Chris,
Thanks for joining in this discussion. Some of these points may seem esoteric and detailed but are actually important since they form the basis for how we use the program.
Before I forget, let me second Mel's comments with which I agree wholeheartedly. In particular, " it would be helpful for you to post popular requests on the user board for a broader notification".
I too find the initialization of a new encounter a bit confusing and think this experience should be improved.
Agree that the page can be confusing to new users. With experience, it generally functions well.
I believe the prior designers intent was to manage some of this with the buttons for "Overwrite all fields" and "Keep existing CC, HPI and ROS"
These buttons should be deleted. Their function is limited at best and I don't known anyone who uses them regularly.
Since you're clicking on the MRE (Most Recent Encounter) you should expect to see just that....the most recent encounter but with the date of the encounter and not today's date. We can change it to display the date of the prior encounter for further clarity
I think this would be a mistake. Unfortunately, not every note is completed on the day the patient is seen. If the incomplete note is saved to a message box, the date will be incorrect and when it is retrieved, there will be no way to tell when the patient was seen.
If a change is to be made, I would simply re-name the MRE tab. The user experience is only confusing because of that name. This should be called the "Note creation" screen (or something to that effect). It makes sense to a novice user that the default upon opening a chart is the "Note creation screen". It opens to boxes with the date of the visit (today) at the top. If possible, have a "user preference" which is to display the boxes empty (like the current ctrl-N option) OR populated with the most recent information (as it does now). This eliminates the confusion with the minimal amount of change or disruption to current appearance, coding, and work flows.
This is why it is difficult to make changes. There have to be enough people who agree. This isn't a very good one for "preferences." One thing that has always helped me is to compare the electronic chart with a paper chart. So, I open a paper chart and the first thing I see that was last written in is the last note or MRE. It's date is at the top. It can't be edited. When I start to write a new note with a new CC, HPI, etc., I write a new date. If the note is done the following day, it will still have the beginning date. AC has a great feature where it tells you when you try to save a note on the wrong date, "This is a different date. Do you wish to save anyway,? Or something to that effect.
I just got back a Western Blot IgM on a patient whose Lyme antibody was reactive. We get a lot of those now, and I wanted to look at the date and symptoms. I chose his name from the patient list, and I clicked on it. Beautiful note. Wrong date. Of course, there is the very small, "This patient was seen two weeks ago on such and such a date."
I guess the date at the top could say Seen on June 5, 2015 @ 4 PM. You can't edit the note except for allergies. I agree that all of the other stuff doesn't need to be there including the stepping off point (but maybe others use this). I believe a simple icon which you click on could open the new chart and which point the HPI, ROS and the objective side of the note clear. I don't know why one would want to start any new note with the old HPI, etc. there. But, if so, just have two icons to click on.
As soon as you click on this, you have a new note, fully editable, with a new date at the top. The date that will be saved when you sign off, whether it is today or next week.
I have always thought the perfect way to do it (which also goes back to the paper chart) would be to have a Face Sheet. (I remember back in the day, when 50% of the board was about improvements, many of us shared Excel spread sheets of a good Face sheet. With a paper chart, if you had time and you did things correctly, you would look at the front of the chart, which listed current important historical information.
I always envisioned pulling the chart from the inbox where it would default to something similar to the summary sheet only more organized and better. It would have a very prominent PMH and Problem list with a list of past encounters. Medication allergies would be prominent. A prominent flashing light or something to let you know there was an important comment would alert you to read that you shouldn't bring up a certain point or that you weren't supposed to discuss the visit with one of the parents.
I do not know how many times I have diagnosed a suspicious heart murmur only to tell the parent and find out they have already been to cardiology twice. I know it is listed in PMH, but it just is something you look over. Especially when it is the fourth line and is covered until you scroll. I also always thought it would be cool to have the plan from the MRE show up at the bottom right which somehow was taken from the last visit. Just some thoughts.
I almost think you would need a committee on this.
