Home Forums Discussions General Discussion Start-up Costs with Amazing Charts

Here's a quote I found on another site today:

I was pretty astonished by this claim. I know I didn't spend anywhere near that amount! Does anybody here want to post some estimates or actual figures on how much it costs to get started with Amazing Charts?

Here's the link to the actual post:

http://www.emrupdate.com/forums/p/13312/80564.aspx#80564

Brian,
Althought the guys numbers may be a bit inflated he does have a bit of a valid point. If one was to purchase, new well built and well insured machines, with 3-4 years of support and accidental damage type stuff (urine in your laptop or the "Pepsi Syndrome" for example)2 or 3 laptops or other clients, and a strong, fast P2P server tower from some of the main reliable vendors (Dell, Gateway, HP, etc), AC and support ($1500 right there), some basic router and other network hardware, and then add some sort of PM module ($1-$2K) and the X-Link (was it $500 or $1500 for that?) to connect that PM module to AC, you really could be quickly starting to look at at least $10K if not even much more.

This has always been one of my gripes. Even with AC which is a wonderful company in terms of bang for the buck, my QuickBooks of EMR example, by the time one does even a small P2P network of 3 or 4 machines the cost is still getting pretty steep. And this is not AC's fault, it is mostly hardware and networking, along with purchasing some support from a contractor to help set it all up, if one doesn't feel ready to tackle learning everything all at once. And even all this will not be enough to satisfy those CCHITTY SOB's at CMS just to maintain our already starvation medicare fee schedule. They are just insane. Now imagine if someone wanted to purchase a new server based system with the addition of MS Small Business Server and a few extra CAL's for all the terminals or users in the office. It can get very expensive pretty fast.

I have been farting around with the idea of purchasing an extra laptop and a new main P2P server or NAS as many of you have read. But this could easily mean at least $2-$4 K by the time all is said and done with good coverage for the machines. Especially from a reputable vendor with, a RAID 1 or 10 set-up on the tower with the extra good support and protection. Now add a nice little MidMark based ECG and/or spirometer that interfaces nicely with the EMR (as these bastards say the want us to) and that is another $2-$4K again. BULLCCHIT! People want these things, but they need to put up or shut up. Has anyone noticed that the price of ECG's keeps going down all the while folks keep trying to get us to use these expensive high tech ECG's that interface with EMR's??? Bullcchit.

Let's turn it into a challenge:

What's the lowest-priced set-up you can envision for a solo practice running Amazing Charts, starting from scratch?

This is one of the favorite topics on this forum since so many solo practices need help setting up their initial configuration. $10,000 is about right for a solid, reliable setup for a non-IT physician that doesn't have time to tweak or play too much with their systems.

I had to start from scratch when the AC support staff told me they didn't have a recommended configuration or documentation. Hopefully, putting these configurations out there on the forum will help others so they don't have to start from scratch too.

In my previous post, I did a couple shopping lists on newegg.com:

http://amazingcharts.com/ub/ubbthre...ds=&topic=0&Search=true#Post5896

Basically, buying hardware & software can run a practice anywhere from about $5000-8500. There are a couple levels at which you could purchase, depending on your available cash flow.

Add to this the cost of AC itself at $1500, you get a range between $6500 and $10000. This does not include installation. I assume that you will do that yourself with help from this forum.

For our practice, we chose the $10,000 option to initially implement the AC EHR. This was spread across about 4 months (with AC being the last payment we made).

When you use an outside billing service like AC's or others, you don't need to spend upfront for a practice management system. Rather, it is spread out at about 5% of your receivables. This decision depends much on your willingness to learn about credentialing and collections from insurance companies. We chose to leverage a billing company.

If money was too tight to buy new, a physician could shop on ebay for 2 year old equipment and software. They would need to mimic the newegg.com shopping lists I have already have posted on the forum. My $5000 configuration could feasibly be purchased for about $1000. Add the AC tab of $1500 brings you to the rock bottom price of about $2500.

However, doing this would require spending a much larger amount of time shopping & configuring. Although hidden, this time cost should be comprehended as well. When you buy a few add-on computer components and install them yourself, that time is part of the overall cost. Even the time browsing on ebay for the deals and time spent bidding...they all add up in hours spent. Back in school in economics 101 they called this an opportunity cost. Each person must decide for themselves what value you place on your own time to make this opportunity cost calculation. Add this opportunity calculation to the $2500.

Many regulars on the forum love IT & computers or they wouldn't be contributors. For them, the minimum cost route is the path to pursue as IT is a hobby. For most other solo physicians that would rather see a patient than mess around with a computer or network, it might be a better decision just buying the new equipment for between $6500-$10000 and spend more time generating billable patient encounters instead.

Eric,
I agree completely. And this is for just a simple P2P set-up with like a single router and a few computers. This push to force everyone into EMR's all while not coughing up the cash to off-set the expenses is so maddening. There are so many other, none CCHIT, mid-range EMR's that cost thousands of dollars and many require a real server based system too that this whole force it down practices throats in just insane.

Now we as a brand new practice just figured we would just start this way and never look back. But we are like a number of other early adopters, the first product we picked just didn't cut it in terms of easily living with it on a day to day basis. At a good discount via the forementioned AAFP that was still a $10K mistake! And now we live with an old single laptop with this old program on it in as our first year's Archive. That laptop has to hang in there a very long time... But nobody wants to know about all this added expense, time lost in productivity attending to tech instead of something else. It really is just insane. Thank goodness for AC.

Good Night and Good Luck,
Paul

Later this week I'm gonna look a the challenge and run some numbers. I think I'll have time. Trying to get my internet marketing campaign for travel vaccines off the ground right now.

It depends if you are able set up and maintain a network by yourself, how many exam rooms you have, and if you are going to outsource billing.

AC = $995
computers = $400-500 average for each computer
router/switch = $100
wires = $200-300
scanner = $300-500
software (antivirus/firewall, remote back up) = $200
network fax machine (optional) - $300-500

So, entire setup would be around $5000 if you set up your network yourself.

+ $500 a year optional AC update/support

I guess that's all. For billing in house there would be extra expenses for billing software.

I have posted our practice implementation cost for AC, which was about $10,000 out the door. I tied it back to the AC forum.

http://www.emrupdate.com/forums/p/13312/80577.aspx#80577

Guys,

The guy who posted the emrupdate note believes that all EMRs should be CCHIT certified and expensive. Geez, check out his avatar!



That says it all... I like Contrarian- a lot of what he says makes sense, but when it comes to the cost of EMRs, I just ignore him.

This seems like an exercise in futility. I suppose you could do it for under $5,000, but depending on the rooms, I would think at least $10,000 would be more likely. I am way more with Eric and Paul. With peer-to-peer, you can save around $4500. Servers cost money due to 1) server 2) OS 3) CALS 4) Antivirus (usually around $700), 5) Backup software ($299 to $799) or can use native ntBackup, 6) BackUPS/AVR.

I have a friend who almost spent $12,000 for a server. Of course, you can spend much more.

Hi guys, I'll stand up and raise my hand to Bert's comment.
I'M THAT FRIEND!!!
thank God for Bert who said something like this to me: "are you stupid or something?"
He then sent me Dell links for several server configs, each for around $2,500-$3,000 and at the most $5,000.

I have a great server that was just under $3,000, SBS/Cal's, Vista Business/Cal's, server-based antivirus/Cal's, 2 laptops, (free Cisco PIX 501 firewall from Bert), (free network switch from Bert), (free video card that didn't work from Bert), cables, MS Enterprise 2007/Cal's, external hard-drive backups, BackUp Assist, Uninterruptible Power Supplies, A.C.: total cost about $12,000.

You know I ran up my low interest credit card, spent quite a while paying it off, however I have an excellent system that is reliable and robust. I've had no serious down time for hardware issues yet. I've had some occasional software issues.

I've also learned IT myself and with help of my very best friend.
I would not ever hire someone to set it up for me. I think these computer guys get paid more than us per hour! AND that's cash payment they demand.....not an insurance policy that they'll have to argue for their money, and get only 60% of the face value.

Wait, I feel it coming upon me....that FEVER....only one prescription to fix it........MORE COWBELL!

More like "reductio ad absurdum". It's a challenge, Bert!

If someone said to you, "Bert, I have had it with paper charts. I want to set up my clinic from scratch with EMR, and I only have $5,000 to spare. Can you help me?" What would you do?

So do I. I disagree with the Contrarian who suggested the figure of $19,000. So, how would you do it?

I may move to a dedicated server "someday", but presently I run eight computers with AC P2P, six wired and two wireless and I don't have any speed issues.

My cost issues were mitigated by the fact that we had most of these computers already, which is why I haven't really jumped in with my figures, as I don't think it makes for a fair comparison.

However, many practices are exactly like mine and already have a number of computers which they were using for other purposes. It is a virtue of AC that it does not need the latest and greatest computers in order to run acceptably, especially with a small clinic. So, this may affect many people's start-up cost.

I agree for someone starting from scratch it would be about $5000, and they would have to learn tech. Or do something smart like my wife did, marry a techie and he spends his lunch hours and after work getting things to work.

This weekend I build a server for mty wife's practice and it is a good server with RAID 0, installed windows 2008 server(I get it cheap(almost 90% off) since I am a ex microsoft employee).

I am seriously thinking of openning a small consulting to educate the docs that one need not spend $10K to have a EHR, and they can do it in pieces and start off with just P2P.

It si fun to do this stuff(my actual job at software company is boring).

I set up my office network/AC for less than $5000. Like Nephron said, I spent hours drilling holes in the walls, pulling wires, setting up network, installing software, etc. I only hired a guy to crawl and pull wires through the attict. So far my P2P network works fine. The only mistake I did, I got refurbished computers made from used parts instead of new ones. They were very cheap, but didn't last too long, and some of them were slow because of limited RAM, so I had to replace them later.

If you buy "refurbished" locally, the problems lies in that a lot of mom-and-pop places do take old computers and put their remaining working parts to make an old working "refurbished" computer that will soon fall apart.

On-line "refurbished" computers and other gizmos can be a good deal, though. Reputable dealers, s.a. the many found on eBay, will sell computers returned for one problem and once fixed, will be a "refurbished" item that is BETTER than new, since it's been tested and usually issue-less. They also sell "open box" and "off lease" stuff that 95% of the time are excellent deals.

Geez, I've purchased 12 refurbished and "off-lease" laptops on eBay over the past 3 years and they are all working still except one which fell from the overhead bin on an airplane (my fault). Heck, tonight I bought a refurbished HDTV for a savings of $300 (check out this ebay win). Other purchases in the past 2 months alone:

* Scansnap scanner (open box)
* Nintendo Wii (open box)
* X2Gen Monitor (open box)

I love this recession that we're in... can't buy enough junk.

I look for stuff on places like Frys.com or other forums or sometimes dell and HP outlet for refurbished deals. Ebay I am skeptical since either shipping is high or sometimes in the bidding war the price gets too high.

Another great place is overstock.com

I like HP or gateway refurbished since they come with standard components(unlike Dell), and if something fails I can always replace it with off the shelf component.

Nephron,
I have been a loyal Gateway user for years and then suddenly they ditched us business customers with little fanfare. Nice, Right? So anyway, I was going to try a switch over to Dell products, but what is this "non-standard" components thing you are talking about???

Just wish I still had my good old Business Class Gateway. Our machines have really held up well over the years.

when i say no standard stuff I mean components and thier cases. When a power supply breaks down in a DELL machine, I cannot just walk into loacl computer store and buy a powersupply and get back on my feet in 2 hours, but have to call DELL and then they schedule a visit etc.

With HP and Gateway, they use mostly standard parts, so I can always swap the broken part, and get running with just that part.

Gateway is a dying company, I think HP is a way to go or sometimes one of the local computer store builder is good too. They will give you support and build boxes on demand. Ofcourse I love building my own box as per the need.

Wow Srini,
your wife is very fortunate to have a business manager with such computer skill.

>>> Ebay I am skeptical since either shipping is high or sometimes in the bidding war the price gets too high.

You actually spend time trying to OUTBID someone on eBay? Don't do that!
I either buy it with a great "buy it now" or I use one of the many "slamming" sites- www.bidslammer.com . They will bid for me on the last 5 seconds of any bid and charge me about 50 cents to a dollar for the service! They even offer group bids. Say I want to bid on a Dell laptop- I'll list 10 of them and then put down rediculous bids. One after another will lose- but usually one does come through and bingo! A WIN. The rest of the remaining laptop bids are put to rest.

Shipping costs are a problem sometimes, but you simply have to consider it in your overall bid consideration. Sometimes there isn't even a shipping charge, s.a. like the Sharp Aquos HDTV that I won. Occasionally I do use other sites, though- www.ecost.com , www.amazon.com and www.buy.com are 3 of my favorites due to their lack of shipping and great prices.

when I remind my wife, she says that she would not even have tried getting into practice if I did not do this for her .

I have hope after seeing you all about physicians and technology.From what I have seen it is a major disconnect between docs and technology, but looks like many docs are being forced into it and some like you all are in way ahead of the curve.

Srini,
I know that Gateway looks to have taken a backseat, but do you know more about their standing that makes you say they are on the way out??? Or is this just a smart guess from their recent behavior? I know that frequently folks inside an industry know much more than those of us watching from the sidelines, so if you know anything interesting or important I and many others are all ears.... Thanks much.
Paul

That's exactly what I did - bought locally refurbished computers - was bad idea.

I agree. Those of us "techie-docs" are also small businesspeople, as you know. It's fun and liberating to me that I have the ability to wear many hats. For some, it's all they can handle to simply be a physician. I work w/ pride each day knowing that docs like us are forging ahead where few dare venture these days.

Just smart guessing. There is not much space between dell and HP and the variety of chinese markers for Gateway

I went to Best Buy and Circuit city this week and wireless notebooks with 2g ram were 550 a peice. Bought a Buffalo Nas server and a walmart 300 buck computer, a linksys N router for about 150 and I was good to go
Fujistsu scan snap for 450 was a splurge (but it is fast), an EKG Burdick off Ebay for 500 and some all in one printer scanners 79 a piece from Staples and life is good so far.

10 sheet shredders are 39 this week at Circuit City

Gerald

Is your entire system Vista or mixed with XP and Vista? I ask because it seems many people are having issues with mixed systems. Those of us who are will probably need to keep buying custom mail order machines with XP until either MS teaches Vista to play nicely with others or we are finally forced to go all Vista against our better judgement and wishes. But yes those $500 mid-range computers at the box stores sure do sound nice.

"Ask not what Vista can do for you, ask what you can do (purchase?) for Vista!" Those ads are just great, aren't they???

Paul

I think though with the proper version of Vista (Business Ed.) and turning off User Access Controls, it works fine....certainly it's working better than my old XP Home. I never bought XP Pro so I can't compare Vista Business to XP Pro. I can just say that it works well, aside from some harware/software compatibility issues.

I joined Sam's Club 18 months ago when I opened my own solo practice and got a decent server (DELL) for about $1600 (no RAID however), which was about $500 less than Costco and the Dell site itself. New computers are relatively cheap nowadays ($400-600 for good desktops and $500-$700 for nice nontablet labtops) so buying used/refurb makes no sense. The cost comes in the operating system software (I use Windows XP Pro) and getting machines or stand alone upgrades adds at least $100 to the above costs.

I'm just about ready to become a registered user of AC and I find it runs really nice on my 2 exam room/5 desktop/1 laptop/1 server configuration. So far no speed or reliability issues in approx 45 days of use and 380 patients entered in. Of course I haven't started selectively scanning in old records or importing new correspondence or labs yet.

I was wondering from those who have used AC for a while about how much storage space is needed for a practice with approx 2000 patients (Int. Med). Currently I have AC on my server which has a 160GB hard drive with approx 80% free space. Thanks for the help and the wonderful advice in the other sections of the user board.

JMayer,
Welcome to A.C.!! YOu've joined an elite class of foward thinking physicians and physician-extenders. Congratulations. I hope you find the message boards helpful and insightful. I've learned many tips and shortcuts here.

I started converting from paper to A.C. Jan 21st, 2008, and I have just over 2,000 patients (I'm solo F.P.). About 30-40% of our paper-sharts are scanned into A.C. However, we have more than half of the TOTAL estimated pieces of paper scanned in. All of our thickest charts are complete, we are scanning as the patients come in. So our frequent flyers and most of our chronically ill patients are scanned.

I am currently using 3.5 GB on my server's hard drive for the entire AC folder. Therefore I estimate we'll use about 7GB by the time all of said and done. From that point forward, the total size will grow much less rapidly.

One other user and I were talking about backups, and he's been using AC for several years. He stores all reports and incoming data using the Imort Items tab. His total folder size is just over 8GB.

Don't worry about eating up all of your drive space w/ A.C. By the time you could possibly do so, your server and all of your computer equipment will be out of date. In fact you probably will have replaced all of your computer equipment several times over.

What's your name, so that we may welcome you officially?

JMayer wrote:
I couldn't agree w/ you more. I realize that other users feel they must, out of financial necessity, buy used/refurb. However the small savings coupled w/ lack of customer support/warranty is disadventageous. I personally would only buy new equipment.

Since 4 (out of 8) of my office desktops are nearing 3 years old, I'll need to replace them in the near future. I could donate these to a school or church orgainzation for some tax deduction. I've also thought about letting my kids have them to create a home-gaming network for their friends. Another fun use may be to smash them all to bits. I'm undecided as of yet. Maybe I'll post this to AC and ask the users to tell me what they do.

Seeing 25 patients per day, I have found that you will use approximately 10MB of space in the AmazingCharts.mdb database. I doubt that it's much more for billing. With Access database, the most you can ever use is 2GBs and you will notice a substantial performance hit before then. It is completely independent of the number of patients; only dependent on the number or progress notes, letters, messages, billing, etc.

As to ImportedItems, that is much different. Only speaking for me with a solo practice, we have accumulated 3.5 GBs of files in just over a year. So, space doesn't seem to be an issue for you.

J, it sounds like you are very knowledgible about computers. I am wondering if the choice to go w/ out RAID was a choice, or a function of cost?

Bert and I have debated the benefits of RAID many times. He is RAID 5, and I am RAID 10. We agree to disagree on this matter of which type RAID is best for our given situations.

Or is that RAID 1 + 0?

If nothing else, I get a post out of it.

Interestng that you guys ahve Raid 5 and Raid 10. I just put in two 500GB HD's with Raid 1(mirroring) at hardware level.

I like building the server or machine from scratch since I get MS software for a big discount(former MS employee), so dont feel like giving $400 for SBS 2003 server when i can get it from company store for $150

Nephron,
You are probably familiar w/ the Microsoft Partner Program then?
I am a MS Partner, as such I've subscribed to the MS Action Pack.
It's an awesome bargain. There's talk of requiring certification in order to continue. That might squelch the deal for me, but we'll see.

>>> I know that Gateway looks to have taken a backseat, but do you know more about their standing that makes you say they are on the way out???

If you go to eBay, you'll notice that you get about $100 more equipment for a "Gateway desktop" than for a "Dell desktop" due to more folks bidding on the latter.

I like to look at Gateways on eBay for this very reason. The work well; I think that they get a raw deal by folks regarding quality.

I don't quite understand your statement. Of course, if you can get SBS for $150, why wouldn't you. Or are you saying you can get Windows Server 2003 for $150. I would agree with Adam, that you should be able to get the MAP and get SBS 2003 or Windows Server 2008 (if I am correct on the MAP) for free.