Over the last 10 years, I have had the opportunity to review several different SOAP Note Charting Systems and Electronic Medical Record keeping software programs.  EMRs as they are now called are fast becoming the method of choice for documentation and a paperless office.   Of those I have tried, MediNotes has a lot of good points, but for those in the field of manual medicine, this one falls short in many aspects.

Overall the MediNotes’ system is quite pleasing to the eye and its usage appears simplified.  Its main selling point is was the claim to have a chiropractic module - a problem we will later discuss. Its other benefits were that it integrated with many 3rd party billing programs to essentially cut the middle-man, had user friendly graphical interfaces with that of ADAM (the Anatomy and Physiology Software), and was fully customizable. 

Like most SOAP programs, there are the standard subjective findings, but this program seems to be more complete as far as adjectives are concerned.  Its user friendly environment boasted a Windows look and feel. Orthopedic and Neurologics are defined decently, but nothing out of the ordinary for chiropractic examination procedures. 

Assessment and Plan are linked with current ICD9 and CPT coding for accurate diagnoses and billing, the latter of which works quite nice. For those offices looking to buy software that not only provides a Notes, but takes into consideration of what you did on that visit (ie. CMT, modalities etc) and provides the appropriate CPT codes to be exported to a billing program, this is ideal. Essentially, there are no entering charges for the day in the 3rd party software as it has already been mirrored from the Note.  The setup on such a feature is not an easy task mind you as there are no clear cut instructions provided. I spent hours trying to figure it out before calling the company who had to walk me through an arduous set up process. This is unfortunate because there should be a manual or online instructions.  The online support forum Medinotes offers is a plus to any consumer, but plan on doing this during a day without patients.  Obviously live online support has its advantages, but when what appears to be one technician assisting possibly dozens of others, I was online for about an hour.

Regarding the wide variety modules MediNotes offers, everything is add-on, which of course costs extra.  The base price is excessive in my opinion, costing nearly $4000. In a podiatry practice or Orthopedics, this may be suitable as I can only assume the program is already fully layed out as stated on the site. As far as the templates for the "Chiropractic" version are concerned, this was not as comprehensive as I was led to believe.  After I purchased what was said to be the “Chiropractic Version of MediNotes” I was told that 'they' were still developing this particular aspect of the program but I would be receiving updates at no cost.  When I purchased the MediNotes Software in October 2003, it was still March 2004 and I had heard nothing from MediNotes. This was despite several attempts to contact them. My only salvage was the vendor whom I went through to get the program.  While I am certain there are more Medical turnkeys for the MediNotes program, as indicated by the absence of "Chiropractic" on the web site, there is still a lot that needs to be developed.  For example - to name a few, the first Template in MediNotes main page, "Chiropractic Medicine," is empty.  Virtually everything in the program was design for the Orthopedist.  Normally this would be fine considering our specialty in examination procedures, but the type of care we render on  a fairly regular/routine basis would not justify the folder being null.  Second, the cost of this program alone should not necessitate an end user to customize every aspect of the module.  

Further, when creating the "Initial" Examination Visit, there is no Cranial Nerve assessment available, rather it too has to be customized. Then there is no default to list all of these procedures as "normal" or WNL.  What's more is the "Cerebellar" portion of the examination is nearly void - I could not even locate Romberg's or Finger to Nose tests.

Under Chief Complaints, the 'modifying factors' are random and unorganized relating to any specific musculoskeletal region and lacking many common palliative/provocative factors.

Another example utilizing MediNote's Outcome Assessment tab, the Oswestry Disability Index is listed under the cervical spine region, rather than the Neck Disability Index.   Other Indexes (Headache, Dizziness etc) are not even here.  For someone to just have one Index, in the wrong place nevertheless is pretty much useless for documentation purposes.

In reference to Muscle testing, strength can only be achieved via the graphic they provide and offers no options for cervical or lumbar spine; flexors, extensors, rotators, or lateral flexors. There is also no Dynomometer testing that I can find.  Both of these are standardized measurable orthopedic/neurological procedures.

Moreover, in the Objective sections, there are no templates for the grading of muscle tone/spasm/trigger points/pain.  These are common among many medical disciplines and paramount for the neuromusculoskeletal specialist, including but not limited to Neurologists, Orthopedists, Chiropractors, and Physical Therapists.  Worse, there is an 'error' when one clicks on the "Postural Exam," leading nowhere but having to customize this section as well.

Most important to the unique domain of the Chiropractic Doctor, is the detection and correction of subluxation/segmental loss of motion/fixation. The template here states "Osseous Manipulation" but offers no selection as far as joints. There is no static or motion palpation listings. The Cartesian biomechanical system is not even considered here. Worse, MediNotes software only demonstrates muscles in this category! Every aspect of this portion has to be customized.

In summary although the program has a lot to offer in terms of immediate functionality for the 'Medical' practitioner, the Chiropractic portion of this EMR is seriously lacking. Unfortunately, one of the determining factors of the MediNotes purchase was that it actually had a 'Chiropractic' template.  This is clearly not the case.  Further, I was told that once I had the software MediNotes could further customize this aspect of the EMR should there be a need.  At this juncture there is certainly a need. The number of elements needed to bring the EMR up to Chiropractic standards would take even the most experienced end user countless hours of customization. One should not have to customize the very basic elements in any software in order to simply use the program however, let alone bring it to par with others, the phenomenal cost notwithstanding.

Lastly, and as of this review, MediNotes was virtually useless for technical support. Besides that first setup, and despite numerous phone calls, e-mails and requests, not one was returned. Despite being lied too, I gave them the benefit of the doubt, a chance to prove me wrong and even produce the module I was promised. But after five months with nothing to show for several thousand dollars, I returned the software through the vendor with whom I purchased. It’s unfortunate too because MediNotes program appeared to have a lot to offer in terms of templates and ease of use. That alone would be appealing to everyone in practice, but as they say, “looks can be deceiving.”  And considering MediNotes’ lack of customer support on top of everything else, I highly suggest you look elsewhere for your next major software upgrade.  For the MediNotes EMR Software, Buyer Beware!

Dr. George Langlitz III, DC CCSP
Certified Chiropractic Sports Physician
Certified Whiplash Traumatologist
Certified Disability Evaluator
Board Eligible Certified Rehabilitation Doctor
Trained in Accident Collision Reconstruction and Trauma Biomechanics

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