burnpac Posted May 1, 2012 Share Posted May 1, 2012 My surgeon and I have recently started using DrChronos (DrChronos.com) as the EHR for our plastic and reconstructive surgery practice. We are both glad that we waited until now to take the leap, as the technology and software is finally robust enough to really live up to the expectation of an EHR that facilitates and doesn't hinder the administrative work of seeing patients. This EHR is iPad based and fully in the cloud, with a web-based element that is accessed through a browser. There is no need to have physical, hard copy records. It is infinitely customizable through the web interface. Our experience has been very good over the past four weeks, but we are a small, surgery based practice. There is built in medical grade dictation, faxing reports / records directly from the iPad, eRx, and a host of other easy to use functions. I use it on the go in the practice, pre-op and PACU daily. You can see it in action on their website and on apple.com on the business section. I'm interested in hearing other PAs' experiences with EHRs. Link to comment Share on other sites More sharing options...
Joelseff Posted May 2, 2012 Share Posted May 2, 2012 I am at a brand new practice and we are looking for a long term EHR. We are currently using Practice Fusion which is not too bad but not too good either. For example: The billing function/Superbill pulls up weird ICD9s when you search like today, tried to look up Laceration repair and it pulled up all the Perineal Lacerations but no simple laceraion ICD 9 and it would not pull up Suture removal. I think it relies on Kareo for the full fxn of billing. We are using Practice Fusion in the interim while we shop EHRs. We have looked at Allscripts Myway, Greenway, Amazing Charts, MediTab, and NextGen. Allscripts just made some news and it seems they are having CEO problems. We are also trying to look at Cloud based vs Server based or if server based, at least one that doesn't require the USS Enterprise's resident computer to run sufficiently. Greenway looked good until their IT guy told me that "it is notorious for hanging up when you try to print wirelessly to a printer..." nuff said. It really is a tough choice. We kind of are in a rush so we can abstract in our patients and their paper records but don't want to make a hasty decision.... Thanks Steve for the heads up on Dr.Chrono we'll throw it in the list! Cheers. Joe Link to comment Share on other sites More sharing options...
LESH Posted May 2, 2012 Share Posted May 2, 2012 Steve We are trying to figure out how to get EHR training in the didactic year. It has been an interesting experience as well. Link to comment Share on other sites More sharing options...
burnpac Posted May 2, 2012 Author Share Posted May 2, 2012 Thanks Steve for the heads up on Dr.Chrono we'll throw it in the list! Cheers. Joe Another surgical group uses practice fusion, and from what I can see, I'm not impressed because you can't use it on devices. DrChronos is written for the iPad. Link to comment Share on other sites More sharing options...
physasst Posted May 2, 2012 Share Posted May 2, 2012 We have almost ZERO paper in our processes, but it also results in a complex EHR system. I was on an institutional task force a few years ago when we were selecting a new EMR for the ED, and the process was, shall we say...enlightening. We use QReads for images, Synthesis for charting in the clinic, ChartPlus for charting in the OR, Pulsecheck for charting in the ED, and MICS Last Word for orders, prescriptions, labs, allergies, etc. There are other systems as well, but it is often overwhelming for someone just coming here. After a few months though, it seems like second nature. Link to comment Share on other sites More sharing options...
jmj11 Posted May 2, 2012 Share Posted May 2, 2012 Another surgical group uses practice fusion, and from what I can see, I'm not impressed because you can't use it on devices. DrChronos is written for the iPad. The main advantage with Practice Fusion . . . well, its free. For a new start up, it has been a godsend. I had to rewrite the format to all our clinical notes as well as our fax report service (the one with PF is terrible). I had to buy a separate billing and scheduling program (Kareo). At this point PF will only work on Android tablets IF the tablet is networked with a PC. They hope to make it tablet friendly in the future. So, as we work down our "Maslow's Hierarchy of Needs" we will eventually replace PF . . . unless they have evolved to a better product by then. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted May 2, 2012 Moderator Share Posted May 2, 2012 Our hospital system recently went with Cerner, which I tend to like- the latest version allows to do a completely free-text EMR if you choose, or do all "clicking" of what you find. I miss being able to draw pictures, as the method it employs for putting pictures on the record is exactly like MS Paint. The order system is only a major issue when you have complex drips (results in a battle with the pharmacy back and forth as to what you can and can't order on the system). At first we had a lot of trouble getting to medications during truly emergent situations/codes (the Pyxis that is used is also from Cerner, and is linked directly into the system), but we have fixed it so that the nurses can override it if necessary. The only thing I don't like is that the ER is completely EMR, while the floors are still doing H&P's/consults on paper- and I dream of a time when I can read prior H&P's and especiallyconsults perfectly legibly. I've seen a medicine resident testing out a version on his iPad, so I'm sure we will be rolling that out at some point, but I'll never carry an iPad around our ER. Just common sense. Link to comment Share on other sites More sharing options...
burnpac Posted May 2, 2012 Author Share Posted May 2, 2012 Our hospital system recently went with Cerner, which I tend to like- the latest version allows to do a completely free-text EMR if you choose, or do all "clicking" of what you find. I miss being able to draw pictures, as the method it employs for putting pictures on the record is exactly like MS Paint. The order system is only a major issue when you have complex drips (results in a battle with the pharmacy back and forth as to what you can and can't order on the system). At first we had a lot of trouble getting to medications during truly emergent situations/codes (the Pyxis that is used is also from Cerner, and is linked directly into the system), but we have fixed it so that the nurses can override it if necessary. The only thing I don't like is that the ER is completely EMR, while the floors are still doing H&P's/consults on paper- and I dream of a time when I can read prior H&P's and especiallyconsults perfectly legibly. I've seen a medicine resident testing out a version on his iPad, so I'm sure we will be rolling that out at some point, but I'll never carry an iPad around our ER. Just common sense. We use Cerner at our hospital too, and I'm running it on Citrix Receiver on the iPad and iPhone. I do use it for rounding as I have multiple templates for surgical visits that I have developed (we do the same things at the same time in our postoperative course) with many wound care macros so I can chart with almost no typing in most situations. Cerner is still clunky on an iPad because is is still just windows crammed down. Link to comment Share on other sites More sharing options...
Joelseff Posted May 2, 2012 Share Posted May 2, 2012 I think Cerner and Epic are geared for larger facilities and hospitals vs solo practices. For one they're expensive. I used both at Stanford Hospital and lucille Packard during my hospital rotations at Stanford. They were very text heavy and not what I would want at my practice but were very stable. I like the clicking for globally nl exams. Saves time and my CTS from flaring up. Also the other ehrs pretty much have the draw fxn. I'll let u guys know about allscripts and greenway once they demo it for us. Anyone try amazing charts? Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 2, 2012 Moderator Share Posted May 2, 2012 The only emr I like is elctronic t-system. have used several others. epic is the worst. it doubles the amt of time spent on a pt encounter. meditech and cerner(at least the older verions) are too involved for reasobale real time ordering and charting. exitcare is nice for discharges only and I use this at my rural job and dictate the charts themselves. Link to comment Share on other sites More sharing options...
burnpac Posted May 3, 2012 Author Share Posted May 3, 2012 The main advantage with Practice Fusion . . . well, its free. For a new start up, it has been a godsend. I had to rewrite the format to all our clinical notes as well as our fax report service (the one with PF is terrible). I had to buy a separate billing and scheduling program (Kareo). At this point PF will only work on Android tablets IF the tablet is networked with a PC. They hope to make it tablet friendly in the future. So, as we work down our "Maslow's Hierarchy of Needs" we will eventually replace PF . . . unless they have evolved to a better product by then. I hear you. DrChronos is by the month with multiple tiers of pricing, per clinician, with a 25% discount for groups. We are at the second level now so that we have dictation and faxing. i love that I can see a patient in consult, generate a beautiful H and P with full surgical orders, and fax it to pre admission testing, before the patient leaves the office. We do a lot of workers' comp, and our referral sources love that they have our consult and followup notes faxed to them the day of service. When we have a new patient that is an inpatient, I can generate a new record on the fly in the House, schedule them for followup, and know that they are going to get automatic e-mails and SMS text messages about when and were to followup with us outpatient. It has dramatically cut down on the number of administrative phone calls we get. Patients can even reschedule their own appointments online if you extend that access to them. So far, what we are paying is worth the price in making us look and feel more professional, and in providing better service to our patients and referral sources. BTW, it also give me, brandon, and our staff a much better QOL! Link to comment Share on other sites More sharing options...
jmj11 Posted May 3, 2012 Share Posted May 3, 2012 I hear you. DrChronos is by the month with multiple tiers of pricing, per clinician, with a 25% discount for groups. We are at the second level now so that we have dictation and faxing. i love that I can see a patient in consult, generate a beautiful H and P with full surgical orders, and fax it to pre admission testing, before the patient leaves the office. We do a lot of workers' comp, and our referral sources love that they have our consult and followup notes faxed to them the day of service. When we have a new patient that is an inpatient, I can generate a new record on the fly in the House, schedule them for followup, and know that they are going to get automatic e-mails and SMS text messages about when and were to followup with us outpatient. It has dramatically cut down on the number of administrative phone calls we get. Patients can even reschedule their own appointments online if you extend that access to them. So far, what we are paying is worth the price in making us look and feel more professional, and in providing better service to our patients and referral sources. BTW, it also give me, brandon, and our staff a much better QOL! One of the problems with the pricing structures for us, is that I see 95-98% of the patients, my SP works 1-2 days per month. But because he is an MD, we must pay full price for him as if he was working daily. Now, this would be the ideal situation for the spirit of the EHR incentive bill (Hitech), because as a start up, we could certainly use the 44K to buy an excellent EHR. However, because the way the bill was written, our incentive check was only $1500, because the payment was based on medicare patients seen by the MD only as I, because I'm a PA, become invisible at that point. If you look at the work it took for attestation, I think we earned about 50 cents per hour for the EHR money. I have been able to take the free PF software and integrate it with MS word plus (oddly) our Brother Copy.Printer,Fax software so I can send decent looking consult notes immediately back to the referring provider while the patient is still in front of me. But that took a lot of work to make PF better. I also had to delete all of their off the shelf templates and notes and create about 20 new documents based on our practice that have toggles and drop-down menus so I can document the note as the patient speaks. I know the better programs, such as yours, came that way. Link to comment Share on other sites More sharing options...
burnpac Posted May 3, 2012 Author Share Posted May 3, 2012 One of the problems with the pricing structures for us, is that I see 95-98% of the patients, my SP works 1-2 days per month. But because he is an MD, we must pay full price for him as if he was working daily. Now, this would be the ideal situation for the spirit of the EHR incentive bill (Hitech), because as a start up, we could certainly use the 44K to buy an excellent EHR. However, because the way the bill was written, our incentive check was only $1500, because the payment was based on medicare patients seen by the MD only as I, because I'm a PA, become invisible at that point. If you look at the work it took for attestation, I think we earned about 50 cents per hour for the EHR money. I understand how frustrating the incentives are and it is not fair. You can be on a paid plan, and the physician can be on the free plan. He or She just won't have access to the higher level features, nor will you be able to be considered a "group" combining the records. However, when you factor in the billing, and ease of use, it may be best to consider the whole package as a cost of doing business that is cost effective from a work flow, revenue generating, and QOL standpoint. These are business decisions that we all have to make individually based on our individual practice needs. Link to comment Share on other sites More sharing options...
medic25 Posted May 3, 2012 Share Posted May 3, 2012 The only emr I like is elctronic t-system. have used several others. epic is the worst. it doubles the amt of time spent on a pt encounter. meditech and cerner(at least the older verions) are too involved for reasobale real time ordering and charting. exitcare is nice for discharges only and I use this at my rural job and dictate the charts themselves. You are really making me look forward to our transition to Epic next year :) Has anybody had a good experience with it in the ED setting? Link to comment Share on other sites More sharing options...
SCHMITTIE120 Posted May 3, 2012 Share Posted May 3, 2012 You are really making me look forward to our transition to Epic next year :)Has anybody had a good experience with it in the ED setting? Keep in mind this is from a student but I loved Epic compared to the other EMR crap that I have had to deal with. I was able to log the entire visit from history, physical, ordering labs and coding the diagnosis very easily and quickly. I have only used it in inpatient and office settings though. Link to comment Share on other sites More sharing options...
jmj11 Posted July 27, 2015 Share Posted July 27, 2015 To bring an old topic back from the dead . . . I'm looking into outsourcing our billing department and down-sizing our practice. Our present EHR/PMH will have to go if I do so because they require us to purchase their billing software. The package is about $1500/ month. I'm looking for a good, simple, modifiable EHR that has electronic prescriptions, patient portal but no billing that is less. I have test driven many. Anyone with experience with "Amazing Charts?" I will not go back to Practice Fusion because it is one size fits all and they put ads on all your correspondences. Link to comment Share on other sites More sharing options...
RealityCheck Posted July 27, 2015 Share Posted July 27, 2015 Epic was written by Group Health in collaboration with Providence - based on what I was told. It is not THE worst EMR but certainly lacks intuition and customization properties for specialties. I learned on Centricity and have been sad to see it go by the wayside - it really was pretty nice. ALLSCRIPTS IS THE WORST PROGRAM EVER WRITTEN - EVER IN HISTORY, I SWEAR. I hate Allscripts in any form - Mysys, pro, whatever ludicrous name they give it. They are based in NC but outsource to India for customer service. You have to buy customer service after forking over for the program itself. It is heinous and horrible. I would actually NEVER take another job that uses Allscripts just based on the misery it caused me while I had to use it. Remember, that 99% of EMRs were written by billers, coders and meaningful use people - not by anyone that actually uses it or understands the flow of a patient through a clinic. My main caveat is - NEVER compromise on notation, detail and appropriateness for the patient. CLICKS do not equal good medicine. Tell the story - paint the picture - do right by the patient. 25 yr PA been there, done that Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted July 27, 2015 Share Posted July 27, 2015 Best EMR is the one that allows for dictation or just free typing the note. Submitting Rx and billing codes electronically is ok by me. Always liked T-Systems paper version and digital is close to that. Sent from my iPad using Tapatalk Link to comment Share on other sites More sharing options...
jmj11 Posted July 27, 2015 Share Posted July 27, 2015 Best EMR is the one that allows for dictation or just free typing the note. Submitting Rx and billing codes electronically is ok by me. Always liked T-Systems paper version and digital is close to that. Sent T-Systems appears to be ED-specific, correct? Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted July 27, 2015 Share Posted July 27, 2015 It was established by local ED physicians but as they were coming out with digital version they were starting to branch out to FM. Docs sold company shortly after they went digital as I recall. Sent from my iPad using Tapatalk Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 27, 2015 Moderator Share Posted July 27, 2015 we go from paper to epic next week. there is a pool regarding wait times and left without being seens #s. most bets are around 6 hr waits and 30+ lwbs/shift. this will burn down an already overburdened system. I have been seeing 30+ pts in a 12 hr shift. no way that happens on an emr. I can see 6/hr on paper if we get a rush and max 3/hr on epic(after 15 yrs experience with the system elsewhere). Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 27, 2015 Moderator Share Posted July 27, 2015 T-Systems appears to be ED-specific, correct? yes Link to comment Share on other sites More sharing options...
Evolute Posted July 28, 2015 Share Posted July 28, 2015 I currently work in 2 ED's. At one I use Next Gen.. the absolute worst program ever written. not customizable, not user friendly at all. the only way they could make it less user friendly would be to have us chisel onto a stone tablet. At the other ED we use Epic. It does have a steep learning curve, but is very customizable. I disagree with EMED (after the learning period) it doesn't slow down pt encounters for me at all. I have made/borrowed templates. If you use the templates (that you can make and customize yourself) it speeds things up. the other nice thing about epic is that information crosses over from the inpt and clinic side so you have that information available within the ED context. E, I feel your pain. when we "went live" with epic in 2013. admin. stated all clinics (3 total) would schedule one pt/hour b/c they knew the new EHR would slow things. I asked the CEO if the ED providers would get extra help b/c we cannot "schedule" one pt/hour. I was told the ED providers would just "need to work through it". E, if you are interested pm me and I can try to send you some of my templates, I think it would speed things up for you. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted July 28, 2015 Moderator Share Posted July 28, 2015 Epic was written by Group Health in collaboration with Providence - based on what I was told. It is not THE worst EMR but certainly lacks intuition and customization properties for specialties. I learned on Centricity and have been sad to see it go by the wayside - it really was pretty nice. ALLSCRIPTS IS THE WORST PROGRAM EVER WRITTEN - EVER IN HISTORY, I SWEAR. I hate Allscripts in any form - Mysys, pro, whatever ludicrous name they give it. They are based in NC but outsource to India for customer service. You have to buy customer service after forking over for the program itself. It is heinous and horrible. I would actually NEVER take another job that uses Allscripts just based on the misery it caused me while I had to use it. Remember, that 99% of EMRs were written by billers, coders and meaningful use people - not by anyone that actually uses it or understands the flow of a patient through a clinic. My main caveat is - NEVER compromise on notation, detail and appropriateness for the patient. CLICKS do not equal good medicine. Tell the story - paint the picture - do right by the patient. 25 yr PA been there, done that I cannot agree more- this "Allscripts" system is atrocious. My hospital uses MedHost in the ER which I can deal with, but to look up stuff on the inpatient side it's through Allscripts- and it's eye-gougingly difficult to navigate. I cannot imagine having to use that as my main EMR to chart on. As an aside....I started using Epic when picking up some locums positions in other parts of the state. Know what? I LOVE it. I'm faster on it than MedHost, and it's much more customizable and user-friendly than Cerner (Cerner is a totally stripped-down version of Epic), and all inpatient, outpatient and ED records are all in one place and easily accessible. It's almost my dream EMR, to be honest. Sorry E- I'm a fan, and I can't wait until my main hospital dumps MedHost/Allscripts and goes to Epic Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 28, 2015 Moderator Share Posted July 28, 2015 I use dot phrases, but not macos. I think indiscriminate use of macros leads to a lot of false charting. and that opens you up to liability.... Link to comment Share on other sites More sharing options...
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