Are we there (Version 4) yet?

I know we are all eager for 4.0. My guess is though it is in Jon's best interest to release it as soon as possible. Therefore, it probably isn't ready.

We should just let Jon code in peace.

great advice
ready whenever the program is.

I agree with the above comment also. Why let a version loose and find out it has preventable flaws. I am anxious for the new version. I know Jon spoke of a good version of AC (like we have now) and CCHITY version. I just received a letter about updating my Liability insurance and they are asking about trackable data, preventative health issues and the like. They ask if my EMR is CCHIT or not. If you have an EMR that does this....less cost for liability insurance. I'm sure you are all receiving similiar notices, or will be.

Feel like a kid waiting for Christmas.
Looking forward to seeing the new package!!

I Know,I know!! Well, actually I don't know much, but Jon and the crew are/were here in Las Vegas at the American Osteopathic Associations annual convention. I hung around the booth as much as I could to watch what he was doing with it as he showed it to potential customers. I wasn't sure there would be any significant (or should I say obvious) changes except for the SEQUEL database. I didn't take any notes and I didn't see enough things repeatedly to memorize what I was seeing. But I DID SEE SEVERAL THINGS THAT LOOKED REALLY COOL. I am not trying to be clever about this, I just have sensory overload from the last three days. (And a little anti-histamine fog!)
I guess the important thing is it was up and running all the time at the show without a glitch and they are (I believe) Alpha testing very carefully on some sites to make sure nothing goes wrong when you are running with a big data base. He offered to include me in the testing, but I declined because I feel I have such limited skills that any little installation glitch would distract his crew from getting onto the Beta test. I will definitely be glad to get in on that as I believe it will open our quest labs faster. It looks good. He is feeling the heat to get the e-prescribing fixed right away and that is very close as well.
My guess is that the Sequel database will let the flood gates open a good bit and future updates will come in time to make us all happy.

Nice to hear about e prescription.

We just signed up for DrFirst succumbing to the same heat here in Michigan.

What is CCHITY version?

Do you like DrFirst?

I HATE ALLSCRIPTS!!!!

That's what I have been using. Figures they joined with Misys the ehr company with the lowest satisfaction around.

Used Misys in St. Louis-clumsy, poor support, lack of flexibility

I've been using OnCallData and I'm very satisfied with it. It's easy to use - my staff started entering prescriptions for my approval the first day with only a few minutes of instruction. If it would interface with AC it would be just about perfect.

CCHIT is the Certification Commission for Healthcare Information Technology and they have a set of criteria for ambulatory EHR's. Has Jon said whether he will attempt to get CCHIT certification? For me, it doesn't matter right now, but I suppose it will at some point.

It sounds like many of you have kinda given up on the prescription writer in AC. I'm just getting AC set up in my clinic and plan to use a Star TSP 800 printer (if I can get it up on the network ). We don't have to do e prescribing here yet.

I've sure found this group to be a valuable resource while learning the program. Thanks everyone.

to get 'certified' by cchit, jon would have to put up a boatload of money-and is one of the reasons cchit programs cost so much more (along w/ other bloat issues). as long as not being certified doesn't influence reimbursement or legalities, i think keeping it the way it is would strengthen AC's position in the low cost emr market.

Version 4.0 is just Sequel and a few other small bells and whistles. Jon is going to go CCHIT, he really has no choice. He does remain committed to his original core of users and is exploring a twin pathway, CCHIT or NO CCHIT and I think that is a great option. A low cost bare bones for those who want it, and the full --hit for those who must. In the past I considered CCHIT a negative thing. Now I have mixed feelings and will accept it as long as the advantages come with it.

I'm not too sure that Jon will gain much from joining CCHIT. AC may well lose as he devotes more time and energy to an otherwise useless endeavor, ignoring the development and support of the basic EMR product feature base. It will not only cost him the $30000.00 fee but the multi-thousand dollar investment in retooling his software. Other issues:

-- Most of his userbase are folks that want an easy-to-use EMR that is inexpensive.
-- The CCHIT market is dominated by a few dozen software vendors, most of whom are going the OTHER way- i.e. trying to put out "lite" versions of their products.
-- The annual CCHIT certification rate continues to decline; joining CCHIT now would be like booking a cruise on the Titanic while it's sinking.
-- The CMS/Medicare demonstration projects to date have been failures with little to no money going to the participants.
-- The CCHIT market has stagnated since 2005 as per the biennial CDC report put out last October (2007), while the rest of the EMR market continues to grow. ( http://www.cdc.gov/nchs/data/ad/ad393.pdf )
-- Nobody knows how President-elect Obama will side with certification in general, especially if providers begin to stop accepting Medicare patients because of HIT.

I would personally hate to see AC go CCHIT. It would be an endorsement which will give CCHIT a political boost like no other.

Just my thoughts...

Al

CHIT Happens!

Exactly. I don't understand what all the fuss was about. Version 4.0 is basically Version 3.7 with SQL and the ability to use your own signature.

Four things I can think of: there is a bug in the lab import that causes the inboxes for the practice to be wiped out; the vaccination system is rumored to be improved; the item sign off is rumored to be improved; and, AC will hopefully be faster.

I believe vaccinations and imports don't affect you though Bert, so it will likely be of less interest to you.

Why the hell is Allscripts being backed by the government.

1.the 0 bug (inbox wiping out bug-don't ever delete a lab labeled 0) does seem to be fixed-i encountered it in the 3 ver, but not in 4 yet. w/ ver3, daily backups saved me when my inbox was wiped.

2.haven't tried the vax module-still makes me enter in lot no, where, etc, when all i've been doing is putting 'flu vax-08' in the fam hx section (altho if i have a pt w/ probs, i'll likely have probs too tracking down where it came from

3.ver4 is faster, esp if you're importing labs-that was the slowest part of 3, even on a totally wired network. and if u are getting labs, getting those "cannot connect w/ server" messages (even on the main machine) are all gone too.

4.i also have started writing consultants notes w/ ac, and kept getting a printing error when i tried to print subsequent notes, but that's all gone now w/ 4.

5.best thing (IMO), ver4 can print any (controlled, scheduled, etc) script w/ any printer and any paper now (compliant w/ new guidelines)-no need for special papers/printers or having to fax when the pt will change their minds and goto another pharm anyways. it keeps away phone calls from pharmacists refusing to accept your scripts and ur staff from verbaling a rx u just wrote that morning.

6.it also has improved signing off (closer to full screen previews), but i'm trying to make it work w/ .tiffs and MS office doc imaging

7.i'm getting some errors when restoring backups, which is keeping me from totally recommending the alpha version for now.

I can't see where the vaccine entry is any different. My program won't work now due to the new database. I will try to work on that.


OK, someone has to help me with this one. Where are these new guidelines? The only difference I see when printing a prescription on version 4 is that the number has asterisks next to it so you can't change it. Can I really simply print out Oxycontin or Concerta on plain 8 1/2 by 11 paper and sign it and use that as a CII script?

Finally, while FAP can still work with a workaround, my V.I.P.E.R. immunization program cannot unless my programmer fixes it. That will possibly keep me from using Version 4. AND, now we can forget Brian's and my AmazingMeds databases with SQL. So, I will definitely not change to Version 4. I can't possibly bring myself back to using that awful medication database.

It is fast however. I am running it on a virtual machine just to play with it. Now, of course, the database is on the same machine (virtual), but it is much snappier.

Why are you restoring?

Bert,
For those of us now using FAP are you and "Special Ed" going to be working on this "work around" in case folks like us want to move forward with V 4.0??? Not sure we do want to, but we certainly might once it has gotten most of it's bugs out. Oh and whoever posted that warning about not deleting an imported lab labled "0" thanks so much. Now that is a really bad bug just waiting to bite someone in the fanny... Gotta run...
Paul

Paul,

Working on it.

it's the new medicaid requirement (http://www.cms.hhs.gov/DeficitReductionAct/30_GovtInfo.asp). i think you were using one of those star printers (w/ tamperproof paper), so you're covered. for those who are using regular printers and paper, tho, we'd get daily calls about problems in medicaid pts. ac4 not only has *'s, but also tiny print (i forgot font size) that can't be copied, and a statement about these measures. that's enough to cover the reqs. altho w/ CII, some states require handwritten rxs, but haven't gotten calls about those--yet.

ac4, by using the new sql db, does break 3rd party addons that relied on manipulating the old access db. for me, my demographic bridge that uploaded my pt's info to my lab broke, and i'm waiting for a fix, but for me, the +'s outweigh the -'s. w/ sql, there may be additional benefits of synchronization remotely, and i'm looking into that now.


no showstoppers, just trying to make sure i can recover completely from a completely clean slate (uninstalling and deleting the AC dir).

vroberts:

We just signed up for DrFirst. Not used it yet. Will post once we get familiar with it.

djkym:

Re: restoring.
When we changed our server, we downloaded AC from website to new server and just copied/overwrote AC folder (in program files)from old server to ac folder in new one. That copied 100% of contents in AC (including license/pt data/imports etc..). Did you try it that way?

joseph2:

you're referring to ver 4? w/ ver 3, restoring was easy-just copy back your 6 mdf files and imported files directory and you're good to go. w/ ver 4, if all you have is your .enc backup file and the AC program .exe, i haven't found a way to restore.

Thank you for all the interest and comments! Here's an update on our current thinking, though, as always, I'm open to other thoughts or ideas.

1. Version 4 Status: We are getting much closer. In fact, I believe it is just about ready for beta testing, though I would like to do a bit more alpha testing. From the standpoint of data integrity and migration from V3 to V4, this seems to be working well in general, though there may still be issues with Midmark, and UpDox testing hasn't been done at all yet. If you are tech savvy and don't rely on UpDox, you can test the alpha version at this point. You will need to be on the latest version of Amazing Charts (3.7.15) before the update can proceed. The alpha is at www.amazingcharts.com/alpha. You can ping us for help at www.amazingcharts.com/help.

2. CCHIT: Although the interoperable part of CCHIT is important, the vast majority of the hundreds of CCHIT requirements are BSHIT. That said, the third-party payors have, as they always do, believed the hype and over time will be varying reimbursement based on whether the note was documented by a CCHIT-certified EHR. Thus, it is time for Amazing Charts to suck it up and get certified. As you've noted above, this will entail significant work and expense, but we've budgeted for it and will be developing a plan to be certified sometime in 2009 or early 2010 before these disparate payments become significant.

3. e-Rx and HM: We are working on this now, and hopefully it will be ready for testing later this year after V4 becomes our official release.

4. Practice Management: We are designing the overall big picture for PM, and I would like to ask some users to volunteer their time and knowledge. Specifically, I am looking for a few people from existing Amazing Charts practices (providers or their staff) who feel they completely understand the ins and outs of billing and are willing to share their experiences with existing software to help us develop nothing less than the best billing software for small practices. My plan will be to bring these people together both physically and virtually to design the specific windows, features, reports, etc. that the software must have to work amazingly. If you are, or know of somebody, who clearly knows and are able to articulate their needs to do outstanding billing, please email me their name, contact information, and what software they currently use.

Thank you again for the comments, constructive criticisms, and being part of the Amazing Charts community.

Jon

Hey guys and gals,

Anyone out there that can help. I generally know how to make a digital signature from a .bmp, etc.; but I can't figure out how to make it fit in the box it is supposed to fit in under user.

Any help would be appreciated.

Thanks in advance.

BERT,
I used Paint and just kept adjusting the size and saving it until the signature fit. Trial and error.

Leslie

This is a reply from Al on another thread and I thought since Jon and the greater gang are watching here for things of this matter that it might make sense to bring it over here...

[quote=alborg]Paul and Vicki-

More good news: http://ducknetweb.blogspot.com/2008/11/cms-names-four-phr-vendors-for-medicare.html It seems that Medicare doesn't care whether or not PHRs are CCHIT certified!

Every such development is another nail in CCHIT's coffin. Now, if we could get Jon to rethink the CCHIT certified AC idea, things would be even better...

Al

same trial and error here--can't remember my dimensions, but i did note that you just have to match up height--the length was always long enough, unless you have a really long sig.

Yeah, CCHIT has been having its licks, although as long as big government and vendors continue to help fund it, it'll continue to survive. According to a CCHIT newsletter that I got today CCHIT is still gearing up for PHR certification!

Here are the cracks in its armor, though:

1) Only 10 have certified for 2008 (http://cchit.org/about/news/releases/200...HR-Products.asp)
2) As monumental as AC's certification would be, another development is the fact that e-MD's has yet to recertify for 2008.
3) There are 3 CCHIT certified failures (pun intended)... Acermed, Medcomsoft, and Catalis. There are several more on the "watch" list:


(actually, Catalis will be changed to "BANKRUPT" in the next poster printout)

Al, you mentioned eMD's. Dr. Winn posted a while back at EMR update about why CCHIT is important, not good, he was sure to not say that, just important. The minimalistic view where CCHIT ensures a minimum feature set sounded alright to me. If CCHIT were more like that would you still object? (I'm assuming you remember the post.)

I'm going to look at the requirements later this week, but right now I like Dr Winn's view of what CCHIT should be. Although perhaps the government should have more say. (I'm generally for small government.)
Could someone please explain to me why the AMA makes royalties on their codes when the US government backs it? It should be free. (is it free to AMA members at least? it bothers me when the government backs things without getting any direct benefit to taxpayers.)

Hi Benjamin:

If CCHIT were free, easy to set up, and use so as not to increase vendor pricing, then it would be good for the HIT industry. Some things should be regulated by government- CCHIT is one of these items. Leaving the wolves (HIMSS/EHRA) to guard the hen house is NOT a good idea- what the "enterprise" EMRs wish to do is to limit the choices of EMRs to say, 30, then maintain a pricing structure that is 15 to 30 times that of AC. <sigh>

Dr. Winn dislikes the current concept of CCHIT as much as we do; he is just as upset about having to shell out the costs of CCHIT associated programming and development as well as the cost of CCHIT certification. Unfortunately, he is going for the mid-tier market where CCHIT begins to matter more, at least for now.

I agree that the CPT codes should be free, especially because they are used for Medicare billing. Such setups in healthcare are sometimes very peculiar.

Al

Looks like V4 has been released for Beta. I had tried out the Alpha version awhile back to test out the AppointmentQuest import, but later on when I tried to reopen ACV4 I had difficulty and bailed. I might try the Beta on my laptop, but I no longer have a database on the laptop.

I don't think it is. The beta website has been accessible since we were told on the forum of the alpha. Since it is the alpha site that has received the most recent update I think it is still alpha.

Heh, erm, perhaps I am mistaken. Sorry, I'll go now.

By the way, was the alpha version announced by Jon on the message boards?

I think so

That's a great way to introduce an alpha. It's awfully brave to introduce an alpha version en masse.

The alpha was not released en masse per se - I think he had some practices using the alpha version 4 for a while, but there were actually several different version 4's as he did incremental work. I noticed that he did send a version 4 to beta testing, but has one newer alpha version in the queue.... I think he was willing to let anyone with some tech savvy try the beta version, but I would call tech support first just to make sure. It is not completely turnkey on all computers (I have XP Home, XP Pro, Windows 2000, Windows 2000 server, Windows 2003 server and Vista Home Premium computers) - there were some subtle nuances on many of them.....

I am basing my view point solely on being told or hearing that the alpha version was advertised on the boards. If that is the case, then it was released en masse as anyone would be able to try it. I don't know how an alpha version could be newer than a beta version unless Jon decided to label it as such. By definition, software is usually developed as:

Pre-alpha --> Alpha --> Beta --> Release candidate and finally several other terms.

Alpha programs are generally tested within the company and is very "buggy." Once stabilized, it is usually beta tested by a select group of people outside of the company or sometimes distributed via download to more.

I think I will not comment on what practices were given the initial alpha version.

I have beta tested many versions of AC and always had good luck, but I was a little nervous using the alpha version. The way I see the releases by Jon is that on this same line of posts he advised everyone they could use the alpha version on 11/10/08. Since that time he has made 1 or 2 incremental new versions and they are now alpha while the alpha version at that time has been moved to the beta site.

I am nervous about jumping in - I actually played with version 4 alpha on a backup server I was no longer using on my network. I downloaded the most recent 3..7.... and then installed it with a copy of my current DB from my real network. I played quite a while just making sure it wouldn't crash, etc. before I put it on my real machines. It seems about as stable as my old 3.7... but it still crashes sometimes when importing labs, etc.

I have sent some error reports as well as suggestions to AC, but overall it is working okay.

I have a lot more testing to do. I am not sure I would have released alpha or even beta to the world until more testing was done.

I am a little baffled that there would be a post that V4 is best for XP and Vista as the DATABASE site. Many of us are using Microsoft Servers whether they be 2000, 2003, SBS 2003, SBS 2008. It is not playing well so far with the native SQL on SBS 2003. I am not the SQL expert by any means.

Again, the alpha testing should have been done by a select few -- possibly even the beta. I never knew anything about the alpha version and, frankly, don't know why.

Jon let me play with a copy of V4 at the AAP conference in Oct. He even helped me to load it on my laptop. I played with it quite a bit and found a few bugs, but it was very stable.

He intimated it was on the website, but never told me about the alpha site. I actually found it when I was messing around. It had a version later than the one I had on my laptop and I upgraded it without problem. Most of the bugs I had found were gone.

I will probably put it live soon, as I think it is about ready. Jon's betas have been amazingly stable.

I am prepared to revert the entire system back if need be. You should to be an adverturesome sole if you want to work with beta's. You should be prepared for dire consequences. It takes time to upgrade 7 computers, but I guess I don't have much of a life because I think it should be interesting.

When will the practice management module/upgrade be available? I am unhappy with my current billling service and wondered whether this function would be included in the upgrade, how soon it might be available, or should I look for another billing option?

I would look for another billing option. But, emailing Jon directly would probably be a better answer than mine.

@Wendell I agree Jon's betas are rather stable. Still haven't gotten Microsoft SQL 2005 Express Edition to work well with Microsoft SQL 2005. Keep getting an error message I can't figure out.

But, I am also still working with my AmazingMeds database. I have converted it to .mdf and it works fine in the new version, but it seems to cause a crash when I do a certain thing.

For me this is not even a question. If my database or Brian's database doesn't work with V4, then I can't use it. I just can't stomach that old and horrible medication database. I don't even know why such a thing exists.

But, I know you have more of a life than I.

Bruce, no billing is not part of this Version 4. In talking with Jon, it appears that SQL will be stabilized first and then he will proceed with other major changes. I recently went with MTBC the internal company (meaning the one that will accept output directly from AC). THey are only OK, we are still sorting things out since July.
I did upgrade and there are some connectivity problems at this time. Sometimes a windows account will work, sometimes it won't. On some machines most accounts work on some only administrator accounts. Actual functioning is good, including my win 2K 400mHz machine.

I still wish Jon would just focus on making AC the best little EMR. Building a PM application will take a lot of resources and may take away from further updates and upgrades for AC.

Just my opinion.

I thought the PM has been a project for at least a year and a half. Things would be so much easier if it is integrated. I agree it takes time, but when it is done then it will be a much more attractive program.

Bert:

1. Re: EMR updates and upgrades, is there an end point for upgrading or you think the possibilities are endless/always there to keep improving?

2. Re: same EMR part - how much benefit the users will have after certain point as I have read that 90% of users use the same xx% (whatever that low number is) features of EMR and not use the major XX% of features?

Regards.

Those are good points Joseph.

My belief is that there should never be a time when a program should stop updating and upgrading. I guess I can't think of any application out there that doesn't. Granted some of these upgrades are for the bottom line. A lot of upgrades are to keep compatible, i.e. my backup program's newest upgrade is compatible with SBS 2008 whereas the current version is not.

The percentages is an interesting point as well. A little like 20% of your patients take up 80% of your visits or time. I certainly don't use more than 5% of Word, but I do always like the newest versions.

The perspective on here gets blurry, because everyone is either used to or expects Jon to listen to and try to implement the suggestions they have. I can't think of any other major application where you can do that. You can email Microsoft and Adobe and whatever, and they will even email you back, but NO feature other than Service Packs and security patches and bug fixes will be changed until the brand new version, i.e. 2007 for Office. That was four years. But, that being said, Jon could work well over a year implementing things that have been suggested. I also think he could be the only EMR (I know of) that is pseudo-open source. Not truly open source, but where the EMR is constantly changed and shaped based on not only his vision but the needs and vision of the users as well.

As an FYI on upgrades, the biggest reason for Jon to put out upgrades (from 3 to 4 to 5 -- the actual new numbers) is to insure that users continue to pay for them otherwise, he would have no way of receiving continuous revenue short of the infamous subscription service. Oops!! There's that dirty word again.

Hey Guys. I'm just wondering how V4 has been performing for the folks that are beta-ing it (so far). Is it ok? Do all the old features work?

I've been a little nervour about beta-ing this one.

So far in testing it has worked great.

How about go to one of your work stations and transfer your AC folder there just for testing. Run SQL there and then connect to that database when testing and connect to the Access database during the day. Just a thought.