If you were going to start your DPC practice again, which EMR and communication tool would you use?


(Dana Sanderson) #30

We signed with Elation in December 2014 and had a Spruce demo two weeks ago but will not be signing up yet. The biggest issue we have with both of them is about the requirement for each patient to use a unique email address for each patient profile they would access. With a family practice including internal medicine and pediatrics, we have many patients who therefore require a separate email address for access to each of their minor children’s charts. Also, if a patient already sees a specialist whose office also uses Elation, that patient has to use different email address to access Passport (Elation’s patient portal) with our office. That’s too complicated.

Other than that, ElationEMR is a huge improvement over eClinicalWorks!


(Ken Rictor, MD) #31

Thanks for the feedback Dana. We haven’t had much of an issue with the email access but I know exactly what you are saying. I think Elation is aware that this is a big barrier for many practices and that this has become an issue. We used eClinicalWorks as well and you are so correct that Elation is a huge jump from eCW.

As I understand, Spruce will have connection to Elation in the next few weeks so that we can have a direct link.


(Robin Dickinson) #32

Oh, that’s really good for people to know. Almost a quarter of my patients are under 10 so don’t even have their own email. Plus a lot of my patients will all use the email address of the family member who actually checks their email. So there may be a mom receiving the emails for both her and dad and all the kids.


(Jack Forbush, DO) #33

I’ve had 5 (Centricity/Logician, SpringCharts, MacPractice, CareCloud, Practice Fusion)…ugh!


(Jack Forbush, DO) #34

What I have recommended to parents is to create an ileus email account for their children, i.e. janedoe+kid@whatever.com as most female providers allow for “wild card” email addresses. So far so good!


(Ken Rictor, MD) #35

That’s a good suggestion Jack . We can try that


(Dana Sanderson) #36

Thanks Jack. Up until now our clientele has balked at creating aliases, but you’ve given me the idea to perhaps write up a simple how-to for Gmail since that’s the most prevalent email provider in our practice.


(Jack Forbush, DO) #37

I had some patients/clients balk to begin with as well as they thought that it would make managing their email more difficult, but after some education about how this works and creating filters, etc…they’ve been on board.


(Ken Rictor, MD) #38

Yes I have found that patients really have their own preference for communication and some are totally foreign. Having a variety but not too many choices is good. It also depends on notification and how the system can get a hold of the Provider without killing your time in the process. Our email tool is good and we have many that use the portal and standard email response.


(Robin Dickinson) #39

Yes, anytime you introduce something new, be prepared for training! I have nearly everyone trained to the portal but it required me taking time during appointments to help them get it all figured out on their phones or tablets.


(Bruce Jung) #40

I am curious as to why people are not using or recommending AtlasMD? It costs ~$300/mo, includes membership management (no extra Hint fee of 1% of all billings), inventory management (no MDScripts $0.05/pill fee or $50/mo min nor Flexscan - just quoted >$80/mo) and no need for Spruce (at $99/user in your clinic/mo). If I add all of these to the cost of Elation (now up to $350/mo) I am way over $750/mo (around $830/mo) and close to 3 times as expensive as AtlasMD. And what about Amazing Charts with an unintegrated Hint? (If you don’t do med dispensing?) I ask all this because I just came out of InLightEHR which was closer to $250/mo and included decent enough membership management with an intuitive, simple, yet quite robust EHR. Thanks for any advice.


(Robin Dickinson) #41

We talked privately but in case anyone else is wondering, I can’t manage without a robust patient portal (so not Atlas) and fairly integrated tools (so not Amazing Charts). The quality of notes and patient summaries is also important to me. That said, you have to find what works for your brain and your situation. All payment platforms will charge to run payments but beyond that I have MD-HQ for about $250 a month (no staff).


(Bruce Jung) #42

Thanks, Robin, for your insights. As an FYI, it appears that MD-HQ is now up to $350/mo with a $1k-2k upfront “loading” fee. I am with you and like to have neat, thorough notes. My patients have been used to Twistle (which I would not call robust by any means), but it sure was convenient to message them with attached labs that came into InLightEHR and “text” with them about medical problems. I am reviewing AtlasMD, MD-HQ and ElationEMR. Elation is the most intuitive to me from a charting perspective and their portal solution is improving, but no affordable (to me) membership or med dispensing solution keeps me vacillating back and forth. I’ll let you know what I end up with as my InLightEHR access is running out in 1.5 months…


(Robin Dickinson) #43

@thedocshoppe I know several docs who have been put into crisis mode because of InLight shutting down…to lose your whole system at once really stinks. The important thing is finding what works best for you. Since you were involved with InLight from the beginning, I’m sure nothing is going to work as well for you because everything else is there proforma. I feel like I’m offering condolences here but seriously, I can’t imagine having to suddenly change everything! Best wishes with it!


(Michael Kagen) #44

I’m using Elation, HINT, and Spruce. I recommend all three especially in combination.


(Larry Riddle) #45

Thanks to all for sharing your experiences. We’ve been using Elation EHR but are beginning our transition to MD-HQ. We used Elation for a year and love it for it’s ease of use. We recently also added Hint integration for managing membership/retainer patients, and Spruce for patient communications. The Elation + Hint + Spruce is a very nicely integrated trifecta that handles most of the major challenges for practices.
That being said we’re beginning our transition to MD-HQ, which after much research and trial we’ve determined is a better fit for our type of practice. We’re a direct-pay, integrative medicine practice offering both memberships or per-visit, fee-for-service payment models. We also retail natural supplements, and offer some ancillary services.
MD-HQ is better tailored to integrative/functional medicine, and the customize-able forms options that load into charts is a huge time saver. MD-HQ also offers a native inventory management capability, which is another huge time suck for staff. We intend to retain use of Spruce, though it doesn’t automatically push patient communications into charts like it does with Elation (there’s a manual work-around for now).
No one EHR offered that perfect combination we sought - ease of use, customize-able forms, automatic upload of patient intake forms, inventory management, charting tailored to integrative medicine, patient portal, Point of Sale capability for retail transactions, recurring billing management for retainer patients. Obviously a lot to ask of any vendor. IMO MD-HQ comes closest when combined with some other, third-party offerings (eg: Spruce, Hint). We’ll continue to look for that pink unicorn as we scale and learn more about the market.


(Jack Forbush, DO) #46

early adopter here, so my price point is much lower…nonetheless, AtlasMD is a great product, just not for me. Although I haven’t looked at AmazingCharts in a few years, I got tired of their waiting for a truly web-based application (they use or used .net). I’ve opted to stay put given the increasing integrations across multiple services…yep, I’m paying for more, but I feel as though I’m getting more of what gets me


(Bruce Jung) #47

Thanks, everyone, for your input! It’s nice to have your thoughtful feedback. I really thought I was helping develop the elusive “pink unicorn” (@Larry_Riddle) with InLight. The team had integrated the most challenging facets of a DPC EHR with a robust and intuitive charting platform using a problem-oriented medical record format, simple and clean patient engagement, comprehensive lab integration, document management (both scanning and faxing) with user defined tagging, wellness module, a timeline with mouse-hovering for details, better membership management than MD-HQ and AtlasMD combined, etc… The next steps were going to be inventory management for drug dispensing (the easiest part of the puzzle in my mind) and fine tuning the ability to access charts on a portable device. It’s like being engaged to the partner of your dreams and be stood up at the altar… (Ok, that might be a little too dramatic of a comparison, lol.) Anyhow, I’m excited about the future to see how the rest of these remaining products develop with all of our input. I’m leaning toward Elation/Hint/MDScripts and (unrealistically?) optimistic that they will put their collective efforts together and offer a “package” deal with price points adjusted based on community demographics, practice membership size, age of practice and referrals. I’d take Spruce, too, but at $99/clinic user, that is way beyond me in my practice setting.
Thanks again for all of your advice and insight! - Bruce Jung, MD at www.docshoppe.net


(Larry Riddle) #48

Thanks, Bruce, and everyone for your valuable feedback. InLight did indeed look promising, so we were disappointed they shuttered. You’ll like Elation’s simplicity and native integrations. As the husband/MBA I look at the practice management side of the equation. My wife, @JennMD is the real brain, and from the physician side MD-HQ just offered some features better tailored to integrative/functional medicine. Re: Spruce - we didn’t want to pay for yet another 3rd party service, but they have a great patient communication offering that keeps us HIPPA-compliant. Almost all of our patients - concierge and FFS alike, prefer SMS and tele consults with @JennMD, and most have come to expect that. As a premiere priced practice competing for discretionary dollars a patient communication platform of some sort is a must. We did explore AtlasMD and like the holistic approach, and Dr. Josh’s efforts to build not only a better EHR mousetrap, but also to both champion the DPC model and also craft an direct-pay ecosystem for the community. Dr. Josh also is unselfish with sharing his knowledge and experience. He’s a true leader in the DPC movement. As usual, if we could only take a little bit from EHR A, add it’s best features to those of EHR B, combine with capabilities of practice management software C, throw in dash of inventory control brand D, and cap it off with the best capability of Point of Sale E we’d have the home run. For now we’ll settle for a triple. We’re newly-opened and in start-up, and we appreciate Hint’s connecting the community. I’ll be encouraging my bride, @JennMD to explore the forums and engage her peers to tap your knowledge. Thanks to all! Larry Riddle - MVP Medical Care PLLC


(Robin Dickinson) #49

I think this is the key problem…no one EMR has it all. Maybe someday…

And here’s the ultimate solution. :smile: