Home Forums Discussions General Discussion Photos to Encounter Sheet or Imported Items?

When taking a photo of a patient's wound or injury, should it be imported into the imported items or to the encounter sheet?

I think it's probably more correct to put it in the encounter sheet, but since that's difficult computer-wise for the medical staff, I am doing it during the lunch break and after work. Unfortunately, that means that the chart is already signed by the doctor. So if I put it in the encounter sheet, that generates a whole new encounter (can I just say that we HATE not being able to edit charts after they're signed). That means the doctor has to sign the chart again AND it will cause problems when we export the billing to MTBC.

If I just import the file and give it a good descriptive name, that will work, although the doctor STILL has to sign off on the chart.

Which way should I go?

I actually never had good luck putting pictures in the encounter - I find that if you put stuff like this in imported items it is easier to find them later - for instance label it skin lesion excision, date of service, etc.

I find it hard to go back and find the pictures on encounters - plus in past versions the pictures stayed attached to all notes after that date if you printed the encounter.

Thanks so much. I'm going to go ahead and put them there.

I have used the Pictures in the Note area, and IMHO have found it to work flawlessly. The pictures always pair up w/ the visit. I dont know where they are actually stored, but they print out great as monochrome on my laser. I take the pics w/ a 5+ MPixel camera, and insert the SD card into my laptop to import into the note. This is a strong point of the program. Great for Dermatology and funky rashes.

But where are the pictures when you look at Past Encounters? I know they will show up when you print an encounter and you can find them if you go through "Print Preview" for each encounter, but where are they when you just scroll and look at Past Encounters? Am I missing something? There is not even a note there saying there is a picture.

Leslie

You are absolutely correct, I had to print it out to see the pictures. Reviewing the "Past Notes" does not reveal that a picture was even taken. I did not realize that. I thought that they would be there to see, but I guess I missed that since I usually print out all my notes. I think that this is a bug that should be looked at, as the pictures should automatically import into a Picture file associated w/ the patient and the Date of Service in question. Lets forward this to Bert and also Jon. This is a very valuable feature to pursue for Primary Care and Dermatology.

I have done it both ways. I sometimes do both but you can find and view the photos without printing. Go under the most recent encounter, on the upper right where you can scroll down to use a previous visit as the template hightlight the visit where you imported photos during the encounter. This will bring up the note and photos. I had to have tech support fill me in on that one The drawback is only 2 photos, often I have numerous and I then put them in imported items and just put reminder in that note to look in imported items. Hope this helps!

Unless I am wrong,scrolling down still does not tell you which encounter has a photo attached. One would still have to open each and every encounter until they find it.

Leslie

Thanks for the vote of confience Neil. Since I rarely use pictures, I may not be able to help or undderstand the issue, but I will try.

I did a quick workaround, and if you take a picture on a certain encourter, and then typed the word PICTURE or PHOTO on the right side of the chief complaint, it will show up in the Past Encounters and the drop down list that Alexis refers to.

In fact, if I had the time, I would ask my MA to be the chief complaint in the HPI section and then type in the diagnosis in the Chief Complaint section. This would insure that the past encounters list would look like:

Asthma exacertaion
URI
Eczema PHOTO
URI
Sinusitis

rather than

Green runny nose
Can't go to the bathroom at night
Coughing for one week, phlegm
Still sick
Ear pain
Question ear infection

I need to look through the history and see the diagnoses and open that encounter. I need to be able to count the number of ear infections in the past year. I need to know that the cough and fever was actually a diagnosis of Strep throat.

And, while I am venting, I wish somehow one could filter out the messages and vice versa.

Great suggestion Bert,

Leslie you are correct. Mostly I know because of what I put in the chief complaint, ie fish hook, lacertion or rash. But Berts suggestion is a great one and very easy to do. I also often put the photos into imported items. Mostly out of habit as this did not work correctly until recently!

Actually I was already doing Bert's workaround.

Leslie

I didn't think the photos would be a big deal in our primary care practice, but in the month we've been open, it's been nice to document the before and after of things like warts and moles. I can see how sending a photo will be useful for certain types of consults as well.

Our MA uses a tablet C5 to take the photo but the process of saving and then finding the file was taking too long to do while the patient waited, which is why I asked the initial question.

It made more sense to me to have the photo in the pt encounter, but since they hadn't been directly imported automatically, importing under the imported items is easier because the chart had already been signed by the time I got around to addressing the photos.

The C5 takes great photos - super easy to use, which for a highly computer phobic staff makes a big difference. I wish there was a way I could set things up to directly import though.

I think the Idea of tagging the visit w/ the word PHOTO or PIC is great. However I think I will add it to the Assessment field after the Diagnosis and ICD, instead of the CC field, because I think the CC should really be reserved for the CC. The MA doesnt know the diagnosis until they are diagnosed. It would be great if we could sort the Past visits toilet paper roll by the diagnosis or other fields if we choose, for the purpose of "counting".

Neil,

I agree that CC is for CC. But, the problem is if you put PHOTO anywhere else but the CC field it won't show up in an easy place to find which would be the past visits.

The other thing is while CC is your chief complaint (and looks good on the paper), it populates your past visits and turns what should be a diagnosis history into a bunch of chief complaints.

When I am looking to see how many Group A Strep pharyngitis infections my patient has, it is difficult to sort through:

Came in for sore throat
Has headache
Headache and stomachache
Fever to 102

I would much rather see

Strep throat
Strep throat
Strep throat
Strep throat

You can always use shortkeys or a template or other shortcuts so that it says, "Patient comes in today complaining of _______
in the HPI and then skip a line and do the HPI.

I wish I had more time, wasn't lazy or always remembered, because if I did, I would always put the diagnosis in the CC field. It may as well say, "Assessment."

But, I was the first to copyright it, lol.

My MA's do put the cc in the cc field and I almost invariable try to remember to change it to an actual diagnosis so that it will make more sense when I scroll through the Past Encounters. Trouble is, I don't always remember. Same with the Messages. Rather than having to scroll through a gazillion messages with only "(Re: patient's name)" I try to put something more informative there.

Leslie

I do have a hard time changing to the diagnosis. BUT, it is a crime punishable by having to make a Dunkin' Donuts run if anyone leaves a subject line "subjectless."

That includes me.

Again, I wish we could also separate those from the encounters.

On the topic of photos:

We want to import a photo of each patient into the demographics; has anyone found the best format for this. I think the lowest resolution setting on most digitals is still too large. Any suggestions.

Same goes for importing photos as part of the encounter or imported items; what resolution is reccomended?

Thanks,

I take the pic using my iphone. Then at the end of the day I plug the iphone into my computer, upload the photos, and one by one open each in MS-Paint, and resize to 25% or so, crop it into a square (otherwise it will import into AC distorted), and save it.jpg.

Then I import it into the demographics.

In other words, instead of worrying about the resolution, I resize and crop; I find it doesn't take much time.