Chief complaint
Medical record software is built for billing departments and hospitals. I wanted a chart that does the work.
I am an internist in Okeechobee, Florida. I see patients every day, and since March 2024 I have been building the software my practice runs on. This page is the record of that work: what exists, what does not, and what went wrong along the way. It is here so the work can be examined. It is not an advertisement and there is nothing to sign up for.
History of present illness
My practice is one physician and six advanced practice providers caring for more than 10,000 active patients. Like every other practice, we ran on a commercial EHR plus a fax machine, payer portals, sticky notes and a great deal of retyping.
I started with the parts that hurt most: faxes that arrived and sat, orders nobody could track, prior authorizations kept in people's heads, notes written at ten at night. Each piece was built for a real problem in a real week of seeing patients, used the next morning, and fixed when it failed.
Flowsheet
Every capability and its current status. Statuses mean exactly what they say.
| Capability | Status | Note |
|---|---|---|
| Incoming faxes and documents read, matched to the patient, and filed | WORKING IN THE PRACTICE | A document never files itself onto a chart when the patient match is uncertain. It waits for a person. |
| Order tracking: every referral and imaging order followed until the result is back | WORKING IN THE PRACTICE | About 1,300 orders opened in the last 30 days. |
| Prior authorization ledger and rules | WORKING IN THE PRACTICE | |
| Care gaps and quality measures per patient | WORKING IN THE PRACTICE | "Eye exam: none" once counted as a completed eye exam. It does not anymore. |
| Risk adjustment view on the official CMS V28 model | WORKING IN THE PRACTICE | No diagnosis is suggested without a verbatim quote from the chart to support it. |
| Pre-visit brief for the provider | WORKING IN THE PRACTICE | Ready before the patient arrives. |
| Note drafting, with co-signature queue | WORKING IN THE PRACTICE | About 5,000 notes drafted, then reviewed and approved by a clinician before signing. |
| Live insurance eligibility from the chart | WORKING IN THE PRACTICE | Six payers answering, including Medicare. Upcoming patients are checked automatically. |
| Roles and permissions | WORKING IN THE PRACTICE | |
| Visit recording to draft note | IN TESTING, PHYSICIAN ONLY | Every statement in the draft is checked against what was said. What could not be heard clearly is marked "verify", not guessed. |
| Superbill with coding rule checks | IN TESTING, PHYSICIAN ONLY | Claims are built and checked, not sent. Nothing has been billed from it. |
| Standards-based data access (SMART on FHIR, C-CDA, patient data export) | IN TESTING, PHYSICIAN ONLY | Built and deployed. No outside system has connected yet, and formal conformance testing has not been run. |
| Patient portal | WORKING IN THE PRACTICE | Live. Patients sign in with a code texted to their phone plus their date of birth. |
| Immunization reporting to the state registry | IN PROGRESS | Onboarding requested with the state registry. |
| Electronic prescribing through a certified network partner | IN PROGRESS | Agreement signed. Waiting on the test environment. |
| Claims and remittance through a clearinghouse | IN PROGRESS | Clearinghouse account open. Nothing is sent. |
| Mobile app | IN PROGRESS | Planned. |
| ONC Health IT certification | NOT DONE | No date promised. |
Allergies and contraindications
Things this software must never do. These are design rules, not intentions.
signs without a clinician's approval.
A clinician reads and approves every note before it is signed.
suggests a diagnosis without evidence in the record.
If the evidence is not there, the question goes to the physician.
shares a visit recording outside the practice.
files a document on an uncertain patient match.
Names are not identity. A person decides.
merges medication lists from different sources.
No list is better than a wrong list.
sends a claim, a prescription or a registry message without a person approving it.
guesses at a word it did not hear.
It is written as heard and marked "verify".
Progress notes
The build log, newest first. Failures included, because a record without them is not a record.
Eligibility went live, and failed the first time a staff member clicked it.
Every test had passed, just not the way staff actually use it. Lesson, now a rule: a feature is not tested until it is tested the way staff will use it.
A patient named "Jr."
The first Medicare check was rejected because the suffix went in as the last name. Fixed the same hour.
A button that lied.
"Stop and draft" stopped the recording and drafted nothing. I found out in the exam room. It now does what it says.
The draft note now has to show its work.
Every sentence of a drafted note is checked against the visit. On the first real visit it caught three things the patient said that the note had left out.
The risk model was mislabeled.
Our reference carried the old model's values under the new model's name. Replaced with the official CMS V28 tables.
Too careful is also a bug.
The patient-matching safeguard was refusing matches it should have made, and nearly all of them were the same person. A safeguard that refuses everything is not safe. It is just useless in a different direction.
I broke it for everyone.
An update I shipped failed across the practice. Rule since then: prove it on one, with real evidence, before anyone else gets it.
Started.
Vitals
As of 09/18/2026. One practice.
Plan
- Finish testing the native visit note in my own practice before any colleague sees it.
- Complete e-prescribing, registry reporting and claims.
- Run formal conformance testing on the data-access interfaces.
- Pursue ONC certification when the work is ready for it, not before.
No dates are promised here. When something changes, this record changes.
Disclosures
Chartwork is developed by Chartwork Health LLC, Florida document L26000476412. CHARTWORK is the subject of U.S. trademark application serial 50112376 (Class 42). Written by Muhammad K. Syed, MD — Florida licence ME99470, NPI 1447440342. Chartwork is not certified health IT, is not offered for sale, and is not accepting users. Nothing on this page is medical advice. No patient information appears on this page. For colleagues and reviewers: msyed@chartwork.ai
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