Best EHR for dermatology?

[golf4mbs]

Hello all,

Was wondering to get the opinion of some residents/practicing derm physicians on the best EMR, which ideally would be dermatology specific.

After checking a few out at the AAD this past year and hearing from a few in private practice it seems EMA by modernizing medicine is sounding the best right now, although I don't like that you have to purchase a separate practice management program to integrate with this.

Nextech is all-inclusive but I hear it is insanely expensive

I played around with EZ Derm a bit but they seem like a tiny company and I haven't met a single person using it.

It seems like it would probably still be best to do paper charting, but for a newly starting MD coming out and ICD-10 implementation pending I don't really think this will be a feasible option down the line.

Anyway, leave your opinions. If it matters this would be for a small 1-2 physician group in private practice

Thanks!

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[asmallchild]

Hello all,

Was wondering to get the opinion of some residents/practicing derm physicians on the best EMR, which ideally would be dermatology specific.

After checking a few out at the AAD this past year and hearing from a few in private practice it seems EMA by modernizing medicine is sounding the best right now, although I don't like that you have to purchase a separate practice management program to integrate with this.

Nextech is all-inclusive but I hear it is insanely expensive

I played around with EZ Derm a bit but they seem like a tiny company and I haven't met a single person using it.

It seems like it would probably still be best to do paper charting, but for a newly starting MD coming out and ICD-10 implementation pending I don't really think this will be a feasible option down the line.

Anyway, leave your opinions. If it matters this would be for a small 1-2 physician group in private practice

Thanks!

I'd also vote for paper charting given how insanely expensive these products are but I do understand the concerns with long term feasibility

EMA seems to be the "best" but it has its warts (the largest of which is ease of use. It's an incredibly complex tool but trying to training my older support staff with it has been a trying process over the last 6 months)

Nextech is not only expensive but is significantly clunkier than EMA in the EHR department (although I do like their practice management tools)

I had a chance to play around with EZ Derm as well and liked the interface but as you noted, it isn't a large enough company (and subsequently, lacks in the support department) for me to recommend going with it

 

[MOHS_01]

I use EMA; I will say that it sucks less than the Allscripts Enterprise that I used before it.

 

[username456789]

The only good EMR is a dead EMR.

Unfortunately, they won't be going away anytime soon.

 

[ExpertSkinDoc]

I've been using EMA for the past 3 years, I had switched over from the defunct Medinotes, only been using 100% electronic charting with EMA for past 2 years, I can tell you it's a love and hate relationship.

I love the specificity of it for dermatology, love the way it keeps up with all the PQRS and MACRA, so-so with their ICD-10 coding, and getting decent support from their big support team. But that comes with a price.

I hate their monthly inflated price that keeps rising, hate their dumb no-AI way of doing things, hate the way I can't really customize certain things to the way I want, hate the way their email and intramail work, I can go on all day...

I am still spending 2-3 hours after work to do all the charting, despite having a scribe/MA with me to see each individual patient.

I just hate the way all the EHR vendors keep their software closed to themselves, their goal is to make money and not to integrate or communicate with anyone else. I digress.

 

[ballerdoc]

I've been using EMA for the past 3 years, I had switched over from the defunct Medinotes, only been using 100% electronic charting with EMA for past 2 years, I can tell you it's a love and hate relationship.

I love the specificity of it for dermatology, love the way it keeps up with all the PQRS and MACRA, so-so with their ICD-10 coding, and getting decent support from their big support team. But that comes with a price.

I hate their monthly inflated price that keeps rising, hate their dumb no-AI way of doing things, hate the way I can't really customize certain things to the way I want, hate the way their email and intramail work, I can go on all day...

I am still spending 2-3 hours after work to do all the charting, despite having a scribe/MA with me to see each individual patient.

I just hate the way all the EHR vendors keep their software closed to themselves, their goal is to make money and not to integrate or communicate with anyone else. I digress.

That is so discouraging! How is it possible you're spending 2-3 hours at the end of each day charting when you have scribes? I've heard of this problem if you don't have scribes, but never if you actually have scribes!

One thing I wish EMA would implement is an inbox tool, where once the MA/scribe is done with the note, they can send it to you for you to sign, rather than you having to go to your patient list for the day every time to sign a note.

Another thing that I would love for them to implement is the ability to "free text" edit the note as you are reading it, rather than having to go back into the virtual exam room and go through the clunky system.

 

[asmallchild]

That is so discouraging! How is it possible you're spending 2-3 hours at the end of each day charting when you have scribes? I've heard of this problem if you don't have scribes, but never if you actually have scribes!

One thing I wish EMA would implement is an inbox tool, where once the MA/scribe is done with the note, they can send it to you for you to sign, rather than you having to go to your patient list for the day every time to sign a note.

Another thing that I would love for them to implement is the ability to "free text" edit the note as you are reading it, rather than having to go back into the virtual exam room and go through the clunky system.

I have the same problem, the scribes can only do so much especially if working at a brisk pace.

Other providers in my practice feel comfortable just blindly finalizing their scribes notes but I can't do that. Our billing is also handled via EMA (we finalize the note, EMA comes up with the billing suggestion, and it gets funneled to our practice management software for billing). I also don't trust my scribes with handling my billing.

All in all, it also takes me a few hours upon getting home to get everything tucked away for the day. Definitely a downgrade over pen and paper charting.

 

[MOHS_01]

I have the same problem, the scribes can only do so much especially if working at a brisk pace.

Other providers in my practice feel comfortable just blindly finalizing their scribes notes but I can't do that. Our billing is also handled via EMA (we finalize the note, EMA comes up with the billing suggestion, and it gets funneled to our practice management software for billing). I also don't trust my scribes with handling my billing.

All in all, it also takes me a few hours upon getting home to get everything tucked away for the day. Definitely a downgrade over pen and paper charting.

Is your billing in house? Or do you use EMA’s RCM?

 

[ballerdoc]

I have the same problem, the scribes can only do so much especially if working at a brisk pace.

Other providers in my practice feel comfortable just blindly finalizing their scribes notes but I can't do that. Our billing is also handled via EMA (we finalize the note, EMA comes up with the billing suggestion, and it gets funneled to our practice management software for billing). I also don't trust my scribes with handling my billing.

All in all, it also takes me a few hours upon getting home to get everything tucked away for the day. Definitely a downgrade over pen and paper charting.

@asmallchild , what do you think about EHRs that are hybrid systems between paper and electronic?

I'm in my final year of residency, and we use an EHR called SRS. We write notes on paper which are scanned in at the end of the day. We are able to access notes on desktops/laptops, and also photos, path results, lab results, all documentation is scanned and uploaded into the patient chart. This EHR is also able to meet all the MIPS/MACRA requirements with ePrescribe, etc, and the ICD-10 coding is also done electronically.

I used to think that EMA would be a step up from this system, but when I moonlight for doctors who use EMA I realize how tedious, clunky, and unnatural the user interface is. On top of all this, the notes generated by EMA are PDF and look similar to the notes we upload (as opposed to looking like a webpage). Additionally, there is also a mound of paperwork needed to be uploaded into EMA (path reports, consent forms, labs, new patient paperwork). So simply scanning patient notes on top of all of that isn't too much more work for the staff.

I was considering using EMA or Nextech in a future practice, but now seeing how clunky they are, and that there's mounds of paperwork that still needs to be scanned and uploaded, I'm considering using a hybrid system that allows paper notes that are uploaded into a digital chart. Do you think a hybrid system as this one can stand the test of time down the line as ICD-11 emerges and as documentation requirements continue evolving?

Thank you for your opinions.

 

[MOHS_01]

@asmallchild , what do you think about EHRs that are hybrid systems between paper and electronic?

I'm in my final year of residency, and we use an EHR called SRS. We write notes on paper which are scanned in at the end of the day. We are able to access notes on desktops/laptops, and also photos, path results, lab results, all documentation is scanned and uploaded into the patient chart. This EHR is also able to meet all the MIPS/MACRA requirements with ePrescribe, etc, and the ICD-10 coding is also done electronically.

I used to think that EMA would be a step up from this system, but when I moonlight for doctors who use EMA I realize how tedious, clunky, and unnatural the user interface is. On top of all this, the notes generated by EMA are PDF and look similar to the notes we upload (as opposed to looking like a webpage). Additionally, there is also a mound of paperwork needed to be uploaded into EMA (path reports, consent forms, labs, new patient paperwork). So simply scanning patient notes on top of all of that isn't too much more work for the staff.

I was considering using EMA or Nextech in a future practice, but now seeing how clunky they are, and that there's mounds of paperwork that still needs to be scanned and uploaded, I'm considering using a hybrid system that allows paper notes that are uploaded into a digital chart. Do you think a hybrid system as this one can stand the test of time down the line as ICD-11 emerges and as documentation requirements continue evolving?

Thank you for your opinions.

They would not satisfy meaningful use is the problem; sure, EMA's output looks like any other PDF, but the data itself is very much a searchable database box checked **** record -- which is why I dislike any "compliant" EHR.

Medical notes are supposed to tell a story -- what the patient presented with, how it came about, how they got to you, what you see, what you think, what you worry about, and what your plan is. It's a narrative; the problem with narratives is that they cannot be efficiently datamined. They are not easily monetized information. So... function from the perspective of patient and clinician gives way to function from the perspective of payer and .gov

There are no great systems -- why do you think they had to be mandated? You don't have to force people to buy **** that is good for them.

 

[asmallchild]

Is your billing in house? Or do you use EMA’s RCM?

Our billing is in-house. When initially presented, we liked EMA's clinical services (although that has degraded with time) and did not like EMA's practice management software suite

 

[asmallchild]

@asmallchild , what do you think about EHRs that are hybrid systems between paper and electronic?

I'm in my final year of residency, and we use an EHR called SRS. We write notes on paper which are scanned in at the end of the day. We are able to access notes on desktops/laptops, and also photos, path results, lab results, all documentation is scanned and uploaded into the patient chart. This EHR is also able to meet all the MIPS/MACRA requirements with ePrescribe, etc, and the ICD-10 coding is also done electronically.

I used to think that EMA would be a step up from this system, but when I moonlight for doctors who use EMA I realize how tedious, clunky, and unnatural the user interface is. On top of all this, the notes generated by EMA are PDF and look similar to the notes we upload (as opposed to looking like a webpage). Additionally, there is also a mound of paperwork needed to be uploaded into EMA (path reports, consent forms, labs, new patient paperwork). So simply scanning patient notes on top of all of that isn't too much more work for the staff.

I was considering using EMA or Nextech in a future practice, but now seeing how clunky they are, and that there's mounds of paperwork that still needs to be scanned and uploaded, I'm considering using a hybrid system that allows paper notes that are uploaded into a digital chart. Do you think a hybrid system as this one can stand the test of time down the line as ICD-11 emerges and as documentation requirements continue evolving?

Thank you for your opinions.

I would agree with Mohs_01, I don't think it would meet meaningful use criteria

While clunky, EMA does help with meeting MIPS requirements which I don't think a scanned paper system would assist with either

From a logistics viewpoint, my residency system also used a hacked paper notes / scanned into a crippled EMR system. It was a nightmare with paper notes routinely being lost and paper notes routinely being delayed with scanning. I am mostly surgical at this point so I still use a paper Mohs map but the tedious part of the day is converting all that data into EMA's format at the end of the day.

You can look into Nextech, you may like it better. I found their EMR to be even clunkier than EMA's but I did like their practice management software side (we used to use them for scheduling and billing)

 

[Skindoc83]

I hear good things about ezderm. My friends that use nextech dislike it and EMA while ok is very expensive.