It\’s official. The road sign clearly welcomed me here. I guess all business start-ups have to go through this town.
![\"hell-sign\"](\"http://static.squarespace.com/static/522db17de4b04287ea7b6e6c/523f411ee4b05acd87cbee70/523f4128e4b05acd87cbf0e3/1364934732000/hell-sign.jpg?format=original\")
What? No bravado? No chest pounding about how my ideas will change health care while making patients smell as springtime fresh? Nope. None of that. It\’s hard to get excited about ideas when only money pays the bills.
Having now left the safe confines of my leftover earnings from my old practice, I am now supposed to be self-supporting. Two big things have caused this to not go as smoothly as I have planned:
- My construction took twice as long as I expected.
- I have yet to find a computer system that doesn\’t make me want to pound on my desk and wantonly overuse the word \”inconceivable.\”
A month behind on beginning to earn money hurts a lot, as does the extra cost of construction, but the computer problem has me beyond frustrated. Why do they make medical records in which:
- Neither I nor my nurse could figure out how to put in vital signs
- You can\’t print out a letter with lab results
- You can\’t enter a \”historic\” or \”handwritten\” prescription to document it was given
- There is no flowsheet in which to enter lab results (we are 4 for 4 on that one)
- There is no way to attach external documents
- There is no marital status of \”single,\” but there is \”polygamous\”?
I guess I am just a perfectionist, expecting everything from a record, but why do I have to settle for an EMR by choosing the one that is \”the least aggravating?\” But this is what I\’ve had to do, and today I was entering data and getting distracted by my frustration, thinking bad thoughts about software engineers and fantasizing about building my own system? Before anyone tells me I should do just that, let me point out three things:
- I don\’t have the time.
- I don\’t have the money.
- When feeling insecure about how I run one business, the solution isn\’t to add another new business.
So this is hell. I am doing my best to be satisfied with my \”minimum viable product,\” meaning that I am satisfied with putting out care that my patients are happy about (which they are) even if I am frustrated with the process of giving that care. I need to grow, but the computers are making it very difficult. I\’ve had lots of suggestions thrown my direction, ideas of how I may solve my problem. It\’s probably just going to take time. I am learning patience. I am learning humility. I will be stronger for the lessons I am learning.
I\’ve even considered trying to raise money as a \”health care start-up.\” I\’ve looked into small business incubators (although, being in Hell, the idea of an incubator isn\’t that appealing). I could have people buy bricks. I could sell autographed pictures of llamas (although I\’d have to find a llama who can write first). I could engrave the name of supporters on my \”humongous handicap ramp of awesomeness.\”
![\"theoden_leads_the_charge\"](\"http://static.squarespace.com/static/522db17de4b04287ea7b6e6c/523f411ee4b05acd87cbee70/523f4128e4b05acd87cbf0e6/1364936688000/theoden_leads_the_charge.jpg?format=original\")
I\’m waiting for the Riders of Rohan to appear on the hill, but so far they haven\’t come.
Come on, Theoden. I\’m counting on you. I just hope you\’re not a software engineer.
A little of what you are saying is common always and everywhere to users of CRM softwares or other “enterprise” software systems (Oracle, SAP etc). Let’s not be shy though what programs have you evaluated?
GE Centricity (at my old practice) – perhaps the devil you know is better than the one you don’t. Expensive and far too much, but at least I knew how to finesse it to get things out of it.
eClinicalWorks – way too difficult to document with it.
Technex – the CEO offered it to me for free – not sure if I’d pay that price again.
Kareo – Presently using this, but frustrated at inability to attach documents or put in structured lab results.
PracticeFusion – looked at, but found it to be too idiosyncratic (although I think they all are, to some extent).
Have looked at Open EHR project as well. Trying to see if it’s worth going after, as it really has far too much to it that I wouldn’t use.
Have you looked at http://blog.medsphere.com/ and Edmund Billings, MD blog, I know nothing about health IT, but I have been reading with interest about their system and the fact that the VA has adopted it. At my last VA appointment, I asked the person I saw how she like it and she was quite happy with it. She felt it had some short comings, but for the pluses greatly out weighed the minuses. Just my thoughts..
Thanks. I’ll read more. From what I’ve seen many of the solutions are not “hosted” – i.e. you have to download the server software and run a network. I greatly prefer hosted for simplicity’s sake. Still, VistA is something I’ve been looking at. Of course, my nurse will kill me if I swap to yet another system at this point. I think we are stuck for the moment until we get something more comprehensive and geared toward my practice style.
Interesting that you should mention the problem with entering prescriptions, as I saw that firsthand today and tried to explain to a doc that a statement in the note that implies a med was given was not sufficient documentation for billing/coding purposes. I’ll be curious to see tomorrow if he was able to fix it so the right kind of information is in the record somewhere…all I could remember in the back of my head was one of the mantras that got endlessly repeated in college: “Not documented, not done…” You’d think they’d make it a little easier for all of us, no?
Nearly all the docs in our city use this open source EMR: http://OSCARcanada.org. Not sure if the billing aspect will work for you (Canadian) , but the clinical aspect is good.
Thanks for the link. Will check it out.
Have you looked in to practice fusion?
Yes, it’s OK. I honestly would’ve made my whole process go easier in the big picture if I had started out with it, but my ideas on EMR have evolved since then. There are significant limitations still, but it’s a decent choice for those within the system. The price certainly is good.
I’ve been using it for the last 4 months. The only thing it does that you were wishing for is allow you to upload documents. They just rolled out a new superbill last week (I suspect because the billing company they were partnered with, Kareo, went rogue and is starting their own free EMR) and it is practically un-use-able.
I think you should do a kickstarter campaign – recruit programmers and providers and get money to make a better EMR (yes, that sounds pretty daunting in the midst or starting a new practice to me too).
Hi Dr. Rob – We would be happy to help you take a closer look at Practice Fusion if you’re interested. The billing updates that Sasha mentioned below are being launched tomorrow night. We don’t always get everything perfect – but our iterative release process assures that fixes and enhancements happen every week.
Had an opportunity to use PracticeFusion last week and it was infuriatingly slow. With every button click I had to wait several seconds for the action to occur. Could not work with this long-term. Hope they are working on this, but the physician who owns the practice tells me it has been very slow like this for at least the past month.
Have you researched Mitochon it’s free and a free patient portal is coming soon. Perhaps some none medical software to accomplish what you need since you are not billing insurance but maybe linked with an accounting software for your practice. Have you consulted with non-medical software gurus that could find what you need? A patient portal can be purchased as a stand alone.
What about ElationEMR? That seems to get rave reviews, including from physicians who’ve tried Fusion. And btw, it’s produced by a start-up. 🙂
I recently came across ElationEMR. (I’ve looked at more EMRs/EHRs than any rational human should!) I can see why the rave reviews. Very fast. Little waiting for refreshes. Very intuitive. Very flexible. They have IDEO as a partner (the “human-centered design” people) and you can certainly see their impact. Maybe the best EMR user experience I’ve ever had. And, perhaps the best part for your biz model, they are focused on physician/patient, not billing/coding. It’s only $149/month complete. Nothing up front. Cancel anytime.
It’s new, which always gives me pause, but the UX and the price point have me thinking this may be the new “best of breed” for us small, independent docs.
FYI, that “Guest” was me. Somehow I mucked up the sign-in. D’oh! I hate leaving unsigned posts. (BTW – I’ve no relationship to ElationEMR, just really impressed with the UX that I encountered on their test system.)