EMR User Experiences
Post your comments and experiences here regarding your EMR system. Is it good, great or simply adequate? What does the system do well and what would you like to see as enhanced features? Has the EMR allowed you to improve efficiency and see more patients in a similar period of time to your pre-EMR practice? Have you been able to improve your quality of care? Perhaps you have learned something about the use of your EMR that could be useful to other users of the product? To enter your comments, simply click on the 'Comments' link below this posting.
I am using MacMedical, and can highly recommend it. I do remember 4 years ago the agonizing moments trying to figure out how to make this major investment. We did a lot of research, but could not come up with any answers. In demo mode they all looked good. We realized however that at the end of the day, the thing that really counts is how well it works in practice.
I started calling colleagues who were using various EMR's. Many had very bitter experiences, others adopted themselves to the software. But the one system that seemed to have a lot of satisfied customers was MacMedical. We took the plunge and bought it. We have been using in the office for 4 years, all are records are now on computer.
If I have a complaint, it is the cost of input. Both myself (I type all my records), and my staff have been doing a lot more keyboarding than I care to admit. On the otherhand, all data is at your fingertips at all times, easy to analyse, graph, search etc. It is a real time saver on the receiving end.
The beauty of MacMedical is that its developer is a Family Physician. It thinks the way I do, does the things I need it to do. A great messaging system, easy consult notes, graphs whatever I need, and easy to get it to do searches. It is basically very user-friendly. I highly recommend it.
Posted by: Les Solomon | January 05, 2004 at 04:56 PM
I would like to see the inclusion of MMS COSTAR as an EMR option. This product has quietly been providing EMR to doctors in Canada and the USA for 34 years with an evolving and highly functional product.
As a member of a Family Health Network (primary care reform in Ontario) COSTAR was invaluable in assisting in the rostering of our practice and the ongoing tracking of rostered status of our patients. Rostered status represents a critical prameter in over 85% of the income in the FHN model.
COSTAR is allowing us to track and monitor our complience with the preventative measures of Pap Smears, Flu shots, Mammograms, and childhood immunization. These parameters are directly rewarded in the FHN model and represent a potential income of $8,800 per doctor per year. All this is additional income, achievable only through effective IT.
COSTAR has the ability to operate as a secure wide area network (WAN) which allows groups in different offices to use a common clinical management system.
This product has a proven track record, it works, and it deserves serious consideration for primary care practices operating in one of the reformed payment systems.
Posted by: George Southey | January 05, 2004 at 05:07 PM
Thanks George, the link to MMS COSTAR has been added. If any visitors to the site are aware of EMR systems that have not been added to the link list on the left side-bar, please let me know and I will add them.
Posted by: Alan Brookstone | January 07, 2004 at 08:51 AM
Our group of 13+ family docs and another group of 4 FPs share a server and have been Chartless this past 4 years using CLINICARE's EMR. The EMR combines speed, reliability, security, with productive software enhanced by end user input along with an experienced stable company.
I have realized my goals for implementaion of IT in our office with this EMR. These goals were to do a better job for my patients (one on one as well as population health) and to go home chartless. I now work more efficiently, with less total hours in the office, less hours of work at home and my volumes are up. Patients are hitting targeted goals for treatment/prevention far more often than before.
In rating our EMR I have to give it top marks for speed, stability, flexibilty (every doc is different) and practical end user productivity features (search, recall, request for referral letters, prescriptions, in office messaging and delegation of tasks). The company gets top marks for service (Ontario install, Calgary Head Office - no problem), professionalism, and for constantly moving this industry and it's product forward.
KLAS has recently rated many systems in the USA and found CLINICARE's EMR to be "highest rated EMR in North America for group practices under 25 phusicians" KLAS Enterprises.
Improvements to the product are always happening. Four years ago, I would not describe our EMR as 'elegant" but their latest version, EMRxP, hits the mark.
Not everyone was enthused in the beginning and the changes required to transition from paper to chartless can be challenging. The company told us where the hurdles would be (archiving) and suggested solutions.
Now, none of us are going back to paper.
Posted by: Stephen McLaren | January 07, 2004 at 12:51 PM
For the specialist in chronic diseases (I am a rheumatologist) it is critical that the EMR will connect to other data sources, in particular - lab and DI. Standard messaging practices in Alberta are beginning to emerge and are proving very valuable.
Security concerns for the laboratory and the associated health authority tend to be road-blocks to progress, until a concerted effort is made to understand the clinical and security issues. The regional health authority has different options, but the one I prefer is the "secure FTP" with PKI. It keeps the cost down for the vendor, and thus the costs are less for me.
The secure FTP process is an approach that should also be considered for posting discharge summaries, DI reports, and other information that needs to be share
Posted by: Steve Edworthy | January 15, 2004 at 08:26 AM
I tried an earlier version of purkinje for a research project. The input was through a tablet mouse.The experience was a good one, however I was dying to try an input on a tablet platform where my probing was on a touch sensitive screen. As well, in primary care we need to make "complex notes" and the opportunity to write free text with good hand writing recognition software is very appealing. I would therefore would be very interested in an EMR that works well with a tablet PC.
Posted by: Mark Roper | January 19, 2004 at 07:55 PM
Mark, I have been testing a Tablet PC with the EMR that I am using. Currently I am using a Motion Computing M1300 tablet Motion Computing which is available in Canada as an OEM product under the Gateway label Gateway Computers: Canada.
I really like the Tablet interface as it is very natural especially for tasks such as prescribing. However the handwriting recognition depends on the clarity of your handwriting and the vocabulary that is native to the Tablet PC (similar to speech recognition). There are also some third party tools that increase the accuracy of the handwriting recognition. I purchased a 70,000 word medical vocabulary from a company called Ablet Factory. This has significantly increased the accuracy of the handwriting recognition.
As far as the Tablet PC is concerned, I really enjoy using it, but there is definitely a learning curve.
Posted by: Alan Brookstone | January 19, 2004 at 10:25 PM
Thanks Alan. You are certainly ahead of the curve in this area. Can you tell me which emr's available on your list are most adapted to the tablet pc input(be it free text or hand writing recognition)?
Posted by: mark roper | January 20, 2004 at 07:23 PM
Our office, a 2 person family practice, has been using the YorkMed Purkinje EMR since the early days of COMPETE and I would highly recommend it. For me it is like a well broken in hockey skate. It has all the usual advantages of an emr system – lab values online, a drug prescribing/ interaction module that I would be really uncomfortable working without, summary tables, automatic document generation – referral letters etc, and allows easy tracking of all the data that is entered.
Although daunting at first, data entry is actually very flexible. It is based on a series of over 300 templates for various symptoms or diseases and data is entered using a touch pad, which believe me is much faster than a mouse. The templates are based on a common structure with expanding trees and are based on the standard CC, HPI, PMH etc, although they can be adapted to a SOAP format. It allows for number and letter recognition through the touchpad. One may also dictate and have a transcriptionist type into the record, one can type oneself, or use voice recognition. One can customize templates and a followup mode is useful for chronic conditions.
It has been interesting to see the progression form version 1 to the present version 3.x that we are using. There have been many added features to improve the efficiency of using the system, to ease navigation through the templates. Output has been made flexible to allow printing anywhere in the office or faxing as in the case of a prescription directly from the clinical encounter.
The other interesting aspect is the decision of YorkMed, in the administrative area of the emr to go with Microsoft Outlook as a basis for the appointment schedule We have only begun to scratch the surface for realizing the potential of integrating the rest of the emr into Outlook for optimizing our workflow. We have been using Outlook for internal messaging for many years, but this integration allows greater efficiencies, for example a message sent from the exam room, prompts my receptionist to book an investigation of consultation, fax the requisition or referral letter to the appropriate place and hand the patient their appointment as they walk out the door.
We look forward to utilizing more of the functionality that is available and the caveat that ease of use does not come overnight and an investment of time is required to learn the system and develop it to suit one’s own needs. I can’t wait for my new hockey skates!
Posted by: Dr. Michael Pray | January 22, 2004 at 05:31 AM
I am another MacMedical user. I switched to EMR in 1995 and I regret waiting as long as I did. It has made a tremendous difference to me.
I was peer reviewed by the College of Physicians and Surgeons of Ontario 1n 1998 and that experience alone was worth the price of admission. The reviewer was thrilled - "You mean I can read the notes effortlessly?" he said.
It is a major time saver when an insurance company wants a report or when someone moves to a new practice - no more photocopying - I just hit print.
Everything is available immediately for review and the cumulative patient profile can be flicked on and off at will. Data searches are extremely simple and straightforward and I can add an endless series of preprinted forms and layouts. For example, I use the Folstein Mini Mental Status Exam. It took me 5 minues to type it in and now, when want to use it, I type fol followed by command i (for insert) and it's ready to use.
I use a Visioneer scanner caled a Strobe Pro that sits on my desk and is always turned on. It takes up very little space (28 cm x 8.5 cm x 4.5 cm) on my desk and is always turned on. When a consultant letter comes, I scan it and run it through optical character recognition software so that it becomes part of the electronic record. If it is handwritten, I can just save an electronic photocopy of it instead, but it uses up more disc space that way.
I have a comment about backups. It seems to me that it is almost as important to have hardware backup as it is to have software backup. If you come into your ofice in the morning and the machine is dead, you are all the way up the creek (this has happened to me). I have two Macs on my desk. One has the EMR and the other one is connected to the internet. This is probably more paranoid than I need to be about record privacy but that's how I am. If the EMR machine is not working I can start up the EMR on the other machine in about 10 minutes and run it that way while I figure out what happened or get a repair.
I backup the EMR daily onto a 512 MB USB memory device (9.5 cm x2.5 cm x 1 cm) and keep it in my briefcase and then I backup the whole internal hard drive once a week onto two different external hard drives, one of which is portable and also lives in my briefcase. I believe I am thief, fire and computer screw-up resistant.
I love Macmedical. It's stable and easy.
Posted by: Tony Wells | February 11, 2004 at 11:49 AM
HEALTHQUEST - By MICROQUEST
Hi all. I only just found out about this site.
I work in a 2 doctor practice in Leduc Alberta. We have the expandability to 4 doctors. We use HQ EMR. We have a mixture of fixed pc's, laptops and tablets. Hence we have a mixture of hard wired and wireless networking. I am also able to access the system from outside using a VPN.
I am working with the local POSP (physician Office Support Program) people and I will be doing some Vendor conformity testing (VCUR).
We have found the software to be excellent with easy integration, training and usability. My colleague was not able to use the tablet and now uses a laptop dee which he still likes the system a lot. I personnally use a compaq tablet pc and have adapted the software to optimise the tablets performance and strengths. I use a lot of phrase lists so I just point and try to keep the typing to a minimum. I found the experience was quite easy and I have had excellent support from the company. Once the hardware was installed the software required only a few hours and we were up and running the following day. We have had virtually no down time for either hardware or software - except when I left my tablet at home! I do suggest any prospective user gets a professional to install and maintain hardware as the vast majority of doctors have neither the time nor expertise to do a good job in a complex professional area network. We used our local computer dealer compusmart.
The first few months were fun, because despite the demagraphic data upload, everything else was new and had to be entered. Now we are running on gas. We have our labs downloaded, we always scan xray and letters and so we no longer lose a staff member trying to find documents. We don't pull charts except in rare cases and it is still decreasing. Filing time has been cut to a minimum. Prescriptions are easy - we can use the official PIN network but access restrictions and sloooowwww software mean we don't bother.
The staff love the sofware as it has eased their jobs. We passed our Privacy impact Assessment (despite wireless) with no problem. We have achieved our goals as set out by POSP thanks to good work by all our staff and second to none support from HQ.
We would not want to go back
Posted by: David Woolliscroft | March 16, 2004 at 02:45 PM
I am a Family Physician working in a group practice of 6 FP's in Calgary. We implemented an EMR in September 2002 using Jonoke's Medifile. We have been extremely pleased with the product and with Jonoke in general. As always, the first month was a bit challenging as trying to learn a new way to do things from a work flow perspective was a bit difficult. However, this product is very user friendly and we all developed confidence in the process fairly quickly. Jonoke's support staff were very helpful at all times. We had a few staff with fairly limited computer skills and great skepticism about the project and even they became comfortable in a fairly short period of time. All of us have found this system to be friendly and easy to use, has helped us organize the enormous amount of paper that flows through our offices on a daily basis,and helped us to provide better care for our patients with more legible and better organized chart information and well as tracking, reminders for prevention and followup issues. Personally, I find using the product has enhanced my enjoyment of daily practice. I have become more efficient in dealing with daily tasks translating into a small increase in daily volumes of patients. I can work from home via a VPN connection to our network if I chose to without the burden of carrying charts around. As well, for after hours calls, hospital calls, etc I can access patient information away from the office to help me in dealing with issues that arise. None of us in the office would consider going back to paper and the previous way of working.
We have found Medifle to be an excellent, user friendly, flexible and comprehensive program with great support from Jonoke and would have no problems recommended this product for EMR implementation in any sized medical practice.
Posted by: John Coppola | May 15, 2004 at 09:27 AM
Has anyone any experience with the P&P Data Systems EMR? We have looked and it and it looks pretty good. I would appreciate any comments regarding service, user-friendliness,etc
Thanks
Fred Freedman
Posted by: Fred Freedman | May 18, 2004 at 11:47 AM
The EMR of choice in Australia in "Medical Director", with about 85% of the EMR audience. It has been continually beta-tested with upgrades for years. I practiced in an office and that used this system for about 2 years. It is extremely user-friendly and has a well integrated drug database which is unfortunately Australian. It is odd that there has not been any communication with this company, and that the company has not attempted to market itself overseas.
Posted by: Clay Hammett | August 07, 2004 at 06:40 PM
Clay, that is very interesting. I looked up the Medical Director site and was unable to view much about the product. See AustralianDoctor.com.au > Medical Director >> Product Details
Can you share what your experience has been with the conversion to EMR and why you believe that it was possible for one system to become dominant in Australia?
Alan Brookstone
Posted by: Alan Brookstone | August 09, 2004 at 11:05 AM
I am looking into establishing an EMR for my new office, and am interested in any favourable comments regarding different EMRs for a specialist surgeon.
Many thanks
Matt
Posted by: Matt Fletcher | September 15, 2004 at 07:17 AM
Hi Matt,
I discussed your question with a specialist I know who is very much a believer in EMR. He feels that you need the same database as the family practitioner, but a smaller subset of information presented to you in the user interface.
My experience in the past for specialists is that EMR systems need to be much better at text entry and possibly take advantage of speech recognition input as most specialists need to generate detailed consultation letters. If you are searching for an EMR product, I would suggest going though the list of vendors on this site, doing as many of the demos as possible on the vendor sites and then asking a vendor to come in to demo their system. Hope that helps you.
Posted by: Alan Brookstone | September 17, 2004 at 01:59 PM
Does anyone have experience with MediPlan from Telin? We are looking at implementing this product in our paediatric office in Calgary (3 docs) as it appears to meet our workflow needs.
Posted by: Stephen Wainer | September 19, 2004 at 01:52 PM
Alan, thanks very much for the helpful comments. I am looking through a number of different options at present.
I must say I prefer the hosted ASP concept to a local server delivered product. The idea of having a remote backup solution as part of the whole system is attractive.
Posted by: Matt Fletcher | September 21, 2004 at 04:54 AM
Well, I have been researching and looking at a number of EMRs over the past couple of months. For what it's worth, if I can be of help here's some comments:
Every vendor out there has 'the best' system. Others may look good but they have 'service problems' or 'can't deliver what they promise'.
Jonoke: they got good reviews from a couple of people on this forum. I had an on-line demo (I'm in Toronto)...nice enough system but looks and acts very much like any other. The on-line demo didn't work out as first scheduled...their software was acting up so we had to re-schedule...a foreshadow of what may be?
They referred me to the University of Toronto health services to see it in action...as they were just in the process of installing it. Two calls to UofT to see it resulted in 'we'll call you back when we're ready'. One month later I called Jonoke and asked them to please arrange things with UofT. He spoke to them and announced they would call me the 'next week'. That was last month and I've given up.
Either UofT is disorganized, too arrogant or the installation has not gone well. No further followup from Jonoke has not made me a believer.
Abel: O.K. but very pedestrian program. A lot of people seem to find it a bit 'simple'. The salesperson said she would fax me a quote but when I called her she referred me to their website where I got a generic quote based on me calculating from what I thought I might need.
This isn't customer service.
Healthscreen: Looked pretty good in the demo. In general, I would say better than average although it didn't blow me away.
We arranged an on-line demo which went well but when I called in to set up the remote software prior to the demo they technical line was busy and they said they would call back within 10 minutes....it took 1/2 hour. If my office were down I think that would be unacceptable. With my current software vendor (P&P) I usually get right through to tech support.
There is the concern that Healthscreen is a publically traded company and their stock has gone down to just pennies and there seems to be some concern about their economic viability.
P&P: this is what we have been using for about 6 years. Their service, when I call, has been good to us but I hear complaints from other people.
On thing I don't like about them is that there have been no real enhancements to the software for 4 years until their latest re-write for which they are charging a complete new purchase price. Doesn't sound right to a faithful customer.
As well (and I am having another demo from them in 2 days) their software is modular...meaning navigation between functions may require too much key-stroking to re-type names, etc. They say in the next demo they will show me how they plan to improve this. If anyone is interesting I'll let you know.
MacMedical: this is the program I think is the best. It's not perfect but the patient profiles are indeed the most like a doctor's thinking than any of the others. It is not the best appointment scheduler I've seen (I quite like P&P's). The problem is that I am a little nervous about moving to the Mac world when everything I know is pc-based. Am I being too conservative about this? I'd love to hear from others.
The other concern is cost. The programme itself is top dollar and about $10,000 more than some others. They charge $9,000 per year for maintenance in a 3 doctor office. This seems to me to be double the going rate.
Are they worth it? I'd love to hear comments.
One thing I can say is that I have heard nothing negative about MacMedical which is very unusual in this industry.
York Med: another ho-hum programme.
That's it for now.
Posted by: Fred Freedman | September 28, 2004 at 12:29 PM
Currently my short-list is looking at either Nightingale or Wolf; both offer a hosted service, and relatively reasonable costs, although Nightingale do make a significant charge for initial training. Having tried out the online Nightingale system, I was very impressed, although I feel that a lot of the functionality is most suitable for family practitioners rather than specialists. I have yet to try out the Wolf system, but will report back with my opinion.
Accuro by Optimed does look like an impressive system, but only offer a local solution; I will be working across several sites, so a web-based system is ideal, and the idea of setting up a VPN along with everything else is not attractive.
A few other of the EMRs available to Western Canada really do not look like they add up to much IMHO.
Posted by: Matt Fletcher | October 07, 2004 at 06:59 AM
Healthscreen, especially the most recent version, does everything it promises. MacMedical was my first choice, but my accountant pointed out that, as a solo MD, equipment and other costs meant I would still be $10,000 down after 5 years of increased productivity. Plus it is NOT a publically owned company. HS software support has been excellent, considering that I mess up the system regularly playing with hardware and software as I do. I have been using it since Oct 02 and have all the bells and whistles: graphs, searches, scanning, photos (as well as hospital links, x-ray downloads, PDA, and Internet). I've tried wireless, but prefer LAN. Use both typing and voice dictation, macros. It all works. In fact, there are now 3 of us sharing space (2 GP's, one specialist), but completely different networks, each using Healthscreen sucessfully in our own unique fashion.
Posted by: dseguin | October 10, 2004 at 06:59 PM
Medical Director
I (and a few other Canadians) have been using the Australian Medical Director for a few years. It is notable by having literally over 14,000 users in Australia. It has been highly polished for their use and while I don't suggest it (due to the workarounds needed for Canada), I have thought about why it has such market dominence in Australia and what elements make for good program design.
Such usability is rarely appreciated at the first look at a software program, but become important the longer you use a program (I digress, but having to go through 4 screens to pick a patient as I have to do with the hospitals EMR, or sticky notes around the edge of the screen on how to use the program are a good reason not to go there)
Posted by: Peter | June 27, 2005 at 05:28 PM
just a comment about switching to a Mac:
Do it.
It's easy and simple. It took me ( a not so tech-doc) just a few weeks of playing around to get used to it. There are tons of web sites to help you through the switch. The macs never crash and the the interface is clean and simple. The macs are build to last and are great quality. I'll never go back.
I'm planning on setting up my practive with a mac based EMR with voice recognition software. I'll use the next few years of residency to figure out the bugs and which products have what I'll need.
cheers,
Posted by: Peter Inkpen | November 11, 2006 at 02:47 PM