AdvancedMD Is A Love Hate Relationship With Our New Medical Record

Electronic medical records, or EMR for short, is a big decision for your company to decide which one will be used. This should be one of the most important things you “stress” over when you start up your practice. We decided to change from Practice Fusion to AdvancedMD. This decision was one that we have been mulling over for about a year. We simply outgrew Practice Fusion. Today I’ll give a review of AdvancedMD and tell you why we chose this medical record compared to others.

Wow, now that I have finished the article, I didn’t realize how long of a post this is going to be. I really did want to give my opinion on the good, the bad, and the ugly of both medical records and why we did what we did.

AdvancedMD

Founded in 1999 in Utah, this company has been around for over 2 decades. Per their website, they claim:

“AdvancedMD serves an expansive national footprint of 40,000 practitioners across 13,000 practices and 850 medical billing companies. 9.5M insurance claims are processed every month on the AdvancedMD billing platform.”

They initially started as more of a billing platform (often called practice management), but then in the 2000s added a health record.

Our Old EMR, Practice Fusion

Initially, Practice Fusion was a free EMR. Practice fusion then transitioned to a paid service sometime around 2017. This medical record was very popular with small practices due to the very low cost. They got around the “free” aspect by charging companies for advertising on the side of the screen while you were logged into the medical record. This constantly fed advertisements to their users. This backfired when they were finally sued for this practice.

I started my practice with Practice Fusion and used them as my EMR for 3 years until 2022. It was cheap and worked. I didn’t know what I “needed” in a medical record when I started out.

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Why We Left Practice Fusion

Online Schedule Is Terrible

Practice fusion has the ability to put your schedule available online. However, let us say a patient goes to your website and clicks on an appointment that says it is available at 11:30am. Until you accepted that appointment request, more patients could continue to book that time spot. Even worse, if a patient canceled their appointment, it would open up a spot online on the schedule for anyone to book.

It would be very common for us to walk in Monday morning to a patient who canceled their appointment for 10am and we would have 15 appointment requests for that one appointment spot.

There were lots of ticked off patients and lots of annoyed staff calling these patients to apologize for this issue. We kept giving Practice Fusion feedback about this issue, but they kept giving us the same statement.

The usual response from Practice Fusion: “Our engineers are busy with tasks outlined by our company, thank you for the feedback but this issue is not something that we are prioritizing at this time.”

Patient Portal Messages

This was my biggest issue.

There was no possibility to triage messages. Even worse, no one can see a message even exists until that doctor signs in and acknowledges that message.

When a patient logs in and wants to message the doctor, that message goes straight to the doctors inbox. Not the nurse or MA. There is NO way to set up a tirage system.

One month, I averaged 100 messages per day hitting my inbox. That is when I had an almost mental breakdown and turned it off while shouting enough. We ended up adding Spruce to our website for texting and messaging while we turned off messaging on practice fusion. This cost $50 per user per month on Spruce.

Everything Is Fragmented In Practice Fusion

Practice Fusion is only a medical record. They do not do any practice management. This means you must have another service to actually do your billing. This is often described as practice management software.

When I started with Practice Fusion, the 3 main companies that they recommended were

1. AdvancedMD
2. Kareo
3. Collaborative MD

Kareo was the cheapest, so I chose them when I started my practice. However, it is very annoying that patients receive a bill from a different service that does not talk well with practice fusion. Lots of patients thought these text bills from Kareo were scams.

It was death by a thousand cuts with Practice Fusion.

1. We had to have a separate messaging service
2. The scheduling software was broken and we needed a new one
3. Our billing service was separate from Practice Fusion
4. Telemedicine was not integrated into the EMR, meaning another platform was needed
5. No way to automate reviews with only Practice Fusion, you have to buy a third party software

Lack Of Automation

Very few things in practice fusion could be automated. If I wanted weekly reports on how many patients we have seen week over week, I must do this manually. Every single week.

I wanted an EMR with loads of data to work with our automation goals, not make me work harder to pull the same data repeatedly.

Downtime

While both AdvancedMD and Practice Fusion are on amazons cloud (AWS), Practice Fusion seems to go down much more often. When Practice Fusion goes down, sometimes it goes down big. All day outages are not uncommon in our opinion.

Sometimes downtime is not just “downtime.” The EMR will still be listed as running but it is so slow that you can’t even work with it because it may take 2 minutes for the lab page to load. So much productivity is lost with downtime with Practice Fusion.

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AdvancedMD

AdvancedMD helped with a lot of these issues but has its own shortcomings. I’ll detail those first then talk about the benefits.

Orders For Labs, Imaging, or Medications Are A Disaster

Lets say you put a lab order in for a patient as an annual physical and you always attach the same diagnosis codes to these tests. This is super common for us since we do a lot of annual physicals.

AdvancedMD does not have the capability to bind these tests and codes together in an order set. This means that for every order, I have to click or type in diagnosis codes manually. What a huge waste of my time.

AdvancedMD claims that there is “no way” to fix this. They know this is not true. They are not prioritizing it. I also am irritated that I cannot “repeat” an old lab order easily. If I am checking diabetic labs on a patient and every 6 months, it is the same labs, it would be nice to have a copy forward order button.

Nope, I have to put in every test manually each time and attach a diagnosis code to it one diagnosis code at a time. Labs that took 5 seconds to order in Practice Fusion take 1-2 minutes in AdvancedMD.

The Medication Ordering Disaster

I’ll give AdvancedMD one benefit before I roast them here. They actually pull in medications from their pharmacy. Practice Fusion does not do this.

Let’s say you pull in a medication into a patients chart from this automated pharmacy check (see screen below). What is nice is that you can pull a list from their pharmacy and mark it as current, historic, record only, or ignore it.

However, once it is in the chart, it takes 11 clicks

In order to prescribe that medication for the first time, I have to update:

1. Type: List is as routine or PRN
2. Define the frequency, one daily, twice daily etc.
3. Put in quantity and number of refills (not a big deal)
4. Define if its a tablet, capsule, grams etc.
5. Hit the update button to update the signature
6. Click drug interactions to acknowledge them. 90% of prescriptions have them since drug alerts are super high in this EMR. For example, Losartan will give a flag about checking kidney function.
7. Change provider to my name
8. Location has only one option, Office for us. However, it defaults to blank, and we must change it every time to office.
9. Select the correct pharmacy
10. Uncheck dispense as written since this means “brand name necessary” and defaults to being checked
11. Click the send button, then two more send buttons to confirm that you actually want to send the medication

FOR EVERY MEDICATION

So, for many patients that are on 20 meds, it takes forever to do all 11 steps for the first time we prescribe any medication for them in our system. This takes so long that we must offload this to a nurse. In practice fusion we could batch the meds together and make changes at once. Super easy and took 90% less time.

AdvancedMD, if you are reading this….for the love of God please fix this. It should not take longer to prescribe someone’s meds than do their actual visit.

Oops I Forgot To Add One More Lab To Your Lab Request

Like I said above. You have to input lab orders and diagnosis one by one manually. If you forget one test and already signed that lab order, you have to do everything all over again. There is no way to “copy” your last order. Practice fusion let us do this and saved so much time.

Ordering medications, labs, and imaging is a nightmare and takes forever. Infact, it takes longer to do this than document.

Too Many Options

You can customize everything in AdvancedMD. By everything, I mean you can even customize what font the buttons are in.

It is too much and overwhelming.

If you love to code and want to make this super specific to you, it could be great. However, the learning curve is huge. Below is the screen you will see when trying to create a new template.

Each box, each text you manually drag and dop. For each box, there is a “code” associated with it.

Each box is given a “name.” Here I clicked on the LastLabResults white Box in the picture above to open this option.

In the default / predefined you can see I put in [LastLabResults]. In another area in the medical record backend, I have defined what those results are and will be automatically pulled into the note in that section.

Sounds Not Too Bad, Maybe?

It doesn’t sound that bad once you know what you are doing. However, we received literally zero training on how to do this. When we asked why we did not receive training, they offered to charge $400 an hour for this training that we opted out of for our contract apparently.

The other option they give is you can self-learn. On any page in the medical record or practice management, you can push “ctrl + F1” and it will take to you a help screen like this one.

You can do it yourself, but you have to read help for every little thing, every note, every preset. There are so many things you can customize that you will be self-learning for many hours in the beginning.

Straight Up Lies Or Misleading From AdvancedMD Sales?

When we switched from Practice Fusion to AdvancedMD, the rep for AdvancedMD told us that since they were the preferred vendor for billing for Practice Fusion that we could easily pull in all the data. We could even do it ourselves we were told, with a “bulk upload” tool.

It turns out that this was completely wrong. It was so wrong that our rep made so many false promises that he was terminated after we signed up and we were given a new rep.

The cost to bring over about 12,000 charts….we were quoted about $20,000. Not free. Not easy.

They compromised with us and imported demographic information only of our patients. However, I felt like the sales pitch was very much into “misleading” territory when we signed up for AdvancedMD. Our rep overpromised big time, so big that he was terminated for it. Sorry Tyler if you are reading this, but you really did give us a lot of false hope.

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The Good With AdvancedMD

Customization

Once I overcame the learning curve, the idea that I can change pretty much everything in my EMR is wonderful. It takes a lot of time, but I do like that I can change almost everything and anything in our system to my liking. However, there was a lot of cussing, a lot of yelling at my screen and frustration along the way.

I feel like I now know why some computer programmers gets so frustrated at why “it” is not working when you follow the directions but what you are trying to accomplish is just not happening.

Texting Patient After Prescriptions Sent In

The EMR automatically sends a text to the patient in less than 5 minutes after I put in a new prescription.

This text has the medication name, dose, and pharmacy plus the estimated cost of the drug with their insurance plan. I love it, it has cut down on many issues with refill requests. I didn’t realize how much I would love this. Patients no longer have to keep calling back in to see if their medication was refilled. They get a text almost immediately when it is done.

Reputation Management

AdvancedMD includes reputation management for free. It texts every patient after a visit about their experience. If the patient gives a 4 or 5 star review, it directs them to google to post the review there. If it is 1,2 or 3 start it directs them to internal feedback and not to google.

Our reviews went from 85 to 215 – 5 star reviews in 4 months after we turned this on.

Works perfectly and included for free. Love it and it has massively help grow our practice since Google reviews matter.

Everything Under One House

Billing, messaging, lab results. Everything in one central location. Patients wondering why they owe $4.33? Log in and see your itemized statement online. They can even pay their bill online, and we get free text message and email bills to patients.

I can click in settings if I want patients to see everything, or not view their notes. Again, customization is nice but overwhelming in the beginning.

Real Time Eligibility

This one is huge. Practice Fusion claimed to do this, but they do not. In Practice Fusion it was wrong 99% of the time and took 5 minutes or longer to do once you clicked on the “eligibility” button.

AdvancedMD is right 99% of the time and works in less than 20 seconds. We can instantly check if someone has active insurance and how much their bill will be with their insurance. It is amazing and saved us a lot of money and time hunting down patients who gave us wrong insurance information.

Cost

Practice Fusion

• Practice Fusion: $150 per doctor per month for EMR
• Kareo The billing platform which you have to have one of these, was $330 for billing and practice management portion
• Spruce $50 per doctor per month for messaging
• Reputation Management $100 a month or higher.
• Updox for faxes directly into your EMR $150per month

AdvancedMD

Depending on what you all include in your plan, usually $500-600 a month flat fee for everything included. No other surprise bills. Oh, and this also included faxes directly into our EMR. I love no surprises and fixed costs.

Why I didn’t Chose Athena

The elephant in the room for small to medium size practices is Athena.

They are massive. I mean a huge company. While AdvancedMD claims to have 40,000 providers on their system, Athena in 2016 according to their website had 80,000. I suspect it is well over 100,000 now since most practices in my area use Athena.

Since everyone uses them, why did we opt not to?

For starters they gave us an initial quote of 8.99% of any money collected. This includes cash payments.

We laughed at them with this initial offering and after 4 months, we finally got them down to 6.5%.

They claimed to have lots of benefits, but their so-called amazing benefits were almost the exact same benefits AdvancedMD offered, but for a flat fee.

I like the idea of a fixed cost. We don’t have a lot of doctors coming in and out of the office, so for us the benefit that Athena pushes; if a doctor doesn’t bill, Athena does not make any money off that doctor. It is not really a benefit for us.

The other reason we did not go with Athena is that they mandated that we must change over our bank account to their bank account. This is all (in my opinion) to make it very hard to terminate the relationship with them. There were too many issues with Athena and in our opinion, was not worth the price.

The average primary care doctor bills for about $50,000 a month. At a 6.8% fee, this means we would be paying them $3,400 a month for Athena per doctor. Right now we pay about $500 a month flat fee per doctor. A HUGE savings to not go with Athena.

But Athena Claims To do Billing Better

Athena claims that their platform is worth it because they do the first pass billing for you. While that sounds great, one less biller and less cost for your practice, we have found those fears overblown. With AdvancedMD, the real-time eligibility occurs in less than 20 seconds. We KNOW when a patient checks in what their copay is and if their insurance is for sure active. We have a greater than 90% of her claims go through clean on the first try.

So far, with AdvancedMD we have noticed about the same 90% plus success rate for first pass billing, the same billing success rate Athena has quoted us for their system. Oh, and you still have to have a biller for Athena to deal with rejections or denials.

Check In Forms

Even though practice fusion claimed to have check-in forms, they never worked for us. These are the forms sent to the patient to fill out demographic information, or alcohol screenings. Any form you want the patient to fill out prior to during the visit and be uploaded into the chart.

AdvancedMD forms, they are not perfect, but they actually work. These forms can be customized based on appointment type and automatically sent to patients. For example, we have an annual physical appointment time. Every time that is booked, one week and one day before the visit, the patient gets a form that they have to sign acknowledging what is and is not covered by an annual physical.

We were getting too many patients booking as a “free” annual physical and then complaining when they claimed they didn’t know that they couldn’t ask 11 problems at that visit.

Once the forms are filled out, they are upload into the chart automatically. We love them. There is still a ton of improvement to be had, but it’s a great start.

Advanced Insights

If you are a data nerd, you’re going to love advanced Insights. Here you can create graphs, charts, any type of recurring metrics or data that you want to measure. Of course, income is the most common, but it can do so much more.

For example, above I created a way to see what the codes each provider is billing for. I can quickly see the level of acuity of visits that someone is seeing based on these codes and compare them to any other doctor in the practice.

We measure the number of appointments, number of no shows, billing, and accounts receivable to name a few.

Every time that I log into the advanced insights portion of the billing platform, it automatically updates in real time for these spreadsheets or graphs. You get a way to get instant metrics on anything that you want to create for your practice.

This is such a powerful part of this program that it’s one of the hidden gems. We are starting to use it to automate emails for patients with uncontrolled diabetes requesting follow up visits if it’s been too long since they have been seen.

Final Thoughts

AdvancedMD is not perfect, but it is a step up as a medical record for us compared to Practice Fusion.

I can see why it is not a popular EMR. Other than one small practice in town, I have never even heard of anyone using it before.

It’s learning curve is quite large and the updates they push out often don’t work right away. Even their own tech support tells you that AdvancedMD has a habit of releasing an update well before it’s ready. We have had 2 big updates since we started using them four months ago and both updates got rolled back due to significant coding issues and glitches. Not a good, polished look.

It is a step up from practice fusion for us. This EMR really is meant for medium sized practices or larger practices. If you are a solo practice, then frankly, there are better options out there. Expect lots of learning hurdles and little support from AdvancedMD beyond them emailing you the self-help references if you decide to set up with them.

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