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05/13/2015
RESPONSES/COMMENTS (EMR)
RE: EMR is Here to Stay
From: Gerald Mauriello Jr., DPM
Like it or not, EMR is here to stay. If you are not utilizing it now, very soon you will be forced (in how long, is debatable). That being said, Web-based EMR (so called “free” EMR) must be considered with a great deal of care. When EMR software is being sold for 30K, 40K, 50K and above, what makes you think that a company will give something away for free? This is something they have spent a great deal of money developing. They get paid in a variety of ways, but they get paid nonetheless. Whether this cost is upfront, deferred, or if it’s imposed on labs or imaging companies, it still exists. Frankly, if it costs a few grand to get records in a workable format, then so be it. Nothing is really free, is it?
Additionally, I believe it is better to do your homework; find an EMR that suits your needs (which admittedly, can be difficult) and implement it now in a controlled way. Paper charts are no longer the standard, like it or not. Just think how much it will cost your practice if we are all forced to convert by 2016? Admittedly, this is a hypothetical, but certainly a possibility. How many “free” EMRs will exist then? If you think it’s expensive now, wait until we are mandated to use EMR. Get that checkbook ready.
Gerald Mauriello Jr., DPM, Redbank, NJ
Other messages in this thread:
12/05/2024
RESPONSES/COMMENTS (EMR)
From: Kenneth Meisler, DPM
I agree with Dr. Musella that you should NOT scan your paper records when switching over to an EMR system. I switched from paper charts and traditional x-ray film to an EMR program and digital x-rays about 17 years ago at the same time. At the time, I had already been in practice for more than 30 years and our office had 30-40 thousand patients we had seen and many active patients. We did NOT scan any of our charts or x-rays. We kept all of our existing charts in the office.
If a patient came, in most of the time, we did not have to pull out their old chart or x-rays. In some cases, we did have to go back to old notes or x-rays but it was not often. We kept all of the charts and x-rays for the legal period and eventually destroyed them. Any x-rays that we felt we wanted a copy of, we took a digital photograph of and stored it by the patient's chart number in a file.
Kenneth Meisler, DPM, NY, NY
12/03/2024
RESPONSES/COMMENTS (EMR) - PART 2
RE: Scanning Paper Records (John Moglia, DPM)
From: Al Musella, DPM
If you’re dealing with old records, I wouldn’t bother with an EMR system for them. Instead, just scan each entire chart into a single pdf file, including all reports and even billing records if necessary. Name the pdfs with a consistent format, like LastName_FirstName_DOB. For file organization: If you have fewer than 1,000 charts: Store all the files in a single root directory. If you have more than 1,000 charts: Create sub-directories for each letter of the alphabet and organize the files into folders based on the first letter of the patient’s last name.
To secure the data: Encrypt the drive using a tool like BitLocker (included with most versions of Windows except the Home edition). Backup the encryption key or password in multiple secure locations to ensure you don’t lose access. Make three copies of the data on three separate external drives. Keep one in the office for quick access. Store one in a safety deposit box for long-term backup. Keep one at home as an additional backup.
Important Notes About Storage Media: Hard Drives: Hard drives don’t last indefinitely, especially if left unused. Their lifespan is typically 3–5 years. I learned this the hard way when I tried to recover photos from a 30-year-old drive. Solution: Each year, copy one of the drives onto a new external drive. Verify that you can open and decrypt the files, then destroy the old drive. Rotate this process yearly so that each drive gets replaced every 3 years. Optical Discs (DVDs/Blu-rays): These last longer than hard drives but are harder to encrypt. Thumb Drives: Thumb drives are easier to access and encrypt, and they’re simple to destroy when no longer needed—just smash them!
Al Musella, DPM, Hewlett, NY
12/03/2024
RESPONSES/COMMENTS (EMR) - PART 1
RE: Scanning Paper Records (John Moglia, DPM)
From: Kenneth Coates, DPM
Regarding Dr. Moglia's query concerning scanning records of inactive and deceased patients, I recommend not wasting time and money scanning these records. I retired 5 years ago with paper records, and I can attest that after the first 6 months to one year you probably won't need to access them at all.
However, as you stated, you need the records kept for 7 years. This can be done by boxing the paper records in whatever order you currently have and storing them in a corner of your basement or in a rental storage unit. Don't waste a lot of time on this, you are a busy doctor and you should be working towards your future.
Kenneth Coates, DPM (retired) Cape Coral, FL
03/05/2024
RESPONSES/COMMENTS (EMR) - PART 2
RE: How to Save EMR Notes
From: Daniel Chaskin, DPM
Why not save every chart note electronically as a .PDF file to protect against your EHR provider closing down? If you are computer savvy, you can program a macro to automatically perform this task.
Daniel Chaskin, DPM, Ridgewood, NY
03/05/2024
RESPONSES/COMMENTS (EMR) - PART 1
From: Jack Sasiene, DPM
I have used Nextgen for 10 years until I recently was forced to change to a hospital-based EMR. Nextgen was great for my single doctor practice. It was fully customizable at each level of charting with the ability for the user to change/create whatever was needed very easily. You could create letters to docs, merge patient data into them, and save the original template. You can create favorite tabs for diagnoses, procedures, care plans, etc. that include the CPT code modifiers, macros; and it puts it into the billing module. The eRx module allows creation of favorite meds AND multiple favorite sigs (e.g. BID) for that medicine.
These features eliminate much of the typing and clicks needed to fill the chart, but still allow for alteration. As with any system, it requires work to set it up the way you work. This takes a few months or hair pulling, But once done, it is possible to create unique charting in minutes and be done. My front office had no complaints about the billing module .We sent out all claims at the end of the day. Their clearinghouse was fine. You need to spend some time with each system and try to use it yourself. Don’t just allow them to “show how quickly you can work” in a system they have already set up.
Jack Sasiene, DPM, Texas City, TX
08/28/2023
RESPONSES/COMMENTS (EMR) - PART 1 B
From: Jeffrey Kass, DPM, Navin Gupta, DPM
I currently use Sammy, Practice Fusion, and Criterions. Of the three, if I had to choose one - I like Practice Fusion the best. I don’t do any billing with Practice Fusion or Criterions, so I am really only comparing charting, e-prescribing, etc. I find Sammy has the most frustrating e-prescribing. I get kicked out of it on a daily basis. I wish they would drop their third-party e-prescriber or create a better interface as I have never had an issue e-prescribing in Practice Fusion.
Jeffrey Kass, DPM, Forest Hills, NY
I have used EMR/EHR and electronic claim transmission since 1992, yes 1992, at this point I'm on my 7th EMR. Having seen EMRs from infancy to today (still not matured). My latest, MODMED, is an all-in-one system. It's good on claims and on the financial side, but on the clinical side, the chatting is a MESS. The clinical side is like a grocery list with no logical flow. If you click on plantar fasciitis 10 times, it will add plantar fasciitis to your note 10 times. Answer: the grass is not much greener on the other side.
Navin Gupta, DPM, West Des Moines, IA
08/28/2023
RESPONSES/COMMENTS (EMR) - PART 1 A
From: Robert Dale, DPM, R. Alex Dellinger, DPM, Little Rock, AR
My current EMR is raising prices too. So, I am switching to an EMR called NextGen. It is a few hundred dollars less a month and is endorsed by the APMA.
Robert Dale, DPM, Clarksburg, WV
Our group, I am sure like many, was using a podiatry specific EHR going back to the days of the government's $44,000 "enticement". After recently being acquired, to use the new and improved product, we were quoted a price that was about 3x what we were paying before. What I didn't like about the new system was that the cost to use the system was based on gross collections. After researching other EMR systems, this seems to be the new way of doing things. What sense does that make? So we pay them based on a percent of collections? Seems like a money grab to me. We finally settled on Tebra (previously called Kareo). They still charge a set fee per provider. Quite frankly, they were the lesser of the evils -- but my billers like Tebra. They say billing, collecting, etc. is very good with this system.
R. Alex Dellinger, DPM, Little Rock, AR
08/23/2023
RESPONSES/COMMENTS (EMR) - PART 1 B
From: Jon Purdy, DPM
EMR has been a joke. There is no interoperability. It has taken away the concentration on patient care. The costs to a practice are far more than most realize. The obvious costs are those of the EMR system itself, and those are always rising. There is the cost of having to transition when these companies go out of business or are purchased by other companies. There are the costs of computers and IT to maintain them. There is a payroll cost to the added amount of time it takes employees to input data. And the biggest cost is a reduction in patient visits secondary to the time it takes to process them. There are other microeconomics at work as well.
The biggest joke is that “canned templates” were a big compliance problem in the past, but somehow they are perfectly acceptable...
Editor's note: Dr. Purdy's extended-length letter can be read here.
08/23/2023
RESPONSES/COMMENTS (EMR) - PART 1 A
From: Carl Solomon, DPM, Ivar E. Roth DPM, MPH
I also attended that EHR discussion in Dallas. Pete, do you remember the attorney's concluding comments? I vividly recall his words..."For the first time in my life, I'm not disappointed that I became a lawyer and not a doctor!"
Carl Solomon, DPM, Dallas, TX
It would be interesting to see what percentage of podiatrists are using EMR. I for one as a concierge podiatrist never found the need to use EMR in my practice, and I am very happy with my handwritten notes. The extra time goes into seeing the patient, not writing up a slew of notes that meet some criteria that has nothing to do with patient outcomes.
Ivar E. Roth DPM, MPH, Newport Beach, CA
08/21/2023
RESPONSES/COMMENTS (EMR) - PART 1A
From: Eric Trattner, DPM, Brian Kiel, DPM
I couldn’t agree more!
Eric Trattner, DPM, Twinsburg, OH
In response to Dr. Sullivan's letter regarding EMR, try using the dictating part of the software. I use MModal Fluency Direct. I dictate directly into the chart. It is compliant with HIPAA and while you can’t go back and change a chart (which is good legally), you can add addendums to any record. The charges are entered as you finish the chart. That can be posted and sent to the appropriate carrier. Also, there are other dictating systems such as Dragon Speak.
Brian Kiel, DPM, Memphis, TN
08/21/2023
RESPONSES/COMMENTS (EMR) - PART 1 B
From: Elliot Udell, DPM
Our office switched to EMR many years ago. The trigger was that my own handwriting devolved to a point that I, myself, could not read it. EMR for me was a learning curve and even to this day, it takes a lot more time to do a note using an EMR program than to write it by hand or to dictate it. When my own GI doctor switched to EMR, he had to spend more time on the computer than with me.
The problem for this momentum toward EMR is to create a note that can easily be shared by other providers as well insurance companies and legal entities. The ideal, which has not been reached, is to somehow get all EMRs joined in some form of fashion so that if a patient comes to you from a doctor in Kalamazoo, you theoretically would be able press a few buttons and access all of the patient's notes, lab tests, and radiographic studies. This would cut costs because you would not need to repeat certain tests. Will we ever get there? Who knows? Bottom line, Dr. Sullivan: hang in there and eventually you will not want to go back to the days of handwritten notes.
Elliot Udell, DPM, Hicksville, NY
02/08/2022
RESPONSES/COMMENTS (EMR) - PART 1B
From Elliot Udell, DPM
Dr. Bass is correct, Modernizing Medicine might be one of the best podiatry EHR programs. The problem with Modernizing Medicine and similar high-end programs is that for the small office practice, such as my own, these programs are not affordable. I would love to buy a new Lexus this year, but will most likely settle for a much less expensive car, based on affordability. Perhaps, the owners of Modernizing Medicine can come up with a scaled-down version that would be affordable for small practices and could be upgraded as the practice gets larger.
Elliot Udell, DPM, Hicksville, NY
02/08/2022
RESPONSES/COMMENTS (EMR) - PART 1A
From: Alan Bass, DPM
In response to Dr. Meisler’s comments, I had not been with NEMO Health for the last several years prior to their acquisition by Modernizing Medicine. I have no affiliation or financial relationship with Modernizing Medicine, so I had nothing to disclose. If Dr. Meisler had any concerns with my post, he should have reached out to me directly.
Alan Bass, DPM, Manalapan, NJ
02/23/2021
RESPONSES/COMMENTS (EMR)
From: Jane E. Graebner, DPM
Last year, I was finally able to celebrate the end of all paper charts in my office. We began using EMR in 2011 and I opened my solo practice in 1982 so you can imagine the volume of paper. We had put date stickers on our paper charts so we culled them every year. I hired my daughters when they were young (then employees' children or young people whom I trusted and knew from my church or even patients who lived nearby) to pull them and shred them. They checked the birthdate of each patient since you must keep children and minors much longer (we scanned those into our EMR).
We kept charts for adult patients for 7 years, but I believe you should check the requirements with your malpractice insurer. Young people just put on their headphones and listen to their music and get the job done. Hiring your kids and teaching them to save for their college education is a good money lesson for them. Both of my daughters are debt-free Millennials whom I am very proud of.
Jane E. Graebner, DPM, Delaware, OH
01/15/2021
RESPONSES/COMMENTS (EMR) - PART 1B
From: Donald Blum, DPM, JD
When we set up our eRx for controlled substances, we had to get tokens. The vendor charges an annual fee. Additionally, I can use an app on my cell phone to create the 6-digit number for verification. You might check with your EMR provider to see if you can use an app (like Authy authenticator or similar) instead of renting the tokens. I have not used the token for authentication in 7 months.
I have not inquired about returning my tokens.
Donald Blum, DPM, JD, Dallas TX
01/15/2021
RESPONSES/COMMENTS (EMR) - PART 1A
From: Brian Kiel, DPM, Salvatore J Galluzzo, DPM, RPh
My practice uses VIP Access. After writing the script, you activate an icon and get a code that you put into the Rx.
Brian Kiel, DPM, Memphis, TN
We have been using a program called "MD Toolbox". It is key fab and password protected for $38/month/provider. It is easy to use.
Salvatore J Galluzzo, DPM, RPh, Clifton Park, NY
03/12/2020
RESPONSES/COMMENTS (EMR)
From: Pete Harvey, DPM
I have used MDSuite out of Kansas for almost 20 years. The stand-alone system is about $850/quarter plus start-up which includes support and updates. The cloud system is about $350/month automatic draft. This includes support. Updates are automatic through the cloud. They offer both. The system is very comprehensive.
Pete Harvey, DPM, Wichita Falls TX
03/11/2020
RESPONSES/COMMENTS (EMR)
From: Richard D Wolff, DPM
We use Traknet with a local server database (not the cloud). Single practitioner license. No extras. $427.93 per month.
Richard D Wolff, DPM, Oregon, OH
10/25/2019
RESPONSES/COMMENTS (EMR) - PART 1B
From: Brian Kiel, DPM
We use NextGen for our EMR and use Entrada virtual scribe for our data entry. I no longer have charts to do at home or on the weekend. I see 40-45 patients daily and am able to keep up using the virtual scribe app on my phone. If anyone has questions, please feel free to contact me.
Brian Kiel, DPM, Memphis, TN
10/25/2019
RESPONSES/COMMENTS (EMR) - PART 1A
From: Bill Beaton, DPM
We switched to PracticeEHR in December and find it to be very user-friendly. We used Practice Defenders, a third-party to transfer our data and it went very smoothly and was much more economical than paying thousands of dollars for our data. Our schedule exported to an Excel spreadsheet, so it transferred over nicely, but we still had to make manual changes and verifications.
PracticeEHR has built in templates for podiatry visits and they have someone who works with you to customize them. Our digital x-rays import nicely as well. I recommend that you look at a demo of their system.
Bill Beaton, DPM, Saint Petersburg, FL
11/08/2018
RESPONSES/COMMENTS (EMR)
From: Ron Werter, DPM, James Koon, DPM
I’m a very satisfied Sammy user and highly recommend it to everyone. It’s efficient, does what’s needed, and saves time - which is money.
When I was in private practice two-and-a-half short years ago, we were using MacPractice MD. Our entire office was Mac-based and I loved it. It was easy to navigate, had all of the features that made it compliant with Meaningful Use/MIPS, and always worked. Their support was always available and competent and not terribly expensive (about $4,000/year for the two practitioners and electronic billing). Because everything was Mac-based, everything always worked. We used an on-site MacMini for our server and backed up off-campus every night. Being that I've been away from them for almost three years, I am only guessing when I say they likely have cloud-based server capability.
The program itself was very customizable, a feature I loved because...
Editor's note: Dr. Koon's extended-length letter can be read here.
11/07/2018
RESPONSES/COMMENTS (EMR) - PART 1B
From: Brian Kiel, DPM, Jeff Frederick, DPM
We were bought by a multi-specialty group 14 months ago and had to go to NextGen from McKesson. This EMR (NextGen) is much more complete and gives much more information. It does take a lot of clicks at times, but it is possible to make templates and customize many of the entries. I am satisfied with it.
Brian Kiel, DPM, Memphis, TN
TRAKnet is the only EHR that is owned and operated by podiatrists for podiatrists. The EHR is totally podiatry-centric and the most used EHR by podiatrists who use electronic health records.
Disclosure: TrakNet is a product of Nemo Health
Jeff Frederick, DPM, Executive VP, NEMO Health
11/07/2018
RESPONSES/COMMENTS (EMR) - PART 1A
From: Michaele A. Crawford, DPM
I have been using NextGen for 3 years. I honestly cannot recommend them. Although they claim to be the #1 program, we have found that the reports are difficult to understand and locate, their auto-post component was posting incorrectly and writing off patient amounts, and their tutorials are outdated. It requires multiple clicks to get to different areas of the patient note, and you cannot access the note and the scheduler at the same time. My staff has to keep 2 windows open, one with the “dashboard” where you create the notes and another with the “Practice Management tab” to do the scheduling. The initial setup was painful, as I’m sure it is with many. They imported all of my data from my prior program, but much of the data is flawed and I am having to pay a monthly rate to the prior company to access that data. It does have all of the components necessary to report for MIPS. That portion of the system was fairly easy to understand.
I switched to them from TRAKnet. I left TRAKnet because there was no communication, initially, that they were going to be compliant with the PQRS requirements. I wish I had never left them. The program had a fast learning curve, and setup was easy as they allow access to other podiatrists’ note templates, which you could download and modify to your liking. Reports were easy to locate and read.
Michaele A. Crawford, DPM, Butler, PA
01/26/2018
RESPONSES/COMMENTS (EMR) - PART 1B
From: Joshua Kaye, DPM
It is not at all surprising that Practice Fusion has been sold for a large amount of money. The sale follows the usual path of essentially all start-up companies. The so-called “free” EMR was really just a cost deferment. How can any company function with minimal income? Sadly, there will likely be a huge ransom payment for the EMR data, as the data is stored in a proprietary format which will likely be difficult or expensive to transfer to another EMR program. If the stored data within Practice Fusion were in a common format such as pdf, the transfer at this point would be easy. This matter is additionally complicated being that the software is cloud-based. And as Dr. Udell predicted, the change is going to be very expensive. Allscripts did not pay $100M for the purchase of PF with the intention of losing money on the transaction.
Joshua Kaye, DPM, Los Angeles, CA
01/26/2018
RESPONSES/COMMENTS (EMR) - PART 1A
From: David Secord, DPM
VistA EHR, more formally known as the VistA Computerized Patient Record System (CPRS), is an open source electronic health record (EHR) system developed by the United States Department of Veterans Affairs (VA). It requires a partition on your hard drive to run Linux, and you can elect to simply run a version such as Redhat Linux so that you have a GUI (graphic user interface). More can be found at the forum (which is open source and free, by the way).
David Secord, DPM, Corpus Christi, TX
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