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
12/04/2024
RESPONSES/COMMENTS (EMR)
From: David Secord, DPM
When I transitioned my office from paper, I rented a scanner and did it myself. Commercial scanners are able to do a lot of pages in a short amount of time. I converted my entire office in a weekend. Here is some data on the scanner I rented: BancTec IntelliScan XDS.
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BancTec IntelliScan XDS |
BancTec has, once again, stepped to the forefront of the marketplace with the introduction of IntelliScan, a next-generation document processing suite that redefines speed and produces superior, higher resolution images. The latest in BancTec's proven line of integrated solutions for...
Editor's note: Dr. Secord's extended-length letter can be read here.
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
12/02/2024
QUERIES (EMR)
Query: Scanning Paper Records
I recently joined a large podiatry group using ModMed EHR. I am transitioning my active patient paper charts by scanning into Mod Med easily enough. However, I need to scan my prior inactive patients and deceased patients' records onto a separate external hard drive with an EHR that is not part of the group practice responsibility.
What would be a relatively inexpensive EHR or alternative method that would allow storage and retrieval of patient records if needed, as I am now legally responsible for the past 7 years for these records?
John Moglia, DPM, Berkeley Hts, NJ
11/04/2024
QUERIES (EMR)
Query: Transitioning from Sammy
Now that Sammy is ‘expiring’ does anyone recommend a system with a fairly easy transition and pricing structure?
Jay Kerner, DPM, Rockville Centre, NY
08/09/2024
RESPONSES/COMMENTS (EMR)
From: Larry Kosova, DPM
Dr. Weiss, I have been involved with speech to text and integration with EMR systems for about 25 years. I beta tested 5 AI medical charting (Ambient listening) systems. After working with the companies' programmers, I have been live in the office for over 5 months now. There are major differences between the products. I am a medical advisor for Heidi Health AI, since it was very clear to me the differences. There is a podiatry specialty. There is even a podiatry assistant and one for about 50 different specialties. They are also showing at the APMA meeting this week and are one of the sponsors of the meeting. I am at the booth. The big differences are the ability to use the product the way you want to, and be able to tailor it for your personal needs.
Many products only have 1 or 2 ways to make a note. With Heidi you can make any template or any note you want to. We use it for our back to school forms, patient summaries, referral notes, etc. It listens to me and my patient. I push a button. It creates a note in 30 seconds. It automatically creates the SOAP or H&P note. I re-read, if needed, for minor edits and done. It is so much faster than using Dragon. I haven't touched it since starting AI charting. There will be more on this in the September issue of PM magazine. Please reach out anytime.
Larry Kosova DPM, Medical Advisor - Heidihealth AI
08/08/2024
QUERIES (EMR)
Query: AI Scribes/EMRs
I am curious to know if any DPMs are using AI scribes/EMRs, and if so, which ones? What has been your experience using them? What are the costs involved?
David T. Weiss, DPM, Richmond, VA
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
07/15/2024
QUERIES (EMR)
Query: Source to Affordably Send eRXs
I am a podiatrist in Louisville, Kentucky. We are required to electronically prescribe for controlled substances. I do not write prescriptions for controlled substances that often and my EMR will charge a large fee for that service. My office has already filed a temporary exemption for this prescribing mandate but my exemption is about to expire. Do any PM News readers know of any affordable services which allow me to electronically prescribe controlled substances?
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.
04/26/2024 Lawrence Kosova, DPM
EMR /EHR Recommendations (PM News Subscriber)
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 is their projected timelines. I am
perfectly happy right now being about 98% finished
with my chart note when I walked out of the
patient room. I then spend a few minutes to review
the chart note and make some edits then copy and
paste into my EHR. As you might be finding out,
this is such a time saver and I end up with more
comprehensive notes that I could never get from
using a Dragon speech product.
So what will you do when the product you are
currently using is better than the one the EMR is
suggesting? Many companies are allowing multiple
AI Scribe companies to do some sort of
integration/testing. I just know from experience
with speech integrations with EMR in the past that
there are different levels of effectiveness.
I heard some companies are going to use a product
I decided against since it was just unusable in a
live clinic situation. Price and not effectiveness
might be their deciding factor. I read a quote
from the AMA the other day and a patient that is a
teacher told me something similar also from their
association. "AI won't replace doctors. But
doctors that don't use AI might be replaced". I
thought that was very telling ass to where things
are heading.
Lawrence Kosova, DPM, Naperville, IL
04/25/2024
QUERIES (EMR)
Query: EMR/EHR Recommendations
I recently started using a very competent remote scribe and I am very thankful and grateful after making this decision. I feel like I can continue working solo, see more patients, and not bother hiring another doc - or get sidetracked with “burnout”! I am wondering what other pods are doing regarding current EMR.
PM News Subscriber
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
02/29/2024
QUERIES (EMR)
Query: Which EMR Do You Like?
I am looking into a new EMR system for my established practice. I am looking into MODMED, NextGen, and Populate. I would like to hear comments from those who like their system.
Mitchell Greenbaum, DPM, Roslyn Heights, NY
11/08/2023
QUERIES EMR
Query: DrChrono EHR
Is anyone currently using or have used DrChrono EHR in their office? Could you please give your feedback on the system?
Peter Sardella, DPM, Providence, RI
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 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
08/25/2023
QUERIES (EMR)
Query: Recommendations for New EMR
I am wondering what EMR other practitioners are utilizing. I am unhappy with my current system and how they are kicking the old users to the curb unless we move to their new system. Any suggestions would be greatly appreciated.
Scot Zindel, DPM, Lynchburg, VA
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.
08/24/2023 Brian Kiel, DPM
Regrets About Switching to EMR (Jon Purdy, DPM)
I responded to PM News previously, but after seen
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 were talked 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 template but they all have
places to individualized them and if the patient's
condition varies from the norm I just dictated as a
fresh note. I see 35 to 40 patients a day, working
from 8:15 to 11: 15 and from 1:00 to 4:15 daily. I
see approximately 5 new patients in the morning and
approximately 5 new patients in the afternoon.
When I leave at 4:30 PM or so, my charts are done
and my charges are in. No one has to interpret my
handwriting. The patient once a copy of the chart
they can have it at that moment. If I need to pre-
cert or if I need to send a chart for an MRI or
physical therapy it can be done at that moment. If
I write a prescription and there is a
contraindication, I get an immediate red flag. If I
prescribed a medication and there is an allergy
which the patient did not tell me about I get a red
flag.
When I get chart notes from other doctors, there
may be extraneous information but I can read it
because it is in a typewritten form.
When you dictate, you have to think about what you
saw and what you did. When you scribble your note
usually is exactly what they are scribble notes and
not a complete chart (I know everyone does not do
that but it is very common.).
I have used some form of EMR since 1981 and I love
it. It seems to me the biggest complaint about EMR
is the cost. Yes, there is a cost but there is
always a cause for new technology. I do not think
any of you dependent upon a land line for anything
any longer. You have your cell phone which is more
expensive more difficult to use but it gives you a
lot more information and is far more useful than a
landline.
Brian Kiel, DPM, Memphis, TN
