it certainly isn't for everyone.

Todd are you a family doc? If you are I can tell you about a resource that might help. PM me.

We looked at Praxis very seriously. It is a really cool program.
From another message board I connected with a long time user who said support is a big problem. Praxis does the updating by logging into your server. During an update, they deleted a lot of her imported items and her labs. She had to have her staff fax items back into the chart.

Or you could have good backups and fix it in less than an hour.

True! Not all of us are computer whizzes and have to depend more on support from the company.
It is a really neat program.

I have always said no matter how good Praxis is, there is every other EMR in existence on one side and Praxis on the other.

Vicki, Thanks for using AC and being on the board. I appreciate you and your posts.

AC is great program and I am proud to be a user.
The support is best in the business and no one has a user community like we do.
Group hug time.

Doesn't Praxis adapt to your charting style instead of using templates, with an AI brain of some sort?

Praxis uses a concept processor which continually stores progress notes in a bell-shaped curve. When you see a patient, the HPI is entered by using placeholders and changing certain characteristics. It's been a long time, but you then choose a key component of the current visit, and the computer brings up the progress note that most closely matches it. You then edit that note.

After many notes, the note that is chosen is so close that antibiotic choices, other medications, even letters, e.g. with strep you would get an auto-generated letter stating the patient has strep and will be non-contagious in 24 hours.

That sounds pretty amazing. I have never talked to anyone who has used it. I wonder how well it works out in practice...

You mean, "how well it works out it praxis..."

I used it for a bit but changed due to partner pressure. It really is pretty cool. The learning curve is rather steep though. They do train you one on one with a Praxis Expert on the phone and transcribing. You do many progress notes until you have a decent size library.

I wonder how this works 'in praxis' when you have 6 major medical problems. It may just take longer to build up enough of a library to cover all the possible combinations of COPD, CHF, HTN, DM, and so on. Also, there is no set pattern for this. Along with multiple combinations of this there are multiple treatment plans for the chronic diseases. I think I would just find myself going back to typing what we actually talked about, and the AI would be as useless as the templates.

I don't think it is that simple. I believe different parts of different notes can be pulled. I guess if you look at a small example: On almost every OM, I prescribed amoxicillin 80 mg/kg divided bid. I find myself looking quickly to the left of the prescription writer and am happy to see amoxicillin. Now having Flecanaide pop up for CHF every time, may be scary. But, it would be nice to have Topamax and Zomig pop up every time for Migraines and albuterol, pulmicort and perineb, jet neb and regular neb come up for moderate to severe asthma and Prednisone, Zantac, Zyrtec and Benadryl to come up with chronic urticaria. Then edit. Of course, you can pull up an instruction sheet but to have something pop up for hypercalciuria each time would be awesome.