We now live in an electronic-savvy society. This not only applies to healthcare providers who rely on BlackBerrys, PDAs and cell phones to function, but it is also true for our patients. Patients are becoming more empowered as well as more intimately aware of the technologic advances that affect their healthcare, one of which is the electronic health record (EHR). Since President Obama has taken office, healthcare consumers are becoming more aware of EHRs, largely as a result of the media coverage of the proposed requirement to implement them nationwide.

Even though purchasing an EHR and practice management (PM) software may be financially feasible for larger practices, the cost may be prohibitive for smaller practices. The cost of EHR/PM software can range between $13,125 and $58,628 depending on the company.¹ Even though software programs promise to provide comparable services, ease of use may account for some of the differences in price.¹ Other factors affecting sticker price are a system's ability to interface with third-party providers, such as laboratories or pharmacies, and how a company classifies nurse practitioners and physician assistants - as a "physician" or as ancillary staff - when calculating costs based on number of practitioners.¹

In addition to purchasing the software, there are numerous miscellaneous costs that will affect the overall cost of implementing an EHR/PM system. First, consider hardware costs. These costs may include purchasing computers and any networking that may need to be done by a computer-networking specialist. Hardware costs and ancillary software purchases may represent 20% to 30% of the first year costs of the EHR.² Other start-up costs include installation and staff training along with the likelihood of decreased productivity when staff members and providers first begin to use the EHR. Costs of decreased productivity may range from none (the staff worked overtime to see the same number of patients) to $20,000, depending on the practice and provider type.²

As co-owner of a small practice of nurse midwives, I set out to find a reasonably priced EHR/ PM program that could accommodate the needs of a medical office while being affordable enough for a small practice. I found that AmazingCharts came in far below the costs of other EHR/PM systems and gave us a 3-month, full-feature trial. The following review delineates the functions available as well as the start-up costs associated with AmazingCharts, not including hardware costs, networking or productivity losses.

Product Overview
AmazingCharts is a full-package electronic health record and practice management software program that allows "scheduling, intra-office messaging and complete medical encounter in a fast, efficient way."³ The company was founded in 2001 by a family practice physician who had a desire to create a user-friendly, cost-effective electronic health record system that would not slow down the flow of the office. Now, according to the company, more than 2,500 practices have purchased the product.³

The minimum system requirements necessary for installing this software are as follows:

• Windows 2000, XP, Vista or better
• Pentium IV (or comparable) running at 2GHz or faster
• 512 MB RAM
• 1024 X 768 screen resolution or higher
• At least 1 GB of free space on the default hard drive

Installation
Installing AmazingCharts was quite easy and straightforward. In the 3-month free trial period, we had access to the complete package, which is identical to the product we purchased. The overall download time on my computer, with high-speed Internet access via satellite, took approximately 11 minutes. The program included an "installation wizard" that walked me through the download process. It addition, you can view a software demonstration during the download time.

The software trial also included an online demonstration on how to download the program, how to upgrade the program, and how to increase computer screen resolution for better viewing. Additionally, video tutorials take the user through the various features, such as adding new patients, scheduling patients, creating the provider schedule, changing the user password and accessing off-site support. There is also the option of installing to one main computer or to several practice computers.

After downloading the software, you must create an administrator password and then enter each user's information. You choose varying security levels when you choose provider type, with independent providers (such as physicians) having the highest security all the way down the office hierarchy. I chose to login as "nursing" (as opposed to "midlevel provider"), since the midlevel-provider security level had a forced field completion for a supervising physician, which is something that is not required for nurse practitioners and nurse midwives in my practice state.

Overall, the installation process was simple and efficient with the added plus of a demonstration of the software while waiting. Since we live in a multitasking society, it was refreshing to have the feeling of not wasting my time while waiting on the download process.

Installation support is available during the installation process should there be a problem. This technical support will not only help you set-up the program, but also train the office staff and providers, on-site, for a fee of $1,000 per day. The AmazingCharts Web site does not indicate how many hours constitute a day of training.³

Costs and Services
The most striking feature of this EHR/PM software is the price. I found the cost extremely reasonable, more so than with any other EHR/PM software we priced when starting our practice. First and foremost, the costs are one time only for the providers in the practice, unlike with most companies, which charge a yearly licensing fee per provider.² The cost of the AmazingCharts service is $995 for the first provider and then $200 for each additional provider as a onetime fee, not an annual charge. The program also comes with a money-back guarantee. The Web site states, "If you don't like it or won't be using it, don't pay us."³