Home Forums Discussions Problems How can a note disappear?

I had a note on a patient that was signed and saved. I went back into the chart today and I couldn't find it. I know it used to exist because I have a hard copy of it. The only thing I noticed is one of the employees entered an addendum with a superbill attached to the same DOS. I can't figure out how that happened. I'm thinking may be I had a copy of the chart in the mail box.

That might have done it. I believe (note the emphasis on believe) that when a note is signed off it is well and truly saved absent some major server crash.

I do wish the parts of the program that warned you when you were about to dump an unsaved record were more robust. Most programs idiot proof themselves better than AC.

Khaled, does your hard copy say "DRAFT OF CURRENT NOTE"? near the top? If it does then we may assume it was printed before you signed the note, otherwise what version are you on? I had someone claim they lost a note, but I checked the log for that day and patient (new in v5, can be reached from the admin console) I saw no SIGNED OFF BY [doctor] in the log. You may want to check your log if your hard copy doesn't say draft.

Benjamin
Thanks for pointing me to the log. Turns out the patient had 2 charts. My receptionist probably overrode the warning about having a duplicate patient when she entered the demographics. Now if there were a way to merge the charts (just kidding)!

I must say that this has been the biggest difficulty that my office, including me, is having with AC. In my normal work flow I use Dragon to enter the note, then send it my secretary who proof reads it and sends it back to me for signing. This may take a day or two for complete turn around. We have lost numerous notes in various stages of completion due to errors in knowing just where the chart is and whether we are working on the original or a copy. It seems to get more confusing when we someone tries to retrieve the chart in order to add imported items, etc.

This situation has become worse because we have become somewhat paranoid about deleting the charts that are in our inboxes and thus have even less clue which is the real chart.

I don't know if it is just us, but this seems overly complex in AC. I know of other EMRs that place such notes in a "notes in progress bin" but that allows everyone to access the rest of the chart even is the note is not competed.

Richard,

I probably shouldn't even comment as you have your work flow which works for you. In other words, you like to dictate, and you want your secretary to proofread it. I am going to apologize in advance if this is just a stupid answer your question since it really isn't. But, here goes:

At least in your situation sending the chart to someone makes some sense as that is the only way to get it proofread. I hear of others who send charts to nurses who send the charts to billers who send the chart back to the doctor who reads it and signs it.

I can give you two statements that are not coincidence. In over six years, I have never forwarded a note to anyone, maybe five times even to my inbox. And, I have never lost a note. My take on it is AC isn't designed to be like the other EMRs. It just seems to be designed to write the note and save it. I guess that is a huge advantage in typing. I realize, too, that your notes may be used when you reply to the referring doctor, so good punctuation, spelling and grammar is important. And, the spell check is not very good with AC. But, wouldn't you be better off dictating the note and checking it yourself? Or better yet, get the DNS more and more accurate so that proofing it isn't necessary. From my perspective, finishing the note while in the room will solve all your problems. Except, of course, your work flow.

Bert,

You are right that ideally the note would be done in the room, and for that reason I envy most primary care physicians. Unfortunately, while consult codes are no longer reimbursed by CMS, the notes back to referring physicians are basically the "product" of the general neurologist and needs to compete with the group across town. Therefore, the types of errors that Dragon creates (due to my lack of clear speaking) are always real words and therefore not amenable to spellchecking.

I have spent the extra time speaking clearly, proofreading myself only to have my secretary find glaring and inexcusable mistakes only after the note has been faxed. As there is no way to have my secretary proof and correct after the note has been signed I am left to my current scenario. Try as I may I just can't catch all of these errors. Ideally the person proofing would be able to hear my voice file while correcting, but I do not believe there is a way to save this in AC (as there is in some other EMRs such as MEDENT).

As a consultant I really wish this were easier, as well as the ability to modify font and formatting in the created letters to referring MDs.

Richard
You can dictate your notes in the COMPOSE letter section and when you hit the PRINT/ FAX button , you will see an EXPORT symbol to the right of the PRINTER button and if you look at the drop down menu , it gives you the option to save it as a text file and you can save ot to your Secretary's folder for her to proof read and make changes and save the corrected letter before it is faxed out.
Just a thought
Gerenville

Richard,

Gotcha. Here are my three ideas.

One, I would just make it a practice to forward it to your inbox only. Your secretary, can go in under your name (we all have the same password here) and read it from there. When she is done, she can simply close it there.

Two, Only you and her can touch it until it is sent or signed off. No need for imports. Not sure how much need you have for inputs anyway in a note to a referring physician.

OK. You mentioned being able to modify font and formatting just as another doctor did. I use the following method pretty much all the time for letters. It seems very complicated. It is rather easy. You just have to set it up and understand it and you are typing/dictating in Word, which can be saved to the chart.

No one ever used it as it is rather scary looking.

http://www.amazingcharts.com/ub/ubbthreads.php/topics/24241#Post24241

Richard,
I can understand how this can be a big issue....too much time spent thinking about whether to open a new chart or one in a box, and then what to do when you close it. I think that particular problem can be resolved without too much trouble...It isn't so easy to fix the letter problem. As a consultant I share your desire for a better letter writer; spend a little time here and you will see that the primary care providers feel the same way!

This may be obvious, but keep in mind that a note "in progress" (i.e. not signed off) is essentially a draft. If you open a new version of the chart, you are starting a new version of that note. That is almost always a mistake (you end up with two "competing" versions). The key is to NEVER let anyone who is working on a note (you or staff) open a new version of the chart when one is already in an Inbox. If you can follow that rule, you will save a lot of time and consternation.
How to follow that rule? Step 1 is to be sure that your notifications are set to warn you (and staff) when a chart is already in a box. Then, you will know NOT to open a new one.
Step 2, opening a chart that is already in a box, is a bit tougher, and there are two options:
a. Let your secretary use your sign-in when she wants to work on a note. So when you are done dictating, you save the chart to your own box (hit Ctrl-S) and she (or you) go into the box to edit it.
b. If you don't like giving her complete access under your sign-in, then set-up a new provider called "Notes in Progress". When you are done dictating the note, send it to that provider. She also goes to that provider's Inbox to edit it, and sends it back to you for sign-off. The "Notes in Progress" Inbox is essentially the "bin" you are talking about.

The good news....imported items are handled separately. You can still import items into a chart when they are in someone else's box, and nothing gets lost. Staff can freely import regardless of where the chart is located. The above process need only be used to edit notes.

Jon and Bert,

Great advice. Thanks a lot. I like the notion of creating the new provider and saving charts there. Seems to me that it should be more difficult for some to open a new version of the chart. The pop-up is helpful, but too easy to click through if you aren't thinking.