Home Forums Discussions General Discussion Version 6.3.3 - should I upgrade?

I believe so, if you ask.

It is not on the download site directly.

I never moved to Version 7 because many were reporting speed problems, some necessitating new hardware or network changes.
And, no disrespect to Steven, but "pretty stable" is not what I expect from critical software.
AC is the only program that I have used to have so many issues with upgrades.

V7 and V8 require more memory and ARE somewhat slower. Not substantially, but slower.

Both were quite stable for me. I have no qualms about recommending them from a stability standpoint. I would recommend a good amount of RAM.

I must disagree with you on the last point. Microsoft does weekly updates. Major upgrades have been every 3 years. AC is responding to government requirements, which it must to remain competitive. When you look at the enhancements, I hope you can understand why there have been so many upgrades. No EMR can be static in this environment.

Donna, given your setup, the choice will be hand-coding ICD10 entrues in the chart, or taking the upgrade and a slower application experience.

For your size office, you should be able to run it on the machine you have without hardware upgrades.

As has been pointed out to AC repeatedly, there is a growing group of users who want an OFF button for Meaningless Usury. Physicians and Providers want to do medicine, not government-mandated data collection on their patients.

The larger the office, the more significant the performance impacts of going from 6.3.3 to 7.x or 8.x.

People's appetite for slower varies, but we are now being contacted by practices of 10-15 users that want to look at their options.

Thanks, Indy, I will resign myself to the upgrade. But, it has been soooo nice not having to deal with the hassle of an unneeded upgrade.

Why is everyone upgrading when 8.2 will be mandatory not too far away.

Donna, since you code outside of AC IIRC, you can sit tight for now. I suspect that this will be a hot subject this summer in Laramie.

Indy, are you upgrading your existing practices to ver 8, or waiting a while for things to sort out? Isn't October & ICD-10 getting closer?

I upgraded to 8.1.1 (on the cloud) two days ago.
Biggest problem is speed opening and closing patient charts -- 3-5 seconds each time.
Chatted online with support, they tweaked something, told me to empty my deleted folder which I did, but that hasn't made much difference.
Once the chart is open it seems fine.
But when I get a phone call from a patient or want to add a note about a test result, I do a fair amount of switching, and that's very annoying.
It's not an issue related to how many people are accessing the program, I'm the only one.

Michael
NY

If Congress delays ICD10 again would the upgrade still be mandatory?

Hi Scott,

Any real chance of this happening? I thought the big hospitals and insurers were ready for ICD-10, so it was pretty much a done deal....

Gene

I don't know. It seemed like everyone was "ready" last year and then at the last moment the AMA was like , "No stop!" Who knows. I'm hoping Rand Paul will do some Executive Action like Obama and just make all of this go away if he gets elected. lol

I wish the delay in opening / closing charts(or for me clicking on demographics tab) wasn't the time delay it is; and I'm on 6.6.5, really worry about V8, esp since I'm not meaningless use oriented. Perhaps if you could have multiple charts open at a time I wouldn't grump so much when I get a question on a different patient while working on a patient chart.
Have to admit I've started looking at alternatives.

Would Rand Paul make that announcement using the official .gov email address or his own Yahoo! account?

I think it would be really cool to make it mandatory, albeit not by October; maybe the first of the year. To have everyone on the same version for the first time since v1.1, would have a lot of advantages.

It has been a while since the new regime took over and the development philosophy and direction is completely different than it was before.

AC's ability to alpha and beta test prior to final release has been hampered by the fact that it has had to stay one step ahead of the government which has added more bugs to our software than the sloppiest of a software engineer.

It would be so cool if AC could get out one very stable version and then do upgrades using a well thought out alpha/beta process. Even more, if they had time to upgrade over six months and not over six weeks. Alpha test for weeks, squash tons of bugs, then get it ready for beta testing where users could squash fewer bugs and critical changes and additions could be added before a final release.

Just a link to look over. Would love to see a release that wasn't anticipated or known about in advance.

http://www.centercode.com/blog/2011/01/alpha-vs-beta-testing/

Yahoo account because I don't think the .gov would work while the government is shut down. lol

Bert --
Would you mind very much doing a summary of this thread, or at least restate the most sensible conclusions?

I'm on ver 6.3.3. It has been working very well, with the well known deficiencies.
Is there any value in upgrading to any form of 7.X.X?
Is v8.x.x out of beta? If (when) it becomes generally available (April?) -- will there be any reason to go to v7.x.x or will that be totally passed over?

For now, I am sitting tight. I am at the edge of mental and financial meltdown right now!

Hi Tom,

6.3.3 for me as well, I see no reason to upgrade until it's mandatory. I think we then will be able to skip v7, and go right to the new version.

There is a link around somewhere for the v8.0.2, I have it in a sandbox, but I'm certainly not going to upgrade until it becomes mandatory!

I'm standing right alongside you on the edge? And it's getting slipperier...

Gene

Gene --
I still want to visit you, next time I take the Amtrak to visit my daughter in DC. It hasn't worked out, yet -- I haven't been able to get away. Some time later this year, though.

What do you think of 8.0.2 in your sandbox?
Is it any more functional that 6.3.3 if you don't do MU. I so gave that up.

John,

Unlike some folks who will remain nameless, we never dictate versions to our clients, we provide them high touch conceriege services, which means they run what they want, including a multitude of third-party apps and systems, and we make it work for them (which includes dealing with the circus clown car of clowns sometimes).

The discussion about upgrading is complex, and by AC using the words MANDATORY, it has become MUCH more charged for some Physicians/clients.

We will be doing a survey of practices that we deal with to determine what their current perspectives are, and then summarizing that for participants. AC has asked to recieve a summary of the anonymized results. You are welcome to PM me if you would like to be included, but you are not sure I have your email for the survey.

Here is a summary of factors as we see it:
<>What version are you on?
<>Will you be doing MU going forward?
<>Will you be coding in AC going forward?
<>Are you considering Hybridization of your practice? (e.g. Separating govt payer into a separate practice in the same facility, non-par, etc)
<>What is your appetite for new hardware/software?
<>How close are you to your exit strategy?
<>How focused are you on delivering value/good medicine outside of what a EMR does?
<>Are you considering other platforms?
<>Do you desire to retro-grade to a previous version?

No two practices are the same, but all of the external pressures on independant Physicians and Providers are causing more to think outside of the box, and we have been contacted about all of the above multiple times.

For all, the business aspect of practicing medicine is now a major component; something we didn't talk about nearly as much 7-10 years ago.

Whether it is a payer, the government, or your EMR vendor speaking in imperatives, INDEPENDENT professionals, especially Physicians and Providers, respond poorly to threats (explicit or implicit). We are increasingly hearing that folks will take their financial penalties just so they can be more free to practice medicine as they see fit.

More practices are finding financial success and personal gratification in exiting the government payer systems, providing care for eggs, produce, whatever, and are financially more successful and far more pleased with practicing medicine.

Our experience is that beaucracies usually fail to grasp WHY our clients practice, and therefore they are danergously clueless as to what is happening and why they are actually provoking it.

For example, practices are doing the math, and determining that billing outside of the EMR, including coding, is something they can outsource, or staff, giving them more time to focus on patient care. For some, that is more important that MU or ICD10.

I suggest each practice determine what their answers are to the above, and then we talk to practices about how to achieve their future goals.

I'll be on the road in April going to/from Anahiem, and meeting with practices and user groups along the way, so folks can talk this through and get answers. Please let me know if you want to meetup in Anahiem or along the way.

Hi Indy,

I find your approach most refreshing. And enlightening. As always.

However, if one were to stay with Amazing Charts, I don't see that there's any way around the upgrade. Even if you separated out billing, I can't imagine a medical record being viable without being able to generate ICD 10 diagnoses. Lab orders, x-ray orders, and so forth, of course, require diagnoses to justify the test.

So are you actually suggesting it might be possible to stay on a prior version of AC?

Thanks.

Gene

Gene - Thank You. Your words mean a lot to me. I have often been told I should "answer less and charge more", but the collegial atmospere here has always been a rewarding contrast to the corporate world.

We do our part in giving Physicians and Providers the tools to practice medicine as they like.


The burden has become great enough, that practices are having staff/outsource code the note (ICD-whatever), then forward it back for review and sign-off. One pass at coding, and at a cheaper labor rate.

Since we provide the tools so that the coding can be done when/where/how you direct, it makes sense to reduce Physician/Provider time/effort/irritation. There are some excellent ways to get this done, and the math is usually even or positive.

Bonus is you can chuckle politely (or perhaps to yourself) when others are ranting about ICD-XXX.

Life is short, practice medicine. Or go sailing, or fishing, or join us at a MeetUp.


I'm telling you that we already recieved calls/inquires about staying or retrograding versions after folks hear MANDATORY. Independent professionals don't respond well to imperatives.

We've been asked to do it, and if that is what clients choose after hearing all of the facts, the we will help the client accomplish their goals.

As I have told others, I've been figuring out how to do things (sometimes claimed to be impossible) for over 30 years, I wouldn't bet against either myself or my crew.

Not even a case of Iron City Light????

Gene

Gene,

That isn't a bet against, that sounds like incentive payment.

The majority of the crew are verterans or spouses, so that would be well recieved.

Well, thanks Gene and Indy.

Do you really think outsourcing billing in a small family practice makes any sense? Many people say that, but outsourced billing is generally not well received by patients around here, and it leads to a much less flexible approach to loyal patients who have found themselves in financial distress.

I'm going to ignore transition to v8 and ICD10 until the reality is upon me. There are so many other distracting issues at the moment. Like practicing medicine, for example.

We will have new platform announcements this Spring, but the short answer is that practices will have more, and better options starting this year.

Billing has, until recently, been a binary choice. For some billers, that will remain the case. We have been encouraging the RCM companies that our clients use to consider other alternatives.

Part of the cost that RCMs incur is all the friction of calls/messages/etc dealing with coding issues. Based on the feedback from both groups, we are testing a solution that reduces friction, and costs, and puts RCM companies to offer services to practice in somethign more similar to our on-demand model.

If the practice maintains local control, but can focus more on patient care, then having coding dealt with more cost effectively works for everyone.

I am not sure what is so wrong with ICD-10.

Hi Bert,

Maybe nothing is wrong with ICD-10. Maybe it is even better than ICD-9. Maybe if I were just starting practice I would embrace ICD-10.

But I have thousands of patients, mostly older/complicated, with multiple diagnoses. So I am doing a recheck of someone post MI and stent, with high chol, DM, BP, and the patient complains mostly of pain in their R knee, and of generalized muscle achinng.

How long will it take me to determine 6 or 7 new diagnosis codes? And how many times/day will I have to do this?

Gene

I struggle just as much with ICD-9. I have to look them up online and then enter them.

But I have the ICD-9 codes already in the patients chart, and I can easily bring them forward. ICD-10, each will have to be redone.

For 1 patient and 1 problem, not so big a deal. But 100 (25 patients X 4 per pt) in a day will be.

Gene

That's true. I apologize if I sound like I am arguing. I am just trying to get a handle on all of this.

Not at all! To an extent, we live in different worlds (at least worlds with different ages!!)

Gene