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I am closing the office and retiring from medical practice 12/31/22.
We have to keep charts for 7 years except kids some years past age 21. Not really sure of specifics -- we get different answers from different people

AmazingCharts is paid up until mid March, but I don't want to keep paying support for a program that I won't be using.

Will it run in "read only" mode so I can access and print charts for administrative and legal needs if I just stop paying for support?
I imagine the server will keep going for 7 years -- these things seem pretty durable.

I make a backup copies, but it seems like I can't install that on a different machine if the server craps out -- so I'm not sure what value that will be.

James says he can convert everything in the database and ImportItems to PDF -- but that sounds pretty clunky. Maybe it's the only way?

Any input, advise, suggestions, anecdotes will be helpful. I have never done this before1

If it pleases the court, I'd like to make a case.

Maintain a server for the next 7 years.

* That includes upgrades if you have to. If your current server already has some age on it, some type of upgrade is almost a certainty.

* That includes backups. You'll have to maintain licensing for whatever backup software you use. And you'll still need to periodically test your backups.

* Updates. Updates for Windows, AC, SQL Server are all still on the table.

In other words, letting your server sit on the shelf for the next 7 years and just print something whenever with the idea that this will all be maintenance free may not be plausible.

PDF files, however, can be moved to whatever machine you wish or to multiple machines or USB drives. You can even hire my friend Andrew to host your files for you and take legal custodial ownership of those files. You'll be free to retire to some island in the Pacific surrounded by margaritas and senoritas and never to worry about calls from patients/doctors for medical records again or having to deal with some annoying server that will turn into an eyesore in your house.

If you wish, you can send me your data and I'll convert a few patients and let you have their files. If you like what you see, we can finish the conversion when appropriate and move forward. If you don't like, then I'll delete your data from my server and no fee and no hard feelings.

I'll PM Andrew's contact info.

JamesNT

I would go w/ James' proposal.

My parents had 2 separate practices but in the same office. When my dad passed, we kept the medical records for 7 years. That part wasn't hard. The hard part was when his patients contacted us to get those records, we had to verify their identity, go look for those (physical) charts and then coordinate how they would get the records. Actually it wasn't bad for me bc the same office was still open with my mom's practice. But if you're going to be fully retired, you probably want to avoid having to do all that.

James sounds like a great plan, depending on the cost. I guess you would just have to sign a business agreement for HIPAA with both James and his friend then you would be out and free to retire!

@ChrisFNP,

You would only have to sign a BAA with Andrew at Desert River Solutions if you went the route of Andrew doing custodial ownership. I already have an agreement with Andrew and Andrew would be contracting me for the work so hence my fee would be built in.

I go direct with clients when they want PDF files to move to another EMR where Andrew is not needed so, yes, in that case, a BAA with me would be required.

JamesNT

Thanks all for the advice.
I'm uncertain how to proceed. I plan to keep someone on staff for a few months (at least until my AC annual agreement runs out) because we want to make every reasonable effort to get records transferred and patients established with a new doctor, including possibly refilling some prescriptions when people have real problems finding a new doctor. Around here there are very few primary physicians who are accepting medicare/medicaid patients, and all of the new doctors who have come to town get employed by the hospital clinics -- and they mostly don't stay very long before they move on,

Keeping PDF's on a regular Windows machine (and closing down AC completely) might be an option -- but I have never found PDF's from other doctors' practices when they transfer to us to be very useful. Very hard and time consuming to pick out nuggets of important information from those endless, repetitive files.

Two thoughts:
1. Let pt's know you are retiring and give them a paper copy of their chart or continuation of care document and all imported things on a flash drive, may be a little time consuming but then you could have a record signed saying that they received the chart and get you off the hook to a degree.

2. Contact one of the hospital run clinics and see if they will take the records. I know it may not the type of care you want for your pt's but then you could retire in peace, the way it should be.

The only problem I see with that plan is #2. That clinic is now on the hook for maintaining patient records for 7 years for patients that may not want to visit the clinic or may even move away. Now they have to expend labor doling out records for patients who just say "see ya" and don't utilize their services. For the clinic that's wasted labor.

It could work; however, if the clinic agrees to take on the records in the hopes that enough patients will swing their way to make it all worth their while (in other words, accept the risk) or if they charge a modest fee for patient record maintenance.

JamesNT

True, it would be a waste for the clinic taking over the records if pt's don't move over but the bigger facilities may not care as much. I know the hospitals here are trying to get practices all the time. One hospital has done a 'golden parachute' deal with some of the physicians. They just have to continue to practice for the next 5 years.

That's pretty much what we did. The big hospital based clinic took the works and we were able to assure some continuity of care. We felt no guilt at all... their care may not have been what i would like, but it was still good care and seamless.

Around here doctors just leave practice and disappear -- it is nearly impossible to get any records from anyone. Nevertheless, there doesn't seem to be any consequence, regardless of what the law says.

Hospitals don't seem to be much better. Try to get surgical operative summaries or image reports from 5-10 years ago -- good luck. Usually "not available".
So I guess I won't worry too much about that!

One of the 3 clinicians in the office retired last Dec 31 -- we had given a six month notice that he was retiring 12/31/21, and that the entire practice was closing 12/31/22, with a deliberate shrinking through the whole of this year. People are slowly getting the idea, but it is amazing how after multiple communications in multiple channels, they still seem surprised.

Of course, the problem is that the hospital clinics, which are now almost the only game in town, are not capable of taking over our practice entirely. Many of the patients are "too complicated" or have problems like chronic pain and chronic insomnia and chronic anxiety that they simply refuse to address. I'm sure it will all sort out eventually -- but it seems like medical practice has taken a huge step backwards since it has been industrialized and forced into hospital-based clinics.

To my fellow physicians..

The most wonderful part (of my terminating practice) was unexpected. I mentioned our offering "exit exams" to those who felt they needed it. By in large these are medically unnecessary... the next provider could really look at our last comprehensive exam, which we do yearly and in which we summarize all current problems, and get what they need.... but a lot of patients felt they needed this. For the most part, they did not need it for any medical reason... they needed it to come say "goodbye" and thank us for what we have done. It has been an amazing, moving experience, like being alive at your own wake. People bring us presents. We cry together (and I am not a terribly sentimental guy). We hug. They send us cards... lots and lots of cards... telling us how much we meant to them.

I am convinced that it is not because we were such amazing physicians. We are good doctors, we try to do good and cost effective medicine, we treat our patients with care and respect.... but no more so than any other good physician. I think they were honoring us as a symbol of what we all do, that we care for those that are vulnerable, that we earn their trust, that we do our best for them. So, for that reason, I want to share that thanks with all of you. Corporate America and the government would have you believe that what is important is about meeting certain metrics, or specific standards. Like "No Child Left Behind" this is an exercise put together by accountants and actuaries, and others with small minds, to try to quantify what is truly important. They may rule the money, but they rule neither reality nor the ethics to which we have promised our lives. In the midst of all the bullshit of Meaningful use, and whether NewCropScreens is working, or anything else that irritates your day, try to remember that what you do is terribly important. And appreciated.

That is very moving testimony.
Sue and I have experienced the same thing-- we have established long-term trust relationships that will be hard to pass on to a new physician, especially to a corporate salaried physician who has to adust his/her practice to the needs of the corporation rather than the needs of the patients.

I can't believe that the current state of medical practice in the USA is stable -- no one seems to like it, and the results, by world standards are not good. On the other hand, I don't have any idea how we will get out from under the corporate iron fist,

Tom, we bailed and now live on a remote island the in the western Pacific. There is a life after American medicine. Not perfect, but SOOO much better.. Just sayin'.... http://www.saipandoctors.com

Dave --
I think there are options for new doctors to have some of the amazing experiences I have had, but not likely in the USA. Most everything is owned by a corporation or a private equity fund, and hardly anywhere that practicing doctors can follow their patients from the office to the hospital.
The wall between the office and the hospital is a sort of semi-permeable membrane, so we really don't get a chance to work side by side other doctors. Hospital meetings are run by the corporation with corporate agendas. I don't see that the new doctors have any control over their schedules or their practice ecology. Just a cog in the corporate machine, but at least for now they make a lot more money than I do.

This is a retirement question for AC on the cloud. My nurse practitioner has her own practice, is retiring and her caseload will transfer to my new nurse practitioner. Obviously we would get dual purpose of preserving my current NP's records for years to come and passing on the current records to my new NP. Anyone out there retire with a cloud-based AC database? I suspect we could get a backup.

If she is taking over the case load just add her to the current AC database as a second provider and then on renewal take of the retired NP. That is what we did a few years ago.

Will that work?

What I got from AC is that they will charge the yearly subscription fee for the new provider (I'll pay it) but since the Guardian Angel support was already paid that will be continued with no additional fee. They want to set up an appointment to discuss how to offload or keep the old charts available to the retiring NP.

I guess I am missing something, can the NP not just log into AC and see the charts?
Are you changing business names?

When my old partner retired the new person came in and just logged in as a NP for the business group and took over her charts. When the new person decided to leave the clinic, I still have access to all charts that she or the retired partner had in the clinic's Amazing charts.

I am confused as well. Do you have one AC database now? And will continue to have only one? And all you are doing is switching out one NP for another?

This should just be a matter of adding a user and deleting the old one. I don't see why there should be any cost at all.

Do your NP's prescribe?

Do you have one AC database now? And will continue to have only one? And all you are doing is switching out one NP for another?
YES, only one data base for the clinic, yes will only have one and add users as needed. Yes, just retired (inactivated)NP1 and added NP2 so that she could see pts and chart with her own name and numbers.

I don't see why there should be any cost at all. Each Provider is a charge and has their own support/backup charge.


Do your NP's prescribe? Yes, I am an NP, run the practice and prescribe every day. I also only bill under my own numbers to avoid any issues with incident to billing. In Texas we have a collaborating physician so he does not see my pts, I work under my APRN license.

Sorry Chris... I think I understand your set up - you are good to go. :-)
I was asking about shrinkrap.

Sorry, I misread it as asking me, but hopefully it will still help shrinkrap! I only put in bold so the answers would stand out, not yelling!

I understand