Choc, think of the ?patient list? as the electronic version of your file wall of paper charts. You wouldn?t put a chart back on the wall with an incomplete note, in part because you would never remember that it was unfinished. So you would put it in a pile, or a ?box? of partially done charts. You could keep it in a box on your desk (your message ?inbox?) or you would give it to a staff member to work on (their message box). Only when the note is finally complete would you sign it and put the chart away.
So see a patient and do part of the note. If you have more work to do on it, but want to work on another patient?s chart, hit ctl-s which puts it in your inbox. If you want someone else to work on it, send it to their box. They will later send it back to you when they are done, and you sign it at that point.
I have been saying this all along, and I can't agree with Jon more. I think one gets confused because of the two different places a chart gets pulled from. To reiterate a bit, let's look at the flow again. And, use the Jon analogy and another important analogy.
You pull the chart from your inbox (paper version -- the chart files), you chart...if you don't finish the chart and you sign it off, it is now considered a complete chart because you signed it and it is in the database. You can't put it back in your inbox. Signing it off puts it there. If a nurse triages, you had only a half-done chart. She can't sign it for multiple reasons, not the least it won't let her. So she has to park it somewhere. So, she sends it to your inbox. Your inbox is the same as the plastic doohingy on the door. Now, you pull the same chart but it comes from your inbox. The ONLY different than your pulling a virgin chart from your patient list and pulling from your inbox is that your nurse has entered vitals and whatever else in the subjective area you want to her/him to fill out.
Bruce makes a lot of good points and it has come up in the poll. However, in some ways we are trying to make this too complicated. Trust me, the letter writer issue and the II closed folder issue has been going on since time immemorial. This chart saving, changing, etc. is relatively new. Doesn't mean it is wrong.
You can always sign off a chart, realize it wasn't done and then do another chart again and state on it, it is a new chart. The addendum feature of ADDING DIRECTLY TO THE CHART IS INVALUABLE.
You can now add allergies on the fly. I still thing having the ability to add PMH to a chart without signing it off is dangerous. You could then also take off other data such as family history that you claim was invalid. The four family members with CAD in their 30s that you overlooked.
My guess is that new user are trying to learn a work flow too soon. When you buy a new car, it can take up to six months or more to learn where the headlights button is and the four different settings they now have.
Set up a dummy chart and chart on him or her 100 times until you feel comfortable. Tell yourself that you always pull a chart from your patient list, chart and sign off. If not done, forward it to your pile as Jon said until the evening except here it goes to your inbox. Play nurse and pull the chart, put in vitals and forward it to your inbox. She has to send it somewhere. Now, it is simple because it is right there and it says chart on it. Pull it, chart, sign it.
Do these things and practice. I think you will soon see it is fairly easy (I mean that in a good way).
No one on the board, and I mean no one, cares less about medicolegal issues than I. But, being able to change data after the fact, unless there is really good auditing, is dangerous. I can change from Access and beyond, and it is very tempting when that one month old comes in with a 102 fever and I didn't notice it.
