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08/18/2023
RESPONSES/COMMENTS (EMR)
RE: Regrets About Switching to EMR
From: Tip Sullivan, DPM
After more than 30 years in practice, I allowed myself to become convinced that converting over to EMR (electronic medical records) was the thing to do. I believe that this has been the greatest challenge of my career. How I hated those stacks of paper charts on my desk every morning! Now, how I wish I had them back!
I am a simple-minded man and it seems to me that this could be done much easier. Think about it... the police wear cameras, sports people use Go Pro. I wonder why we can’t have a simple camera in the exam room or on our jacket to record the visit. Patient confidentiality could easily be handled with a consent. Billing could be done easily by the physician or a transcriptionist. We'd probably would have to get insurance companies on board—but mark my word - it is coming!
Tip Sullivan, DPM, Jackson, MS
Other messages in this thread:
07/17/2024
RESPONSES/COMMENTS (EMR)
From: Pete Harvey, DPM
I use MD Tool Box. My service fee is $30/month excluding controlled substance. You can contact them for a quote on the extra fee for controlled substance. I think it’s only $10-20 more. I also do not write many controlled substances. However, in Texas, the pharmacy board provides a script pad with a specific barcode on it to identify the prescriber. They provide that service as a courtesy for low prescribers.
There are six security features such as: Thermochromatic Rx ink mark, Repetitive VOID when copied, Rx must be blue, true fourdrinier watermark, paper is chemical sensitized to prevent alteration, and invisible fluorescent fibers revealed with black light. My pads are kept in a safe. You should contact your state controlled substance overseer and ask if they provide that same service.
Pete Harvey, DPM, Wichita Falls TX
07/16/2024
RESPONSES/COMMENTS (EMR)
From: Elliot Udell, DPM
We use Veradigm for all of our prescription writing. They are a branch of Allscripts.
Elliot Udell, DPM, Hicksville, NY
04/26/2024
RESPONSES/COMMENTS (EMR)
From: Lawrence Kosova, DPM
The question you are asking is an excellent one and will be answered by the end users/doctors.
Just so you know, I have beta tested 5 products in the AI scribe world and I am on the medical advisory board for HeidiHealth. This is a free AI scribe with multispecialty language models including podiatry, so you can get your SOAP and H&P notes done efficiently. All the EMR companies I have talked with, including the large players like Epic and Athena, are beta testing solutions now.
These will be profit centers for the EMR companies. So whatever product you are currently using, you should be asking what EMR companies are they currently in discussions with for integration and what are their projected timelines? I am perfectly happy right now being about 98% finished with my chart note when I walk out of the patient room. I then spend a few minutes to review the chart note and...
Editor's note: Dr. Kosova's extended-length can be read here.
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
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
08/30/2023
RESPONSES/COMMENTS (EMR)
From: Brian Lee, DPM
The best solution I've found for the ongoing cost of EHRs? My biller provides the EHR at no cost to me! And it's NextGen. I've had it for almost 8 years and have been pleased.
Brian Lee, DPM, Mt. Vernon, IL
08/29/2023
RESPONSES/COMMENTS (EMR)
From: Howard E Friedman, DPM
I recommend Practice Fusion as an EHR. I have been using it for the past 10 years and can say that they continue to make it better and better. Practice Fusion is cloud-based, cost-effective, and comprehensive. It includes an eRx as well as integrated electronic ordering of labs and radiology studies. It also has built-in electronic faxing outbound, and integrated scanning of documents that makes scanning and adding documents or photos directly into patient charts very easy.
Practice Fusion now has their own integrated billing which I cannot comment on. However, they integrate with a number of billing softwares, one of which I do use, so codes from each visit are directly uploaded into our billing software. In the most recent upgrade, they added was instant checking of insurance eligibility with the ability to easily pull up patient benefits and co-payment information.
Howard E Friedman, DPM, Suffern, NY
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
08/28/2023
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
08/24/2023
RESPONSES/COMMENTS (EMR)
From: Brian Kiel, DPM
I responded in PM News previously, but after seeing Dr. Purdy's letter, I felt that I had to respond. I do not think that EMR has been a joke. It has not taken away my concentration on a patient as I am not busy writing into a chart when talking with the patient. I can concentrate on the patient, I can look them in the face if I have to make a note, I keep a pad next me. Then I leave the room and immediately dictate into the chart through my EMR.
Yes, I do use some templates but they all have places to individualize them, and if the patient's condition varies from the norm, I just dictate as a fresh note. I see 35 to 40 patients a day, working from...
Editor's note: Dr. Kiel'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
08/23/2023
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.
08/22/2023
RESPONSES/COMMENTS (EMR)
From: Pete Harvey, DPM
Many years ago, I attended an EMR discussion in Dallas. This was during the time the government was offering incentives for EMR. The speaker was an attorney. At the end of his talk, he posed the question, “How much money do you think EMR (EHR) will cost you over the next few years?” Several of the audience posited anywhere from 10K-25K. My guess was over 100K and climbing. The attorney scoffed at this.
Turned out I was right. Hardware and software maintenance and continuing software updates are very expensive. However, in today’s medicine, EMR (EHR) is necessary to do business and effective record-keeping. There are many reasons for this, ranging from submission of electronic claims, effective communication with other healthcare professionals, compliance with the law, electronic Rx submission, and, of course, accurate medical records available at the push of a button.
Pete Harvey, DPM, Wichita Falls, TX
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
07/18/2022
RESPONSES/COMMENTS (EMR)
From: Devin Poonai, DPM
I joined a private practice after finishing residency 7 years ago. So I am relatively young in age and experience. I do not use any EMR/EHR. For the first 6 months, I used a pen and paper templates. Then I created Microsoft Word templates and have been using them and printing notes and placing them in paper charts since. I take the MIPS/QIP, etc. hits from insurances, have cases of printer paper in the stock room, and have cabinets of paper charts. I could not be happier. My notes are not the canned, generated generic notes I get from so many other doctors/nurses.
“neck supple, trachea midline, no RRR, normal S1/S2, no bowel distension, AAOX3, sclera non-icteric, no jaundice, normo-cephalic, no Babinski sign.” Give me a break. I throw those notes out when they...
Editor's note: Dr. Poonai's extended-length letter can be read here.
07/15/2022
RESPONSES/COMMENTS (EMR)
From: Adam Siegel, DPM
Most (good) EMRs are integrated with SureScripts which gives providers real-time access to patient-specific and formulary-based benefit and cost information. Surescripts is integrated with over 80% of PMBs nationwide.
Unfortunately, that type of integration doesn’t exist for many of the budget EMRs I see discussed on this forum. My prescription for you: invest in a better EMR.
Adam Siegel, DPM, Tampa, FL
07/06/2022
RESPONSES/COMMENTS (EMR)
From: Patrick Caputo, DPM
For Docs of the same/similar age, similar training, practice, etc. of Dr. Tip Sullivan...I have used 3 different EMRs, (the free Practice Fusion, the 16K TrackNet Server-based that went bankrupt before ever going live and never refunded, and NueMD, which was way too clumsy).
I went back to dictating, proofreading, saving a copy on my computer, and printing the hard copy into an old-fashioned chart. We purge unnecessary stuff from time to time. My "older" PCPs love my notes, especially diabetic foot notes for DME. They tell me that the notes are succinct and tolerable to read, compared to EMR notes from other DPMs, which are not. It has generated more referrals.
My long-term strategy and advice is NOT to take on an EMR now but let the next doctor or acquisition firm take on the burden, especially if they want to use a different EMR.
Patrick (Pat) Caputo, DPM, Holmdel, NJ
05/11/2022
RESPONSES/COMMENTS (EMR)
From: Michael King, DPM
None of us like EMRs, but it is what we have. I have had great luck with the Athena platform. It has amazing metric measuring tools to help with negotiations with payers, has easy-to-use and adjustable macros, and the billing platform is stellar. No, it is not pure podiatric, but the payers are recognizing it as the premiere program for E/M record-keeping and tracking of practice metrics. It is the wave of the future for value added care and where the DPM sits in that world.
Michael King, DPM, Nashville, TN
03/16/2022
RESPONSES/COMMENTS (EMR)
RE: Affordable EMRs (Charles Morelli, DPM)
From: Gary S Smith, DPM
I switched to Sammy a couple of years ago. I was very satisfied. Modernizing Medicine has purchased Sammy and things have gone downhill. We do not get adequate support. We use Sammy for billing and their system stopped billing Highmark advantage programs correctly 6 months ago, and they still can't solve the problem. It seems that support is often clueless about many things we ask them.
As Dr. Morelli stated, you pay the full amount for each doctor but all doctors share the same software. In other words, the software is customized for each doctor but all the pre-built documents are shown on all users' software, leading to unnecessary huge menus to scroll through. It's really not a great program for a multi-physician office.
Gary S Smith, DPM, Bradford, PA
03/14/2022
RESPONSES/COMMENTS (EMR)
RE: Affordable EMRs
From: Charles Morelli, DPM
There was a brief discussion last month regarding EMR and comments were made about Modernizing Medicine, Tracknet, etc. I also inquired as to whether or not there is some type of database that could be accessed to see what programs are available for podiatry, their fee structure, and features of the programs but as no one has responded, I'm assuming there is not.
This is unfortunate as those of us in private practice need to use programs in order to run our businesses. I started with DR software over three decades ago and then transitioned to ICS software/Sammy for the past 25 years and have been satisfied but...
Editor's note: Dr. Morelli's extended-length letter can be read here.
02/10/2022
RESPONSES/COMMENTS (EMR)
RE: Free EMR Programs (John Moglia, DPM)
From: Jeffrey Kass, DPM
I always felt the Government should have given all physicians the same EHR for free. This way physicians would have all patient records and duplicity of tests would not be ordered. Having said that, I felt the APMA made a faux pax by also not creating an EHR, and so individual practitioners paid for programs individually which was not very cost-effective. I understand the current leadership is in the process of doing this and commend them as I guess better late than never.
Jeffrey Kass, DPM, Forest Hills, NY
02/09/2022
RESPONSES/COMMENTS (EMR)
From: Elliot Udell, DPM
When Practice Fusion first began, it was free. As soon as they amassed a critical number of clients, they sold out to a much larger company and the new company started charging monthly fees. As the saying goes, "there are no free lunches" out there. Hence, you can use a free program but be prepared for there to be an eventual charge, or worse... with the company going out of business along with your patients' medical records.
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
02/08/2022
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
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