Home Forums Discussions General Discussion Granular fever

How important is it for users to track this:

Do you have any suggestions to make this happen in AC if you feel it is useful:

The sensation of foot:


http://www.emrupdate.com/forums/t/10889.aspx?PageIndex=2

Joe No offense but I hope you are joking. This is the problem with where medicine is heading. Having small offices becoming collection stations for tons of data that may or may not prove to be relavent one day is some study, just so we can get paid the rates we used to get paid before all this extra busy work and tech is just insane. And then compiling that data is some central server for other to access and use no less. And usless collected under "controlled" circumstances of a proper research study, at best such data might make for an interesting "Meta Analysis" one day.

I think if something like AC ever tried to get so micro level, then it just wouldn't be AC anymore. There is data, and then there is data. And then just look at the title of the thread; P4P! I want people out of my office and out of my doctor's and patients charts, not deeper in them. This movement is all bull just like HMO's. P4P is not about outcomes. Because real research that is relavent to outcomes takes lots of really good statistical number crunching with properly designed experimental models and questions that eliminate all of the possible sources of bias. The collection of the data itself is not controlled or double blind, so just how relavent or accurate can it be??? But now your reimbursement is going to be affected by it anyway??? Now that's BULLCHITT.

The gov't and carriers don't really care about that, they just want a nail to hang their hats on, so as to withold more of your payments. Such really good studies need to be reproduced over and over again is properly peer reviewed journals that have no bias of their own we would hope (I've lost my faith in the AMA and most of the other specialty societies and boards). And in the end the outcomes measured in P4P are mostly influenced by personal behavior. Be it lab values for sugar, cholesterol, BP, sensation loss caused by diabetic neuropathy. I can't make you buy healthy food or cook it tonight. You insurance carrier wants you on the older cheaper med, not the one my doc wrote and you just hit the fastfood drive thru on the way home.

And you all thought I was just some darn fool practice manager. I studied a hell of a lot of stats and experimental methods as a Pysch major years ago.

Sorry for screaming, but P4P just really gets my goat.
Have a good night.
Paul

It's much simpler: We do not need P4P.

Common sense says that if a payor wants your records, they're looking for an excuse not to pay for the work you've done.

This should not be surprising: the payor's raison d'etre is to take in as much money as possible, while paying out as little as possible.

What should be surprising is that our fellow physicians should be falling all over themselves to help the weasels do it to us.

The whole conversation on that forum was about people striving for a method to reduce our patient care into discrete data points that non-medical personnel can analyze. Why do they want to analyze our data?

1. Because they hope that our compliance with their policies will make people live longer and have less illness. All sane individuals will understand that these organizations do not promote these policies because they care, mind you, but because they make more money when there are fewer claims.

(As the big roulette wheel of life goes around, they are putting their chips on whatever the latest research says will make people live longer and have less illness. They may be right sometimes, but the trend will be for flashy studies that get a lot of publicity to be turned into draconian policies, more and more quickly, because the policies will become easier and easier to implement through technology).

2. Because as they raise the bar higher and higher, there will be a certain lag time between institution of the new measure, and the ability of physicians to jump through the hoop. That lag time means money that they won't have to pay out.

3. Because information is power, and the payors want to control us, because we are the ones who order all the stupid expensive tests and treatments! In the past, trying to control physicians was likened to herding cats, but technology is giving them the means to instantly monitor us, instantly correct us, and instantly deny us our daily bread.

Viewed in this context, all the self-congratulation in that forum is a little disgusting to me.

Well, last night's post made a lot more sense last night. It seems like my record needle was skipping a bit (to any youngsters on the forum, I am referring to the technology that allows you to extract analog audio information from vinyl record albums).

Anyway, what I was trying to say was:

Payors obviously do not have the best interests of physicians at heart. Any information they try to gather is intended to be used agaist us. Where their goals and our goals happen to coincide, it is entirely coincidental, and may be considered temporary. Therefore, any goal they promote should be viewed with suspicion, and resisted on principle.

I think people who work actively to help payors achieve mastery over physicians should properly be viewed as enemies by physicians (and by society at large, but I digress). Therefore, I can't read a bunch of people talking about how easy they're making it for outside agencies to scrutinize and control physicians without getting a little sick at my stomach.

Yeah that.

But, again, a physician from our hospital based group spent thirty minutes with a slide presentation talking about EBM and P4P. Of course, they use Logician, which does allow the access of some of that data. I found it interesting that he stated he and his colleagues have to see three or four less patients per day due to Logician even AFTER three to four years of practice.

I guess it's not important to use a more user-friendly and faster EMR that allows more visits and better patient care.

Brian,
My point exactly. These SOB's don't really care about long term outcomes, they only really care about quarterly profits. And yet doctors, Medical societies, IPO's, and software vendors are falling all over themselves just to cater to this bullchitt. It's just smoke and mirrors. Two totally valid scientists could use real data and argue pretty well for two totally differing views on almost anything. Numbers don't lie, people do.

There is a large employer here just down the road from us. We have some of their employees as patients here. In three years they have switched from Aetna, to Local BC/BS and now this year back to Aetna and this time for a screw the employees and the doctors HSA type plan no less. Once they are out the door if you haven't collected, good luck. There's another write off for ya. Under such conditions of swapping patients and employer groups back and forth, these idiots couldn't give a good rat's behind about really spending serious money and improving outcomes.

They just want to pick and choose the lit and reports that best support their ability to withold your hard earned dollars. And I just want to shake all the people and beat them over the head when they fall for this chitt. Doesn't anybody remember the old lie and pitch about managed care and HMO's??? Are they really that dumb, deaf and blind (Tommy can ya hear me....)??? Those who do not learn from history are doomed to repeat it, right?

Good Night and Good Luck,
Paul

The short answer to the original question, is NO WE DON"T TRACK THIS. Sorry.

The trade off in ANY computer system - be it EMR, accounting system, or other system, is level of detail vs time to feed the "elephant's child", and whether all of the information that initially everybody thought would be useful is actually going to show a benefit for the cost. In this case, having a separate data field for whether a person has sensation in their feet (remember, an AC chart note has the same fields for everybody) means spending screen real estate for a checkbox with little if any real clinical usefulness.

If you REALLY REALLY REALLY want this - create a bogus diagnosis code, and then report out on it when its time to fill out the Extortion for Hoop Jumping.. er.. I mean Pay for Performance paperwork.

There ARE EMR packages that keep this level of detail in their templates and allow reporting all this junk out.. We tried one and it was impossible to use (unless you can get away with taking 20 minutes to do each chart note)

Regards,

V.

< sigh >

I don't know if I'm missing something here - but that forum reads like a full-time commercial for Medtuity. Yeah, they've got pretty screen shots of all of the data gathering stuff, and a fancy picture of feet to document just where you poked your diabetic's feet, but take it for a test drive before you decide to buy anything.

We evaluated Medtuity less than one year ago for our practice. Initially they insisted that they would only do an online demo, that no "live" copy of their system is available for testing. In their online demo, where a salesperson lets you share his desktop while he walks you through their features, they couldn't complete an encounter, code it, print it, and put it away. They kept dancing around it - but the program couldn't handle these basic functions. Sorry, Medtuity.

After much wrangling they agreed to send us a "live" copy - and we agreed to purchase 350 "visit tokens" - half the normal initial purchase. We basically told them it was either that or nothing - I was not going to pay $700 to purchase a "demo". They gave us 35 "visit tokens" to play with - we never had them enable the 350. When we tested it, the program indeed couldn't finish an encounter. Also, the copy they sent us had an interesting problem - when you exited the program and restarted it EVERYBODY who has ever been seen is still in your building!! They told us "Oh! we fixed that!" - well if they did, why would they send a new client an old, non-working copy of their program? This bug kinda makes the program unusable - how many people are actually running their practices on this with it this way?

They then posted an emergency program update for us to download - and their programmer didn't realize, I guess, that you can't just update the Microsoft HTML library without testing things - the updater wouldn't run, and kept bombing with a runtime error. They had no idea why this wouldn't work, either. At that point we decided that while they have some ok ideas, the package couldn't do even the basics reliably, and we walked away.

They tried to save the sale, asking me why I kept telling them it didn't look very promising.. well, if the program's core functionality was solid, I could deal with bugs in the seldom-used features.. but the core functionality simply didn't work.

In case you were wondering why I would spend almost an entire week pounding on Medtuity, please understand.. we were angry with Jon, and ready to dump Amazing Charts..(over what I don't even remember at this point) We were SERIOUSLY looking, and looked at a number of products - and everything we looked at was much worse than what we have.. Jon and I made up, we worked it out, and here we are.

I guess, like any forum, take every post with a grain of salt. At least on the Amazing Charts forum, you know that we're all using this software to run real practices.

My suggestion would be if you REALLY REALLY want to track this stuff, create a template for it, so that the free-text of the notes can be parsed. The argument made by the Medtuity guy about granularity is somewhat correct - but I'd much rather that the work be done on the back end by a program with some smarts, than make the doctors punch in a ton of fields to get a few pennies more - our time is too valuable for that.

For the diabetes foot exam stuff, a template in physical exam makes more sense than a diagnosis code. In our office, all physical exam systems are in all caps, with a colon after the system. Creating a template for "DIABETIC FOOT EXAM:" and parsing for that text could do the trick, without creating whole screens or special pictures or other bits to slow down the busy doc.

Regards,

V.

Folks:

Thank you all. You have been wonderful. All the points are 100% correct. I agree where this all heading to, less payment for providers based on data.

Paul, Vinny, Bert, Brian and others:

They love you at EMRupdate.com. I have been there for 3 yrs now. Learnt a lot and had have expressed my opinions about various things. I invite you to start posting at EMRupdate.com. It is very easy to create a new account.

Cheers.

Thanks, Joseph, I may at that.

V.

Joseph:

I look in on emrupdate.com from time to time and there is a lot of good discussion there, and I have been intrigued enough to post a couple of times, but found myself unable to create an account.

I have actually tried several different times using different handles, different email addresses, etc. without success. I even tried to contact Al Borges directly once and got no reply. I finally decided it must be an "invitation only" forum, for EMR high muckety-mucks.

It's good to hear that we're loved. I wondered why I was feeling that warm glow inside! (I thought it was the carnitas with chili verde sauce from lunch).

Take care!

Joe,
You say that the folks at this other site really love us. How do they know about us??? Are they coming and reading the board here? Have you been passing on some of our more "interesting" posts to them? Just curious. I'm glad to know that some of what we have been knocking around here is reaching a somewhat larger audience. Really I would love to find a way to get much of this great banter out in front of the public at large so they can see for themselves just how tough things are for many of us, and just how much we care about them, their health and their privacy and rights.

And remember it's not just cutting payments based on data, it's really doing the same based on very questionable if not extemely bad data. The experimental model itself is very poor, no less the lack of any control or double blind to the picking and choosing of that data. Who is in control of picking and choosing the data and with what predisposed biases, with what agenda in mind. It is CHITT science and that in and of itself renders it meaningless. And therefore patient's access to treatment and provider reimbursement should not hing upon it. Under "normal" conditions such stuff would simply be laughed out of town. How come as these supposedly learnered docs are falling for this so easily? If a guy with a BA in psych can understand the flaws in the model why isn't the AMA and everybody else simply running these guys out on a rail???

Please let us know and keep up the good fight right back at ya.
Good Night and Good Luck,
Paul

We're stars! The whole internet is watching us, Paul!

Women want to be with us. Men want to drink what we drink...

I am amazed at reading this.

Vinny, you never had us enable the 350? No, no, no. You never paid us for those. They were enabled. We don't even have the option to sell 35 credits.

I can remind you of the reasons. You were upset about spending your weekends documenting. You were upset because John gave you the source code to the program so you could spend your free time fixing bugs. Then, when you fixed a bug you were questioned..."Vinny, are you SURE you fixed it? You're SURE??" You said you wanted your life back. You wanted to come home on the weekend and do what you wanted to do. Not document the previous weeks charts and program for free for John.

When we discussed switching to Medtuity you said, "Yea, I can send you our CCR data!" Then you tried to export a CCR file, never worked. You sighed and mentioned there was another bug you'd have to fix but that you refused to do more programming.

You evaluated the program for a couple hours in the middle of a conference. It didn't do exactly what you wanted right away and you refused training.

"After much rangling?" Come on. We did an hour long demo, in about 5 minutes I said, "Fine. Let's just do half."

You never received a moments training, never accepted it and, had you accepted our training you would have seen how to complete a chart and code it. I don't see why you would want to print but if you really wanted to do that you would have clicked print.

For somebody that never lived up to their end of the agreement (paying) nor accepted training you have a lot to say about a program you never really used.

Brandon,

I'm pretty amazed at reading your post, actually.

You did, indeed, enable 35 visit units on our system, so that we could evaluate the system without wasting real "patient visits". Our agreement was for us to purchase 350 patient visits - which indeed we never paid for because the product NEVER WORKED. We didn't purchase the 35 - your people GAVE them to us so we wouldn't waste our "real" patient credits while playing with your product. If you recall, we had also agreed that when we had finished with demo patients that you were going to reinitialize our database so that the demo patients wouldn't be in our real database with our real patients. YOU agreed to this.

Our system WAS NEVER ENABLED for the 350 patients. We elected to walk away from your product before the 350 patient credits were enabled.

Let me remind YOU of a few "reasons", Brandon.

The code you sent us a patient NEVER left the office - they always showed as still being there. Whenever the program was restarted, everybody was magically back! We were told that that had been fixed. Um.. ok.. then why are you sending me code that's broken when your REAL users have this fixed? You finally attempted to send me a patch - which did not work. Seems we're the only client you had who ever had this problem. Um.. ok. If your installed base were anything like Jon's, your phone would have been ringing off the hook about this for days - but ok, whatever. You're right, the product works JUST FINE.

We didn't evaluate the product in the middle of a conference, although part of our evaluation period was during a weekend while we were at a conference, I'll admit. I spent well over a week - in total over 30 hours - and every place we looked the product was buggy as hell. If you recall our conversation, when I told you - and I quote "It doesn't look good", we had quite a number of issues, not just the "Elvis hasn't left the building" issue.

We refused "training" because even the functions we tested which did not exactly need a rocket scientist to use - like checking a patient in and out - didn't work. At that point I was not willing to invest any more time in your product.

During the online demo, by the way, we also kept trying to steer you to closing out a patient encounter, coding it, printing it, and billing it, and we were never able to get that particular part demonstrated. We also were never able to get your product to actually do that when we had it in real life to play with. Very simply, in a demo what we wanted to see was patient transaction cycle - get them in, document them, code them, print them, bill them. You wanted to show bells and whistles, not core functionality, and we didn't seem to be able to steer you in that direction.

Quite frankly, this is why I don't spend hundreds or thousands of dollars on software without being actually able to run the program in a work environment, and do not consider purchasing products where the only pre-purchase hands on is the salesman driven "demo" or a flash movie of the product. The "wrangling" you talk about, from where I'm sitting, was that I'm paying you half the purchase commitment to be able to do a real evaluation of your product, rather than committing the future of my practice and potentially thousands of dollars on a mission critical business application on a guided tour. I'm not willing to buy something outright to later find it doesn't live up to its promises, which is unfortunately all too common in the EMR world, and the software world in general.

Simply put, Brandon, your product didn't work. No way around that. Attacking me and calling me a deadbeat is fine, I can accept that. You're right, I didn't pay you - and you didn't deliver a product that worked. In my book, that makes us square. Sorry you don't see it that way. I'm open to discussing a reasonable settlement with you - but it's not going to be paying for 350 patient encounters we're never going to use in a product that was buggy as hell. Actually, at the time this was ordered you were given my credit card number. You could have charged it at any time.

Brandon, I'll admit, and EVERYBODY on this board knows that I've had issues with Jon and Amazing Charts at various times during my relationship with him and his company, and have frequently been pretty frustrated with him. My career before medicine was computer engineering, and I've been in the software industry since 1974. I need my tools to make me more productive - not add tons of extra clicks and screens to simple patient encounters. Maybe for a practice like ours PAPER is a better alternative to ANY EMR. Maybe not. Whenever I get frustrated with Amazing Charts I go looking to see what I can replace it with - and so far every time I come back to Amazing Charts. Yeah, it's frequently a love/hate relationship. I'm in a rare position where I can actually write patches and fix bugs, and sometimes I DO INDEED get frustrated with Jon over whether he'll accept a patch upstream. No secret there.

At the time I contacted you we were seriously looking to purchase another EMR. We looked at a number of them. Yours didn't make the grade. Sorry. If it's any consolation, neither did the other two semi-finalists we evaluated.

If you want money, great, lets talk. You spent a week on the phone with us, and I do not expect you to totally eat the costs of that - but you're not getting $350 for code that never worked.

You've had your rebuttal, and I've had my say in return. Sorry your feelings are hurt.

Regards,

V.

Brandon,
I'm not really sure who you are, but I think I have a good idea. I'm sorry if you and Vinny had a falling out and a difference of opinions as to how and what transpired between the two of you. But Hi-Jacking an old, but still valid thread to have your arguement with him out in public no less, there at the AC user board is extremely "Bad Form" old chap as the brits would say.

Perhaps the two of you should go get a thread, if you catch my drift? At least then it could be hashed out in it's own forum. Although again sort of chasing him down here to then go at him in this fashion seems like pretty bad sport on your part.

Again I'm not a hundred percent sure exactly what transpired between the two of you, and perhaps you do even have a valid greivance, but here at the AC user board at least, Vinny is a trusted advisor and a good friend who we all trust to have strong sense of self worth and good moral fiber. Although he is known to be the type to be involved in many a heated debate, it is exactly because he cares passionately and morally about a number of important subjects and has a low tolerance level for people with selfish intentions who try to do things for their own self importance or gain. I know, although he and I come at life and politics from opposite sides of the political fence we actually share many common sense values and respect eachother for the others convictions. As Vinny coined himself, "It's not about Left or Right, it's about Right or Wrong".

We wish you well, but come on, let's do this in a better way...

Just re-read what I hadn't read in a long time and now I know why Brandon is so hot under the collar as Vinny gave his opinion here about his program way back when this thread was now. Sure took him long enough to come back on it. And how and why he would track you down back to this board is still kind of weird, but at least now it all makes sense....

I'm really unconcerned with compensation at this point. The whole problem is over a year old. "Track him down"? I did a Google search on granularity and this thread just happened to pop up so I read it out of interest. I couldn't believe the things that were said. If I really wanted to "track him down" I would have called his office. After he called me on Saturday just to say things didn't look good I threw in the towel to collect the $350. I've got other things I'd rather do with my time than hunt someone down for a few hundred bucks.

That's fine that Vinny is a trusted adviser and such. Take his advice on AC and I hope the users of the program have much success with it. But, let's keep the advice to things you know, AC and medicine. You do not know our software well enough to give advice on it or granularity in general.

The software didn't work for you, you lost no money in it and very little time. It just amazes me that you would post negative things about a company that you invested virtually no time into and know very little about the product. You were given our time, software and support and we received nothing at all in return, never call to hassle you but now I find negative things being said. I call that bad form and it would irk me to no end to just bite my tongue.

That's all I have to say on the issue. You can have the thread back. If there is more to say feel free to send me an email and we can have the rest of this conversation on the phone. I won't be checking this forum any longer.

Bradon,
Part of what we do here is share our experiences with other products, including other EMR's. I've posted about Dr David Tully-Smith and his company Chartware here before. As for not knowing enough about a subject, first who the heck are you to decide who is "knowledgable" enough and two even if Vinny was not formerly a tech and software man, isn't it the opinion of us average everyday folks that is just as important as those who see themselves as experts???

Granuality will be the downfall of every provider's clinic freedom, the loss of every citizen's civil rights of privacy, and the financial destruction of most practices and providers. But as the rep of some large bloated program that seems to be in that vein you can't see past your spreadsheet to understand the consquences of this direction. And EMR should be for the most part an "E" replacement for a paper chart, not a means of centeralizing every last patients, AMERICAN CITIZENS, health records in ceteralized servers for every last greed insurance carrier bean counter to have full time access to.

Were you not required to read "1984" in HS or lit 101 back in college? Does this not offend and worry you? If not then I can have no repsect for you or anyone else who shares your lack of vigilance in the protection of your first 10 ammedments, "the Bill of Rights". Unwarrented searches remember that one???

We don't even need to go into the fact that two truely honest scientist could totally not agree on what outcome should even be measured no less what the results of any research ultimately means. No less that clinic data collected not in the blind, that is then to be interpruted by people who also have a strong vested interest in the final outcome (the gov't and the carriers want to keep the own costs down at any price) contaminates all data collected in a CCHITT like system totally. It's full of experimentor biases all over the place no less subject biases from patients who have thousands of personal reasons to report what they report in contaminated ways....

Mr Google, do some basic research like I did at the lowly City University of NY bakc in the early '90's as a mere Psysch Major and look up "Bogus Pipeline" read the articles, you may even find my in there somewhere, and follow some of the references that those articles were built upon. Getting honest answers out of people even in the blind no less face to face is nearly impossible. Subject bias is all over every chart and every peice of data you will ever try to collect. And I'm just a little BA in Psych.... Why do all these people fall for all the "data" collection stuff as thought it could ever be valid.... Instead it will be garbage in and garbage out, but now my wife and her friends compensation will be based on this junk pertending to be real science. This is why real research is seriously controlled for and usually only one variable is manipulated at a time. Scientific Model, go take a level 300 course at CUNY and then get back to me....

Lastly, last time I looked subjects in any research project especially medical ones are always entitled to "informed consent". I hardly see signing some HIPAA form you can not understand or have the time to truely read as informed consent no less the fact is and when you would ever talk to real live average everyday American patients almost all of them (except those who are Practice Managers, lawyers or consultants for the messed up industry) are under the mis-informed concept that HIPAA actual protects their rights of privacy instead of really throwing them down the toilet so the courts, the gov't and most importantly, our corporate masters at the anti-trust waived carriers can all spy on each and everyone of us. And who is the number one carrier of healthcare??? The government. So unless and until each and every American has the right to honestly and knowingly "opt-out" of all of this garbage research and have all of the medical data kept of of the brave new world servers, I will always fight this CCHIT.

Lastly, at $30-$50 for a level 3 est patient visit and no real expensive and decent paying procedures to code for, can you explain how the average Primary Care provider and her office is supposed to afford all this ganuality and CCHIT? And not the first, corporate welfare paid for install, but all of it, each and every day, year in and year out. I the lowly BA in Pysch is the entire IT team in my wife's little solo practice and I am all we can afford in our little P2P world. Those who want to enslave and control each and every citizen still need to at least find a way to help those of us who are being coopted or hood winked into assisting you in your aweful plot to at least afford the whole kit and kabudle.

Lastly, since your signed up and joined this board, search and read our posting about CCHIT and privacy for a complete update on how most of us feel about all of this. Even this thread from before you climbed on board would be a good place to start. So can your system finally take a patient thru an entire encounter, smoothly from sign-in at the front desk to sign-out at the encounter desk, all in a way that the average HS graduate can understand and master???? Have a happy mother's day, I've got to get my kids, wife and mother-in-law to the Zoo now....

Paul

Hi Folks,

I'll contact him privately this week. Just a few parting points, however, as we hopefully put this to bed:

1) It's not that the software didn't work FOR ME.. it was BROKEN. I do NOT want to harp on this - but I could post screen shots with error messages and demonstrate the bugs.

2) Investing THIRTY HOURS into evaluating a piece of software I think is well enough to know if a piece of software is going to work or not. It didn't. That doesn't mean that the code that they ship to their "regular clients" didn't then or doesn't now work. It also doesn't mean that the bugs we found at that time haven't been fixed. IT DOES mean that the software was given a reasonable evaluation, and it had a lot of problems. These aren't problems that would go away with training. These were BUGS. Not being able to close an encounter and put the chart away to complete the transaction cycle isn't a training issue. It was a MAJOR bug. We were told it was "fixed", but the question of why WE were sent code with this bug still there when the "other users" had had this "fixed" still hasn't been answered, and I found the situation to be a bit odd. THREE DAYS later we were offered a patch, and the downloader for the patch was broken as well because the downloader wasn't tested by their developers. Again, I'd be happy to post screen shots of the error messages.

Did it take three days to figure out what existing code we didn't have so that they could send it to us and how to package it to send? Or did they have to scramble to fix this bug so that they could try to save the sale? I have no idea, and at this point don't much care. It proved to be a deal breaker for them, though, and precipitated the "It doesn't look good" phone call.

3) While there was a conversation that Saturday telling him it "Doesn't look good", there were quite a number of OTHER calls, both with "how do I do this" questions as well as "why is it doing this" questions. As he puts it we were given their "time, software and support" - this wasn't just the one phone call.

Yes, he got "nothing in return". If the product had actually worked, they would have made a few thousand dollars each year in an ongoing, mutually beneficial relationship. Their current out-of-pocket costs are a total of a couple of hours of telephone support, and one overnight envelope via UPS. Minimal at best, which I've offered to reimburse him for. We ALSO got "nothing in return", as the software did not deliver on its promises.

Hopefully, they've fixed their bugs and moved on, and will do well with other potential customers. In NONE of his posts has he addressed the points I've raised - all he's done is complain that we weren't fair and that I stiffed him out of $350. The software issues are over a year old, and I'd be surprised if they HAVEN'T been fixed as one major bug affected core functionality. It does not mean that at the time we evaluated the program it wasn't broken.

If there weren't issues with the software, they were in a PERFECT position to flip us from AC to Medtuity. We just couldn't go from one solution where we were having issues to a brand new set of problems. We were not going to stake our practice on the hope that once we were up and running they'd deliver a working version of their program. In retrospect, this turned out to be an excellent decision.

They have a lot of good ideas. The original point of the thread, having to do with EMR granularity, being able to report and track on health measures, etc, raise a number of valid issues, which should continue to be discussed. This is an area that Medtuity does do a reasonably good job.

I'd be happy - now that this detour is completed - to discuss and debate thing like keyword parsing of free text vs storing discrete data fields, front-end granularity vs back-end processing for reporting, template organization and the like, from either a theoretical standpoint or as it applies to Amazing Charts.


V.

I am amazed at Medtuity's approach to Public Relations.

For any readers who don't know, Matt and Brandon Chase run an EMR company called Medtuity.

If Brandon's post is any indication, their idea of P.R. is to scour the internet for negative comments on their product, then attempt to harrass or embarrass the person making the comment.

Obviously, they are free to pursue this approach, but I believe it is bound to backfire.

I actually tried to Google up this thread with terms like "granular, granularity, etc." and couldn't do it. I even Googled "granular fever amazing charts medtuity" and couldn't bring it up.

Now, Brandon has posted to this forum, which is increasing the pagerank of this discussion on Google, making it more likely that Googlers will see Vinny's negative comments about Medtuity, and Brandon's nasty accusations.

He also bumped an old and forgotten thread to the top of the Post List, and made a lot of people read to figure out why Vinny didn't like Medtuity.

Also, his retort to Vinny was very provocative, which adds fuel to the discussion, and introduces the possibility that other sites will link to this discussion, which further increases the pagerank of this discussion.

And, since he personally attacked Vinny, who is a respected member of this forum, he has branded himself as somewhat of a hothead, and likely did himself no favors with those Amazing Charts users who might consider switching to Medtuity someday.

As the pagerank of this post increases, so do the odds that people will find this post when they Google Medtuity.

Eventually, people Googling "Medtuity granular EMR" will be directed to an argument about Medtuity, instead of Medtuity.

If I was trying to promote my EMR, I think I could think of a more productive way of doing it.

Medtuity granular EMR
Medtuity granular EMR
Medtuity granular EMR

Oh and if any of you didn't get it the first time....

Medtuity granular EMR
Medtuity granular EMR
Medtuity granular EMR

But seriously, Brian makes some very good and valid points here... Especially about attracting negative attention to himself and his product as well as the results of attacking our well respected friend Vinny.... Vinny has been there for us when we have needed him, and therefore I will always be glad to return the favor. I am a good and extremely loyal friend, but I also make one hell of a nasty enemy. As a boy from Da Brond, don't mess with me and mine, OK???

Good Night and Good Luck,
And Happy Mommy's Day to all Your Moms Out There....
Paul

It shouldn't take 30 hours to figure out a EMR program. That in itself is indication that the software is bunk. When I first trialed AC, I did so for about 2 or 3 hours and had 90% of it figured out.

I hate non-intuitive programs and ones that don't work.

Vinny has sold me. I will not ever switch to Medtuity.

Well said Adam.... Bye, bye Brandon.

Better said Paul..... Bye, bye Brandon.