View Your EHR on Your Android Phone

I just logged into my EHR and viewed some charts, checked my schedule, and sent myself a reminder message all from my mobile phone. It was very cool and can be done by anyone using practically any EHR. Of course the usability will depend on your phones screen size, but with everything getting bigger and by using "pinch and zoom" I found it to be quite functional. I used a couple of freely available programs for this and it only involved a few simple steps. I am using an Android phone, but I have heard this will work for an iPhone as well, I am not familiar with the apple iOS so you will have to investigate yourself to find the compatible app for your iPhone.

First, I downloaded TightVNC - a free, lightweight, fast and reliable remote control/remote desktop software and installed this onto my desktop computer. Then I made sure to open up port 5900 on my firewall. Installation of TightVNC is very quick and easy. It can run as a service so it will automatically start when your computer starts, and you can set a password to prevent unauthorized logging in to your system.

Next, I installed Remote Ripple from the Google Play Store onto my Android phone. Then, I entered my desktop computer's IP address (just type "What Is My IP" into Google and you will get it) into Remote Ripple, signed-in with my password and - voilà - connected!

I can do this whether or not my phone is connected to WiFi or not, so I can access my PC anywhere my phone works. It runs very nicely on the 4G mobile network. So not only can I access my EHR, but I also have full access to any file or program on my desktop. Here is a screenshot of my EHR running on my desktop computer as viewed on my Android phone in landscape orientation:

Some Helpful Tools

Every once in a while I like to point out to my fellow EHR users (and future users) a few helpful tools that I use in addition to my EHR software that enhance my medical record keeping. Usually, these are very reasonably-priced programs that perform a specific task that fills a void or completes a task that my current EHR cannot. While the use of said software may take an extra minute or two, the function that is performed increases the level of patient care and generally makes my life a little easier in the long run.

The first product I would like to suggest is called A-PDF Merger from A-PDF.com. This little gem provides a very quick and easy method of combining multiple files into a single PDF. I find this particularly useful for clinical photos. Often, I will have multiple photos of a clinical condition that I would like to be able to see at the same time. With A-PDF Merge, I can combine the multiple .jpg photos into a single PDF that I can view with a single click of the mouse. Many EHR programs will allow you to embed a link to a document in a chart note. By merging the individual clinical photos into a single PDF only one link needs to be embedded. This is definitely a time-saver for me and enhances the functionality of my EHR.

The file downloads and installs quickly and the program works beautifully. In addition to combining .jpg's it can also be used to combine multiple PDF's into one single PDF; combine multiple scanned images or documents (.tif, .bmp, .png and a host of others); and even append pages to existing PDF files. You can download a fully functional trial version from their website that is only limited in that it puts a watermark on the output file. The program can be found here: A-PDF Merger and here is a screenshot from their website:

The next program I would like to suggest, is useful for those of us who need to measure angles on our computer screen. I've already mentioned in a previous blog post that I couldn't justify the expense of a digital radiography unit and therefore I take a digital picture of an x-ray on my view box in a darkened room and import the image into my EHR. The program I use for angle measurements is called Screen Protractor. Although I have found a mediocre "freeware" tool for on-screen measurments, Screen Protractor is reasonably-priced and works exceptionally well. It places a floating, adjustable protractor on my computer screen that I use to measure all of my pre-operative x-rays and obtain measurments for pre-operative planning. It really works great, is a very useful tool and can be found here: Screen Protractor. You can download a trial version to see its usefullness first-hand, but the trial version is limited in the angles it will measure. There is both a Windows and Mac version available. Here is a screenshot from their website.

Lastly, I use a program called Snag-it to capture the X-ray with the protractor overlay. I also use Snag-it as my "go to" screen capture utility. Compared to some screen capture utilities (some are even free) it is a little pricey at just under $50, but I use it on a regular basis and can justify the cost. If you are looking for a less-expensive screen capture utility, you might want to check out ScreenHunter. They have a free version and also a more full-featured version for just under $20.

Do you have a favorite program that you use to enhance your practice? If so, I'd love to hear about it. Drop me an email or leave a comment below.

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

On Track For Success

Biomedix TrakNet

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.

And Sammy Walked In

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.

Back To The Hunt

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.

- Roger

A Quick Diversion

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. ;-)