Since maintaing an accurate med list is one of the most important ways of practicing protective medicine, I wish we had more flexibility in printing the med lists in AC
1. I wish we could use larger print for our senior patients
2. I wish it printed in a tabular fashion (names of meds directly under each other, instructions directly under each other).
Vicki Roberts, MD Family Medicine of Southeast Missouri Sikeston, MO
Although e-prescribing will alter how we interact with prescriptions, the present prescription system in Ac is very rudimentary.
We should have better medication lists for patients available on demand to print out.
We should have distinctions between chronic (take all the time), active (taking now for short duration) and inactive medications (not taking anymore). Short term medications should have a duration option and move automatically to inactive after that time, (ie If I write Amoxicillin for 10 days it would become inactive on the 11th day) This may be fixed with e-prescribing but we should have the default sizes and dosing options for medications (especially liquids and creams)
Although e-prescribing will alter how we interact with prescriptions, the present prescription system in Ac is very rudimentary.
We should have better medication lists for patients available on demand to print out.
We should have distinctions between chronic (take all the time), active (taking now for short duration) and inactive medications (not taking anymore). Short term medications should have a duration option and move automatically to inactive after that time, (ie If I write Amoxicillin for 10 days it would become inactive on the 11th day) This may be fixed with e-prescribing but we should have the default sizes and dosing options for medications (especially liquids and creams)
Greg Phillips
Amen!!
Vicki Roberts, MD Family Medicine of Southeast Missouri Sikeston, MO
Is there a way to inactivate a medication without having to generate a note? Today I noticed Azithromycin on a patients medlist from a visit in January. I can't figure out how to just inactivate it without doing a note or addendum. Thanks
Bill Leeson, M.D. Solo Family Medicine Santa Fe, NM
The scary part about the list in AC is that it is so easily alterable. It currently is a liability.
When I send a copy of charts to someone I print their current med list and a disclaimer that none of the lists within the notes are accurate.
A big improvement is that we can go to the eprescribe within the note. The help desk said that improvements to eprescribing have been put on hold until the certification process is done. I hope AC isn't spending a lot of time and effort in vain. I read an article in Medical Economics this past week that said the the CCHIT is probably going to go by the wayside when a more robust certification process comes along.
Anyway, AC is still a great tool and a nice value.
Vicki Roberts, MD Family Medicine of Southeast Missouri Sikeston, MO
I wish other parts were more easily alterable....like when a typo gets by me and I print a note, only to discover the mis write or mis-spelling. I have many repeat notes for the same day of service. Any work arounds? I do try and proofread, but tha's obviously not fool proof.
tom
Tom Young, DO Internal Medicine Consultants, PC Creston, Iowa
@Bill To add to Wendell's statement, after pulling the prescription writer, you aslo can click on Quick Edit, and inactivate many medications at one time.
@Vicki Can you elaborate on what you mean by it is too easily alterable. I don't follow.
@Tom Do you really redo the whole note? And, there is a spell check, although not a very good one I must say.
@Bill To add to Wendell's statement, after pulling the prescription writer, you aslo can click on Quick Edit, and inactivate many medications at one time.
@Vicki Can you elaborate on what you mean by it is too easily alterable. I don't follow.
Anyone who uses AC part of the prescription, can alter the medication, the dosage, the quantity to dispense. These should not be alterable without a record of the change. I practice in an area where drug abuse is a big problem. It's also a concern to me that the only way my front office is allowed to print med lists off of New Crop is to give them the ability to send refills. There should be a clerical option for printing lists but not being able to send refills.
@Tom Do you really redo the whole note? And, there is a spell check, although not a very good one I must say.
Is there a way to print a note without a medication list? A director of nursing is giving me a hard time about my notes. She thinks that if my chart is audited by a state surveyor and the medication list in my note is not exactly the same as the one in the order sheet, the nursing home will get a deficiency.
I don't think I can help you there. It would seem to me that your note has what you think to be the correct medications. I am not sure how they are to relate to each other.
If I were to use an analogy, I would admit a patient to the hospital, and I would write for four medications. But, that has nothing to do with what medications the patient may be on at the time, which is why we have to do medication reconciliation.
The short answer is no, there is no way that I am aware of to print a note without medications. I would seriously sit down with this director of nursing (who is probably do what she thinks is correct) and with the director of the nursing home and see if you can find a way to have the medications coincide.
I use my AC initial chart note as my admit H&P to the nursing home - then whenever they request to start a med or add something I make sure that I use AC's writer to write a scrip (without quantities and refills) and fax that to the nursing home as orders (I use the default 8.5 x 11 scrip and autofax it so that it has my signature). That way my med list is up to date - ask the nursing home to fax you all changes made by covering docs, specialists, etc. so that you can add to your med list.
The other way you can do a med list is whenever they want a current list go to the summary page and print only actives (diagnoses and meds) - you just need to make sure it correlates with the actual list (only problem is bowel programs and such which have day 1, day 2, day 3, etc - just takes a while to put in the first time).
I find that my nursing home likes the fact that they have nice readable charts with full H&P's on the day I do rounds and it costs them nothing (they used to pay for my dictation). I make sure all the diagnoses they list are on my active list and it makes for easy billing for me also.
Yes, I usually redo the whole note and make a mention on how the previous note contained an error. There are also times when I'm dictating the office note the next day(went home without doing all the notes in AC) and I forget to change the date, so the wrong date of service is on the chart. These are build in for a reason, but I wish there was an easier way to correct the error of my ways with in the program....without having to have all my notes done for the day, on the day of service.
Tom Young, DO Internal Medicine Consultants, PC Creston, Iowa