My MSO has been using nextgen for over 2yrs.. It is without a doubt, the most frustrating, idiotic program I have ever used. The learning curve is too steep, the interface is completely non-intuitive (think DOS, not even windows for workgroups), etc. Our productivity is down 20%plus. At my last count, 15-20 mouse strokes on 6-7different screens just to tell my nurse to call the patient back and tell them the answer is 'yes'. Our lead receptionist made the comment last week "It's like someone is intentionally trying to sabotage our office with this program."