Best EMR options for pain management?

[Aether2000]

I have no recommendations at this time since I haven't found a single EMR that satisfies my requirements. Add to that the new DEA fingerprint or random number key fob generated security for schedule II script faxes, and there are virtually no EMRs that are configured for this new change in the interpretation of the law by the DEA.
I hope to learn from others in Maui about their systems. There is a government incentive program that does promise $44K but the details are murky by the government and they may not require CCHIT certification. But the money has not been specifically allocated yet either...it is more of a promise for the future based on passage of a law. Some companies are indeed outrageous with their prices and other newcomers are offering to sell your the system for free if you promise to fork over whatever the government gives you. The problem with this approach is that these are new companies, and may not be around in 5 years after the next two iterations of the Windows operating systems, and therefore the programs may cease to function if they are not upgraded to match your OS.

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[yms01]

Practicefusion indeed looks great except for inability to electronically recieve and send faxes etc. Plus (not having made any templates - used to dictating on phone), i didn't know how difficult it would be to get the pain specific templates ready and to incorporate things like Oswestry, Opioid Risk Tool etc.
I do have access to friends that build software so maybe need to plug that in with practicefusion.


HECK, maybe i can sell that, get out of the rat race and then concentrate on practicing medicine like it should be practiced.

 

[yms01]

The $44,000 is a staged payment from feds for conversion to a certified EMR. You get a certain amount each year over next 4 years or so. They have certain conditions for the EMR to be eligible. Any EMR website will be a source of info on this. Bear in mind that as it stands currently, there maybe penalties later on if you have not converted to EMR.
So right now they are offering a carrot if you start adopting the EMR now, but also showing the stick if you don't eventually get to it.

 

[yms01]

Hi Traxtar, great that it works out for you. I have a question. What do you mean by 'custom software' , 'fill in the ...'? did you get the practicefusion customized or did you buy a off the shelf software to compliment the missing parts/features in Practicefusion? Or you customized Practicefusion itself to suit your needs. If you got the Practicefusion customized, did they charge? if yes how much?. I would greatly appreciate if could elaborate on customization.I have a friend who works with software. Any help would be great.

 

[yms01]

I checked out Writepad EMR ( made by addison health systems). Their pain module is great and pretty specific with built-in ISIS and ASIPP protocols etc. But MONNEY is the issue - more than 10K.

 

[yms01]

BTW guys. Checked out MTBC. No pre-existing pain templates or info, but regarding my earlier post about charges for transcription, i was wrong. They only charge if you use A HANDHELD RECORDER but not if you use voice recognition (Dragon etc) to input your notes.
I think for the 5% billing and comparable free EMR i might go with them. Will update if any bad joojoo happens.

 

[LookingAround]

Algos what system are you currently recommending, and also I believe you are doing a lecture on this for ISIS Maui, what is the general consensus there on best EMR for pain practices? Practice fusion is currently looking good to me as it is free and web based, which I personally like.

I was at the ISIS in Maui, which lecture did he give?

 

[LookingAround]

I was at the ISIS in Maui, which lecture did he give?

nm, I got it.

So there doesn't seem to be a good EMR that allows simple click and choosing for procedure notes? Ideally, I'd click "LESI" then choose from a menu L1-2, L2-3, L3-4, and have it populate the appropriate fields. I know misys allows that customization (very easy to use if you talk the time to set it up). But the Allscripts folks aren't seeking meaningful use certification.

If Amazing Charts and eClinical Works doesn't allow for it...

 

[psu06830]

Hi all,

With pain management clinic for 10 years. And ready to hop on EMR bandwagon. Been researching EMRs for nearly a year. Came to some conclusions. Eclinicalworks not ready for Pain Management. Meditabs is not bad but will not know if they can be compliant with all new regs for certification. Currently use Medisoft billing not impressed with their EMR demo.

Read through all the posts. Great Info. In summary, it sounds like there is no software that stands out above the rest. Considering the investment costs, that is a bit disheartening.

My partial dream wish list (though not exhaustive):

Hoping to have a software with:

• preloaded pain management templates;
• decent billing software merging to superbills/coding for multiple specialties (physical therapy, rehabilitation, emg) , electronic billing, able to send records electronically with billing;
• eprescribing that works and tracks patient med history well, warns regarding medication interactions;shows minimum of 3 months patient history so doctor sees trend;
• allows for multiple ways to input to med records (e.g. - dragon, point and click, typing, macros);
• portability - able to login offsite/multiple locations, yet software on local server vs. cloud; upgrades and updates that do not rip you off every few years;
• Faxes/emails med records/ scripts straight into software, eliminates office time for scanning paper correspondence;
• Autopopulates next visit of patient (i.e. - medications, demographics, patient history, things that do not change much);
• Multiple access of same medical record;
• Decent A/R reports, financials, employee tracking, graphs

I need opinions about licensing vs. buying software outright which better option?

Currently running Medisoft V16 and Office Hours, was considering their EMR until found out Medisoft mainly used by Chiros, and Podiatrists - so no templates for Pain. Since invested about $8-10k with them already - likely stick with them unless really better option comes along.

Looking into SpringCharts and awaiting their answers regarding merging with Medisoft and templates for pain. Will keep you all posted. Anyone know any decent EMR that interfaces well with Medisoft (needs decent bidirectional interface)?

Best advice I've heard, go visit pain offices that are currently using the software you are interested in once you narrow it down to your top 3-4 vendors.

Perhaps the moderator can have one post where all the pain docs can add their wish lists for a decent EMR to one location so that all the docs (and hopefully vendors) will have a great idea of what the perfect pain EMR will have to do.

Sincerely,

In pain from EMR

 

[drpainfree]

check out unicharts emr. very easy to customizie, and run off from a PC in your office and can be shared off from wireless network. No need to store data on big server or across the internet.

the best part, the program is cheap, less than 1k.

i don't have any affliation with unicharts. i'm trying out the software, and think it's very reasonable option.

 

[kris713]

Kernez, when did you start using them?

 

[mid|ine]

Please ignore the spam from kris713 and kernez. The posts have been reported. I don't know anything about EZHealthcare, but if they market with spam like this I would avoid it.

 

[NO 2 PAIN]

Try unicharts. Its under 1000$. the database is in your hard drive. Templates can be customized, ICD9 codes can be imported. Web based access from remote locations and e prescribe. not bad.....

 

[drpainfree]

Try unicharts. Its under 1000$. the database is in your hard drive. Templates can be customized, ICD9 codes can be imported. Web based access from remote locations and e prescribe. not bad.....

hey glad you like unicharts. i'm customizing the ICD9 codes right now as I type.

how did you "import" them? you mean like importing from a text file or something like that?

 

[nwop09]

an any one tell me how to make templates for practice fusion -with drop down menus-is there such a program that I can get to incorporate inti practice fusion? thanks for the help.

 

[melancholy]

Sorry to also get off track, but one person mentioned eClinicalworks (EMR used at a potential job setting) and Epic (which I currently use in fellowship). How is the transition from Epic to eClinicalworks?

 

[PMR 4 MSK]

Sorry to also get off track, but one person mentioned eClinicalworks (EMR used at a potential job setting) and Epic (which I currently use in fellowship). How is the transition from Epic to eClinicalworks?

I can't decide which one sucks more. We use eCW in our office and the hospitals use EPIC. Both are very cumbersome, take extensive training to use and you will spend many hours writing your templates and "tweaking" things. The reports generated are better in eCW. It often takes me a while to find something in Epic - it is not intuitive.

eCW has terrible support staff. I suspect it is all outsourced, as none of techs speak English well and their favorite question is "Can I close this ticket now?"

 

[powermd]

I can't decide which one sucks more. We use eCW in our office and the hospitals use EPIC. Both are very cumbersome, take extensive training to use and you will spend many hours writing your templates and "tweaking" things. The reports generated are better in eCW. It often takes me a while to find something in Epic - it is not intuitive.

eCW has terrible support staff. I suspect it is all outsourced, as none of techs speak English well and their favorite question is "Can I close this ticket now?"

I liked Epic in fellowship. It's a beast to learn, but I like the flexibility and the intuitiveness of template design. I liked how you could call up macros on the fly with "dot phrases". You would need to put a lot of time into optimization to make it work for you.

My new practice uses E-MD's. It's okay for pain management, but it's not set up for specialty practice. From what I can see so far, every note written must follow the CC/HPI/PMH/PSH/etc format, which is strange when all you want to do is write a procedure note. Template design is weird too.. You set up individual clickboxes that can nest other groups of clickboxes. You can't just set up a note with dropdowns, etc. It works, but it's counterintuitive and takes a lot of time to set up. The manual sucks, of course.

 

[Tenesma]

the more time i spend on templates with drop downs and click boxes, etc, the more I realize I was quicker/more descriptive w/ dictation... so now i dictate templates into my templates...... argh

 

[melancholy]

the more time i spend on templates with drop downs and click boxes, etc, the more I realize I was quicker/more descriptive w/ dictation... so now i dictate templates into my templates...... argh

I think our department used to do that.. dictating designations for templates within a template, then moved to full EMR with Epic. I've been with Epic for residency/fellowship and I rely heavily on lots of custom smartphrases, drop downs, keyboard shortcuts, etc. to the point where I almost don't need the mouse. Our templates have been "optimized" as you could imagine. The hope is to transfer a lot of these potential templates/macros to whatever system I end up using in the future.

As long as I can access essentially the same basic functionalities in eClinicalworks as I could Epic, I think that'd be swell.

 

[powermd]

I think our department used to do that.. dictating designations for templates within a template, then moved to full EMR with Epic. I've been with Epic for residency/fellowship and I rely heavily on lots of custom smartphrases, drop downs, keyboard shortcuts, etc. to the point where I almost don't need the mouse. Our templates have been "optimized" as you could imagine. The hope is to transfer a lot of these potential templates/macros to whatever system I end up using in the future.

As long as I can access essentially the same basic functionalities in eClinicalworks as I could Epic, I think that'd be swell.

Hah... I think you're going to be very disappointed. I haven't seen ANYTHING as slick as Epic for this kind of ease of work flow. Epic is a beast and great for huge institutions with zillions of clinicians, but it's excessive for a single specialty practice.

I've got E-MD's under control now. I dictate the assessment and plan for that personal touch. Dragon works surprisingly well!

MacPractice is forms-based and the most efficient EMR I've used. You can set up a new patient or follow up intake form (filled in by the patient at adata kiosk) that imports the data perfectly into your note (all pre-clicked with normal findings for documenting by exception). You have total control over form content and layout, including how it translates to the written note. You can set up macros for the assessment and plan as desired. It's not perfect, and some basic functioning is a counterintuitive if you don't think like a programmer, but that seems to be the theme with EMRs anyway.

 

[IPCS]

Looking to establish new independent pain clinic from scratch.
Need help and expert advice for
1) EMR/EHR
2)Advertisement of practice
3)Establish referrals
4)equipment like RF / flouroscope ( planning new OEC 9900)
5) hiring nurses and ancillary staff
6)advice for billing and bussiness management software and companies ( payrolls, health plans).

At this stage I have approved bank loan of 175000 for equipment
and decided a space to lease ... working on documents.
Any help or support will be appreciated. Thanks
IPCS

 

[Lizard1]

So has anybody found an established company that offers a good EMR that is client server based rather than web based? I can only seem to find web based ones that I do not want

My current system is Medappz which was recently purchased by MedLink. They are web based and their server is getting worse and worse with it "going down" or requiring significant "maintenance" about once a week. This completely halts my clinic and creates a tremendous amount of work to go back and tidy things up. When you can get them on the phone, it seems like their phones are forwarded to the cell phones and they stall and and just say they are working on adding bandwidth. Otherwise, you just get recordings and leave messages that don't get returned.

I looked at Amazing Charts but can't tell from the downloaded demo if it is really sufficient

THANK YOU for ANY leads!!!!

 

[Ligament]

Why do EMR at all? It will cost you more to implement and maintain than the "penalties" CMS is threatening.

 

[facets]

Why do EMR at all? It will cost you more to implement and maintain than the "penalties" CMS is threatening.

I'm glad someone else agrees with me. I have been in clinics where the whole place shuts down when the EMR goes down. I have refused to get one for my own place and have been told that that "government is going to make us." Well, I don't know if it's my stubborn fighting Irish blood or my age but that's the quickest way to get me to dig in and say "Oh, yeah" Can't help it.

 

[lobelsteve]

I dictate still. We use Allscripts. Nurses enter the useless CMS data points for maintaining meaningless numbers for avoiding a cut.

I have never seen a pain note that wasn't a templated POS done in EMR. Every note for 3 years exactly the same. No useful data for the clinician.

SML

 

[DOctorJay]

Lobel
Do you use dragon or dictate a digital file and send to transcriptionist?

 

[hyperalgesia]

I dictate still. We use Allscripts. Nurses enter the useless CMS data points for maintaining meaningless numbers for avoiding a cut.

As long as you fulfill the Meaningless Use Criteria, you're fine...

 

[Pain Applicant1]

Not all EHRs cost money. Some are free and compliant with meaningful use. I just attested and my check is on the way. None are perfect, but I'm happy with mine for the most part. What I don't understand is why pay for something if you can get it for free

 

[DOctorJay]

Agreed, are you using practice fusion?

 

[Ligament]

If you actually ever get a check, let us know. Also let us know how much you spent on emr including manpower and opportunity costs.

 

[specepic]

I dictate still. We use Allscripts. Nurses enter the useless CMS data points for maintaining meaningless numbers for avoiding a cut.

I have never seen a pain note that wasn't a templated POS done in EMR. Every note for 3 years exactly the same. No useful data for the clinician.

SML

When we first got an EMR I created a bunch of templates for common referrals. The problem I found was that, in my type A physiatric mind, not every ESI referral is the same. Also, when I saw the pts back, I could not tell what my rationale/impresson was b/c all I had to look at was this cookie cutter template. I still have templates for things like procedure consent, or the 4 A's, etc. These are just add ons to an outline template in the A/P section that has Data, Diagnoses, Plan, with bullets under each that I Dragon into. Everyone in the office uses this same outline which makes it easier to follow each others notes.

 

[Pain Applicant1]

Agreed, are you using practice fusion?

If you actually ever get a check, let us know. Also let us know how much you spent on emr including manpower and opportunity costs.

Yes, practice fusion. If you want to sign up, let me know and I'll give you half of the finder's fee if you use me as the referral

I definitely had to sacrifice some opportunity and manpower at the beginning but not now. I'm at about 30 minutes including notes for new pts. Procedure notes take about 1 minute maybe, including log-in time. No dictation nor dictation fees required. Plus, more room in my office as I have no need for storage of any paper charts. With that said, the system is definitely not perfect.

My check will definitely come, I'm not worried about that. I'm more concerned about being audited after the check arrives. However, I tried to be as compliant as possible and I think I met all requirements. Nonetheless, I will let you know when the check arrives.

 

[hyperalgesia]

With a free service like Practice Fusion, what happens if you have a problem with the service? It goes down or you want to bail on it? I worry about a free service because you can't really complain to anyone or get service.

I'm planning on starting PP soon and plan on just having my own in-office server and simple program. It's not rocket science.

I don't trust anyone, especially someone free. And especially the slick, non-medical types who run some of these "free" companies. If I get dinged for not complying with the meaningless use criteria, I will ding back and accept less/no Medicare.

I will leave the practice of medicine before I will be bullied into wasting my and my patient's time.

 

[Pain Applicant1]

With a free service like Practice Fusion, what happens if you have a problem with the service? It goes down or you want to bail on it? I worry about a free service because you can't really complain to anyone or get service.

I'm planning on starting PP soon and plan on just having my own in-office server and simple program. It's not rocket science.

I don't trust anyone, especially someone free. And especially the slick, non-medical types who run some of these "free" companies. If I get dinged for not complying with the meaningless use criteria, I will ding back and accept less/no Medicare.

I will leave the practice of medicine before I will be bullied into wasting my and my patient's time.

To each their own of course...

...but what happens when you have a problem with your server or when it goes down, which it eventually will. It takes time to correct the problem no matter where the problem happens. I would rather someone else be responsible for fixing it than me. If you leave PF, you can export your patients out. They do offer good customer service, their business model is based on making you happy. Just because you don't directly pay doesn't mean they don't make a lot of money off of you indirectly, just ask google or yahoo.

Enough free advertising for them, I should get a cut for promoting their product.

 

[Pain Applicant1]

meaningless use criteria .

 

[lobelsteve]

Lobel
Do you use dragon or dictate a digital file and send to transcriptionist?

We have dedicated and antiquated phones to dictate into. But I can use my iPhone or a little Sony digital if I want. My office has 2 FT employees who do the transcription. No change from prior to EMR. I'm sure they will cut back in 2 years to a single person or they will outsource it. I'm glad I don't have to think about these things.

 

[drusso]

Also, has anyone used / seen this product - WRITEPAD emr. saw their ad in Pain Physician.

Any follow-up experience with WritePad?

 

[drpainfree]

writepad seems to be designed around physical medicine/pain management. yes, any update?

 

[hyperalgesia]

How much do you guys like/use e-prescribe and e-lab-order? I'm still doing things the old fashioned way and writing a script or calling the pharmacy. But wondering if it's worth adding this functionality to my EMR. Can you use for opioids?

 

[lobelsteve]

All my rxs fo through ehr. All controls are printed. A combination of our ehr and the pharmacies software has limited us to not be able to get the controls to go through. The law allows, logistics and software do not. I hear it is also a pain in the azz to do once it is setup. Cymbalta, pamelor, doxepin, robaxin, baclofen,etc all get escribed.

 

[Ducttape]

May be state dependent. All NY prescriptions are supposed to go through electronically. Need to verify that you have checked PMP, then need 2nd electronic verification with phone or fob.

Does it take longer than just ripping off a script? Yep. But the PMP is very nice... And it definitely cuts down on doctor shopping and illegal scripts.

 

[bronchospasm]

Started EPCS (Electronic prescription of controlled substance) exactly one year ago. Lot of pushback from local pharmacies initially. Now it's smooth sailing. No problems. Would not do it any other way.

Way easier than writing scripts.