Hi, I am in texas and an oncologist with a solo practice. I am frankly too cheap to drop huge money for an emr like varian nex-gen etc.

I like ac but was wondering if any specialist are using it particulary oncologist and was hoping for a few tips. i have many questions and i appreciate anybodys input.

1) is there a way to write orders and it not show up on your soap note but be sent to your MA who is grooming the patient directily?

2) how do you guys put in documentation for INR checks via fingerstick or things like procrit neupogen injections. I was thinking letting my MA write a procedure note for these encounters.

3) anyway to get rid of the silly add codes to note before signing. I dont like adding codes on my soap note: it clutters it up.

thanks in advance

and of course how would you handle chemo treatments. Im thinking of paper and then scan after each cycle into the emr.

It can be done in the MS Access environment pretty easily in a what-you-see-is-what-you-get (WSWYG) environment... you just have to learn a little bit of VBA coding and talk to Jon about linking it to the main program. In that way you don't have to write a complete EMR, just a small applet. Going to a MS Access based EMR sure beats shelling out up to $100000.00 a license! The AC EMR, though, allows for the common doc to get there for a fraction of the gallery price.

The program that I've used for 20 years (since the days of DOS) has done well for me. In my area, even though I run a solo practice, I'm the only computerized oncologist that I know of.

This said, I am using the oncology part of my EMR hardly at all nowadays. The issue that you may force you to rethink your EMR choice is that before Congress is a bill called the " Oncology Improvement Act " which may require oncologists to participate in a souped-up P4P program in order to get paid at least 5% LESS than what you are getting paid now. It's to keep Medicare "budget neutral", which means that as drug prices increase, you'll need to own an enterprise-level CCHIT-certified EHR which YOU'LL have to pay for to allow them to find excuses to pay you LESS.

This is one reason, aside from the fact that oncologists in 2008 were singled out for a 10% pay cut, why I've severely limited my oncology practice and may end it once and for all in 2009. Solo and small group oncologists will be DOA in the near future. You'll be scr*wed and will be forced to either join one of your competing large groups, go into general medicine and increase your patient load by a factor of 2 or 3, or simply retire.

This said, let me show you some pics on how an Access EMR looks like. Here is how you can set up the form to pick the chemotherapy protocol-

































Here are the printouts for in-office chemotherapy-
































Here are the printout for hospital chemotherapy-












































Although at my how-to-write-your-own-EMR program website I go into many tips and tricks, I don't plan on going into the chemotherapy section just yet.

My database fits on a thumb drive which I plug into hospital computers, using the MS Access program already installed in just about every computer. The INOVA hospital that is my secondary hospital, though, now has changed over partially to a Novell interface where they turn off Windows, forcing me to use a laptop again. It sometimes seems like I'm always going against a head wind...

Al
Oncologist, Virginia
www.msofficeemrproject.com

Wow, I finished my fellowship one year ago and did not realize I was entering such a downturn in Oncology. I love being an Oncologist and will keep on trucking. My generation will never see the "good old days" I just wanna pay off my loans and thats all folks.

Thanks for your advise. I probably will not be able to set up chemo templates. Looks hard.

I think we are going to go with AC and scan in chemo orders and flow sheets.

also will keep superbills hand written since they go to a biller and I dont want him to miss lets say something as cheap as an Avastin. heheheh. smile.

thanks for ur advice.

I don't know about this myself, but...

There are some on this forum that say importing an excel file works well for building and following flow sheets. You could build yourself a template sheet for your patients and have someone import it. This way you can edit it more easily.

You could also use OpenOffice.org iff you don't want to pay microsoft. Just make sure to do the advanced install and verify that the activeX plugin is installed (for IE).

PS: I think it was Bert who said it. There was once a cash reward offered, I don't know if anyone won it