Home Forums Discussions General Discussion Forgetting to chart a patient

I wouldn't say I'm forgetting to chart on a patient but I'm occasionally missing a patient completely. I usually don't find out about this until I realize I don't have an H&P for surgery or during the post-op visit.

I'm not even close to fast enough to chart on every patient as I see them. I tend to type a fair amount of HPI and Plan as it changes for every patient in some way or another.

Except for printing of a schedule and manually marking off the people I chart on, is there any other system someone can think of to assure that every patient gets the note on the chart?

I tend to chart on f/u and post-op's as I go but new patients tend to get their note after clinic. I have intake sheets that new patient's fill out so as long as I have that, I don't forget to chart. If I don't have that piece of paper for some reason, or if I didn't chart on a f/u during clinic, I have no way of looking at AC and knowing that all the notes are done for the day.

Would be nice if the schedule changed color after I signed their note for the day or put a big smiley face next to it!

Simple things for simple minded people like me.

do you have a receptionist? if so, they can initiate the encounter on patient arrival and then forward the chart to you when the person enters room. This way you will always have the record.

this would be like treating your inbox as your "to do" chart signoff list.

I agree with Eric. My MA always starts the visit with vital signs, CC and a quick history of her own. She then always sends the chart to me. You can always add to the HPI, but with a few sentences from her, if I do chart on it three days later, I at least can recall what it was about.

There are times where I see a patient after hours in the office, but I would NEVER see them without pulling his or her chart. I usually do a CTRL + S to send it to my inbox and then open it from there.

I can't recall any other way of doing it for the past six to seven years. Let the computer help you rather than using paper.

HTH

Ditto to the above, have the staff start the chart and send it to you.

You generally know what order the patients come, based on the time vitals were done (usually the next one on the list, but not always.

If I want to do late or extensive charting, I forward the chart to myself.

Don't think I've lost a chart yet, using this method.

Simple enough. I rarely get vitals on a patient for a post-op appointment so the front desk person never opens the chart. I'll have her just open it and send it to me when they check in. I guess we don't routinely do this because, for new patients, all of the PMHx is put in after clinic by the MA then she forwards it to me (which is why I rarely forget to chart on a new patient). With follow-ups, the just never get opened by the staff.

Funny how I've used AC for 7 months now and I still haven't perfected my workflow. Drives me crazy. Lived with paper for too long so adapting to the computer is a slow process.

There must be something your receptionist can add to the workflow even if it's using something like Shortkeys http://www.shortkeys.com/ to put the time that they came in.

Or, even though we tend to do this on the Superbill and my staff adds it later -- if they do it, grrrr -- your receptionist could open the chart and then go to the demographics and see if anything has changed. But, then again, you probably only see a post-op a couple of times.

In the short time I have been using AC, I have recognized the same issue trying to keep track of unfinished notes. I have no MA, and I am reluctant to rely on my front desk to put an entry in the chart (they might forget, and I don't want to give them more work). I have found that Bert's suggestion works well for me. If you do nothing else when you see a patient, open their chart. I usually do this before the patient is even in the room (often with the plan to do the whole note). But even if you put NOTHING in the chart, if you hit Ctrl-S, you have a reminder in your messages to finish the note (the reminder of course is the blank note staring you in the face).

Jon,

That's an even better idea. I had the same feelings of not putting more work on my front office person as she is already checking in the new patients (i.e. scanning in drivers license, insurance cards, verifying all demographics, collecting co-pays, obtaining their weight, and rooming them). F/U patients she just grabs the already printed superbill and rooms the patient. I know it doesn't take much time to open a chart and forward it to me but it is another step to slow down clinic. Plus, like Jon says, she may forget and then the patient may never get a note.

I have a tablet PC that I don't use as much as I thought I would to finish charts as I go. I mainly use it to open CT scans and X-rays to show patients and pull data from the hospital. So I will take it upon myself to open the patients chart and hit Ctrl-S when their heading out the door.

All of these work-arounds could be fixed with a better scheduler in my opinion. I just want the front desk to be able to check a box next to the patient's name when they check in (this should change the color of the patient and document time checked in), and then, when the note has been signed on the patient, it changes to a different color so you know they checked in and that you finished the note. Nothing major as the current scheduler is very easy to use. It just needs to track the patient's progress through the encounter better (and only show the patient once for a 30 minute visit instead of 3 times...I have 10minute blocks)

v5 has all of this health maintenance crap that I will NEVER use. There was a reason it was called CSHIT. Wasted Jon's time so it could be certified and didnt' provide much help to the physicians who use it everyday. Hopefully some of you guys can use some of the new stuff added to AC. I doubt anyone outside of primary care will ever use any of it.

Sorry for the rant.

Hey, that was my suggestion. J/K. Who cares, lol. I still maintain though, Travis, that if she is checking the demographics (from within AC), then why not save them and send the chart to you. I would say the number of patients she should forget in one year should be...ummm...zero. And, even if she did, it would be obvious when you went to find the chart, and then you send it to yourself. Do you have a list of the next day's patients? If so, ask her to send all of them to you the night before.

The scheduler is an afterthought in EVERY billing or EMR program, whether it is Medisoft, Lytec, Medware, etc. I think they put 50 programmers and one year on the billing software and then 5 programmers and one weekend on the scheduler.

Couldn't agree with you more. I despise the health maintenance. I wish there were two different programs.

Sorry about that Bert. Give credit where credit is due. I also like the idea of forwarding all the patients on the schedule the night before. Of course no shows would be in my inbox but easy enough to delete.

Glad someone agrees about the health maintenance. I saw Martin make a post that he liked it. Everyone needs something different from an EMR. I need a good work-flow, scheduler, documenter, and letter writer. That's it.

Travis,

How about documenting your current work flow and then posting it here. Maybe we can all put our heads together and think of a way to help you out. Take one patient from start to finish...including what you did and what your plans for them were. I have some ideas but want to make sure I know where you perceive your problems w AC to be.

Alright Leslie works for me. Its a lot different for a new patient versus a follow-up. So let's start with a new patient that will need an operation.

New patient with gallstones
1. Checks in and my front office person asks for their drivers license and insurance card (most times we know the insurance beforehand from my referring docs). Those are scanned in.
2. Give the patient the history questionnaire, demographics sheet, and HIPPA/Financial forms
3. Copays collected
4. Patients pre-printed superbill from my PM system as well as their history questionnaire are placed on a clipboard
5. Patient gets vitals (which are just jotted down on the history questionnaire so I'll have them in front of me) and then roomed
6. I see the patient, plan surgery and mark on the paper superbill
7. Fill out a form for pre-op orders (on paper) that are faxed to the hospital
8. Other Front office girl (I have 2) schedules the procedure and gives the patient a pre-op sheet (what time to show up, NPO, blah, blah)
9. While I'm in the room, the demographic info is entered (time permitting) or rechecked if we have that info from before
10. I hand the history questionnaire to my front office girl for later. She enters in all of the vital signs, Allergies, medications, PMHx, PSHx, and review of systems into AC and forwards the chart to me (usually this doesn't get done until after clinic). I fill out the HPI, PE, A/P, create a letter to my referring doc, and fax a copy of the H&P to the hospital, which is usually that afternoon or the next morning.

Follow-up or post-op patient

They walk in the door and tell my front office girl their name. She grabs the pre-printed superbill and rooms them. Rarely do I repeat vitals unless there was something markedly abnormal before (because I don't adjust meds for blood pressure or pulse, I just need them for pre-op). Occasionally I'll get a weight but not routinely. I see them and mark on their superbill their f/u if needed and give it to my front desk person.

Any suggestions? I know I'm essentially just using AC for documentation. My hospital wants labs on a certain triplicate paper so using orders in AC is a rarity. They also want radiology orders on a different sheet. I wanted to send all of those items to the hospital through AC initially but that ended up being more of a pain than just filling out their stupid sheets. I'm working on that though so I can avoid some of the paperwork.

I would say my most common prescription is pain medication and if Schedule 2, must be written on Rx pads. Otherwise I try to send them by e-fax/e-Rx

OK, well your flow is like mine in many ways with a few major differences. I also use a pre-printed superbill from my PM program.
Consider this:
As soon as you get the referral from your referring doc, ask them if they would fax all the demographics/insurance info and any other info they might have, such as their last office note, to you (We do this routinely and, as we already have everything in AC it is very easy for us to comply).

Then, have your front office person enter all of the demographics into AC and your PM before the patient ever arrives (if they do not show, simply inactivate them). She can also go ahead and import the labs or xrays that may have been sent by the referring M.D. She can also import the referring doc's note into, say, "Incoming Correspondence". Their superbill is then ready to be printed out the day of their appointment. Perhaps this is work that could be done while you are in surgery and not in the office.

When the patient arrives, have them sign their superbill (allowing you to bill their insurance), have the front office person confirm their demographic and insurance info, collect their copay,marking it on the superbill, scan their driver's license and insurance cards, ask them to complete your history form and hand the superbill to the back office person.

That person then rooms the patient, taking their history sheet with her. She opens their chart, collects vitals, completes the Chief Complaint (e.g. Evaluate Gallbladder, referred by...) and then, using the history form that the patient completed, enters current meds, allergies, PMH, etc. I have templates made for PMH, SH so that it is easy for my staff to simply enter the information where indicated. They then forward the chart to you. All of this is going on while you are in another room seeing another patient.

You enter the room, see the Chief Complaint, and open a template such as "Gallbladder, NEW"
in the History section, add or delete pertinent info, then review the info entered by your MA/nurse/person off the street trained by you.

Then go to Physical Exam and open your template (Normal Exam?) and add or delete info where needed. Then to Assessment where your codes are selected.

Then, under "Plan", open a template for Gallbladder which delineates the fact you have reviewed the labs and xrays, discussed options with the patient, and devised a plan, e.g. schedule for cholecystectomy at what ever hospital.

Fax any scripts or adjust any meds you want to give now.

If you have more orders, do them now so they show up in your plan. Tell, don't ask, your hospital that this is the way they will be receiving lab and xray orders from you. If they do not like it you will refer your patients elsewhere as you are not going to keep track of separate forms for every lab in town. If they need triplicates, they can copy them there. I developed lab templates which include the CPT codes for each test or panel(which I took from existing lab forms from the hospital). You can either print out these orders for the patient(as I do) or go ahead and fax them wherever.

Then, sign and save this note...YOU ARE ALMOST FINISHED!! Forward back to the front desk. Staff then get the note, know what to schedule before the patient ever leaves the room.

Next, finish the superbill which is in the room with you, take the patient to the front desk, tell the scheduler to schedule a cholecystectomy...blah, blah, blah.

The front person then schedules the surgery (or other xrays/studies), prints out an instruction sheet (which is stored on her desktop or somewhere. In my case, it is stored in Paperport. They duplicate it, put in the name,date,time, etc) and hands it to the patient. She then puts the patient in the AC schedule denoting the date/time/hospital/surgery and the patient leaves. She then faxes your note along with a standardized cover sheet saying something like, Dear Dr. So and So. I had the privilege of seeing your patient, Rotten Gallbladder, on this date. My assessment follows. Thank you for your generous referral.
Sincerely,

Dr. Travis

She then forwards the chart back to you.

Then at the end of the day, perhaps you make an Addendum with the heading "Hospital Orders", open a hospital orders template, fill in anything unique, such as "Notify Dr. So and So", and save. Then open the letter writer, delete the "Dear" heading, put in your note to serve as your H&P, delete the "Sincerely" and fax both to the hospital, save and YOU ARE FINISHED!!!

For the most part, I will have completed all my hospital work before I leave the room with the patient. But, most of my hospital admission go straight from my office to the hospital. And, as I use a hospitalist, the orders need to be there when the patient arrives.

Now, as far as follow ups, this is easy as you already have everything mostly already in place. Staff rooms the patient, puts in Chief Complaint "FOLLOW UP CHOLECYSTECTOMY", you open your "Post Cholecystectomy" template, add/delete info, open Physical Exam Template (The wounds are healing nicely without any redness or purulence. Sutures were removed blah, blah...)
Put in your Assessment, Go to Plan and open your template "Post Cholecystectomy" (The patient was given ongoing wound instructions and was asked to call us if any redness, purulence or other problems arise...blah, blah...I will be happy to see the patient back if needed in the future.) Fax with coversheet to referring doc and you are done.

Anyway, just some thoughts. I wish you could experiment with your work flow and see if you cannot complete your notes while in the rooms. If you can manage to spend some time up front developing templates, this will help you a lot on the back end.

@ Leslie: Wow!

@ Travis: Who takes your vitals and writes them on your history questionnaire?

Bert: My main front desk person takes vitals and rooms the patient. My other front office person schedules surgeries, fills out lab slips/radiology sheets, does the financial part if needed, talks to the patients about the day of surgery, etc.

Leslie: Thanks for all of that thought and energy! Holy cow. Some great ideas. I would love to have my charts done by the end of clinic. I don't know if my obsessive compulsive nature will allow it completely. I schedule new patients for 20 minutes and follow-ups for 10 minutes. So a complex new patient will obviously take longer than 20 minutes. The problem is that I absolutely am psycho about seeing patients at their schedule times. If I get behind 15-20 minutes I'm not a happy camper. There is nothing I hate worse than going to a doctor's office and sitting for hours waiting. I don't want my patients to have to do that either. I also don't want to make new patients 30 minutes just because of my EMR.

The problem is that I only have 2 employees. If I come out of a room and have one person scheduling surgery,radiology, labs, and setting up the patient, etc then the other has to be checking in new patients and can't be tied up in a room documenting PMHx, etc.

We do have most demographics front the referring docs already put it. Only if they are truly a "new patient" from off the street do we not have that info. So she's essentially just checking the demographics with the sheet we have the patient fill out to assure we have the most up-to-date info.

My templates are set just like you discussed. For a gallbladder, I can chart that in about 3 minutes. Post-op's fly with the templates and those are usually done by the end of clinic. For more unusual things like a carcinoid of the cecum or complex ulcerative colitis, there is no way I'll have a template for that and therefore it can't be quickly done in the room. In fact, it takes 10-15 minutes to type that HPI and Plan usually.

I'm going to incorporate some of this stuff and see if I can get it a touch smoother. Getting the lab and radiology ability to send it from AC to the hospital will be less paperwork for my staff.

This week I'm going to have one front office girl record every f/u patient's weight everytime and record it in AC and forward the chart to me. That way I won't forget to chart any patient who I saw.

I'm going to do baby steps on trying to get the charts done by the end of clinic. I refuse to sit in front of a computer or laptop while in the patient's room. I just lose that physician/patient interaction if I'm typing instead of listening and letting my brain work on the complicated patients.

I'm going to have the girls fill out all the history after I see the patient (in between me seeing patients). That way they can be at the front desk to check new patients in and work on the history in between. So hopefully by the end of clinic the only ones that will need me to chart on them will be the new patients. Not perfect, but I'm working on it. If AC allowed two people to work on the same note then it would be easier but I'm actually glad you can't do that for several reasons.

I've converted my staff back over to the official "Leslie" Paperport e-fax again this week. We tried it when I first started using AC and it failed miserably. But, I got sick of all the faxes coming in, scanning them into AC, and shredding the paper. We'll see how that goes as well. Our fear is the Brother e-fax program dropping out and losing faxes. We'll get over it.

Travis,

I only have 2 employees "up front" also. I do have a full-time biller as well. The "front" person does "front" things while the "back" person does "back" things. Actually my 2 employees switch jobs back and forth each week so they remain skilled to work either spot. I also hate running late. But, I also figure if the patient is brought back to a room at their appointment time and most of the history is already being entered into the chart by the back person, then I do not have to spend nearly so much time typing and losing eye contact with the patient. I was also concerned about how my patients would accept me typing right in front of them (particularly because I am not a skilled typist...more of a hunt 'N pecker) but they are impressed that I am up-to-date on the "latest" technology. When they hit the front desk and their orders, scripts and handouts are there waiting for them they are really impressed. Although I do no where NEAR the office procedures you do, other than irrigating ears (which is very time-consuming and generally yucky) I otherwise do most everything...remove staples, change dressings, I&D junk, inject joints, EKG's etc....without nurse assistance. This frees her up to do the chart work and also enhances the patient's impression of the face-to-face time I spent with them. I would much rather do this than sit and type in PMH. But this is me...you have to find what works best not only for you but for the competency level of your staff. I am always a little confused though what difference it is to spread out your patient appointment times so that you can get your charting done at the time of the visit vs tacking on another 2-3 hours at the end of the day to do it.

As far as losing faxes, I doubt there is any fool-proof way to prevent it in any fax program. I have accidentally deleted them myself. But, you can always play dumb like insurance companies and say "We never got that" and have it sent again.

Also, Travis, one other thought. Why can't your front person, who is already scheduling the previous patient for surgery, simply ask the person who has just come out of a room to please have a seat and she will be with them in just a minute? This leaves the back office person to do back office stuff. Also, when we seem to get behind up front on a really busy day, my staff may simply tell the patient they will make the arrangements and call them either this afternoon or the following morning and let them know the details. Then when things slack up a bit, they get on the phone for pre-auths, xray appointments, consults, etc.

Leslie always has great ideas. At least that's what she tells me.

My only thought would be to have the front person get demographics in AC, but if not feasilble, then at least put the vitals there. That way, you get the chart in your Inbox (good thing) and when you open it, you get the CC and the Vital right there complete with red, yellow and normal color. I don't know how many times the red blood pressures have saved my a...

A lot of it boils down to training. If you can get the person putting in the vitals to open the correct templates, most of your note is done.

Most charting is repetative, that is the point of templates.

I operate with 1 front desk person (checks insurance, sets new appointments, answers phones) and 1 MA (who does vitals and puts in the CC and relevent templates and gives immunizations.) Both are cross trained and I can operate with only 1 in a pinch.

We schedule 15 minutes for established patient but also do some walk ins. I almost always complete all the charting. Occasionally, I will hold a chart because I plan on doing more extensive charting than I want to do in the office, or I would rather complete the note without the patient in the room. The receptionist usually uploads billing 1-2 times a week on a day I am in the other office.

What would be nice is a global note template (filling in multiple sections in the note) but it is not now available.

Oh, on another note, I set the brother to answer after 1 ring and the PC fax modem to answer after 4 rings. If the brother "misses" the fax, occasionally the PC fax will pick it up.

This board is excellent. This stuff has very little to do with AC really. You guys are just helping me on my workflow and I appreciate it.

Leslie: The difference in having a new patient in 20 min versus 30 min isn't about charting. It's about seeing more patients in a day while the office doors are open. The charting is secondary. One of the biggest advantages to my practice over other general surgeons in the area is that I can get a patient in the same week or the next week at the latest (Oh, and the fact that I'm not a complete hack helps)

On busy days, the girls often schedule surgeries and such after clinic and call the patients with the times. That clears the patients out of there.

I do almost all of my office procedures by myself as well.

Wendell: Agree with global template. Would make AC ridiculously fast to chart with on at least 50% of my patients.

Bert: I talked to my front girl today and she says that the demographics are almost always in before we see the patient. She just verifies it and moves on.

So really, you guys are trying to tell me to shut up and teach my people how to get the stuff in the chart before I see the patient. Got it. I'm just stubborn. Don't you guys know how surgeons are?

Thanks Travis. Really appreciate the feedback and the nice comments.

Stubborn is fine, throwing Mayo stands and hemostats is not acceptable

Wendell,

I also agree that the ability to have global templates would be fantastic. This is another thing I miss from the old SoapWare days.

Travis, may I make one other suggestion and I hope this does not sound too righteous or Helen Reddyish (Remember the song "I am Woman Hear Me Roar"?)and this is something I have to keep reminding myself also. Try not to call your staffers "girls". I had an employee tell me one time how insulted she felt every time I told a patient that the girl at the front desk would take care of every thing for them. And, thinking about it I realized it really is demeaning. Not one employee in my office is a "girl". So I have had to retrain myself to refer to them as "staffers, staff members, scheduling specialist, medical assistant, billing specialist, medical records specialist", etc. I really do think the patients respond better to those terms also.
OK, enough of sounding like Andy Rooney.

I do agree.

I sometimes slip into this, because even among themselves they will sometimes call themselves "the girls," but I must admit it can and has been seen as demeaning.

My wife will always let me know if I slip.

"Staff" seems to work. Most of the other options almost sound too formal.

I preferred Delta Dawn.

OK, the other side. And, I really feel we can't win. Where I went to medical school, I got a very quick lecture on girl, woman, and lady. Of course, being from the south, I always found lady to be a good thing. But, it still means more of a proper female, so woman was the most generic, although female is probably the best.

I have no issue with calling them women, but the problem is that for whatever reason, they call themselves girls. And, it is hard for me not to go along with that. Many times I tell my patients they prefer that term.

I also think using the singulair "girl" is more demeaning than "girls." I think we take life way too seriously. I do agree with Wendell and Leslie, though. But, if I may quote Adam who doen't even know we are talking about this, if they are going to leave the practice because of that, then...oh well.

I don't find it demeaning, unfortunately, others do. Oh, where is Peter when you need them.

I've actually thought about the "girls" comment before. I was trying to find a good word to call them. "Ladies" was what I used most and I got away from that when my wife worked up front. She said it made her feel old. I can't win. And my "staff" are younger than me so when I was 25 they were 10 and were "girls". Oh crap, it doesn't matter. I practice in freakin' Arkansas, do you think these people care? 99% probably don't even notice it.

Politically correct: Hell, I had a patient trying to tell me his primary care doctor's name but he couldn't remember it (Good as gold 84 year old). So he called the office (which has 5 different FP docs) and asked, "What is that black doctor's name?" Cracked me up. Did it in front of my waiting room. We all got a kick out of it and I told "the black doctor" the story and he said it didn't surprise him coming from that patient and laughed about it.

So I guess "girls" doesn't really phase most of my patients and definitely not my staff.

Point taken though.

“This board is excellent. This stuff has very little to do with AC really.”

So true, Travis! It is somehow satisfying for me to sit in the small office of my big city, East Coast practice and identify so closely with the challenges facing a solo Arkansas surgeon. There are so many similarities in the issues we sweat about on a daily basis; both the big ones and the little ones. It is equally gratifying to watch others from across the country pitch in with so much thought and energy to try to help with those problems. AC is part of the picture, and this forum is “all about” AC, but it does go way beyond that. Without sounding too dramatic, it is good for the soul.
You have already gotten lots of great suggestions. Let me offer two, one “macro” and one “micro”. First of all, looking at your overall schedule, I would suggest that we are not magicians; we can’t manufacture time. You schedule new patients for 20 minutes and follow-ups for 10. You (admirably) are insistent on staying on time. I would suggest that is impossible! How long do you spend talking to the patients and examining them, as well as ordering tests, explaining surgeries, and plain-old handholding? If you want to stay on time, I would bet that you have roughly NO time to do your charting. So when you say “I also don't want to make new patients 30 minutes just because of my EMR,” I would suggest that the EMR is not the real issue. Sure, it helps to have an excellent EMR (like we do), and the staff utilization and document management suggestions are invaluable, but you can’t create something from nothing. In other words, I think you need to rearrange your schedule. The choices, as I see them: add time to the visits (e.g. if it takes 10 minutes to chart a new patient, make the slots 30 minutes); or do your charting later. What you don’t want is for “later” to mean days later when the patient shows up for surgery. What it could mean is at the end of that day, or the end of the session. So if you now schedule mornings from 8-noon, change it to 8-11 and leave an hour for charting. Or end your day an hour and a half earlier and do the charting then. Or, worst case, stay late and do all the charts at night. If it were me, I would lengthen the visit times, but that is just my 2 cents. Bottom line: there are only so many hours in the day, and though the work eventually all gets done, why not rearrange the schedule so you don’t feel perpetually behind?
My “micro” suggestion is ShortKeys. I have already run afoul of Bert in this thread (or really, you did…I didn’t try to claim credit for one of his ideas…you just gave it to me). So I must preface this by saying “Bert recommends ShortKeys”. On the other hand, I have been using it for years, way before I ever heard of AC (or of Bert). Yes, templates are wonderful and I use them all the time. But nothing beats the satisfaction, for example, of typing “nlmpe” and getting the full paragraph of a normal male physical exam. And it is quicker than right-clicking, finding the template, clicking it, and entering it (ok, not by much, but still, I like it better). Plus, as a consultant, all your regular referring docs have abbreviations, too. So you type “JS” and you get “John Smith, M.D.”….an even bigger bonus if “JS” is “Dr. Jennifer Smithfield-Johnson”. There a million ways to use this inexpensive program, and every time I use it, it feels good. You are only limited by the number of shortcuts you can remember (you can pull up a list, or hints, but that reduces the fun and the time saving).
Oh, and in my office, we have NO girls…all the people who work with me are women. :-)

Travis...you are too funny! Had a great laugh at 5 AM already this morning!

Jon, ditto on the Shortkeys (www.shortkeys.com. In fact, I think I was the one that told Bert about it. I have also used it for years. It is a great program, well worth the small one-time charge. It helps tremendously with "individualizing" templates and makes a pitiful typist like me look like a pro.

I also agree with your other suggestions above.

Shortkeys:

Leslie told Bert who told Jon who was already using it before he knew Leslie or Bert, lol.

I can only add two things:

1. Just remember that Shortkeys can be networked, so whatever you put in it, can be used on every computer.

2. I would say that in six years, I have finished charting in the room with the exception of maybe ten times. Put your emphasis on your impression and plan and only put in what you need for coding.

But, we are so conditioned to be politically correct. Especially in certain situations.

It would be perfectly acceptable to call the office and ask to speak with the person with the red hair. I think asking to speak with someone who is overweight whether it be a woman or a man would be detrimental.

So identifying someone in that way isn't really a racial slur at all. Having said that, I would be rather careful.

Oh, he didn't mean it in a "racial slur" at all. He's just a funny older man trying to identify someone. It was just hilarious because he was in the waiting room on his cell phone and he is very hard of hearing. It was loud and watching this 84 yo yell into a cell phone about the black doctor in front of other patients cracked me up.

Well, I've made some adjustments in the office and the workflow is markedly improved. I had every f/u and post-op patient charted and referring doc letters sent before the end of clinic. I finished morning clinic (8-12) and all the history was on the new patients. I sat down and ate some lunch and finished the new patients' charts, sent the consult letters, and sent the H&Ps to the hospital. Done by 1pm and off to the O.R. without having to come back to the office to finish up. Perfect. No, I'm not finished with the patients before they leave but that really wasn't my ultimate goal. My ultimate goal is to be done with office charts/responsibilities before 5pm each day. So really that is a marked move in efficiency from my old paper chart days.

I would dictate in between patients, or at the end of clinic, pay a transcriptionist, read through the transcriptions a couple days later, send off the referring docs letters, fax a copy of the H&P to the hospital. So instead of a 2-3 day turnaround, it's done within a few hours.

I have to type a lot more than usual but fortunately I'm a fairly good typist. It's very difficult to template things that you are used to just commenting on when dictating. I used to do this a lot to better identify the patient when I reviewed the chart later. A lot of people have GERD that may need an EGD and Lap Nissen. I can template those symptoms. I can't template the fact that the patient is the wife of one of the ICU nurses and she finds it odd that lettuce really bothers her stomach and not the normal "spicy/caffeine/etc". Or that she was seen at Mayo clinic for an odd persistent leukocytosis, had 2 bone marrow biopsies that were inconclusive, and still doesn't know what's wrong with her. So I can template the basics signs and symptoms, but these types of facts that I like to include for thoroughness are time consuming to put in a chart. I've tried Dragon9 and thought it was more difficult to use than simply typing.

O.K. Having my front office "staff" put in the weight of the patients and send me the chart to my inbox works great. I love that. Plus, it forces us to get weights on patients and in many operations, weight loss/gain is a significant vital.

So I'm using many of your suggestions and improving my workflow exponentially.
Thanks again.

I have used the dragon program, and I find it saves a lot of typing time if you train it and use it daily.

I have a template for that if you want to borrow it.

Bert, you probably have 2.4million different templates. At some point, trying to find the dang template in the list because more painful than just typing it out.

I want Dragon to work. I want it to work badly. Maybe I need a different microphone, or maybe my southern accent is too thick, but I spend more time correcting things than I feel I should.

tlelio, what mic do you use or do you just use a generic mic.

Travis,

Before Brian Cotner (bcmd) left, he was the king of DNS. He even got Jon to add a number of commands to get it work much better. He would be the guy to speak to.

I have been using dragon for over 10 years, I am very pleased with its performance in Amazing Charts, I am currently using a Phillips SpeechMike, microphone choice is critical, you also need a fast computer with L2 cache. If you specific questions, I would be delighted to help you. unfortunately, Amazing Charts is not Dragon-friendly as far as navigation, and as far as free-text input, it is outstanding.

I am also very happily using Dragon Medical 10 for dictating into Amazing Charts.

I second the comments above that the choice of microphone is critical. The USB microphones definitely increase accuracy. Get something better than the mike that comes in the DNS box. I used the Andrea USB-NC1700 for a while, and then the Parrott VXI, both headset mikes with good accuracy, but taking them on and off frequently was inconvenient. I finally (over)paid for the Dictaphone PowerMic II, since it has excellent accuracy and works much like the dictation equipment we are used to, with the "press-to-talk" switch on the handset, and programmable buttons to spell-correct, tab, backspace, etc. It is also very tolerant of moderate background noise.

There are several good commercial sites that compare microphones with sufficient accuracy and noise cancellation needed for effective dictation.

I wish someone with Amazing Charts would survey DNS users to make DNS work more effectively with AC. It annoys me when I dictate "no" or "in" with a momentary pause that makes DNS think I'm giving a navigation command, and suddenly a menu drops down or the patient weight changes to metric.

Alright. Its worth another try. I've ordered Dragon Medical 10 (man that's expensive) and a Dictaphone PowerMic II. I've always just used some generic mic which may be a reason it doesn't work well. I'll keep you updated.