Home Forums Discussions Problems disappearing notes and error message in eRX

Okay - I am on day 5 of going live with AC and I have had 6 chart notes disappear on me. I charted on the patient this morning, completed the chart and signed off on it. My MA scanned the EKG into the chart. I signed off on the EKG. I went into the chart this evening to add a med that I forgot to refill. The note from this morning is missing. The problem list is still there and so are all the meds. (I cant go into "lastnote" on the c drive because it was no where near the last note made). I decided to recreate the chart note and add the med that I forgot - when I went into eRX to download the prescriptions, the thing locked up on me and an error message kept coming up. (I had message but I am so frustrated that I closed the connection to write this note).

Why and how do I stop losing my notes!! I called the Guardian angle desk and they mentioned that it was a flaw in the system. He nicely mentioned that sometimes they "just disappear". I still have charts to do and the system is locked!! And how is this going to make my life easier!!

okay the message reads:
Unhandle exception has occurred in a component in your application. If you click Continue, the application will ignore and attempt to continue.
Conversion for this string "'to type 'long' is not valid.


Clicking Continue DOES NOT HELP!! I still can not get into the program!!

I can't remember but if you go into Newcrop where it is downloading meds - check and delete them. The New crop will then allow you to close it. This is a flaw which ac states is from New Crop and I had it happen once recently.

Carolyn,
I sympathize with your frustration, but don't lose the faith! Lost notes RARELY if ever occur, especially for no good reason. Don't let support pass this off as something that "just happens". If you are losing more than a note a day, either something is significantly wrong with your install or you are doing something wrong. Have them walk you through the process of saving some "dummy" notes until they see a note disappear and that will help track down the cause.

I agree that you should not be losing chart notes. I have been using AC for over 4 years and can only think of 1 maybe 2 instances where a note has gone missing without a program crash, which has also been rare.
I think it is more likely user error, although a problem with install is a consideration. When you are fist using the program there is a learning process that dose take some time. The important thing to remember is that it is designed to only have one chart open at a time. My work flow is to have the MA send me that chart after she enters the CC and vitals. I open the chart and try to finish the chart completely and sign off and enter the CPT codes before going on to another chart. I try to minimize moving the chart around. Rarely I will forward a chart to myself and then open another chart to work on, but try to avoid even this.
You might try printing out your notes when you finish them for the first week at least as your confirmation and backup for troubleshooting.

I have avoided using the e-prescribing tab and just use the AC front-end (Write Scripts)to write, refill and e-prescribe. For now my refills are still coming in by fax.
Greg

I think I had the same problem you are having and it was simple user error. It is VERY stressful Right at first as you wonder if you have made a huge mistake, you are behind and thinking of twenty things at once. In my case, (I have no idea if you have been guilty of user error, I'm just saying this is what happened to me) I would be working on a note, get interupted and open another chart, without realizing I had not finished signing the chart or forwarding the chart. For example you are signing the chart and trying to answer someones question at the same time. You don't click a CPT code, you click sign it, a box come up asking if you want to add a CPT code, you say "yes". You have done enough steps to be finished, but of course it is not saved and when you click to close it, or click to open something else, it will ask, "are you sure" but if you are in a hurry or distracted, you are toast. Anyway all three of us in our office lost a lot of notes Right at first. I worked from a scratch sheet made by printing the patient demographic at the front desk, then the MA would hand write the Chief Complaint and vitals on the paper, (which she used to enter the vitals from when we didn't have enough work stations.) and finally I would carry the paper in the room, maybe jot down a note like, EKG or CXR or Flu shot, so I would remember to do the billing, finally at the end of the day we compared the sign in sheet with the completed superbills, and if I was short, we went through the stack of papers to find out who got lost.

We do the same thing as DocMartin. I was closing unsigned charts during the heat of multitasking as well. Now we check at the end of the day for any missing charts. I sign everything after it has been reviewed and coded by my trustworthy coder. At the end of the day, any missing chart can be retrieved from that trusted coders mailbox if anyone else (me) inadvertently closed it before signing. As long as we check at the end of the day, before closing amazing charts we are able to retrieve anything missing.

Thank you for all the help. I have only lost one note in the last
week and that was because computer froze up and AC closed down.

My new question today is: Is there an "undo" button?? I was typing an extensive HPI and pressed some series of keys that quickly highlighted the text and then deleted it. I know that I caused it but I was hoping to find an undo action that would make it return.

I am taking a quick poll - do you create a new chart for a patient when they have a L&I, MVA and their regular medical record. Or do you have one chart that has everything in it??

Last things first... I am a "lumper". Everything goes in one note.

We had a lot of frustrating problems like lost notes at first. You would think that a mature computer program would have figured out all the ways that a user could shoot him or herself in the foot and then prevented it, but in fact there are so many combinations of ways to an end that we found several. After a bit, as our work flow stabilized, it just sort of stopped happening.

The first thing I do when something seems gone is to go to the deleted messages. My commonest problem was pulling a chart from messages, saying "Yes" when asked if I wanted to delete the message, then clicking the "close" X button before having done anything to the chart. In that case, it just disappears with no warning. If I have added anything, then the warning "do you want to close without saving" comes up, but not if I have just opened it and then closed it. If it is in deleted messages, just moving back to the inbox and pulling it again solves the problem.

No UNDO button that I know of.

One patient= one chart, multiple charts is a recipe for disaster.
They will never only want to deal with one problem. You think you are dealing with their MVA or work comp issue but they also will ask about their BP or other problems

Greg

I do not remember exactly when I had the problem described at the very top of this thread, it lasted a several days at about the same time cfreed posted above ( I haven't been checking the board as often as I used to) and was exactly as described. Diagnosis codes were in, medications were in but the note was not. My IT guy looked at our system and we had a virus that was sending files to the wrong place and then they were dumped. ( Don't ask me how we got the virus, he said it was a very clever one.) At about the same time we had also just had one of our hard-drives go bad and it needed replacing. Another symptom of one or both problems was that AC was running slow and freezing up alot.
I have the same user error problem described by others, one of my staff checks to make sure that yesterday's patients all have notes in their chart, it is uncommon that there is no note.

Ctrl-z is Undo. It doesn't always work, but it is always worth a try. In the example you site, clicking in a box in the encounter (e.g. in HPI) will often (but not always...) select all text, and then hitting "enter" deletes the whole box. That is likely what you did accidentally. Ctrl-z brings it back.