Home Forums Discussions Problems Meds listed in plan section

does anyone know of a way to have only meds rx'ed on that visit to appear in the plan? right now, it seems like any med that was rx'ed gets in (or from visit before), and prints out more than 1 page sometimes.

If you use the Rx button to add meds and do not check the box about putting meds in the plan it will only put in the plan those meds you prescribe that day.

Hello djkym,
My experience is that everytime I write a script in AC during the visit, it shows up in the plan. That way, only rx written during the visit show up in the plan.

Are you using eprescribing through AC?

no erx. just reg plan stuff, i have a provider that likes writing his plans in plan (go figure..:) and when that gets added, some of the things don't get deleted.

I've notice that the prescriptions show up in the plan section only if the active cursor is in the Plan box when you select the Rx button. At the same time, the medication is not added to the medication list in your progress since the patient was not historically taking it, and the plan section reflects the future. If you select the Rx button while the cursor is in other boxes, it does update the medication list, but doesn't the prescription in the plan section. You can also put in an updated medication list by clicking the Update Meds box.

Steven is correct. I am not using V4 yet, but in ANY version I have used prior to that, it shouldn't matter where the cursor is.

Basically, this is how it works. When you open a chart to do a progress note, there will be the list of meds the patient is on or at least what you had him/her on before. The ONLY way to change those for that visit, is to double click in the Current Medications field. This will open up the prescription writer. When the prescription writer is opened up by clicking in the Current Medications field at the bottom left, then EVERYTHING you do at that point in the script writer will affect the medication field and ONLY the medication field.

So, what should be happening is that you open the writer from that field, and go through each medication to see if the patient is still on it. Or, if they were on a medication such as Cefzil and it is over, you would inactivate that. So, if a patient has stopped a medication or changed how he or she is taking it or if a medication has run its course, then you would click on the medication to load it into the middle of the script writer and choose inactivate medication or edit it. This will remove it from the active list and also remove it from the current medications field or edit it. Alternatively, you would never prescribe something new from the script writer that you pulled up by clicking in the Current Medications field, BUT you would want to add meds if the patient was new and you wanted to have a list of his or her medications in the Current Medications field as they were on them when they came in.

Now, after you do the physical exam, et. al., you then open the script writer from the actual presciption writer icon button on the right. When you open it this way EVERYTHING you do will be in the plan. If you choose to discontinue or change a medication, say change from Prevacid to Prilosec, then you would inactivate Prevacid and prescribe Prilosec. In the plan, it would show "Discontinue Prevacid blah, blah...and Prescribe Prilosec..blah blah.

Vicki is correct that you normally wouldn't click on the button moving a copy of the current medications to the plan. There are times that you may want to.

It should be noted that most of the time you will wish to inactive medications so there is a record, but at times you will want to delete the medication altogether. You do this, by choosing delete in the script writer and clicking yes on the warning. Again, if you do this from the script writer obtained by clicking on the script button, it will delete the medication and it will be gone next time, but it will stay in the actual recorded note for that visit. If you were to delete it from the script writer from the Current Medications, then it would be gone in that note and in the record as if the patient never came in with it.

Once you are used to it, it is rather intuitive, but maybe the script writer from clicking in the Current Medications box should be labeled boldly at the top "Current Medications" and the one from the button "Medications Prescribed At Visit.

I reread this, and it isn't the most perfectly written or clear, but I believe it is accurate. Let me know if I can explain it better. Or if I am wrong.

But, really, if it has to do with where your cursor is, then something is wrong. The only thing I can think of is that the times you use the script button is generally the time when your cursor would be somewhere on the right side of the window.

Well, I guess I made that about as complicated as I could. LOL

In short, when you bring up the prescription writer by left clicking twice in Current Medications, anything you do in the window will affect the Current Medications.

When you bring up the prescription writer by clicking on the Prescription Writer button on the right, anything you do in that window will affect the plan.

Hope this helps.

good answer Bert.
Where in Heck do you get the time to be here so much?

I have no life
I have no wife
And, my best friend is always in Florida

I don't have a wife either, and I was just in Florida.
What a coincidence!!!

Cool. Did you happen to run into my friend?

I did run into him.
He said you spend too much time on the computer and need to take a break.

you guys are funny.

I don't think Bert mentioned this:

If you prescribe a med and it shows up in the plan as expected but then forward the chart to yourself and open it to finish it, I see the newly prescribed med, showing up in the med list- as if they have been taking it previous to the visit..pretty sure this is consistently happening- I watch for it and delete from the med list when this happens.

Carla Gibson

Good to know. Yikes! Or is that bad to know?

i almost always save notes b4 finishing, will look for this behavior-maybe that's what my prob is...

Actually, I can't reproduce that at all.

If I prescribe a med from the script writer on the right I can save it to my inbox as many times as I want. The medication is not put in the medication list on the left. When I sign it off, it is now there when I reopen the chart. It is not present (as it should not be) in the med list the patient came in on in the note in visit history.

I am not sure what you are doing to make this happen. Is it occurring in a certain version?

This morning one of my providers had a question about why AC didn't work right when she was entering a patient's prescription in the script window (didn't save to the chart).

I did an advanced search and landed here. I cut and pasted Kevin and Burt's posts and messaged them to everyone. Once people understand the reasoning behind something it makes sense. When it makes sense, it's easier to remember.

When I first started using AC, I would often forget to update the current med list. I would have written the RX in the Plan and then go back and open the Current Med list and "always" happens, the Plan RX would then populate the Current med list. I therefore learned to carefully check and update the Current med list BEFORE I wrote any new RX in the Plan. AC doesnt allow you to "forget" and go back!! If you do that by mistake, then you have to do a bunch of deleting. Too bad, the older I get, Oh well, you know the story.

Peggy,

I am so confused. Please help me understand what you are saying.

First how would updating the current med list (which change anythng about what you write in the plan showing up in the current med list?

The only thing that will do is to cause the medication (let's say amoxicillin from 100 days ago) to still show up in the medication list and in your actual note.

If during that same visit (where you didn't delete the amoxicillin), you write for Concerta in the plan, the current med list will not contain amoxicillin and Concerta. The Concerta SHOULD now be in the current medication list as it is now a current med. When you reopen a chart even one minute after the visit, it is helpful, but in many, many ways is not a true representation of the documentation of where the patient is when they leave. For instance, you may add a PMH or delete asthma, you may add thet a family member now has diabetes. But, if you go to the past visit section and open the note, it will represent the true documentation of that patient when they came in and when they left, e.g. no longer on amoxicillin, now on Concerta, has out grown asthma, etc.

I do make it a habbit to check and update the current meds when a patient comes in on every patient as the first thing I do. It helps to keep the chart up to date and to recall the patient AND to know that they stopped taking their Abilify and Prevacid without informing me.

But, it still seems as though what you are doing is exactly what Amazing Charts should be doing and the only thing that will be documented in correctly will be anything you forgot to update on the left side of the chart -- mainly the medications. All you can do is when you see them again and delete the medication and change the date in the upper right side of the script writer to reflect more of when they stopped it.

I may be off base, but a few observations.

If you click on the prescription box in an office visit and delete or add scrips it will not go into the plan section (I use this sometimes to erase old meds or inactivate ones the pt is not taking). If I want it to show up in the plan as ones I prescribed that visit you use the RX button on the right side of the office note and that will bring up the prescription writer and you can inactivate or enter new scrips which will show up in the plan automatically. Although both of these steps will bring up the scrip writer this is the only one that consistently puts them in the plan.

If you want to generate a list of all current meds when you are done you should then check the box ADD UPDATED MED LIST TO PLAN and that will put it at the end of you note. Some might do this if they use plain english in all their scrips to make a complete list for the pt, although I try this and forget and start putting po, pr, tid, bid etc and that makes it hard for the pt. to read.

You also should note that if you add an allergy within the note that it won't show up in the scrips until you save the note and come back. This is obvious when you see a new pt., print all new scrips and the allergies show the blank verbage - will be there the next time. I hope Jon is going to eventually make a place for us to check meds for allergies and that will require us to actually search for the med in an allergy list, as well as scrips and not use free form scrips.

I may be misreading what is asked but thought it would be good to reiterate what I have seen over the years.

I have to apologize to both Steven and Peggy before I write this in case I offend them. Steven, everything you wrote is true and is a good refresher, but I don't think it is the question. On the other hand, I have read the question now ten to fifteen times, and I still don't know if I understand it.

Reason being the only reason to edit the Current Meds on a visit is to obviously delete a medication they are no longer taking or add a medication that they started since the last visit.

NO MATTER WHAT YOU DO ON THE CURRENT MED LIST OF A VISIT BEFORE OR AFTER A VISIT, any prescription written by the script writer on the Assessment and Plan side of the note will NOT populate the current med section for that visit.

YES, if you save the note and open it again, you will see everything you did for that visit, AND you will see your new medications in the current med list as the patient has left and is now on those medications. This is even true if you delete a medication as PART of the plan, e.g. D/C Abilify, Start Seroquel.

Where the confusion may be coming in (if I am understanding the question or confusion) is when you open the progress note again from the Patient List after it is saved, you will see the current medication, and it may appear as though your note shows that they came to the visit on the medication that was actually started at that visit. And, while there is some value to opening that progress note after it is saved as you can get the gist of what you did, it is indeed after the fact and, therefore can not be looked at as the actual visit. It does not become accurate until the next visit after you open it and use CTRL - N and start a new note.

To be clear, again, if you want a true representation of the progress note of that day, then you have to go to the actual saved note in visit history. That note will reflect the correct medication list (if you edited it during the visit) and the correct medications that you prescribed in the plan.

Not to be too confusing with all of the details, but the note in the visit history will show in the medication history of the note what the patient came in on if you edit it. The same medication history will now show what the patient when home on if you order it in the plan, including any medication that you DELETE during that visit. After all, you show in the plan that you decided to take the patient off Atenolol, but he/she still came in on it so it should be in the current med history -- which it will be in the visit history but it will NOT be there if you simply open the note from the Patient List or open the script writer from the patient list.

I know this may sound jumbled and long, but it is accurate and makes complete sense to me.

Think about it this way, and it is easy:

1. Edit the current medication list when you see the patient.

2. Write for new scripts and delete any medications at THAT visit they had been on from the script writer.

If you do these two things, then your note and your records will be accurate and recorded properly.

Once making the changes that Bert suggested to reflect the Plan section, you've deleted and added meds. Go to the medication history (below the window for Social history and Allergies). Then place the cursor somewhere in the medication box and hit the <delete> key. A window will popup tell you that you can't edit meds from this window. Click "yes" to the question and the prescription writer will come up. Then simply close out of the window and it will repopulate the Medication history window to reflect the current changes.

And, on a similar note, even when it tells you during the live progress note that you can't delete from the medication history, you can override it.

FYI, V4.072 is still not renewing previously inactive Rx's correctly, in that it creates two duplicate lines for the meds, and does not update the current sig if you change it. I figured that they would address this in the most current update, but apparently not. When I originally reported this bug, I was under the impression that it would be fixed.

The meds sometimes duplicate in the plan section. The "Advised/ Ordered" also sometimes is duplicated in the plan section. This does not happen every day, but when it does happen it happens lots of times during the day ( but not every time during the day). The duplicate entry can be deleted and is not a safety issue, but to make the note look like you are a first class OCDoctor you have to delete the duplicate entry....not time efficient.This has persisted from when I started with version 4.0.60 to today, on 4.0.72. I thought in the first place that I might be double clicking instead of single clicking, but I have convinced myself that it not a double click issue.

Trust me Deborah,

You are not double-clicking. Other try to tell me what I am doing, but it is simply that you get double entries. It drives me crazy. I agree with you.

Bert and others, I don't think I'm crazy, so I went back into AC and opened my "test patient". I opened a new note and as if it were a new pt visit, went into the Current Med LIst and discontinued Tylenol and it took Tylenol off the list. Then I went to the Plan section and RX a new prescription "methotrexate" which correctly populated the Plan window. Since I am human, I forget that the patient told me they were taking calcium and I go back to the Current Med List to add that, or make any change to reflect the current situation. When I finish adding the calcium and close the Current Med window, the "methotrexate" then populates the current med window -- this isn't supposed to happen according to what you are saying. I signed the note and went back to visit history to see what was there.....the Current Med list had "methotrexate" in both places (current and plan). Is something wrong with my AC? I have v 4.0.72.

If you open up the med section directly (vs writing a script) it will take any meds you have as the current list.

ie: I write an Rx for amoxicillin then and close the prescription writer. I look at the med list and see bactrim from last year and decide to delete it. If I open the med list by double clicking and delete bactrim, amox will now show up on the current med list.

Moral, do med reconciliation before you write Rxs.

Wendell, Thanks, this is exactly what I was commenting about in my earlier pose. However, Bert writes "NO MATTER WHAT YOU DO ON THE CURRENT MED LIST OF A VISIT BEFORE OR AFTER A VISIT, any prescription written by the script writer on the Assessment and Plan side of the note will NOT populate the current med section for that visit. " I think that he is referring to "after a visit" as having completed and signed the note. I'm referring, as you commented correctly, "during the visit". I'm not really trying to make this hard. I do appreciate the input I always get from everyone. The best part of AC.

Peggy, my sentence above is somewhat confusing. I think what I was saying was no matter what you do on the current med list of a visit, any prescription written by the script writer on the A/P side, will not populate the current med section. I now see what you are saying and stand somewhat corrected, lol, but still do stand by what I was saying. Once you write a new med, THEN, close the note, nothing happens to the other side.

I now finally see what you are saying. If you write a new medication, then open the current meds, the new medication populates the current meds, which is certainly NOT what you want. So, I see your issue. But...

I don't think this is a bug in the program. I think it is doing exactly what you are telling it to do. You already know if it is used in the right order, that current medications will be correct and the new scripts will show up correctly. But, in your scenario of opening current med section to make changes AFTER prescribing medications by the script writer, you will have the new meds in the wrong place.

But..the key here is that as soon as you write a new med it now not only populates the plan section, it is now in the prescriptions list -- it is in the script writer window and always will be there forever unless deleted later. So, in THAT visit if you open the current medication window it WILL show the new medication as you state.

Wow, even if I'm able to understand all this, it's a mind-bender! I think I get it. But I do not agree that it should be that confusing for the sake of up-to-the-minute accuracy.

That should be what the summary sheet is for: to keep a "real time" list of current meds. If I write a progress note (encounter note) and I close it and re-open it, it should reflect nothing more than what it did when I closed it, IMO--the meds which were current prior to forming a treatment plan.

Hi Peter,

Welcome to AC. What do you mean by close it and re-open it?

I understood this (along with some other posts) to mean: if you make a note, then close the chart and open it again immediately, then drugs prescribed in the plan of that note will show under current meds in that same note--unless you access the note through the visit history.

I guess if you mean "sign the note" by open the note, then yes I would hope it would be there.

Do you expect AC to know when the next time is you will open the chart? Usually, it would be at the next visit. Once you sign the note, it is done and what you prescribed is not a current medication. In fact, the moment they walk out the door, this is a current medication, and the note should reflect that.

Hope I am not coming across in a wrong way.

OK, I think now I understand what you mean.

I was referring to opening a note which I had already signed previously. Sounds like we are in agreement. Just took me awhile to know what we're talking about

I like the Avatar. And, again, welcome to AC.

Tell about your one doctor, zero staff signature.

Thanks, Bert!

I'll mention that in a new thread, so as not to hijack this one.