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Emr /practice management

  • 1.  Emr /practice management

    Posted 11-18-2016 03:37

    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

  • 2.  RE: Emr /practice management

    Posted 11-19-2016 04:18

    I used Athena for 3 years and when the MU dollars dried up they were changing platform, customer service was not good, billing processes were slow, they wrote things off, and they had some mandatory changes to workflow with document labeling, collections and forcing people to give a reason they did not invite to the portal! They took 6.5-8.5% of collections including charging $1 per prescription because they called it an "order". 

    I went totally for the cheap solution - I switched to Practice Fusion EHR =  $60 per month to get the Updox fax solution, and NueMD =$204 per month for basic billing but there was a discount to $154 per month for this first year (a year ago). NueMD charges extra for many features but for eligibility, claims, automatic EOB posting it's all there and support and training was good. I took the absolute minimum. If you want to do phone appointment reminders, electronic statements, online payments it is extra through NueMD. I just put a paypal button on my website for online payments. 

    The PF portal is not as good but it's functional.  PF has e-mail appointment reminders and that seems to work well enough but you must manually enter the appointments that you put in NueMD into Practice Fusion. This works for small practices but double entry of demographics and appointments can be frustrating for high volume, larger practices. There is also double entry for insurance when labs are ordered but all of this is typically done one time per patient. 

    EHR is always a labor of love. I spent many hours doing chart transfers. Once I gave my 90 day notice to Athena, I immediately began using the 2 EHRs side by side to be able to easily do chart transfers and really focused on getting a good picture of the Athena A/R and getting it collected. Practice Fusion IMMEDIATELY transferred my demographics from Athena, e-prescribing, Lab interface was done in a couple days, fax interface set up overnight. NueMD also transferred insurance info and demographics from Athena but I had to make sure the data was in the format they wanted and that took a few weeks to get straightened out. 

    Whatever the problems with PF, at least I can always tell myself it is free. You can pay for billing interfaces but I did not do so. 

    I also looked at Kareo EHR, Elation and drchrono. Those all seemed like possibilities and all had trial version to play around with. I downloaded them all and played around with all of them. I almost went with Elation but they got into this long corporate process about implementation. However, that seemed like a good EHR --they did not have templates for office notes at the time I looked at them.  

    When EHR first started, it used to be choice between "best of breed EHR only" or "integrated system with EHR + PM". I went back to the idea that one company cannot do everything and that I would look at EHRs which is what we need to be happy with daily as we see patients. 

    Things I miss about Athena:  **How robust their medication history feature was. It always pulled in every prescription the patient had previously filled including vaccines from pharmacy. The PF version of this is not as good and must be done manually. However, as they changed platform, I don't know what they did with that feature at Athena. **family balances were visible, **integrated credit card payments (I bought the Groov payments machine as a replacement and it's worked fine), 

    In the end, Athena gave us excellent pdfs of our charts. I am still able to copy and paste chart info into PF charts with those pdfs! I am able to see the patients' last heights, weights, vaccine records, last visits easily. There was actually a contact person for terminations and they handled that well. 

    Mamatha Agrawal, MD
    Family Doctor CaryNC
    Cary, NC
    Live in Raleigh, NC
    Solo since 2012
    Practice Fusion and NueMD

  • 3.  RE: Emr /practice management

    Posted 11-19-2016 07:37

    Hello  Margaret  good to see you

     I am switching emr s right now  My wonderful small server based emr cannot afford to get to MU 2 /MIPS  No wonder I could afford it  700/yr Purchased 11 yrs ago for 2700 EMR vendors are gouging America  I am finishing PCMH and  struggling with the new  vaccine probelm I posted plus my cats are fighting other words  I am overwhelemd but I am switching  to  Practice fusion So far not bad   Now  very early though.    1 I got a demographics  file done for me by Old emr -PF can import demogrhics into it   The rest the meds Fh etc you know I suppose I do one patient at a time My advantag eis that OLD emr is always present so I do not know yet but PF  seems easy to use  And its free   I also have mandated e rx for  controlled substances in July and pF  does not have it yet-  you in NY were the first   If need be I do Dr first stand alone 800 a yr for while One step forward one  back  Craig Ross here also has PF  I would like to hear fro others    To me  noone helps us We always have to do one more thing   All you can do is speak up The country needs ONE emr

    Jean Antonucci

  • 4.  RE: Emr /practice management

    Posted 11-20-2016 06:05

    Hello guys.

    I'm really thankful for Craig who showed me practice fusion when we went to Colorado. I started my practice last year in October. when I came back  from Colorado I sat down for 5 minutes and I had emr!!! so far It has been working really good for me. I don't use specific practice mgt. I send superbills to my biller, who has access to emr and who charges me 6% has worked really good also. I am not a "techy" , I can not type without looking at the keyboard  and I hate templates!! but it has been very user friendly for me. I am sure I need to learn to use the system better. So far I can see 8-12 patients / day and finish my notes within 24 hrs. Greetings from COLD Florida ! !

    Edgar Cruz
    Cruz Medical Services
    Clermont FL

  • 5.  RE: Emr /practice management

    Posted 11-20-2016 04:37


    I recommend that before you invest heavily again in an EMR that you take a look at Practice Fusion. It was the last EMR I used before accepting a faculty position in a residency program. I had used a number of systems before and found the Practice Fusion platform to be by far the easiest, most functional and useful EMR I had ever used. There is a comprehensive support team-very responsive. Also there is an on-line community of physicians who share templates and workflows. It is worth a look and it is free, free, free. Their business model is to use the collective clinical data{de-identified, of course}as a national cohort .Their clients are data driven organization who utilize this large database. There are  turnkey  integrated office management systems,too.

    I have missed Practice Fusion from the moment I started my current position.

    Good Luck.


    Free Electronic Health Records | Practice Fusion

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    John Nevins

  • 6.  RE: Emr /practice management

    Posted 11-21-2016 05:54

    Thank you so much everyone for your input. I have spoken to a few people who are using OfficeAlly. Anyone else using that option? I would need practice management/billing piece to go with EMR.

    Part of me is wondering again if I should just  "go off the grid" and drop medicare and not have to deal with any of these things like MACRA, PQRS, EMR, and whatever other initials we can come up with! So frustrating!

    Margaret Coughlan MD
    Millbrook, NY

  • 7.  RE: Emr /practice management

    Posted 11-21-2016 15:06


    I have also recently left employed position for private practice. Have been researching EMRs & like Drchrono: cloud based, patient can enter (you can have a kiosk set up with an iPad) their demographics & all past med history/meds/allergies which can save a lot of time (just need to check for accuracy which I would review at 1st visit anyway), it looks awesome for templates, seems very user friendly, & you can either pay for just the EMR $500/mo or get it free if you allow them to do your billing 96% collection rate with an assigned billing team that meets with you weekly if needed for 4-9% of your collections depending on your volume, & has a very open API so it can interface with most any lab co. you might need to receive results from.  Others I have been looking at: AtlasMD (for DPC practice model), MediTouch, Kareo, PrognoCIS, WRSHealth, Elation, Care360 & Practice Fusion.  If I go with PF then I will either need to do the billing myself (never done) or pay a private biller which I am finding rates vary from 6-9% of collections.  The trouble with any biller or company that does this for you I am finding is that they all seem to vary on how hard they try to collect & correct or inform you of coding issues for max collections & how they handle denials. You could be dumped with all the denials to rework or just write off. So it seems to me that you either go with a free EMR & pay for the billing or get the EMR for free & that company charges similar collection fees. The company providing the EMR for "free" then at least has 2ndary gain to provide a good EMR with updates to keep you as a paying customer via collection rate.

    Has anyone actually used any of these EMR systems? Feedback please?


    Cindi Croft
    New Dimensions Family Care
    Bradford NH

  • 8.  RE: Emr /practice management

    Posted 11-22-2016 05:34
    my two cents is that no doctor should do the billing Choosing a small personal billing company  whose success depends on our si well wortht the 8% or whatever You can refer people there  when they have issues,  not  do it yourslef    Mine is also a coder and    I tell her the dx if I do not  code it and she does it  well worth delegating it and just seeing patients


         Jean Antonucci MD
         115 Mt Blue Circle
         Farmington ME 04938
    ph 207 778 3313   fax 207 778 3544

  • 9.  RE: Emr /practice management

    Posted 11-22-2016 05:59

    Our office moved from Amazing Charts to PF in June 2015.  PF transferred all patient demographics for us, very easy to start.  First month, we only scheduled in PF and slowly started to transfer patient information from AC to PF as each patient came in.  Time consuming, but it wasn't that much work.  Because PF is a lot of data text boxes for past medical history, we were able to do a lot of "cut and paste from AC to PF.    We decided to use CollMD for billing.  Love how easy PF transfers info to CollMD.  CollMD seems to be a good fit for our office but can become pricey as we add more providers to the office (assuming that may be the same with other software).  They offer the ability to send out statements for a few cents more than the cost of a stamp.  Large time saver for us.  

    I am not the provider in our office, just the office manager - here are the pros/cons from my perspective: 

    Issues that make my time inefficient: 

    1) Printing out patients' medical records - TIME CONSUMER - you have to print every lab and documentation separately.  We have several patients that we get disability request for records from the state.  Get paid $15 and takes me 20 min to print their records.....  

    2) When PF transferred demographics from AC, the zip codes did not transfer.  So when we started, when a patient needed a lab slip or refill (and had not been seen in PF yet), we continued to get an error until we went in and added a zip code.  Not an issue now that we have been in it for over a year, but those first 3-4 months it was a hassle.  Not sure if that was just our office issue or everyone who has had demographics transferred.  

    3) We use PF to report for MU and PQRS.  The way we input services we did in PF so that it picks it up for the MU/PQRS reports could REALLY use work.  This is a huge time consumer for me.  Easy, yes.  But there really could be a more efficient way.

    Things that make my time efficient:  

    1) Online scheduling - LOVE IT!  

    2) We us Updox for our fax and it works with PF, which makes uploading documents from the fax to a patient's chart extremely easy and quick.

    3) If I do have a questions, PF is good at getting back with me quickly.

    4) Very simple set up, easy to train others on very quickly.

    5) Easy to run MU/PQRS reports at anytime.

    Renea Clark
    BlueSky Health - Office Manager
    Howell MI

  • 10.  RE: Emr /practice management

    Posted 11-22-2016 10:36

    I have used 4 EMR's over the past 16 years:  first, SOAPware (pre-version 5.0) in a group multispecialty practice, then eClinical Works in a hospital-based system, then Practice Fusion in my own practice, switching to Amazing Charts Cloud version.  The pre-version 5.0 SOAPware was a great, intuitive, adaptable, straightforward EMR, but subsequent versions got lost in needless complexity.  If anyone approaches you about eClinical Works, run screaming in the opposite direction.  We used Meditech for PM at the multispecialty group and later in the hospital system, but also had full-time billing staff.  

    In my office, I started with Practice Fusion because it was free, cloud-based, easy to use and had a (fairly primitive) one-way billing interface with Kareo, the PM system I chose.  I would have started with Amazing Charts, but they had no cloud option at the time and I did not want to have to maintain a database.  About two years ago, I made the hop from PF to AC, while my partner remained with PF.  PF exported my demographic data into AC, but all other information had to be re-entered manually, which is a drag, but.....We have used Updox (which is miraculous) from the beginning, currently configured for AC, which means a couple of extra steps to put things from Updox into PF, but it's not that big a deal.  AC and Kareo have a better, though imperfect, interface, with demographic information populating both programs and billing going one way.   AC is a more versatile, better organized and navigable EMR than PF,  very cheap and their help desk has been extremely diligent, and though they are not always available by phone or chat, they return messages promptly.  But, if I had to, I would happily continue using PF, Updox and Kareo in combination.  Kareo's EHR is mediocre, and clearly an appendage of their PM program, but I have found their PM program very reliable and my receptionist-biller likes it, also.  Their help desk has generally been prompt and effective.  I subscribe to their premium package, which includes the maximum support.  Five years in, I might actually be able to do with a less comprehensive plan, but I haven't changed and I would highly recommend all the bells and whistles when starting out.

    On the matter of bells and whistles, my partner and I decided not to chase Meaningless Use or the subsequent, mini-carrots held out by Medicare and Medicaid to date, though we'll have to deal with MACRA; therefore, I can't tell you how good the reporting functions of either PF or AC might be.  So far, we also have not wanted to go through the headache of patient portals or email, nor do we want online scheduling.  Our patients seem to get hold of us just fine by phone.  We use RingCentral for that, which I'd also recommend.  They aren't any less unreliable than trunk-line phone companies and you can use it anywhere in the world there's an internet connection.

    Vahe Keukjian
    Your Family Doc PC
    Ghent NY

  • 11.  RE: Emr /practice management

    Posted 11-24-2016 12:30

    We currently use ElationHealth for our EHR integrated with Kareo for practice management.

    Kareo is really good for billing but a hassle otherwise.

    We LOVE Elation for all the time it saves both doctors and staff, which we estimate saves us plenty of money despite the costs. They make common clinical action steps and inter-office communication task management easier than other EHRs we have tried. And they spend a lot of effort making sure their practice management integrations are as functional as the other vendor will allow them to be. Perhaps most importantly Elation is somewhat special among software companies in that everything they say will work actually works the way they say it does.

    I am always looking at new options though. So this thread is very useful to me. For example I would love to add truly functional online scheduling.

    We have tried Practice Fusion in the past and liked them for what they did but it was not enough for us. We also tried CareCloud which was absolutely terrible in multiple ways.

    Fred Klemmer

  • 12.  RE: Emr /practice management

    Posted 06-13-2017 21:45
    That's a strong endorsement!  Will it print claims to a file?  If so, one could use OfficeAlly batch upload for billing- free.

    Peter Liepmann MD FAAFP MBA
    My mission is to fix US health care
    Bakersfield CA

  • 13.  RE: Emr /practice management

    Posted 11-25-2016 12:31

    Hi Margaret,

    I was on e-MDs for 13 years and switched to Athena in March of this year because I joined in with a horizontally integrated network which highly encouraged the change. The change has been awful. The workload involved in changing systems is IMMENSE. Even if the demographic info gets pulled over, every patient is essentially a new patient in terms of having to put in the current medical problems, FH, SH, Allergies, and potentially even Meds (Surescripts through Athena automatically loads that which is nice). That does not even include the downloading of the old information off my server and then uploading it into Athena as a pdf (which is nice to have but not nice to try and search through). Suffice it to say it will take at least a year for you to get back up to full speed when you change over. In regards to which EHR I like the best, e-MDs is really quite intuitive and nice to use but, at least as of early this year, its portal was horrible. Athena is bloated and slow and I believe far more difficult to document in. However, it has a nice portal and the fax server seems to work nearly flawlessly--which is nice. I am changing over to the "streamlined" version of Athena in the next month, so some things might be better, but I am guessing that some things will be worse as well. 

    One other comment. I would disagree with Jean that "no doctor should do their own billing." I did mine until I changed over to Athena. Here is the way I would think about it. With automation and clearinghouses and Previsit checking of insurance eligibility, about 97% of your claims should go through without issue. The real issue is the amount of time it takes to post the claims and send out statements (and much of that can be mitigated by keeping a credit card on file). In my experience, it would take me about 50 minutes/week to package up the claims and send them to a clearinghouse (10 minutes/day). That time would be nearly the same if you are sending the claims to a billing company so I am not certain there is any way to save there. BUT, at least in my experience with e-mds and gateway edi, it would only take about 1 hour/week to post the EOBs and send out the statements. So doing the billing and collections is really about a 1-2 hour/week job. To pay someone 6% of ALL collections for 1-2 hours/week seems nuts to me. I mean if you collect $200,000 and pay 6%, you would owe the biller $12,000 = around $160/hr based of 75 hours of work/year which is more than I make. Personally, I would set up everything to be as automated as possible and try and find someone to upload the EOBs into the billing system and send out statements to the patients for $15/hour. They can even track down the denied claims--though, unless you are using codes you do not normally use, my experience is the claim is more likely to be paid if you send a patient a note and have them call. 

    I hope this is helpful and I wish you the best in your transitions!


    John Brady
    The Village Doctor
    Newport News VA

  • 14.  RE: Emr /practice management

    Posted 11-26-2016 04:25

    I am so grateful for everyone taking the time to reply to this discussion. Have fun with streamlined John on Athena! I think that term is an oxymoron!

    I agree that paying 6% of billing is crazy, that is what Athena charges I believe.

    I will look at Amazing Charts again. A colleage from residency had started it and I did not think to look at it now that it is part of a larger organization. But if you say you are happy with it Vahe, I will take a peak. The patient portal definitely has its pluses and minuses. Most patients use it appropriately, send me an email update a few days after the visit. I do have a handful that use it constantly and sometimes I question having it, but I claim to be available to them so this helps me to be more available. 

    Margaret Coughlan MD
    Millbrook, NY

  • 15.  RE: Emr /practice management

    Posted 11-26-2016 06:38

    EHR discussion has changed to a billing in-house vs. outsourced discussion and I agree with the most recent post.

    Sending claims only takes about 10 minutes per day. It takes another 1-2 hours per week to do everything else. Once in a while I will have a staff member call an insurance company to ask a question about a claim. 

    I have done both ways and both ways work. Technology is much better now. When I was doing billing in-house 2002-2010 range, it was more difficult. I took a 3 year break while there was Meaningful Use dollars coming in and treated myself to the 7% of collections Athena took. I grew to resent that bill each month. 

    Now I am back to collecting in-house and I can promise you that I have collected the exact same amount this year with in-house billing as I did with Athena last year. The first step is entering insurance correctly and checking eligibility. That takes the same amount of time with either system. Automatic EOB posting takes seconds. You can print statements and have staff send them or sign up for electronic statements for an additional cost. 

    The worst part of doing in-house billing is the initial set up. There is a feeling of terror as one worries about cash flow and making sure that money is coming in right from the start. All the paperwork for electronic claims, remittance and deposits into bank account must be done correctly. Check and double check. If that's in place, you're good to go! 

    Some male physicians in the past wrote in that they had a terrible time with outside billing companies and having their spouse come in and clean up billing worked very well! In my case, my retired father enters my payroll, Quickbooks and does all my online banking for me so I have a little time to do the billing. Having the luxury of a family member who cares pick up some of the slack really helps in an IMP. 

    Mamatha Agrawal, MD
    Family Doctor CaryNC
    Cary, NC
    Live in Raleigh, NC
    Solo since 2012
    Practice Fusion and NueMD

  • 16.  RE: Emr /practice management

    Posted 11-27-2016 07:21

    Well just briefly  for what it is worth  Those advocating doing  the billing seem to have  staff and fathers in law:)I have neither   true I  know nothing of billing so there would be fear of the unknown  But while I am not of the ilk that says do only what  you can do  to work to the top of  your license   billing is complex  It isnt the gateway posting checking eligibility thing, it is the arguing, re submitting and answering patient  questions   The bottom line is that it is a moot point    If a doc spend 2 hrs a week doing all that  plus your initial learning curve  I think of it as me  plowing my own driveway  I COULD invest in the plow oh but do much better to earn money and pay someone  You folks are paying staff to help you   2 hrs a week of my time  is at minimum 2-3 medicaid patients 99213  $100-150 or at max 2 99214 harvard pilgrim MCHO at 130 each so $ 260  I spend far less on billing and    she answers questions  codes etc.

     I think it is preference. I would like coding and billin g to go away . If you want to  know where to get a good snow plow though...


    Jean Antonucci

  • 17.  RE: Emr /practice management

    Posted 12-04-2016 05:01

    I'm late to respond to this thread, but wanted to add my own system, I think it works pretty well. I use DoctorsPartner. They have a simple documenting area, you can make all the templates you want, on the fly. The practice management is integrated and works really well with Gatewayedi (now Trizetto) so you can easily send your bills and then post the eob with just a few clicks. Only the small insurances don't use the clearinghouse and then they mail me the eob which I have to enter.

    DoctorsPartner has been compliant with all MU requirements and now they have helped me write report after report in my system so I can comply with every stupid requirement for Maintenance of Certification, PCMH, PQRS etc... All without charging me extra. They are really wonderful, although a little expensive. For a single provider, using the practice management I think it is $499 a month, adding in my NP it is $790 and then I have to pay for the clearinghouse. Also there is my time, about 2-3 hours a week as Brady says. Sending and receiving most bills isn't an issue, way, way way easier than being a doctor. It is not worth 6% of revenue. The issue is that there are a few that don't get paid and tracking down the reason is time consuming and I end up putting it off until it is overwhelming. 

    Kris Oaks
    Kristin L. Oaks D.O. Inc.
    Worthington OH

  • 18.  RE: Emr /practice management

    Posted 12-09-2016 04:29

    Has anyone used Azalea Health EHR?  It is free with managed billing running 5-7.5%  and the EHR seems pretty robust.  There are some extra fees for some of the less essential bells and whistles like efax and reminders. 

    We use Kareo for EHR and billing.  But are looking to change both.   Out of the blue they started invoicing me for their "free" EHR.  It seemed ok when it was free, but not worth paying for.  The billing software is also fair but the main benefit was it integrated with the "free" EHR.  We also had a lousy time trying to purchase their online appointment software.  They had no idea what they were doing and never got it working; but this did not stop them from charging us a monthly rate for absolutely nothing.  Overall I was fairly satisfied with the EHR and PM but pretty underwhelmed by their underhanded business practices. 

    This is such an overwhelming issue with 1000s of companies offering a product with 100+ facets under various payment models.  Perhaps IMP could put together a spreadsheet or buyers guide using member experiences/reviews and data from the different EHRs and then charge a fee for access.  I certainly would be willing to pay for it. 

    Thomas Weiner

  • 19.  RE: Emr /practice management

    Posted 02-06-2017 16:41
    I saw the discussion late.
    OfficeAlly is a great (free!) billing sytsem, a TERRIBLE EMR.
    I'm still trying to figure out whether PF will export bills in a batch- couldn't ~2015.

    Do you know?

    Amazing Charts will do so. Whether it's worth $200/ mo to you or not would depend on how you find it to use.  Overall, people like AC and PF  (and VISTA, but hard to set up.)

    Peter Liepmann
    Bakersfield CA

  • 20.  RE: Emr /practice management

    Posted 01-01-2017 10:20

    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

  • 21.  RE: Emr /practice management

    Posted 06-02-2017 20:06
    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

  • 22.  RE: Emr /practice management

    This message was posted by a user wishing to remain anonymous
    Posted 06-13-2017 16:05
    This message was posted by a user wishing to remain anonymous

    Dear Fellow Doctors

    I've seen good comments about Elation, and I'm going to try a demo. A doctor mentioned a feature request on "truly online scheduling". Elation claimed that they have it; a patient will request an appointment online, and the staff/doctor can approve to confirm the appointment. Has anyone tried this?

    I also want some features for the whole patient flow, starting with: having a new patient use iPad to input initial data or main complaint before seen by a doctor. I wonder if any doctor also finds this important.

     Elation doesn't do billing on its own but chooses to work with 3rd party software. I've heard that they suggest Practice Suite, Collaborative MD, MDConnection etc. Some doctor here suggested Kareo or AdvancedMD. In your experience, what would work more seamless with Elation? We plan to do billing by ourselves first.

    About Orchestrate One. Their basic plan for practice management seems good, but Elation seems o cover some of those as well. Why do we need Orchestrate One? Is it mainly for billing? Their billing seems to be $5 per claim (according to their website); which seems a lot, if the number of claims is a lot, or the amount of the claims is low. Does anyone actually use it?

  • 23.  RE: Emr /practice management

    Posted 06-13-2017 22:05

    I've seen good comments about Elation, and I'm going to try a demo. A doctor mentioned a feature request on "truly online scheduling". Elation claimed that they have it; a patient will request an appointment online, and the staff/doctor can approve to confirm the appointment. Has anyone tried this?

    They dont have online scheduling but they are working on it. We are 50-50 on using it if available because we try to follow a scheduling protocol based on appointment type and likelihood of no-show, so online would get unwieldy. Instead we just have them email (piped to all employees), chat (zendesk chat on website) or call, and we make sure to not let request go unanswered. 

    I also want some features for the whole patient flow, starting with: having a new patient use iPad to input initial data or main complaint before seen by a doctor. I wonder if any doctor also finds this important.

    Our anecdote: we want a human in the loop making sure stuff was filled out correctly, and we want to push the effort of intake forms outside of appointment time. we just use a form on our website that walks them through and then automatically sends the data to us, and we advertise it as "save time at appointment and fill this out now"

     Elation doesn't do billing on its own but chooses to work with 3rd party software. I've heard that they suggest Practice Suite, Collaborative MD, MDConnection etc. Some doctor here suggested Kareo or AdvancedMD. In your experience, what would work more seamless with Elation? We plan to do billing by ourselves first.

    - You have to remember that Kareo EHR + PM and Kareo PM only are not the same. Kareo doesnt even seem to understand this: 1. theres a frustrating amount of clutter on Kareo (stuff you already do on your EHR). 2. There are also two versions of Kareo - a downloaded version and a web app. web app is not usable with Kareo-elation, so all you get is the sluggish downloaded version. to put it more succinctly, dont use Kareo.

    - Consider your operational flow and how it matches the direction of the connection between EHR and PM.  For Elation
    Practice Suite:
    • Appointments: Bi-directional
    • Demographics: Bi-directional
    • Billing: Uni-directional (pushed from Elation)
    • Appointments: Uni-directional (pushed from CollaborateMD)
    • Demographics: Bi-directional
    • Billing: Uni-directional (pushed from Elation)
    A deal breaker because was the appointments direction for Collaborate. we like the scheduler in elation better.

    About Orchestrate One. Their basic plan for practice management seems good, but Elation seems o cover some of those as well. Why do we need Orchestrate One? Is it mainly for billing? Their billing seems to be $5 per claim (according to their website); which seems a lot, if the number of claims is a lot, or the amount of the claims is low. Does anyone actually use it?

    We havent even begun our trial so I can't recommend yet, and we might have to build our own connection to Elation ( they are negotiating with them now)... But they are compelling. They are trying to eliminate (be) the clearinghouse. they automate the entire process and make it  Better



  • 24.  RE: Emr /practice management

    Posted 06-14-2017 19:03
    Practice Fusion has truly online scheduling.
    It's not amazingly flexible - you have to choose set hours for each day. You can block time and have repeating blocks.
    The slots are just 30 minute slots that are not specific to an appointment type.
    You can approve or deny the request.

    I had chosen Elation but they assigned me an onboarding person and didn't have the patience to go through another onboarding after my 90 day onboarding with Athena 3 years prior.
    Elation did seem better. I've always believed in the "best of breed EHR" that doesn't do the practice management because that's all they focus on. The downside is the double entry of demographics.
    When I looked at Elation they did not have TEMPLATES, but maybe they have added those.

    The Practice Fusion guy helped me get started in 15 minutes. The templates are very customizable for full visit or each section of the note.
    It's worth playing around with that one for free since anyone can start an EHR and can do the same with Elation.

    Mamatha Agrawal, MD
    Family Doctor CaryNC
    Cary, NC
    Live in Raleigh, NC
    Solo since 2012
    Practice Fusion and NueMD

  • 25.  RE: Emr /practice management

    Posted 06-15-2017 06:40
    My name is Seth Merritt. I  use practice fusion  as well as Genbook for scheduling and office ally for billing. I developed macros which are computer programs that integrate all these separate  websites and help us maintain a small staff to operate. Currently we are a combination of seven providers and one Business manager who does all the billings and collections and returns phone messages.
     The macros help us with those tedious data entry tasks and helps us integrate these different websites to avoid double data entry.
     At one point I thought maybe a little side business would be to sell these computer programs two other small micro clinics that want to use these cheap, free, and better services to piece together a more functional electronic Health record system.


    Seth Merritt

  • 26.  RE: Emr /practice management

    Posted 06-15-2017 07:59

    I'm currently using nextgen in a group practice, but we are going to look at elation.
    Nextgen....does what it is supposed to do, but the back end either requires very good support or an in-house staff of developers to adjust the system to your needs.
    Our vendor was very good at selling the product but not very interested in any specific configurations.
    As we learned the hard way, the out of the box configuration isn't very good.

    At least elation seems like it was first coded more recently than 1980.  Given they have gotten good at conversions from other EMR systems, they must be doing something right.

    From my limited demo, it is nice to have an actual provider inbox that has everything--outstanding notes to sign, messages from patients to sign off or reply to, labs to one place when you log in.  In Nextgen , at least the ud2 version isn't as slick when it comes to handling messages or tasks.

    The other thing I noticed--nextgen has SO many options buried in the sub-menus, it can do some weird stuff, and you need your vendor or a developer/business analyst to go in deep to make sure things are set correctly.

    David Feig

  • 27.  RE: Emr /practice management

    Posted 06-16-2017 08:11
    One problem is that all these  extremely expensive EMRs are sucking time  and  money from us and we ought to  have  professional organizations stand up and say so  instead of trying to find the best one of  what? a  line of complex toosl that are  not helpful,  just required?

     E-r x of controlled substances happens here in MAine JUly 1     I was just told Practice Fusion  is all  set  YAY!
    ah not so fast
      I went to get it ready today
    Ah   600.00 a year( 49 a month)
     and I pass that along how?
      The hospital has wired practices years ago so we could see Meditech their labs er notes hospital stuff   Well they took all the pT/  ot notes away and put them in the office practices E cw    without telling or asking  med staff- so now   unless I  save and file cannot see them
     and now
     ransomware scare in europe-- so at 5 pm one friday night gmail was cut off
    No more access to email
    The state and  the medical supplier and on and on communicate to me this way even hospital folks Can't use it   MUst get my own ah 42.00 a month

     I  had a PCP patient here yesterday  sobbing
     SPEAK!! you guys SPEAK UP!
     You are paying hundreds of dollars a mont h to use something that  does not work.

    Jean Antonucci

  • 28.  RE: Emr /practice management

    This message was posted by a user wishing to remain anonymous
    Posted 07-27-2017 22:55
    This message was posted by a user wishing to remain anonymous

    I have a quick question about EMR & EKG integration (and other diagnostic devices), particularly I'm considering Elation.

    Can I start an EKG machine inside a patient's chart, and then the results will be imported into EMR and add a CPT code on EKG?
    In Elation help center, I didn't find a document on it.

    Welch Allyn lists many EMR partners but didn't include Elation.

    If Elation doesn't support this, what will be a good EMR that supports this? Thanks!

  • 29.  RE: Emr /practice management

    Posted 07-28-2017 16:50
    You might also check MD-HQ.  I don't remember what I liked about it when I looked at it a few months ago, but I do remember thinking that I'd make the switch if I hadn't locked into a cheaper rate with Elation 4 years ago.

    Concerning scheduling, I know it's a little redundant for staff (I have 2 part-time) to use a separate online scheduler (I use Full Slate, but I know there are others just as good if not better) along with Elation.  But I was very happy I did on 2 occasions in the last year - once when Full Slate had difficulties after upgrading their system and a second time when Elation had their system go down (this has only happened twice in 4 years and after the first time they set up a separate view-only chart website).

  • 30.  RE: Emr /practice management

    Posted 11-07-2017 22:55
    Anybody know anything about talkEHR?

    I have no experience with it. I only saw a quick blurb on it.


    Milton (Moshe) Stern, M.D.
    Staten Island, New York
    He [Hillel] used to say: If I am not for myself, who is for me?
    And if I am only for myself, what am I?
    If not now when? (Avot 1:14)

  • 31.  RE: Emr /practice management

    Posted 11-08-2017 04:54
    I LOVE our emr.    We had been through Practice Fusion, Dr. Chrono, and Aesthetics Pro.     We have now been with IntakeQ since 2015.    All of the intake forms are online and when the patient starts to fill it out, a little window pops up, letting you know.  They sign electronically and it goes straight into the patient chart.   That has saved us SO MUCH TIME IN SCANNING.    They have in-office tablet set-up, where patient takes their own photo and it populates into chart for photo ID.    You can attach custom consents to custom forms and IQ only charges $9.00 for creating your forms.    You can self create, and they are SUPER easy.   It has payment collection features, newsletters, appointment set-up, customization for reminders, birthdays, follow-up visits, etc.   You can set up a test account for FREE to play around in for 7 days..., don't even need a credit card.   No sales person will try to make you set up a demo.  It is so user friendly and they are adding features all the time.    It has built in fax features (pay minimal amount) after 10 free ones.   We use this feature to do all of our scripts.    You can also email patient a Hippa secure copy of visit plans, etc.    It is truly the most user friendly service we have ever used.    They also have some pre-built  templates, but it is super easy to build your own SOAP note templates, nursing note templates, etc., and it is easy to build templates that need to be scored.   They also have text available for another nominal amount. (we aren't currently using)   Their price ranges from $29.9 a month 1 practitioner to 99.90 a month for 5 practitioners.    Their customer service responds right away and they are just great.   We started out using them strictly for the intake forms, which we would then upload to Practice Fusion.   The intakes we sent with PF were really hit or miss as far as when the patient received them.    When you send a form in IQ - the patient has it immediately.   We then started using it for scheduling and now use it for our EMR.
    We are a cash based practice, so I have NO idea what their insurance capabilities are, although you can create superbills in them.  One draw back is they don't currently integrate with any labs that I know of, so we do have to scan the lab results into the chart...   Their payments integrate with Square and Stripe.   Their site is IntakeQ - Online Patient Intake Forms .   Hope that helps.   Feel free to write if you have any questions.

    Donna Powell
    Practice Mgr.
    Dr. Scott's Restorative Health Ctr.

  • 32.  RE: Emr /practice management

    Posted 11-09-2017 05:50

    I was using eMDs and had to switch as I joined Privia.

    Privia on the whole has been helpful for many good reasons.

    However they use Athena.


    I cannot recommend it to anyone.

    It is not intuitive and as mentioned their responsive to problems or requests is terrible.  It is a billing machine at its heart and that is a major problem.

    Yesterday they were down most of the morning ( "on the cloud") which has happened too many times.

    Lots of ICD 10 , HPI, etc.. problems. You have to type and click a lot.


    Looking back EMDs was a much superior product...however they have changed ownership twice since then so cannot comment on how they are now. I really miss the flexibility and tools they gave us. Their annual conference was well worth the time. It was definitely designed around our work.

    I was on EMDs for many years and the switch to Athena was essentially very traumatic. I ended up having to take 10 days off work just to get away from computers...during that switch.

    I am now 18 months past that and still am having to look back in my old EMR for data.

    Even getting the expensive "conversion" done ( I did not) does not work that well.

    Which is why we need interoperability so that the EMR companies do not have us hostages.

    I would dread having to switch again.  

    So please look at each system hard.

    Talk to others who use it.

    Talk to others about how that company handles the switch over.

    Good luck.




    Scott Macleod, MD

    Solo, Independent FP

    Highlander Family Medicine

    Woodstock, Virginia


  • 33.  RE: Emr /practice management

    Posted 11-20-2017 12:45
    I like Practice Fusion for the most part.
    Use Updox for e-faxing
    Kareo for billing
    I do not schedule with Practice Fusion, because I feel I do not like the process (the patient bascially asks if they can have an appointment at a certain time, and you have to respond-from my understanding).
    I use Orchestra One for scheduling-approximately $30/month, it also sends text appt reminders two days in advanced, and one hour prior to appointment. There is also an app for your phone (although, there are a few glitches with the app). Patients can schedule online, or you can add them to the schedule. I am pretty happy with this, and my patients love the appoinmtent reminders.


    Marie Amina Aryan, NP-C
    Lakewood Family Health Clinic
    Lakewood, Colorado
    Empathetic Family Healthcare clinic
    Lakewood CO
    303-981-1902Empathetic Family Healthcare clinicEmpathetic Family Healthcare clinicEmpathetic Family Healthcare clinic