Chock,

There are so many ways to do the work flow. These are all good suggestions.

First, poll choices 4, 5, 24 and 51 all pertain to your issues and are, by far, the highest number of choices involving one problem. The first three have a high vote count with 51 having only 7.

I think maybe you are making this too hard. In two practices, I have done it two ways, and they both flowed rather easily. I think the first thing you need to do is decide how you are going to work with your MAs. For instance, at my last practice, the MAs brought the patient into the room and triaged directly on my AC on my computer just like Leslie.

Now, with only two rooms, I have only one MA and a triage station, so she sees the patient, triages, and does the subjective, meds and vitals, then forwards the chart to me. When I unlock my computer and hit refresh (another issue -- we shouldn't have to), the patient is there.

Where I am different now than Solodocmom and Leslie is that I WANT the charts in my inbox with my messages. There may be two charts in my inbox, and they will usually be at the bottom. I open them, chart and ALWAYS sign them off. I like the charts going there, because when the visit is long, I can refresh and see if the next patient is in the room. I can highlight it and see the HPI and my MA has put the time in the HPI section, so I can see whether the patient is conjunctivitis, put in two minutes ago or extreme depression and has been in for 12 minutes.

I don't get labs or x-rays in my inbox, and everything else goes into my own program, so the only things in my inbox are Charts, messages and orders. The stat ones are red, the ones already done but just need to be checked and saved and blue, and the white ones I need to do something with. I also like the chart there, because OCCASIONALLY I walk into the room with a very sick patient, and I don't even open the chart, and after admitting them, I have to go back and chart. It's easy to remember.

Now, I do things completely differently than Bruce (we know that from past threads) and there is certainly no one way to do things. Basically, MA sees patient and pulls up chart, forwards it to me, I open it, chart on it and sign off. Again, this is nothing against Bruce as his practice is different, but I have never lost a chart in seven years. If the chart is forwarded to you, then you can't lose the chart (some charting can be lost, not good, and you can delete a chart to the deleted items folder (which should not empty when anyone closes the chart).

If you open from your patient list, then you can x out of the chart and lose it.

While I understand how helpful it would be to save a chart and then edit it, I do think that opens one up to medicolegal issues, unless that change is audited in the chart, otherwise you could changes things after the fact.

Finally, I wouldn't recommend signing off charts for fear of losing data. If you feel as though you need to save the chart, you hit CTRL + S.

I have never understood those that say they want to be able to work on a progress note, then save it without signing it off. Whether you pull the chart from your patient list or from your inbox, you chart as much as you want, and then save it back to your inbox. The time and date is recorded and the chart is there with all of your charting.

I guess I don't understand those who want to open more than one chart, simply because I don't use imported items. There have been other reasons, but I just don't see it as an advantage. This is not to argue with anyone, this is just from experience. In seven years, I have never needed to open a second chart. So, that says a lot at least for me.

So, either pull the chart from your patient list, chart, then save it or sign it. Or pull the chart from your inbox, chart, then sign it or save it.

The other safety valve if you pull your own chart or your MA does, is after doing the vitals and subjective, forward it to your Inbox. Then you can open it immediately, and it is safer, because if you delete it by mistake, you won't lose the subjective.


Bert
Pediatrics
Brewer, Maine