I have to give the people at Biomedix a lot of credit - they really did their homework to produce an outstanding product. If you are looking for a podiatry-specific EHR with integrated billing, scheduling and inventory, TrakNet should be on your short list. This EHR product has all the bells and whistles and then some. The feature list is very comprehensive and contains most if not all of the features a podiatrist needs - and probably some that are not needed. Template creation appears fairly straightforward and the video tutorials on the TrakNet website are excellent. You will pay for this specificity and robustness and it is up to you to decide whether it is worth it. Sometimes when a program has too many features you can get caught up in trying to use them all. I call this the EHR/OCD complex and it can sneak up on you if you’re not careful. You find yourself clicking your mouse for every small detail associated with your practice. This can be good, but it also has drawbacks and for a solo practice might be overkill. The good part is that even though the program is feature-rich, you don’t necessarily have to use them all. If TrakNet is the first program you demo and you fall in love with it, you need look no further. Just be prepared for a price tag on the high side.
Here is a brief overview video of TrakNet EHR:
I am quite impressed by TrakNet EHR. The good news is that they are podiatry-specific, however that's also the bad news. When dealing with a vertical market such as podiatry, there is always the possibility of a company being swallowed-up by a larger company. When that happens, the smaller company's software is "retired" and the users forced to switch to the larger company's program. I have personal experience with this. Fortunately, I survived and you would too, so don't let this be a deterrent to your purchasing TrakNet, I'm just sayin' - Caveat Emptor.
Server-Based vs Web-Based
I'm going to leave you with two excellent videos produced by emrsimplyput.com. These videos provide a brief comparison of server-based vs web-based systems. They are quite limited in their scope and depth of material presented, but they do offer a nice comparison of both types of systems and are presented in an easily understood and visually appealing manner.
Pros and Cons of Server-Based EMR Systems
Pros and Cons of Web-Based EMR Systems
I also want to share a great video I found on Physician-Patient interaction and the use of computers. I'll let this video speak for itself...you should really watch it to the end, it's well worth it.
Coming up: more reviews, tips and info. Be sure to contact me either by leaving a comment here on the blog or email me at roger@podiatrysoftware.com.
The title of today's post is also the title to a fantastic Latin-Jazz tune by the incredible pianist Michel Camilo. If you want to forget about EHR, MU and podiatry for a few minutes and get lost in a virtuoso performance of Latin-Jazz, go HERE. The significance of the title is that I am going to take a look at Sam Notes EHR, which is part of the Sammy Systems software for podiatry developed by ICS Software LTD.
ICS Software has been in the software business since 1986. During that time they have remained under the same ownership and committed to podiatry. That’s a pretty good track record, and if you are currently a satisfied user of their practice management software Sammy, it just makes sense to go with their EHR product. In my opinion, any time you can stick with what works, you will be ahead of the game. If you are just starting out in the hunt for a podiatry specific EHR, then Sam Notes EHR certainly deserves investigating.
I will give you my impression of Sam Notes EHR, but in fairness, I have never used the program and I have not had a demo of the program. My experience is limited to what I’ve seen on their web site. Fortunately, the web site is quite informative. In addition to a video or two, there is a collection of PDF files for download which are quite helpful. These range from patient intake forms, to tips on getting claims paid. Their expertise in podiatry is a definite advantage over some other software vendors.
My impression of Sam Notes EHR from watching the above video is that it is lacking in the visual appeal department. The screens look outdated and the color scheme could use an overhaul. Of course looks aren’t everything and if the program does what you need it to do, then that may be all that is important. For me, if I’m going to be staring at screen everyday for hours on end, my preference leans toward a more modern look. I like buttons that look 3D, text boxes with drop-shadows, and soft color gradients filling up parts of the screen instead of just a boring solid color. It looks like Sam Notes EHR was made using the 16 color palette that heralds back to the pre-Windows days of MS-DOS. Again, a personal preference and not a requirement if the program functions the way you need it to function. I also notice that there is quite a bit of mouse clicking going on. This is actually an advantage if you are using a touch screen or a tablet computer with a stylus. I find it quicker to dictate using Dragon rather than doing all that clicking, and fortunately Sam Notes EHR will let you do that as well.
The feature list is impressive and the fact that they are tailored to podiatry is another plus in their column. The built-in fax server is a nice feature, and the “Sammy University” online resource is very good. In addition, I’ve heard other podiatrists speak highly of the program. My main gripe with Sam Notes EHR is the lack of modernization of the program screens. I think an updated look would be a step in the right direction to make this Sammy a virtuoso performer and increase the appeal of Sam Notes EHR dramatically. Be sure to check out the Sam Notes EHR website.
That concludes today's post. Future posts include a breakdown of some of my EHR implementation expenses, more on my EHR decision process, and a look at TrakNet EHR.
Let's get back to investigating and exploring some of the EHR's that are out there. I know it is a real jungle, and as I've said before, most programs do exactly the same thing. So how do you narrow down your choices? For me, a good place to start is to watch some videos of the program at work. What does the program look like? Is the layout appealing? Is the screen too cluttered? Are the icons too hard to decipher? How intuitive does the program look? Once you've answered these questions, you can decide whether the program warrants further investigation and perhaps a demo.
GE Wiz
The first program I'll look at in today's post is GE Centricity. To be honest, I really don't know much about this program other than what I've read online. I did not consider Centricity in my search, but that doesn't mean you should overlook it - it's probably a great program. Actually, it has a few things going for it right off the bat. It's put out by a huge company (GE) that is not going to vanish into thin air, it has a fairly large installed base of users, and it has been embraced by a number of hospitals. It comes in different flavors and the private practice version is likely to be quite different than the hospital version, but that's probably a good thing. I took a quick look at the video (shown below) and must say the layout looks very logical. Then again, I didn't really see anything in Centricity that is handled any better than all the other EHR programs. Once again, it comes down to those critical (deal-breaker) features you feel you must have and how easily the EHR can perform them. If you are offered a great deal on this program through your hospital, it's probably worth taking a look at it. I don't know about the practice management integration, that's something you'll have to look into yourself. Here is a short video of GE Centricity:
Since one of the goals of this blog is "audience participation", I urge any readers who are familiar with any of the products I have reviewed here (or even those I have not) to please take part in the discussion by leaving a comment below, or contacting me by email.
Sweet Program
The next program on my list is SuiteMed IMS. Wow - what a pretty program! Very visually appealing. Nice use of colors, decent screen layouts. Yeah, I could definitely like this program. I actually went so far as to have a one-hour online demo with a rep. This program can do just about everything except wash your car (and they may be working on that for the next update). Seriously, this is one very deep program that could easily fit into a busy podiatry practice. My dentist uses a version of this as does my ophthalmologist. So why didn't I choose it for my EHR? Well for one thing, all those pretty screens don't come cheap. This was one of the more expensive EHR programs I considered. The second reason - feature overload. This program has so many features, that for my solo practice I felt it was overkill. I know there are some of you out there that probably use this in your solo practice and love it. But I will wager that there are a whole lot of features you don't use. I just felt using this program would bring out too much OCD-type behavior in me. I also wasn't too thrilled with the nested clicking that is done to complete a note. But then again, to each their own - you may like to produce a note that way. I still think it is a really nice looking program and worth investigating. Here is one of many videos found on YouTube:
I have a few more programs I want to review here, including some that are podiatry-specific. So keep checking back, subscribe, comment and contact me with your questions. Together, we can get through this jungle without getting lost or eaten.
I said in my last post I was going to continue to review EHR programs - and I am, but first a quick diversion. One of my blog readers has asked a couple of good questions so I thought I'd answer them here instead of in an email as some of you may have the same or similar questions. The first question is:
"How did you set-up client machines?"
My EHR software runs off a Dell PowerEdge T310 Server. It has a Quad core Xenon processor with 8GB RAM and 1 TB of hard drive space in a RAID-5 configuration. I am running Windows Server 2008 R2 64 bit. This system meets or exceeds the requirements specified by my EHR company. Make sure you check with your EHR company for their requirements. Remember, the more powerful your server, the faster your entire system will run. I will get into other hardware specifics in a future post but suffice it to say, this machine is very nice.
I am running four hard-wired workstations using a gigabit ethernet switch and gigabit ethernet cards in each machine. I will go into more detail on the workstation configurations in a future post, but you can get a very nice workstation for under $600. At one station, I'm actually using a refurbished HP workstation that cost about $300. The four workstations are set-up like this: one workstation for my receptionist, one workstation for my biller, one for my nurse (just outside the treatment rooms in a private area we call the "lab") and one in my private office. I also have two laptops running wireless. One of these is a Fujitsu T580 convertible which allows me to use it as a tablet, (but I rarely do) and the other a Lenovo laptop. I have not yet wired systems into my three treatment rooms, as I prefer to carry the Toshiba with me from room to room. It is nice and small and works fine running on wireless-n. I use a Belkin wireless-n router with WPA security and it works great. I found a very nice and inexpensive cart to use in my treatment rooms for my Fujitsu convertible laptop:
I found it on eBay from the store HERE. I haven't seen it on his site lately, so if you are interested you should send him a message on eBay asking him about the Studio Designs Vision Mobile Desk/Laptop Glass Cart. It was under $100 including delivery. If you look at any of the "medical" laptop carts, they are as high as $700 - ridiculous.
Having been using my EHR for 1 year, I still am not comfortable using the laptop in front of a patient. I'm slowly changing, but for most patients, I still use a clipboard and paper to jot quick notes and then dictate my note into my EHR after the visit using Dragon. I have found it is quicker for me from a standpoint of patient flow and I am able to see more patients that way. I'm working on changing my work flow and may be singing a different tune by this time next year, we'll see. Therefore, at the present time I carry the Fujitsu T580 between the three treatment rooms. It's light and easy and works well for me. I also don't have to worry about kids banging on a keyboard or having to log-in and out of the EHR each time I go into a treatment room. As I become more comfortable with using the computer during a patient visit, I may decide to put a workstation in each room, we'll see.
Question #2:
"Have you gone to digital radiography and what system to you recommend?"
No, I have not gone to digital radiography, well I take that back, yes I have! It's not the digital radiography you think, but for me it works. I ran the numbers, and at the present time I can't justify the cost of a digital radiography system. I may change that in the next year or so, but I am happy with my current "digital" system. Here is what I do:
I take a regular x-ray and run it through my automatic processor. I can have bilateral AP and Oblique views out of my machine in under 5 minutes, which gives me just enough time to fit in a routine care, or follow-up visit while the patient who had the x-rays taken is catching-up on the latest gossip in this weeks People magazine. Then, either at the end of the day, or when I have a break, I put the x-rays on a view box in a darkened room and use my $120 Canon digital camera with macro feature, turn the flash off, and take pictures of the x-rays. I can then manipulate the images in the fantastic (and free) image editing program called Faststone Image Viewer and then I import them into my EHR. So now I have both a hard copy x-ray that I store in an x-ray folder in a file cabinet (films take-up very little space) and I have an image to view in the patients electronic chart. Here is a video showing how I uses Faststone to adjust x-rays and images and add them to my EHR:
Yes, I know there are advantages to a true digital x-ray system, and if money were no object I would have one. But for now, this just works and works more than adequately. Check back with me in a year or two and see if I've changed my mind. Another way to go digital (although more expensive and more work) is to purchase an Epson V700 USB scanner with 8 x 10 transparency adapter ($539 on Newegg.com) to scan your x-rays. It will only work with an 8 x 10 film and scanning takes much more time than taking a digital photo, but I'd thought I'd mention it as it is an option. Also, if you are concerned about Dicom compliance, you can convert your .jpg digital photos of the x-rays to Dicom format using a couple of different programs. The first one is free and can be found here: K-PACS Viewer. The second one will cost you about $189 and is available here: Power Dicom Basic Edition.
That's all for today's s post. I'll get back to reviewing EHR's soon. In the meantime, please feel free to ask me questions either as a comment here on the blog or by email at roger@podiatrysoftware.com. And thanks Andrew, for the great questions. ;-)
In this post I will examine some of the EHR programs I looked at but didn't choose. It’s difficult to get an idea of a program's capabilities in a one hour demo. That's why I've assembled a collection of videos and information below to help you get started with your own research. Then, if you are interested in a particular program, schedule a demo. If you like what you see after the demo, schedule a second demo. You might even consider a third demo for your top contenders.
I’ll let you in on a discovery I made - almost all of the EHR’s out there do exactly the same thing. It’s just that some of them handle certain tasks better than others. The key is to find which tasks are important to you and find the EHR that accomplishes those tasks the easiest. It might not even be a charting task, it might be related to the billing side. No single EHR will have all the features you want. Decide which features you must have (deal-breakers) and which ones you can live without.
Here is a short breakdown of some of the EHR programs I investigated before making my final decision. I have included some links to videos that can help give you a quick “peak under the hood” but you won’t have a real feel for a program until you get behind the wheel for a test drive.
1.Acrendo – I really like this program. I wanted so much to have this be my EHR. It has a great interface, user-friendly template creation, highly customizable options. Unfortunately, when I was ready to purchase it was not officially ONC-ATCB certified for meaningful use. The company told me it was expecting certification any day, but I had already delayed purchasing an EHR and did not want to wait any longer (it has since passed certification). The other big factor was the billing part of the program. It looked nice and had the best electronic superbill of any other program, but I was concerned that my billing person would have problems adapting to a radically different program. The last thing I needed was a pile-up of unbilled claims. One more thing concerned me – my online demo was conducted by the owner of the company (who also authored the program). This was fine, but I was worried that a company this “small” might not survive if and when a shake-up occurs in the EHR industry. Granted, Acrendo has been around for quite a while and I may be totally off-base with this - and it might just have been that everyone else was too busy to give me a demo - but somewhere in the back of my mind I think it entered into my decision making. I still think this is an excellent program with great potential and should be investigated by any Podiatrist looking for a reasonably-priced and full-featured EHR. Here is a video showing the EHR in action. This was done in November 2010 so I’m sure it’s been updated but this will give you an idea of the what it looks like:
2.Allscripts MyWay – One of the big players in the EHR industry. My hospital was offering a price break to use this EHR. As with all EHR's that charge by the month, it's a bit on the costly side when you look at long-term. The EHR uses lots of clicking and nested items. Overall a very nice feature set and appealing layout and design. I wasn’t thrilled with some of the small cryptic icons, but I imagine it just takes time to get used to them and their functions. Integrated billing and adaptive learning are two very nice features. Drawbacks for me were web-based – I really wanted to keep my data in my office; and having to upload documents. Definitely a very nice EHR and worth checking out, it just didn’t seem to fit my workflow and didn’t quite feel right for me. It might be a good fit for you, that’s for you to decide. Here is one of many videos that you can find one YouTube:
3.Aprima – Basically the same as Allscripts MyWay. The Aprima rep told me that Aprima was about 2 versions ahead of Allscripts MyWay. You can view a demo below:
4.Amazing Charts – In my opinion, this program gives the most bang for the buck. A very full-featured EHR at an unheard of $1995 price. Nice use of the mouse right-click to access templates and fairly easy customization. The last time I checked, you could download a fully working version and try it out (you are only limited by how many patients you can add in the trial version). I gave this EHR software a test drive and I liked it. It “compartmentalizes” each section of your note which I wasn’t thrilled about, but many of the EHR’s work this way. My main reason for not choosing this was it did not have a seamless integration with a billing component (although I heard one was in the making). If this program does develop an integrated billing section, it might be a real winner in my book. You can watch a video of this EHR in action below:
5.eClinicalworks – Another big player and popular with some of the Primary care groups and hospitals around me. This appears to have a very large installed base of users. Even Costco is selling it. I wanted to try and like this program but for me the screens were just too busy. This also has some cryptic icons that probably take some time to get used to. I probably didn’t give this as much time as I should have, but it just didn’t feel right from the start, and for me, first impressions are important. The inkable forms feature looks nice and as with most EHR’s, you can use Dragon. You can watch a video of eClinicalworks in use below:
6.eMD’s – A very full-featured complete EHR with integrated billing program. The website is quite informative with loads of screenshots, which is nice as a lot of these EHR vendors guard their screens like they were military secrets. I didn’t give this EHR much of a chance and didn’t actually get a demo of it. It probably is worth taking a look at. Fortunately, one of my blog readers Dr. Marc Garfield has taken the time to contribute a very nice video showing him creating a progress note in e-MD's for a heel pain patient. As I've mentioned before, this blog will be a great benefit to our colleagues if we all contribute. If you have anything to add about any of the programs here (or others) please add a comment at the end of this post or contact me by email. If you need help in creating a video demo of your EHR let me know and I will help. Although this video does not contain narration, you can get a pretty good idea of what it takes to create a progress note. The program appears to be very customizable. As with many of the EHR's reviewed on this site, there appears to be a lot of nested pop-up windows and quite a bit of clicking involved. One nice thing is that it puts all of those clickable answers into a nice readable format in the final note. I was impressed with e-MD's the first time I saw it. After watching this video, I continue to be impressed.
For more information, check out the e-MD's web site here: eMD's Web Site Here is another demo showing e-MD's in action:
7.Greenway PrimeSuite – Another entry in the SAAS or ASP model of EHR delivery. I didn’t get a chance to check this out and since I didn’t really want a web-based program, I didn’t bother with a demo. It appears to be a very robust program and worth a demo. There is a demo showing it in use here: Greenway PrimeSuite Demo Be sure to click on the far right of the title bar where it says ehr/pmdemo to view the program in action.
8.MDSuite – not to be confused with e-MD’s this is also a full-featured and robust EHR complete with integrated billing. If I remember correctly, it was a little pricey, but it might be worth it if you like it. I was getting a little burned-out and by the time I had the online demo, it became a blur among all the other demos I had. I didn’t really give this much of a chance, but don’t let that stop you just because I didn’t pick it. It really does have nice features and I am sure performs more than adequately. You can check out their web site for more information at: http://www.mdsuite.com/ Here is a short demo below:
In my next post, I will cover a few more programs including SuiteMed IMS and TrakNet EHR.
So how did I make my final decision and what factors influenced my choice in purchasing an EHR? First, I found it beneficial to find out exactly why I wanted an EHR. I decided to make a list and here is what I came up with:
Why use an EHR?
1. Government incentive 2. Increase efficiency 3. Eliminate missed billings 4. Increased (better) documentation ===> better reimbursement 5. Less Paper ====> Paperless 6. Ease of documentation - less time on dictation - leave office earlier 7. Better patient care. 8. Make things easier, run smoother. Less time tracking down charts.
The following tasks to be eliminated: 1. Preparing paper chart folders for new patients 2. Pulling charts for former patients 3. Adding stickers to charts (date, allergy, medical alerts) 4. Printing out dictation and sticking in charts 5. Re-filing charts 6. Entering charges using superbills
Now that I know why I want an EHR, it's time to investigate. First, I did a significant amount of online research. I am a very visual person and I wanted to see what each EHR program looked like. Unfortunately, many companies do not provide screen shots or videos of their programs unless you fill out a contact form which gives them permission to continually hound you with sales calls and emails. As a side note - I am trying to change the lack of available online visual material with this blog and am contributing as many videos and screen shots as possible showing different EHR's at work and am encouraging my readers to contact me so I can help them create their own videos of their EHR.
Of course some companies do have videos online and a quick search of YouTube.com and Vimeo.com using the EHR's name is a good start. Also, using Google and clicking on "Images" on the left side of the browser will take you directly to some of the available screen shots.
After completing my online research, I narrowed my selections and made direct contact with companies to provide me with an online demo of their product. In an upcoming post I will discuss the pitfalls of doing an online demo as well as what to ask the rep doing the demo, but for now I'll just concentrate on the process I used. But before I do, let me tell you about...
Practice Fusion
I actually used Practice Fusion for my ePrescribing while I was still using paper charts. It was free, easy to use, and helped me meet the Medicare ePrescribe requirements to avoid penalties. I tried the EHR but found it too limiting for my use. If your charting needs are simple, you may be good to go. By all means you might as well try it, after all it's free. But for me, I just couldn't get past the limitations. In addition, I like to take a lot of clinical photos and incorporate them into my charting and Practice Fusion just didn't make this easy enough for me. I also wasn't thrilled about having to upload every photo I took or every document I scanned. So that is why you don't see Practice Fusion in the spreadsheet below, but I certainly gave it a good look and a trial as should you.
The Spreadsheet
I built two different spreadsheets. The first, a cost analysis and the second a breakdown of pro’s and con’s of various systems.
Spreadsheet #1 - Cost
For the spreadsheets, I narrowed my EHR choices down to six different programs. This was down from my initial search in which I chose 10 to investigate further and then narrowed it down to eight serious contenders. From those eight, I cut it down to six, deciding one was just too high-priced and another was just too complicated (the screens were very complex and just way too much going on in the program for my needs).
In the following spreadsheet, I examine the costs of four web-based systems and two that use in-office servers. This is a cost breakdown based on figures and quotes directly from the company reps. These costs included software and training costs for the web-based systems and includes software, training and hardware costs for the server-based systems only. (The web-based system costs assume no new hardware will be purchased). One note: the server-based figures do not reflect the fact that the server will need periodic replacing (or upgrading) which would add about another $2500 to the cost every 5 years or so. As it turned out, I was able to negotiate a significantly much better deal for software and training then I was given initially, but these figures would give me a fairly good idea as to the cost. I felt it was important for me to look not only at the initial cost, but also to calculate total cost after 5, 7 and 10 years. This would allow me to get a feel for how the EHR would impact me financially. While this should not be the main factor in choosing an EHR, it should be given careful consideration as should anything that will affect your bottom line. Here is what my spreadsheet looked like:
As you can see, while the initial cost for a web-based system is low, the long-term costs are quite high. This, along with the second spreadsheet (coming-up in a future post ) helped me make my decision.
I mentioned in my first post that I was going to jump around quite a bit in this blog in order to allow both current EHR users and future EHR users benefit. Today's post will take a look at how the progress note is created in the EHR I am currently using in my practice. As you will no doubt learn, no EHR is perfect and the one I am using is far from it. One must learn to retrain oneself in order to accommodate for the inadequacies associated with whatever EHR you choose. I will go more into detail about specific EHR's and why I chose the one I did in future posts. I will also discuss the various demos and some of the pitfalls to avoid during an EHR demo. However, in this post I wanted to provide a quick overview of one method of creating a progress note - as this really gets down to the nuts and bolts of using an EHR. Remember, I am not providing this information to get you to use the EHR I use. In fact, I would prefer that you don't pick the one I use because then you won't blame me when you get to the "hate" part of the love-hate relationship with your EHR that inevitably develops along the way (you'll see what I mean in a future post).
To start with, any EHR you choose will have some templates available, but I can guarantee that you will need to customize these to your own liking. In fact, many times I will use only a very basic skeleton template and most of my chart note will be dictated using Dragon NaturallySpeaking. I prefer this for many of my notes as this is the method I am accustomed to using, having been a Dragon user for over 10 years. Dictating with Dragon also makes the note easier for me to read on subsequent visits as well as being able to provide a narrative rather than a series of yes and no answers. Each person will have to decide on what works best for them and much of it is trial and error. I have found a combination of Dragon dictation and templates works the best for me. As you will most likely need some templates, here is a link that can help give you some ideas in creating templates Example Templates. Some of the examples are not very good, but I've found the ROS Template useful. In a future post, I will provide a link to download some of the exact templates I use. I would also love to have some readers contribute to this collection as well (hint, hint).
In this demonstration I'm going to show one method of creating a progress note using only a template and no dictation. Almost all EHR's will work in a similar manner providing clickable options as well as pop-up pick lists. What the demos don't usually show is what is involved in creating the clickable options and the pick lists. This can range from a simple editing process to a very complex series of steps. Was the template I used in this EHR easy to make? No. It took several hours to generate the pick-lists and clickable items. Unfortunately, the EHR I use leans more towards the complex side of template development. I have learned to live with this inconvenience and made this compromise in order to achieve several other benefits of the program which I will discuss in one of my next posts where I explain the logic I used in choosing my current EHR. This is all part of weighing the pros and con's of choosing one EHR over another. Am I going to stay with this EHR? Yes, for the time-being. It works fairly well and has many nice features. It also has some attributes that frustrate the heck out of me. I will go more in-depth in a future post about why I love this EHR and why I hate it.
The first video shows a basic ingrown toenail template and its use. As with most EHR programs various data is pulled from other parts of the electronic chart such as vital signs, current medications and allergies, past medical history, etc. and inserted into the current progress note. Some programs may look easier to use than others but it usually has to do with the person doing the demonstration having familiarity with the program. I don't think there is such a thing as the "easiest to use" EHR. They all take effort on the part of the practitioner to learn how to best utilize the strengths and weaknesses inherent to that particular EHR.
This second video is a very brief demonstration of how an image template can be used for examination in diabetic peripheral neuropathy.
As always I welcome your comments, questions and suggestions - let me know what you want to see in these posts.
Upcoming posts include "Show Me The Numbers - How much Did My EHR Cost" and "Where's The Logic - How Did I make My Decision"
Be sure to read my first post below (scroll down) if you missed it.
