Sunday, June 6, 2010

EHR Bargains Review - Amazing Charts

(Survival Tips for Small Practices)

Amazing Charts is the best kept secret of the EHR industry. It’s like that little Italian restaurant on a back alley behind some church known only to locals, where the food is exquisite and the prices are dirt cheap and you won’t find any tourists hanging around. You don’t see any Stimulus Conferences sponsored by Amazing Charts and as a matter of fact, you don’t see much marketing efforts. Amazing Charts is bought and sold largely by word of mouth.

The company was founded by a physician in 2001 and it is still privately held and self-sustaining with about 3500 customers. There are many small EMR companies out there, some owned by the doctor who started them, so why is Amazing Charts special? Amazing Charts is 2008 CCHIT certified and Amazing Charts can be obtained for about $125 a month, inclusive of all the bells and whistles that come with CCHIT certified products. This is an anomaly. Most CCHIT certified EHRs cost at least 4 times as much and all have additional charges not obvious when you start out. The 2008 certification is very important because unlike older certifications, 2008 includes interoperability. For EHR products certified by CCHIT in 2008, obtaining Meaningful Use (MU) certification will be almost trivial.

The Model

Amazing Charts is a client/server EHR. You download it from the company site and can try it out for 90 days. If you don’t like it, no harm done. If you like it, you can buy a license. This is not SaaS or web based software. The server sits in your office and so do all your patient records. However, I am now logged into an instance of AC which a friend of mine across town downloaded to try out. I am using Remote Desktop and I see no slowness or any performance issues. So if you are adamant about having your server sit outside your office, you can do that. However if you are set on getting a browser based EHR, this one is not for you.

Pricing

The basic AC price is $995 per provider, where provider is defined as an MD, DO, PA or NP. This however will not be sufficient for Meaningful Use. An additional $500 per provider/per year will buy you support (including a very convenient live chat), upgrades, electronic prescribing (from NewCrop) and annual maintenance for your other interfaces. This brings up the price to $125 per provider/per month for the first year. Interfaces for most labs and radiology are free, as they should be. Interfaces to office equipment and practice management software run between $250 and $500 (one time fee), which is the very bottom end by industry standards.

AC offers off site backup services for $250 per practice/per year and like many other EHR vendors, full service billing (from third party partners) for a flat 5% of net collections. The percentage is low for Primary Care, particularly Pediatricians, but a bit high for interventional specialists.

As far as training goes, AC has a wealth of online training videos and the software itself is pretty intuitive and easy to figure out on your own, at least when it comes to basic functionality. Onsite training is billed at $1500 per day, which is in line with industry customary charges.

Features/Functionality

Amazing Charts has all the administrative features of a modern EHR, including scheduler, messaging, detailed demographics and role based security. All the CCHIT clinical advanced features are also present including order sets, registry, clinical decision support, alerts and most important ability to export the records in CCR (Continuity of Care Record) format, which means that if for any reason you choose to buy a different EHR down the road, you can get your patient data out of AC. One very important thing to note is that AC’s documentation templates are not based on discrete data capture, and therefore are not point-and-click. You can create prefilled templates by adding canned text and type or edit the rest. You can also use Dragon Medical if you prefer dictation. Pretty simple stuff and very fast, but this may prove to be a problem if the Government insists on discrete data reporting.

AC does not currently have a full Practice Management System (PMS). There is no way to work claims in the system. You can create claims and export them to another system or drop them to paper for your billing service, but if you do your billing in house, you will need a PMS. On the AC user forum people are talking about a PMS module due out soon, but I have not seen any definitive dates. This is particularly important for Meaningful Use, since it requires that you do Eligibility checking and that claims are electronically submitted. It would be interesting to see how AC will deal with these challenges, if MU is not scaled back.

AC does not offer a Patient Portal, or PHR, but it could probably be integrated with third party portals like Relay Health and that CCR can be exported to commercial PHRs. There will most likely be costs associated with such integration.
One of the nicest features of Amazing Charts is the user community and the very active forum for discussions, assistance and just plain camaraderie. The forum is open to all, so you may want to take a look.

Bottom Line

Amazing Charts should most definitely be on the very short list of any price conscious small practice, particularly Primary Care and Internal Medicine. The price of $166 per month for year one and less than $83 per month afterward, is a great bargain for a CCHIT certified product and according to the 2009 AAFP EHR User Satisfaction Survey, Amazing Charts is ranked at the very top of the heap, outdoing all the big and expensive products. If, or when, AC adds a PMS that is as comprehensive and as friendly as the EHR, it should move to the top of the shopping list for any small private practice.

07/18/2011 Update: Amazing Charts EHR Version 6 is ONC-ATCB certified for 2011/2012 as a Complete EHR. It is also pre-market CCHIT certified for 2011.

21 comments:

  1. It should be noted that the $995 price is not per year - you pay that once per provider and then a $500 yearly maintenance fee. For the $500 they include all fixes, upgrades, e prescribing and continuation of any interfaces.

    I have been using for 8+ years and it is 'Amazing'

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  2. Thank you Anonymous for pointing this out. I made appropriate changes to the original post.

    It is indeed an Amazing product....

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  3. Is anyone out there using Amazing Charts and Availity billing service? I am considering this combination and wondered if anyone had experienced any glitches or if they worked well together. I am a dermatologist--does anyone out there think that it would work just as easily for me as it does for primary care docs?? Any feedback is truly appreciated . . . Thanks!

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  4. You should post this question to the Amazing Charts User Forum
    http://www.amazingcharts.com/ub/ubbthreads.php/forums/3/1/General_Discussion

    It is very active and very friendly. I did a quick search and found several threads regarding Availity and several others concerning Dermatology.

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  5. "but this may prove to be a problem if the Government insists on discrete data reporting"

    I guess that since the government decided on discrete data reporting with the meaningful use criteria, this product will not be viable in the marketplace because it won't meet meaningful use.

    What a shame... I guess the big boys like Allscripts will continue to corner the market.

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  6. Actually, AC captures all the discrete data that the Government requires for meaningful use, so it should be able to certify and remain as viable as ever, at least for Stage 1 of Meaningful Use.

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  7. Unlike other EHR I have used, which includes the US Army version which nearly killed our pharmacy and office (we switched to paper and pencil as government workers were too stupid to use an EHR for scheduling), the pharmacy shut down for over a month (as the government tech support could not get it going, and we did paper and pencil pharmacy when the patients got too angry) and two hospital versions .... Amazing chart is so simple, even a junior high kid can use it with almost no training (my son helped chart input two summers ago).

    It is easy to use, hard not to use right. Which is important in the front office, where complicated EHR which require too many click on the mouse - causes appointment NOT to be made, when you think it was made. This was the problem with the US Army's version.

    As far as using the EHR itself, templates are already created for primary care diseases and conditions. I have deleted them all and created my own template for my specialty.

    Dragon naturally speaking interface with it fine, but you will need the medical version which is expensive. Last I heard... whispers..... don't let Nuance know. Version 11 of Dragon speaking can interface with AC and you do not need to have the expensive ripoff medical version..... Buy the vocabulary file from Knowbrainer, and you have got a great system for dictating into AC.

    AC is quite efficient.... At least the earlier versions. We used to use windows XP home edition on a 1 GB RAM system at first. But gradually upgraded to a Vista system with 3GB RAM as a server. Now we finally use a Window 7 pro system as the server with 6GB RAM and have not had any glitches. Using Windows XP system as a terminal with 512K RAM will work, but you'll have to shut down your local firewalls.

    It is easy to maintain, and easy to back up. We use a 1TB external fireproof harddrive for less than $150 to back up data, and use their $500 guardian angel support which usually get you tech support within 2 hours for help when restoring data and uggrading is required.

    As opposed to "free" script writing software, AC included script writing is encorporated into the EHR and input the drugs directly into the "Plan" section, and the "Med" sections. Your diagnosis is inputed directly into the "problem list". The free script software (Allscript) we tried last year bog down so much in the afternoons, I quit using it. Now they are cutting out useful features from the free version so you'll buy into the supported versions. AC script writing allows you to look at all the pharmacies in a city, or all the pharmacies in a zip code. Unfortuately, most patients do not remember a zip code. They just remember two cross roads. I hope future versions of the script program will crosslink the pharmacy with mapquest or google map so we can verify the correct pharmacy.

    The more I use this program, the easier it gets. Down load it and try it out. The version 5.029 is a little resource hungry compared to earlier "leaner" no "Chit" version. But I am sure it is leaner than other EHR systems sold out there for more.

    So far, AC has outlived a much more pricier version that my friends had bought. I don't believe these garbage about .... Don't worry, you will never lose support as we will be around. Not true. At least with AC, it is cheap enough and small enough that you can back it up into a small laptop. Synch it to a laptop to take to the hospital. Or to use it in a second office.

    We use Logmein free to work from a second office. LogmeinPRO (not free) does use up a little more resources, so if you use the full functions of the EHR and print out at the remote site, you have to log into a terminal at your office with more than 3GB RAM. Once you do that, it is like being in your own office and you can print up bills and labs at your REMOTE office. But the LogmeinPRO does cost an expensive $50 a year!

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  8. I forgot, the guardian angels support service not only provide free support, free electronic script writing, free drug interaction check, and free data back up service. Which we use in addition to our external fireproof hard drive. Back up is done automatically, first to the external drive, then next to the internet AC database. Restore is also quite rapid, as it is usually done from the external hard drive. Some physicians use a RAID 1 configured server (can be bought at Microcenter.com for $550) which has a mirrored harddrive for instant data back up in the same computer, if you want a more stable data base.

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  9. That was a very thorough review.

    Just wanted to add that AC is now ONC-ATCB certified for Meaningful Use Stage 1.

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  10. With respect to the Patient Portal. Amazing Charts partners with a company called Updox (www.updox.com) which provides an integrated patient portal, electronic fax, and secure messaging solution to get information in and out of the chart. It is also a very affordable option which can be offset by cancelling your dedicated fax line with the phone company.

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  11. Very informative post. Thanks for sharing this review I understand it very well.

    -mel-

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  12. I enjoyed reading your post. It is explained well about EHR bargains.Thanks for sharing..
    Regards
    Web-based integrated EMR/EHR
    Medical billing companies

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  13. I have had amazing charts now for 4 months and I have had nothing but frustration. It is archaic software, not intuitive, not designed the way a physician's brain is designed to work and the support is not happening!!! You can never get someone to help you when you need it. Don't buy this software. I have used epic, next gen and practice partners in my training and in other practices and they blow amazing charts away. I'm frankly shocked by what appear to be good reviews. They must be spending all their money paying people to post bogus reviews. Dr. Delea

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    Replies
    1. Finally!!! someone says the true. Agree

      Delete
  14. I completely disagree with "Dr. Delea."

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  15. NextGen, not AC, is "archaic software, not intuitive, not designed the way a physician's brain is designed to work and the support is not happening!!!" I am frankly shocked that anyone would say anything good about NextGen! We have been trying to use it over the last year. It was forced on us by administration and it is destroying our clinic. NOTHING is intuitive! As one RN said, "I couldn't think of a better way to torture physicians than NextGen!" It is SUPER expensive, click happy (15 mouse clicks to print a school excuse), slow, can't see chart note you are creating, and support is a joke! "Wait for the next update!" Ha "Put in a 'ticket.'" Nothing gets resolved.
    Only a person who has been duped by their sale team would spend 100s of thousands of dollars on NextGen instead of $1995/provider on AC. Please don't make the same mistake our clinic did in 2011!

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  16. Dear Anonymous,
    Why are you anonymous? Are you perhaps AC? or somebody that benefits from AC sales,support, etc?

    Please REVEAL yourself for all our good.

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  17. Is anyone using it for plastic practices or medical spas?

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  18. Is any chiropractors using AC, and if so, what kind of results?

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  19. This comment has been removed by the author.

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