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Terry McLeod of ehrSIO ProjectsehrSIO Projects
A blog about the technical and software sides of mental health and addictions

Electronic Health Record (EHR) Software Review: Netsmart

Terry McLeod Updated: Oct 10th 2012

If the Electronic Health Record (EHR) selection process was a beauty contest, Netsmart's myAvatar product would likely take the prize.

laptop computer and dataThe look and feel of the software as it was set up for a recent presentation I attended was excellent. One of the problems that can arise with EHR software is a lack of attention to making the software work within the special workflows in a mental health clinic. myAvatar's workflows were well designed, suiting process flows for different user roles like billing, executive and clinical users. The idea is still along the lines of displaying sub-windows and rows of documents, activities and appointments; It's easy on the eyes. As I've shared before, when an EHR takes this sort of detail into account, it makes for a more complete record of treatment, and the professional is better able to address the specific needs of each individual consumer. When information is at a professional's fingertips, it's more likely to be used; if not, and the records of previous sessions aren't reviewed, is the consumer getting the best care?

Additionally, the inclusion of pulling data from Outlook is a plus for the Case Managers in the field. There is likely a way to launch Outlook from a hyperlink embedded in the program. I say this because it's simple technology and a feature that was included in a previous version of the product. Data can also be pulled and pushed internally. The example was pushing problem data from an assessment to the treatment plan, and pulling goal and objective data from the treatment plan into a progress note. Professionals are human, and can be under pressure to see a high number of consumers in a given week. Those two factors conspire to make time-saving features like these vital to make the most of a professional's time while giving her the information she needs to treat the consumer's problems.

The reporting engine for Avatar is Crystal Reports, and although many vendors are moving toward internal reporting engines, Avatar provides a great map to the fields where certain data resides called "option documentation"; it's quite simple to use, organizing the electronic record so it's simple to pull data out of the system. As long as you have a person around to write the Crystal Reports, you're set. From my experience, folks like yours truly can write Crystal Reports much less expensively than Netsmart (NTST) staff, so your organization may wish to consider outside consultants.

The EHR's RADplus toolkit is essentially a design tool that enables the customer to build their own system. In fact, this is what a number of customers have done. Because the RADplus is so robust, it also requires a level of skill somewhere between the design tools I've seen in other products and those of a programmer. If I had to guess, I'd say a slightly better-than-average Crystal Reports writer would have no problem using the tool. I've designed a number of screens and associated reports to them, and the outcomes have been good for the professionals using the system.

It's tempting to use the RADplus tools and Crystal Reports to design a system from the bottom up because it would seem perfect. It would not be. The tried and true method to use for implementation is the same as for any major product on the market. Start with the existing forms and reports, modifying slightly during the implementation and approach improvements to make the system truly "my Avatar" only after the initial implementation has progressed to a level of Meaningful Use, billing and regulatory compliance.

The use of RADplus to design dashboards was flashy and impressive. Widgets can be included on dashboard screens to track whatever metrics exist in the system, from census to treatment plans due to authorizations due.

Predictive Modeling is a recent addition to NTST initiatives, encouraging research by sharing de-identified patient treatment information among the user group, a program reminiscent of the MindLinc business model. I'm not sure how far along in the process of bringing this offering to life, but if research is your bag, this is the sort of work that broadens data samples required to measure new methods of treatment and can help consumers recover on a grand scale.

Like most of the systems we've seen, Utilization Review and Quality Assurance problems are avoided by the customer adding compliance rules to specific activities like treatment plan reviews coming due and insurance prior authorization renewals. This removes most of the labor intensive data management from these two functions, and transfers tasks to a sort of "informed policing" of data and activities.

Netsmart has acquired a number of EHRs over the years, as well as ePrescribing, on-line education and other options. This has made them the largest EHR provider in mental health and addictions treatment and worth a look if you're a professional whose organization is in the market for an EHR.


Disclaimer Added 10-16-14 from Terry:

Let me clarify that I haven't worked for Netsmart for around five years, and have absolutely no ties to that company and am not employed by any software company...I'm busy enough with my own business.  I try to keep reviews positive, and usually they are based on demonstrations, which is a great opportunity for a software company to put their best foot forward.  As you might guess, software demonstrations given by the manufacturer may ignore a product's shortcomings.  I encourage folks to post their clinical, billing, administrative and IT experience with the products I review because my experience with products that are on the market today lies in managing projects for selection, implementation and optimization of Electronic Health Records.  I'm always interested in learning about practical experience in the field.


Terry McLeod

Electronic Health Records (EHRs) are a required part of our society, and improving business workflows with the EHR is imperative for the survival of your local mental health and addictions treatment clinics. Terry McLeod provides the bridge between the mental health and addictions professional and the technical world, as well as the glue to keep it working. Contact McLeod at and get more information from his website and blog,

Reader Comments
Discuss this issue below or in our forums.

From IT dept: - - Mar 23rd 2015

All these negitive reviews are correct.  Avatar is a complete piece of garbage.  It occupies all of our time in IT with our staff that have no idea how to use it.  I CAN'T BLAME THEM!  It's not their job to understand everything there is about Avatar software.  It's their job to treat consumers.  No medical knowledge was used in the creation of this product.  This EHR is a prime example why our world will turn to mush and we will all die.

Seriously...netsmart upper brass should be thrown in jail.

Believe the Bad Press - - Jan 16th 2015

We went live with myAvatar on May 1st, 2014.  We have experienced everything that the other commentors have mentioned and more.   Here's what you have in store if you become a Netsmart customer:  Netsmart will push you to go live before your system is ready;  you will have to carefully test every patch and release after you go live because they break your system.  BTW, patches come on a monthly basis.  None of your agency's staff will be able to find information quickly because the system is so poorly designed (especially the Client Chart).  Your reports will run slow and so will the system whenever it sees fit.   To be honest, I can't adequately describe all of the bad experiences you will have once you implement this software.  I've raised these issues to the VP of Customer Experience at the Netsmart Conference and she pretended to care but never followed up.  We are currently working with Netsmart Support to figure out why some progress notes mysteriously disappear, later to re-appear a few days later.      

A Beast of an EHR; DO NOT BUY IN - - Jan 16th 2015

While I want to start with a positive note to say that myAvatar is very customizable and has a significant number of "options" within the core product, it is also unweidy, not reliably functional (our eprescribing module went down as I was writing this; the second time in that many weeks), the business model is unrealistic and you need your own staff of IT applications specialists to keep you afloat.  Our medical and clinical staff hate the product.  Moving from place to place within the EHR is not intuitive, takes way too many moves (clicks) and the product freezes or is dysfunctional in some way more often than not.  The venture capitalists that own this company clearly believe that we in behavioral health are the million or billionaires that they are.  Each "module" has associated "professional" costs to set up, concurrent and named user feeds on top of purchase cost of the products.  QA and support are the WORST!!!  It is rare that we apply a maintenance release, patch or upgrade that does not result in breaking some other functionality.  In order to get level 1 support your entire system needs to be down.  I am certain when I finish this and contact my IT manager about the OrderConnect outage she will tell me the ticket is level 2.  If I were the CEO I would cut my major losses and move on.  

After one year... - Erin F. - Oct 23rd 2014

I was on the evaluation team and was very impressed with the web site and demos.  This company has a fabulous marketing department.  

The software has all the features that the marketing department promises, too.  There are glitches but none that have proven to be show-stoppers. 

We've used the software a little over a year now.  A little over half of staff have been through the training sessions.  Be prepared to have each of your staff sitting in training classes before logging in for the first time.  Work flow is not what you would expect.  After a few weeks of using the system daily, staff gets used to it.

We need to build some modules onto the system before we can fully deploy the system to all departments.  We got some of the modules started, but that staff person has since left our agency and he has not been replaced yet.


NOT A GOOD EHR SYSTEM - - Oct 23rd 2014

Just did an employer change and they use Avatar. I would have to say being as electronic proficient as I am, this would have to take the cake on being a bad bad bad EHR system. It is absolutely slow, not configurable, freezes up, loses documents, It is not integrated at all. Everything is seperate. It literally takes 5 minutes just for the system to create a pdf of any report, I timed it.

Ex-Netsmart Sales Executive - - Oct 16th 2014

What Mr. McLeod fails to disclose is that he worked as a Sales Executive at Netsmart for over 10 years, something surely worth a mention in any credible review.

From his public LinkedIn account (
Sales Executive
Netsmart Technologies
Privately Held; 501-1000 employees; Computer Software industry
October 1997 – May 2009 (11 years 8 months)
Strategic selling to large accounts, account management, projects to kick off sales for new products. I spent a dozen fruitful years at Netsmart.


Response from Terry McLeod:

Let me clarify that I haven't worked for Netsmart for around five years, and have absolutely no ties to that company and am not employed by any software company...I'm busy enough with my own business.  I try to keep reviews positive, and usually they are based on demonstrations, which is a great opportunity for a software company to put their best foot forward.  As you might guess, software demonstrations given by the manufacturer may ignore a product's shortcomings.  I encourage folks to post their clinical, billing, administrative and IT experience with the products I review because my experience with products that are on the market today lies in managing projects for selection, implementation and optimization of Electronic Health Records.  I'm always interested in learning about practical experience in the field.


Lack of info - J. Dorian - Oct 12th 2014

The thing that gets me is the fact that i cant seem to find much documentation about the programing of widgets and all that anywhere online. The only things i can find are advertisments selling the product or trying to get 450$ to sit thru a siminar....

It would impress me a lot more if they attempted to build a community instead of just a marketing department.

Horrible software - Psych RN - Oct 1st 2014

I can't believe that the review is of the same program that is used by my county mental health department.  Avatar is cumbersom, slow, difficult to use, distracts from being able to interact with client, crashes easily and times out too quickly causing a loss of all data entered and not saved as a draft or as final.  Very stressful and a waste of time and money.

It is terrible - M.D. - Sep 25th 2014

90 seconds to put an appointment in IF the system doesn't crash!  This system is ridiculously slow, redundant and cumbersome.  LA County Mental Health is having a heck of a time and had to suspend implementation.  The "learning curve" argument is bogus. The problem is not us getting up to speed, there is no speed to this turkey.  Even our computer savvy docs who are no strangers to EHR know this system is ridiculous.

You have to be kidding. - - Jun 11th 2014

It takes 90 seconds to schedule ONE patient in the system.  Antiquated, cumbersome, ridiculously redundant and time consuming.  The time spent waiting for screens to open, the incredible amount of unnecessary steps to write any sort of note is simply horrible.  And after you write a note it appears jumbled and disjointed. Very difficult to read.  a disaster for patients.

NY Times news article - Peter - Jun 10th 2014

To Michael, do you have any idea what San Francisco Dept of Public Health do after? Did they just drop NetSmart Avatar and move on to another product? The issues that they described in that article is exactly the same issues we are experiencing now. Both the setup of the billing side and the feedback I am hearing from our clinicians. I have statistics and found out our service count is 12% lower compared to first quarter of last year. That  is after about 5 months removed from implementation date. This application is just really crappy. The support is also very bad, they just think their product works no matter how much you explain why as user you think it doesn't work. They just won't listen and with that kind of attitude the product will  never improve.

M.D. - - May 28th 2014

I agree with all of the comments above.  As an MD learning the system, I can tell you there are several  unnecessary steps prior to performing the most basic functions, all of which add time -genuinely unnecessary time- for me.  

So, if you are in the field looking for a product, consider that all of the comments here are fully in opposition to the "review."  I also cant help but believe that this reviewer has been somehow blinded by the salesmanship of this company.

Take this review with a grain of salt... - Michael - Apr 16th 2014

Sounds like this review was not genuine.  But don't take my word for it.  Here is a New York Times article that gives you a picture of how great  Avatar really is:

Agree with the one comment - Anon - Mar 25th 2014

Netsmart's Avatar and Tier products are worthless garbage software. Extremely confusing and designed like a maze. Whoever designed these products have no prior knowledge of software or medical fields.

IT Systems Implementation Analyst - Peter - Feb 13th 2014

I wonder how much netsmart is paying this guy. MyAvatar is the ugliest system I have ever worked with. The backend configuration of the billing side is so awkward that even their support is admitting that some screens are hard to work with. The people  who designed this in my opinion have never done the actual billing process because the process flow just doesn't seem to be workable at all. There are lots of room of error. The CWS side is much even worst. the group progress note ridiculous. What else? The reports, they have canned reports which they call ugly reports so you can imagine what they look like. You will need to design your own reports on Crystal, you will get lost in 1500 tables which does not seem to be normalize. We are stuck with this product, but if you are still in the market for an EMR/Billing System, stay away from this. Marketing is so good, but implementation support is almost non-existent. They only have two people as far as I know who is knowledgeable on the system.

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