Why Is CHARTSandNOTES Being Offered Free?
Electronic records seem like such a good idea. But the cost! Many thousands of dollars for the initial software and required hardware addition, plus specialized training, and then annual maintenance/upgrade fees at a significant percentage of the original cost. Not to mention the frustration and cost of delays due to software bugs and delayed assistance.
That is why the author developed CHARTSandNOTES over several years of office practice, constantly improving it to make his life easier and the records better. It does what it was intended to do, reliably, and independent of any outside help, or wires, or phones, or signals. It is a realistic first step into an electronic future for “the little guy”. And it’s inexpensive (how about free?) for all.
In the world at large, and even in the U.S., a lot of medical care is carried on with minimal resources. A simple and inexpensive way to keep good medical records might be invaluable, even life-saving. So, CHARTSandNOTES is being made available at no cost and for anybody, under a free-software license that only requires acknowledgement of the copyright. The author would be happy to see CHARTSandNOTES being adopted wherever there is such a need — in under-developed countries, at remote clinics, in charity practices, etc. (While it has been developed for U.S. practices using the English language, adaptations for other areas and languages could be arranged).
In the U.S., many of us agree that the costs of medical care are ballooning, in large part because of exaggerated costs of regulatory requirements for everything from drugs & devices to information systems. Even if powerless to affect the former, CHARTSandNOTES is a small step to alleviate the latter. It may make solo practice remain an affordable option for some who would otherwise have to quit or join a big group or corporation. The author thinks that would be a good thing.
Who It’s For: Solo Practitioners keeping paper charts
This EMR should be an attractive option for those solo or small-group physicians (or extenders) who presently keep written notes. Among the advantages for them:
- No internet connection is required, and no cellphone signal is needed.
- With free-standing software, you never need the internet. That means no connection costs, and no vulnerability to hackers. (And even if you want to store your records on the “cloud”, you only need to connect long enough to beam them up).
- There is no cost for CHARTSandNOTES software or maintenance.
- Except for Microsoft Office programs Access, Excel, and Word — annual subscription roughly $200 from Microsoft. (CHARTSandNOTES requires those software packages on your computer(s), either free-standing or via the “cloud”).
- Some day we may set up a mechanism for receiving tokens of appreciation (how about the cost of a single office visit?). But if and when, it will be purely voluntary, and you will never be nagged.
- There is no requirement for upgrades, maintenance, or hand-holding.
- CHARTSandNOTES will always run on today’s software: if you keep it, you will miss nothing by declining to upgrade your MS Office versions. What it does for you today, it will always do for you. Just like your written notes up to now.
- There is no cost for special hardware.
- CHARTSandNOTES will run on any computer using a version of the Windows operating system that will run MS Access 2016 or later (Windows 8, 10, and later; not sure about Windows 7). As long as you have such a machine and a keyboard, mouse/touchpad, and monitor, you need nothing else except an ordinary printer.
- Immediate painless startup: just open CHARTSandNOTES and start typing in your notes.
- Your written notes are replaced by your typed-in SOAP entries. No further setup is required, unless/until you opt to track prescriptions and diagnostic tests, and print their orders for your patients.
- Everything you record is password-protected.
- As long as you use a password, all data is saved in encrypted form and cannot be read by any other means.
- Nothing lost if you decide to quit.
- Your notes from CHARTSandNOTES can be printed and saved with your written notes, then carry on as before.
- Anything recorded in CHARTSandNOTES is always available to you if your database is accessible: either on the “cloud”, or from a hard-drive or memory stick in your computer.
- Got a call from a patient while you’re at home? That patient’s records are right there with you.
- Practically no risk of information loss.
- Fire could always destroy your printed records. But provided you back up regularly and effectively, your CHARTSandNOTES records can always be replaced.
- No change in filing system needed.
- If you file paper charts now, you will continue in exactly the same way. Just print out each visit’s record, sign & date it, and file it in the same chart.
- No question about legality.
- Electronic records can always be challenged on the basis of reliability: how can it be proven that they were not altered after the fact? But there is no difference between your signed and dated printouts from CHARTSandNOTES and your previous written notes (they just are more legible!).
- Ready for clinical studies.
- If you choose to engage in clinical trials, CHARTSandNOTES records include everything needed for bullet-proof source notes that track adverse experiences, concomitant medications, etc.
- Flexible if desired, but no need to bother.
- Once you add your contact information, all the printed forms have everything needed to be filed or transmitted. You can write your own individual notes on any of them. If you really prefer your own designs, you can make them (or even ask us to make them, but that could cost something).
- As for the software itself, your version will always be available, and you can copy it and spread it around at will as long as you include the CHARTSandNOTES copyright notice. If changes or improvements should become available, you will never need to accept them. However, to maintain its integrity, we won’t distribute any versions under the copyright name CHARTSandNOTES unless we approve of them.
- Convertibility potential.
- If or when you decide to take on a commercial EMR, it will be extremely difficult to make much use of your previous written records, except by painstakingly reading scanned images of them. However, all the numerical data (such as weights, blood pressures, visit dates), all the text notes, and all the specific orders (such as prescriptions and diagnostic test orders) can be translated into your new EMR by any programmer familiar with that EMR.
Who It May Not Be For: Present EMR users and Group practices
If you already use an EMR, you may (understandably) be upset with the never-ending costs of updates and maintenance. Before deciding to abandon it and switch to CHARTSandNOTES, however, you must consider these realities:
- CHARTSandNOTES will not accept your current electronic data.
- Maybe a skilled programmer could convert it for you, but the cost would likely be extraordinary.
- CHARTSandNOTES will not interact with other systems you have added.
- Tied-in labs, pharmacy benefit managers, drug-interaction software, etc. will no longer function.
- There has been no attempt made to make CHARTSandNOTES qualify for Medicare or other governmental or third-party requirements.
- Therefore, you may have to forego future Medicare qualifying-EMR bonuses, etc.
- You must return to using paper charts.
- While CHARTSandNOTES is self-contained, it also is absolutely NOT recommended for use on its own. You need the paper charts for legal purposes. CHARTSandNOTES is just your way of creating those paper charts much more easily and reliably than by hand.
- CHARTSandNOTES is designed for solo practitioners and very small (i.e. 2- or 3-person) groups.
- Scaling up to larger groups would likely be relatively easy, and transparent to the users; but data storage requirements would increase, and use without being online would likely become very difficult.
- CHARTSandNOTES does not do billing.
- While you will record the type of service and the ICD-10 code needed for billing, the payments for services rendered are a variable well beyond any aim of this software. In fact, payment codes may need to be licensed, for example from the AMA in the U.S., and a license cost cannot be included in software being given away at no cost.
Security and HIPAA Concerns
Privacy is always a major concern when dealing with medical records, and in the United States, the HIPAA (Health Information Portability and Accessibility Act) adds legal requirements. The best source for answers to HIPAA concerns online is from the government’s own site, which you should view: https://www.hhs.gov/hipaa/for-professionals/covered-entities/index.html
Basically, HIPAA does not restrict your ability to keep electronic medical records at all. It only covers transmission of the information, and does not appear to inhibit it in any way that would adversely affect normal medical care usage. Your paper charts could be stolen; you have an obligation to prevent that, but only within reason: you do not have to store them in a bank vault when you leave the office.
Similarly, you need to take your best shot at protecting an electronic record. It is easier to steal, but you protect it anyway because you don’t want your computer stolen, let alone the information on it. So you lock up your computer and the media storing your records when they’re not with you. Better still, you encrypt ALL the data in the records, so they are illegible (you can’t do that with your paper charts!), using a key known only to you. Then, your responsibilities under HIPAA seem to be just to write down these procedures, and follow them. (I say “seem to be” because this is NOT intended as a legal interpretation; it is from my layman’s reading of the official published materials).
The bottom line: As always, you are responsible for taking reasonable precautions to protect the information you have on your patients. There is no difference if you tidy up your paper notes using a private EMR like CHARTSandNOTES, and view your records on your computer anytime, anywhere. If you never use the internet to send or fetch your charts electronically, that should be the end of the matter. [But since every local government can have its own requirements, it would be prudent to check your local legal situation, of course.]
Even if you should decide to use the internet to view your records, you can follow reasonable security precautions (such as encrypting the records and requiring a password known only to you) which you have documented, and be within the requirements. HIPAA even allows you to store the information on the “cloud”, although that involves transmission and you may need to confirm other security arrangements with the internet provider(s).