Home Forums Discussions Problems Add meds to active list without prescribing

As I am just starting with AC, all my patients are being added to the AC database, new and established patients. I want to add medications a patient is already taking to the DB so that interaction checks will be performed. However, I don't want to "write" new prescriptions for these meds.

How can I add the medications to the active medication list and have the medications listed in my first note as medications and not as a "PRESCRIBE:..." line added to the plan section?

Open the Summary Sheet tab with that patient's chart window open, and click on the "Edit/Refill" above the medication list to open the list of meds.

Does this add them to the list without adding any information to the current encounter? I'll give it a shot.

Yes

I add med to the list without prescribing through the prescription writer and just leave out the quantities. Then I know that I didn't actually write a script with there being no quantity entered or refills.

Just double click on the active medications window and then there will be a new window popping up to add medications. It also has room for who prescribed it and what it is for.

Also where you can easily add meds given by ER or consultants to reconcile, or also to delete old medications no longer taken, rather than deactivating them in the write prescriptions tab.

Both will work, but the Write Scripts will add a line to the plan and using the active meds window will not add the line and will update the active med list for the current visit.

A word of caution, if you prescribe medications using Write Scripts and then double click on the active medications window, the new medications will now be in that list also.

Greg

A question in that same vein: basically I'd like to *Prevent* having my newly prescribed medications appear in (pre-existing)current meds box until *after* my consult letter is finished. . .

As a Consultant, I typically first write scripts for my new patient consults using "Write Scripts" box on the right *before* I've written my note.

After the patient consultation is fininshed (including newly prescribed meds), and I then write my note, I then fill in the "Current Medications" (by double left-clicking which summons the "current medications" box). Entering the patient's pre-exiting medications, however also automatically includes my newly prescribed meds as pre-exiting ones - which they aren't yet.

I'd like to keep the medications I've just prescribed *out of* the current medication box untl *after* my consultation letter has been written (after the letter has been written, then I am happy to update current medications with my newly prescribed meds, but not before.

ANy suggesions on how to do this?

Thanks,

Bruce Morgenstern, MD (Neurology)
Denver, CO

I think that currently there is no way to do this with the work flow you have described - you will have to enter meds they are on first. Unfortunately this I think was designed so that when you write new scrips the medication interaction checking, etc is done. I realize you look at their old meds probably on paper and do your own mental interaction checking, etc - but one of the 'meaningful use' criteria is interaction checking.

Bruce, I may have this all wrong, but I think you are making this way too difficult. I guess part of it is I ONLY use the Current Med List writer for current meds. I never use it for a list of current meds in which case you get just what you describe.

My suggestion would be to first pull up the Current Med List writer by double-clicking in the current meds list on the left and adding the medications they came in on. Then in your note write your new medications. When you finish both of those things, you now have current meds they came in on on the left and newly prescribed medications on the right, which is how they should be. I don't think it is a good idea to "update current medications with my newly prescribed meds but not before" If you do this (and I may be reading you wrong), the saved note will now show that the patient came in on the medications you prescribed.

Now for the letter. If you have the current meds ahead of time, then prescribe three new medications, when you sign the note, your new meds will populate your current meds. BUT, when you write the letter, there are two check boxes for choosing meds. The check box under Subjective will only list the medications the patient came in on. The check box under assessment will list all of the medications the patient is on.

I don't know if this helps.

Bruce,

I agree with Bert. You are making this way too difficult. Rather than try to make AC totally fit your work flow and desires, you may have to bend a little and make some concessions as to how you have done things in the past. No EMR will fit you personally unless you write it yourself and, even then, you may not be able to actually make it fit. Software is rarely (ever?)as flexible as the human mind.

Thanks for the double-click information, that was new to me.

After reading the message that would pop up when I started typing in the medication box, I thought that double clicking got me the rx-writer since that's what comes up if you "yes".

May I suggest changing that message to clarify that double-clicking in the box gets a med list, and clicking "yes" gets the rx-writer.

First, there is a lot of confusion about the medication logistics. Not saying I am not confused. It just is.

In my opinion, the Current Medications window should NEVER be written in, therefore, not bringing up the prescription writer. Any new meds should be written on the right side (the objective side), which is how it is in a SOAP note. In 5.1.6. if you do write in that window a popup window is much clear as to your options.

The current medications field should be for medication reconciliation, e.g. a patient who transferred or comes back from a consult. You enter the medications there, BECAUSE THEY CAME TO THE VISIT ON THAT MED. You can also remove any medication they are on. That box should be for medications that a patient comes in on. It should not be for CURRENT MEDICATIONS.

Currently, IMHO, the system is flawed given that any newly prescribed meds are added to the current medications so that when you save the note and then open it again, it appears as though the patient was already on the medication you prescribed. If I see a baby and prescribe Zantac, it should show in the note as prescribed that day and not as a medication they came in on. To say that this box is for the updated current meds is correct but confusing and not useful.

There are three groups of medications on a chart:

1. The meds the patient came in on
2. The prescribed meds
3. The updated med list

Currently, the Current Medications List is serving a double role as updated med list and meds patient came in on.

One should not have to bring up the Current Medication window (large grey box) to see current medications.

Again, in my opinion, I think it would be more accurate if the chart had MEDICATIONS PATIENT ARRIVED AT OFFICE ON in the left hand bottom window on the subjective side, THE NEWLY PRESCRIBED DRUGS IN THE PLAN SECTION, and either another box for updated med list. Or even better use one of the tabs under plan for updated med list. All three would print in the proper place in the note, and all three would still be present when opening that note both as the present encounter or Past Encounters.

The letter writer should reflect all three of the above.

I HATE TO SAY IT, BUT THIS IS WHERE LOGICIAN/CENTRICITY HAS IT ALL OVER AC, even if it is formatted poorly.

One of the things Jon said in the updates was that the left hand box would be locked. Apparently, that is not true.

Hi Bert,

A thought: you mentioned SOAPware. The lay out of SOAP's main chart is to place on the chart's LEFT side all the fields that ( a) stay constant (Family History, Social History,etc ) or (b) contain lists that are constantly updated and referred to (Medication List, Problems list, Intervention list).

The RIGHT side of the chart contins the components of a new encounter that change with each visit- Subj, Object, Asmnt, PLan & Meds . The layout looks something like this:

CHART LEFT SIDE: CHART RIGHT SIDE:

Problem List Subjective
PMHx
ROS Objective
Interventions
SHx Diagnosis
FHx Assessment
Allergies Plan
Current Meds Prescribed Medications

I know you are working hard to improve AC. - I didn't get a chance to suggest this layout before yesterday - but I'm wondering what you think?

Bruce

Addendum: (message didn't fully print)

The RIGHT side of the chart contains

Subjective

Objective (Exam)

Diagnosis

Assessment

Plan

Prescribed Meds

(Bruce)

Bert,

As in the recent thread on diagnoses/problems, I agree with you 100%. I just upgraded to 5.17 and the current medication box is now completely locked to whatever has been prescribed in the current visit. And the behavior of the letter writer is strange -- populating the meds field with whatever was originally in the med list at the start of the visit.

The med list field should behave more like all the other fields: it should originally be populated from the patient's current medications, but then should be writeable in, to reconcile with reality.

If a patient is on propranolol 10 mg tid, that should show up when the note is first created. But if he isn't taking it, I should be able to either delete the line, or write: "hasn't been taking for 2 weeks, ran out" next to it. I think this is really important.

Then, if the patient agrees to restart it, and it's left in the medication list, it would again show up in the updated med list.

I think this is basically what you were suggesting, and it's the first really big problem I've seen so far with AC. The problem/diagnosis thing is work-around-able, this one doesn't seem to be.

Michael Jacobson

addendum to my previous post

Have now played around with the various rx options, and I think I have a better understanding (also I think a bug?).

When you pull up the current rx list from that box, it gives you what the patient is currently on. You can reconcile that with what the patient is actually taking and delete and add meds. This then reflects what the patient is taking at the start of the visit.

To make changes to the regimen, you have to use the prescribe button. I was trying to make changes by using the same current rx list, which doesn't work, obviously, since the new meds now become part of the old meds list.

But when you make a change using the prescribe button, the medication is prescribed (or inactivated if that's what you're doing), and that change is noted in the plan but the current rx list isn't changed.

So the final note will reflect the old meds (as reconciled) and the new meds that have been prescribed.

I think there is a bug, however. When I click on "add updated med list to plan", after having prescribed stuff, the old med list appears, unchanged.

Interestingly, when you create a letter based on this visit, if the exam is part of your letter and you click on the "updated med list" check box, the correct, newly prescribed meds appear. But in the copy of the note, if you attach it, it's the old rx list again. So the updated rx list doesn't seem to work for me in most places.

But at least I have a better handle on how to use the current meds list to document the meds at the start of the visit.

Michael Jacobson

Michael,

Can you go through your reconciliation and Updated Med List step by step? I can't seem to reproduce it.

Sure.

When the patient comes in and the most recent note tab is open, I double click on the medication field and the current med list pops up.

I make any and all changes in this form, stopping meds they aren't taking, adding meds and changing doses. The current med list and the corresponding field now reflects exactly what they're on.

I go through the rest of the history, physical, etc. Fill in the other fields. At the end of the visit, when I'm making treatment decisions, I use the prescribe button at the lower right to make prescriptions (which brings up the prescribe screen). Can also delete stuff I don't want them to be taking anymore from this screen. I hit prepare prescription, then prescribe (even if I'm not printing an rx or e-prescribing).

When that is done, the new prescriptions are written into the plan section ("PRESCRIBED: xyz"; I can delete those lines if I want), but no change has been made in the current medication box yet! Now you have to sign the note, and the signed note will reflect the corrected med list from the beginning of the visit, along with annotations as to what you have changed in the plan. This will show up in any subsequent printing of that note, as well as in the detail in the history tab.

The key, as someone pointed out earlier in this thread, is not to double click on the current medication box or otherwise bring up the current med list after you have prescribed the new stuff and before signing, or else the current med list will be reset to the status AFTER you made those prescriptions. That's what was messing me up, I think.

Finally, once the note has been signed, the "most recent encounter" will now reflect the new meds, but that's by design I assume. I think the description "most recent note" is a misnomer -- it's really the "new note". For the most recent note, you need to go to the history tab.

HOWEVER, as I mentioned in the previous post, I think there is a serious bug. If, after you have reconciled the current med list and also made your prescriptions, you hit the "add updated med list" button, it will not put in the changes you made with your prescriptions, it will just put in the reconciled med list, which is not at all what you want. It should insert the new medication list. This is a bug, and needs to be fixed.

Hope that's clear (and that I'm correct!)

Michael

A bigger issue is what if you like to prescribe first and then realize you did not reconcile meds? I don't want fields changing until I sign off.I can adjust to this behavior if I must, I just would like to know if plans are to fix it in the future or not.

I am not sure if I agree with everything said, but it is getting awfully confusing. Anyway, I made a video that can be downloaded here:

http://www.box.net/shared/static/i301dyrq7h.zip

The part where I do the letter gets a bit disorganized, but is ok at the end.

This is great, Bert, I love it! What program do you use to capture the screen?

Basically this illustrates everything I was saying, I think.

1. When you correct the medication list on arrival, and then prescribe some meds at the end of the visit, the corrected med list on arrival remains the same, the way it should.

2. In the letter, the current meds reflect the corrected med list on arrival. I think that does make sense, as you showed in your letter -- when the patient came to see me, he was taking blah blah.

3. In your plan, in the letter, you note what changes you made, and the updated med list reflects the patient's med list when he left the office. That's fine.

4. And again, as I mentioned, the updated med list works for the letter but not as part of the original note! That's the bug. In the Plan section of the original note, the updated med list should show what the patient's meds were when he left the office, just as they do in the letter. This is the one place where I think it's a mistake and where it doesn't do what one would expect it to do.

Great video!!!

Michael

Thanks Michael.

http://camstudio.org/

Bert,

That video was fantastic!!!!I think you have just increased your work-load exponentially. Now everyone, including me, will want you to show them how to do such and such. Thanks for the great addition to this board!

LOL. Wait to I start adding the audio.

Ummmmmmmmmm....gee, that might be too much for us!