Monday, October 5, 2009

Melissa Young, MD: The Search for the Perfect EMR, Part 2

After narrowing down my EMR choices to two, I scheduled site visits for each. Oh, let me preface this by saying I did ask a practice management consultant that I had met at a conference what his opinion was of my two options. He said that they were both good choices (not helpful), that they had very similar features (again, not helpful), but that e-MDs had better ratings for customer service than the other company I was looking at. (I was asked not to publicly diss any specific companies or products, I’m not hiding anything from you. It’s really a fairness issue, and my experience might not be representative of the company overall. Also, I’m not being compensated by any company that I may praise)

He said that “Company B” had become more and more popular, and rightly so, as they do have a good product, but that their customer service ratings had gone down as they grew because they couldn’t keep up.
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So the closest endocrinologist who uses e-MDs is about 45 minutes north of me. I had spoken to the office manager (a.k.a. wife) of the senior partner and the staff was expecting me. I sat in the receptionist’s area and observed how the workflow went. I liked the ease at which they could check patients in, refill their prescriptions, and answer questions with a couple of clicks of a mouse. Mr. Joe Somebody would call, ask if his prescription had been called in, and without getting up from her seat, the secretary could tell him that yes, yesterday afternoon it was called in to XYZ pharmacy. Mrs. So-and-so showed up for her appointment and her insurance card was scanned in – no more mistaken ID numbers. It seemed that from a front-desk perspective (and I later learned from a billing perspective), that it made the workflow seamless and smooth.

I was, however, a little disappointed that the providers (MDs and PAs) didn’t use the system to its fullest potential. Some put notes in. Some used templates from time to time, but at other times free texted their note (which does not allow the system to come up with appropriate codes), and some still hand wrote notes for the most part. I asked a couple of them why. They blame themselves for not taking the time to learn to use the available templates and for not creating templates they would like. Having done the remote demo, I knew that there was a lot of potential as far as note creation, use of forms, creation of letters, interfacing with labs, e-prescribing, etc.

Company B didn’t have any endocrinologist in New Jersey that used their product. So off I went to New York, about an hour away, to meet with Dr. DM. I had spoken to him on the phone the week prior and after I said Fridays were best for me, he said Friday would be fine, but that he didn’t have patients in the afternoon so I may not be able to see him in action. I said that was fine, so we arranged for my meeting with him at 1 p.m.

I got there a little early, and found a waiting room full of people. But, I figured, I’m early, I’ll wait. So I did. A long time. During which I had the unpleasant learning experience about the value of a closed glass window separating waiting room visitors from staff who have no qualms about talking about other patients. Loudly. But that deserves a post in itself. As does a discussion about where to let chatty drug reps wait if they are going to gossip about other doctors.

But I digress. After waiting over an hour and a half, Dr. DM’s secretary called in me. Well, thank goodness, I thought. But when I got inside, she pointed to the phone and said, “That’s for you.” For me? How could it be for me? It was a rep from Company B asking me why I was there. I was flabbergasted. I told him I was there for a site visit. “And Dr. DM wasn’t aware?” Expletives went off in my head, but I was able to (semi) calmly say, “Of course, he was aware. I talked to him last week and made this appointment.” The rep said he didn’t understand why he was called. Well, neither did I. And did I mention during none of this had Dr. DM even bothered to stick his head out and say, “I’m sorry for the wait” or “Hello,” for that matter? At this point, I was convinced that staying was pointless. Besides, I still had an hour-long drive home.

I was seething the entire drive home. Still, I told myself, it’s not Company B’s fault that one of their clients is a jerk. But a couple of days later, I got a call from one of their reps. “I heard there was a little snafu last week, and wanted to know what happened.” A snafu? Wanted to know what happened? Didn’t the rep who sent me to Dr. DM know what happened? Didn’t the rep who called that day know what happened? She offered to set me up for another site visit. I said there was no way I was driving an hour again. She asked if it had to be at an endocrinologist’s office. I said so long as the practice saw a lot of diabetics it would be fine. She gave me names of rheumatologists, dermatologists, orthopedists, gastroenterologists. In the middle of her list, I got disconnected. She never called back. I don’t know if she thinks I hung up on her.

I still think Company B’s product is good. And clearly lots of people think so. It is very popular. But I figured, if this is how their customer service is when they are still trying to make a sale, what will it be like after I’ve signed the dotted line?

And so, I’ve made my choice. In my next post, I’ll tell you about my experience in getting the EMR up and ready to go.

Melissa G. Young, MD, FACE, FACP, is an endocrinologist in private practice, an assistant clinical professor at Robert Wood Johnson, and a working suburban mother of two in Freehold, N.J. She is a regular contributor to Practice Notes.


  1. Sorry about your lousy experience. I use that "other EMR" and love it. We also host site visits and I block my schedule so that I can be ready for the visit; my office manager and billing supervisor each spend about an hour with the visitors orienting them to our processes and the benefits and downfalls of the product (yes, we are honest in our praise and criticism.)
    I have posted your blog entry to our user group for others to digest and comment ( BTW it is the only completely open EMR user group in the industry- 81, 000+ posts, 4,200 members- the EMR owner even participates but has no control over the posts at all!)

  2. Melissa, I am looking for an EMR app for our clients, a large Head & Neck and a large Plastic Reconstructive surgical practices in NY

    I would be very interested to learn names of firms with which you have a positive experience. I am greatly concerned about getting the docs to fully utilize the apps. Some allow notes to dictated into the system w voice recognition and provide integrated billing

  3. Signaturedoc - are you psychic or did I inadvertently indicate which compnay "b" is?

    David - if you give me a way to contact you, I would be happy to give you the names of my "finalists". I will say that in the end, I went with e-MDs.

  4. Melissa- You did not slip; 90% of docs in the US end up choosing between e-MD's and my choice- company B. Our forum has a lot of talk about the previous support issues that come with growing so fast; I can assure you they have fixed the problems. We had an issue on Saturday morning, I called support and within 15 minutes they were in our server and fixed it. On a Saturday!!!

  5. Well, this is why they (physicians practice) discourage bloggers from identifying names of brands or companies with whom we have negative experiences. My experience may not be representative of that of other people. Clearly, you are satisfied with your choice. I am surprised to hear that 90% of docs choose between these two companies. I have seen a lot of practices that use GE, Allscripts and NextGen. I have also heard of lot of small practices using Amazing Charts.

  6. OK, you got me! I made up the 90%! But these are the two of the most popular ones. And of course "popular" does not mean "best."
    It is frustrating that EMR's cannot talk to each other; I would love to be able to transmit to you all the lab results on a diabetic that I am referring to you so they can populate your flowsheets in your EMR automatically. Perhaps after health insurance reform there should be EMR reform with a universal EMR.

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