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Amazing Charts EMR

3/2016

Amazing Charts is an electronic medical records (EMR)system.

This is an energetic start-up EMR software company that we use in our medical practice. WE have used it for several years. We were forced to buy an EMR to comply with new government regulations, called "meaningful use". After looking over many products, we settled on this one. Mainly we did this because we didn't think it was worth it for 2 physicians to pay $20,000/year for yet another software system (the price of e-clinical works, a competing product).

Overall, the effect of adding this EMR (perhaps any EMR) has been to add to our cost of doing business, and reduce the quality of medical care. We spend more time typing, and less time thinking every day, and adding more time to our day. It has not improved medical care. This is sad, but not unexpected given the usual effect of adding a layer of government to a previously working process. Think of the post office.

Warnings regarding Amazing Charts

One should be very proficient with the "Task manager" in Windows (i.e. Control-Alt-Delete), as one must use it several times/day because Amazing Charts either gets lost or hangs up fairly often. That being said, one can learn to live with this program, and given that the government insists on an EMR, it does manage to comply, in a partial way, with the regulations involved with "meaningful use".

Amazing charts does not do some basic things needed for Meaningful use, such as track the "transition of care" documents. It does not collect a full set of "CQM" for meaningful use part 2. These can be "worked around", if you keep testing the water every few months. To use AC for meaningful use, plan to add at least an hour every month to your workload, to see if AC is complying.

Amazing charts does not do "PQRS".

Also, Amazing Charts is vulnerable to "crypto" viruses. Be sure you back up early and often, or put your AC behind a remote desktop system that is isolated from your staff's email. It is foolish to practice using Amazing Charts, without a 2ndary method of reconstructing everything you do. The author's method is to print out notes and scan them in. Every day.

Amazing charts is not really useful for more than about 3 providers at the same time. It is slow, it hiccoughs ( the computer version). Mysterious errors crop up every day - -error messages, etc. It is not for anything more than one or two physicians max.

Prescriptions:

Prior to adopting Amazing Charts, we were using a commercial product for automated prescriptions. It worked fine. After adopting EMR, we dropped this, and now we use the prescription manager built into amazing charts. The good thing is that we track medications from visit to visit - -this is easier and better than the old method where medical assistants asked and misspelled medication names and doses time after time. The bad thing is that periodically, Amazing Charts goes belly up, and we lose most of our ability to practice medicine. We go back to using microsoft-word to print out prescriptions.

Electronic file cabinet:

Prior to adopting Amazing charts, we had our own home-grown medical records storage system. This worked very well, and in fact, we had not revised the driver program for at least a decade. We do not use Amazing charts to store documents -- we still use our old system. We have 5 network attached devices, each with approximately 10+ terrabytes.

We think it would be foolish to use AC to store files. AC is so vulnerable to corruption from viruses and computer crashes -- this would be ridiculous.

Interoperabilty:

Amazing charts doesn't "play well" with our other office software, although there is a written intention to do so in their marketing information online. As an example, we use "Office Hours" -- a scheduling/billing application, sold by McKesson. Amazing Charts of course does not talk to Office Hours, because of some strange glitch. Perhaps what is said is not what is actually implemented. Instead we were referred to "xlink". This additional piece of software, is supposed to read office-hours, and migrate it to Amazing Charts. Our experience has not been good -- Xlink messes up Amazing charts, and makes more work for our staff. We turned it off. Of course, we didn't get a refund. We advise staying away from Xlink.

Portal

Part of the whole meaningful use government mandate, is a mandated portal. Without an EMR that is integrated with a portal, you can't comply. Amazing charts does this by using another subscription provider, called "updox". Updox evidently started their company as an electronic fax system for medical practices. They have subsequently added messaging applications and hooks into Amazing Charts, so Amazing charts can report portal use. Practically, Updox is a much more of a government compliance tool than something intended to be truly useful. From the medical practice standpoint, it is just more work. We would rather communicate through phone or fax, and not have this clumsy email-like application that costs us time and money.

Meaningful use and PQRS

We adopted the amazing charts EMR so we could "comply" with meaningful use. In essence, the US government forced us to buy software that we didn't want or need. We now have hired another full time staff member to click the buttons in Amazing charts required to comply with meaningful use. There are innumerable silly things like "sending records to portals" (few patients want a portal), and going through complicated menu after menu.

The portal associated with amazing charts is called "Updox". Funny eh ? It originally was a fax portal, that was turned into a patient portal and has "hooks" into amazing charts. By hooks, we mean that whenever you finish anything in amazing charts, it sends something to updox. Usually whatever it sends is mysterious to us, and we don't get many thank-you letters from patients about this either -- in other words, pretty useless on both ends. But presumably it keeps the government happy.

Updox provides a method of secure emailing between patients and staff. It looks like a 1990's style email system -- you know - -the ones that we all dropped after gmail came out. Of course, the price of security is that one's staff and patients both have to learn a new email interface, and their email client is not nearly as well worked out as gmail. We wish gmail had a "HIPPA" compliant mode. An idea for you there Google.

The Updox portal is somewhat of an annoyance to both patients and staff. It is just there because of meaningful use. If meaningful use went away, we would drop updox.

PQRS is another government mandate. Amazing charts does not do "PQRS". The goal of PQRS is to exert penalties on physicians. The US government has cleverly constructed an impenetrable labyrinth of cross-referenced rules, mysterious bureaucracy, and then when it is impossible to comply, claims that the medical practice has not complied with their "quality" rules. The goal is to reduce the medicare costs. We think this is cheating. We would prefer that the government would just say "We are going to pay you less".

Amazing charts does not do some basic things needed for Meaningful use, such as track the "transition of care" documents. It does not collect a full set of "CQM" for meaningful use part 2. These can be "worked around", if you keep testing the water every few months. To use AC for meaningful use, plan to add at least an hour every month to your workload, to see if AC is complying.

 

Software issues with Amazing Charts

For several years, we have had the problem that the amazing charts screen "disappears" -- basically it times out and hides somewhere behind another open program window. Then, when you restart amazing charts, it says that "amazing charts is already running, or shutting down".

This is nonsense. Actually, there is always a login box for amazing charts somewhere on your windows desktop - - hidden somewhere. The most efficient way to fix this is to become proficient with the windows task manager- - you use control-alt-delete, pull up the task manager, find amazing charts, right click on it, and have windows bring it to the front. Then you can see it and login. The other, not so good way to go about this is to use the task manager to "kill" amazing charts, and then login again. Method 1 is much less intense. We wish someone at amazing charts would use whatever windows and many other programs do when you click on the "word program". It doesn't say "word is running already", it just puts you back into the program. Well, it could be worse I guess.

Amazing Charts Vulnerability to Computer Viruses

Amazing charts, like other EMR's that are not cloud based, can be corrupted by the "ransomware" type viruses. The xml file can be overwritten without any protection, and amazing charts is vulnerable to a virus attack.

These sorts of viruses are "invited in" -- a staff member might click on an email attachment that is supposed to be, lets say, an invoice. Actually it is a virus that then corrups your EMR.

Some observations about hardening amazing chart's resistance to viruses that your staff invite in:

Of course, common sense for any business that has data that they value is that you should also make sure that data cannot be sent "out" of your business by keeping your firewall running, and make sure your business is not on the public internet at all so that hackers cannot attack you from the outside.

The problem then breaks down to what do you do when your staff clicks on something they shouldn't ? Amazing charts, like any other complex computer system, is vulnerable to this "attack from within" style of ransomware. The only rational solution is to back it up as often as you can afford. That being said, we have recently realized that if AC was running behind a "remote desktop", it would be much more resiliant. We are implementing this -- we think this is a good idea -- think of AC as sitting on a cyber island somewhere, with the only communcations to and from it being through a very narrow road. This should keep AC from going down by the proliferating population of PC viruses, that sneak in through emails or websites. Practically, you can't keep your staff from clicking on whatever.

Unfortunately, you cannot backup the core part of Amazing charts yourself, because the database is always active. You have to use a utility within Amazing charts, that takes quite a while. The restore process also takes quite a long time (think hours here, not seconds). The backup process on AC runs once/day. This means that you could lose a day of a practice's EMR records. Amazing charts, understandably, is not designed to make it easy for one to create a backup medical record system. It would be too easy to bail ! We suggest being extremely sure AC is backed up at least once/day, and also being extremely sure that your entire practices electronic records are backed up.

Note: There are portions to amazing charts that are not included in the "backup" file created by AC. In other words, the "Backup" process that is provided by Amazing Charts, is incomplete. The best strategy here is to set up your own daily backup of amazing charts -- include the entire installation directory - -do not assume that vendor's "backup" will work.

Don't save documents within AC -- as you have no idea where they are, and they are also not part of the backup.

Report writing and interoperability.

Dr. Hain is used to writing fairly long, well formatted, referenced medical reports. Microsoft word is a good tool for this. Amazing charts stores everything in a database, and produces crude output that looks like it was written by a computer. Imagine that.

Dr. Hain wrote a "post-processor" for amazing charts. Reports are printed to the "miraplacid text driver". This produces a text file. Then a PHP program strips out all of the tabs and Amazing chart logos and other useless stuff, and produces an "rtf" file. Dr. Hain then edits the rtf file using microsoft word, using a reference manager (endnote), embeds graphics, and produces reasonably well referenced and coherent new patient reports.

Amazing chart's data is in their database, but it is not easily accessed by the providers. If Amazing charts were to increase their prices 1000%, and say we had to pay or else -- we would be stuck with our old electronic file cabinet record system. I guess at least we have a backup system.

Like almost all EMR systems, Amazing charts has no way to display results from other EMR's (for example, EPIC). This is rather sad.

 

© Copyright March 2, 2016 , Timothy C. Hain, M.D. All rights reserved.
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