Home Forums Discussions Problems How do I copy a patient's record to a CD etc

I have patients that would like to have their records copied to an electronic medium rather than printed out. Similarly, I would like to be able to send patients records to other doctors electronically. I assume their is a way to do this in Amazing Charts but I have not been able to find it. Thanks, DDW

Download some type of program which lets you print to PDF - I use PDFill.com - go to past encounters and under File - pick Print Partial Chart - print to PDF all old visits - then use PDFill.com to merge charts - I merge that Partial chart and then go to AmazingCharts directory - Imported Items under that pt. chart number and choose all. It will create one large PDF file with all visits and imported items - seems cumbersome, but after doing it a few times it is very easy.

UpDox allows you to do this as well.

Similar to most of Steven's post. I use PDFreDirect... print to it anything you want to combine as one big PDF. Even easier if you temporarily set PDF-reDirect as the default printer... I print the chart sans imported items, then from the Import Items viewer, selectively print the files. Then save the file and set a password (still with PDFreDirect). I copy that file onto a blank CD, along with a separate ReadMe file that includes details about the file being confidential yada yada yada, and hinting to the password category for the patient.

I posted a similar topic awhile back. I still think that it is a miss in the programming that there isn't a simplified way to copy a record to CD for a medical charting program. I have contacted AC to tell them so and encourage you to do the same so that maybe in a future release they will offer this option.

For those of you using the PDF programs, I have two questions. First, is there any way to organize them into a reasonably usable format? It would be nice if the next doctor getting the records could actually use them.

Secondly, it doesn't seem to be much different to use the PDF program than to simply export them or save them to the disk other than you are printing them to the program instead. Is there something that I'm missing in your description that is the time saver or is it simply the file format that's helpful?

Thanks for your help!
Amber

Similar question... is there anybody trying to import records directly into the main body of AC rather than into imported items? I could see making a new encounter with a CC of "old records" and then cutting and pasting the text into the HPI field, for example. It strikes me that having old records as PDF files in imported items pretty well negates any value over paper charts other than not having tons of paper to store.

And, what if the other physician is also using AC? Is it more possible then?

I find when I am picking Imported Items it can be difficult to figure exactly which I need. It would be nice if the Imported Items were stored with filenames related to their descriptions.

If you import using UpDox you can import with a descriptive name and make your own category; like "normal colonoscopy" under a category "endoscopy."

[/quote=Amber]Secondly, it doesn't seem to be much different to use the PDF program than to simply export them or save them to the disk other than you are printing them to the program instead. Is there something that I'm missing in your description that is the time saver or is it simply the file format that's helpful?[/quote]
What format would you be exporting in?

Also, there are many 3rd party CD burning programs and Windows has its own built into Explorer. Are you saying that AC should have a CD burner as part of the program.

@David Can you elaborate on the cut and paste to HPI for imported items?

Bert,
In my eyes, the central advantage to an EHR would be the ability to visualize each physician encounter, by whatever provider, sequentially, so the cardiology visit notes would fall after my last visit, but before the nephrologist if that is how it happened. Currently, all notes from consultants just live in imported items as PDF files, and they lose the critical quality of temporal placement. If I were to be able to copy the text from that note, however, and put it in as an encounter note (or addendum) and label it appropriately, then just by looking at the past encounters that consult would flow in sequence. Is anyone doing that? What is the easiest way to translate a PDF file into text? And, is it at least theoretically possible to export/import from one AC chart into another if the other physician is also using AC?

I see. Thanks for clearing that up. That is a great idea. I am not sure how you would do that. I am sure many EMRs have that functionality. I know if I ever left AC, I would take a good hard look at Praxis again. Very steep learning curve but different than any other EMR that I have ever seen.

Yes

I use the compatible parts. I buy from Inksell.com

Bert,
No, I don't expect AC to have an actual CD burner but I would like a simpler output option. As it is now, you need to go through multiple steps to export an entire chart to disk and this is not a streamlined process like I would expect. If you choose to export imported items with the chart then each individual item pops up in its own window and needs to be hand exported to the disk. There is no option of just choosing a patient and saving. This is the "easiest" way I have found to do it:
Step 1: Open Chart (highlighting and choosing "print formal health record" doesn't give you the entire chart)
Step 2: Go to "Past Encounters" Tab
Step 3: Go to "File" then "Print Entire Chart"
Step 4: Fill out records release info (or skip)
Step 5: Check mark "Imported Items"
Step 6: This may be the change listed above? You can't just choose "print" or it goes to the default printer so I choose to preview...maybe their file writer program is the "default printer"
Step 7: Each document or set of documents pops up in its own window. For the test patient I am using while I write this, it was 19 windows and we've had our EMR for less than 1 year (what will it be in 5 years???).
Step 8: Save or export each file to disk as works for that file type (Pdf is save as, AC notes are export, excel file is save as, ect.) Since I have to hand touch each one anyway, I choose a file name that fits the document making it more usable otherwise it saves as a random file name
Step 9: Repeat for each of the remaining 18 documents
Step 10: Burn to disk
This seems like an awful lot of steps just to get the information from our EMR program to a disk, not to mention that one of those steps would be repeated as many times as are documents and someday that could be in the hundreds.
I contacted Angel support and went through the steps with them and they admitted they had no better way.
Anyway, I am just trying to find a more efficient way and was trying to see how, specifically, the pdf programs were improving that process.
Thanks for your help Bert am hoping you have the light at the end of the tunnel on this one.
Amber

I'm sorry if I offended you on the CD burner comments. You are right. It is a horrible process. Which is why I don't use imported items.

I can generally burn a CD with a patient's records in less than five minutes, depending mainly on the time it takes to burn the record.

I also never send messages as there generally are comments in there that don't need to go with the chart. To be honest, I sent all progress notes, immunization record and what would be in Imported Items.

Prior to using my own program for all files not in AC, pretty much used the PDF theory. You have to commit to making sure that everything that goes in imported items is a pdf. So, a lab faxes in as a pdf. An x-ray faxes in as a pdf. All other faxes pdfs. If I print a letter from AC, I print it to pdf, and my staff would then import them. In this way, everything in imported items were PDFs.

At that point, I would then go to Pull Visit History and click on Progress Notes Only and then choose Print at the top right, I would then choose my Adobe print driver and "print" it to the imported items folder of that patient. So, if it were patient 1256, I would browse to the \\Server\Amazing Charts\Imported Items\1256 and print the progress notes to that folder. Now I have the 20 PDFs plus the progress notes. I then, unfortunately, would have to go to the summary sheet, find the immunization record, and print it to the same folder. Luckily, the path is remembered by Windows. Now, I have 22 PDFs. This process takes about 45 seconds.

Now, I am not sure about other PDF software and it is not that Adobe is necessarily better, it is just what I have. I then highlight the files, right click, select Combine supported files and then arrange them the way I want, which is generally Vaccine record, the PN then records and letters. I then choose Next, and the files are merged. This process takes about one minute. (literally). I then right click on the resulting merged file and select send to my CD burner and walk away. Five minutes later, it is done.

I use my method - works well to make one PDF file. My real assumption is that unfortunately most offices don't really read all the notes they request and that just opens them to liability. On most non-complicated patients I would just prefer getting their last note, most recent labs and a recent mammogram - just my input.

Basically, just like mine for the most part. But, you must have mostly, if not all, pdfs in imported items to merge them.

I think that is the part Amber doesn't know about. A) keeping everything PDF and B) that she can go directly to the Imported Items folder and work with the files there. Unless you are merging HTML and Word files into PDFs.

My gut reaction is to go with Steven. A physician recently retired here, and did pretty much that... the last chart note was a summary... and it was great. But, I know Amber is looking to the future when we eventually retire, and patients are entitled to ALL of their records. I know this, because she works for our office. There is a big difference between what works best, and what we are legally required to provide. The total record times a few thousand patients is an awful thought.

In our state, you only have to provide the records you generated. Now, I think that is pretty lame, so we send the whole record. We can also send a summary letter, although I never have as I am sure this would meet with way too many problems. I think that works best with psychiatrists.

Actually, come to think of it, there is no statute requiring one to give any records to anyone after they retire in the state of Maine.

But what works best and what is legally required to provide can be the same thing.

Amber, if you don't check the Imported Items box (step 5), those items won't automatically pop up in their native program. I always thought it annoying that it did open all 80 imported items at one time, and you have to address each one... so it's much simpler to just preview (NOT open in it's native program) the imported item in the AC window, and click the little printer button to send it to the PDF print driver (especially easy if the print drive is temporarily set as the defaunt printer)... whatever can print can go to it... even the EKGs via Midmark interface, with margins intact... so it doesn't matter what the file format is, it will become PDF... and PDFreDirect collects each file printed into one superfile... so the "Combine" function in Adobe is not necessary, and it creates only one file that your are naming/saving... and you can set a password protection on the file, which I find invaluable... since I don't think a whole chart should be floating on around on a disk without such protection.
Using the previewer in AC to selectively identify what to include in the released file is important, I believe. By just going to the ImportItems folder where the actual imported items are kept, and choosing to combine all of them into one file allows it to include unnecessary items like copies of certain Rxs, and other things I don't think anyone else would really find of value... unless you were trying create a chart with as many pages as possible to increase the amount of whatever reimbursement you seek ($/per page).

So, print the progress notes to PDF, then selectively the imported items... it really is easy/quick.

I would want to make each as a PDF, not keeping the Word or Excel files as editable documents... you never know what a patient may do with these documents in a format they can edit. Sure, as a .xls file it "might" be more usable for the next provider in a constructive fashion, but not likely. And saving each as a separate file is a lot of "hand touching"... too much work... just send to the PDFreDirect print driver.

Again, as above, I'm not sure how "useable" I would want them to be. How far do we have to take it to make the created patient's medical record "useable" for subsequent providers? Do we have to create versions of it in 5 different languages, or compatible with ALL software programs... eventually the format will be more standardized... but considering most providers still don't even use EMRs, a PDF file is still a fairly universal way to provide information that can at least be functionally used by almost anyone.

If you run an OCR text recognition (at least on my Adobe and/or scanner), it will convert the text to a format that can be copied/pasted into your note. Of course, this won't work very well with copies of chicken scratch notes that I usually get from prior providers, less often from consultants.

I agree.

I also know that I have discussed with one of the programmers at AC and they were trying to make it possible to print all records based on date range, etc - this would allow you to choose all records for a pt including imported items and all chart notes - this is great for when insurance or an office requests last 5 year's notes, etc. I think they will get this working after the MU and PM is done.

P.S. Note to David - just tell Amber there is no retiring until AC is perfected......

Chris,
Great post!

I do about the same thing but I print to the Paperport Desktop, stack all items and then either burn a CD or fax them out. I do have Cute PDF also but Paperport works just as well for us.

Bert,
Thank you and no worries, I wasn't offended. I like the idea of going directly to the server for the files and will look into that.

Chris,
Very detailed and I will look into some of your suggestions. To fully understand, I think I need to walk myself through the process.

Steven,
It's David you have to tell not to retire, not me. But please, feel free to remind him of that.

I do appreciate all of your suggestions and I will look into incorporating them into our office processes. Unfortunately with the way we do our charting, imported items are a must and with our records retention laws, we have a potential for a nightmare in the future when David does retire as we are required to offer the full records even after our doors are closed.

Again I am hoping for a future release that simplifies this process. I guess I assumed there would just be a "print to file" or "save to disk" or "export file" or whatever option that would just wonderfully allow a full copy of the file to be exported to CD. Clearly this is not what we are offered even though the process can be made somewhat less cumbersome with the suggestions here. FYI, I did go to our statewide EMR conference and this was offered with many of the other programs but for the price, I think my 5-10 minutes on each chart may make up for that.

I have spoken with AC many times about this and stressed the importance of a feature which allows you to export records or print all records and I think they will get this working - just takes time.

A couple of thoughts about this process.

I understand (and agree) that an easier way of doing this would be useful, but the whole concept of "copying the record" is not as simple in the era of an electronic record. To state the obvious, a patient's record is maintained by a program (or a series of programs). There is no universal standard for looking at a record, so unless all patients and docs have a version of AC available to them, they won't be able to see the record like you do. The most you can hope for is to put it into some form that is generally readable. So you start with a chart that is part-AC and likely includes various other formats. Then you switch them to (probably) a text, Word, and pdf format (or a combination of these). It may be a bit much to expect your EMR to convert that chart "in one click" to something easily viewable.
In addition, we generally want to help out the doctor or patient who is receiving the files, so some editing is in order. It is easier to copy it all, in no particular order (analogous to putting a paper chart on the copier and printing it all). Usually, you will want to be somewhat selective and order the documents in a way that is more useful. Again, I don't think it is realistic to expect AC to do that with a single click.

When I want to make the process as quick as possible, I do it in three parts:
1. Print demographics (I usually print to Updox; you can use a pdf "print" program as described above and "print" to a cd).
2. Print progress notes (go to "previous encounters" and print as in #1).
3. Navigate to the patient's "imported items" folder. This is on the server; the folder has the same number as the patient's ID in AC. Copy that folder to the disc or other media you will be sending.

This seems to work for us.

I agree with Jon. But, it is not so much a record being out of order (which is bad but can be attributed to the other office not paying attention), but it is when they come haphazardly with some in the right direction and some upside down, with black copies and blank pages, etc.

As I mentioned, I think there are two scenarios.

One: the occasional patient is leaving town, or seeing a consultant. I want to make that transition as smooth as possible. I will be selective, probably do some capsule summary.

Two: 2,000 patients need their records. As nice a guy as I am, the provider who follows me is going to have to do some digging. I'd like to send what I have in a chronological order, and make sure everything is there, including notes from consultants, labs, etc., but I can't afford to edit and label everything. There needs to be a purple button in the menu someplace that says "dump everything to disk".

And Jon, you again point out my biggest rant about the EHR: the lack of a common data storage standard and inability to cleanly import records. If I had been emperor, I would not have dreamed up giving money to doctors who adopted a random program; instead, I would have taken all of that money, and given it to Google or Microsoft and told them to build the EHR equivalent of Word or Excel. Then I would have given it away for free, and simply said "if you want to get paid by Medicare, you have until January 2012 to put this in place."

Agree totally, we need standards for an EHR, by a company that has a proven record for setting standards. Not Uncle Sam.

David Grauman for emperor!

Then maybe Google or Apple, but not Microsoft. But, I think Google and Microsoft need no more money.

How about Mark Zuckerberg or Sean Fanning. If they can get to billions out of a dorm room...