Home Forums Discussions Feedback and Recommendations Feature Creep?

Gang,
As Jon had told us as much, it seems that our nice little EMR is starting to get hit with Feature Creep. Now some features may be great, and what is one man's junk is another man's art, but I think that we all might want to think long and hard about what we wish for verses what we really need. I as much as anybody else have been guilt of such in the past, so I fess up as one of the contributers to this issue. And some of the features that were added are really neat and/or helpful too and many thanks to Jon and his team for their time and efforts for all the work that certainly went into making them for all of us.

But as Bert, Roy, Vinny and a number of others have pointed out so many times before that the main thing that makes AC so valuable to all of us, is it ease of use, straight forward design, that helps our offices flow smoothly, providers chart easily and just in general live a better life thru eligant design, by a man who understood what little offices like ours really needed.

So I was just thinking that perhaps some of the features we thought we needed but perhaps we really didn't, or were more pie in the sky wouldn't that be nice kind of things be re-thought before AC becomes some patch worked monster none of us would recognize. And before Jon and his team put too much time and effort into building and de-bugging features that may or may not be so needed and might actually hurt our favorite little EMR.

As the forementioned Brain Trust have also memtioned previously, what I think most AC users would really like is to polish and refine many of the things we sort of already have. Tighten up various sections like the codes, the vaccine section, the enhanced PM features so all data works smoothly from the medical side to the business side back and forth (and no more need for less than perfect other 3rd party softwares and linking programs), the reminder system, and all the other things we already know and use every day.

It is just a thought. We love our AC and it is a large part of our daily work flow around here, and we would hate to see it become too bloated like many of the other programs that Al and others have warned us about. As Leslie, Wayne, Bert, and Roy have warned me before, be careful of what you wish for with AC, you just might get it.... What say all of you???
Thanks,
Paul

I agree completely.

While there are lots of neat bells and whistles we all could use, I for one, don't want to pay for them. I bought AC because of its charting ability (really because of its price) and am content with that side of it. Sure, there are little things I'd like to see, pt ID # on the schedule screen, some tweaks to the prescription writer, but overall that side of it is really great.
I import an Excel spreadsheet to track labs, I'm starting to use the Directives sectioned as mentioned in another thread... It seems as if the AC community is able to readily mold this nice little program into something MUCH better than a simple chart.

I WOULD like some improvement in the PM side as it is essentially worthless as it stands. I'd say fix it or dump it. I would like a couple of adjustments to help with generating an accurate HCFA, and line item posting, and that would do it.

With SQL, we might be able to dump data into other formats (like EXCEL)for tracking and evaluating as appropriate for each practice.

I'm for fixing what we have, and let's keep sharing our ideas for using this wonderful (and cheap) little program.

Bill

Bill,
Version 4 is supposed to have a fairly robust PM module which was something I was one of the largest requesters of I confess. I still think if properly done it would be great and I for one would rather give my money to a company I know verses some of the others out there.

I'm just not too sure how much I want Jon and AC killing themselves and bloating out AC on things like P4P type tracking down to the last hang-nail. I for one want to eliminate P4P totally. It's just another scam to take away money from hardworking PCP's and other high need patient providers. Pay us better so we can see less patients everyday, you'll get all the performance you'll ever need.

I still really want my every other program has it that creates data or documents, "Save" button! Who over looked that little issue, right? So we can save our data properly formatted in just the way AC likes best that is easily restorable in event of a real emergency. Be able to save the data to any drive accesable to the computer just like almost any other program, Word, QuickBooks, Excel, All the PM programs I researched worth considering.

The MidMark file naming set-up, the vaccines and codes. All these really needed day to day, meat and potatos type issues and features.

In looking over what Jon has proposed I see value in most of those items.

P4P is not loved by many, but if you must do it, automating it in AC is very valuable. There can be value in creating checklists to ensure that you have completed all the items on a patient, but the devil IS in the details. Will it have to be manually populated or will it pull information from other sources? If it is too cumbersome, we won't use it. I don't currently use the immunization section.

If you truly want to go paperless, you need to verify that all the needed paperwork has been done, so this would be useful as well.

As a pediatrician, I have little need for all of the current MidMark bloat, but I understand the need for it to be there for most.

You can always stick with version 3 But really, most changes in version for AC have been evolutionary not revolutionary.
Sure, the more add ons you make, the more things to break. They do an amazing process of making a stable product.

HERE HERE, I AGREE. AUTOMATE THE P4P REQUIREMENTS USING AC. THAT'S THE POINT OF AN EMR, AUTOMATE ALL THAT YOU CAN.

Be careful, indeed!

Once you have automated everything that can be automated, you may find that your EMR doesn't run as quick as it used to, doesn't run as smoothly as it used to, doesn't come as cheap as it used to...

It's a natural fact: none of these things come without a price.

Think about it, y'all.

Brian and the Gang,
Ya this is what I was sort of getting at. If and when it becomes a real P4P or go to jail, go directly to jail, then perhaps we should have Jon devote a whole lot of time to such a thing. But until then I'm not to into it myself.

Furthermore, as I was talking to Vinny and Bert in a PM a few days ago, there is a very nice, not for profit, charity based S-CHIPS carrier here in NYS, that uses nothing more than claims submitted to track lots of positive for quality things, all without a stitch of input from the providers or an extra chart watching and doctor patient spying. They are a wonderful example of how to have a positive impact on care all without further violating the privacy of the doctor patient relationship or adding any extra work for the already over-worked PCP's office. When you think about it though, it kind of funny because they are paying us and giving us incentives to do basically do exacty what we would have done anyway. It's just good medicine, now we get a thank-you for doing our jobs as we should and do.

P4P is hogwash, BullCCHITT. Henry Ford needs to stop being a greedy fascist pig, starting paying us reasonably well for what we need to and should be doing each and everyday, and he'll get all the quality he needs. Tell me why PCP's rates are the lowest as compared to other specialists that have lots of good paying procedures to off-set their expenses. Why are office visit codes the ones with the lowest relative value units when that is all PCP's do all day, we live and die by these E&M codes. We have little or no, well paying other things to help pay the bills. And yet everyone admits this is where the rubber meets the road, where the real care and care managment is and should be, so why can't PCP's get a 50% bump in all their office visit codes, stop having their other little procedures or extra well care things bundled out of their submitted charges and finally say thank-you for all your hard work. But instead of giving us the bump we need to finally make up for all the cuts, and stagnant fees and finally start paying our bills; but instead its regular pay for all the extra CCHITT and sizable cuts for not doing CCHITT and P4P.

I must be a psychic because I predicted this 4 years ago. It is just another way to take money out of the pockets of hardworking primaries and give it to the large for profit insurance industry or to keep the feds from having to actually pay for the healthcare they insist on giving people. FOOD STAMPS, remember Food Stamps. We as a society want to feed the poor but we still pay the retailer his full free market based prices and we don't treat him like a criminal for wanting to be paid for his goods or services. Instead we as a society pay the real normal price. Sorry for spouting off so, but I'm really sick of all this CCHITT.

Anyway, as Brian said many of these "womderful" extra features will if nothing else really change the look, feel and performance of AC, no less its ease of use and how easy it is to learn and teach. I think Al could probably speak to this best and this was the type of creep I was talking about. Al has tons of data and info on how P4P and CCHITT influenced EMR's just get bloated to hell and become animals to use and maintain. I for one as much as I want AC to stay current and useful, it is the useful part that I want to make sure remains. Isn't that why almost all of us chose to go the AC route in the first place??? Al are you listening? Care to chim in here?

Whether we like it or not (I FOR ONE DON'T LIKE IT), our world is monving toward P4P. I'll be the 1st to say P4P is the next generation scam by the insurance companies. HOWEVER.....

In Maine, many of our commercial carriers have already implemented it. I'm losing money every year (past 2 years) for not having an EMR. Now this year, I hope to change that. They want data base managing, such as tracking our diabetics and their A1C's/ACE's, asthmatics and their use of inhalded steroids, etc.

Medicare has a test program which I HOPE you are all aware of. P4P is being implemented in Medicare. Currently it is not mandatory. Currently in order to comply with Medicare P4P, it's a major pain in the rear-end on the claim submission end. And I have not yet started.

In light of the Medicare mandated 10% (that's right, TEN%) cuts coming forth this Summer, P4P could make or break some of us. I hope Congress delays the cuts again. But w/ very delay in cuts, the percentage gets larger and larger for the following years cut.

I support P4P capabilities in an EMR. I hope AC can help us in this regard....ultimately it means we make more money. In an era of decreasing reimbursements and increasing overhead, I am looking for any source of improved income.

Adam,
Be bolder and more true to your beliefs my friend. This is just the problem, docs just keep back peddling hoping something later on will change. They will keep coming after each and every one of you until you say "ENOUGH ALREADY!!!". Is this a Capt Ahab moment or one of enough is enough already, but Nancy and I are starting to talk about ways to survive more and more off of the grid and to promote it as it really is:

The only way to keep these invasive SOB's out of your charts, and our relationship with you. Yes some patients won't be able to afford it, but we must preserve the sactity of that examroom and those charts, plan and simple. Do you really want to be known as a collaborator??? That is how I see it. We are no longer giving any shots so as not to have to comply with the new NYS vaccine reggie. Let the patients go to the health dept in droves bitching and screaming. Will it hurt, yes, but not as much as destroying our constitutional rights of privacy, medical or otherwise.

Yes it won't be easy, just ask Vinny, he losses money to his largest carrier in his area too, but he refuses to give in to them on this invasive, let us look at your records all of the time mentality. It is tough sometime to stand up for your beliefs but if we don't do it and real soon, there will be nothing left to fight for, because they have taken way too much already. This is the begining of the end, mark my words my dear friends. P4P is the death of us all and the death of decent healthcare as we know it. Did the schools improve with marking, setting and recording standards and data with no A$$hole left behind??? Why should it be any better for healhcare then? Teaching to the test or treating to hit some mark on a chart is no different. You just can't quantify this stuff properly in real world, day to day art of, free willed, still smoking, not resting, eating garbage, not exersicing, meds denied, treatments denied system. But you sure can use it to count those beans and reduce providers payments.

In the words of Jean Luke Piccard (I have quoted this one at least once before, but I love it so) when talking about the Borg always advancing taking more, Everytime they attack, they loose another world, and retreat, over and over again. "The line in the sand must be drawn here!" Bitch loud and clear and resist, resist, resist.....

Good Night and Good Luck,
Paul

About P4P -- although letting the government spy on records is not necessarily a good thing. I do think the ability of the chart to track data, collect statistics and let ME practice to the standard of care by telling me when a diabetic has not had labs, when a child is due for a well child, etc is great. I think that adding these features for me is the next natural step for an EMR.

In regard to the vaccine registry - I as a parent was quick to put my child's records in - if a paper chart gets lost in a fire, if the school has flood damage (recent NW storms did lots of damage) or whatever I can reconstruct their vaccine records in about 3 minutes on the Net. I even know adults who had to redo vaccines just because they could not prove when they were done for college, employment, etc.

When I read the vaccine notification requirement law in NYS, I said to myself "Every single pediatrician should stop providing vaccines for children." Its an ornery requirement for physicians.

Sometimes people have to take responsibility for themselves and their family. Maybe the doctor should give you a "vaccination record card" with the vaccine information on it. Then you keep it and update it. This gives you a duplicate of the info in the chart. But no one seems to want to take responsibilty for their own business these days.

Although not a bad idea, we ourselves don't accept shot records that are patient or parent carried. Those few pages we insist go doctor to doctor direct, because there are so many people who have "doctored" them if you catch my drift.

I just want to know if vaccines being required for any kid to get into school, how come the rates are still so messed up sometimes? I personally trust my kids doc to properly track their shots and keep them up to date. I don't want my own kids in this stupid state run database. If a 19 year old can opt out, then why can't I as my kids legal parent and guardian opt out for them too? Why can't my wife the provider opt out as a licensed provider for personal and constitutional reasons???

We can't even violate citizen's rights in NYS to ask about their sexual partners even after they have tested positive for HIV, but now we will violate ever minor, eventually every citizen in the state, PHI, and privacy without an imminant health crisis? Just seems way overboard to me as compared to other laws and standards that have already been set.

The cost benefit, the balance of the violation of medical privacy vs the health benefit is just not there. This needs to be challenged on constitutional grounds. I could see it having a negative impact on things such as Roe v Wade even. If we can violate the privacy of patients and doctors for such weak reasons, then why not Roe? This is a bad slippery slope and we need to stand against it.

Funny how feature Creep became Vaccines Reggie now isn't it. But such is the nature of these things...

Why not just tatoo vaccine info on a kid's inside lip? We baby boomers carry our smallpox 'brands'.

Leslie

Not a tatoo. A brand! sssssssssss!

>>> P4P is not loved by many, but if you must do it, automating it in AC is very valuable.

Actually, Wendell, P4P is a dead end for AC (as for most EMRs) since Medicare only is allowing those offices with CCHIT-certified EMRs to participate. Jon knows that and will most likely focus on other matters, s.a. the new MS SQL backend.

Eventually, most P4P initiatives, whether governmental or insurance industry associated will follow Medicare's lead. What needs to be done is for physicians to form a focus group to sue to get the right to participate with P4P (if you want to, of course) in any which way, including using paper records. I don't see how this situation, where government is actually destroying EMR competition and physician freedom of choice can win out at the end.

I'd like to know where the patient's freedom of choice and right to informed consent, and right to opt out of any and all databases altogether went. Patients and providers need an avenue to opt out all without any penalty what so ever. In any other case of research and data collection patients have such rights to know what they are getting into and the free choice to be in or out. Why is this any different? They are going to use these things for research and policy puposes and therefore folks should have the right to opt out. Providers and practices too. You can't force a provider to be part of a study, it has always been voluntary, without coersion or fear of penalty.

Al, again I feel the best way to fight all these things is to use the violation of the patient's rights of privacy and other constitutional rights. That is the way to win this thing. Privacy baby plain and simple...

Check out what has happened in England concerning its centralized database:

English Physicians Plan To Boycott Patient Health Record Database, November 20, 2007, http://www.ihealthbeat.org/articles...t-Health-Record-Database.aspx?topicID=54

Alborg,
Thanks for the article!
Very timely.
State of Washington embarking on identical project.
Fortunately, I'm a stakeholder (representing physicians) and I will bring this article up to the Stakeholders meeting next week. The forces for centralized medical database in this state is very strong.

>>> The forces for centralized medical database in this state is very strong.

They only ((( seem ))) strong, since politicians are making a lot of noise about HIT nowadays. It's politically correct to seem to know and want HIT, even when you know nothing about computers- s.a. President Bush and Senator Hillary Clinton.

You just have to hit them with reports, studies, and the facts. These usually make politicos think twice, since HIT could be worse than an Iraqi IED the more that they push.

You might also mention RHIOs- i.e. how badly it's gone for them in the USA. One article that could be useful is the one quoted below:
"A Harvard University survey published late last year found that 54% of RHIOs in existence in July 2006 were still in the planning stages as of early 2007. An additional 26% could be classified as defunct, according the survey. Among those is the Santa Barbara County Care Data Exchange, one of the organizations that CareSpark looked to for guidance."

NOTE: 26% DEFUNCT!!!
URL: http://www.healthdatamanagement.com/issues/2008_45/25619-1.html

There are numerous articles about bankrupt RHIOs... just do a Google search for "RHIO dismal" and you'll be up all night reading.

I'm glad I could help you out. Fight on!

Cheers,
Al