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ASP EMR & Connectivity Options

Andrew Eriksen — Thu, 26 Apr 2012 08:01:26 +0000

Are ASP-Model EHRs Ready for Prime Time?
As Web connections get faster and the technology improves, more vendors are delivering acceptable results.
By Ken Terry

As you consider how to finance an EHR, you may wonder whether you should have your software and data hosted on a remote computer server. That approach requires a smaller upfront investment than an in-house client/server network does. However, physicians who have used these application service provider (ASP) EHRs are divided over whether they deliver patient data fast and reliably enough to support top-notch care in a high-volume practice environment.

One physician reported that, even with a fast DSL connection to the Internet, “the waiting times after every click” in his ASP-model EHR “felt like torture.” So he switched to an in-office client/server system, which gave him much better performance. Another doctor was using a CCHIT-certified EHR that accessed the server over the Web. He had a fast, business-grade cable connection; yet, he wrote on a bulletin board for EHR users, “The application is very slow and at times is not even workable. I am always late on my appointments because of the slow speed of the system.”

Other physicians are very happy with the performance of their ASP-model EHRs. S. Hughes Melton, a family physician in Lebanon, Va., says that his e-MDs EHR loads Web pages in less than two seconds, except during periods when the vendor does upgrades. His practice has a fiber-optic connection, but its download speed is no faster than the cable link of the doctor with the “unworkable” EHR. Family practitioner Peter Forman, a soloist in Delmar, N.Y., uses a Verizon FiOS link, and the pages in his remotely-hosted Allscripts MyWay application load in less than a second.

Internet connections are getting much quicker and will soon be a non-issue for ASP-model EHRs, except in some rural areas where broadband is not yet available. However, several factors besides download speed can affect performance. Chief among them is the nature of the application you’re using. As we’ll see later, it’s important to know whether or not your EHR software was designed for the Web.

The other thing to bear in mind is that EHRs are still a work in progress, whether they reside on your own server or a remote machine. “The density of documentation and information that a physician has to navigate is the real barrier, rather than response time,” notes internist William Bria, president of the Association of Medical Directors of Information Systems (AMDIS).

Optimize your bandwidth

That said, your Internet connection is still critically important to your ability to access patient information. While Bria believes that most physicians are willing to tolerate download times of two seconds per screen, other experts note that doctors expect pages to be available as soon as they click on them. Depending on your connection and software, an ASP-model EHR may load a page in anywhere from one to four seconds.

So what kind of connection should you have if you want to improve performance? Dialup is way too slow, and you should also ignore residential versions of DSL and cable. But business-class DSL and cable connections, which come in multiple bandwidths, can be fast enough for an ASP-model EHR, several experts say.

Several factors affect speed. If you have DSL, for example, performance varies inversely with your distance from the local phone company hub. A DSL connection is effective up to about 10 miles from the central office.

The performance of cable modems is not affected by distance. But the available bandwidth drops as more computers, medical devices, and scanners use the connection, either within your practice or in the neighborhood. The same is true of DSL. So the advertised speeds of cable and DSL may be considerably higher than the actual data transfer rate.

Think of the bandwidth of shared connections like highway traffic. If it’s a two-lane highway, a certain amount of traffic will clog it up, and data will move slowly. A four-lane highway can accommodate more traffic before it slows down. But in either case, the speed of your connection is not under your control.

That’s the No. 1 reason why many practices get a T-1 line, both to access the Web and to connect their satellite offices. “On a dedicated pipe, there’s no one in that last mile but you,” notes Sheri Rose, a telecommunications expert and a partner in the Louisville, Ky., consulting firm Commonwealth Leverage. “If you’ve got a T-1, you’re guaranteed 1.5 megabits per second.”

Have a backup

Practices should have a backup system in case the Internet connection goes down, experts say. Consultant Michael Uretz, executive director of the Seattle-based EHR Group, recommends that practices get both DSL and cable connections, in case one is interrupted. If you have multiple links, you can add on a service like Ecessa, which provides “load balancing” to ensure that if one connection is overburdened, the load is shared with the other line.

Rose of Commonwealth Leverage points out that T-1 vendors are much more likely than cable or DSL vendors to provide you with “service-level agreements.” These contracts provide penalties if your uptime is not close to 100 percent, and they also promise very rapid repairs if there is a problem.

If you plan to have a wireless system in your office, make sure it’s business class. If your wireless connection is poor, says Bria, “you’ll have a nice fat pipe coming into your office, and you’ll never realize the benefit of it.” A top-of-the-line wireless setup, including the latest wireless cards for your laptops, a couple of transmitters, and a first-class router, will cost a small practice under $2,000.

Finally, the most efficient way to connect with an ASP server from multiple offices is to go through a router in one of the offices, says Uretz. If the network is set up properly, performance should not be affected.

While some physicians have reported problems using commercial cable links between offices, most practices don’t need T-1 lines to join their offices unless they’re connecting to a picture archiving and communication system or receiving radiology images. Mark Anderson, a consultant in Montgomery, Texas, and president of the AC Group, notes you don’t need a T-1 to scan old charts into an ASP-model EHR if you store the data on an office PC and upload it in batches overnight.

DSL and Cable Becoming Faster, Cheaper

Download and upload speeds for T-1 connections are always the same. In contrast, DSL and cable transfer data much faster downstream than upstream, which can be an issue if you’re scanning documents or sending large files.But that advantage is rapidly fading as high-end DSL and cable speeds increase. For example, Comcast now has an Internet Preferred Plan for $89.95 per month that offers16 Mb/sec. on downloads and 2 Mb/sec. on uploads. So its advertised upload speed is 25 percent faster than that of a T-1 line.

Soon Comcast will have a “deluxe” tier rated at 22 or 50 Mb/sec. downstream, and 5 or 10 Mb/sec. upstream.

DSL is also becoming very fast and cheap. Verizon offers a business-class DSL connection with a maximum connection speed of 7.1 Mb/sec. for $39.99 a month. Usually, business-class DSL starts at around $70 to $80 a month. Covad charges $149.95 for a DSL link that delivers up to 8 Mb/sec. downstream and 1 Mb/sec. upstream.
A T-1 line will cost you quite a bit more. Covad sells full T-1 lines for $389 a month, and fractional T-1s for $359 to $379 a month, after an installation charge of $1,599. Monthly T-1 charges can range up to $800 or even more, depending on what services come packaged with it.

For example, Atlanta South Gastroenterology, which includes two physicians in two offices and an ambulatory surgery center, pays $1,500 a month for a T-1 connection for its eClinicalWorks EHR and a 20-line phone system. Gastroenterologist David Martin says that the amount his practice is paying Cbeyond, an independent vendor, is “very competitive” with AT&T’s charges.

Family physician S. Hughes Melton’s practice also uses an independent provider, Bristol Virginia Utilities, for phone and Internet service. However, his practice is paying only $230 a month for fiber-optic cable that gives the practice 5 Mb/sec. downstream and 600 kB/sec. upstream. This is more than adequate for the practice’s e-MDs EHR, Melton says, although the practice does most of its scanning offsite and runs financial reports in the evening to avoid system overload.

Soloist Peter Forman says he gets 20 Mb/sec on downloads and 5 Mb/sec on uploads from his Verizon FiOS connection, and he’s paying between $100 and $200 per month. Current prices for Verizon FiOS, which is only available in some areas of the country, range up to $165.99 for the fastest business-class connection without phone service.

Where the rubber hits the road

Until the late ‘90s, EHRs were designed for client/server networks, in which an onsite server stored data and sent it to user PCs that contained copies of the EHR program. As EHRs moved to the Web, most vendors simply combined their client/server EHRs with special software (provided by Citrix or Microsoft) that enabled them to emulate Web applications.

Even today, says Anderson, few ASP-model EHRs are “Web-native” — that is, written specifically for delivery over the Internet. Such EHRs have significantly better performance than client/server applications do when they’re hosted online.

One defining characteristic of Web-native EHRs is that fairly little of the program resides on local computers. However, most EHRs place some program components on practice computers to speed up processing of data requests, says Jeff Amrein, one of Rose’s co-partners at Commonwealth Leverage. “To get something to run over the Web efficiently, you need to design it in such a way that you do as much local processing as you can,” he says, noting that it takes much less time to run a report locally than over the Web.

What takes the most time, however, is downloading data. Vendors of advanced ASP-model EHRs accelerate this process by using two approaches. First, they’ve reduced the number of screens that physicians have to call up to document a patient visit. That can make a big difference if your system now takes two seconds to call up each of 40 screens during a typical visit, notes Anderson. And second, some ASPs download much of the data that physicians will need before they need it. Both of these methods are aspects of what IT mavens call Web 2.0, which is widely used by leading Web companies such as Amazon and Yahoo.

Ed Park, chief technology officer for Athenahealth, which offers an ASP-model EHR and practice management software, explains that the performance of Web-based services “has less to do with the connectivity than with the way the Web application is architected. With Web 2.0 technology, you can create a very snappy user interface that can handle the most demanding applications.”

Basically, the Web 2.0 ASP does this by downloading “a lot of the content and logic necessary to run your application,” he says. “Then you have a core library of logic that allows you to run your application in real time. The only time you go back to the server is when you need more information.”

What this means is that the user doesn’t have to keep downloading the same elements to “paint” new pages. And, while the provider is documenting the encounter, the program is preparing for the next step. So, for example, when a drug is prescribed electronically, all of the possible interactions automatically pop up on the screen without the doctor having to click on anything or navigate away from the page that contains the other data he needs. Obviously, this improves performance.

The next step for EHRs

Download speed is becoming less of an issue for ASP-model EHRs, and performance is continuing to improve as developers of Web-native EHRs use techniques to reduce the number of screens physicians must move between. According to Anderson and Uretz, EHRs that use only a handful of pages per visit are just over the horizon.

But veteran EHR users say that these programs still have a long way to go. “The intelligent display of contextual information is the goal — but we’re not there yet,” says Bria.

In the meantime, physicians can adopt Web-based EHRs with some degree of confidence. Just make sure, advises Bria, that your EHR vendor and your IT service company demonstrate that the system works as advertised before you plunk down your money.

Ken Terry is a New Jersey-based freelance writer and the author of the book “Rx for Health Care Reform.” He can be reached via physicianspractice@cmpmedica.com.

Top Ten Chiropractic EHRs

Andrew Eriksen — Thu, 26 Apr 2012 07:58:28 +0000

We have made it easy for you by supplying you with a quick overview and pricing on the ten best EHRs for Chiropractic offices.

CareCloud PM & EHR

Andrew Eriksen — Thu, 20 Oct 2011 14:02:17 +0000

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CareCloud is a cloud based practice management and ehr system that is widely recognized as being one of the best available. This program is changing the landscape of healthcare one practice at a time. Carecloud employs advanced, intuitive technologies that solve the problems other systems have thought to be too small to deal with. CareCloud not only solves the major headaches of systems but also looks at the small things that make a practice run more efficiently and in the end be more profitable.

Schedule a Quick Demo of Carecloud and Find out our love affair is all about.

CareCloud Review

Andrew Eriksen — Mon, 03 Oct 2011 14:05:56 +0000

CareCloud Central Practice Management Software

The heart of the CareCloud Central system is the Dashboard which puts everything at your fingertips. The medical billing and practice management module allows the user to track and manage key practice metrics from their dashboard. This software has all the features and tools needed to manage any size or type of medical practice.

Features

CareCloud Central has a variety of modules to handle many tasks including a Patient Dashboard. Here is where you can view a clinical summary on any patient. You can view demographic information, scan documents and attach notations quickly and easily. The Medical Billing Collections feature allows the user to do payment posting automatically. It has a robust reporting system that can create all types of customized reports. It is cloud based which means uptime and scalability are easily satisfied.

System Requirements

The only requirement for accessing CareCloud Central is a web browser. It is web based with a user friendly interface with lots of emphasis put on the graphic design of the software. The output is done in Adobe Flash so the interface is very fluid and responsive. It is built using ruby on rails which is the gold standard right now for web based programs.

Implementation and Deployment

This cloud based software allows patient records to be accessed from anywhere using a web browser. There is no additional software or hardware to purchase. This software can be accessed from all types of mobile devices such as an iPhone or iPad.

Recap

CareCloud is very intuitive and designed to eliminate reduntant time comsuming tasks. It is a monthly subscription solution that is webbased and can be accessed from anywhere through a web browser. The system is fully integrated so the practice workflow runs smoothly and effeciently. All practice and patient documentation can be accessed from the customizable Practice Management Dashboard.

Pros

VERY User Friendly

Web based

Fully Integrated

Innovative Features

90%+ First Time Claim Submission Success

Cloud Based

Cons

Cannot see any at this time except that there is not a ghost program available that would run locally in the event of an internet outage.

My Opinion

CareCloud Central is a powerful cloud based software that has innovative features including an unique electronic reminders system. I was very impressed with all innovate and high tech features this software had to offer. It can used by any type or size medical practice with very little implementation time needed. I would recommend this effective, straightforward medical practice management solution.

AthenaClinicals EHR

Andrew Eriksen — Mon, 03 Oct 2011 13:50:10 +0000

athenaClinicals EHR from athenaHealth

athenaClinicals EHR from athenaHealth (http://www.athenahealth.com ) is web based so all information is available to the entire staff. This means the workflow can be measured and monitored by the entire network. This is an integrated solution that allows patient information to be seen at the point of care; plus many other capabilities such as online record keeping.

Features

The athenaClinicals EHR has an innovative five stage patient encounter feature that gives multiple charting options and collects clinical data. AthenaHealth is constantly integrating government mandates and provisions into their software. This is done automatically and with no cost to you. This system allows the entire staff to be able to access patient information and clinical data quickly and efficiently. The software seamlessly integrates with their billing software which is one of the best in the industry.

System Requirements

athenaClinicals EHR is a hosted web based system that doesn’t require additional hardware. This software is compatible with Windows XP Professional, Vista and Windows 7. It is recommended that Internet Explorer 8 or higher is used. Dragon Naturally Speaking version 9 or higher is also compatible with this software.

Implementation and Deployment

The technical experts at athenaClinicals will assist your practice in implementing and deploying your system. They will assist you with all aspects of setting of the application and training your staff to use it. There are many online resources available for support and training issues.

Recap

The cloud based architecture of athenaClinicals means there is no need for additional servers or maintaining servers. AthenaHealth hosts all data and software in their very secure data centers. All information is contained in a centralized single database including clinical guidelines, payer requirements and government incentive programs. The five stage patient encounter feature optimizes time to make the workflow run smoothly and efficiently.

Pros

Customizable

Innovative features and tools

User Friendly

Excellent billing platform

Integrated EHR/PM

Cons

The EHR is used in conjunction with their billing service which can be costly. The implementation fees are a little high and billing percentage is not always competitive depending on your practice size.

My Opinion

athenaClinicals is a robust system that is very user friendly. It has drop down menus that are easy to understand and use. I liked the fact that most things were automatically inputted into the chart such as lab results. This is a web hosted product that can be used my any type or size of medical practice or clinic.

NextGen EHR Review

Andrew Eriksen — Fri, 05 Aug 2011 15:26:50 +0000

NextGen Ambulatory EHR

NextGen Ambulatory EHR is a complete system that meets the ARRA Meaningful Use criteria. This software has many innovative features and tools, including prebuilt clinical templates for over twenty six specialties. It also has disease management templates that captures patient data at the point of care.

Features

NextGen Ambulatory EHR has multiple integrated modules that assist in documenting patient information. It features an E&M coding calculator to help prevent lost charges and helps to maximize reimbursements. The ePrescribing & Medications module helps to prevent interactions and errors. It automatically checks a patient’s current medications and allergies before it electronically transmits the prescription to the pharmacy. There are a variety of other management features for health maintenance, images and referrals.

System Requirements

System requirements vary depending on the size of your medical practice. The technical experts will assist you in deciding what type of hardware and software is needed for your specific medical practice.

Implementation and Deployment

The experts at NextGen will assist you in planning and preparing for implementation and deployment of your software. They assist you in setting up a system that is designed specifically for your medical practice. NextGen offers many training options and will assign you a customer care specialist. The specialist will assist with support, training and licenses.

Recap

NextGen Ambulatory EHR can be used in hospitals & health systems, group practices and in small practices. The software uses scalable enterprise architecture so hospitals and large multiple location health systems can connect though the system and share patient documentation. NextGen EHR is designed to work in group practices. It allows each physician to have their own workflow and the patient information is stored in a central location. Small practices can also use this software to run their practice efficiently.

Pros

Innovative tools & features

Customizable

Multiple Modules

User Friendly

Cons

Additional licenses and add-ons may increase the cost of the solution. The overall cost of this EHR solution may be cost prohibitive to smaller practices. Majority of NextGen clients are using server side hosting as the web based side of this program is not there just yet.

My Opinion

NextGen Ambulatory EHR is a robust system that can be used in hospitals, group practices and in small practices. The interface allows the user to quickly navigate through the entire system. I was impressed will all of the timesaving tools and features. This product is well suited for any type or size of medical practice.

eClinicalWorks EHR

Andrew Eriksen — Fri, 05 Aug 2011 15:24:51 +0000

eClinicalWorks EMR

eClinicalWorks EMR (http://www.eclinicalworks.com ) has innovative features and tools to improve efficiency and allow the physician to deliver the best patient care possible. Patient documentation is faster by using the templates, drop down lists and other built-in tools. This software is customizable to accommodate a practice’s workflow.

Features

The design of the eClinicalWorks makes all data and patient information available anytime including test results and medications. This system makes it simple to send and receive information. This software has tools and features for more than forty specialties and sub-specialties. This is a complete EMR system that any type or size of medical practice can benefit from.

System Requirements

The eClinicalWorks is a web-based product. The system requirements will depend which type of software you purchase. You can either have a client server in-house or by SaaS. The application server works with Windows and Linux. It supports both MySQL and SQL server options.

Implementation and Deployment

Since eClinicalWorks is a web based application with state of the art technology, deployment is fast and easy for any size medical practice. There are two implementation models to choose from. It can be deployed via SaaS or on premises using a client server.

Recap

eClinicalWorks uses a single database to hold all patient demographics, billing and claims data. This solution is designed to improve the workflow and can be customized to fit your specific needs. The design and interface makes it easy to navigate through the entire system. The user can mange medications, access labs, and find patient education materials quickly and efficiently.

There are two options when you purchase eClinicalWorks EMR. The first option is the upfront model with annual support and maintenance. The upfront pricing is $7,500 for the first provider and $4,500 for additional full time providers. The second option is a monthly subscription. This option is $250 per month per provider and includes maintenance and support. You can also have it hosted by eClinicalWorks for an additional fee of $100 per month per provider.

Pros

Customizable

Innovative tools and features

Multiple modules

Cons

The purchase of additional services and software can boost the cost of the solution. Support is overseas and some providers state feel that there are too many clicks involved in seeing patients. You also will need infrastructure investment to insure the integrity of the system.

My Opinion

The design and interface of eClinicalWorks is excellent. You can easily navigate through the different modules. It has many innovative tool and features that makes the workflow of a medical practice run efficiently. eClinicalWorks software can be used by any type or size of medical practice. This EMR is user friendly and I would recommend it for anyone looking for an all-in-one solution.

AdvancedMD EHR Review

Andrew Eriksen — Sat, 09 Jul 2011 06:32:25 +0000

ADP AdvancedMD

ADP AdvancedMD (www.advancedmd.com ) is an integrated EHR and practice management system that is web based. It is designed to improve revenue capture, reduce errors and to simplify the entire process of managing a medical practice. This software allows all practice and patient information to be seen in a user friendly interface and is compatible with a variety of specialties.

Features

ADP AdvancedMD has many innovative features including a physician dashboard that gives you a customized view of all aspects of your medical practice. It gives the provider easy access to staff and patient scheduling, test results and patient charts. This system includes hundreds of customizable templates that can be used by physician in a variety of specialties. This system makes it easy to navigate through the various features and puts all information at your fingertips.

System Requirements

This software runs best on Microsoft Windows, Internet Explorer and Office. It is recommended that each work station have a Pentium 4 or better processor. Windows 7 and Windows XP business version are supported. Windows Vista is supported but not recommended. You will also need a broadband Internet connection and Internet Explorer is the recommended browser.

This system can also be used with a Tablet PC. For the reports feature you will need Microsoft Word 2007 or 2010 for HCFA claim forms, letters and statements. For exporting reports Microsoft Excel 2007 or 2010 is required and Microsoft Access is needed for the data export feature.

Implementation and Deployment

The experts at AdvancedMD will work closely with you in every step of the implementation process with only a minimal disruption to your medical practice. Each medical practice is assigned a training professional to guide them through the deployment process. They will implement and deploy the system, including electronic data interchange, customizing paperwork and integrating outside suppliers.

Recap

ADP AdvancedMD has an array of innovative tools and features. It has a built in unified messaging system that allows all staff members to communicate easily. The Patient Portal is a secure web based communication system that can be used by the medical staff and patients. It has a robust document and image management system that stores documents, audio, video and images. The pricing varies depending on the size of the practice. This is a complete system that can be used by any type or size of medical practice.

Pros

Excellent design and layout

Innovative technology

Customizable

Cons

Additional add-ons and services may boost the initial cost of the software

My Opinion

ADP AdvancedMD is a complete system that will handle all aspects of patient documentation and practice management. I was impressed with the design of the interface and how easy it was to navigate throughout the different modules. The Physician Dashboard is a great feature that allows the user to have all information at their fingertips. I would recommend this software for any type of specialty and any size of medical practice.

Health Data Stolen from Hospital

Andrew Eriksen — Sat, 12 Feb 2011 17:57:24 +0000

BY JOSEPH DE AVILA

The confidential personal health data of about 1.7 million New York City patients, hospital staffers and others were stolen in December, the city’s Health and Hospitals Corp. reported Friday.

The medical files, which were stored on magnetic data tapes and extend back as long as 20 years were stolen on Dec. 23 from an unlocked vehicle belonging to GRM Information Management Services, the city’s medical-records vendor based in ..

This article proves just how critical it is to know where and how your data is being secured. This also speaks to the point of having a feature like the IPAD has which can wipe data remotely. I would also argue that many of the ASP hosted EMRs could use this as possible leverage in showing how easy data can be stolen from an office. All it takes is someone breaking into your office once and stealing your server. It happens every year all across the country in Medical offices but you just don’t hear about it as much.

Full article link below. Wall Street Journal Article

Greenway EMR/EHR Review-2

Andrew Eriksen — Mon, 15 Nov 2010 15:01:00 +0000

Here are two reviews left as comments on a previous Greenway EMR review posted here (Greenway EHR Review). We have posted both a negative and positive comment so you can make your decision. We recommend utilizing our free EMR/EHR tools to help you in selecting the most appropriate EMR/EHR program for your practice.

Request information on Greenway: Free Demo – Free Price Quote

Positive Review of Greenway Review:

Kris says:

May 29, 2010 at 6:04 am

I just happened to come by this site and was surprised by the negative comments regarding Greenway. We implemented Greenway in January of this year and have had a very good experience so far.

Ours is a 15 provider practice in South Carolina. We implemented the Practice Management first and the EMR next. I agree with the comments that a user made in one of the earlier posts, there is no software out there that is going to be a perfect fit. Having said that, Greenway was the closest to a fit that we could find. Below are some of my experiences with our Greenway install and life since:

- Integrated seamless integration of the EMR and PM components with single login (I don’t recall seeing it in any of the other products we demoed – Allscripts and Nextgen included)
- Intuitive use
- Extremely knowledgeable salesperson in Nick. His knowledge of the product made it so much a easier sell for us as we knew we had an added resource to go to once we went live. I don’t think he ever mad a promise or sold a feature that the product did not have. Now there are features that were supposed to come in a future release that are not out yet and we might have had some expectations that they would have been out sooner.
- We were at 100% of our volume on day 3 of implementation
- A 10% increase in revenue due to better tools in tracking patient visits, insurance verification, insurance claims, and patient balances
- Training expenses and training billing could have been managed a little better from Greenway’s end.
- Knowledgeable help desk on both chart and pm side. Rarely have I called the help desk and not got someone on the line that did not know the answer to my question or could not get it resolved within a few hours.

My belief is that any successful software implementation has 6 components to it
- Good Software
- Good Training
- Good Processes
- Able employees
- Good Data during transition
- and most important of all a strong leader who can manage the project and control the demands and manage the expectations placed on the implementation. This perhaps is the number one reason implementations go sour.

As long as a practice keeps its side of the bargain, I don’t think they would have an issue implementing Greenway. I would recommend Greenway to any practice but make sure you have your ducks in a row and don’t expect a plain software switch to solve all your problems.

Having said all this, is Greenway perfect? They are a fast growing company and have had their fair share of growing pains that at times have been a frustration to us but at the same time has been insignificant when compared to the gains in patient care, productivity, and revenue.

Now I will post one of the negative comments left on our original review. You should always do your own analysis of the programs to ensure that they will work for what you need. References of similar practices are also very important.

Erik says:

November 13, 2010 at 11:59 am

Would have to fall into the camp of those who have been thoroughly disgusted by our choice of Greenway for our gastroenterology practice. I am young and new to my group, with experience of having used 3 other office EMR platforms prior to moving to my present location. The group (none of whom had EMR experience) purchased it both for clinic and ASC, totally based on a few brief demonstrations and a BUNCH of promises as to what could be put into place for our practice. I can tell you that unlike any other company I have EVER dealt with for Endowriters, EMR, or other computer projects – I have never had some many promises made where the company’s promise was based on the sole expectation that YOU as the practice would have to build/create/write in all up in computer language yourself. It’s been kind of like buying a car, where Greenway has many beautiful models on the lot, says “yes we do/yes it can” to anything you might inquire about what the car can do, only then find you have no spark plugs, battery cables, transmission fluid, belts, or gas line with which to be able to make the car get off the lot. As docs we are as human as the next guy, and there is truth in terms of us having realistic expectations about how life with an EMR is to be very different. Having used several EMR’s before, there may be a few weeks to get one customized to my style, but I have always been able to jump in from day one using it. We are still 3 months out and can’t make it work for our office or endo.

The company now admits that they have absolutely no endoscopy programs at all, in their library or otherwise (contrary to what was said in initial discussions). What groups use it for ASC’s have apparently had to hire an IT person on the side to come in and try and write them for the groups. We were told on front in that having Greenway in the office and in ASC would make everything seamless — YET Greenway is one of the few EMR’s that is still lacking in the ability to interface with anyone except just a few lab organizations…..they don’t even interface within themselves!!! All the regristration data that our staff have to enter on our practice side have to turn around and be re-entered into the ASC portion of Greenway because the two parts don’t talk to one another. If we stick with Provation or go with GMed then that takes care of endo programs as we are currently doing but requires continuation of having to scan the reports into both the ASC Greenway and the also into Greenway PM.

These are just the major and financially painfuly headaches. While practice mgmt part of Greenway seems to be OK, it has been awful in the clinic. Everything takes an overly complicated amount of mouseclicks to get to where you need to be, with buttons in what are not obvious places to be found and with cryptic symbols that you have to remember (little to no right-button functions). I cannot tell you the number of minutes and clicks it takes just to print off a paper copy of my daily schedule!

For some specialties, where scope of practice is very refined and repetitive, a template-driven EMR makes sense and should work fine. I would imagine that for OB, where most visits are checklists of things anyway, template notes would work great and do little to drain a docs efficiency. For any practice where there is considerable variety in the types of patients that are being evaluated, you will never be able to create enough templates to run smoothly (and if you do you will waste huge amounts of time sorting through the hundre or so trying to find the “perfect template” for that patient. Face it, folks–medicine is part science and part art. Patients are not like an automobile, and they don’t lay out their stories in the same sequential fashion for each disease. You can forget trying to do a note in the actual exam room–unless you demand that a patient keep quiet and answer only the pre-determined set of questions that you are fed on your template as the boxes scroll across the screen. I think most of us as providers would be sadly disappointed to see medicine reduced to such a level.

I agree with prior comments about anyone out there exploring options for EMR. GET ALL YOUR WANTS IN EXPLICIT WRITING before signing contract. Be very leery of Greenway right now until they listen to their customers and get their act together. If you have an EMR that is not delivering what would be a reasonably expected thing to deliver — give ‘em hell about and continue to press them hard – even legally if need be. I wish a few practices would start banding together in taking on Greenway, in particular, as I am afraid that is what it is going to take before they come back down to reality.