The benefits of an EMR were recently brought home to me when I entered a note by hand (the patient was 99 and I decided four years ago that she was too old to waste "MB's"). This experience highlighted to me how much Praxis organizes my thinking. First - it forces me to review the list of medications and their entry into the note requires only a few clicks (we ask our patient's to bring a list each visit). A quick review of the problem list and past medical history focuses my thoughts on the job at hand for today. The HPI forces me to ask the pertinent questions to my geriatric patients. Multiple problems are easily handled by combining assessments or using multiple assessments. If set up correctly and thoughtfully; this allows for quick and meaningful note entry. It also reminds you to ask the right questions.The ability to set up "virtual assessment" allows you to extract the necessary tests for lets say an anemia w/u with one or two rapid clicks. Health maintainance reminds you to repeat needed tests and when.
Agents are quick notes which flash in front you before a visit to remind you to bring up certain issues or order certain tests etc.

To use an EMR correctly you need to invest the time. It needs to be loaded with the correct information (otherwise garbage in - garbage out). It needs to allow you the flexibiltiy to easily format it in a way that fits your mode of practice. My approach to a patient (whether correct or incorrect is a matter of opinion) has developed from many years of practice. I don't want pre-made templates to dictate otherwise.

I have found Praxis to excel since it is molded to my style and only my style. It is blank on arrival - but easily populated - the only limitations are your own cognitive abilities and typing skills. But even that can be overcome by online textbooks and good medical assistants."

Daniel Griffin, M.D., Internal Medicine, Fort Collins, CO
"As a physician using an EMR, not only is PRAXIS the best electronic medical record out there--I say this as I spent two months of forty-hour weeks devoted to this important choice--but also the best supported. As a physician I realize that down time and delays with support just can't be tolerated. PRAXIS dramatically improves my quality of care...the satisfaction of my patients, and the satisfaction of my colleagues to whom I refer my patients. And...the efficiency and effect on my bottom line is darn impressive. I have even come up with some tricks for doing an intake prior to the visit which allows me to very quickly perform a new patient visit and in less than an hour they are through the process and exclaiming how exciting it is to see a doctor who can sit and listen and not have to rush them through. I don't think I have to comment on the financial side of doing two level 4's on new patients in an hour and then at the end of the day being done; no end of the day dictation catch-up or review because its done while I am in the room.

Curtis E. Harris, M.S., M.D., J.D., Practicing Endocrinologist, Professor of Medical Law University of Oklahoma, Oklahoma City, OK
Doctor Curtis Harris is not only a practicing physician (Endocrinologist), and also an attorney and a Professor of Medical Law at Oklahoma University, but also happens to have a Masters in Computer Sciences and is a Praxis client.

"PRAXIS has much greater utility and flexibility... than a template-driven program. In addition, PRAXIS has another very valuable feature that you may not have considered: that is, enhanced legal protection for the busy practitioner. Good documentation is critical to properly defend a physician against a malpractice claim. However, it is not only important to record what was done, but also to show the logical progression of thought that lead to a diagnosis or course of action. PRAXIS requires the physician to record his thinking process, and to refine the logic with each new patient. By focusing on the difference between patients, the record necessarily reflects why one given diagnosis or therapy was chosen over another. This in turn allows the defense attorney to use the record to assert the uniqueness of the patient, and why this therapy was chosen for this patient. Since a physician is not held to be a guarantor of a cure of a good result, but instead must choose an acceptable treatment based on the information available to the physician at the time the choice was made, clear documentation of what was known is usually an adequate defense.

There is another related problem that is latent in every template-driven program that is not present in PRAXIS. The templates in other systems are subject to discovery and to use against the defending physician. Imagine how pleased a plaintiff's attorney would be to find that a physician's entire practice could be reduced to a series of simple statements. Suddenly, the art of medicine is diminished, and the defending physician appears to be a mere technician in the way he practices, forcing all his patients into a single mold. However, since PRAXIS is based on the examination of previous patients, these records are not subject to discovery since they are protected by physician-patient confidentiality. While the process by which a physician using PRAXIS to enter data is discoverable, that process is little different than what is now done without PRAXIS.

While several other systems provide for such things as accurate and legible recording of notes and prescriptions, it is the flexibility and theory behind PRAXIS that will, in the long run, provide the best legal protection for the practicing physician."

Ted Fisher M.D., Free Standing Emergency Department, Rowlett, TX
Uses Praxis for quick handling of serious Emergency Patients.

"Proper and complete documentation of the patient encounter is critical in the Emergency Department," says Doctor Fisher, "and that is why I chose Praxis. It is my hope to extend my model of free standing emergency departments based on the one here to many other areas of the country, and of course, Praxis will come with it."

Allen S. Uhlik, M.D., Diplomate, American Board of Internal Medicine, Copperhill TN
" I am fascinated with the idea of a Concept Processor, I thought I was very much against loading my own medical knowledge in the computer. I have since found that it is actually essential that you load your own information. It is fascinating to put a diagnosis down, watch it load, make a couple of adjustments, and all of a sudden the chart is done for that patient. As I sit here dictating this letter, I am still looking at the other (template) system sitting on my shelf."

Shane Avery, M.D., Family Medicine, Terre Haute, IN
"... PRAXIS has the potential to cripple the competition this year. I can state this because I have had a fair amount of experience using two other EMR's and reviewing 5-6 others. PRAXIS has been a hit with my office staff and the patients. A couple of colleagues came over today and were floored when I showed them the system. It is rare to find an EMR that actually improves a physician's efficiency and assists them in the care of the patient. This is why I describe PRAXIS as, "The working doc's EMR". Where I am only human, PRAXIS makes perfect."

Cecelia Hissong, M.D., Family Medicine, Dearborn, MI
"The new Medicare coding requirements are so complicated and time consuming you will spend half again as much time figuring out the correct code as you spend with the patient - PRAXIS will be miles ahead of any other program in dealing with this. PRAXIS is the one tool which will make practicing medicine easier. Now, at 58 years of age and after 30 years of practice, if I can get it, you youngsters out there can do the same. It takes perseverance...and patience...and it will come. The rewards will far surpass the cost."

J. Craig Barnett, MD FACC, Cardiology, Lake Mary, FL
"The most important aspect of medical office software, after billing, would be the creation of the patient data in a way that not only maximizes care but also minimizes your time doing this. Therefore, out of my experience as a cardiologist and software developer, I would highly recommend PRAXIS as the single best way to do that today."

Thomas C. Davies, M.D., Family Medicine, Farmville, VI
"This is an amazing program that greatly surpasses my expectations. I really found PRAXIS worth it in terms of reduced fatigue and improved quality of records, which is also how I justified it. There have been very few things to come along to make my practice life easier - this is one of them so I grabbed it. The requirements from HCFA (now CMS) are bizarre, elaborate and unnecessary...I see PRAXIS as a way to match the challenge. This is a great program and the commitment of PRAXIS to continually improve it on a short cycle should serve as a model for software development."

Lewis Lipson, M.D., Cardiology, Chevy Chase, MD
"(PRAXIS) has the potential for coming close to being an "ideal" EMR. I am hopeful that PRAXIS may initiate a whole new approach to EMRs that will be much more physician-friendly. The level of interest and support from the company is impressive because the developers seem sincerely devoted to improving the product based on users' feedback. PRAXIS is unique in being a physician-created program; the developers are incredibly responsive to problems and suggestions."

Ronald S. Haxton, M.D., Diplomate of the American Board of Pediatrics, Mission Viejo, CA
"You have created a revolutionary and inexpensive computer charting system that could become the universal standard. Anyone with a serious interest in practicing high quality medicine and an interest in computers needs to look at PRAXIS. There is nothing else that even comes close. It is the best system that I have found for medical practice note-keeping because it is far superior to any of the 'template' systems and has superb flexibility characteristics. I have recommended (PRAXIS) to many physicians. It is a program that any physician with a modicum of computer literacy would see as the answer to his practice needs. You are limited only by your imagination, intelligence and time as to what you can do with PRAXIS. When you get into PRAXIS you will love it. Using it is 'addictive'. When you realize how much you can do to generate a superb medical record and be reminded of all of the details that are so important to quality medical practice with speed and documentation for the snoopers, you will be glad you got involved."

John Davis, M.D., Family Medicine, Birmingham, AL
"It took us many years to learn to think along the lines of the medical model, and it will take you time to learn to think along the lines of the concept processor. But if you try, I'm sure you will feel it was worth the effort."

Michael Moses, M.D., Endocrinology, Parkersberg, WV
"I have little doubt in my mind that PRAXIS is superior hands-down to ALL other means of charting...once used even for a short time, (PRAXIS) becomes the most effective, accurate and "honest" way to do charting in your office."

James Sills, M.D., Family Medicine, Hamed, KY
"I am a busy Family Physician and on July 1 will have been at it 40 years. PRAXIS shows me a way I can get back to "hands on" medicine; sit and talk to people again, and document everything with a mouse click. E&M guidelines be damned! PRAXIS has found a better way. I used the single-user PRAXIS for a long time, but only with the network version have I begun to realize its true value. The learning curve is steep, but PRAXIS has made medicine fun again by helping me generate great records with less effort every day. I love PRAXIS. It keeps beautiful records. I can document everything from the Past History, Surgical History, Family history, medication records...and do all of this effortlessly. With the Present Illness and ROS, I've documented well enough to finally be paid for what I do. Yes...you can teach an old dog new tricks. I'm a good example."

William Stuppy, M.D., Family Practice, Los Angeles, CA
"PRAXIS has become as much of a tool in my practice as the stethoscope. I am a family practitioner and have built up a huge database of patients with this wonderful tool. Now it takes me an amazing 40 seconds to build a chart."

Rafael Sanchez-Montserrat, M.D., Pulmonologist
"The features of PRAXIS cannot be obtained in any other pre-designed formats type of program. It may take an extra effort to start running the program but it is an intelligent program that can be perfectly customized to our individual needs or styles."

George Liu, M.D., Surgery, Corbin, KY
"It is outstanding, and easy to use. The beauty of the program is that it can document so much better than we can ever dictate or write...and all is included for review. The concept engine is brilliant and VERY easy to use."

Cary Zietlow, M.D., Internal Medicine, Indianapolis, IN
"PRAXIS is a powerful tool. It takes time. Even a hammer takes some time to be used well by the skilled artesan. Just wait, as a referring doctor gives you a compliment about how quickly you got the latest note to them. Then they know EXACTLY why you sent them the patient and their job is easier/faster. Now I get new patient referrals because of this courtesy. None of us learned the art of heart sound auscultation over night! PRAXIS has much more potential. It will become an extension of your patient management just as your auscultation abilities did. I am VERY pleased I have this program."

Richard Folan, M.D., Gastroenterology Associates of Colorado Springs, CO
"Your enthusiasm is what 'sold' me on Praxis when I jumped in last Fall. We all need an EMR like praxis, not just another database program."

Roger Ven Torres, M.D., Internal Medicine, New Berlin, WI
"Personally, this 3.0 version is a newer product rather than an ordinary upgrade. I really luck out on this EMR! ...Eagerly awaiting full implementation of Praxis 3.0 into my system".

John R. Adair, M.D., Ardmoor, OK
From those whose "sound bites" have graced our ads and articles through the years....
"...PRAXIS will revolutionize Medical Records...."

Anselmo H. Humaran, M.D., Miami, FL
"Praxis has been a very helpful program for my practice. It is very easy to utilize, making my work very simple. The program is a revolutionary way to help me learn new concepts while working. This is the best investment I have made to help my practice."

Joseph C. Eichel, M.D., Family Practice, Zanesville, OH
"It appears to me that the success of family medicine in the near future revolves around information management. I have been quite pleased that PRAXIS has taken the first step in creating a tool which allows me to actively blend current medical data into my active patient files. This allows me to become more aggressive in my work-ups. It helps me to avoid forgetting the details of treatments I learned six months ago. But is much more practical than template software which is awkward to reconfigure when there are subtle changes in patient presentation. It provides a way to annotate my treatments with literature references and is quite helpful in medico-legally supporting my treatment choices. If the success of medicine in the future revolves around information management. ... Praxis has taken the first step...."

Clayton Reynolds, M.D., Lakeside Medical Associates, Lancaster, CA
"..."PRAXIS is an electronic engine that not only creates a chart, it takes us physicians to a position of control in the world of medical records ... PRAXIS appears to be the ideal 'student' in that it retains everything it is taught ... It is also the perfect professor because it teaches and reminds the user of how previous cases were handled. PRAXIS is the perfect servant; it does what it is commanded, not usurping the role of the user, who always remains in complete control. It is an artificial intelligence engine whose knowledge is derived from the physician-user. The potential for its use in patient, medical, nursing student, and continuing medical education ... is therefore astounding. I anticipate that PRAXIS will become the gold standard in the field of electronic medical records."

Bruce W. Cummings, D.O., Associate Director, Emergency Services, Holy Cross Medical Center, Mission Hills, CA
"As the Chief of a very busy Urgent Care Center, I had been actively looking for an electronic medical record system ... I was immediately impressed (with PRAXIS). It is such an easy program to learn, even my most computer illiterate physicians should not have any problem. The Urgent Care physicians are convinced that the PRAXIS program will decrease their medical risks by vastly improving their documentation.... Keep up the good work! "

Daphne Favroth, M.D., Urgent Chief, Dallas County
"I am writing you to express my great satisfaction with ... PRAXIS ... from my practice of Emergency Medicine. Our Emergency Department sees 30,000 patients per year. We obviously cannot afford this "luxury " (of dictating charts) so we handwrite the majority of charts. I hope this product reaches the medical community soon, it will be very much appreciated by physicians and administrators!"

Doctor John Schwab, Diplomate American Board of Family Practice, Akron, NY
"... all my requirements were met with PRAXIS. ...PRAXIS will allow (us) more time to be doctors, instead of writers of medical paperwork who also see patients."

A. Gomez,. M.D., Diplomate of American Board of Internal Medicine and American Board of Ambulatory Medicine, East Dundee, IL
"...as many times as I called for support and nothing but the utmost of support was given to me. Keep up the great work."

Max R. Boone, M.D., Family Practice, Athens, AL
"...after more than a year of use I am still convinced that it has significant advantages over template-based programs."

Bradley Binnington, M.D., Binnington Surgical Service, St. Louis, MO
"Other programs with fixed templates would be stilted and not reflect my peculiar verbiage and use of grammar."

Todd R. LePine, M.D., Internal Medicine, Stockbridge, MA
" I have been using PRAXIS now for several months on a limited basis, primarily for documenting school physicals, routine physicals, etc. For the most part I am very pleased with its performance. The concept of PRAXIS as a concept processor is truly revolutionary."

Lorne Bigley, M.D., Family Practice, Lacey, WA
" I see between 25 and 30 patients per day. I now enter about 75-80% of my notes using PRAXIS, and I do it between patients. My nurse informs me that it hasn't slowed me down, but I think it takes about 2-3 minutes to do a note, where before it would take 1-2 minutes. For 1 minute more time, I save about $3 for transcription costs. That's a great deal if you think about it. My quarterly costs for transcription were $2400. With PRAXIS, I see this cost going down to $500-$800."

Martin Wiseman, from the Cardiovascular Associates of Cleveland, OH
"I guess you have taken the concept that the customer is always right to the next level - if the customer is right, let the customer tell you how to design the program!"

Phil Rhyne, M.D., Family Practice, Monument, CO
"I have a chronic auto-immune disease and when it flares, I may be bedridden for days. This kept me totally disabled for a few years, but about two years ago, we opened a solo practice and are trying to keep things going. It has been tough and finances are not good -- if the only doctor is out sick one third of the year, money won't come into the practice as it should and must. Several weeks ago, I had a flare of this illness and was out for three weeks. About that time, the state Medicaid fund ran out and reimbursement stopped (that's about 35% of our income). If this had happened three in January 2004, we would have had to lay off our staff and close our practice. Why didn't we have to do that in late March? We had Praxis 3.0!

Using Praxis 3.0 and gotomypc.com, my staff could take messages and do telephone triage (Agents), my nurse could do Nursing Assessments (Protocols & Agents), I could review lab and diagnostic results (Agents), and refills for patients who had to be rescheduled were handled with ease. Our practice didn't make a profit, but our losses were not as horrific as they would have been and the disruption to patients, staff, local pharmacies, and to one not so chipper physician (me) was minimized. Had we not been able to do this, our financially anemic office would have closed (and it might not have been a temporary closure). Praxis 3.0 quite literally saved my practice!!! ... know that in a very small town in Georgia there is a tired, often sick, Family Practice doctor who firmly believes that you folks are wonderful and who offers comments /criticism with care, respect and the firm belief that Infor*Med and Praxis are the best in the business!!"

Joe Merritt, MD, OB-GYN, Oklahoma City, OK
Another...which makes Praxis v3 the absolute best out there. From the hospital (or anywhere with internet) I can access my office Praxis program. I call up my Admitting Note assessment, pick a subgroup (suffix) and print the note to the hospital printer. If I had a fax modem set up and designated as a printer I could print to the fax modem at the office and have the pages faxed to me or anywhere I choose. I can use the internet connection with Praxis while doing the new visit... takes all of about 2 minutes to do this generally.

Jaime Wong-Dominguez, Medical Student, Coos Bay Clinic
"I'm the third-year med student Dr. Peter Lund (Coos Bay Clinic) recently e-mailed you about. I want to tell you that Praxis has helped me to work efficiently and has even taught me a lot about medicine! My rotation with Dr. Lund is coming to an end--I leave on Wed., 3/15.

I'm writing a short paper and presenting it to OHSU Rural Health faculty and students on Fri., 3/17. My paper is tentatively titled "Transforming Rural Primary Care: Electronic Medical Records (EMR) in Coos Bay, Oregon." I plan to review the literature on transitioning to EMR, and to focus on how it's going for Bay Clinic using Praxis."