The EHR Program That Tests My Sanity On A Daily Basis

First off, please don't take this post as an endorsement of the EHR program I use. Although I am very happy with my current EHR, I would prefer you don't use this blog post as a testimonial of its usefulness for you. Each practitioner must perform their own due diligence when it comes to choosing an EHR. Also, you won't blame me when you find out there are parts of the program that drive you nuts (as you are bound to discover no matter which program you choose). I am merely showing the logic I used to arrive at my decision to help you begin the thought process in choosing your own EHR.

LytecMD

First, a little bit about the program. This is a combination of two programs – Lytec Practice Management program and Practice Partner EHR. (This is also sold as Medisoft Clinical, which substitutes Medisoft for the Practice Management part of the program). Lytec PM has been around for a good 20 years which has allowed it time to develop into a very capable billing and scheduling program. The group that created Practice Partner EHR was established in 1983. That has given it plenty of time to mature and develop a very extensive feature set.  The depth of this program is quite significant which also means there is a bit more of a learning curve.  In addition, there has been some lack of updating.  This is most evident when it comes to navigating through the program which shows inconsistencies that can be quite frustrating.  For example, not all pop-up boxes can be navigated using the scroll wheel on the mouse and pressing the enter key over a highlighted item does not always produce the same results throughout the program. This inconsistency of behavior leads to wasted operator effort. Even though it is only a few seconds, it adds up over the course of the day.  But quirky functionality aside, this is a very capable EHR which will allow the user to accomplish just about anything they need to.  Just be prepared to work at it a little more than with some of the other programs I have discussed.  For example, template creation, while extremely customizable, can take considerable time and uses some conventions which if updated would save time and keystrokes. I actually am envious when I look at some of the other programs and see their modern look and feel as well as simplicity in developing templates. 

Why LytecMD?

So why would I go with a program that I felt was inferior to other programs?  For one, all programs are going to have inadequacies and it is up to each individual purchaser to decide which features are critical and which ones are dispensable.  Start by making a list of essential features and considerations. Then, narrow it down to items you feel are absolutely essential, maybe one or two at most,  and make these your “deal breakers”. In other words, without those one or two key features/considerations, that EHR is automatically eliminated from the hunt.

For me, considerations involved:

1.     Cost - certainly not the primary consideration, but a consideration nonetheless.  My plan was to qualify for the first stage of Meaningful Use and apply that amount to cover my complete hardware, software and training.  Therefore I set my budget at $18,000.

2.     Ease of use – all programs have a learning curve.  Since I was used to dictating all of my charts with Dragon and was already using shortcuts such as voice macros, I wanted to make sure that whatever program I chose for my EHR would allow me to continue this workflow.  At the very least, this would mean I did not have to change much of my style of charting. I would expect however, that the EHR would enhance my charting, making it more complete and take less time. This last statement, I found out, is a misconception. Yes, certain repetitive visits chart very quickly, but as I discovered, new patient visits and former patients with new problems can take quite a bit longer to chart. In addition, there are many ancillary items that must be charted in an EHR that take more time such as Computerized Physician Order Entry (CPOE) and entering current medications  - although the latter is made easier if the patient has an insurance plan participating in Surescripts as these are pulled in automatically.  

3.     Customization – how easily can the program be customized to my exact needs and requirements? This consideration is more important to a novice computer user, but I found out this will still be a source of frustration to an experienced user.

4.     Ease of transition for staff – as somewhat of a computer "guru", I felt it was more important for my staff to not have to deviate from what they were already accustomed to.  I knew I would have little difficulty in adjusting and accommodating to whichever EHR program I chose and therefore it was most important to me that the transition for my staff would be as easy as possible. (This was one of my deal breakers).

5.     Interface with billing program – Allowing me to enter within my progress note all of the necessary information that would then transfer directly into the billing side of the EHR was number one in my book as far as importance (my other deal breaker). This also would be a big step in going paperless as it avoids the use of a paper super bill.

6.     Stability of company - I wanted to make sure that I was dealing with a company who had a proven track record and financial stability.

7.     Layout and design - is the program attractive and graphically pleasing? Are there keyboard shortcuts to avoid multiple mouse clicks? Do I have to go through multiple nested menus or folders to find the information I want? I knew that all programs would take some time to become accustomed to, but a good design and layout can help to minimize this learning curve.

8.     Complete control over data - if by any chance I ever decided to switch to another EHR program, as long as I owned the program and the data resided on my computer I could always access the information.  This would not necessarily be true if I was subscribing to a web-based EHR.  For example if I discontinued my subscription how easy would it be for me to access my patient's records?  I did not want to be held hostage by any one particular program and therefore this freedom was an important part of my decision process. Cons: completely responsible for maintaining the hardware as well as backups. Pros: I would not be dependent on Internet connectivity or speed for performance and by performing my own backups and restores I was assured that I did in fact have a full and complete backup in place.

In the end, my choice for an EHR (LytecMD) came down to familiarity and ease of transition.  Since 1994 my office has been using Lytec Practice Management for scheduling and billing. My staff was very familiar with the Lytec part of the EHR program. Since my billing is done in-house this was a huge factor. Without having to learn a new scheduling or billing program, the transition from a paper chart to an EHR was relatively smooth. I closed the office for only 1 day for installation and training. There were a number of items in the negative column trying to sway me away from LytecMD, but each time I made an analysis the outcome was the same – if I wanted a relatively painless transition for my staff, LytecMD was the way to go. Notice how I did not include myself in that last sentence. I knew that the “MD” part of LytecMD was far from ideal and that there were other EHR programs that looked like they would be easier for me from a usability and clinical charting standpoint. In fact, if my staff were not happy and so at ease with Lytec, I am sure I would have chosen a different EHR. But I was willing to make the sacrifice and take the harder road to make it easier for my staff.  Making my staff happy has been an important part of enjoying a successful practice and is one of the reasons my employees have all been with me for 15+ years.

Back That Thing Up

I want to end this blog entry with a quick note about backups and the way I handle them. I felt it was so important that I had a complete and full working backup in place that I spent about $250 and purchased a used but very adequate Dell server from eBay.  I set this up at my home and then performed a full backup at the office and restored this onto the server at home.  It worked like a charm and for $250 I had an insurance policy and peace of mind against a catastrophic event such as fire, flood, theft, earthquake, etc. I also tested the daily backups that I performed onto a portable external hard drive by periodically restoring this onto my home server to make sure that the backups were valid.  The backup of all the EHR data takes less than five minutes at the end of the day.  I also subscribe to an online backup service which for $9.95 per month automatically backs up my server every evening at midnight and stores the information in the cloud. I have also tested this and performed a restore of the files from the online service.  The service I use is from iBackup.  As for external USB back-up drives, I recommend the Aegis Padlock USB 3.0 portable hard drive. This drive incorporates Military Grade hardware encryption as well as a keypad for PIN access. If this drive ever becomes lost or stolen, the data is completely safe. It looks pretty cool too:

That’s all for today’s entry. In the future I am going to give my complete cost breakdown for both hardware and software. I am also going to continue with my review of EHR products. Until then, please post a comment here or email me with your questions or information to help contribute to this knowledge base.

-         Roger