Staying Independent...Together

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   RE: Emr /practice management
 From: Andy Zelinski
 To: Member Forum
 Posted: 06-02-2017 23:06
 Message: EHR and Practice Management software companies had their time in the sun where they got to extol the benefits of their systems compared to paper systems and printed CMS1500 billing from the 90s. that time should be over now; its time to hold them to the same standards as actual good software we are used to, like LinkedIn, Netflix, Gmail, etc. That was our mission (I live in Silicon Valley so I was practically obligated), and we went through many trials and errors... here is our findings.

  •  most of these were architected over a decade ago
  •  Most have little to no User Experience(the study of interaction and intuition of software) expertise as part of the design
  •  Most waste a ton of your time with click lags of 10 seconds, or, in the case of some PM like NeuMd, lags for literally 60 seconds opening because of an archaic java web start technology. 
  •  Good software should not require 3 months of training and booklets and scheduled hour long phone/screen share sessions 
  •  Good software should not hide common things behind 7 clicks 
  • Good software companies should be confident enough to have a demo version, a free version, or provide a free trial. make that a requirement if you are looking
  •  most of these are way over-engineered. simple things should be simple 
  •  Nobody has done EHR + PM well, and most PM softwares have also a terrible version of an EHR. It makes me question management - why are they wasting man hours building sub par EHR? Why not just focus on a core competency? There is a compelling argument for having one system vs two, but the differences in designing for billing and designing for clinic have proved too difficult so far. We recommend a PM software that does not also try to do EHR

EHR and PM Reviewed:

Epic EHR:    this might be considered good software if the year is 1978
Athena: did not enough time for an emphatic review, but i would rate it a solid C+
Dr Chrono EHR PM: it seems they got off to a great start but flubbed the detail of the implementation. overall poor
AdvancedMd EHR PM: did not get passed the annoyance of the high pressure sale and having to remind ourselves that we are looking for EHR not a time-share. seems over engineered and they are EHR plus PM
NueMd EHR PM : Might be the most brutal software I have ever used, of course behind United Healthcare's online claim status checker. We started with them and I wasted probably 20 hours of my life waiting for the program to load (on my fast computer). we left half way through first year.
CollaborateMd PM: if accepting that all PM is clunky and over-engineered, this ranks toward the top. they are not also EHR - they focus on billing. however this means you have to have a partner EHR. B+
Kareo EHR PM: we are currently transitioning away from Kareo. Promising at first - they have a web app(browser) version, and its very pretty, but it's a disaster. it does not sync with the downloaded version and lacks most functionality. Another example of good intentions but an over -engineered product. Click lag up to 15 seconds; we use just as PM but the thing is cluttered with appointments, create patient, messages, patient portal, etc that we would never use. B- or C+
Practice Suite PM: These guys seemingly are on the right track.. they claim they are dropping the EHR to focus on PM. Its much snappier than most PM, and is one of two we are deciding between for our switch. The interface and UI needs an update though. They have a free version you can play with
Practice Fusion EHR: Still a startup but widely used because its free. It's a great way to start, and has lots of functionality. In no way can one consider it "good" though. They also have young management and in my opinion lack the vision and ability to quickly innovate or respond to requests. In fact I predict they wont be around in 5 years. Overall a clunky experience if you have high standards, a great example of how engineers dont understand docs. I used to get frustrated taking 7 clicks to find something that should be on the page already. Overall things just take way too long, especially super bills. We also encountered all kind of bugs. Start with PF, and immediately plan next move.

Our current:
Elation EHR: Elation (also a startup here in SF) is such a superior EHR to all the other ones i have seen that it literally has made my staff giggle with how intuitive and simple it is, how snappy it is. In other words, simple things are finally simple. I think we ended up going through about 3 additional hours of training just to get to mastery, but we did no training for the first month or so after the initial demo we did with the support team. They have a demo version to play with.  Its what you call a single page application (like gmail). Everything on the EHR is visible from the main page, unless you open a persons chart, then it opens a new tab so you dont lose your place. it's a well designed system. I can look at my docs note on the left side of the screen, and code the visit with 7 CPT codes in about 15 seconds. That used to take 5 minutes with Practice fusion.

Orchestra One A completely new approach, and very young company. started as a scheduling and messaging platform, but have morphed to be your PM software AND Clearinghouse. All you do is "check out" after a visit and they handle everything.  Read and commiserate with their blog to understand why they exist-- They were also tired of the terrible tooling in this industry. We are looking  to use it with Elation and write our own interface (they will provide this for everyone in the near future) to sync them

Sorry if this is long, but i believe its important. Not that we do not want to be jobs creators, but with the right tools, one person can do the job that used to require 3 people. Don't accept sub par tools!

Andy Zelinski
San Francisco, CA
Tucson AZ
Original Message:
Sent: 01-01-2017 13:19
From: Michael Barron
Subject: Emr /practice management

We've come a long way from using computers to automate tasks/workflow --> increase productivity.  The evolution of PCs supposedly brought computing power to individuals and small businesses but doctors now find ourselves having workflow/tasks imposed on us.  This makes using/choosing an EMR painful.  I wonder if it has to be that way?

  • Could we spend some time defining our workflows?
  • Could we do better using a bigger variety of software rather than picking one program to do what we need?
  • Could we make better use of scripts/macros?
  • Could we hire programmers to write small programs or linking software between programs (this can often be done for a couple hundred bucks on sites like
  • Are we willing to return to pen/paper or dictation where appropriate?
  • Is meaningful use still providing a return on that investment or is this a sunk cost that should be abandoned?

My interest in these things led me over the last 13 years to develop my own EMR.  However, there are opportunities for anyone to improve their workflow without learning to program.  Creating incremental workflow improvements is something I really enjoy about my practice.  Over time this can make one's practice better and better; intermittently switching from one EMR to another seems to undermine that possibility. 

If anyone is interested I'd be happy to help with a project as long as they agree to publish updates and results on the forum.

Michael Barron
Barron Family Medicine
University City MO
Original Message:
Sent: 11-18-2016 06:37
From: Margaret Coughlan
Subject: Emr /practice management

Hello all,

I have been using Athena for over 4 years. It is quite expensive but very comprehensive.  They do my billing and posting as well as patient portal, etc. However I have issues with customer support lately so in the market to switch vendors. Two questions,  anyone love their emr/pm program?  Second, anyone switch after several years, how hard is it? That is one of the issues with this whole thing, we almost get stuck to keep the same one due to inertia...

Margaret Coughlan MD
Millbrook, NY

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