Home Forums Discussions General Discussion Clinical Advisory Board Meeting 2015

The clinical advisory board (which is a group of 9 clinician users of AC) spent the day at company headquarters in Boston recently. The charge of the CAB is to facilitate communication between the company and EMR users. What follows is a brief personal report on particularly relevant aspects of the meeting.

Overall, I would say that AC leadership is trying to maintain the personal, "by physicians, for physicians" philosophy initiated by Jon Bertman. This can be a challenge as AC is now a division of a much larger company, and that division is no longer responsible for just one product. Direct interaction has convinced me that John Squire and his team are serious about this goal and have been successful in maintaining this relationship with us through the transition.

With this new corporate structure comes the benefit of many more resources to tackle product and support issues. A major area of concentration has been quality assurance. The QA team has been dramatically expanded, and significant resources have been directed towards formalizing the beta testing process and automating product testing. The end result should be fewer bugs in new releases and less need for quick, patch releases. More resources have not always translated into smooth sailing for users. The issue of slowing of recent updates has been recognized and is a major area of attention. Improving product performance (e.g. speed) is now a major focus of quality improvement.

Another focus is on meeting release date targets, with regular (quarterly) releases. Easier installation of AC was another priority; one that most of us would agree has been met. The challenge of meeting government mandates while trying to simultaneously address user-requested improvements continues. The process for receiving and quantifying suggestions for product enhancements has been formalized. Your suggestions (e.g. those submitted via the "Recommend Improvements" tab under "Help" in AC) are being read, considered, and analyzed. If you would like to provide additional input in more specific areas, you can join "Product Ear" which is a group of users who agree to respond to surveys on particular aspects of the user experience.

An update on "Inlight", which is a cloud based EMR being developed by AC in parallel to our current one was presented. This EHR is based upon a problem oriented medical record and may prove to be a good alternative to AC for certain practices (especially those transitioning from another EMR).

Messages conveyed to AC by clinician members of the CAB included:
1. In the process of creating improvements, it is critical that upgrades not "break" old features or degrade performance.
2. Close attention to exactly how we use the EMR will lead to improved product development. Adapting the EMR to our work-flows (rather than the other way around) is what we want to see.
3. A variety of product improvements were suggested. Some were already in the works, a number seemed to be "moved up" in priority in response to our comments, and others were essentially new ideas.
4. Additional communication, including more participation here on the user board was encouraged.

My opinion remains that AC stands near the top of software companies in their willingness to engage and pay attention to its users. While we still have issues to pursue with the company and the EMR, some facts are indisputable. Over the past year the company has devoted significant resources to quality assurance. The process for "intake" of recommendations for product improvements has been significantly improved. The number of rapid, patch updates has dropped. Finally, the number of implemented improvements and fixes that we have requested is accelerating. Here are a few examples of items from the "wish list" here on the user board that will appear in upcoming releases:
- automatic medication inactivation
- category creation for imported items
- fix the conflict of the current date showing on the "most recent encounter" tab
- an "archiving option" for imported items, so older items will be hidden
- PQRS and prior auths from within the program
- better order reconciliation, including a reconcile button on the sign-off page

If you go back and look at Bert's development poll from 2011(!) you will see that many features we requested have been added in the past year and many more additional ones are in line for inclusion.

As always, government mandates on the horizon may complicate things. The initial look at how AC handles ICD-10 is pretty promising. If MU3 is put on hold for awhile, and if AC can tame performance issues in the coming year, the planned enhancements to the program should make all of our lives easier.

Thanks Jon for a good summary of the meeting. Some other points I would make:

Inlight is a new web based Problem Oriented Medical Record. It is currently for those with a direct primary care office as they do not have PM or billing component integrated into it. It has a separate group of programmers but we have jointly benefited from their developments.

One example would be the newer ICD natural language list in V7-8 group.

They have not given up on Amazing Charts, just looking in another direction to attract those who are looking for a better online option. (Yes AC has an online option but this is different.) There are few options in EMRs with on premises databases, AC will always have a place in the market.

PriMed AC is actively pursuing updating AC. It did get bogged down in governmental updates, but this was necessary just to stay in the market. There were 1100 EMRs that were MU1 certified but only something like 240 for MU2. Many of them dropped by the wayside. While you may think that MU is junk, probably most of the new adopters would see this as a requirement, and we would see a steady loss of current users who either ARE actively involved in MU2 or need related services to avoid getting cuts in other areas.

On another note...
AC is actively pursuing speed improvements in each version. They have heard and listened. Although they have testing networks set up, it's not the same as being in an office with a number of people working at the same time. They realize that many of the changes have slowed things are trying to focus on speed as a priority.

I will tell you that EVERY version of AC has been slower since version 2 or 3! Version 1 opened from initial click in 2-3 seconds, not the minute or so it now takes. Clicking on a chart opened it almost immediately. I believe it was V5 that slowed me down to a crawl in beta but bounced back. That was WAYYYYY worse than V8. Computers are faster and I have noticed that upgrading them is necessary to keep up with increased demands (see http://amazingcharts.com/support/hardware-os-requirements/ ) Remember that AC used to work on Pentium 2 400 MHz with 128 Meg of memory.

Yes, it does a lot more but it also takes a lot more.

It would be GREAT if archiving Old imported items would also allow separation of those so that back-up option would not need to include those that are archived.

Thanks Jon & Wendell for the posts. This was my first CAB meeting. It was nice to see that the company is putting a lot of resources into improving AC. I didn't realize how much MU affected the company as significant resources had to be taken away from product improvements just to maintain MU certification.

My take away from the meeting was that the company continues to listen to its users. For those of you who make suggestions here on the board, I would encourage you to formally submit suggestions through the "Help / Recommend Improvements" tab. The more users suggest the same improvement, the more resources can be allocated to this. They do read all of the suggestions.

While AC is not perfect, I am still happy to recommend the software to my peers. I don't see a better company out there. I am confident they will continue to improve.

Thanks Marty. I agree about sending through the official channel. But, I would encourage to send them here as well. It's just good to know others have the same issue or we can help them or us.

Just FYI..Our new Amazing Backup is incremental...in that it archives everything once the first time and each time after that only backs up what has changed since the last backup so it's much faster.

which versions for this new backup???

Koby and mkweiss,
The new AC Backup that Chris mentions is not a part of any version; it is a separate product which replaces the old AC back-up. It is described here.

Incremental backup of II makes it less of a need to archive a portion and backup the rest (as mkweiss' suggested).

When do current AC Backup subscribers get the New AC Backup?

Josue,
The new backup was not discussed at the meeting in Boston; in fact, I was not even aware that it had been released yet. I don't know how they plan to transition users from the old to the new. If you click on the link to the product above, you can then click to request more information. At that point they ask about your current back-up approach, so I would submit that and ask how you go from one to the other.

Thanks Jon.

I was hoping cconrad@ac could enlighten us here. Anyways I requested more info.

Dear Jon and Wendell:

Thanks for the update. Was there any discussion about ACPM, practice management, at the CABM?

John

There was, John. Hopefully AC will have something to say soon.

One of the issues AC struggles with is how much to comment on the USER board. They consider this OUR board and are reluctant to intervene.

Yes, they do make occasional comments (such as Chris' comment above) but they are do not want to feel they are either intruding or interfering with comments here.

It is a fine balance. We have told them that more comments would be helpful, and we will let them know if they are overstepping. For years, even Jon Bertman would only comment a couple times a year.

We in the CAB are probably the closest to the "official" comment and to an extent we are far from it, in that while often we know the official answer (and usually give it) my comments come with sarcasm and wit that could chafe the corporate collar, even in a company as liberal as AC. And I am might be the most PC of the bunch

Yet we lumber on. I have been told countless times that this forum is both the best selling point and the most helpful thing about AC. Fortunately it is a very intuitive program.

I agree with Wendell. Personally, I would rather AC stay off the board completely. And, yes, the board probably is the biggest advertiser for AC. But, it is also the biggest anchor around its neck when something goes awry.

I think the overriding philosophy should be for AC to communicate in more official channels such as email and their website, which has come a long, long way.

But, when there are HUGE issues that come into play, the eRx and TSP800 crash of 2009, the ACPM debacle of 2015 and the performance issues of v8 in the same year, one long thread can cause major damage.

That is where I see AC commenting. And, not one comment in response to another. But, the top people (the very top) coming on and making a statement owning the problem, apologizing and laying out steps as to what is going to happen. I would think that someone would come out in a Post to the People about ACPM and tell it like it is. Saying there is a problem and that they are aware of the problem and are doing A, B and C to fix it goes a long, long way.

Agreed Burt! 'A State of the Union(AC)'from on high to the users would be appreciated.

This is an area where Bert and I disagree. I feel strongly that over time, more communication from AC would help to answer many questions and resolve many issues. This board should not replace other means of communication, but should augment them. Announcements and conversations here by company representatives benefit everyone, as opposed to private information in emails, tech chats, or other personal communications which may only reach one or a few.

I was vocal about this at the recent CAB meeting. I would be happy to give past examples of areas where a short communication from AC here would have resolved questions and made lives easier. There are several current areas where this is the case. Some things are much better addressed by an official company representative than by a single user who (officially or unofficially) has "heard something".

Wendell is not overstating this; several people at AC have expressed this concern. I have reassured them that they need not worry about this; I would encourage others to do the same. I cannot think of even one time when a comment by someone at AC has been intrusive; they are usually quite helpful. Just look at recent weeks where Mark and Claire have both provided useful input to answer specific questions. I welcome and appreciate that.

Yes, we need a statement about ACPM. That helps with a "big picture" issue. We should also welcome input in more discrete but still useful and important topics.

Jon is right. We do disagree.

Perhaps I stated it too emphatically. An answer here or there is helpful. The policy two to three years ago of having them patrol the boards was just too much for me.

Major State of AC addresses are lacking.

I agree with Bert

Thus you see, there is a divide among the members of the CAB about more company involvement in the board vs (silence).

I see both sides, but I would lean toward more involvement, so I guess I am closer to Jon.

The company has been very reticent to increase involvement, and now you can see why

@Leslie we miss you

Jon & Wendell,
Thank you both for your updates and agree the AC input here on the board quite helpful.

I, for one, have never found AC comments on the Boards a problem--but a help.

As a struggling ACPM user I would really welcome a statement from AC to "clear the air." Two days ago (8/24) we sent an email to the head staffer for ACPM at AC, Ms. Laurie Hart, and it bounced saying that: "I am no longer an employee of Amazing Charts." Last week she was very helpful to us in resolving a problem with Medicaid billing. Sorry to see her go. It's not clear to me if this is a good sign or a bad one. It certainly doesn't clear the air about PM but makes it even more unsettled.

I have never found it a problem either. I am just one who likes consistency. There will be a time when support staff watch vigilantly and answer questions. These are mostly technical questions like how to use search.

I simply prefer my questions to be answered by Donna or John of Sandeep. That's just I.

Now,a State of Amazing Charts would be helpful.

Getting an auto-reply from the top person of ACPM when there are issues is inappropriate. An email to everyone, especially those using ACPM and her would have been more appropriate. Like you said, it makes one wonder.

Sorry to come across as Shrek.

That's not Shrek; I think it is Game of Thrones.

One other point from the meeting that may be of interest:

AC is considering a nationwide ACUC.
The regional meetings will continue, but 2016 may be the year for a national meeting, similar in scope to the ones in years past.

Another interesting point from the meeting

AC users can attend PriMed conferences FREE

Just enter the discount code "amazingcharts" when you're registering for your next Pri-Med CME conference online

I guess 1K trumps $25-100 registration and they decided to give us a break

It has always been free for those attending the AC conference at PriMed conferences.

I checked with AC before posting and had not realized that it was at the bottom of the last newsletter. If I missed it, I suspect I'm not the only one.

I miss Amazing Charts!
I do hope that the User Board will maintain it's integrity.
It is nice from time to time to hear from the company in a formal post.

As a current user of ECW, I can tell you, AC users don't want to lose their ability
to directly communicate with each other. ECW regularly responds to user posts directly instead of allowing for other users to respond. I have had to ask them explicitly not to do so.

The banter and the collegiality is not the same in ECW. The user board does help, but it is not an open forum of communication.

Vicki,

Just thinking about you the other day. All good. I want to THANK YOU, THANK YOU, THANK YOU for your thoughts and your experience.

A month or so ago, I posted that I prefer when AC does not post on the board. I think people misunderstood me. And, I certainly understood their point of view, especially when it was an easy technical answer. But, there are different kinds boards. Backup Assist has a user board, but it receives very few, IF ANY responses to the questions. In fact, it has become the defacto support. But, it is now just that so you don't look at it in any other way.

I simply can't explain it the way I want to. You just want the community to post and help. That doesn't mean their won't be times that support can't jump in rather than watch 10 of us wallow around trying to figure out how to do a search involving the combination of four queries.

The conversation is actually mute, because the board functions that way anyway.

You have to say the formatting is probably better on eCw, correct? But, you likely have to enter in more information.

Good to hear from you. Good thing I didn't ban you.

I agree with Bert. As a Epic user now, I too miss AC and the bantering back and forth.

Miss having your frequent input on the board Leslie!

Too busy clicking

I agree the forum collegiality is great. Especially for us solo providers. It makes us feel were not in it alone.

Someone copy the CEO. For all our occasional whining. The board can also be AC's strength. Open non-censored exchange and feedback goes a long way even though it's a little tough to hear sometimes.

Yup, to echo the above comments, forum collegiality is great. The ability to directly respond to each other is valuable. Community input and banter is helpful and fun.
No one suggests that we change those aspects of the board.

What WOULD be helpful is to have AC staff at all levels participate here. Can anyone give a single example where AC participation has inhibited the free flow of conversation on this board?
On the contrary, I can easily provide a handful of very recent examples where AC participation did not occur, and would have been very helpful. If you posted an unanswered question or unaddressed issue here, you know what I mean.

As Bert says, the point is moot since AC- for whatever reason - has chosen to generally stay away and leave those questions and issues without a response (with the recent exception of the PM thread).

Larry, John Squire is well aware of this.

Jon,

I think you are missing my point. Which is my fault for not being clear. If I post that when I install 8.2.4 on a brand new computer it makes me run the database tuner before and after the install, would I care if Dave came on and said, xyz? No.

What I don't want to happen is what occurred maybe back in the Jon days where support was practically mandated to get involved, and they were a lot more active on the board. (relatively). Like with ACPM.

Now, ACPM is a good thing. We made them mods, because those three were specifically hired to work with ACPM and ACPM users. Only they can answer those difficult "support-type" questions.

I just wouldn't want that to occur with the other part of the board. Which is won't, so it is a moot point.