Home Forums Discussions Feedback and Recommendations Seperate Out Our Family and False Patients

Here is something I feel needs to be brought back up. I kind of copied this from another thread I just answered, so yes it will look familiar.

First off: A Suggestion to all you AC Newbies. Set up one or two "false patients" early on with a low chart number. Now you and your people can play to your hearts delight with all the features of the program, all without worring about putting bad stuff in a real patient's chart. We have James Bond and poor James is a very sick man. Our last program (but that is another story for some other day) had a few pre-made, sectioned off from the main database false patients too.

I have asked AC to allow for a separate sectioned off place for this but as of yet no reply or implimentation. Right now as we create encounters for James his data and his monitary totals get factored in with the rest of the practice's and that day's data and totals, which is really very inappropriate and even possibly dangerous. Yet having such a false patient to try new features on, test the program or your system when you suspect a problem, is really a great thing to have. Who cares if you enter weird data to a false patient testing the system because it is behaving funny? Right?

On the same idea. We should have a way to enter folks like false patients, our own kids, our own parents and in-laws, all of whom we don't charge for, but we should none the less be tracking what we do for them, just in case. CMS says we shouldn't bill for these and that makes sense. But every time my kid has an allergy issue or a clogged ear doesn't mean that we are calling or having a visit with their PCP. And she is cool with that. So we should have a way to section off a dozen or two charts as, not part of the main practice, off line, and not being calculated into the practice's data and demographics stuff.

I feel the more AC becomes a PM, the more important this becomes. I'm not sure if this could work, but a simple button with a big red warning flag window popping up that screams at you, "Warning: Are you sure you want to create this patient outside the main database???" So you could cancel if need be. Hit the button on the demographic page, click yes to the warning and now, AC knows not to add any of this patient's data to the main database's calculations... Be they lab values, BP, money charged or paid, number of visits, or anything else. That's been one of my wishes ever since we first joined AC... Nancy and I are very attached to dear James. He is great for visiting reps who you want to show AC to but don't want to share real patient info with, New Hires love having a safe place to play. We have Med students rotate thru here so he is great for visiting Med Students and Residence too. Did you hear this Vinny? Thanks.
Paul

If EMRs of the future allows intrusions into our records (as CSHIT is proposing), I'm in trouble. I set myself as a "dummy patient" and I have virtually every diagnosis (including legal execution)and CPT codes as I use my records to demonstrate to others how I use Amazingcharts in my daily life. I'd like to remove my name off the database if there is a way. I have prescription list with hundreds of controlled substances!

I think this is a great idea. I am currently using AC to keep track of vaccinations, worming and hoof care (podiatry consults) for my horses, as well as foaling records, consults with their PCP, etc.

Please tell me these records are not accessable to anyone else...I don't need CPS down here wondering why my 10 year old "patient" gave birth to her third foal this spring!

Patty
Solo GP since 2005,
AC user 5 months

No need to worry at this time. However, ONCHIT has signed off on recommendation to incorporate having portals open for insurers as a condition for approval for CCHIT. See other thread in DISCUSSION section.

Hey, maybe Jon should modify his avertising slogan.

"IS THIS PROGRAM CHITTY? No way. We're not touching that CCHIT!!!

Elvis,
Very good. I always knew you had a good sense of gallows humor. But seriously, I know that privacy of records for both provider and patient has always been of great importance to you, me, Vinny and a great deal of others too. As much as Jon tries to be CCHIT compliant, without the expense of the stupid sticker that we has also discussed previously on other threads; perhaps we should all approach Jon, that this is one feature on this standard that scares us all to death and to not incorporate it? Or at least allow us in the admin section the opportunity to say yes or no to such a dangerous option. I think we need a direct answer on this one from the man himself. But perhaps one of you who have a friendlier and more open relationship, should be the one to approach him on this. It may not be as well receivced coming from me, if you know what I mean?

I think if and when such an feature gets incorporated into a software, that is when we here at our office get off of the EMR bandwagon and start printing out and handwriting our charts again. I guess I better start looking at all those catalogs from those paper files places...Used to just recycle them and pay them no mind, but now.....

This really stinks of big brother all over it. At what point once such a feature is designed will having it enabled be a requirement of PAR'ing and of being HIPAA compliant? Once we bill electronically, will we all have to allow big brother into our offices and onto our systems? It's just amazing how insightful George Orwell really was so many years ago...

Good Night and Good Luck
Paul

Hilarious. Roy is adding to Elvis' legend.

Paul:

Sadly, if Dr. Bertman follows the typical business model, his program will get overloaded with features and regulations until it is no longer simple and affordable, and a new barebones EMR will rise to take AC's place.

I don't know Dr. Bertman, his goals or life's ambitions, except what I read in the PR pieces. Here's a quote:

"Most of the programs were far off from what I needed, which was a quick, easy way to get information from the encounter stored into a database. I wanted it fast, I wanted it efficient and I wanted it cheap. I actually found that working with other EMRs slowed down my documentation." (Dr. Bertman)

Respectfully (I mean that), if I was Dr. Bertman, I would spend my time making good on that original solid business plan, with *simplicity* as the guiding principle.

To me that includes improving AC's *existing* functionality (prescription writing and billing/practice mgmt) and just making it more foolproof, eliminating glitches.

You know, paper charts do not evolve. Why do electronic charts have to? Let AC just keep getting better at what it does already, for crying out loud. Make it so simple a child can maintain it, so simple a child could *program* it!

Big corporations can not do "simple", by their very nature; they have to keep getting bigger and pricier. One man, with vigilance, can keep things simple, and I think there will always be a market for simplicity.

Now, if the government moves in and MAKES him glom up his program, that is another matter. That will be a grave injustice, to him and to us.

If it does happen, I will consider other means of record-keeping. This kind of needless mumbo-jumbo seems to be the very kind of thing that drove Dr. Bertman to create Amazing Charts in the first place.

Brian

Brian that was brilliant. I think you speak for many of us; definitely for me.

Keep it simple, add a little functionality to the existing core and fix the bugs. Thanks for saying it so eloquently.

Thank you, Bert, but upon re-reading this thread, I realize that I moved us way off track of what Paul was originally suggesting, and that is indeed a matter of core functionality.

Paul says we should have the ability to create a false patient for experimentation purposes (as Dr. Bertman does in his videos) without creating bizarre repercussions, and I think that anyone would agree that this is important.

Is there a way to do this with Amazing Charts' current features? For instance, if you select "James Bond" or "Black Beauty" as "inactive" patients, will that keep their data from being tracked? If not, could a button be easily created (similar to the inactive/active status button) which causes a chart to be exempted from the various tallies that Paul describes?

Brian

I think the simplest way to do it would be to browse to a different database. If you had five workstations with one of them being the "server" or if you actually had a server with the data that all of the other five PCs accessed, then it would be rather simple. It would depend on how often you used the "fake patient." To be honest, it doesn't really apply to me because our fake patient, Bill Gates, who is self pay by the way as Microsoft has no bennies (J/K) is used a lot, but I am not too concerned with tracking AC data.

But, if you had one or more "fake patients" on the AmazingCharts.mdb database on a PC that was not the "server," then you could easily disconnect that PC from the server database and connect it to the empty database on that PC as if you were using AC on one computer. You could then practice to your heart's content without putting any data into the actual database.

Of course, one would have to remember to reconnect to the actual database afterward. I suppose there would always be the slight possibility of entering real data into the wrong database, but if there were only "fake patients" there, it would be hard to pull up a "real patient" since none of them would be there.

Bert,
You always have the great techno heads work around suggestion. But what I'm looking for is an actual feature with that "button" so we can sort of have a database within a database or AC just tracks and assigns two databases. One for all the "real" patients in the real practice and one for false patients and family members. Or perhaps another easier to design Idea would be to have all copies of AC come with the real practice and the "Practice Practice" and that we are all entitled to use the practice practice as we see fit for any non-practice purposed. Like Med Students and Resisdence, new staff training, showing off AC, and charting non-practice based patients, like family and James Bond's.

On another suggestion. We have created a patient named, "New Patient" and we use him to hold slots for new patients that have yet to estblish. Again we don't want AC's numbers to tell us that we have hundreds of extra patients that new lived to estblish. This is why the button to then put all info in this second database is really best.

We can put a never estblished patient over there for tracking and documenting purposes; but yet they are NOT part of all our numbers for our real patients. And should little miss no-show, no-call ever live to estblish we still have her stuff in AC and can then switch her over. It also documents that we took her stuff and that she no-showed on us, so we are covered in case she wants to call "Do We Cheat 'Em and Howe" because she claims that we dropped the ball on her care some how. We can have all her calls and appointments, missed and otherwise still documented and yet still off of the main datebase. Again if AC wants to become a EMR with a great PM then these are the types of issues that we are going to need to track and address. All while having ways of NOT skewing our demographics and financial numbers all to hell on no-show, never-established "patients?". Get it?

But good try there...
Paul

I guess I was just trying to give a workaround that is actually fairly easy for those wanting to practice only and not put the patients in the actual database.

I don't see why one couldn't have a very cheap computer which is set aside for practice AND for the Little Mr. No Show documentation, which could also be documented in the real AC if you wanted by having a patient named Not Yet Established Patient. Sort of like preregistering.

The PROBLEM is that while these are all good ideas and maybe even possible with VB, etc. adding buttons is not always such an easy alternative. It isn't as simple as changing a train track to alter the direction of the train, although it may take as much force. I think the real issue is that most EMRs were designed the same idea AC has -- to document real patients in real databases. While there are probably many that do both, I haven't seen them.

Just my opinion. Could easily be wrong.

Again I ask, what effect does making a patient "Inactive" have on practice statistics in our current version of Amazing Charts? If it doesn't exempt someone from statistical analysis of your practice, then it should.

If someone has been dismissed, or dies, or falls off your active panel of patients, you mark them as "Inactive". If a patient is Inactive, why would they be considered part of your practice?

In a pay-for-performance environment this would be especially important.

The "Inactive" button is not a new button. Just make it do what it should logically do (if it doesn't do it already).

Brian

I really think that never established patients are unto themselves and need to be tracked separately. They are not patients that once where and now are no more... They never were. But yet in today's legal and business climate they can still come back to haunt us. Why not a third button for entered but not yet established? When they finally arrive, you hit established and "boom' they are in.

Furthermore, I don't want 500 extra chart numbers that never where out of a few thousand. I think if possible there should be Temp123 chart numbers and then AC123 type chart numbers for the real and inactive patients. So someone is TEMP123 as you enter them and make them an appointment or just take their info. When they finally establish you hit the est button, now AC takes them from the TEMP side and properly assigns them the next in proper sequence chart number. And perhaps even keeps their original temp # and the date that they first got entered. These are all things that can and do come up and that is what a database is for. To track all this garbage for us so we can document it just in case it comes back up someday....Right????

And again. I can make a record on paper for my kids or my mother in law and the like. Most programs come with false patients to play with, show off the program and the like. Doesn't AC want us to "show them off" to non-covered people who none the less might help spread the word? "Hey I saw this neat, well thought out, inexpensive ERM at Dr Smith's office yesterday" This really is a common feature in a number of other EMR's and it really makes life easier in many ways. Want to see how a new feature works, play with "drawing" where a cyst is on a limb, importing items, running tests. We always do it first in James Bond before we did it the first time in a real patient's chart. It just make common sense...Give people a place to track these difficult patients and a place to play and learn.

I don't disagree with what you're saying, Paul. That would be neat, but whenever we start talking about ADDING BUTTONS, Bert jumps into the discussion and starts making like Chuck Norris. ;-)

However, I would still like an answer to my question. Who would know the answer? Are "Inactive" patients factored into our practice stats?

Brian

Great Question: I am no more sure than you are... Anybody got an answer here? Chuck Norris are you listening?

Perhaps if Roy can be Elvis, Bert can be Chuck Norris??? lol. Does that make me Wayne Gretzki; Kerry Frazer ???

Paul

Paul, you can be Nancy Kerrigan!!

First of all, I am not Chuck Norris. I can be Sergey Brin if you want. For those of you who do not know who Mr. Brin is, he along with Larry Page, founded Google.

Now for the data and inactive and active. Let's see:

Let's search for hematuria. Ahh...one patient. Not many urine dips in peds. Let's make him inactive and search again. Hmm, still one patient with hematuria. I guess it doesn't affect diagnoses.

How about medications. Let's search for itraconazole. OK. Eight patients with the antifungal. Let's make three of them inactive. Search again: Hmmm, still eight patients with itraconazole. And, the same patients, too.

Now, let's go to financials. Today I brought in $1938. (Fictitious figure). Let's make everybody inactive! Do the financials again. Still the same figure.

When you click on the little radio BUTTON (wow! a button), a little check mark goes into the column marked inactive in the demographics. This filters out that name and it doesn't show up in the patient list anymore. But, I would seriously doubt that that table would relate to the other tables in such a way as to change the data. In fact, you could most likely delete that entire patient in AC in the demographics table and the table with the messages and the table with the notes would most likely still be there. That's the whole idea of a relational database. Wow, it may get even tougher with SQL Server Express.

How do I know these things? Because I am Sergey Brin. I doubt that a singer from Nashville or Wayne Gretzky could do it. It really only takes trial and error.

I work a lot on workarounds, because I hear what users are saying and, knowing that a magic button is not going to appear, I find ways to help them. You know, like Vista's greatest workaround where you can install the Vista Upgrade (what about $125 cheaper than the full version) and install it CLEANLY on a virgin hard drive WITHOUT any OS. Very cool. I didn't come up with this. Or, I figure out how to get rid of the double login and the firewall from hell.

These ideas are really good. And, who knows, maybe Jonathan or Vinny or I (if I had access to the code) may write them in sometime. But, it isn't just as easy as adding a button. See, for every one person who wants a database button, there are 500 other users wanting something else. You can't simply add things willy nilly. A program has to evolve with a plan. When was the last time you wrote to Microsoft and asked them to change Office 2003? Didn't matter. They didn't change it for four years.

So, I will go by Bert, peruse through the rest of the boards seeing if I can learn something or add something and then get back to my interesting paperwork.

Oh, and you don't HAVE to do the workarounds

Bert:

Thank you for that authoritative and conclusive answer. There can be no further wondering! Thanks also for the workarounds, by the way. It is a lonely thing if you post a question and nobody even takes a stab at it.

Now, you are of course correct that there is only room for so many buttons. Major structural modifications should only be made if there is a major need.

However, the main issue to come out of this thread is that Amazing Charts allows no way to set aside fake patients or family (or horses!) from statistical analysis of the practice. I consider that pretty major.

The solution, on the other hand, seems relatively simple, in programming terms, namely this:

***ATTENTION***
Amazing Charts needs to be changed so that making a patient "Inactive" exempts them from statistical analysis of your practice!
***ATTENTION***

(I hope that got somebody's attention)

Making the above change is only logical. If someone has been dismissed, or dies, or falls off your active panel of patients, they should not be considered part of your practice.

If you are trying to demonstrate to a prospective partner or a third-party payor how wonderful your statistics are, you do not want the data muddied by people who have been dismissed from your practice for non-compliance, for instance.

A useful by-product of this simple improvement would be that we could make entries for Aunt Erma, William Saffire, or even Misty of Chincoteague without screwing up our practice stats.

Brian

Gentlemen,
Here's the missing piece of the puzzle. If one "inactivates" a patient, any encounters you made for that patient in the past should NOT go away. They did have visits then, they did pay a co-pay, they were part of the practice during those past dates. So old inactive patients need to be taken off the database in a much different, way. Their old data stays as it should, but as of their inactivation date, and should we be able to actually assign one, what date they officially left the practice could eventually be very important one day. Were they our patient on a certain date or not when something awful happened or they needed late night care or something.

But, these "false" and other "non" patients should always be part of a separate part, side or what have you of the database. They should never, ever hit the regular database and it's data. They never have and never will exsist! I can't believe we are debating this so much. Most other programs have this feature. It just makes so much common sense since once you chart something it is there forever, so then simply allow folks a place to play and create interesting scenarios, and add a few family members. I've got a high-tech EMR but I have to make a paper chart for my two kids? Come on...

And then there is still the issue of design the database and it's features around how a real office works and what it has to deal with on a daily basis. We still need my TEMP chart, file thing for all those inquiriers that call, make appointments, no-show, never live to make appointment, they were auto assigned by some stupid HMO or the patient used a dart board to "Pick a doc" out of the HMO's handbook or website. We need to document and track these pain in the neck, potentially dangerous patients, that never the less, never became real patients. They are not real patients, I do not see them, nor should you (you better hope a judge doesn't either) see them as real patients or as real patients that went in-active. There needs to be a real way to track and more importantly "classify" these difficult people and situations. We need that data unto itself for just such purposes. No work around, but instead a firm tracking of them for how and what they really are. People who interacted with our offices and staff, but still never had an establishing visit to consumate the actual Doctor/Patient relationship. Am I making sense here? And isn't this what we need an EMR/PM to track, record and maintain for us and for the protection of our providers??? I certainly think so and I hope so do all of you.

Again I don't write programs, but to have a TEMP area that allows for the development of a record, that can either stay there forever if need be with it's assigned TEMP number, or can be assigned to the Regular database in proper sequence, then never again go TEMP, all while retaining and taking with it any of that TEMP info, is key here. This is how it really works in our offices every day. I would bet for every one thousand patients a provider has there may be as many as 50-100 never established patients that none the less, may come back to bite your behind one day when you least expect it. And they are NOT real patients. Period, short, the end. And so they should not be in your regular database, or appear as regular patients, or even patients that went inactive. They are what they are, and our database should have a way of tracking them as they are not make them appear to be possibly something else. And their data if added to our regular database, is really inapproproiate. It may be a difficult thing to program, but this is how our offices work and what we most protect ourselves from. Plain and simple.

Makes sense to me....Have a great night....
Paul

With a simple registry tweak, you can set aside horses. <G>

Personally, I would much rather see the immunization module get revamped than this, but I can see where it is very important to you.

That's because you are you Bert. You do have a good perspective on things. It's why I value your opinion on many matters. And I too really do understand where you are coming from on the Med's, codes, and other regisitries. That's charting Medicine and encounters and getting those entered correctly and in an efficent manor is just as if not more important.

I'm just sick of having to make paper folders for these painful people. This is what we really do, the database should be able to hang with that. We need to document these too, to protect all you providers. I would hope as AC becomes more of a PM as well, that issues of this nature are properly addressed. It just seems so fundamental. This is really how we encounter and begin and end our relationships with these people, therefore the system needs to be able to track them in this real world way. It's why it needs to be designed by providers and practice managers. We're the ones that have to control the other half of the office for you folks.....

Be well my friend...Good night and good luck.
Paul

Anybody watched "Happy Feet"?

There's a scene where Mumble (the prepubescent protagonist Emperor penguin) has questions about "aliens." He carries a pebble (as an offering) and climbs up a mountain to seek answers from Lovelace (the spiritual prophet of the Rockhopper penguins).

Here's an outtake of this (but modified for purposes of asking the all important questions about immunizations):

MUMBLE (drops a pebble on the feet of Lovelace): What is the most unique entry when we put in all that information about immunization?

LOVELACE: The great spirit tells me it's THE LOT NUMBER. With the Lot Number, you have identified the immunization, amount administered, expiration date, VIS, and manufacturer.

MUMBLE: What would be the easiest way to reduce the entries we must make for each and every immunization?

LOVELACE: That's easy. It's THE LOT NUMBER.

MUMBLE: Oh, I see. When I enter the Lot Number for the first time, I can be prompted to put in the Manufacturer, expiration date, VIS and dosage. Then, the next time you enter the lot number, BAMM. Everything else comes out prepopulated.
Maybe you can put a counter on how many time a lot number is used. And when you used your very last dose of the very last bottle of a lot number, you can RETIRE THE NUMBER. By RETIRING THE NUMBER, it won't appear on our choices to choose from.
So, why do all the lot numbers from the beginning of Creation appear on Amazingcharts? Why do we have to hunt and peck through the lot numbers of expired vaccinations? Wouldn't it be easier to have only lot numbers of vaccines in our refrigerator appear on the immunization screen?
Wouldn't it be nice to be able to make a monthly report of all the vaccine (according to their lot number)that we can send to our public health centers each month to perform the accounting functions? Wouldn't it be nice to have reports like this for flu vaccination so we know we're getting 10 doses per bottle rather than squeezing out 8.5 doses and losing money for giving flu shots? Wouldn't a system like this be better than using our and toes to count our inventory?

LOVELACE: And who ARE you? There isn't enough pebbles on the island to answer all those questions you bring up. Next!!

Disclaimer: It 2:24am and I'm a bit punchy. My kids watch Happy Feet incessantly. In no way am I trying to poke fun at any breed of penguins, Antartica denizens, or AC users. The portrayal of the characters do not represent anyone in general (or specific) alive or deceased. Any such resemblence is purely coincidental and imagined. No feelings were hurt during the production of this dialog.

First it's my horses, then my penguins get victimized. <G> Just kidding.

Roy, no one is offended by that. Or, at least they shouldn't be. You covered all of the major points of the inadequacies of the immunization writer. This is in no way meant to be anything against Jon as he has written one hell of a program. I think what it comes down to is the fact that certain things are more important to some than others, and there is probably no way to separate that bias from anyone including the author of the program. I don't know how many children Jonathan sees or vaccinates. For a pediatrician, it is our life blood. We see tons and go through IPVs as fast as I go through Diet Cokes and PowerAdes.

From my perspective and my own humble opinion, the immunization writer was thrown in afterward with very little thought. It needs to be totally revamped. There has to be a way to do everything that you and I and others suggest. It is far within the reach of current day program applications to do just that. You only have to go as far as the auto populate feature in the script writer, although that would have to be done a little differently. It is painful, I mean painful to enter a vaccine from a cheat sheet. And, forget the inventory which, of course, is essential, but in Maine we have to record what shots were given to what age group another simple function given AC's ability to calculate age by date (if it were broken down to months for the first two years).

Roy, I about cracked my side when I read your post. Reminded me of when a close friend's kids would incessantly watch "The Little Mermaid." Drove us all straitght up the wall.

Dr. C came up with an idea on this. She asked, if I could find the time, to suggest that they add a capability to password-protect select charts. Charts that you don't want your staff to generally see. For example, you share office space w/ another doctor, who becomes your patient (even if only in a limited fashion.) You may not want your (or their) staff to have regular access to their chart. Or perhaps its a family member, or someone famous. Just like in CA, you really have no idea who may come through your office in NY. I know of at least one very well known actress that came thorough our office (saw one of the other doctors). I wasn't around, but the next day our MA came running up to me "Ms. ????" was here yesterday. ohh oohh!" REALLY! If you have more than one MA, you can have the DISCRETE one work w/ the patient and password protect the chart.

Wayne,
Great idea! I have no Hollywood stars or starlets. I do have quite a few physicians see me in my practice (a sizable percentage of the medical staff, in fact). I want their information protected from some of the staffers (who have previously worked for these physicians).
Password protection is an wonderful and a much needed idea.
Bert, any workaround for password protection? Currently we're making the physicians wear a plain paper bag when they come to my clinic to protect their identity.

That is a VERY excellent idea. My staff all come to me as their physician and they don't want other people in the office able to read their clinic notes.

Brian

Roy,

You're too damned funny. You've got me going round and round with all your new abilities with URL pointing and tinyurls. Did I mention, your tiny url was VERY tiny. And, your Happy Feet rendition, although I have never seen it, had me rotfl (as the teens like to say).

What a powerthread. All the boys: Roy, Brian, Paul, Wendell and well, me, I guess. Wendell did I get it right -- there is a Wayne on here, too. I have a favor for Wendell. (again I apologize if it's wrong). But, can you set up an autosign for Wendell? Unless you don't want anyone knowing your first name. I just prefer referring to your first name.

Already working on a workaround, Roy. One nice thing about our setup is the MAs work from one solo triage station. It has always been my dream (I have no life, right) to do it that way. Then, they get to set up everything the way they want. I invested in state of the art digital kg/lb scales with a carseat baby scale. The standup scale identifies the weight in less than two seconds, something we could never do with the older fashioned slide models. Anyway, I digress only to show that the MAs enter all of the patient data in their computers, which are locked. When I go into a room, which has a default of 5 minutes on the screensaver lock out, I am the only one to blame if I don't lock out (not log off obviously) the computer after a visit or while go get something.

OK, talk about learning the hard way. And, this really tangled and untangled the entire HIPAA rule.

15 yo female brought into my office after ED visit night before. 15 yo had gone to ED with her boyfriend's mother, because she didn't want her mother to know. (alreay looking grim). ED treats 15 yo without permission of parents. Boyfriend's mom calls 15 yo girls' mom to let her know she took her to ED for "private stuff." Mom brings her in to me because she is worried. I have no idea what is going on. 15 yo won't tell me, mom knows nothing but is upset and worried. I open PowerChart to pull up her ED visit. I decide to find the best way to handle the situation as stupidly as possible. So, the best way would be to go to the front printer after printing out the note AND leave the computer on with the note on the PC maybe 5 feet from mom. I read the note on the way back and read an HPI that I then realized was something that mom should not have read. So, now I don't even know if she has read it not. Mom doesn't let on. So, I examine the child the talk to her on her own. I send them on their way. I then call the mother that night and she had yes, indeed, read the computer. So, now I am totally embarrassed and am hoping someone on here can tell me the number of ways I screwed that one up. Hell, I don't even know how I would have handled it had the mother NOT read it. But, in the end, everyone having the info worked out for the best.

I have an F7 lockout on all computers, which instantly locks them. I can look at a password but would that be helpful. Doing a CTL-ALT-Delete takes too long. I have posted this before, so I would be glad to share how to do it if you like. The nice thing about the F7 lockout is that it shows ALL patients that you are protective of their data.

By the way, not everyone has jumped on File Assistant Pro Beta (which I am using as a full version). Will share with anyone. Still trying to make a trial version with a nice EULA. I will run the EULA by Paul, lol.

But, I finally have heard back from my programmer. Maybe now we can work on VIPER. I can guarnatee you if we do, VIPER will be the best immunization program in the country -- seriously. We may even make it 32-bit application with auto connectivity to an FTP site of your own.

Hi gang,

What we need is a way to tag the DATE a patient became inactive as well, as when you analyze their statistics, if they WERE active THEN, then they shouldn't be skipped.

In my practice we limit the fake patients to three, an adult male, and adult female and a kid. We do NOT add patients to Amazing Charts until they walk in the door, fill out new patient paperwork and are accepted as patients. I realize this solution won't help those who already have a zillion never-established or never-showed's, but is how we've chosen to deal with it for now.

At my last meeting with Jon we discussed this problem, and there may be a much better way of classifying these people coming in the future, as this is a major problem for a lot of people. If we had a better way of classifying the "Do Not Book" list, and those who have left that are either invited back or not invited back (which I guess would put 'em on the Do Not Book" list), as well as active patients.

V.

Vinny,
Thanks for paying attention to this topic. Again, what I want and what we all really need, is a way to track and maintain a record of these never establised patients who none the less, want to hold us accountable for their misdeeds. And NOT have them be part of the main database, but separated out as they are, because they are different.

Your office and ours does the same thing, they are not patients and therefore they are not entered into AC until the get their fannies in here for that first establishing visit. But the reason we both do this is because AC doesn't allow us some way of tracking, recording, and yet separating out these very difficult and dangerous patients.

Great example. We have a young peds patient that has yet to establish. What has happened is not the patient's fault here, but that of his mother. She has made and broken FIVE appointments now. Never yet to establish!!! This is bull and we all know it. But I need to protect you, my doctor by documenting all these phonecalls and appointments as to why this patient is no longer welcome at our practice. Especially if such patients are SCHIPS, or other gov't type program enrollees. And guess what this kids dad it turns out works for a major insurance company! Like he isn't gonna try and get pushy with us if we discharge his family for abusing our scheduling and wasting our doctor's time and staff resources, right???

Right now we are documenting all new patients in a separate false patient, "New Patient". But having all that data in one folder just isn't very HIPAA, now is it? No more HIPAA than combining all patients into one chart, right? We need a separate HIPAA compliant chart, for each and everyone of these pains in the butts. To document their mis-deeds for any future "suprises". And off the main database because they are not part of the practice. And trackable unto themselves because this is a real issue we need the data from to fight with carriers and the gov't as to the trouble these types of folks are and what they cost us in money, time and resources. Even broken down by products and the like. If and when they establish, then any and all things that happen at that date should then go live with the AC side of things. Do you get at what I'm getting at here???

Would it really be so difficult to have a dual numbering system??? So at the end of the day we may have let's say 1200 TEMP file numbers and 1000 real AC file numbers. With the main subset intersecting so to speak? Most of these folks will eventually become real established patients. Perhaps Some way of changing status while retaining both. Only those who have established get into the real AC numbering system, and all their temp info and their Temp number gets carried over. So any one patient could be both TEMP123 and AC456. But once AC456 the old TEMP123 data is in let's say past encounters sect or imported items??? But never to reuse the same number on either side. So only Paul B will ever be TEMP123 or AC456. They still may have an issue that first arose as a TEMP even though they are now an AC let's say and we should be able to retain and access all of this stuff.

In a paper chart this is easy. Simply create a new paper chart and use two numbering systems. All while documenting these diffucult patients. Messages saved to the paper chart and all the rest. Once they establish, give 'em their new in sequencial order regular number and away you go. All without ever letting the two co-mingle and having all the stuff from both sides recorded and saved...It may be a pain in the butt from a database, programing standpoint for all I know, but this is the reality of our business and the real flow of our offices, we need to find a way to allow this to happen in just about the fashion I have laid out here. It's for the protection of all the providers who use this program.

Thanks for listening....
Paul