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Hello, folks:

Forgive me for re-hashing an old topic, but I had been talking with Bert and Roy about this topic in the past, and trying to decide what to do. I think I have come up with a personal solution to the problem, but I have also been trying to think of a way to solve this problem for other present and future users. This post represents my best thoughts on the matter, which I now present for your consideration:

Many have noted the massive and cumbersome list of items in the AmazingMeds database, fraught with embarrassing misspellings. Many, including Roy, have commented how much simpler it would be to sort through a short list of custom meds, perhaps selected by specialty. Bert has suggested that the best approach is to start with a blank slate and build an excellent list, rather than trying to trim down a list of tens of thousands of redundant meds, which I believe is true.

What I think would be ideal is if Amazing Charts allowed me to populate the database with the prescriptions I personally write every day, in the same way that it allows me to populate my clinic notes with macros of my commonly used phrases.

In other words, every time I wrote a prescription, I would have the option of pressing a button, and (in one fell swoop!) adding the med, the quantity, and the "sig" to a custom database.

In this way, just by writing prescriptions at each encounter and adding them as indicated, my database would practically write itself. I estimate that within a few months (starting with a blank database), it would be populated with 90% of the medications that I commonly use, without any grueling sessions of inputting meds into an Access file. Within a year, virtually 100% would be accounted for.

This feature should also include the ability to modify your entries, from within or without the patient's chart, in case you ever misspelled something yourself, and then save your changes. You could also remove drugs that get black-boxed or taken off the market. You could put in the latest drugs without waiting for an update.

This would automatically create customized databases for each individual doctor who desired it, providing ultimate personal control. The database would be smaller, requiring less memory. It would be faster and easier to navigate through.

Also, instead of some omniscient person creating specialty-specific databases for every specialty (and having to decide what each kind of doctor needs), each person's database will automatically become specialty-specific as each specialist populates his/her own database. It will reduce the job into manageable chunks and nobody will be liable for anyone else's mistakes except their own.

In Dr. Bertman's post of 7/17/07, he favorably responded to the idea of people posting their own customized med lists, etc. Using this system, anybody who thinks their personal database is the cat's meow will be free to copy their database file and publish it on the forum for scrutiny and/or applause.

I see this as a straight-forward solution to a much-discussed problem. I think it fits with the functionality and even the personality of Amazing Charts. I can even hear Dr. Bertman's voice-over as he clicks on the "Add" button, and his favorite medication is added to his personal medication database: "and that's how simple it is!"

As Paul said the other day, "Talk among yourselves"

Brian

Beautiful brilliant idea!
We'll have to be able to opt-out of the updates which will rewrite all of the data. I'm having the same problem with the spell check. It gets reset when I update AC. Not sure what format the spell check is kept. Would be nice to access the database and import the spelling for the doctors in my area. The spellcheck does learn itself much like Brian's medication list would.

Brian, I assume that the personal med database would be in addition to the standard one already included in AC, rather than replacing it. If so, sounds like an excellent idea.

Wayne

Terrific idea!!! You have my full support. Take this idea to Jon.

Leslie

Brian,
Yes a great idea. Now guys and gals, I'm not very database savvy in terms of how they work at the nuts and bolts level. Is it possible to sort of do just what Brian suggests here, all while allowing Jon and AC to send us a "New and Updated" Med file that goes "somewhere else" sort of as a default database to start with? Then perhaps the moment the provider writes their first Rx, the program then creates this "New" Personal folder for Doc-X, that builds and grows in the fashion already described by you folks. Much like the "Imported Items" folder, the first time one imports something to the patient's chart their personal imported items folder is started. So now we do have the New Meds to choose from and each provider has their own personal Rx folder that grows and evolves as they use and create it?

This way Jon is sort of covered as he has supplied us with the lastest and newest Meds as he has been doing all along; we users get them and don't miss out on knowing that they are there (if one cares to read thru them, what a pain)and they are there to use if we do need them from time to time; but now we still have this "safe" from the updates personalised Rx folder that each doc simply creates on his or her own as they go in just the fashion Brian laid out. The loss of this personalised folder that Roy creates and drives him so nuts is understandable. How frustrating it is to have hours of good work vanish? Now we could all have both for all the good reasons to have both....

Lastly, I as a PM don't write Rx's all day like most of you, but Nancy was just showing me that AC does already sort of do this as she types in something. So althought she has never written Rx A for this patient, she has for someone else and so as she types the letters it gives her the options she used previously. So is this feature already "Half" there and will this impede or assist in fishishing the job and making it even better? Sounds like my Dr-X's personal Rx history folder might already be there in some form or another.

Someone should put this in the Notify Vinny of Suggestions thread.
Paul

That is a very good idea. A lot like another EMR I know. It's a little different concept, which I am not sure I completely understand. And, I am not just saying this 'cause I did it a different way.

With a full-fledged (every medication in it to start) database, you would always know the different formats and strengths of a medication. For instance, Amox...would bring up Amoxicillin, and you would know it came in a solution, a chewable and a capsule and what strengths it comes in, which definitely keeps you out of the PDF a lot even though you may have spent two months in it.

So, are you saying that if you write Concerta extended-release tablets 36 mg, 1 po q AM; that you could search for Concerta and that would be found in the Search the Med Database field or in the actual prescription writer fields? It is strange, but we do have a database of frequently used medications only it is a bit strange how it works, in that it is in the registry and only has 54 entries. It places the medication into the prescription writer field, and you can either use that or edit it. I am not sure why it picks some same medication over another, though.

I am not sure if you could have two separate databases, as AC wouldn't know which one to search.

"We'll have to be able to opt-out of the updates which will rewrite all of the data. I'm having the same problem with the spell check. It gets reset when I update AC. Not sure what format the spell check is kept."

You could still update AC. Generally, when updating AC, I do a fresh install anyway. Hopefully, one would save all of the databases including the AmazingMeds. You would simply put that database back in and you would have your old database again. I did run into a problem once when AC went from Version 1 to Version 2. You will know, because it won't be able to access the medication database. You can either go back a version or simply change the format of the database to match the new one.

Roy, the spell check file is the userdic.tlx file. You can open it using a text file and see all your words there. I haven't had much luck inserting words manually, but you can insert manually through the dictionary in AC. Again, copy and paste that file or change the suffix to .old so it isn't overwritten.

I think it may be doable, but I am not sure where the data would be put once it is accessed. Just asking in case I can add some input.

Paul, you explained in detail what I meant when I mentioned "In addition to" the current med database above.

Bert makes good points.

I could envision a set-up where you click a button for the AmazingMeds database, and you click another button to switch to your CustomMeds database, just like you do to sort out "active patients" vs. "all patients" in your demographic screen.

If you could do this, you might be able to click on AmazingMeds, find a med you love, edit the entry (correct a misspelling for example), and save it to your CustomMeds database. Over time, your CustomMeds database has been populated and you only go to the big database when a new med comes out, or you want to check if a certain dose or form of a drug is available.

AmazingMeds would get updated and overwritten. CustomMeds would be proprietary to you, but could also be copied and shared with another Amazing Charts user.

BC

I have been having some conversations with Brian, and this is a very good idea and very doable. Again, it goes back to the and only greatest curve of all time the Bell-shaped curve much like another EMR I know uses. Certainly, it could be written so that any medication written and saved would have its four major components saved to an Access database. Part of the issue would be how would AC know which database to search when looking for a medication? Unless this was done manually.

If I were looking at this like a Vinny or any other programmer, I would ask what is it you exactly want it to do. In other words, when I look at the script writer, there are two ways a medication is presented for choosing from a database: First, when you type in a medication such as Diflucant, and you get to Di.... if that med has not been written in the past 54 times (ON THAT COMPUTER), then it will bring up the medication from the AmazingMeds database and give you all the medication formats on the left. So, it will say Diflucan tablets and Diflucan suspension. Clicking on these would give you the different strengths each comes in. Clicking on the strength places the medication (with its format) and the strength in line one. All other information must be entered either manually or from the dropdown box. I know everyone knows this; just wanted to be sure. Having the different formats and strengths come up anytime you choose a medication is very helpful. It's nice to know exactly what the medication comes in and then what strengths and not have to look it up.

Or is Brian and everyone talking about a medication autopopulating the script writer portion of the writer? So that when you type Cef....then Cefzil suspension 250 mg/5mL, 1 tsp po bid for ten days, Disp QS and no refils. This while it would be helpful, would be less like a database, as if you change the strength to 125 mg/5mL, then it would be saved, but the would it then be the medication brought up?

Paul quote:
"So althought she has never written Rx A for this patient, she has for someone else and so as she types the letters it gives her the options she used previously. So is this feature already "Half" there and will this impede or assist in fishishing the job and making it even better? Sounds like my Dr-X's personal Rx history folder might already be there in some form or another."

This is completely independent of the database. While the database never changes unless manually added to or deleted from or whatever, the scenario described by Paul is due to the registry. All prescriptions when saved then have their four components saved to the Windows Registry under AC and the user. Strangely enough, it used to be 54 entries, now it is 92? So, when a user starts to enter a medication, say Flovent, then if that user on THAT computer (registries only pertain to the computer it is on) has written a script for Flovent, then the last one written (most of the time) will then populate the entire script. Generally, you can use it, (much more so in adult medicine than in children due to weights). Ironically, even though if you wrote for MiraLax and wrote for 527 grams in the Dispensed field, the 527 grams would not be saved in the dropdown box as the dispensed field, refills fields and the sig fields are ALWAYS the same as far as what is there. The medication and their formats, however, do change based on what was written. So, while the last 92 medications, sigs, dispensed and refills are kept in the registry in a revolving first in, last out fashion and will be used to write medications, ONLY the medication itself will be changed in the dropdown lists.

Brian quote:
"AmazingMeds would get updated and overwritten. CustomMeds would be proprietary to you, but could also..."

When a new version comes out and you want to install it on the "server," your proprietary database would be just as much at risk if it were now part of the prgram since if there were code to allow the meds to go there, it would have to be there. I still don't quite understand the overwritten part. I would think that the entire folder would be saved, then the AC uninstalled and reinstalled (or you could reinstall over it), then add back your databases and dictionary files such as userdic.tlx, etc.

I hope I am helping. I'm just trying to make sure all of the information is out there. Finally, I am not sure how one would allow the registry to accept for entries, i.e. could it accept 500 entries instead of 92? I don't think it would be that bad if you copied a key from one computer to the next.

Whoo, Bert, you got my head spinning!

Tell the programmers:

1. I want to be able to save the medications that I personally write for all the time in a custom database, so that I can choose the one version of each med that I always use, instead of having to scroll through the fourteen different lisinoprils that come up when you type "lis" (including three misspelled versions -- no lie).

2. I want to be able to edit my medication database, somehow.

3. I would love it if the prescription writing fields would auto-complete from my custom list, when it is selected.

4. I don't mind to click a button to access my custom database instead of AmazingMeds, but I wish at some point I could set my preferences that the prescription writer defaulted to my custom database when opened.

5. I think it would be useful if I could call up a med from AmazingMeds, edit it, and save it in my custom database.

6. Once selected and edited to my liking, I want my custom meds to be just as secure with a new install as my custom macros and my patient files are currently.

Brian

Okay, I had to re-read Bert's post from yesterday about ten times, but I think I finally understand all the points raised. I may have to respond to them in sections, but let me take a swing at it:

[Bert says: "how would AC know which database to search when looking for a medication?"]

I think the answer has to be: it will look where we tell it to. Just give me one simple button to select "AmazingMeds" vs "CustomMeds or "MyMeds" or whatever you want to call it. Not only is that the simplest and most direct method, it also introduces the possibility of a new feature, the ability to call up a med from AmazingMeds, edit it, and place it in your personal database for easy retrieval later (I had not originally envisioned that).

[Bert says: "Having the different formats and strengths come up anytime you choose a medication is very helpful. It's nice to know exactly what the medication comes in and then what strengths and not have to look it up."]

Well, it *can* be helpful, if all the different formats and strengths are available at your local pharmacy. Or, if you're not already sure what you want to prescribe.

The AmazingMeds database is very comprehensive. In fact, it may be TOO comprehensive for everyday use by many docs. It has *every* form of *every* medication, including forms that are not available at my pharmacy (in a small city of 8,000), and certainly forms that are not going to be available at a small-town drugstore. However, once you learn that a certain kind of medicine is not available, you can't eliminate that med from the database, so you keep writing that med, and the pharmacy keeps calling you and saying "We don't keep that strength!"

Furthermore, if I know I want the Lisinopril 10 mg tablet that I have written for thousands of times, I don't want to have to stop and hunt through the twenty-one lisinopril-containing products on AmazingMeds (eight of which are misspelled) -- I want "Lisinopril 10 mg tablet" to be right there before me.

As I explained to Bert, my idea is founded on the hypothesis that most doctors just don't use that dang many medications.

The average doc probably uses a few hundred medications, in one or two forms, in a few different dosages. And once they figure out what they like, they keep prescribing the same thing over and over again through inertia until overwhelming outside forces cause them to change their ways. And, they want to be able to write for it as quickly as possible.

I just want a way to pick quickly through the few meds that I actually use, instead of sorting through eleven Amoxils and twenty-one Lisinoprils every time I write for Amoxil or Lisinopril. I want the Rxs that I write out of habit to *spring* to the prescription writer, as they spring to my real-life prescription pad now.

Okay, my nurse is banging on my office door. I'll go ahead and post this. Have a great day.

Brian

[Bert said: "Or is Brian and everyone talking about a medication autopopulating the script writer portion of the writer? So that when you type Cef....then Cefzil suspension 250 mg/5mL, 1 tsp po bid for ten days, Disp QS and no refils. This while it would be helpful, would be less like a database, as if you change the strength to 125 mg/5mL, then it would be saved, but the would it then be the medication brought up?"]

This is not what I was talking about. I was talking about a custom database, replacing or parallel to the AmazingMeds database.

However, when you brought this up, it got me thinking, and what I would really like is this:

When I start to type a medication into the prescription writer, I would like it to autopopulate from my *custom* database. These are assumed to be my favorite medications, spelled correctly, in the forms that I most often use.

So, this is how it would work: I open the prescription writer, and start to type in Amoxil. Fourteen different Amoxils come up, including chewables, liquid forms that I don't write for, and a few misspelled forms. Ah, I realize I'm in Amazing Meds. I click on MyMeds or whatever and the little circle fills in black, just like when I change from "All Patients" to "Active Patients" in the demographic page.

Ah, this is better! Now typing in the letters "Amox" causes only two kinds of Amoxil to pop up: tablets and elixir. Why? Because the first time I wrote for them, I brought them up from AmazingMeds, picked the form I liked, clicked "Add" and they went into my personal database.

Now, I click on Amoxil tablets, and 500mg and 875mg tablets pop up. Why? Because I only entered those two strengths. Why? Because that's the only strengths I write for, I write for them all the time, and I know the local pharmacies have them. If I ever want or need another strength or form, I can look it up in AmazingMeds and add it to my custom database.

Or, if we use the autopopulation feature that Bert was talking about, I start typing Amox... and it autopopulates from my custom meds! From what I have already approved to be good, not from what I just happened to have typed that day. That way, I don't have to worry about misspelled meds from other doctors coming up.

Hmmm...as I was typing, I thought of another possible advantage to this kind of set-up: if you're working with P.A.'s or N.P.'s, it would allow you to create some parameters as well. The custom database might represent a "safe zone", a kind of a personal formulary of agreed-upon meds.

Well, I've been typing a lot over the past few days and my hands are beginning to cramp, so I will sign off again. Thanks to everyone for the great feedback.

Brian

"2. I want to be able to edit my medication database, somehow."

You definitely can do that.

Brian,

These are all great ideas. I'm not trying to rain on them. I wish they could all be incorporated. But, it just seems like a lot of code and an added database.

What you're looking for is Praxis. It can already do these things.

"Having the different formats and strengths come up anytime you choose a medication is very helpful. It's nice to know exactly what the medication comes in and then what strengths and not have to look it up.

Well, it *can* be helpful, if all the different formats and strengths are available at your local pharmacy. Or, if you're not already sure what you want to prescribe."

I will give you that. BUT, if you aren't already sure, then it's nice to know what you can give. I guess in pediatrics it's a bit different. Because we don't just write Bactrim DS 2 times a day for all females with UTIs. For instance, Strattera comes in 10, 18, 25, 40 and 60 mg. You have to titrate up. So, it does help if you are trying to remember the forms. Just a thought. I feel bad about your pharamcies <G> Ours carry most meds, but we also have Miller Drug. They have EVERYTHING, and if they don't, then can get it in 4 to 24 hours. Just nice for us.

"Fourteen different Amoxils come up, including chewables, liquid forms that I don't write for, and a few misspelled forms. Ah, I realize I'm in Amazing Meds. I click on MyMeds..."

Now, that's not fair, lol. <G> It was a from scratch hard coded data base vs yours (which is infinitely better, don't get me wrong). But, we have to talk apples to apples not your idea vs 'AmazingMeds that comes with AmazingCharts.'

Again, though, great ideas Brian. It's just that a lot of us have been trying to get the allergies updated to the prescription writer on the same visit for over three years so this might be a big project.

I still would suggest a way that would work exactly how you want to a degree. Take the database as is or better yet one with hundrds of meds from scratch, use a script to place a "." (period) in front of all the meds. Then put your medications in without a period. They would alphabetize to the top of the datbase and be the only ones which came up when you typed a letter (not in the actual writer) but in the window above. If you wanted ALL the meds, type a period. That could be done in less than a minute, although at this point you would have to manually enter them.

Hope this helps. Keep up the good work.

Bert, you may be able to edit *your* database. This is not within the reach of a lot of people.

As I stated in my first post, the point of this exercise was to come up with a way that the average user could *easily* do what you have done so elegantly: create a customized medication database.

I believe this would further expand the appeal of Amazing Charts.

BC

Well, I had never heard of Praxis before, so I went to their website to make sure I hadn't picked the wrong EMR.

Nope, I like Amazing Charts. That bell curve algorithm is fascinating AI, but I'm not looking for a program that's going to revolutionize my practice of medicine. I'm looking for a program that's going to help me do what I'm used to doing every day, only faster or better. I think that's what most people are looking for when they shop for an EMR.

Over the last ten years, I have developed buzzphrases and dictated them thousands of times. Now, with Amazing Charts, I only have to type them once, and I can right-click them - BAM! - and there they are (thanks, Emeril).

Over the last ten years, I have developed prescribing habits. I want to be able to type in my favorite medications once, right-click them and - yes, you guessed it - BAM! - have them appear in the prescribing field.

[Bert says: "For instance, Strattera comes in 10, 18, 25, 40 and 60 mg. You have to titrate up. So, it does help if you are trying to remember the forms."]

If my custom database is separate from AmazingMeds, then you still have AmazingMeds to go to for that kind of comprehensive reference.

If you prescribe Strattera, add it to your custom med list, with its various doses. Now it's on a short list which will be easier to navigate.

Then, later, if you want to start typing "Sta..." and have it autopopulate as "Strattera" instead of "Stratteri", set the autopopulate to spawn from your custom med list when it is the currently selected database.

BC

LOL, this post is becoming like the ones in Experts Exchange or others where users quote and reply, etc. OK, with all due respect, I understand your concept. <G> And, if you can get Jon to put something like that into AC, it would be awesome. It is VERY much like Praxis in that it sort of "remembers" what you like to write. OK, now for some quotes:

"Bert, you may be able to edit *your* database. This is not within the reach of a lot of people.

As I stated in my first post, the point of this exercise was to come up with a way that the average user could *easily* do what you have done so elegantly: create a customized medication database."

Brian, thanks for the compliment on the elegance. But, what you are proposing is far more elegant and helpful than just a simple database. I HAVE TO DISAGREE VEHEMENTLY ON ONE POINT: Editing *My* database is just as hard or easy as editing the *Original* database. Editing either database is extremely simple. Easier, I would say, than taking a blood pressure, and I should know as my nurse was sick today. <G>

You double-click on the AmazingMeds database. It opens. If there are 15 entries for Amoxicillin of which five a redundant, you right-click on that row and delete. It's that simple. If you want to add a med, you type one in. Simple. It's not what you are proposing which, again, as the others have said would be incredibly helpful but much simpler "at this point in time."

I agree with you on Praxis as well or I wouldn't be using Amazing Charts since the fall of 2003. I only brought it up, because I used it in a practice once for about a month and it is extremely cool. There are 500 EMRs in one group which use drill down and are template driven and then there is Praxis which is on the other side and different from any EMR ever thought of, let alone made. But, I don't want to sound like I am advertising for them or I will get in trouble, lol.

"If my custom database is separate from AmazingMeds, then you still have AmazingMeds to go to for that kind of comprehensive reference."

Good point. And, I would come back with this analogy: If you drove a car for NASCAR which was your top car. (like your database), but you needed a backup car in case yours crashed or whatever; wouldn't you want that car to be a very good car and not a terrible car that goes 20 mph slower?

In other words, if I used your database, because it makes my job a lot easier and works really well and cool, but I needed to have the full database in case I needed it, I would want that database to be complete and close to perfect and NOT like the one that comes with AC. Does that make sense? So, in effect you would need two.

Score:

Brian 8 Bert 3

I better quit while I'm behind.

PS, though. Please don't come away from this thread thinking it is even close to being hard to edit the AmazingMeds database.

OK, Bert, I think you're right -- we may be in an echo chamber here. At this point in a medical staff meeting, we would call a close to discussion, and ask someone to make a motion.

So, I make a motion to bring this idea to the attention of whoever decides what features get considered for future addition. (I'm a newbie, so I'm not exactly sure how you do that).

Do let me say that I never meant to imply that editing your database is harder than editing the AmazingMeds database. Editing your database would actually be easier, because it is smaller. Whether editing any database is *easy* or not depends on your experience with computers and databases. You have had a lot of experience, but many people find that kind of thing intimidating.

As far as your analogy of the motorcars, I would say a better analogy would be that of the hospital pharmacy (AmazingMeds) vs. the crash cart (Custom database). We all understand the advantages of having both kinds of medication storage. To continue the analogy, everybody's been wishing for a better, more accessible pharmacy. I'm saying, if you can't overhaul the pharmacy, just give me a little crash cart I can stock for myself.

BC

I agree

This may seem like a really silly idea, but it applies to at least one region of the country (NYC) and it kind of goes along with Meds. So, here it goes (Don't Laugh!)

Many insurance companies and other facilities are requiring Rxs for non-medication issues. For instance, to get an x-ray or a sonogram, the patient needs an Rx (on the right paper). Some insurance companies want to require formal referrals but avoid the cost making referral forms and tracking them. So, they require a referral written on, you guessed it, an Rx.

To keep a record of this, we started writing these in AC! Brilliant Idea, or so I thought. But the Law of Unintended Consequences struck. We now have a list of x-rays and sonogram Rxs a patient's medication list (ooooops!)

I wish to jump onto the Rx bandwagon with the suggestion of a Non-Medication Rx list. This could be kept separately from the Medication list. Where? Well, I don't know but it seems like it could be useful.

Anyone agree?

Anyone?

As a fellow NYS'er with similar issues, I totally agree!!! We write "sick" notes for school and work on Rx paper! Makes it look official and gets both sides in the matter off our back. Another place for un-compensated busywork. Phonecalls, messages, write the stupid note, pt comes to pick up or have to mail no less (41 cents later)...it's just unreal. Try getting a quick note for free from your lawyer. "Hey Bruce, could you write me a quick note covering me for being here at your office today so my boss won't have a fit?" "Sure Paul, I'll bill ya." Right?

But back to that matter at hand. You are absolutely right about needing all sorts of Rx generated stuff that has nothing to do with real meds. Don't forget PT Rx's either. That's another biggie....

Dr. Coghill:

You are not alone. In Arkansas, we have to write prescriptions for some lab tests and procedures, as well as durable medical goods like rolling walkers and ankle-foot orthotics.

However, AC 3.6 does allow us to inactivate or delete those kinds of things after we write for them, so they don't have to stay there forever.

I would consider "inactivating" Rx'ed orders if they are for an orthotic or lab that might need to be ordered again. If you don't want to see them again, you just click the "active tab" on the Patient Med List. If I never wanted to see them again, I would delete them whenever convenient.

I am somewhat new to the program and the board here, so let me know if I missed the point of your question. Maybe those X-ray orders are going somewhere I'm not thinking of?

Brian

What I have been proposing in this thread is someplace to store the custom medications (or x-rays, or orthotics) that we have to write all the time, so we don't have to start from scratch each time we write for it.

As I have already said, if I write for Amoxil tablets or Amoxil elixir (250/5) exclusively, I would like to be able to go right to that without sorting through the multiple other forms of Amoxil. That would be a big improvement.

But also consider this prescription:

Prednisone (10mg)
one tablet QID x 1 week, then
one tablet TID x 1 week, then
one tablet BID x 1 week, then
one tablet QD x 1 week, then
1/2 tablet QD x 1 week, then stop.

or this one:

MAGIC MOUTHWASH
30 mL Benadryl liquid
60 mL Mylanta
4g Carafate
gargle and spit 5 mL qAC & qHS & prn

I would like it if I didn't have to type those Rx's out manually each time I wrote for them. I would like somewhere to store that data on my Rx pad screen.

Or what if you're ordering lab on an Rx pad, as we were discussing, and you are an oncologist? It would be nice to be able to order a hypercoagulable workup a click:

Complete Blood Count with platelets and morphology
Prothrombin Time
Partial Thromboplastin Time
Antinuclear Antibody Test (ANA)
Antiphospholipid Antibody tests
Clotting Assay for Lupus Anticoagulant
ELISA for Anticardiolipin Antibodies
Factor V Leiden
Fasting Total Plasma Homocysteine Level
Protein C Levels and Protein S
Antithrombin III Level
Plasma Factor VIII Level

Currently, I can't find a printable field on the Rx screen that can even hold this much data. This seems to be a drawback with the current system.

Brian

Brian and others:

I may be missing the point, but I usually just pull up the order screen, where I can have templates, and use them for the various repeat orders. I've had labs, DME, respiratory companies take them without problems. However, in most cases, they still want their medicare forms signed, which they fax back to us.

I completely agree we should be able to customize medications - would make it easier for the entire office. And since we are speaking of the medication field, I'll also add, that I'd love to see insurance information, especially for those part D plans in the prescription writer.

Warning: this is a rant...
Regarding notes: they are a pain, and we've allowed society to demand a note from the office for everything from "I was there" to "get me off jury duty", "I have a service dog", "I should be allowed to take dial a ride because it cost me too much money for me to travel to my methadone clinic" and more. I even had a family yesterday ask for a note for dates I didn't see the kids or even know they were ill.

This goes much deeper than "I need a note". It allows/facilities lack of responsiblity on the part of people to get up and go to school/work/jury duty/etc.(I'm glad it's really just a small % of folks)
Rant off....

Just sign me,
Your Neighborhood Excuse Writer

Well, shut my mouth! I haven't used orders much and didn't realize it had templates! What a greenhorn. Well, the point about complicated Rx writing stands.

Forgive me for being dense, but what kind of information specifically, and where do you want it -- for reference or printed on the Rx?

Brian

I agree with Brian to write Rxs that have to be written, but inactive them after. I thought this could be done well before 3.6, though. I also thought I was missing the point since I have a million templates for Orders.

About notes: Unbelievable. My biggest sore spot and probably what makes me Shoot The Messenger more than anything else. Letters and notes for almost everything. I have gotten to where I am so passive-aggressive it is unreal. "Please send a letter with the diagnosis of your patient is." Letter: To whom... Body of letter: Asthma. Then the letters from the daycares and the agencies wanting to do a CYA. I have to write a letter so a mom can give soy milk instead of milk. One daycare wanted a letter to allow the mom to stop giving nebs to her baby since she was no long wheezing or coughing. You should have seen the letter I wrote. It was so sarcastic and funny.

The reason lawyers don't write notes for nothing is because it isn't the expectation. We have allowed patients to do this. Plus, as a pediatrician especially, I can refuse to send a ridiculous letter for awhile, but ultimately it hurts my patient. One thing I did start doing last year, and it seems to work is to charge $15.00 per letter to the agencies and daycares. I get the $15.00 on about 40% and about 25% never call back. So, I am down to 35%.

Bert:

1. How many templates do you have for orders, precisely? How many templates can the template field contain?

2. Is there a way to make the prescription writer print long Rxs like the ones I describe above (steroid taper, magic mouthwash)? I tried cutting and pasting some long recipes into the "medication" and "sig" field and couldn't even get a print preview to come up.

Brian

As you may know, I've been slaving away at getting a new medication list. After looking at my prescribing habits over the past five years, compiling outside sources (pharmacy, insurance companies, chart review) I have my prescription universe (number of prescriptions for drugs, supplies, and other issues) to number around 2200-2500. This includes each and every dosages and variations of some of the same drugs but in different formats.

If there is someone interested in my limited universe of medication list... how can I post the file? Of course, this will reflect my universe which may be different from other user's universe.

Congratulations, Roy. I know that was a lot of hard work.

I'm still working on mine. I'll probably end up at about the same number.

Brian

A million, lol. Actually, I have 44 templates. I don't think there is a limit, but I could be wrong.


Funny you should ask that. Because I was working on a workaround since you brought it up before. You can't cut and paste into the script writer; I am almost sure of that. Here is a weird workaround that has some potential, but would be fairly awesome if you didn't use the letter writer:

One COULD pull up the letter writer and make multiple scripts using the right click-ALT method using PRESCRIPTION as the first word. One thing I don't like about the letter write is the automatic "Dear" in the first line as with many notes (that we hate), the word dear does't fit. It wouldn't have the insurance info and it, of course, isn't formatted as well as the script writer, but it does seem to work when I tried it. Also, the script wouldn't be in the medication list, but it would be in imports. Terrible workaround, but just a thought.

While on the subject, just some ideas that I do which may or may not be helpful. I wonder if anyone else does anything else like this. I have multiple templates that I have put in Addendum which I can pull up when I am in a patient's chart from File. They just have general information like Lamictal dosing or SBE prophylaxis (which I know is changing). I bring the info to the addendum window, but I usually don't save it.

I also have many templates in the HPI field with differentials and questions to ask for chronic conditions or even acute. So, if chronic migraines comes up as the chief complaint, choosing that template can be viewed or even saved into HPI so I don't forget a question. One can even list all of the migraine prophylaxis medications if they wanted under chronic migraines. Of course, that could be a template under plans as well. Or the questions could be in HPI and the differentials in Assessment.

There is Instant Medical History (which costs money) and does a fancy job of interviewing a patient with certain medical complaints, but I have yet to find it easy to customize. The last time I checked, there were like 30 questions for migraines, many of which I don't ask children and adolescents. It has gotten better, and they did give me a new trial period, but I was unable to get another trial period with AC.

If I am understanding your question Roy, you can just post it on the "Helpful downloads" section of the board where everyone puts their templates and I have my AmazingMeds database. Then, Vinny will approve it, and it will be availabe for everyone. It sounds awesome.

Thank you, Bert for that detailed response. I will have to file some of that away for later reference; I can tell there are good ideas there that I will refer back to as I get more comfortable with the all the features of the program.

I asked about the template storage capacity because when I saw how templates worked with Orders, my immediate response was: "I wish I could do that with prescriptions." Just open up an empty Rx page, right click, and blast out a templated prescription.



The idea of starting a prescription with the word "Dear" kind of cracked me up. It's quaint, Victorian even! It appealed to my bent sense of humor. My prescription could read:

**********************************

Dear Sir or Madam Apothecary:

I should be most obliged if you would compound the following for %FNAME %LNAME, to wit:

Three (3) drams anhydrous carbonate
Two and one half (2 1/2) grains iodinated camphor

Instruct him to rub this into his scalp with great vigour.

I remain your servant,
Brian Cotner, M.D.

**********************************

And with prescription templates, I could type all that with one click!

What do you think?

Brian

I am in the process of trying out Instant Medical History. I'm still not sure how they justify charging $50 *PER MONTH*. Is this thing frequently updated/upgraded? I just want to buy the program outright and get on with it.

I am not sure how IMH would go over with patients completing the questionnaire in a lobby kiosk, but I was kind of hoping that my nurse could use it to get a rudimentary history when she takes the patient to the exam room, and then I could fill in the gaps afterward.

I know this is not using all the features of IMH, but I am trying to solve a specific problem: the nurse was hired before the EMR was purchased, and she's just not a great typist.

However, I find so far that IMH asks a lot of dopey questions that might be forgivable in an impersonal computer, but would not be forgivable if the nurse asked them. We will see if she can use common sense and skip the dumb questions. And, I will see if I can easily eliminate the questions I don't want asked.

BC

I completely agree about the templates for prescriptions. It's really too bad one can't make one of the autofill prescription in the registry permanent. Then your long prednisone taper would come up just by typing an asterisk or whatever. But, of course, I am working on this too.




1. You are way too funny!
2. Another thing prejudicial again pediatrics is I can't use the age template "%Age" thing because 1/3 of my practice turns out to be 0 years old. Maybe someone has a suggestion on that.
3. Can that concoction be used for head lice?

BTW, since I am bringing up head lice and in this part of the country they tend to be resistant to Nix as well as other nasty chemicals, I have been using Nix combined with Bactrim with much better outcomes. Anyone else?

"I am in the process of trying out Instant Medical History. I'm still not sure how they justify charging $50 *PER MONTH*. Is this thing frequently updated/upgraded? I just want to buy the program outright and get on with it."

(Just way too much to quote) I didn't know it was now $50.00 per month. That solves it for me. That's WAY too much money. I would rather use a standalone program like HotDocs or the Word one which I forget the name of.

"I am not sure how IMH would go over with patients completing the questionnaire in a lobby kiosk, but I was kind of hoping that my nurse could use it to get a rudimentary history when she takes the patient to the exam room, and then I could fill in the gaps afterward."

Again, an issue with pediatrics. We would have three year olds downloading the latest version of Doom. There is a cool way to password protect it in a maximized setup so patients can use it there. The only time I would want patients to use it would be for the inital visit with family history.

"I know this is not using all the features of IMH, but I am trying to solve a specific problem: the nurse was hired before the EMR was purchased, and she's just not a great typist."

For $50.00 per month, shouldn't IMH do the typing?

"However, I find so far that IMH asks a lot of dopey questions that might be forgivable in an impersonal computer, but would not be forgivable if the nurse asked them. We will see if she can use common sense and skip the dumb questions. And, I will see if I can easily eliminate the questions I don't want asked."

I would only want customized histories.

Resurrecting an old topic:

I was reading through Amazing Charts help section (which is pretty well done, by the way) on the topic of electronic prescribing.

It was talking about the benefits of registering for electronic prescribing privileges, one of which was "you will also be given the ability to download and synchronize your local medication lists with their active list online."

I wondered if anyone around here had ever done this "synchronization". If so, did you notice a big improvement in the Amazing Charts medication database? Was this something that was downloaded into your Amazing Charts database, and could be retained after the service was ended?

I personally would not mind paying $35 for a trial of any prescribing program, if I got to keep their new improved formulary as a "free parting gift" when the trial period ran out (you know, if I wasn't completely satisfied with the service).

Sorry, but it doesn't work that way. You prescribe online on their system, with AC being updated later. It does not update the AC meds database.

V.

Yep, those treating patients over 18 are back to actually entering in the correct meds one at a time. Some things are just meant to be done right.

Dang!

Well, You can't blame a guy for trying.

I massaged the Amazing Meds database with Access, in my ham-fisted way, and came up with a much improved version (certainly it's nothing to Bert's masterpiece), but I'm still not completely satisfied.

Tell me, how often is the Amazing Meds database updated? In other words, if I reformat the database, how soon until new medications are introduced and I have to do it again?

You NEVER have to do it again!