Physicians use a lot of health information technology systems, and their experiences with those systems vary widely. Some are relatively easy to use and provide real value; others drive them crazy on a daily basis.

Carlos Sesin, M.D., a rheumatologist with three-physician Vanguard Rheumatology Partners in Miami Beach, started his career happy with health IT, in turn had a nightmarish EHR experience that soured him on the technology, but once again is an HIT fan.

Sesin started the practice in 2004 with his wife Charmaine Hamada, an R.N. They bought an electronic health records system from SOAPware, and loved it. The EHR, paired with a disparate practice management system, was rudimentary but worked well. But with meaningful use looming in 2009, Sesin started looking for a bigger vendor with an integrated PPM/EHR on a single platform.

He thought he'd found it in the Allscripts MyWay product for small physician practices. He purchased the software from a reseller, and that's when his trouble started.

Sesin wanted the support of a large company, but didn't know what questions to ask when selecting a system to fit his practice, he admits. He bought an in-office server to house the software, and ended up having to learn how to maintain it and do file backups. As the practice grew, with more physicians and patients coming in, so did capacity issues and data security concerns.

Neither the product nor the vendor performed as expected, Sesin recalls. The reseller did not provide adequate service, the accompanying clearinghouse service wasn't able to send claims to many insurers, including the Blues, and as a result the incoming revenue stream slowed to a trickle. The vendor told Sesin and Hamada, who was doing much of the billing, that they were not spending enough time learning the system. In mid-2012, he contracted with CareCloud for an integrated practice management/EHR system, but still has two years to go on the MyWay payments. "Now I tell everyone not to commit to a five-year contract with an EHR vendor without termination clauses."

With CareCloud, Sesin gets hosted software that the vendor maintains, an electronic prescription writer that makes it easy to identify the correct medication and pharmacies close to a patient's home, a monthly rate for unlimited claims that go through consistently, automated flagging of claims not paid within a specified period, electronic remittance advice and auto-posting, and technical support from personnel based in the United States.

The practice is back in the black. Further, a patient portal that other vendors were asking an additional $80 per physician per month to build was part of the package. "I saw in CareCloud something that was different," he says. "It's refreshing. The onus is on them to remain competitive." Sesin says he would like the vendor to provide better connectivity with laboratories, in his case Lab Corp. and the lab at Mount Sinai Medical Center in Miami Beach.

The cover story in the October issue of Health Data Management examining the complex relationship physicians have with health information technology is available here in a printable format.

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