CureMD EMR Software is a market leader providing modern-day health information systems and services that enhance the clinical and administrative operations of healthcare practices and enterprises. The integrated cloud-base... read more
McKesson Practice Choice Electronic Health Records (EHR) software is a web-based EMR software and Practice Management (PM) software solution provider. It is an Intuitive solution that modernizes workflow and improves ... read more
Developed by McKesson Specialty Health, iKnowMed Generation 2 is a quality web-based EHR system designed to fulfill the needs of hematologists and oncologists. This Health IT solution is developed in collaboration with 200+ ... read more
OncoEMR is a quality EMR Software System that has been developed to cater to the needs of oncology practices. It is completely web-based and can work seamlessly with medical practices of all sizes. The company behind this so... read more
ARIA® Oncology Information System (OIS) by Varian Medical Systems in an ONC-ATCB certified Electronic Medical Records (EMR) software & Practice Management (PM) software. It supports a multi-disciplinary approach to onco... read more
athenahealth Electronic Health Records (EHR) Software, was named 2022 Best in KLAS for both Small Practice Ambulatory EMR and Practice Management (PM), athenaClinicals, for 10 or fewer physicians, and Ambulatory RCM Services... read more
AdvancedMD EMR system is a Cloud-based solution offering EHR (Electronic Health Records) software, Practice Management (PM) software, and Medical Billing Services. AdvancedMD EMR software provides support for multiple specia... read more
eClinicalWorks EHR Software is a cloud-based health IT company that provides Electronic Health Records (EHR) software solutions to practices and hospitals. Its products include Electronic Medical Records (EMR) software, Prac... read more
Kareo Clinical EMR software is a cloud-based Health IT solution offering Electronic Health Records (EHR) software and Practice Management (PM) solutions. The company also offers quality and dependable Revenue Cycle Managemen... read more
ChartLogic EMR Software is an ambulatory EMR suite offering Electronic Medical Records (EMR), Practice Management (PM) and Revenue Cycle Management (RCM) solutions along with quality features such as e-prescribing (e-Rx) ... read more
Developed by Epic Systems Corp, Epic is an Electronic Medical Records (EMR) software with an integrated Practice Management (PM) and Patient Portal solution (MyChart). Epic EMR software offers extensive clinical content and... read more
WRS Health Electronic Medical Records (EMR) Software, is a Cloud-based integrated Practice Management (PM) software solution designed by practicing physicians to manage their entire practice. WRS EHR combines features like... read more
NextGen EHR Software is a high quality Health IT solution designed for medical practices looking for an integrated medical software suite featuring electronic health records (EHR), practice management, and revenue cycle mana... read more
RXNT EHR Software is a cloud-based healthcare EMR software provider, offering Electronic Health Records with a Patient Portal, E-Prescribing, Practice Management with Medical Billing Services, and Scheduling as well. Afforda... read more
Finding the right electronic medical record (EMR) system that can match the complexity and diversity of medical practice is vital but can be challenging.
Considering the distinctive and sensitive attributes of Oncology, all its aspects including plans, surgery, radiotherapy, treatments, diagnosis, frequent use of imagery tests, CT scans, PET scans, and mammograms (to name a few) – all require special documentation as well as storage along with all the protocols to be followed correctly. If any of these procedures are not followed properly, the results can be fatal due to the wrong ordering of drugs and dosages. For challenges like these and many more, an oncology specialization requires an EHR system that is not only compatible but exclusively designed for it.
An Oncology Electronic Health Records Software, commonly known as Oncology EHR is designed to fulfill the distinctive requirements of both the Oncologists as well as the Oncology Practices. These EHRs have exclusive hematology, administration, cancer templates and workflows, cancer registry, reporting, clinical trials, and ordering of chemotherapy drugs, all included in them.
Every EHR has some basic features which the remain same in them all, except for a specialty-specific EHR that targets the unique characteristics of an Oncology Specialty. To have a better understanding of how the software works, it is advisable that its different features and functionalities must first be learned. To be able to choose a suitable Oncology EHR, we should check if the software has the following key features:
Integrated Digital Imaging – The oncology-specific EHR software must be compatible with ultrasound, MRI, CT, and PET scans and other diagnostic image formats. This feature helps save all the data and allows it to be reviewed at any time conveniently.
ICD/CPT Codes Specific to Oncology – Identifying the type of cancer, mapping its stage, and recommending options of treatment becomes easier with this.
Workflow Management – In an Oncology practice, you need to deal with recording and storing large volumes of data. The EMR software should be capable of managing, documenting, and maintaining all the oncology-related workflows. With the help of this, the physicians get to have a better understanding of the patient’s condition which helps them take the right decision at the right time.
Built-In Interface With Labs – The results from labs can be received directly through the electronic medical record software and can also be stored digitally. Most of the Oncology specialty EMRs are integrated with labs such as Quest, LabCorp, etc.
Integration of Patient Education Materials – Since this can be a difficult time for patients, an Oncology specific Electronic Medical Record (EMR) must have tools to help educate the patients during the process, helping them to overcome some of the worries related to their health.
Chemotherapy Management and Automation – Oncology-specific electronic medical record software must incorporate and automate the documentation of drug administration, inventory management, billing, scheduling, and even dosing which makes orders easy to read and help prevent errors.
Oncology Dashboard – The best Oncology EMR software should feature a real-time dashboard to help physicians clearly view patient charts, profiles, billing processes, scheduling, etc. all in one place. The dashboard practically saves time in opening multiple tabs.
Registry for Clinical Trial – Oncology-specific EMR software should also have inbuilt analytics to map out potential patients for a clinical trial, current research as well as demographic assessments of patients to support findings.
The EMR vendors are well aware of the fact that not all Oncology specialists are the same. For complications and added challenges like these, they have pre-designed templates as part of their Electronic Medical Records software (EMR) design for:
Once you have picked out the list of vendors who provide Oncology EHR, the next step is to narrow down the selection to those that meet your requirements as a specialty as well as a medical practice.
Size – Some vendors cater better to large practices while some are best suited to smaller ones. EMR systems are designed keeping a certain number of users, scalability, and support required in mind. When selecting a vendor keep in mind the size of your practice.
System Design – The choice, essentially, is between the installation of the software in your on-site computer server, or cloud-based software that is available anywhere via the Internet. Which system a practice goes for depends on their personal choice and comfort level. Some doctors feel more comfortable having the system on their computer server because they feel this is more compliant with HIPAA requirements, while others need to have access to their database wherever they are. You’ll need to shortlist vendors who fulfill your needs in this department.
Certification – It makes sense to make sure the software you’re going to purchase is certified. For oncology, the certification you should be looking out for is by the ONC-Authorized Testing and Certification Body (“ONC-ATCB”). They are responsible for making sure your vendor meets Meaningful Use objectives and is HIPAA compliant.
Selecting EMR software can be stressful and exhausting, but with our detailed guide, it can become, if not a little easier, much more focused on making the right choice.
Electronic Medical Records Software or commonly referred to as EMR Software represents the electronic method of storing medical records for patients. Using specially designed software, physicians and other medical professionals can store anything ranging from patient demographics to extensive clinical information about patients, such as medical history, social history, lab reports, and more.
Since all medical providers (MDs, DOs, PAs, NPs, LCSW, OT, etc.) work in a distinct manner based on their background and medical specialty, EHR Software or EMR Software must accommodate the unique style and documentation requirements. Examples of such specialty-specific features include the ability to annotate images or the capability to store before/after photos for Pain Management specialists and Dermatology specialists respectively. Similarly, other specialties such as Pediatrics, Oncology, Podiatry, Ophthalmology, Neurology, Nephrology, Dialysis Centers, Rheumatology, and Chiropractic Care require their unique set of specialty-specific features to simplify adoption.
Since the introduction of the HITECH Act, healthcare IT has undergone a massive transition starting from the widely recognized Meaningful Use program to what is now known as MACRA, the Medicare EMR Incentive Program. The Meaningful Use program has transformed and now formed part of the four components of the new Merit-Based Incentive Payment System (MIPS), which itself is a fundamental part of MACRA.
For some medical practices, the transition from paper-based records to EMR Software (Electronic Medical Records Software) has not been a simple one. Regardless, realizing that the benefits of utilizing ONC Certified EMR Software far outweigh the hassle and challenges associated with it – ensuring a viable future, most practices today have successfully transformed their clinical and administrative operations to EHR Software.
Aside from ensuring tangible financial incentives and profitability, practices converting to EMR / EHR Software have seen the following benefits:
Just like a medical specialty, EHR Software requirements also depend on the size of the medical practice. From solo-provider clinics to large multi-provider, multi-specialty clinics, every practice has unique inherent challenges that must be addressed by the EMR Software vendor.
A small doctor’s office not only has a limited number of staff members but their EMR Software budgets are also extremely low compared to a large enterprise such as a hospital. Due to these budgetary constraints, many providers simply choose to employ Free EMR Software or choose an affordable EHR Software vendor with a low fixed monthly fee. Cloud-based access is one such important requirement so that these providers can access patient charts even from home when needed.
These practices usually consist of 5 to 10 medical providers often belonging to the same medical specialty. Their requirements are more stringent, and their budget is also considerably large. Aside from specialty-focused requirements (EHR Software by Specialty), these practices also require unique features such as interoperability, dedicated customer support, multi-device support as well as extensive reporting functionality to keep an eye on the overall performance of the practice.
Larger group practices generally comprise more than fifteen or often twenty medical providers. These practices usually provide medical services that fall under various medical specialties (Orthopedics, Pain Management, Surgery, Chiropractic Medicine, Family Medicine, etc.). Therefore, these practices require support for multiple users to access the system simultaneously, as well as for the Scheduling software to accommodate multiple locations, providers, and resources such as Dialysis Chairs, procedure room allocation, etc. These practices also keep replacing or adding staff members and need a scalable solution.
EHR software companies such as Epic, Cerner, AllScripts, NextGen, Athenahealth, IMS by Meditab, eClinicalWorks, Meditech, McKesson, MEDHOST, etc. usually target and provide solutions for larger corporations like Hospitals, ACOs, PCMH, IPAs, CINs (Clinically Integrated Networks), Public Health Departments, etc.
These customers have the most elaborate list of requirements, which are usually documented in the form of an RFI or RFP to assess and shortlist vendors that can meet them. The requirements consist of features like inventory management modules, interface with local labs (LIS), machines, and diagnostic equipment along with drug dispensing (pharmacy management software) and electronic medication administration records (EMAR), etc.
These entities also require the EHR software also need to integrate with multiple other software and medical devices.
Since the introduction of Meaningful Use, most healthcare practices simply have little or no choice but to convert their practice operations to EHR software. However, most providers today select the EHR software of their choice that best suits their specific needs and must perform an extensive search to evaluate all available options before they find one that is suitable. Most potential EMR Software buyers in the market today have the following in common:
Although #3 is ideal, every provider and their practice workflows are unique and therefore what works for one provider may not suit the other. “One size fits all” simply doesn’t apply in the world of healthcare IT. Software experts and industry specialists are an ideal source of information, advice and ultimately ensure that the right decision is made.
EMR software includes several types of software based on specific applications or functionalities:
Apple dominates the digital device and computer market in the US today, so it is no surprise that many providers are specifically looking for their EMR Software vendor to support the Mac operating system (Mac EMR Software). Not all Vendors today work on a Mac device, so looking for a vendor with native support for Mac devices is essential to ensure that the software performs on existing hardware at the practice and does not require more investment in computer systems.
Small doctor offices benefit the most from Cloud-based EMR Software technology since minimum to no upfront cost or maintenance is required and accessing the EHR Software is possible from any location given the availability of internet access. This type of EMR software is also device independent in most cases and can be accessed using devices such as Smartphones (Android & iOS), iPhones, iPads, laptops, and desktop computers.
This is the most significant requirement for most software buyers today as the software must comply with the standards and guidelines set by the Office of the National Coordinator (ONC). The online repository details all software vendors and details related to their respective compliance with the measures set by the ONC (Click here). Software that complies with these standards has undergone rigorous testing and confirmed at a benchmark level defined by the federal body. The software testing done during this exercise checks all areas of the EMR Software system from Patient Portal access to the way the EHR Software communicates with other programs and entities like labs, Pharmacies (via e-Rx), hospitals, HIEs, etc.
Electronic health records software (EHR) for certain specialties such as Hematology must provide specific tools to document the workflow of those specialists such as specifying the area of concern (e.g. Chemotherapy) and should provide a lot more than a mere method of capturing text or raw data.
With competition rising in healthcare IT, EMR software providing integrated Practice Management software as part of their overall software package easily outperform rivals with standalone EHR Software including those that may provide specialty-specific EHR software. EMR Software companies with integrated Practice Management solutions often tend to provide extensive reporting capabilities to track practice performance and manage business operations better.
Medical practice has several needs for software systems to streamline operations across the board. One such important area is billing for services rendered and communications with insurance companies. Medical Billing Software, therefore, works best when integrated with Electronic Health Records software. All clinical documentation seamlessly conforms to the required standard and forms a financial document that can be electronically sent to payers (insurance carriers) to verify and process at their end. This simplifies the operations and ensures all parties are on the same page when it comes to the financial health of the enterprise. Medical billing software helps practices and medical billing managers generate claims, and patient statements, verify patient eligibility, and more. This software is ideal for practices that want to handle billing in-house and can integrate with EMRs.
An EMR Software must ensure the security and safety of patient records while ensuring privacy and HIPAA compliance for patient/doctor communication (Patient Portal). This is a paramount concern for physicians and HIPAA compliance should be guaranteed at all times by the EHR Vendor. Most Vendors today (Epic, Cerner, Athenahealth, AdvancedMD, PrognoCIS, Modernizing Medicine, eClincalWorks, etc.) are aware of the importance of HIPAA compliance and have taken steps to ensure the safety of patient records security in every section of the EHR Software using advanced tools like data encryption technologies to enhance the security of the EMR software.
One of the decisions your practice will have to make is whether you want just EMR software or one with integrated Practice Management for billing and scheduling. There are advantages to having both together but there have been cases where some practices only go for one if they had unique requirements that a vendor could not fulfill, or they had already paid a hefty amount for PM software and weren’t looking to replace it yet.
Doctors are not IT professionals, and though some might be tech-savvy, it would be egregious to expect them all to be experts on EHR software. Ease of use is essential to make the transition from paper to electronic smooth, as well as day-to-day practice to go along without a hitch. If the software is too complicated and hard to understand, it’s a waste of precious time and needlessly aggravating. Some vendors offer free training while others don’t; make sure you ask for training if your practice needs it.
Not all specialties are created equal, so why must their software be generic? Basic EHR software works well and is good for general practice and most specialties, but doctors have complained about specialty specific not being available in the market. The specialty software has inbuilt recording systems that make specialty practices function efficiently. Only a few vendors provide specialty-specific software, so there aren’t many to choose from. But more vendors are cottoning on to the demand and there should be more options in the near future.
Support is a major issue most practices have with their current vendors. A good support team can make small glitches to major roadblocks easy to maneuver while a bad one will just make things worse. Some vendors provide support as part of the plan you’re already paying for, while others charge extra for support. Scout the market, read reviews, or just ask point blank if there will be a special support team assigned to each practitioner and whether you’ll be charged for the service.
There are varying price lists out there, some offer free services, while others charge an arm and a leg for specialty services. Either way there will be hidden costs that you might get to know about later. Fix your budget and talk to vendors you interview about hidden costs within the contract and whether services such as training and support are free.
Smartphones have changed the dynamics of mobile usage. Handheld devices are easy to carry around and can be used for any number of uses. Most people are ditching the cumbersome PC for a handheld device. Doctors mostly use iPads or Tablets in the examination room to take down patient symptoms, check history and note down the prescription, so it’s imperative that the vendor has a mobile application that is synced with all the mobile devices being used in the practice.
Like anything else, the EMR software industry is also subject to constant changes. From new technology to legalities and governing bodies, everything is constantly changing. Here are some of the changes I think it would do well for you to keep track of.
At a recent healthcare conference Andy Slavitt, the administrator of the Centers for Medicare & Medicaid Services declared that Meaningful Use was over, and would be replaced by the end of this year with something better. But a deeper look into the claims revealed that meaningful use would very much still be there, only much improved.
The new measures aim to make the reporting and benchmark for reaching the required reports much easier and laxer than under Meaningful Use, along with other changes.
As the CMS has officially renamed Meaningful Use to “Promoting Interoperability” as of 2018, it’s important to understand its updated principles. Effective interoperability of healthcare data will ensure that electronic health information is shared properly between healthcare and public health partners in the right format and at the right time. Starting in 2022, the CMS requires all eligible healthcare services to implement upgraded versions of EHR software that utilize this updated definition.
Recent research found that only 25% of practitioners are interested in a web-based model and only 50% are willing to have it as an initial model that eventually transitions to cloud-based. Cloud-based EMR software cuts down on steep upfront costs for client servers and can be hosted on any device that has a web browser. It’s no surprise that more and more vendors are transitioning to cloud-based software because the industry demands are changing.
Between 2023 and 2030 we can expect the industry to undergo great growth and changes. It’s estimated that the EMR Market size will grow from $31.22B (in 2023) to $40.05B (in 2028). Due to the low installation cost, easy maintenance, and ease of use for Cloud-Based EHR software, this market segment can also be expected to grow significantly. Additionally, the North American EMR Market is expected to grow greatly as well as in emerging economies in the Asia-Pacific, with the Asia-Pacific market being recorded as the fastest-growing EMR market, due to an increase in industrialization and urbanization.
More EMR software vendors are widening their type of practices, to become accessible to more healthcare practices. However, optimizing these EHR software solutions for these different needs is only becoming more difficult since the number of people with expertise, time, and knowledge in health IT is only decreasing. As predicted by Douglas W. Bowerman, MD, we should see a continuous trend of accessibility in Electronic Medical Records software in terms of how it can be accessed and who it is accessed by.
Healthcare facilities accumulate massive amounts of patient data. Patient health and financial data let EMR software vendors help physicians with Clinical Decision Support (CDS). Leveraging analytics algorithm predictions can solve interoperability-related accessibility issues. Data warehouse development is also an option to ensure more accurate patient data thanks to automation.
Boosting patient engagement through the scheduling and treatment process is imperative to the growth of your business. One method is to make content easily available through patient communities or just increase patient outreach. Regular appointment reminders for upcoming appointments (see Appointment Reminder EMR Software) can reduce cancellations while further increasing patient engagement.
Technology is innovating daily, and this constantly influences the development of electronic health records software. One example is the recent implementations of AI virtual assistants in health IT solutions, speeding up the diagnostic process and increasing practice efficiency. Other tech giants are also entering the healthcare field, such as Apple and Google. With their massive budgets, they can invest heavily in R&D without taking many risks. They have also already witnessed the issues that arise from the lack of interoperability in current iterations of Electronic Medical Records (EMR) solutions and are very unlikely to make the same mistakes. This competition is great for consumers and clinicians as it will force EHR software vendors to rapidly modernize their systems with far more regular updates, meaning large-scale changes are on the horizon.
The current standards that regulate EMR software systems are very lax. Vendors end up having to pay millions in settlement fees due to false claims about meaningful use certifications. However, EMR software regulations are becoming far stricter and more transparent to prevent incidents like this from happening again. The interface between physicians and medical billing coders will likely become more separate. This is because they both need access to completely unrelated pieces of information, so sharing the same regulations often leads to life-threatening miscommunication.
5G networks are poised to become the forefront of data communication methods in only a few years. They offer up to 100 times the speed of contemporary 4G networks yet may still not integrate properly with the current state of healthcare IT systems. As it stands, there are many different formats available that are all competing to become the dominant method for communication in Electronic Health Records software systems. As such, EMRs are currently spread across these different formats. This makes them incompatible, so the different EMR systems can’t communicate at all. Until a standard is agreed on, 5G networks won’t be able to bypass the bottleneck created by two opposing systems.
Despite promising patients access to medical records, this feature has not yet fully materialized in Electronic Medical Records systems. A study in 2019 found that only 10% of patients who had access to their records online actually accessed them; of them, 63% were encouraged to do so by their healthcare providers. In order to prepare for potential regulatory changes in the future, software developers are updating EHR systems to be easier to navigate and better fit the patients’ needs. Practices themselves are also now providing proper guidance and awareness about the importance of regularly checking one’s own records to familiarize themselves before appointments.
EHR systems are the forefront supplier of paper-to-screen technology, so it is imperative for the software to be inclusive of a wide range of digital capabilities. Implementing better use of data liquidity will allow data to be more accessible, increasing the EHR footprint. This can be done without sacrificing the security of the data. Implementing better interoperable solutions will also expand the footprint, allowing healthcare organizations to better access and exchange patient data.
Digital therapeutics involves software that can behaviorally alter patients and help treat mental conditions using different interventions. Usually, digital therapeutics are used through smartphones and tablets. The software is quickly being integrated into EHR software systems and they aim to be more patient-centric. As they begin to meet industry requirements their popularity will continue to rise, and clinical trial results will continue to be published in peer-reviews journals.
In their current state, EHR and EMR software does not properly address medical error prevention. Previously, illegible handwriting on paper prescriptions was blamed, but over-reliance on computers to supply the correct doses for medication can prove to be equally as dangerous. For example, a 16-year-old patient in 2013 was prescribed 38 tablets of medication, but it turned out to be an overdose for someone of that age. These sorts of errors are far more common than we would like to believe. In the future, EMR and EHR software developers are striving to dramatically reduce these errors by decluttering the physician notification center which could cause less time spent attending to patients. Currently, details such as patient implants may not be added to the system before radiological imaging since EHRs don’t actually have a standard place to store notes.
Although more commonly used for cryptocurrency and NFTs, blockchain technology is being increasingly used in Electronic Health Records software as well. The blockchain allows EMR data to be secured through cryptography, making it available only to those who have access to it in the first place. As an example, the blockchain can validate clinical trial and claims results, track medicine distribution and prevent insurance fraud. The usage of blockchain in Electronic Medical Records (EMR) systems started around the beginning of 2022, and it is already being used to secure data and ensure confidentiality.
One of the biggest hassles in dealing with current EMR / EHR software is being able to easily navigate through mountains of data. Despite large leaps in technology in recent years, EMR / EHR software is clearly behind in terms of its ease of use and User Interfaces. Electronic Health Records are designed for easier data access than paper files, and EMR vendors are starting to implement updated iterations of their user interface in their software to better achieve this goal.
Largely spearheaded by big tech companies such as Apple, wearable devices are surging in popularity in medical fields – the market is expected to grow 26.8% from 2022 to 2028. The devices have allowed healthcare metrics to become far more accessible and have, in turn, made medical diagnosis simpler. Integrating the data from wearable devices into Electronic Health Records (EHR) has the potential to massive improve patient healthcare. The devices include various different sensors that can track body activity and monitor environmental factors. Currently, they come in many different forms, such as smartwatches, fitness trackers, and specialized apps on mobile phones.
Electronic Medical Records don’t offer patients the ability to access their own records across multiple healthcare organizations due to the lack of data-sharing standards set between different practices. This causes significant problems for patients who receive care from multiple different centers. The issue also makes the diagnosis of patients harder for physicians and healthcare providers. Due to this, EMR/EHR providers are updating their software to include interoperability and integration features to allow data to be shared between these different organizations.
Patient portals completely eliminate the need for paperwork and the manual retrieval of data. On top of this, medical records can be available on demand by offering a portal that patients themselves can access directly. Having easy access to their data encourages patients to be more involved in their health journey, which eases the medical diagnosis process from healthcare specialists.
In recent years, advancements in AI and machine learning have dramatically changed the healthcare industry. As these technologies continue to evolve, they are likely to have a significant impact on the future of EHR (Electronic Health Record) and EMR software. By leveraging AI and machine learning algorithms, EMR systems can become more intuitive and efficient, streamlining clinical workflows and improving patient outcomes. The application of AI and machine learning will also enable EMR systems to provide more personalized and proactive care, by analyzing patient data and identifying potential health issues early on. Additionally, these technologies have the potential to revolutionize clinical research and drug development by providing access to vast amounts of patient data and insights.
MOSAIQ EMR Software provider, Elekta at the American Society for Radiation Oncology (ASTRO) Annual Meeting, introduced the new MOSAIQ Plaza suite of data-focused integrated oncology software. The company also highlighted a comprehensive strategy for the precision of radiation medicine. The strategy will make complex radiation treatment easier as well as streamline the delivery of care.
Launched by athenahealth EHR Software, athenaOne was recently crowned as the top-ranked US medical app for Apple users. The award and acclamation is due to the many benefits and convenience athenaOne provides to its users through its robust set of tools and features. Not only this, but the app is also favored by healthcare providers all around the US because it has an easy to use and intuitive interface helping practices beat industry benchmarks.
Doctors have noticed quicker workflows and have enabled them to place orders and finish notes quickly. athenaOne has got a 5-star rating and has witnessed an increase in download by the users which reflects that the app is powerful enough to support healthcare providers through their stressful day!