Algos EMR Review for Pain Management 2005 Low Cost EMRs Under $10,000 Al Borges Free EMR   A work in progress that currently consists of a few word documents.  So many disadvantages that the program is not worth mentioning except to avoid it in 2005, even though it is free.  Algos Rating 0/10 LifeRecord EMR   http://www.liferecord.com This is a web based EMR that has surprisingly good features such as a single screen to view all past history, embedded patient pictures in the demographic screen, and embedded scanned insurance cards (up to 3).  The scheduler is adequate.  The system is of course dependent on the internet and any outage can make the entire system inoperable.  But the revisions that have been undertaken are excellent and the system is constantly being updated on-line.  The server in your office can be a central switching station for other office computers.  The system has a built in practice manager and the entire system is free.  Service can be purchased on a pay-per-incident method of about $20 per incident or can be by subscription for the year for $2000.  The company developing the software makes money solely on the service fees. Overall Algos Rating 8/10 OneNote  http://www.abletfactory.com/products.htm    Cost per user:  $295 OneNote EMR Toolkit,  $295 OneNote eScript Toolkit,  $250 abletWordMgr (medical dictionary necessary to recognize tablet handwritten medical words)  Licenses: none  Recurring fees: none  Special Software Databases: none This is a series of small modules for tablets that take advantage of the handwriting recognition graphics interface of the tablet.  It is a very limited program that would not be suitable for an office based practice of pain management.  However, if one wished to develop the templates for procedures, it may be an excellent inexpensive program for creation and storage of procedure notes or brief office followup visits.  There is no scheduling program, practice management software, and the demographic data must be hand entered for every patient (not imported from a billing or scheduling program).  The templates include the ability to import pictures into the template that is an interesting way to describe the pathology, but the program has so many other deficits (inability to code, not linked to billing program, no apparent ability to generate modular letters to referring docs, etc) that I would suggest other alternatives may be better.  It does have a script writing and faxing module which is separate but still quite affordable, but it is not clear if the output can be set to specific prescription size and location on a page.  There are demos on line for a few of the functions but the demo requires an annoying special viewer download then each demo must be saved to a hard drive before opening....not a well though-out way to demonstrate a product. ADVANTAGES:  Inexpensive  DISADVANTAGES: No Scheduling Program, Very Limited Functionality, Unclear if this would operate on a server Poor Integration,  No Other Programs Listed with which to Integrate, No Pain Management Modules, Somewhat Cumbersome To Use     Overall Algos rating for pain management  3/10 DescriptMed  http://descriptmed.com/ Cost per user:  $2500 unlimited users   Annual fee for support plus updates: $300   Optional setup fee $300  Training additional Excellent on-line demonstrations of modules, program cost is available on-line except for training cost. This is an excellent little program that is strongly template based (point and click).  It has a marginal scheduling program that requires typing in of patient names to schedule.  There is integration with a separate billing and practice management program.  The most interesting feature is the multiple screens available for inputting data such as SOAP notes.  It does have a printout for physician letters to referring MDs and also has a prescription printing module.  The company does not have pre-entered  templates for pain management but has access to those developed by  Dr. John Sharid in Battle Creek, MI.  He has said he would gladly share his templates.  Training is optional, however, The Chart! Enterprise ($4000.00) which is sold with eDrawer (www.edrawer.com) includes 6 hours web based training based on their (LSSP Corporation - makers of eDrawer) training schedule.  You can choose a training option e.g. site visit or on-line training.  The  developer believes The Chart! alone ($2500.00) has 2-4 hours web based training.  The system also works with Dragon for narrative notes.  The company is working on an integrated practice management system/EMR that may be available by Jan 1, 2006 ADVANTAGES: 90 day free trial, Embedded patient photo in demographic data;  uses MySQL database which is faster and has a much greater storage capacity than Access database.  Multiple screens for data input options.  On-line forum discussion. DISADVANTAGES: Does not have a physician schedule that can bring up a patient chart by clicking on the schedule (requires alphabetical file access-moderately cumbersome), demographics database may not freely transfer between the separate practice management or billing programs. Algos rating for pain management 6/10 AmazingCharts   http://www.amazingcharts.com Cost to purchase: $995 for first provider (physician, NP, PA) and $200 for each additional provider.  Annual fee which includes support and updates is $500 for the first provider and $100 for each additional provider.  Training is done on-line through modules (free).   Hardware requirements:  Modest server (is a server based software system) along with modestly fast terminals.  Using logmein.com, one may access the program anywhere in the world for free. This is one of the best programs for a small office based practice that leans towards primary care, but is relatively easily adapted to pain management.  It has a reasonably good scheduling program with the ability to click on patients names in the schedule to open the chart.   While this is largely a typed or template data input program, it also works with Dragon.  Is excellent on the initial encounter but poor thereafter in data input as there is no SOAP note format:  the same main screen used for the initial History and Physical re-appears for each note.  The latest edition permits embedding scanned documents and pictures directly into the database. ADVANTAGES: Scheduler is adequate and integrated, has intraoffice mail and popup sticky notes (very useful), demographics have picture of patient embedded, templates are very easy to create but does not support sub-templates or dropdowns from main templates.  Integrated billing output program that can be used to export data to a third party or the company itself offers an integrated billing service (unclear if this includes a module to check patient balances at the point of service) for 4-6% of collections (low for pain management). Support is generally available immediately (big advantage).  Great price, continually updated.  Off site data storage available.  The product is available for a free 3 month trial. DISADVANTAGES: Single screen available for data input, not SOAP note friendly, must open many past files to obtain any idea what the patient has had done unless the data is not overwritten with each encounter (creates gigantic data files that eventually slow the operation of the program).  Lacks linear note reporting to be able to view multiple encounters at one time.  Clunky program that occasionally crashes or slows to a halt for no reason in spite of tech support.  Uses very old database Microsoft Access that is slow and has limits on size of 2 GB.  The EMR works poorly on tablets since the font size is not scalable, and is very small.  It is possible to reset the resolution on the computer screen from the control panel, but then many point and click features and data features of Amazing Charts no longer work.   Coding is cumbersome and slow, the designation of a "common code" often cannot be made due to flaws in the program thereby requiring the physician to go through a massive coding list to find the correct code. Works poorly on any but the fastest wireless systems.  No predefined templates for pain management.  The system crashes or operates extremely slowly at times for no apparent reason (tech support cannot explain this) Algos Rating 4/10 QD Clinical   http://www.statsystems.com/      Cost is $3000 per physician flat fee without any apparent recurring fees routinely A relatively simple but powerful EMR that appears to be written with Visual Basic language.  One can add modular options to customize the system to your needs.  The options cover a wide array of the most desired features.  The system is designed to run on PDA or on tablets and has simple enough screens to make this possible.   Dragon is also useful in the program but templated files are the preferred data entry method.  A few of the major advantages of the program are modules to allow patients to input their own history data on a PDA then have the data embedded in the chart, the ability to perform free SF36 psych tests via PDA.  The output from the prescription module permits compliance with state laws.  Integrates very will with billing programs and the templates in the program are arranged in series of hierarchial nests.  The screens are very easy to use and resemble a doctors chart rather than a spreadsheet. The following is a list of features included and extra: Q.D. Clinical offered on portable, touch-screen computers, like Fujitsu's Stylistic and Lifebook as well as mobile computers like the Acer Travelmate, HP/Compaq, Panasonic Toughbook and the Toshiba Portégé. Also available is a powerful encounter note generator for PDAs like the Palm, Handspring and Pocket PC, but the graphics on these devices are so small that use of an EMR on a palm or pocket PC is not advisable. Ready-to-use visit windows for primary care physicians and specialists. Simple progress notes   Complete H&Ps Quick Rx refills In-office procedure notes Family Practice and Internal Medicine lexicons with hundreds of macros and lists Standard graphs and flowsheets Vital Signs & Chief Complaint windows with "point-and-click" data entry for pen-based use. Built-in image management system Scanned or "Image Bank" Images Annotate with drawings, text Incorporate in visit notes or print separately. LaserFiche® digital document managment* Complete E-Mail system for patient messages and staff communication Messages attached to patient records Includes recall/reminder letter generation Tracking patients for no-shows Message center management tools Customization for all specialties and personal styles Unlimited additional text fields for visits, findings, discussions Unlimited additional vital signs Unlimited user-defined fields for numerical and text data for outcomes, compliance tracking Unlimited lexicons for individuals or groups 50-column flowsheets customized to display meds, vitals, lab data, other variables, text and ad-hoc entries Import customization from colleagues Complete laboratory order and data tracking Lab-specific or generic requests Track open requests and returns to originators Batch or per-visit entry Electronic lab download option* Drug interaction and allergy checking option* Descriptive, pricing and clinical information on drugs Automatic interaction checking Monographs on drugs and interactions Patient information forms Full compliance with records audit and group QA standards - all built-in and easy to use Problem lists Medication lists Other Therapy/referral lists Allergy lists Immunization records Health Maintenance reminders Patient-specific reminders Comprehensive practice research module Profile individual, all, or groups of patients selected by physician or group characteristics Search complex relationships of problems, meds, labs, demographics Clinical Trials Research module* Complete clinical documentation Visit notes Prescriptions - print and electronic Letters to specialists, referrers, carriers Med lists and schedules for patients Patient care instructions Lab orders Customizable Letters and Reports Managed care support tools* Formulary tracking by carrier Carrier and practice-specified protocols Point-and-click selection of carrier-approved meds, tests, referrals Automated requests for review * = Available as separately priced modules. NOT routinely shipped with product. An online demo is available.   Algos rating 8/10 Codonix EMR   www.codonixnotes.com Codonix Notes $89/month   Extended system Module (internet access to records anywhere, anytime $39/mo additional    Document scanning module  $29/month This web based subscription service permits access to your patient records both locally on your own computer and also with the ESM module, in a secure HIPAA compliant web based storage.  The system is quite slick tailored to internal medicine, but there is a reasonably good "back pain" module.  Data entry is primarily through smart templates in which anything not checked automatically is recorded as a negative. in the history.   There is a scheduling program although the billing output is apparently to a pdf printed file that may be difficult to use with external billing companies.  Suggested billing codes are generated automatically based on the pieces of data input to the history and physical exam.  The scheduling program does permit point and click to load a patient chart, but suffers from the need to actually type part of a patient's name in order to pull up the index for the patient.  The system does not permit PDA or palm usage.   ADVANTAGES: Nice pictoral models which may be clicked on to open modules.  Relatively inexpensive...base unit is around $1050 per year per physician...there is no mention in their FAQ of whether support staff in your office also need to pay fees, but it would seem unlikely.  Nice templated screen. Does have a prescription writer but modification to fit your system to comply with state prescription requirements (may not be possible) will cost more if special paper is used (eg. narcotic prescriptions) for certain types of scripts. Simultaneous web and local storage of data is possible with this system.  30 day free trial.  Prices are available on-line.  Demo is available on-line DISADVANTAGES: Billing output method is inadequate, scheduler is cumbersome to use, may not integrate with your current practice management system Algos rating for pain 7/10 Soapware  http://www.soapware.com/ The number one selling EMR for small practices.  This is a modular EMR that does not have a scheduling program or billing program, but is currently in its beta 5 release.  The company hopes to have a working scheduling and billing program in 2006.  One may purchase the base module EMR for $300 per practitioner with the current version 4, and separate modules are available individually or packaged in bundles.  These modules include prescription writing, spell checker, health maintenance, document scanning, OCR document conversion, E and M coding, Chart Exchange, Drawing/annotation module, lab integration, chart portal, flowsheets, flashcodes, enabler for tablet PC, Dragon integration module (requires separate purchase of Dragon), etc.   This type of pick and choose approach of modules that may be added later is appealing to small practices.  The average purchase is $1200 according to the company and currently support is $300 per year, although that will rise to $500 per year with the version 5 release.  There are separately developed templates by many individuals that may be imported and Soapware has a very long history of existence as an EMR.  There are forums regarding its use and methods of tweaking the program to improve its functionality.   The program does not have a free trial, but does have a primitive on-line demonstration.  The manufacturer would like you to sit through a long demonstration in real time, but this is entirely unnecessary due to the simplicity of the program. ADVANTAGES:  A huge advantage over other programs is the side by side display of the current note with past notes.  This prevents physicians from having to flip back and forth as is required by most EMR programs.  Handouts specific to the patient's condition may be selected from within the SOAP note and printed.  Multiple medications can be selected at one time while in the prescription section thereby avoiding the need to re-open the prescription module over and over again as is the case with Amazing Charts,  The importable documents are embedded in the record and the OCR reader permits conversion of scanned documents into search-able text.  The drawing and annotation module permits embedding of pictures and annotated xrays.  Once the new version 5 is implemented, a tablet module will greatly expand the usefulness of a tablet PC.   Soapware changes over time through different version upgrades, but also through addition of modules, and through templating by its users.  The data storage system may be Access or SQL (SQL is a very expensive microsoft program) but there is no MySQL option (inexpensive powerful database).   DISADVANTAGES:  The major disadvantage is the lack of a scheduling program.  In a program that has been around as long as Soapware, there is simply no excuse for this.  The lack of a scheduler means the physician must purchase practice management software from a separate company and attempt to integrate it with Soapware, which may be a very expensive and difficult proposition.  Because of this programming blunder, I would not recommend Soapware at all until the schedule module is released in 2006.   To open a patient chart, the patient's name must be typed in which is defeating the purpose of a keyboard-free environment.  There is no way to format the printed output of schedule II or III prescriptions to meet the state law requirements of some states, thereby causing scripts to necessarily be hand written. Algos rating for pain management:  1/10 now and 8/10 after scheduling module becomes available in 2006 Altapoint  http://www.altapoint.com/medical/ This EMR is combined with an integrated billing system to make a single linkless system that is the best overall value of all EMRs.  Unfortunately, the tabs and layout look more like a business spreadsheet than an EMR and the obscure terminology of business initially makes navigating through the very busy opening screen that one cannot simplify.  The history and physical has extraneous tabs that take up valuable space such as immunizations,  height and weight.  The vital signs section includes three rows of space for pulse oximetry.  The EMR is not friendly to tablets since it requires some typing, and the templates must be developed.  While the program has many features, the navigation difficulties overwhelm the positives, making this a cumbersome program to use.  The cost of the program is $1,000 for each simultaneous user in your office.  In otherwords, if you have 3 secretaries, 1 biller, 1 nurse practitioner, and one physician simultaneously connecting, the charge would be $6000.  For a small office with one physician and one secretary, this is the most cost effective EMR solution on the market since it also includes the billing program.        Even at a cost of $6,000 for the total program, it is a bargain, but would take some time to learn, and the many many many clicks required to do simple tasks may detract significantly from its overall value.   The program uses small type fonts that are not scalable and much of the space on the page is wasted with graphics instead of text.   Training costs $85-120 per hour extra.  There is a reseller in Chicago that will make up your own screens at a cost of $1000-2000 each.  It is not possible to view the daily schedule and click on the patient chart from the schedule to open the chart.  Instead, the doctor views a screen of who is present and must select from those patients:  this is a big disadvantage since the doctor cannot manage time effectively or know how much time to allocate per patient in a fluctuating schedule. Algos rating 6/10 EMRs to AVOID Medscribbler  http://www.medscribbler.com/ Under no circumstance would I recommend this program.  The CEO is overtly hostile to physicians as is noted in his characterization and berating of physicians in the emrupdate.com  forum as quoted direct:  "It is amazing how many doctors think they are "tech gurus" and don't even know why a 63MB download doesn't complete or there is a firewall in XP that is causing access problems in a client / server product.  Many of the same doctors must be entheomanics because they think that reading Readmes and help files is not neccessary to install a medical business patient system.  Most doctors are afraid to move forward because they have to admit they are unable to manage a high tech medical system themselves and must give up control to staff as intelligent as they are.  My main point here is not a shot at EMR vendors but doctors - its time to pony up boys and girls! Talk is cheap!  Medscribbler is not all things to all people but I am an infomaniac and the info says its time for doctors to step outside of themselves and seriously stop talking and start doing. This was a fun post, I've always been a bit of a trouble maker." Medscribbler is a program for doctors that   a) enjoy employing extra information technology people at great expense,  b) for physicians who cannot figure out pointing and clicking in templates.  The following is a quote from a Medscribbler user: "I have used Medscribbler on a few patients now.   Overall it is not for me. I found the handwriting recognition difficult. The Ink boxes were too small for me. The area allowed for a note ended up too small for much writing. I could enlarge the area a bit but only as far as the physical space on the screen would allow. They maybe a way to add more space but I couldn't easily figure it out. The brochure mentions an "Intuitive, 5 minute learning curve" - I must not be that sharp. I even had trouble figuring out how and where it add my PMH. I finally did figure it out. It is in the "edit patient" screen on page 2 after you put in there phone number and address. I think it is not ready for prime time yet (Blood Pressure is documented as "Bleed Pressure" on the printout!) " I didn't see any tutorial that helped other than an online demo that had audio that cut out on repeatly. I was not sure where I should inquire about the simple questions of how to use the software. It was not intuitive enough for me."   Posted by Atticus on www.emrupdate.com 6 19 04                                                           Another quote regarding the CEO of Medscribbler's treatment of physicians:  "I was considering Medscribbler, BUT after reading CeoMike bashing how tech ignorant doctors are, I have decided to pass on Medscribbler. I am both a doctor and an electrical engineer; I don't think doctors are ignorant in tech, they just don't have the time to bother with it as their main concern is in caring of patients and not to babysit an flawed tech product. "  posted on emrupdate.com by tchair 11 24 05 Algos rating for pain 0/10 DrNotes  www.drnotes.com Absolutely avoid this program.  Click here for a 2005 news article on the company's history.  Click here to see a discussion on emrupdate forum.  This is an expensive program with many user complaints .....with hardware (required to be purchased from the company), 2 physicians would cost nearly $70,000 for the program. Algos rating for pain 0/10 NextGen Their small office program cost near $80,000 and there are several users that have found the software to be inadequate with company support non-existent.  You do not need the headaches associated with such an absurdly overpriced and underserviced program.  To view a discussion on NextGen by actual users and the major problems they have had, click here.