Many long time readers of EMR and HIPAA will know I like to call big, bulky, old EMR software systems, Jabba the Hutt EMR. I think comparing these old legacy EMR software to Jabba the Hutt is a great comparison. For those that don’t know Star Wars that well (and I’m no expert), Jabba the Hutt was a very powerful figure. Although, over time he’d grown so big that he wasn’t very nimble (to say the least). So, despite his power and prestige, there was little to admire about him.

Does that sound a bit like some legacy EMR software? They’re big and powerful figures in the industry. However, their software has grown to the point that it’s clunky and not very nimble. Getting something changed on it is difficult and it’s built on a platform that makes it hard to add new features. Thus, they are Jabba the Hutt EMR.

Without naming names, here’s a list of things that will help you identify the Jabba the Hutt EMR software.

You might be a Jabba the Hutt EMR if…
your interface looks like it’s from the 80′s.

You might be a Jabba the Hutt EMR if…
you use a non SQL database.

You might be a Jabba the Hutt EMR if…
you’re better at marketing than programming.

You might be a Jabba the Hutt EMR if…
you cludged together your PMS that you bought from someone else.

You might be a Jabba the Hutt EMR if…
your interface looks more like DOS than Windows.

You might be a Jabba the Hutt EMR if…
your diagnosis description is restricted to 50 characters.

You might be a Jabba the Hutt EMR if…
your EMR salespeople don’t know your EMR developers who don’t know your EMR customer service people.

You might be a Jabba the Hutt EMR if…
iPad interface….what’s that?

I think it’s worth noting that having one or two of these things doesn’t absolutely mean an EMR vendor is a Jabba the Hutt EMR vendor. Although, the more of the above characteristics an EMR vendor has, the more you should look into it.

I hope others will add to this list in the comments.

Things are rocking and rolling here at EMR and HIPAA and Healthcare Scene. As you have probably seen, I’ve been working really hard to provide a platform for the independent voices in healthcare IT. We currently have 8 blogs in the Healthcare Scene blog network and 3 more in beta that will be announced officially in the next week.

If you’ve read this blog, you know that I’m narrowly focused on bringing good information to doctors and practice managers. I sincerely don’t have any particular agendas or hidden motives. My goal is to provide some amount of transparency and quality information to the masses mixed in with some thoughtful commentary on the world of EMR, EHR and Healthcare IT. Hopefully that’s what you see when you read.

A couple of the new blogs I’ll be officially launching in the next week will help in that goal as well. Not to mention a couple other side projects which I’m working on which could be really exciting if all goes well. Was that vague enough for you?

A big thank goes out to the EMR and HIPAA advertisers. They keep the lights on and let me do this as a full time job. Not to mention, I’ve even been able to start hiring some other writers like Neil Versel (see Neil Versel’s EMR and HIPAA posts). Since I last posted I’ve added one new advertiser and had 7 of my current advertisers renew. I love new advertisers, but it makes me feel really good when advertisers renew.

New Advertiser
SynaMed – A web based EMR with fully integrated PM system. Yes, they are ONC-ATBC 2011/2012 Certified as a Complete EHR. They offer an affordable monthly subscription, no startup-fees, no hidden costs, and training and support included at no additional cost. Synamed was founded in 1999 by a physician in New York City with thousands of medical practitioners and patients across the US.

Renewing Advertisers
Intersystems, Sfax, Enterprise Software Deployment, MDCare EMR, MxSecure, eDoctor, Inc, Mitochon Systems

Starting July 1st, I have some nice changes for advertisers. The goal being to provide all advertisers equal exposure to the top spots on EMRandHIPAA.com. I also completed a Healthcare Scene media kit for those interested in advertising on any of the Healthcare Scene network of sites. If you’re interested, just leave me a note on our Contact Us page.

If you have any thoughts on how we can make EMRandHIPAA.com or any part of the Healthcare Scene network of blogs better, let us know. We’re always open to feedback.

Natalie Hodge MD posted an interesting list on Quora of what she considers a strong EMR system:

I am a pediatrician. Here is what I must have in 2011.
1. Usability. When I say usability, I mean I decide the definition of usability.
2. Patient Health Record. nuf said.
3. Lab interfaces that help my patients get convenient and timely blood draws that flow directly into their medical record.
4. Eprescriber that is easy to use and hosted within the same platform so I don’t have to worry about a third parties server being slow.
5. Secure messaging.
a. I need to be able to email patients in a secure fashion, and they need to be able to email me.
b. Text. I need to have secure text messaging visits with patients.
c. Video. I need to be able to do video visits with patients at times.
d. I need to be able to communicate with my team securely.
6. Inbound fax that brings any external communication directly into my emr system. Seriously it’s 2011.
7. Ecommerce. I do membership practice so I can’t be running to the bank all day long depositing checks.
8. Web based. I have to work in a web based world, because I don’t like the expense of maintaining servers and I have to be able to access my data from anywhere.
9. Iteration. I have to have a rapid feedback loop with the developers of the application. If I can’t continually give feedback that makes the emr better, then I may as well go buy an old dell desktop computer from 2004 and start using that.
10. Mobile. I must be able to access all of this on my mobile, right now, I’m Iphone 4 but next week I might be android.
11. Open. The EMR must continually create further opportunities to help physicians manage health of their patients, whether it’s by integrations with loseit.com, imoveyou.com or nike training camp’s iphone ap. Self tracking may be a key tool physicians may use to solving our nation’s health crisis.

So what I am saying is I have to be able to function in an entirely paperless loop, despite the distractions of reform, medicaid, medicare, meaningful use, and payors.

I’m sure many will have a lot to say about this list. Here are a few of my comments:
1. I wonder how Dr. Hodge defines usable. Of course, that’s the problem. She wants it usable, but likely can’t really define it.
5. I love a number of these ideas. Just a few HIPAA/security issues to deal with. Back in March 2006 I wrote a post with the idea of just having the full video recording from a visit in the EMR. I think it’s the long term future of healthcare. It is interesting that in many companies they want more video recording to protect them from liability. In other cases like many in healthcare, they don’t want video recording since it adds to their liability. I’ll be interested to see EMR vendors text message strategies going forward.
7. You don’t like the checks? Imagine that. Online bill pay. Amazing!
9. This is INCREDIBLY INCREDIBLY valuable. It’s one of the reasons why a smaller, but stable EHR vendor is often more desirable than one of the big name EHR vendors.

What do you think about this list? Is it reasonable? What’s it missing?

It’s been about 3 months since I posted about healthcare IT advertising and the advertisers that keep EMR and HIPAA running. However, I’ve been talking to a lot of people lately about healthcare IT advertising since before HIMSS I’m planning:
1. A New Premium Advertising Package Announcement
2. Launch of a New Healthcare Blog Network

In those discussions (and certainly influenced by the crazy money spent by vendors for HIMSS), I like to give this comparison:
“Compare what you spend at a conference like HIMSS with the 1 million ad impressions a 6 month ad run (Currently $2100) on EMRandHIPAA.com will provide.”

Yep, it costs vendors more to fly people out to a conference than it does to advertise on a very targeted EMR site. I’m currently working on a media kit to help better quantify the value that an advertiser on EMRandHIPAA.com and our family of websites provides.

Even with my pretty simple EMRandHIPAA.com advertising page, we’ve had a lot of very supportive advertisers. In fact, since the last time I posted about new EMR and HIPAA advertisers, I’ve had 8 existing advertisers renew their ads and 3 new advertisers sign up. New advertisers are always great, but there’s a great feeling when an existing advertiser renews since that means they’re getting real value from their investment.

On that note, here’s a look at the 3 new advertisers:

Mitochon – I first met the people behind Mitochon at last year’s HIMSS. They have a real vision for how they think that EHR adoption will occur and I won’t be surprised if they’re right. They offer a Free Certified SaaS EHR, but that’s only the start of their services. They really believe that some of the biggest benefits of EHR is in virtual medical communities. So, they offer an integrated HIE, EMR and PHR. One of the best features of a free EHR is that you can signup for free and try out the full application. So, go check it out and let me know what you think.

Nuesoft – I have a soft place in my heart for Nuesoft. No, not because they created the brilliant Lady Gaga HL7 Interface video. I think fondly of Nuesoft since they were the first EMR I came across when I started working in healthcare IT. The intense 3 day training at their offices was the start of my EMR education. I’m really happy to have their support as an advertiser. Beyond their SaaS EHR offering, they also recently announced the launch of a medical billing service called Nuetopia.

Medical Web Experts – This is a new type of advertiser for EMR and HIPAA since it’s a marketing company that does advertising for a number of different healthcare IT companies. Some of the companies they work with include: PrognoCIS, EMR Consultant, EliteHealthm Phylogic and EMR Experts. John Deutsch is the mastermind behind Medical Web Experts and he also was my very first advertiser on EMRandHIPAA.com. He took the leap advertising on my site in the very early days. It’s great to have him back again.

Thanks also to those advertisers that renewed their ads: Intersystems, PracticeFusion, SOAPware, Ambir, MD-IT, MDCare, MxSecure,and SequelMed.

Side Note: If you’re interested in advertising on EMR and HIPAA, I’d act quickly since the price for the ads is going to increase heading into HIMSS.

While I admit that I’m much more suited to comment on other people’s prognostications and predictions for EMR and health care IT in 2011, I decided to throw caution to the wind and try and make some predictions for the EMR world in 2011.

Few EMR Vendor Acquisitions – I predict that acquisitions of EMR vendors will actually slow down in 2011. Certainly there needs to be some EMR company consolidation with 300+ EMR companies out there right now (and it seems more coming every day). However, I think 2011 will be a wait and see period where companies want to see how the various EMR companies perform for their clients interested in getting the EMR incentive money. The only thing that might ruin this prediction is that if many of the 300+ EMR companies have issues selling product and then have to basically sell off their assets in a fire sale. We might see some of those, but I believe even those will wait until 2012.

EHR Incentive Numbers Down – We’ve all heard the $36 billion in EHR incentive money. Of course, this is just the projection of how much EHR incentive money they’ll have to give out. I expect that when we get the total amount of EHR incentive money paid out in 2011 that it will be much lower than the projected targeted. Especially if many of them sit out 2011 and wait for 2012.

Health Information Exchange Success Stories – There are so many people working on the health information exchange issue that in 2011 we’re finally going to start seeing some breakthrough stories about the exchange of health information. Although, it won’t likely come from where we expect it. Watch for some unique approaches by companies and communities to finally make the exchange of health information a reality. It won’t be across the US in 2011, but we’ll see the signs of what could be in 2011.

Reimbursement for Online Visits – I’m far from an expert on reimbursement and trends in health insurance so this might be a stretch, but I think we’re going to see the first insurance reimbursement for some sort of online visit. The first draft will be a bit cumbersome and restricted, but it will be the start of the online doctor visit in earnest.

Portable Doctor’s Offices – A few years back I started hearing about some doctors who were going back to the old days. Not the old days of medical care, but the old days of the doctor visiting the patients in their homes. When I think about this, I always think of Little House on the Prairie and them calling for someone to go and get Doc Baker. In 2011, I bet we see a lot more doctors eschewing the traditional doctor’s office and visiting patients in their homes. With a hosted EMR and the portable laptops and iPad like technologies that we have today, it makes running an office out of your car pretty reasonable. Certainly it won’t work for all specialties, but it is a service that I think many patients would pay to have from their doctor.

PHR Adoption Will Continue to Lag – I just see no signs that PHR adoption is going to take off this year.

First EMR Lawsuit – I predict 2011 will bring the first HIPAA lawsuit where EMR is at the center of the lawsuit. It will be an important one to watch since it will likely set precedent for future EMR related lawsuits.

There you go. A few little 2011 predictions. I’d love to hear any predictions you’d like to make and which predictions I’ve made that you think are wrong and why.

I’ve tried every way imaginable to get away from having to fax things and as hard as I try, it’s just really hard to replicate the beauty of a simple fax to someone. We could talk about the reasons that faxes are so effective and successful (like everyone has a unique identifier…a phone number), but suffice it say that we’re going to be stuck using faxes for a long time to come. Of course, if you read this and you’re in healthcare then you know the love hate relationship with faxing and how faxing is an essential part of every clinic.

Previously, I’ve talked about the value of a fax server in a clinic that uses an EMR. Many EMR companies are even integrating some sort of fax service into their EMR offering. This is beautiful and any EMR company that doesn’t have this service should remedy it quickly. Doctors just get far too many faxes for it not to be integrated with an EMR.

Well, I was starting to get a fair number of requests to fax things and to get some faxes. I dreaded each request since I didn’t have a dedicated fax line and so I’d have to hook up and re-hook up my fax server all the time. Plus, it was pretty unprofessional for me to tell them to call me so I could hook up the fax. As many of you know, I’ve had SFax as an advertiser on this site for quite a while. So, I asked SFax if I could have free access to their faxing service in return for a post talking about their service. I figured their service had to be better than doing what I was doing. Turns out it was 100 times better than I could have even imagined.

Sfax Review
I’m not sure why, but I had the impression that Sfax would be some website where I just uploaded a file and then I could fax it out that way (which they do have). However, one of the coolest features of SFax was their Sfax Driver. It essentially creates a printer on your computer much like a fax server creates. When you print to it, the dialog for sending a secure fax comes up and you’re able to easily fax anything that you can print.

I also wasn’t sure exactly how they’d handle the fax number. Much to my surprise, they assigned me a unique toll free (877) phone number to receive all my faxes. Most doctors office faxes are local, but for me it’s pretty nice to have a toll free number that people can use for my fax number. Obviously, in a clinic you could just forward your existing number to the toll free number and actively promote your new number for a time period. Then, after an appropriate period you can phase out the old number and save the cost of the extra line or re-purpose the line for something else.

It was kind of funny, because the Sfax support people had been reaching out to me to be sure I got the customer service that I needed to be able to use their product. I found their Sfax printer and online product so simple to use that I just emailed them back and said I didn’t need their help. Basically I’d be wasting my time talking to them because their secure faxing was so easy to use.

I will mention that I was pointed to some videos and tutorials that stepped through the process as well. I actually watched one or two of the videos and kind of laughed because the process was so simple it almost felt like the video wasn’t needed. Although, I’m sure some people will enjoy the hand holding.

The receiving a fax was a great user experience too. I got an email notifying me that the fax had arrived. Plus, the online portal gave me access to the entire history of faxes that I’d sent and received. Pretty sweet.

My only real complaints about the product was that at first some of the terminology was confusing. Sfax driver doesn’t intuitively tell me that it’s going to set up a local printer on my computer that I can use to fax out. I also wish they had a quick way to send a fax to a new phone number. Maybe there is and I just missed it, but it seemed like you needed the phone number in your “Contacts” list in order to send the fax out. Sure, a contacts list is a great feature since you often send something to the same place. However, there’s always those one off faxes where you don’t want that phone number in your contact list. You just want it for that fax.

I won’t cover all the other standard benefits of electronic faxing (ie. no printing, no scanning, no creating cover letters, etc etc etc). Suffice it to say that Sfax had those benefits as well. They also had a bunch of features like Starred Faxes, Forwarding Faxes, and Draft Faxes. I’m not exactly sure how I’d use a Starred Fax (It’s like the Starred feature in Gmail if you’ve used that), but forwarding a fax is a great idea and I’ve used Draft Fax a few times when I needed to go and get more info before sending the fax.

I also love that their online portal can be accessed from any computer I’m using. So, I can access all my faxes in one place and can even send a fax from any computer in the world. Pretty sweet.

EMR Faxing Integration
I wouldn’t be EMR and HIPAA if I didn’t talk about the possible integration of the Sfax secure faxing technology with an EMR. Sfax offers three ways to fax: Sfax Driver (Desktop), Sfax Online (Web) & Sfax API (Integrations). Of course, the API integration piece is the most interesting when it comes to EMR.

Sfax actually has provided a white label fax solution for 7 different EMR vendors and 6 other healthcare solution providers with 8-10 other healthcare software company integrations in the works. So, you might even be using Sfax and not even know it. I can’t say which companies for obvious reasons, but I can see this type of EMR integration working really well. They even mentioned some clever integrations with adding/reading barcodes and automating handling.

Here’s their comments on their faxing API:
We have great API documentation, sample code, test harness (and test account) and have had integrators faxing out from their app in 2 hours! Our delivery rates are industry leading along with error reporting through API. When the integration is done right, the document exchange(fax) part is just beautifully fitted into the natural workflow.

If I was an EMR vendor and didn’t have an integrated faxing service yet, I’d be on the phone to Sfax to talk about leveraging their API so I could worry about other EMR features.

Digital Signatures
Sfax offers a built in set of features for digital signatures. I had a lot of questions about digital signatures and adoption of digital signatures in healthcare and so I’ve asked Sfax to do a future guest post on the topic. So, watch for that.

Fax Security
All of the Sfax online faxing portal uses https 128 bit encryption. Yes, that’s the level of encryption that’s used by the best SaaS based EMR software and all the other e-Commerce sites you might use online. Turns out my first fax was filled with my social security number and other personal info. So, this level of encryption was absolutely necessary for me. Plus, is a requirement for HIPAA if you plan on faxing any PHI.

Secure Fax Pricing
You can check out all the Sfax details including plans and pricing on their web page. They just launched a $24/year plan for people like me that do a pretty low volume of faxing. Then, they have monthly plans from $15/month to $199/month depending on the number of fax pages per month, toll free numbers, API access needs, importing contacts, tailored cover pages, etc. You can also sign up for a 14 day free trial to test it out yourself.

Summary
I honestly wasn’t sure how well Sfax had done at taking the headache out of faxing. Turns out, now I don’t blink an eye when someone asks me if they can fax me something or if I can fax them something. It’s as easy as sending an email now. I just fax away.

Needless to say it’s a lot cheaper and easier to use Sfax than a $10+ per month extra phone line, a $50+ fax machine. Not to mention the paper, tonor and desk space the fax machine requires.

New EMR Doctor Blog
I’m really excited to let you all know about a new EMR Doctor blog called Wired EMR Practice. It’s a blog that I’m doing in partnership with a practicing doctor. I do the hosting, marketing and management of the website and he creates the content. It’s still a very new blog, but check out his post on Physicians vs. Health IT: The EMR Culture War and this post on the ROI of EMR to get a flavor of the content he will be creating. If you like it, you can subscribe by email to the Wired EMR Practice.

The Wired EMR Practice has already landed its first founding advertiser and we’re interested in talking with other people interested in advertising on the site. Those interested can just let us know on our Contact Us page.

Premium EMR and Healthcare IT Advertising Package
For those who read this blog and care about advertising their company, I am working on a new Premium Advertising package. I’ll probably launch it a month or so before HIMSS. It’s going to be a comprehensive advertising package across all of the EMR and HIPAA, EMR and EHR, and Wired EMR Practice network of sites. Not to mention on Twitter, Facebook, and other very targeted EMR related locations. Yes, I think they call this a teaser. Watch for more information on this and if you’re interested, let me know and maybe your company can be part of my new advertising package announcement.

EMR and HIPAA Advertisers
Well, I was looking back at my posts and it looks like it’s been a couple months since I recognized my new and renewing advertisers for EMR and HIPAA. What can I say? I’ve been really busy creating all the content, traveling to a number of conferences and actually adding and renewing advertisers.

Needless to say, I’m very grateful for all of those companies that support EMR and HIPAA with their advertising dollars. Looking at the very high rate of renewal, I think it’s pretty clear that the advertisers are finding value as well.

Without further ado…
New Advertiser
eDoctor, Inc. – eDoctor, Inc. offers a comprehensive electronic prescription system, patient data migration services, and premiere health IT support to healthcare professionals. If you’re looking for an ePrescribing solution, take a look at their free e-Rx software. Looks like they also have an EMR in the oven, called urEMR, that’s set to go live on 12/1/10. We’ll have to keep an eye on that.

Renewing Advertisers
The list of renewing advertisers is quite long. It’s always very satisfying to have my current advertisers renew. Many of these advertisers have been doing so for a couple years. So, thank you!
Intersystems
Sfax
ESD
MDCare
MxSecure
The Drug Company
MD-IT
EMR Consultant

Those interested in advertising on EMR and HIPAA can find more details here.

EMR and Healthcare IT Jobs
Finally, I’m sure there are many that read this blog that are still looking for jobs in the EMR and/or healthcare IT field. If you are, there are a bunch of jobs listed on the EMR and EHR job board. For example, one that was just posted yesterday is for a NextMD Implementation Specialist. Hopefully more of you will post the jobs you have as well.

I love when my readers send me emails that are basically a blog post. Especially when they ask in that email to shed more light on a certain subject. Below you’ll find one such email. I’ve made it anonymous since the particular vendor doesn’t matter too much, but it’s an interesting read from an EMR vendor’s perspective.

My comment is that ONC was given the impossible task of trying to create “meaningful use” guidelines that were in fact meaningful. The concept of paying doctors for actually using the EMR is a good one, but measuring and regulating that is much harder. I’m sure many of you will enjoy the following comments about some of the meaningful use guidelines.

Some of my guys were going over the Meaningful Use requirements to feed the developers their next tasks and realized that we had missed a HUGE piece of functionality. That functionality is the Status of a “problem.” Apparently a “problem” can exist in three states: active, inactive or resolved. Notice the term “problem” is in quotes. First, there are no “problems” there are complaints, diagnoses and treatments. If there were a “problem” it would be something like “chest pain” not “essential hypertension.” The use of the word “problem” starts me down the path that the government doesn’t have a clue as to what this is or how it should work. The icing on the cake is that you don’t have diagnoses that exist in the three states that are mentioned above. Once a diagnoses has been made, the patient responds to treatment and gets better or s/he dies. This reminds me a little bit of your blog about documenting by exception. You get a ream of notes that aren’t relevant at all with every visit. Like that, if you have say chronic obstructive pulmonary disease as outlined in §170.302c, it doesn’t go away. It is a CHRONIC condition and as such will not ever be marked as inactive or resolved. The way I see it there are two kinds of visits, chronic and episodic. If I break my arm and I go get it set and have a cast put on it. This is episodic. If I have diabetes, I have to go for a visit every so often to get it checked out and maybe adjust my treatments. This is chronic. Either way, there is no doctor that is going to go back in to his own notes and mark either of these resolved or inactive on subsequent visits. That propels me far down the path of thinking that nobody making these rules really knows what they are doing. I mean the growth charts were a little piece of functionality that was difficult at best, and showed that these people don’t have the faintest idea about programming, but at least they add value.

I am seriously considering not even attempting certification for these and some of the reasons you have stated in your blog. Here is the real reason for my email: I would like to see a blog about this in the near future. Someone needs to raise his or her hand and cry “foul” before these idiots make more rules that have no meaning and only annoy those of us who do understand what is going on and what we are doing.

It must have been a couple years ago when I first heard about a Free EMR called Practice Fusion. Shortly after hearing about this Free EMR, I got a note saying that Practice Fusion had a Live in Five program that would get a practice live on the Practice Fusion EMR in 5 minutes. Check out my initial reaction to the Practice Fusion Live in Five program from early 2009.

Since that point, I’d wanted to try out this Live in Five challenge to see really how much I could get started in Five minutes with Practice Fusion. I still have the email from 9/15/09 when I first wanted to try this. Suffice it to say that I’ve been sufficiently busy with all the talk of the EMR stimulus that I hadn’t taken the chance to try it out myself. Plus, when I did it, I wanted to do a good job. Especially since I knew it would take more than 5 minutes.

Well, tomorrow I’m heading to the Practice Fusion user group meeting to meet with the people at Practice Fusion and to do some interviews for the XM Radio station ReachMD. That should be fun and you’ll certainly hear more about the interviews later. Since I was going to the Practice Fusion user group, I figured it was time to try the Live in Five challenge and see what I could do. So, that’s what I did.

Signing Up
I started at their standard Practice Fusion EMR sign up page. It’s free so I filled out their simple forms. I think the whole sign up process only took me 2-3 minutes. Granted, I’m pretty fast with computers and online forms. I was a little disappointed that they didn’t let me choose my own username and my own PracticeID. I’m not sure there reasoning with this, but likely it would take people longer to come up with their own. It’s just hard for me to remember the username jlynn677. Plus, it takes me back to the days of AOL, and that’s not pretty. Although, this wasn’t a huge problem for me since I was only using one computer and it remembered the info for me.

As any good system would do, it made me use a more complex password. Yes, I deliberately used an easy one to see what it would do. Good thing it asked me to make it more complex. Annoying for many users, but definitely necessary. I also specified myself as a doctor so I could test the doctor interface.

Well, I was quickly logged in and the first thing I see after logging in is the Practice Fusion training page. I must admit that I was touch overwhelmed by all the training videos. Although, I also was glad there was so many and that I could train at my own rate on whichever features I wanted to train on.

I had to get a taste for the videos and so I clicked the first one to see what they were like. The pace of the video was a bit slow for me, but I could see how this would be extremely beneficial to a new user of the system. The only problem is that the video was cutting into my 5 minute test very quickly. So, I clicked off the video to go and click around the system on my own. I figured the videos would be there later if I couldn’t figure something out myself.

First Impressions
Once I started clicking around I saw this layer of tabs to choose from. As I clicked on each one I was a little confused why these prominent tabs were all for things like To Do List (which was empty of course), Community, Forums, Activity Feed, etc. I was looking for schedule, patients, and charts. Took me a minute to realize that the other buttons above those tabs would get me where I really wanted to go. I guess I’m just so use to tabs being the navigation.

I did notice a prominent button that I thought would be very useful. It was a link to a Live Chat with a support specialist. I’m kind of arrogant like that and wasn’t sure I wanted to ask for help, but I was glad to know it was there in case I needed help of some sort.

Appointment Scheduler
Of course, this was well past the five minute mark. I certainly had been logged in and provisioned on the Practice Fusion EMR in well under five minutes, but as I expected it would take longer than five minutes for me to do a good walk through of their EMR.

I then proceeded to check out the Schedule section. It took me to a “Daily Calendar” section which was of course empty. I started to look around for a button to add an appointment (since I assumed there weren’t any). I even right clicked on the grid to try and add an appointment. The right click revealed the all too familiar Flash Player options. Something that I would see multiple times as I tested the system. I guess I’m just too used to right clicking.

I decided the Daily Calendar didn’t have the option to add an appointment and so I clicked on the Weekly Calendar tab and it worked as expected for scheduling an appointment. I would have loved to have a quick patient creation area when creating the appointment, but overall it was pretty easy to schedule an appointment. It was funny when I was trying to select the patient for the appointment, I went to the bottom right corner of the screen to click the OK (or in this case Select) button. Turns out, I almost clicked on the ad that had a button like image on it. Then, I realized that the Select button I wanted was at the top instead of the bottom.

I also tried to drag and drop the appointment to a new time, but sadly no dice there. I guess Flash doesn’t support drag and drop like that very well? I did like how the patient had a space for an email so it could send an email reminder. I wonder if text message reminders are next.

I then played a bit more with the schedule and found it pretty straightforward. After going back to the Daily Schedule (which now had the appointment I made) I saw a drop down for status. I marked my patient as Arrived and the Status drop down box changed to a new set of statuses. I thought this was really cool, because it only presented you the statuses that you would need. I’m not sure how you’d go back if you changed the status on the wrong one though.

Patient Chart
Now with an appointment scheduled it was time to check out the chart for that patient and start a note. I clicked on the hyper-linked name of the patient in my “Daily Schedule” and was taken to the chart. I was a little confused by where it sent me. It was basically a history page of what had been done on the patient. I saw a lot of other options to click, but I was surprised this was the page I got clicking into the patient chart.

I later realized that I should have clicked on the hyper-linked date and it would have taken me to the note in the chart for that day. Although, since I didn’t I must admit that I was searching for a little while to find out where I could create a note for the patient. I finally found the note listed under the title “Events” with today’s date. That felt a little awkward to me.

Before finding the note, I did see a bunch of history items like PMH, Dx History, Rx list, Allergies, etc. I did find the allergies a bit confusing since it was under the PMH (free text) and then there was a separate tab for Allergies (very specific) and they weren’t tied together in any way. If I have a medical history of allergies shouldn’t that go under my allergies? I think they showed both at other places in the chart, but deciding where to add the allergies and how to add them would be important.

Turns out the Allergies were confusing, but there was a link that said “Learn to add allergies” and so I clicked it and it took me to a training video for allergies. Only problem was the training video was for the allergies tab and I was on the PMH tab. So, it took me a minute to figure out that there were the 2 places. Although, the video introduced me to the other area. Balancing free text entry of allergies with specific allergies are a challenge for every EMR. Not to mention even harder with the Rx list. For example, I didn’t see a way in Practice Fusion to enter some Chinese Herbal Medication in the list. One that’s not likely in the database. Let alone if the patient says, I’m taking the pink pill. I’m not sure how I’d have documented that in the Rx List in Practice Fusion.

Charting
I like how simple and easy to use the SOAP note was in Practice Fusion. It was really straight forward to go in and chart items. Not to mention how easy it was to add your own templates to any section of the SOAP note. I did wonder if any of the vital signs section could be adjusted, added to or modified. It certainly has the base needs, but I know in the clinic I worked in we had a pretty customized intake process for collecting vital signs. For example, our intake asked questions based on the gender (ie. last pap smear for females). I didn’t see any sort of advanced templating like this in the documentation areas. Maybe I just missed it.

I did like the way the dxn sections worked and the integrated ePrescribing. In fact, even with my 30 minutes in, I prescribed a drug and sent it to ePrescribing. Yeah, I had to see what would happen if I tried to ePrescribe since it gave me the option. The system then told me that I needed to fax in a form to get ePrescribing set up and I had a link to download the form (which I think was already filled in with my info). I was glad that it wouldn’t let me ePrescribe, and it was pretty slick to prompt me to sign up for ePrescribing that way.

I also found the script printing page to work really well. You had options to add or remove the signature section or header section of the script. This is a good feature if you prefer to use a stamp or are printing on letterhead already.

The signing of the note was easy and straightforward. I of course wondered how and if I’d be able to make corrections to the note after it was signed. At first I couldn’t find anything, but then in a bit of an obscure location, I found an “Addendum” button that allowed me to add a comment to a signed note.

I did wonder how I’d chart a note for that patient for say a phone call. I didn’t see an easy way in the chart to create a simple note like this. I’m guessing it must be done from some other screen, but I didn’t see a way.

Document Management
I liked the Document Management functions built into Practice Fusion. They were quite slick and I love the way that you can sign off documents. The upload process was easy. On my first upload I completely missed the section to assign the uploaded document to a patient. So, later I had to figure out how to assign it after upload. Not a big deal once I figured out where I missed it.

I was missing the Fax Management section. I’d seen a button to Fax a referral earlier and so I wondered how they dealt with faxes. I knew there had to be an answer so I clicked that “Live Help” button to get an answer to my question. Plus, I must admit that I wondered how quickly they would respond and how the Live Help would work.

After a minute or two I got a live person who told me that they only do outgoing Fax Referrals. They didn’t have any feature for incoming faxes yet. That’s too bad since it would have been a killer feature. Although, a fax server is still killer and easy to set up in an office. I also asked the support person about bulk upload of documents and they said I could only upload one at a time. Not a horrible thing, but I could see bulk upload being a useful feature. Then, just assign them after the bulk upload.

Multiple Logins
One problem with the chat with the Live Support person was that the chat took over my whole Practice Fusion browser session and I couldn’t do anything while we were chatting. The tech person that I am, I decided to open up a new Practice Fusion window on my other monitor. Plus, that would be a good test if I wanted to have 2 windows open at the same time.

Only problem was that once I logged into the new window, the old window logged out. Yep, I guess you can only have one browser session logged in at a time. I even tried to lock the browser session (which is a nice feature) and then log into another browser window. Once I logged back into the locked browser session, I was kicked out again since I had opened the other session. So much for having 2 windows open with Practice Fusion.

Second Login Configuration
I did find it really interesting what happened the second time I logged into Practice Fusion. It gave me a series of screens to configure. Simple things like address, phone, etc of my location. It also asked about any lab interfaces I might need. Definitely a good idea to wait until the second time I logged in to ask me these things.

I also wanted to see what kind of configuration options were available. I thought that it would be utterly overwhelming, but it really wasn’t. Pretty straightforward stuff and easy to add new users, new payers, new facilities, etc. If anything, I wonder if it might need more options.

Overall Thoughts on Practice Fusion EMR
About an hour and twenty minutes later I completed my perusal of Practice Fusion’s EHR. A little longer than the 5 minutes, but that was to be expected. An hour and twenty minutes on my own to go through an EMR is pretty good. I think I could log in right now and easily schedule a patient, chart a note and get them their scripts, referrals etc with no problem. I’d say that’s a pretty simple design.

I do wonder if I’d hit a wall when it came to how simple it is. I wonder if there are other features I’d be wishing they had that they don’t yet have implemented. I’ll be asking some of the doctors that I meet tomorrow this question.

I’m sure this is very purposeful on Practice Fusion’s part, but the EMR is pretty much void of billing. I think I saw one button that said “Send Superbill.” So, I’m mostly evaluating it on the EMR basis and not the billing portion. My understanding is that they work with a Practice Management System for this. I’ll find out more on this tomorrow as well.

As far as the ads, they really weren’t that intrusive. It was fun to see who they had advertising. I saw a few Dell ads along with what looks like an IT consultant that specializes in supporting Practice Fusion implementations. Not to mention a number of pharmaceutical ads and an ad for their user conference tomorrow.

Overall, I found Practice Fusion simple and intuitive to use. There is certainly room for improvement in usability in some aspects of the design, but I didn’t find anything that was too hard to figure out. The fact that it’s a SaaS based EHR bodes well for future development of features and usability as well. Plus, for the price (Free), it’s definitely worth an hour and 20 minute test drive to see for yourself.

Full Disclosure: Practice Fusion is an advertiser on this site and is paying for my flight and hotel to attend their user group meeting as a moderator and for the ReachMD interviews. Although, they didn’t pay me to do this review.

Honestly, this is one of my favorite discussions to have about an EMR system. The only hard part is that it’s an endless debate with no clear resolution. However, the choices that an EMR vendor makes in regards to their cookie cutter vs. customizable approach is really important.

For those who aren’t as familiar with the issue, the challenge lies mainly in out of the box utility vs. ongoing improvement.

The first part of that challenge is that most doctors think that when they spend their hard earned money on an EMR software, that it should be able to just work out of the box. I think many of the other software programs and other things we buy have created this culture of things just working. For example, it’s amazing how few things you have to do to setup a new computer when you buy it. The computer manufacturers have done a great job making it dead simple to get your computer and be using it shortly after pulling it out of the box.

Most people want this same type of thing to happen with an EMR. Sure, they realize that there will be some customization and entry of their clinic specific data. It’s understandable to have to create some users, add in your address and phone number and a few things like that. However, there’s this expectation that I should be able to just start using the system. Many are surprised when they start documenting their first patient to realize that there are no templates (or insert other EMR feature) available to them for that patient.

Of course, in the EMR vendors defense it’s a challenge to pre-load the information in a way that it just works out of the box. Certainly an EMR vendor could load it up with every template imaginable. However, then they’d hear the complaint that the pediatric doctor had no need for those GYN templates and what kind of silly EMR vendor would make that simple mistake. Of course the EMR vendor knows this fact, but how do you build a software that can take this into account. Much easier said than done.

Of course, some EMR vendors have approached these challenges by providing a real cookie cutter approach to EMR. The complaints then come that the EMR system isn’t customizable enough for the doctor. Of course, these are the same people that would have complained about all the customization they would have had to do if they were just given a really bare bones EMR software install.

The reality is that every practice is different and so it’s a major challenge for EMR vendors to balance these two competing interests.

At its core, the EMR software needs to be as setup as possible right out of the box. However, it also needs to provide as much customization as possible so that when the out of the box features aren’t right for a particular practice it can be changed to fit their needs. It’s a funny little balancing act that has more basis in art than science. However, when done right it makes a huge difference.

What types of things do you do or have you seen to solve these challenges?