I just finished my demo with PunctureNote, which is the last system that I had on my list this month to look at before deciding about and jumping into one of these EMRs. I have spent some time with Practice Fusion, Charm EHR, Dr. Chrono, AcuSimple and Jasmine these last couple of weeks.
This post details my understanding and my opinion on the two systems that I liked the best. I am not a representative for either of these systems – I’m just an EAM provider who has participated in the 15-day free trial for AcuSimple and gone through the hour long demo for PunctureNote and I’m letting you know what I think. I don’t fully know/understand the features in these systems and I don’t know everything on the list for the developers in the future (nor what they are actually working on right now.) So, please note that this is just me making lists and figuring out which one I’m going to go with for myself.
I am excited about EMR software that is made for us as acupuncturists. I also know that these systems are new, which means they are adapting to the folks who are going to support them. Please don’t expect that right now, in this moment, that you will find the “perfect” EMR system for you. It’s not out there. And, it will never be out there if you don’t support the systems that are showing promise.
There are a lot more MDs and Western practitioners in the country right now. They are all helping to direct Practice Fusion and Charm EHR and Dr. Chrono and those systems are starting to work really well for them. As East Asian Medicine providers, we can support developers in the same way, so that they can make kick-ass systems for us. If you want to use an EMR that’s made for your East Asian Medicine/Acupuncture practice and you want to use it NOW, that means you are going to benefit from a number of great features while also being part of the support network that helps to build that system.
Navigating the EMR/EHR field is like trying to surf on an ocean of new information and can feel frustrating. None of us would choose the same surfboard for the real ocean. The right tool for the job is going to be different for everybody and is highly based on each of our intuition, taste, practice needs etc. So, if you’re interested in an EMR, I urge you to go through the free trial periods or demos for yourself.
Some of you may like Jasmine, but it wasn’t for me so I’m not going to talk about it here. I didn’t like the long drop down lists that gave me a ton of options for pulse or tongue that are outside the range of what I use while not including some of the options I do use. I also wasn’t super keen on the calendar, the ad banner at the top of my screen or the Facebook like feel (which literally allows you and your patients to “like” each others comments.) So, I have to admit that after a couple of days, I walked away from that one, not because of the functionality, but because it just didn’t feel right to me.
I have spent two weeks with AcuSimple and I really love it. After my demo with Puncture Note today, I have to say that I love that system as well. Both have a number of features on the burner that will make them even better. The developer of PN sent me an email asking me not to share any information about what he said about the future of PN with other developers – which is fair and I will try my best to make sure that I don’t do that here.
I don’t think these two tools need to be competing too much against each other. It seems to me that they have one, very large and obvious difference right now: One system offers more customization for a larger initial time investment on your part. The other system offers ease of use from the beginning with less customization for your individual practice. Both systems are being developed by East Asian Medicine practitioners/Acupuncturists. Here are the things that were important to me – and what I’ve seen happen with the systems up to today (September 23, 2014):
If you are using WordPress for your website or otherwise know how it works, you’ll be able to get around AcuSimple relatively easily. The main things you’re concerned about will be in the left column (calendar, E-forms, invoices, chart notes, etc). You use a visual or text field to create your forms, letters/emails, invoices, etc, which offers a lot of variability for people who want to customize your stuff. There is a drop down field of “contacts” above your visual editor where you can select the contact you’re working with. As you slide through the list on the left side, it will correlate with whatever contact you’ve chosen.
Overall, I wouldn’t describe it as an “intuitive” system, though I think it’s user-friendly because I think WordPress is user friendly. It allows for a lot of customization, but you’ll also have to figure a few things out along the way.
For PunctureNote, it looks like you login to the system and then go to “Front Desk” to see who is scheduled for that day. You click on the patients name and then have access to a screen that has all of their information on it. Their information is organized with dark grey block headings that make it really easy to navigate the screen. Personally, that feels more intuitive to me.
I would describe the system as intuitive. It’s easy to get around. You don’t have to do a whole lot of work to get started because they have it all setup for you. You won’t be able to customize the system as much, so it depends on whether or not that’s something you want.
Both systems allow the importation and exportation of data. You can import your contacts by using an Excel CSV file. For chart notes, you have to scan those in. I haven’t gone through this process in either, so I’ll have to come back and report on this once I do it this week.
For exporting, AcuSimple exports chart notes as PDF files, contacts as an Excel CVS file and financials to OFX or CSV files. In the demo today, I was told that PunctureNote can also export files to an Excel CVS.
It’s hard here because I didn’t get to play around myself with the calendar on PunctureNote. However, it appears to be a Google based calendar and the developer said that it’s data can be exported to iCal and Google Cal (though you can’t import data in from your calendar because it’s an encrypted system so it’s not going to allow that.) When patients schedule new appointments, a text is sent to them and an email is sent to you.
On AcuSimple, I’m not sure what the calendar is based on. You can drag and drop calendar events with your mouse or finger (and create them by clicking or dragging as well). There is a separate scheduler that has a scheduling widget that you insert into your website (this is separate from the patient portal.)
I don’t feel like I have enough information about either calendar or scheduler to feel strongly about a choice here. Both systems allow multiple bookings during the same hour, they allow you to set/limit certain appointment types (like things you’ve offered on Living Social, etc), you can look at the calendar for past/future for one patient or for all your patients, patients can schedule and receive email reminders.
PunctureNote allows patients to schedule through the patient portal, in AcuSimple, patients schedule through an online scheduler. PunctureNote allows encrypted communication with patients through the portal. I’m kinda into the pretty portal on AS because I’m a sucker for that stuff…and it has enough functionality for me to wait for text reminders and everything else that will get added to it (so, no text reminders for patients through AcuSimple right now). It seems like you can add patients or they can add themselves in both systems with email addresses acting as unique identifiers. Again, I’m not really sure what I like best here.
For AcuSimple, there is a separate area where the patient portal is housed. The system gives you code for a widget and you choose from two buttons that you can put onto your website. You find your code and settings for the patient portal by going to “edit profile” and then choosing one of the icons at the top (that wasn’t intuitive for me). The patient portal itself is very pretty and customized with your logo and business name. The portal allows patients to fill out forms about contact information and insurance as well as customized forms that you’ve made and inserted into the patient portal. You can upload files from you computer into the portal for them. They can also rate and review you.
In PunctureNote, the patients login to the same main area where you login and then they get into their portal. You can message your patients through the patient portal and it’s encrypted communication between the two of you in the system. Patients can look at a lot of their data, but I just had a quick demo so it was hard for me to see all of the features in the one hour. There is also coding for a button that you can insert into you website. You can personalize the button so that it includes your logo.
Patient Check In
On Puncture Note, you have the option of putting an additional screen in the waiting room and having patients check themselves into the system and then fill out the subjective note for you.
As stated above, PunctureNote allows you to message patients through their encrypted patient portal.
AcuSimple allows you to send out mass group emails to patients through their system (by using an email template) and you can also send emails to a single patient, which are then connected to their file. I believe that these emails go through your regular email address (the one that you’ve identified with the system when you set it up) and so they are not encrypted.
The patient billing was built into PunctureNote and seemed pretty simple to use, but we didn’t spent a whole lot of time on that. Ultimately, it looked really easy and intuitive, partially because the developer was leading us through it and he knows well how the system works. I wish I could say more about the billing here – but I do know that it ultimately ends up in the billing system and gives you a report as you need for your financials. It looked like invoices can be sent to the patient through the encrypted patient portal or printed out for them.
In AcuSimple, like I said, you create a number of categories and define them (and which area they belong to.) For example, if you’re creating an Initial Intake, you can just give it a total cost, or you can insert the various CPT codes that you might be using for that (97202 @ X dollars, 97810 @ Y dollars and 2 units 97811 @ Z dollars). You can do a TOS discount in the category itself or in the invoice when the patient pays. But, you setup your various categories in this way. You setup your inventory, including herbs, as categories too. When it’s time to create the invoice, you insert the various categories that you’re using and ultimately end up with your total cost and an invoice that can be emailed to the patient or printed out.
Right now, there is no herbal inventory on PunctureNote.
On AcuSimple, you create “categories” and sort them into either Income, Expenses or Pharmacy. This was not intuitive to me either – but it’s how you do all your billing and how you run your herbal inventory (or sell anything else) as well as pay your expenses out.
Both systems give you billing reports. As of this time, the financial reports in AcuSimple are much prettier (there are examples on the website) in terms of color coded visual graphs. AcuSimple lets you export financials so that they can be opened in QuickBooks or other systems.
I’m not sure whether financials from PunctureNote can be exported, I’m waiting to hear back about that from the developer. PunctureNote also allows you to export financials.
In AcuSimple, you have the option of creating templates for your SOAP note, as well as templates for your emails, insurance forms, letterhead and more. All of this can be customized with your logo and the information specific to your clinic. You can create letters, invoices or anything else by using these templates that you’ve setup. It takes a minute to figure out how to make these and there is no tutorial at this time. I can be really dense and I did it after two days, but I also know how to use the WordPress visual editor….
For PunctureNote, you are going to open a SOAP note and it gives you nice color boxes at the top for “Subjective,” “Objective,” “Assessment,” and “Plan” that you click on. Once inside, the system is pretty automated so you just go through and there are a lot of drop downs and check boxes. You write very little. If you have an extra computer and your patient checked in at your front desk, they can fill out the subjective piece themselves. Then, you can leave any notes on the subjective piece and it becomes very easy for you to see what the patient said and what the practitioner added to that. For the objective piece, you can pick from three different pulse systems and get a drop down. For assessment, you type in what your assessment was (since it’s too much to make a drop box for everybody’s different assessment style.) In the treatment plan, you can select the type of acupuncture you’re doing (TCM, 5-Element, etc) and you are given a number of check boxes and areas that you can fill-in. Once the SOAP note is completed, it looks very organized to go back through and see everything that you selected.
For AcuSimple, there is a pre-made SOAP note template that you can add to and save as you like (it will not be immediately ready for you, but if you like their template you can save it and use it in about 5 seconds) or you can make your own from scratch. If you make your own, you can use the “E-forms” area to create forms that work for whatever you’re doing. For example, if I’m using Kiiko Matsumoto style for my gyn exams, I can make a check box for all of the different abdominal points and reflexes that I’m testing. I can make another E-form for my pulse diagnosis with a drop down or check boxes or simply text fields. Then, I go to the template area and I insert these forms as well as any images, etc, that I want in my basic SOAP template. When I create the patient chart, I can pull up the basic SOAP template OR, I can pull up the various E-forms that I’ve made and insert them into the chart as I feel like it. This is a cool feature because I can create different E-forms for various things that might be going on with the patient, like “headache,” “digestive complaints,” “back pain,” or whatever I tend to see. Then, you can insert these E-forms into the chart note as you need. This allows you to customize your chart/SOAP note to the patient. However, it means that you have to create the various templates that you want to use.
In AcuSimple, you can import formulas from the reference section and click a drop-down menu of your favorite formulas into the SOAP notes. It inserts the formula and then you format it as needed.
In AcuSimple, you can import any images you want and if you pay for the biggest package, you can draw directly on those. For PunctureNote, they have a really beautiful diagram of the body that is color coded in various sections. You just click on the section of the body that you’re talking about and a check-box menu comes up where you can qualify what kind of pain or what’s happening with the palpation. It’s actually one of the most beautiful parts of their system.
ICD-9 or ICD-10 Codes, CPT Codes
PunctureNote allows you to use ICD-9 or ICD-10 codes. AcuSimple allows you to use ICD-9 codes. Both programs allow you to click on a menu and go through a series of inputs to select the codes you want. Both systems add these codes to your chart notes.
As stated above, in AcuSimple you create your categories for treatments with the CPT codes that belong to them. You then chose one of these categories from the drop down menu and it imports your codes into the chart notes. As of right now, CPT coding and super bills are not included in the PunctureNote system.
Reviews and Ratings
AcuSimple allows your patients to review and rate you and you can decide if you want these to be viewable on your scheduler.
AcuSimple allows you to fill out CMS-1500 forms and do electronic insurance billing, for the medium priced package. You can also create superbills and email those to your patient or print them out.
AcuSimple has built in references for Herbal Formulas (over 450), Acupuncture Points, and a Materia Medica reference (for individual herbs, over 400.) Through the reference, you can add herbal formulas to your drop down formula heading (that is where you select formulas for your chart notes.)
I found the demo through PunctureNote to be great today. I got an email a few hours afterwards asking me if I wanted to sign up. I emailed back with about eight questions on the system and am still waiting for a response. I think that it’s normal for them to respond within 24-48 hours…to somebody who isn’t signed up for the system.
With AcuSimple, I have not signed up for the system but I have been emailing with the developer, non-stop, over the last couple of weeks. I have to say that I am extremely impressed with his quick response time and ability to answer my questions. Everyone else I’ve spoken to about this system has said the same thing, that he is amazing. Every small feature I asked about was immediately added even though I’m not paying for the system yet. So, I have to say that I am pretty stoked and feel like he’s got my back if I start using his system.
A little addendum here. I decided this morning to go with AcuSimple and I’ve signed up. The main reason is that it just feels right for me. It also does the insurance billing right now, and that’s a big deal for me. I know that during the PunctureNote demo, the developer listed a number of things that are on his list, but I need a system now and Dan Axelrod has been amazing about communication and support for the last couple of weeks, so I’m going to go with it.
I really hope that if you’re looking at a Practice Management and EMR system that you support one of these systems because you’re supporting the East Asian Medicine/Acupuncture community and you’re helping to make it stronger.