Posts Tagged ‘EMR’

Please Touch the Demo

June 4, 2014

We have had a few interested clients recently and one thing I have realized is invaluable is that we let them touch our demo.


If you would like a live demo where you can  be in the driver’s seat, send us an email at or request one here.


Some companies seem to think this might hinder their attempts to keep their intellectual property private, but to us, non-touch demos are more of a speed bump.

I have been on many remote-desktop call demos, where a salesperson walks through a pre-written script of the product. I might ask “Can you click on that? I just want to see what it does” or “what happens if you right click there? No, not there, yes, a little higher… There!”

These screen-demos are frustrating and convey a small fraction of what can be illustrated by letting the user create their own orders, drag their own treatment schedules around, modify their own doses (and propagate the changes), maybe even send themselves a real fax!  The user can also get a feel for the responsiveness of the system and experience it as they would after they sign up.

Concerned about using Firefox on Ubuntu? Safari on Mac OS?  Let’s put those concerns to rest with a live demo where you are using Ankhos exactly as you would in your practice!  We can even break out your iPad!

There are benefits of this to us, as well. We get to see what uninitiated users might be confused about; what could be made more clear.  Perhaps the user is keeping in mind all of the things they can do in their current EMR system and can let us know what features could be added to satisfy their needs. It is much easier for a potential customer to wow themselves with a touchable demo than to hear us say how great Ankhos is.

So if you would like a live, clickable demo of Ankhos, please send us an email at and hopefully we can let you experience the ‘Wow’ for yourself.


Don’t forget clinical staff when shadowing Healthcare Professionals

August 23, 2013

In a recent post on EMR and EHR, John Lynn points out an up-and-coming EMR (Elation EMR) company is out there shadowing doctors. We’ve said before that physician contact is the silver bullet to success, but it’s important not to forget the clinical staff: Physician Assistants, Nurses, Nurse Practitioners and even front office staff.   Not only should the MD experience be comprehensive and expedient, but the MD should not be slowed down by limitations imposed on support staff.

In our regional cancer treatment clinic, the whole clinic must run smoothly and in sync. Information is not only trickling down from the MD, but that MD is also basing his decisions on information from other staff:

  • Is that expensive chemo pre-certified by their insurance?
  • Did the nurses notice that there was excessive nausea that should delay a treatment?
  • Have the admin staff filed the correct HIPAA agreement so the MD can talk to the patient’s son on the phone?
  • Lab staff – Has the in-house lab had time to get the BCR/ABL results back?

In order for all of these departments to function smoothly, the entire EMR system must be fast for everyone. When we have a new feature in development, it is part of our design process to put the feature on a test server, then go and sit next to the user and duplicate her work. That’s right, you bring a laptop into the exam room and duplicate the work the MD is doing (or lab tech or nurse, what-have-you). If you can’t do the work faster and better than she can, you sit back in your chair and keep developing until you can.  This is an exotic luxury that we have, as we are developing our software in-house… as in, our dev boxes are in the building.

A prime example of this philosophy was when we put our document scanning process in place. We had worked for months (between crisis-features like ICD-10) on the scanning interface, on the specifics of how to split pages, put pages together, rotate, etc.  I personally spent about a month going back and forth to medical records, spending an afternoon just scanning – eating my own dogfood.

By the time I was done, scanning documents was almost a little… fun.  And once we put scanning into production, the users really loved it.

Having my butt in the seat showed to the users that I am invested in the product and am taking considerable effort to make their lives easier, not harder. This disarms the user against reflexive negative emotions and opens the door to constructive criticism and user buy-in.

Being ‘in-building’ provides its advantages of being able to shadow anyone at any time, but it also provides the advantage of immediate feedback. Something broken? We hear about it immediately, perhaps before it affects most users.  We get to see the emotions that our software brings, both positive and negative. And as developers, it feels really good when we turn those negatives into positives.

The big-dog companies are going to stay afloat with their large sales staff, but companies like Elation EMR and Ankhos will rise up with our willingness to get down in the trenches and develop from the inside out.


Ankhos is Paperless; Next step: CCHIT Oncology Certification

April 30, 2013

I am proud to report that we have reached a major implementation milestone in the development of Ankhos: no new paper is going into any chart! All new patient referral material is being scanned and all incoming documents are reviewed and signed electronically… and our users love it.


We have had our nose to the grindstone for 2+ years and it is now time to look up and make sure we are headed in the right direction.


In the light of the recent meaningful use audits, I think it was a good decision to finish these core features before attempting meaningful use certification.   The physicians I work with are quickly realizing that it is much easier, desirable and predictable to squeeze money out of increased productivity than to hope that the government hands us a check (and doesn’t take it back).  While we are still headed towards meaningful use, we are going to take a short detour – to CCHIT Ambulatory Oncology Certification. 


It’s not that large of a detour either. Because we started with the fundamentals of oncology: regimens, propagating dose changes, a timeline-oriented mentality, and a strong drug administration workflow, we are probably 85-90% towards complete test script coverage.  Having the CCHIT seal of approval for both oncology and meaningful use should help this rocket take off even faster.


Are we and EMR vendor? I’m not sure anymore. I’m beginning to think of us as an Oncology Software Vendor.

Faxing in Japan: Anything but a relic

February 16, 2013

My fellow programmers bemoan the dastardly fax machines in our office.  They are slow, there are always problems like “Only half of the page came through”, busy signals, out-of-service numbers… they all add up to describe a system no one would ever choose in this day and age. And we don’t. Many successful EMR systems HAVE closed that paper gap already and are proud of it. We are weeks away from being there, as well.

However, according to an article in the New York Times, a large contingent of the Japanese population prefer faxes to other types of modern communication.

In Japan, with the exception of the savviest Internet start-ups or internationally minded manufacturers, the fax remains an essential tool for doing business. Experts say government offices prefer faxes because they generate paperwork onto which bureaucrats can affix their stamps of approval, called Hanko. Many companies say they still rely on faxes to create a paper trail of orders and shipments not left by ephemeral e-mail. Banks rely on faxes because, they say, customers are worried about the safety of their personal information on the Internet.

If the Times article is representative of the Japanese sentiment, this might make sense.  However, the article does not mention this phenomenon in Health IT so I looked around. I found a BBC article and a Wall Street Journal article that echo the Times article.  The WSJ journal explained

[the] reason is that computers, at the outset, never worked well for the Japanese. The country’s language — a mix of three syllabaries, with thousands of complex “kanji” ideograms — bedeviled early-age word-processing software. Until the early 1990s, Japanese was nearly impossible to type. Even today, particularly for older Japanese people, it’s easier to write a letter by hand than with a standard keyboard. Japan also relies on seals, called “hanko,” that are required for most official documents.

The BBC added that part of the cause was that Japan’s population is an aging one, where older people are more reticent to give up their paper and the subtleties of communication and respect in a handwritten fax.

One more report by John Halamka, a leader in health IT reported that

Japan has a state-of-the-art wireless and wired networks, arguably the best in the world. However, few hospitals and clinicians use this infrastructure to exchange heathcare information, coordinate care, or engage patients/families.

He doesn’t say the word “fax” but I suspect that this is what he is talking about.

Maybe the HIT community will get to bypass the days of HL7 2.x and live happier lives because of it!



Guest post: Richard Orlowski, M.D.

January 15, 2013

The following is a guest post written by the head physician at Carolina Oncology Specialists regarding the government “quality of service” reporting and its effects on EMR software.
The medical office now is encumbered by an overwhelming array of government regulations and hurdles. The government, as payer, is desirous of avoiding fraud and abuse. The government hopes that the EMR will make records more available to them for analysis of cost, appropriateness and ultimately rationing (which is inevitable in a government system–under some other name). Thus, the idea of “cost savings” pertains to the government and not to the practice.

There are aspects of the EMR that are wonderful, such as immediate access to data collected in a central repository in a timely manner without having to search for charts. Collecting and organizing all of the data is not an easy task and is a major challenge for programmers.

The data must be presented for thorough review and sign off. Also, the EMR is well suited to aid in scheduling events and tracking progress of plans of management and  documenting in detail what is happening in the office. To increase efficiency the EMR must help with these processes without imposing extra work for the medical staff that is under fire throughout the day dealing with living, breathing patients with innumerable real-time problems.

The EMR will not give the practitioner experience, knowledge, intuition, critical thinking, improved mental focus, proper diagnoses, proper treatment, and insight into human aspects of patient interaction or compassion.

The government, in their concern for containing costs, has devised a method of oversight that centers on coding and documentation for such coding. Actual clinical skills do not enter into this analysis. The government asks that MD charges be justified by an incredibly convoluted and complex system of  “bullet points” that testify that a certain level of data collection has occurred.

Computers are particularly adept at data collection so what is seen now is perversion of the patient encounter such that attention is diverted from thinking to data entry. Doctor notes generated under such requirements are voluminous. The notes lack focus such that it is impossible  sometimes to figure out what problem solving occurred during the visit. Despite this, it is certain that data collection has occurred and bullet points have been checked to justify charges. The computer spits out 6 pages of meaningless bullet points. The process is a major distraction. Nowhere in this construct is there the ability to determine if the practitioner acted appropriately and with insight. Nowhere is there a way to measure what was  NOT thought about. The whole process is demeaning and cumbersome and unproductive. It’s no wonder that EMRs are not saving offices money.

Now, in continued effort to reduce expenditures, there is a push by the government to measure what the regulators call “quality”. Excuse my skepticism, but this appears to be another sketchy scheme conceived by the same people who created the above monstrosity with bullet points. They will measure what they are able to measure and call it “quality”. It will amount to more garbage in–garbage out. The practitioners will learn the rules and the EMRs will adapt to spit out more verbiage to satisfy the rules. The measures will miss the mark in detecting and rewarding truly skilled physicians. The computer programs will adapt. Practice management will become more difficult. Efficiency will suffer. EMR’ will fail to result in cost savings in the doctor’s office because they are being used in the government’s game of cat and mouse rather than as a finely tuned tool to assist in evaluation and management. This is a reflection of the difference of perspective of someone in the trenches vs. someone in a government office shuffling papers and trying to control the massive, amorphous, and constantly changing world of medical care.

Partial patient calendar caching with Memcached

October 5, 2011

In Ankhos, we display a lot of information in different places, the most comprehensive of which is the patient’s calendar. I’ll talk about what we put on the calendar, what it looks like, and one of the tricks we have used to make it very fast.


Guest Post: Joy Hester

February 2, 2011

Joy Hester, our lead nurse was kind enough to write a guest blog post about her experiences with EMR. She has been with the practice for many years (I won’t say HOW many) and has been invaluable in the development of Ankhos.

Hello. This is my first attempt at blogging. So I am a little nervous but here I go!

I am a nurse. My knowledge base is in people, not in macros, pigeon holes or textboxes. Over the years I have learned a lot, self taught, what I like to call a “computer geek wanta be.” I know enough to get by. Let’s just say I know just enough to be dangerous.

Having said that, when the very busy Oncology Practice I work for purchased an EMR I was asked to help as a super user and was eager to get involved. Why not? I love this stuff!

I worked on developing the chemo regimens and single agent favorite list of drugs. I also developed documentation tools call Questionnaires for nursing documentation. I thought Questionnaires was an odd name for a documentation tool but, after a while it made sense. The Question was “Why does this have to be so hard?”

I could go on and on about how difficult the EMR was to use but I do not want to relive that. We finally scrapped the drug ordering and administration portion of the software. We now only use the scheduling and note portions of the EMR. We looked at other systems and did not see anything we wanted to pursue.

Then along came Ankhos.

Ankhos is so easy to use. I even have some privileges to add and modify drugs and procedures. These are called Orderables.

In the old system this was the hardest part. We are nurses. We are surrounded by patients who need our attention. We need an easy to use adaptable system where doctors can order and nurses can document treatments accurately.

We now have it.

We are in the enviable position of having an on staff software developer, Nick Orlowski, available to build the software to meet our needs. All we have to do is ask.

Working with Nick, I began to understand that the software should work for me, not me working on the software. I started to ask what Ankhos can do for me. These things are coming and I am excited to see how they develop.

We are accurately documenting on our patients. All the documentation requirements are being met. One of the best parts for the nurses is to be able to pull the treatment to an order sheet when the patient goes to an outside facility for their chemo. Ankhos tracks the location of the patient’s treatment and I am then able to verify the treatment is given after notification from the hospital the treatment is complete.

I review all the previous days encounter forms and having the drugs documented in Ankhos has saved me so much time when there is a question about a charge on a form. All I have to do is pull it up. I would have to physically find the chart to verify the treatment before Ankhos. It is wonderful to have it right there.

We have just begun. I am excited to see what is coming.




January 31, 2011

Hello, stranger! Been a while!

A few weeks ago I wrote a post about a distinct feature of Ankhos called sandboxing. The feedback from our users has been overwhelmingly positive. Many of our users came from outside clinics or hospitals where drug entry was a daily(or weekly) task and each agent had to be ordered at once.   The ability to easily modify a published regimen (or order labs, blood, etc.) is a boon to provider productivity.

The past few weeks have been very busy.  We have reached some serious milestones in our project:

1. Nurses are completely paperless. All infusion time charting and Nursing notes are done in Ankhos.

2. All labs are available in the EMR, imported directly from the clinic lab machines (as well as a Labcorp interface).

3. All Providers are creating their orders in Ankhos.

a. The new Doc is well-trained as Ankhos has actually helped orient him to the practice’s idiosyncrasies.

4. 10 new Toshiba Sattelite (17″/4 g/300 g) were purchased and placed in exam rooms. I will write another post regarding the decisions and setup of our client hardware.  The biggest draw is the great quality of the wide screen. Ankhos is a web app so we don’t need a lot of processing power.

5. My sister was happily married to her long-time boyfriend in a fabulous wedding in downtown Charlotte.

Hopefully I will get back to blogging our development more in the future as things move more towards maintenance mode (HA!)

The oncologist’s workflow

December 21, 2010

I’ve been pretty busy lately, but I’d like to share a link I found about the general clinical oncology workflow. Hopefully this may shed some light on why clinical oncology EMR systems are so much different from the EMR systems of other types of practices.

It takes dedication and focus to come up with a competitive product in this market, and just providing ‘templates’ is not enough to increase productivity, safety and ROI.



Quick edit:

One divergence from the article that Ankhos takes is our lack of automatic drug calculations. There are handy calculators integrated into the system to calculate AUC and BMI, but every dose must be entered by a human in absolute milligrams (or cc, etc.). The computer is not allowed to determine or alter any doses.

Screenshot: Advanced regimen sandboxing

October 19, 2010

**UPDATE  06/05/2012** Contains old screenshots!


Ankhos provides lots of flexibility when it comes to creating chemotherapy regimens. Not only is it easy to create a custom regimen, but it’s also easy to modify them on the fly. We do this with a technique we call ‘Sandboxing’.

Whether we’re using a regimen straight from the textbook or creating our own, we have the option to place it in the ‘sandbox’.  Anything can be placed in the sandbox, from entire regimens to x-rays to comp panel orders…. Anything that occurs with some periodicity in conjunction with patient treatment.

Once in the sandbox, these agents and orders can be modified on a  day/cycle basis in order to match the needs of the patient. Clicking on the right and left arrows will increase/decrease the cycle length, and the days of a treatment can either be typed in or inserted on days 1,8,15,… by clicking the weekly checkboxes.

The sandbox outlines a patient’s entire treatment schedule in one fell swoop.  We won’t need to do any physician data entry for weeks… or until a change is needed.

The sandbox pictured above outlines 4 weeks of (made-up) treatment. Once the treatment is in the sandbox, You can cycle these four weeks as many times as you want. Three cycles of CHOP-R? Easy. Weekly CBCs for 6 months? Easy.

The sandbox has received many accolades and nearly every user who has experienced it describes it as ‘very powerful’ or ‘incredibly easy’.

One limitation of the sandbox is that it is not practical to schedule a follow-up  one year from now or mammogram in 6 months, but we solve that problem by ordering the simpler tasks like a normal EMR might… one at a time.

A final note: As far as patient safety is concerned, each treatment must be electronically signed by an MD before it can be administered so any dose reduction that is required does not fall through the cracks.