Dr. Bertman's amazing adventure: How one doctor built an EMR

A Rhode Island physician figured that if he wanted an electronic medical record done right, he would have to build it himself -- even though he didn't know how to write a computer program.

By Tyler Chin, AMNews staff.
July 8/15, 2002

Jonathan Bertman, MD, makes no bones that the electronic medical record he has designed is beta software -- it's still got some kinks to be worked out -- but says its functionality and price are so superior to existing commercial systems that his product is "amazing."

So amazing, in fact, that the solo family physician from Hope Valley, R.I., named his product -- and company -- AmazingCharts.com.

What also may be amazing is that rather than buy what he thought would be an inferior electronic medical record, he decided to create one himself -- even though he started the project with no knowledge of computer programming whatsoever.

It was harder than he thought. "I learned by doing it. I bought thousands of dollars worth of books on programming, and as problems came up, I sort of tackled them and learned how to do it."

Dr. Bertman's quest to build an EMR began two years ago when he started searching for and testing EMRs as he prepared to buy out his employer and go into private practice. He was determined to use an EMR because he didn't have any doubt that it could help improve his efficiency.

"I'm a technophile. I know the potential of what computers and the Internet can add, and I know that [an EMR] makes a whole lot more sense than writing or dictating because I've done all that."

His search, however, turned up several systems that cost too much, offered more functionality than he needed, forced him to change how he documented or required too much pointing and clicking to enter a single piece of information.

"Most of the programs were far off from what I needed, which was a quick, easy way to get information from the encounter stored into a database. I wanted it fast, I wanted it efficient and I wanted it cheap. I actually found that working with other EMRs slowed down my documentation."

As a physician, he thought he could design a better EMR. The systems he had looked at had clearly been designed by computer programmers who didn't know how doctors worked or what the technology needed to do for doctors, Dr. Bertman added.

He also decided to design his own system because he thought the job would be easy. "I thought, 'All right, I'm gonna get this program written in six months. It will be easy.' The truth is, I'm still working on Amazing Charts actively, and it's taken me a year and a half to get to the point where it is [and I'm happy with it.]"

Lessons learned
Learning the Visual Basic programming language and designing the EMR, which includes fixing problems and incorporating suggestions from physicians, took longer than he expected, he said.

The project also cost more than he anticipated. He estimates he has spent about $10,000 to develop his EMR, meaning that he could have bought a commercial system for that kind of money with a lot less hassle. But had he done that, he noted, he would be complaining all the time about the system and what a waste of money it was.

He also failed to realize the impact the project would have on his family, including two young boys. "The non-monetary costs such as loss of family time are actually a huge thing that I didn't really appreciate," said Dr. Bertman, who spends about 20 hours a week working on Amazing Charts. "I appreciate it now as the frequency of spousal discussions has increased."

The time he has spent on Amazing Charts has been hard on his wife, Sandra Musial, MD, a full-time pediatrician.

"She says, 'Maybe you could help with the dishes' kind of thing. 'Can you help with the [boys'] bath or will you be busy?' "

His older son is also craving some of Dr. Bertman's spare time. "My 4-year-old will say, 'Daddy can you come out and play with me or are you going to spend time on the computer?' When he says that I leave the computer. As he is becoming more articulate, I'm spending more time with him outside. He knows how to guilt me, and I go out immediately."

Dr. Bertman is working to balance the demands of his practice, family life and fledgling EMR business. He is planning a vacation "soon" to keep peace in the family.

He also has stopped biweekly updates and instead posts a new version of Amazing Charts on the Internet every three weeks.

Despite the financial and nonfinancial costs, he would do it all over again. Just quitting and buying a commercial system "never crossed my mind," Dr. Bertman said. "I knew what I wanted. And I saw that as I was building it that I could really take the next step and solve [the technical] problems."

He was also driven by anger that EMR companies ask so much money for their products. "I feel like these companies are trying to take advantage of doctors by charging them so much money. It's a principle issue, too."

And, he just didn't want to give up. "I am stubborn. This was a goal that I really wanted to complete, and it's getting there. Each time something was added to the program, I literally felt that it worked better. I knew this could work.

"I really don't think there is a product out there that does what I need it to do, the way I need an EMR to work. I started thinking of words to describe my product, and 'amazing' fit the bill. That's a little cocky," he said, laughing.

Bugs and crashes
The early versions of the program weren't ready for prime time, he said. They crashed frequently and had a lot of bugs, which is why he did not post Amazing Charts on the Internet until six months ago.

Amazing Charts, which is designed to be used with the Windows 98 operating system or one more advanced, offers patient scheduling, interoffice messaging, ICD-9 and CPT codes, and a medication database. Physicians enter demographic and insurance information, document notes and medications into a computer via free text. Those data are stored into a searchable Microsoft Access database.

Doctors can try the software for free for three months before the software "times out" and they receive an online reminder that if they want to continue using it they have to pay $250 and get an access code.

The price is deliberately kept low because "I wanted to get people to use it," he said. "I know as people start to use it, word of mouth is going to be positive, and so more people will do it. I figure if you got 1,000 doctors using it, that's a nice chunk of change."

So far only five out of the more than 1,200 physicians who have downloaded the program have bought it. "I'm getting plenty of calls every day and plenty of downloads. I'm not worried about it." Dr. Bertman said.

Although he makes it very clear on his site that Amazing Charts is a beta program, that hasn't deterred people from using it.

"It works," said Russ Faria, DO, a solo family physician in Newport, Ore., who tried the program, then bought it. "It flows the way a family doctor's notes usually flow, so it was actually very easy to use. It wasn't much of a learning curve."

But price was the key reason that led him to buy Amazing Charts. "I mean, how wrong could I go?" Dr. Faria said. "If I give him $250 and the software stinks, I'm out $250. ... I'm going to jump into something like this more than I'm going to spend $5,000 on somebody else's software and find out [later that] it stinks."

In any event, Dr. Faria said he more than got his money's worth, recouping the cost of Amazing Charts in one month from reduced transcription costs. "I would estimate, conservatively, that Amazing Charts will save me $2,000 in transcription costs just this year. Savings will likely be twice that in the future as I get used to the software."

The software also has let Dr. Faria to work more efficiently, particularly when he refers patients to specialists. "All I often need to do is write a quick note saying, 'Please see Mr. Smith for his headache, hernia, heart disease or whatever, with the latest patient visit note attached," he said. "The way the notes can be formatted, it can essentially be a history and physical. It makes my work a lot quicker."

ADDITIONAL INFORMATION:
Charting his course

Education

• BA, biochemistry, Vassar College, Poughkeepsie, N.Y. (1986)
• University of Massachusetts School of Medicine, Worcester (1993)
• Family practice internship and residency, Brown University/Memorial Hospital of Rhode Island, Pawtucket (1993-96)

Career highlights

• Family physician, RIH Medical Foundation, South County Internal Medicine & Family Practice, and South County Family Inc., Wakefield, R.I. (1996 to present)
• Clinical assistant professor of medicine, Brown University School of Medicine, Providence, R.I., (2000 to present)
• Founder and president, AmazingCharts.com Inc. (2001 to present)

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Speaking out
Jonathan Bertman, MD, doesn't think much of the electronic medical records products on the market today. He's not afraid to share his opinions, which he does on his Web site, which is distinguished by its blunt, irreverent and easy-to-understand language. Here are some excerpts:

"Companies are out to make a big profit and apparently believe that doctors can afford, and are stupid enough to pay for, some complicated patchwork of modules and options that actually can slow down documentation and office flow."

"Is Amazing Charts crap? Um. No. But don't take it from us. Try it yourself. As we've repeated ad nauseam, you can try it now without any payment or even giving us your name."

"EMRs are a big step, especially if you have to pay up-front, learn complicated data entry, use limited 'demo' programs, or have to spend time going through sales reps."