I agree - Never alter a note, particularly if a medial legal question exists - BUT . . . there still should exist a window of time during which you can proofread your enty and edit it before locking it - that doesn't constitute altering it, it just allows you to finish it.
One easy solution would be a dated "Sign It" -ie when you finalize the chart and sign it, it is dated with the date it was locked. - that would offer all the medical-legal protection you would need (but that choice of when to lock it should not be determined by fear of erasing the chart accidentlly, or determined by the need to look at another chart (ie close the chart you are presently working on without erasing it)
Another solution would again be to lock the chart, (even as inconveniently as AC does) but allow an edit-able (ie changeable, not eatable) letter (again, saved as a *DOC) to be generated from that chart - the locked chart offers you medical legal protection, the edit-able letter lets you profesionally communicate the findings to another provider.
The two solutions are not mutually exclusive, and would liberalize the utility of this program.
Bruce Morgenstern, MD, Neurology
Denver, CO
