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


(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:


(Robin Dickinson) #50

It seems apt under the circumstances! [quote=“thedocshoppe, post:47, topic:321”]
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
[/quote]

I wish the EMRs would all get together and come up with the best of everything! Maybe you could do some screen videos of how it works before it disappears (I use screencastomatic) and share those with your new developer in the hopes they will include some of this in your new EMR.


(Bruce Jung) #51

OK, here is what my screens looked like on a Tim Test patient. Not perfect, but pretty impressive capabilities. I had over 40 pages of suggestion to InLight and I would say they implemented around 25-30% before they went under. (But I feel like I’m showing pictures of a deceased relative here…lol) I will stop dreaming now…


(Robin Dickinson) #52

@thedocshoppe That’s going to be hard to replace!

One of my ongoing themes when recommending EMRs to other people is to find what works with their brain. Nothing beats an EMR designed for your brain.


(Mary Medeiros) #53

I’m almost surprised no one else has mentioned Kareo – I love it for the simplicity of its appearance and it is really quite user-friendly, plus it has cool features such as a Marketing module built in (can create an online profile that interfaces with over 70 online review sites such as FB, Yelp, Google+, MD.com, Healthgrades, Vitals.com, etc), and one of my favorite features is that it automatically surveys GoodRx for every e-prescription I order. Also the marketing module does automated pt communications such as appt reminders (can elect to use email, text, calls or any/all of the above) It has a billing module which I don’t need and also a patient portal, but for a bundle of all available products (Clinical, Billing, Marketing, Portal) for a low-volume practice it is $300/mo with no sign-on fee, training is included. I can keep the data at no cost if I decide to switch.

Like everyone else’s experience it isn’t perfect, and having only a few patients so far I’ve encountered glitches here and there that I think are largely a function of my lack of familiarity with the platform, plus certain things are still in the works like e-Lab integration, etc. Also the company seems a bit preoccupied with accommodating MACRA/MIPS, etc.

I came from a group practice that used Epic which traumatized me with the words-per-sq-inch-of-screen-space busyness, so I am infatuated with the clean, modern, simple, user-friendly look of Kareo.

I use Hint for membership management, but am hiccuping my way through that as well.

I’m just not tech-savvy, I am also a fan of “old-school” free-text note-writing. I agree with [quote=“Robin_Dickinson, post:43, topic:321”]
The important thing is finding what works best for you
[/quote] but am certainly open to hearing about options if Kareo and I turn out not to be a match made in heaven after all!

Good luck to all! I have other documentation questions but will post these in a separate thread.


(Mary Medeiros) #54

Example of Kareo interface. This is the screen when I first log in. The agenda is empty since it is a Sunday and I have no one scheduled, but overall the patient flow process is fairly smooth.


(Robin Dickinson) #55

Thanks for adding an EMR that I think most of us know nothing about! It’s so good to have different choices for different situations.