Sunday, June 6, 2010

EHR Bargains Review - Amazing Charts

(Survival Tips for Small Practices)

Amazing Charts is the best kept secret of the EHR industry. It’s like that little Italian restaurant on a back alley behind some church known only to locals, where the food is exquisite and the prices are dirt cheap and you won’t find any tourists hanging around. You don’t see any Stimulus Conferences sponsored by Amazing Charts and as a matter of fact, you don’t see much marketing efforts. Amazing Charts is bought and sold largely by word of mouth.

The company was founded by a physician in 2001 and it is still privately held and self-sustaining with about 3500 customers. There are many small EMR companies out there, some owned by the doctor who started them, so why is Amazing Charts special? Amazing Charts is 2008 CCHIT certified and Amazing Charts can be obtained for about $125 a month, inclusive of all the bells and whistles that come with CCHIT certified products. This is an anomaly. Most CCHIT certified EHRs cost at least 4 times as much and all have additional charges not obvious when you start out. The 2008 certification is very important because unlike older certifications, 2008 includes interoperability. For EHR products certified by CCHIT in 2008, obtaining Meaningful Use (MU) certification will be almost trivial.

The Model

Amazing Charts is a client/server EHR. You download it from the company site and can try it out for 90 days. If you don’t like it, no harm done. If you like it, you can buy a license. This is not SaaS or web based software. The server sits in your office and so do all your patient records. However, I am now logged into an instance of AC which a friend of mine across town downloaded to try out. I am using Remote Desktop and I see no slowness or any performance issues. So if you are adamant about having your server sit outside your office, you can do that. However if you are set on getting a browser based EHR, this one is not for you.


The basic AC price is $995 per provider, where provider is defined as an MD, DO, PA or NP. This however will not be sufficient for Meaningful Use. An additional $500 per provider/per year will buy you support (including a very convenient live chat), upgrades, electronic prescribing (from NewCrop) and annual maintenance for your other interfaces. This brings up the price to $125 per provider/per month for the first year. Interfaces for most labs and radiology are free, as they should be. Interfaces to office equipment and practice management software run between $250 and $500 (one time fee), which is the very bottom end by industry standards.

AC offers off site backup services for $250 per practice/per year and like many other EHR vendors, full service billing (from third party partners) for a flat 5% of net collections. The percentage is low for Primary Care, particularly Pediatricians, but a bit high for interventional specialists.

As far as training goes, AC has a wealth of online training videos and the software itself is pretty intuitive and easy to figure out on your own, at least when it comes to basic functionality. Onsite training is billed at $1500 per day, which is in line with industry customary charges.


Amazing Charts has all the administrative features of a modern EHR, including scheduler, messaging, detailed demographics and role based security. All the CCHIT clinical advanced features are also present including order sets, registry, clinical decision support, alerts and most important ability to export the records in CCR (Continuity of Care Record) format, which means that if for any reason you choose to buy a different EHR down the road, you can get your patient data out of AC. One very important thing to note is that AC’s documentation templates are not based on discrete data capture, and therefore are not point-and-click. You can create prefilled templates by adding canned text and type or edit the rest. You can also use Dragon Medical if you prefer dictation. Pretty simple stuff and very fast, but this may prove to be a problem if the Government insists on discrete data reporting.

AC does not currently have a full Practice Management System (PMS). There is no way to work claims in the system. You can create claims and export them to another system or drop them to paper for your billing service, but if you do your billing in house, you will need a PMS. On the AC user forum people are talking about a PMS module due out soon, but I have not seen any definitive dates. This is particularly important for Meaningful Use, since it requires that you do Eligibility checking and that claims are electronically submitted. It would be interesting to see how AC will deal with these challenges, if MU is not scaled back.

AC does not offer a Patient Portal, or PHR, but it could probably be integrated with third party portals like Relay Health and that CCR can be exported to commercial PHRs. There will most likely be costs associated with such integration.
One of the nicest features of Amazing Charts is the user community and the very active forum for discussions, assistance and just plain camaraderie. The forum is open to all, so you may want to take a look.

Bottom Line

Amazing Charts should most definitely be on the very short list of any price conscious small practice, particularly Primary Care and Internal Medicine. The price of $166 per month for year one and less than $83 per month afterward, is a great bargain for a CCHIT certified product and according to the 2009 AAFP EHR User Satisfaction Survey, Amazing Charts is ranked at the very top of the heap, outdoing all the big and expensive products. If, or when, AC adds a PMS that is as comprehensive and as friendly as the EHR, it should move to the top of the shopping list for any small private practice.

07/18/2011 Update: Amazing Charts EHR Version 6 is ONC-ATCB certified for 2011/2012 as a Complete EHR. It is also pre-market CCHIT certified for 2011.

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