As I see it, the major work flow problems in AC revovle around three or four inter-related issues:
1. The default erasing of chart contents if the chart is accidently closed before being signed/locked -AC should consider changing the default of closing an unsigned chart to simply saving the encounter contents, not erasing them, without having to forward the chart to anyone
2. The necessity of signing/locking the encounter to prevent accidental erasing prevents physicians from completing their workflow in a normal fashion (yes, there is an ackward work-around by self-forwarding an unsigned encounter, but why should the program contain ackward fixes when the workflow can be so much more easy?) AC should consider allowing the provider to sign/lock the chart when he has finished his clinical work and not as an insurance policy against accidental erasure). Possibly consider placing a small visible stamp on the encounter indicating when it has been signed and locked.
3. Post encounter letters: the letter writer is an unsophsiticated tool. AC should allow letters to be saved as *.DOCS document under "Improted Items" (in so they can be proofread and edited as professional correspondence, even *after* the chart has been signed/locked. (Allowing letter to be composed and edited, even containing edited contents from the encounter in no way produces medical-legal jeapordy - As long as the provider can prove the original encounter is sign'/locked, than he/she is protected against accusations of chart-tampering.
4. (slighly lower priority)A llowing multiple providers or office personel (who in advance have been given a certain level of security clearance) acces to the chart , even simulatneously, without having to forward it back and forth - this is an advantage of an EMR - why not make your EMR *better* than a paper chart, instead of trying to simply emulate paper's disadvantages? (Soapware, another EMR based on SQL server allows multiple office personel even simultaneous access to the chart (the chart fields become slighly tinted indicating someone else is in the chart at that moment)
While Amazing Charts is an intuitive tool, it seems ,to me, optimized simply for self-contained intraoffice use. I would like to see them focus now on expanding its capabilities to handel tasks outside the narrow realm of simple charting/documenting and in doing so, it will expand its utility outside the realm of primary care and into the realm of medial specialists.
Does anyone have additional thoughts on improving the work-flow, or how to deal with these issues? I've emailed the AC developers with these ideas and they have promised to get back to me.
Bruce Morgenstern, MD (Neurology)
Denver, CO
