Home Forums Discussions Feedback and Recommendations Vital signs and growth measurements

As a pediatrician, this particular area is very important to me. Most parents keep a book or diary of their child's well child visits. They like to keep the weight, height and head circumferences as numerical values rather than percentages.

I am asked quite often if I can print out a list of the child's weights. It is easy to do by clicking on visit history and vital signs. The problem is invariably some weights are saved in pounds and some as kilograms (especially if a medicine was prescribed at that visit). So you end up with a list like 8.3 lbs, 9.6 lbs, 4.8 Kgs, 10.4 lbs, etc. The others measurements tend to be the same as we always enter length/heights in inches and HCs in centimeters. Not only do the dual weight measurements make it difficult for the parent, it also makes it hard to use the actual weights in FTT infants.

My suggestion would be to have two columns for the weights so that whether you entered kgs in the kgs column or pounds in the pounds column, AC would auto convert lbs to kgs and vice versa (as it is capable of doing now) and put them in the appropriate column. This would be the best of both worlds.

The other issue is the downside of a good idea, which is a note button. It is good to write comments like "wearing diaper when weighed" or "couldn't get weight due to child's screaming." But, no matter how far over to the right you type in the comment, it always overrides the HCs on the printout. It looks horrible, and I won't even give a printout to a parent which looks like that. I try to tell my staff not to use it, but they do. It seems like one or two lines of code could fix that.

Bert,
An excellent idea!

Currently there is a bug (that's been update resistant) in which the head circumference values units morphs from inches to cms prior to saving. If this is not watched carefully, my child winds up with microcephaly (if entered as inches and then the units change due to the bug).

If I'm the first one to report this bug, I get naming rights. I'll call this bug "MRSU" for "Microcephaly Resistant Strain to Updates"

Roy,

You certainly get naming rights. That does bring up a funny story or actually stories since it never changed. My former partner used to send kids for x-rays and, of course, you had to have a diagnosis.

Well, abdominal pain, would be written as "belly ache" and macrocephaly was written as "big head." Radiology would send some of them back as they had a difficult time coming up with ICD-9 codes.

Along those lines, at a Grand Rounds during my residency, we had a large contingent of providers including the pediatric surgeons. The talk was by a rather famous neurosurgeon on hydrocephalus. During the questions and answer session, one of the surgeons got up and asked a quetion in which in must have used the term "hydronephrosis" five to six times. It was an honest mistake, but it was still hard for the room to not burst out laughing.

I like the ability to print a growth chart, and have had issues with some of the units. What I would like is to be able to enter some dated growth milestones WITHOUT having to make a new visit. I have many children whose records pre-date AC and I would like to enter milestones from BEFORE I started using AC.

Another bone to pick, especially with pediatric patients, is with the enter vaccine form. I have been unable to delete old vaccine lot numbers or expiration dates. It would almost be easier to enter these values each time rather than scroll a list that is over thirty items long and in a somewhat random order.

Bill,
Yes!
1. It would be nice to be able to edit the list of vaccines, Manfacturers, that have been put in incorrectly.
2. It would be nice to tie in vaccine with Lot#/Manufacturer, so that punching in one item and you get the rest incorporated.
3. It would be nice to have defaults (we give vaccine site specific based on which one we give).
4. These will allow me to check to see that a vial indeed did produce 10 immunization (or to see if we were shortchanged or there were some shots that were wasted/diverted).

Such changes will also make it much much easier with the paperwork I have to do at the end of the month separating out the state supplied vaccine inventory/use with our privately purchased vaccine.

Above changes will save me 3-4 hours monthly. Wow, half a day worth of clinic activity! That's worth a lot.

Hi,

I've discussed 1-3 with Jon in the past, and started writing code for this, but have this currently on hold as they're going to do something with vaccinations and health maintenance somewhere in the near future. Since it's no longer one of my development projects, though, I can't give you a timetable.

I currently find the vaccinations section quite annoying, as the lot numbers displayed should only be for the vaccine being given, route and dose should default, etc.

I contributed the code which at least carried the shot information back to the chart note, so it doesn't have to be entered twice - once on the vaccinations form then once in the body of the note. This saves at least SOME time.

V

In general, vaccine records throughout medicine are sadly lacking. As in other parts of the field, there are way too many people doing it way too many ways. It's sad. We have IMPAACT in Maine, and if you have an extra person and are willing to pay $10.00 an hour of him or her to enter old vaccine entries or even knew, then it's great. Not to mention it isn't required.

I love trying to read the shot records from other offices especiaally after it's been faxed. I have no idea why so many entries have to go into the record. Then, we have to fill out a form for Mainecare inclusion as well as informed consent and giving out sheets to educate the parents about the vaccine.

My BIGGEST pet peeve of all time is why vaccines are still recorded as dates. Sure, you need the date, but can't a computer calculate that age? I wold much rather see DTaP given at 2 months and 4 months on a nine month old and realize in less than a second they are behind. Please, we already know AC can do this.

Roy, we do the same thing with Prevar and Polio on the left and Hib and DTaP on the right, etc.

Luckily, my programmer and I on working on our newest software program: Vaccine and Immunization Program Entry Record or VIPER. It should be out in Beta at the end of September. My prediction: I won't be able to give it away. Maybe if I charge $89.00, our server couldn't handle the downloads <G>

"I am the Viper, I am coming at 12 o'clock....(tension builds) I am the Viper, I have come to Vip your Vindows." Old family joke, said with a strong Yiddish accent.

Can I have a V-10 Viper please, daddy, Please..... Sorry this old Dodge Boy just couldn't resist.

For those of you who liked the yesterday's joke here is how it really goes....

It was an old family joke about this guy who keeps calling in a german, yiddish accent and leaving these distrubing messages of "I am the Viper, I am coming at 12 o'clock". And so with every call the folks are getting more and more worried who is this guy and what's going to happen at noon. And so the punchline is that at noon the doorbell rings, the family hits the roof and sheepishly goes to answer the door. Standing in the door is this little 50ish looking kind of guy with a bucket and squeegy. The family asks "who, who are you?" scared as heck and the little man answers back; "I am the Viper, I have come to vip your vindows....."

Have a great day...
Paul

I may be wishing for something that was already wished for. I wish the actual percentiles came out on the vital signs area and on the growth chart. I know a dot is displayed on the growth chart. A number had to be generated to put it on the chart. I wish we had access to those numbers.

Wishing for anything on the vital signs area seems to be throwing coins into an endless well.

I think you need to write/pm Jon directly sometimes - he told me that he is going to add a pain scale on vitals (to comply with CCHIT regs) and will add oximeter then. Maybe if several of us PM ed him or sent wish list he would add this.

I always thought it was just the opposite.

Now Now

I know it is frustating, but there will always be things that one or the other of us want. Cant please all of us.

No, that is not what I meant. I believe Jon gets literally tons of emails asking for this and that. He really doesn't have enough time to deal with these.

Hearing Bert and others talks about writing code for AC. Does anyone have a good registry program that ties into AC? I'm thinking of doing one either in excel or access. Planning to just import an individual document into each patient and then use a master to aggregate all the practices data and have it update to the individual docs automatically. Has anyone else tried this sort of thing?

Thanks.

When I put a wish on here I try to remember to put it on the recommend improvements section. I figure that way Jon and the powers that be can get to it in their own time.

Bert, if you can, please delete the anonymous post. thanks

If I can? I'm hurt, lol.

So does this mean I don't have to worry about "Got Milk"

(Inside joke) Not even sure Vicki will get it. But, she's pretty smart.

LOL, you've earned that cape!!

I used to have a hat, but it wouldn't fit. It just kept getting too small. LOL.