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

Let's Peek Under The Hood

The Ones That Didn’t Make The Cut – Part 1

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.

Show Me What You've Got

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.