Home Forums Discussions General Discussion Making encounter, Inbox etc

I am coming into AC from SOAPware which I used for some years.

I am having a lot of frustration with creating and encounter, managing inbox etc.

If anyone or more among you can help with some anwers to the following questions, I would very much appreciate.

1. How to deal with the the fact that you cannote have an encounter created, unless you sign off on the chart. Signing off usually means the chart is completed. In SOAPware, I could create an encounter for a particular date and I can add, edit it anytime I like until I sign it. That incomplete encounter would remain open for editing or addition until I sign it. In fact I could have several incomplete encounters on a chart.

2. When there are some 100 odd charts in the inbox, I have the impossible job of finding it. Being told that it is in the inbox is of no help because it does not help you find it.

3. When I pull a chart from the Patient List, it forces me to open "a new page" despite informing at the same time that it is in my Inbox. These warning boxes with Lock and Key logos, do not allow my to back away from the impending mistake or the wrong move I may be about to make.

4. Why not allow the incomplete encounters of charts to "float around in pool" so to speak so that anyone in the office can edit it or add information before the provider finally sings them?

You can save an incomplete encounter, which puts it back into your inbox. There are several ways to do this. Control S will save it, I generally use the forward and just forward it to me. If I hit forward then W it jumps to my name.

At the top of the inbox in the center is a drop down box that lets you choose all vrs various elements of the inbox (charts, labs, ect. ) This will make it more manageable.

I am not quite sure what you mean. If you click and say open chart, you are not opening the forwarded version. There are times when this is good. If you double click it will open the forwarded version and give you the opportunity to remove or keep it in your inbox. This is good, for example, if you did not mean to open that chart.

No real answer here, that's not the way it was set up. What it means is that others will not make changes you have to review in the interim. If you make changes and forward it is YOUR chart. If someone were to change the vitals, for example, unless they were highlighted or you reviewed the entire chart you may not be aware when you completed your charting.

There are a lot of different ways to chart, both paper and electronically. I played with SOAPware very many moons ago and not since, so I cannot really address how they are different, except to say that these were different choices that were made in chart handling and it works smoothly in the workflow once you get used to it. A lot of what we do is a routine. Once you adapt, that is NORMAL to you. Your previous experience (on the dark side ) had you used to a different workflow. Can't really say which is better, only I am used to this one and it works well.

Thank you very much for the clarifications on my questions. In particular, it is good to know that I can double click and pull the sought after chart.

Chock
Neurologist
Monroe, NC

Chock,

I came from SoapWare about 7 years ago so I can not comment on how it compares now. But, I do remember thinking the work flow in AC was difficult to get used to. Now, it is so second nature that the only two things I really miss are the ability to have shortkeys (which I have fixed with a program called ShortKeys) and the ability to call up just the physical portion of a prior encounter so it can be used in the current encounter. Give AC a chance. In time, as Wendell said, it will make sense to you.

I am sure I am going through the initial hurdles. I am so very thankful to all of you for your readiness to help. I am going to keep on posting my experiences with AC. Below is one more.


I pulled a chart that was forwarded to me and clicked "no" in the window that appeared thinking that I would not be able to complete the chart to sign off but I did complete and sign off. Later I noted that the chart did not disappear from the inbox, as one would think it should have.

If you click "no" you leave the originally forwarded message in your inbox. What you generally want to do is click "yes" delete it from my mailbox (I am dealing with it now and will do what needs to be done."

You might want to click "no" if you simply want to look at the prior visit more than what is visable on the message screen at the bottom right, but are not ready to deal with the chart.

I usually click on the next patient's chart while I am still in the room with the current patient so I know what I am coming into. Occasionally, I need more than I see on the viewer, then I will double click, say no, read and come in and double click say yes (I am ready to deal with this now) and remove it from my inbox.

Remember, if you screw up and remove it but didn't mean to you can go to deleted items at the top center and bring it back into your inbox. It may be gone... but it ain't dead.

Actually, if you read the message carefully, you should think that Yes will remove the chart from your inbox and No would leave it.

I would only click no for the reasons Wendell stated. Another good reason would be if you have a medical student working with you. If the note is good, I sign off on it. But, there are times the note is terrible or he or she loses it (even though it should be in deleted items), and I want a pristine copy right from the MA's desk.

I have more than 100 charts in my Inbox. I find it very difficult to locate the charts. Where a certain version of a chart is located is often a mystery. I had no idea that something fundamental can be so confusing. The problem is getting worse because the list in my inbox is becoming longer.

I am not sure there is an immediate solution(for me)but I cannot help expressing the frustration.

Chock,

I am not sure we can help because at least speaking for me, I am not certain of your dilemma. Let me see if I have it correct.

You have been practicing a bit and clicking on no all this time and, therefore, a lot of charts have piled up in your inbox?

How to sort these out? If this is the case, and the charts are serving no purpose there, then I would suggest taking care of it sooner than later by sitting down and fixing it.

Unless you are seeing the same patients over and over, then it shouldn't be all that hard to fix. It would seem that you saw patient A, signed it off, and you still have the triaged patient A in your inbox. If this is the case, then when you pull that same chart from your Patient List, it will have a recent note compared to the one in your inbox, which will be missing that note. It will also say on the bottom that the patient was last seen 10 days ago. The patient chart in the inbox will be later than that. Of course, it could represent the same patient that you saw two days ago and chose yes and decided to forward him or her back to your inbox. But, by comparing the two, you should have a good idea which is which. The charts in your inbox will either say CHART on the left or just "patient" on the left. If it says CHART, it will be rather simple to find out if it is the latest chart.

If it says CHART (depending on your workflow) at some point in time your MA or maybe you pulled the chart, entered some subjective data and forwarded it to your inbox. You then opened it soon thereafter I would guess, said no, and then worked on the chart and saved it. You would then still have another version of patient B, let's say, in your inbox. Before you even start, it is likely that any chart with CHART next to it, is a chart, which can be deleted. Just compare it to the chart you pull.

If there are two or three charts of that name with CHART next to them, usually the one on the bottom is the most up-to-date chart. Once you feel comfortable that the chart in the inbox is old news, then simply delete it using the delete button at the top right of your message area.

Now messages and other reasons for a chart to be in your inbox (labs or whatever -- to be honest I don't use the inbox for that so I may be off on this) are a different story. One of your staff could have sent you a message. In that case deal with the message, but for now, open it also and check its standing. For instance, you may have pulled patient C, said no, and signed it off. The chart in your inbox is no longer needed, but then your nurse sends you a message on Patient C. Now, you have a good copy of patient C saved to the database, a copy albeit without the last note in your inbox with CHART on the left, and the good up-to-date copy of patient C in your inbox. BUT, this will be a message recognizable by the "patient" at the left side. So, this version would be a copy you would want to keep but will go away once you save the message or reply to it.

Once you understand this convoluted explanation, you should be able to clean out your inbox in no time.\

That is if I understood your question. If it is the question, and you are still unsure, I can remote into your computer and get you started.

OK, I think I can simplify that. Made it pretty confusing. Again, this will be helpful only if I am interpreting your question correctly.

Just start going through your inbox. Take the bottom chart. If it is a message, highlight it and decide to either save it or reply. Either way, it will be out of your inbox. Don't choose no after replying. There may be a few times you want to do that, but most of the time you won't. I tend to want my staff to send it back to me until I sign it off so I can show I was the last one to read it and decide it is done.

I can't comment to much on labs and things that come directly into your inbox. Maybe someone else can.

Charts: Again, open these and decide if it still needs to be processed (a chart that was never charted on) or if it the one you left behind because you said no and then signed off the other chart. Most of the time just compare with the chart you pull from your Patient List.

Worst case scenario, you pull it and save it. So you have two charts of the same encounter. My database has charts in it like that.

Soon enough you will be through your inbox.

Bert,

Thank you for your attempt to clarify for me the questions I posted.

I think I am going to be wallowing in this confusion for a while.

Nevertheless, let me ask you something again.
Why can't I create an encounter without signing off? There is no option in AC which allows me to make an encounter (with a date) when the patient comes to the office. This requirement, which I think is quite against intiution, makes it very difficult because, once it is signed to make an encounter, one cannot enter anything further for that particular visit.
This is different from several other EHRs that I have tried.

The Inbox system, I wish, was designed for just messages and not for storing(temporary though it may be)charts. If the charts with their incomplete encounters could remain in the charts, it would have been much simpler. If someone else was working on a particular encounter, there should be a message or indication that that is the case.

I am beginning to wonder if it is just me that is facing all this hurdle.

Chock

Chock,

It is not just you. I do not use the message module for anything but messages (except on a very rare occasion) and reminders. I do not forward charts back and forth to staff. Charts are opened in the room under my log in and stay open like this even when the nurses are charting in them (I am solo). I finish charts and sign them off before I leave the room so I am not forwarding them to myself for signing later. My labs are not directly imported into the message box. I agree this is an area that could use some serious work.

Leslie,

Thank you very much for your note. I am in solo practice as well. May be I could do something like you do.

You don't mean your staff are entering their input on your computer, do you? Is it possible to for you to be longged on the same patient encounter on more than one computer at the same time?

What if you are working on two or three patients before you had the chance to sign off. Is it possible to keep more than one chart open at the same time?

Chock

Chock,

I have laptops in each exam room. I log on under my name every morning. The staff then room the patients and simply enter the Chief Complaint, vitals, update medications then lock the screen and leave. I enter the room, unlock the screen and do the rest. The chart is signed off in the room. And, yes, the staff does use "my computer". It can then be opened by the front office person to see what she has to do or she can wait until I leave the room, walk the 5 steps to her desk and reiterate what I want her to do. I can have 3 patients pulled up at one time in different rooms. You cannot log onto the same current encounter on more than one computer. You can however pull up a chart on another computer and review imported items or past encounters. Personally, for the way I work and the way my staff was used to working, this logging in and logging out stuff is a pain. If I were using a paper chart, you would not have separate sheets for each person who enters info. Ideally, with the EMR, there would be a very simple way to note who wrote what without logging on and off.

I have been using AC since June and was initially putting everything in my personal in-box. With all the imports,charts and messages, it was too confusing. Last month I directed the staff to put the charts and urgent messages into the PROVIDERS in-box. This has made it much easier for me to navigate among charts and answer messages promptly. I go to my own in-box by the end of the day to sign-off on all of the imports (letters/insurance cards/faxes). I do the same with my nursing staff in that general messages go to NURSING and specifics go to each nurse. We are all more satisfied with this system.

Thanks for the responses. I feel better now in the sense that I am not alone finding issues with Inbox system in AC. Users seem to have found their own ways to deal with the issue, which unfortunately is not a satisfactory.

Leslie,
So, as I understand, I can have, at a time, one patient's chart open and not more, though I can have more patients' charts open if I used correspondingly more number of computers. I can see that this would work reasonably well with your office system.

Today, I have been signing off even the encounters that are not complete for fear of losing information that is there.

One question:
If I wanted to enter further information on a patient in the sections on past/social/allergies sections on a patient's chart in between encounters, will I have to send the chart to Inbox? I can't send it back to Patient List unless I sign it in which case does it become another "encounter?"

Chock -

I also come from a SOAPware background, and I share your same frustrations: (we are *both* not crazy) It seems almost odd that, while working on one chart, if one needs to open a different chart, that the first chart needs to become permanently unalterable to view the second (almost the equivalent of being in high school and having homework assignment in your loosleaf binder rendered unalteralble if you dare close the binder before the assignment is finished) - Yes, one can in theory forward the chart (with the inherent risk of losing its contents) but I agree that solution is an ackward compensatory measure for a major oversight in the software.

I have recommended to AC (Via their recommend improvements) four Major suggestons :

1. Eliminate Default Erasing - chart contents should never, ever, ever erase except under the most extreme circumstances.

2. Allow chart closure WITHOUT locking the chart. Allow chart sign/locking to be ELECTIVE by the provider when the provider feels the note is comlete

3. Allow multiple providers/staff members (with sufficient security clearance) to open charts without having to forward them back and forth to each other (why give an EMR the disadvantages of a paper chart by being only in one place at one time)

4. Improve the letter-writer so custom letters can be generated from the chart fields, and proofread and altered even AFTER the patient encounter has completed.

The suggestion of acquiring multliple computers to view more than one unlocked chart is a testament to the need for further tweakning of this program. Keep making suggestions

Bruce Morgenstern, MD (Neurology)
Denver CO

Chock,

There are so many ways to do the work flow. These are all good suggestions.

First, poll choices 4, 5, 24 and 51 all pertain to your issues and are, by far, the highest number of choices involving one problem. The first three have a high vote count with 51 having only 7.

I think maybe you are making this too hard. In two practices, I have done it two ways, and they both flowed rather easily. I think the first thing you need to do is decide how you are going to work with your MAs. For instance, at my last practice, the MAs brought the patient into the room and triaged directly on my AC on my computer just like Leslie.

Now, with only two rooms, I have only one MA and a triage station, so she sees the patient, triages, and does the subjective, meds and vitals, then forwards the chart to me. When I unlock my computer and hit refresh (another issue -- we shouldn't have to), the patient is there.

Where I am different now than Solodocmom and Leslie is that I WANT the charts in my inbox with my messages. There may be two charts in my inbox, and they will usually be at the bottom. I open them, chart and ALWAYS sign them off. I like the charts going there, because when the visit is long, I can refresh and see if the next patient is in the room. I can highlight it and see the HPI and my MA has put the time in the HPI section, so I can see whether the patient is conjunctivitis, put in two minutes ago or extreme depression and has been in for 12 minutes.

I don't get labs or x-rays in my inbox, and everything else goes into my own program, so the only things in my inbox are Charts, messages and orders. The stat ones are red, the ones already done but just need to be checked and saved and blue, and the white ones I need to do something with. I also like the chart there, because OCCASIONALLY I walk into the room with a very sick patient, and I don't even open the chart, and after admitting them, I have to go back and chart. It's easy to remember.

Now, I do things completely differently than Bruce (we know that from past threads) and there is certainly no one way to do things. Basically, MA sees patient and pulls up chart, forwards it to me, I open it, chart on it and sign off. Again, this is nothing against Bruce as his practice is different, but I have never lost a chart in seven years. If the chart is forwarded to you, then you can't lose the chart (some charting can be lost, not good, and you can delete a chart to the deleted items folder (which should not empty when anyone closes the chart).

If you open from your patient list, then you can x out of the chart and lose it.

While I understand how helpful it would be to save a chart and then edit it, I do think that opens one up to medicolegal issues, unless that change is audited in the chart, otherwise you could changes things after the fact.

Finally, I wouldn't recommend signing off charts for fear of losing data. If you feel as though you need to save the chart, you hit CTRL + S.

I have never understood those that say they want to be able to work on a progress note, then save it without signing it off. Whether you pull the chart from your patient list or from your inbox, you chart as much as you want, and then save it back to your inbox. The time and date is recorded and the chart is there with all of your charting.

I guess I don't understand those who want to open more than one chart, simply because I don't use imported items. There have been other reasons, but I just don't see it as an advantage. This is not to argue with anyone, this is just from experience. In seven years, I have never needed to open a second chart. So, that says a lot at least for me.

So, either pull the chart from your patient list, chart, then save it or sign it. Or pull the chart from your inbox, chart, then sign it or save it.

The other safety valve if you pull your own chart or your MA does, is after doing the vitals and subjective, forward it to your Inbox. Then you can open it immediately, and it is safer, because if you delete it by mistake, you won't lose the subjective.

To simplify, try:

1. Pulling from patient list, charting and sign off.

2. Pull from patient list, chart and use CTRL + S to save to your inbox, then pull from there later, chart and sign off

3. Do the top two but start with a triaged note in your inbox.

I hesitate to wade in here. Others who are smarter and more experienced than I have already done their part. The issues are complex and hard to describe concisely. I suspect this is a discussion that would work better face-to-face.

Choc, and Bruce, I believe that a good EMR permits us to maintain our basic workflows with some adaptation on our part. On the other hand, to make things fit to the EMR, sometimes we first have to work to understand the way it is meant to function. Bruce, I don?t think either of you are crazy, and you raise some good points. Maybe it would help to re-envision the way the program functions by comparing it to paper:

Choc, think of the ?patient list? as the electronic version of your file wall of paper charts. You wouldn?t put a chart back on the wall with an incomplete note, in part because you would never remember that it was unfinished. So you would put it in a pile, or a ?box? of partially done charts. You could keep it in a box on your desk (your message ?inbox?) or you would give it to a staff member to work on (their message box). Only when the note is finally complete would you sign it and put the chart away.

So see a patient and do part of the note. If you have more work to do on it, but want to work on another patient?s chart, hit ctl-s which puts it in your inbox. If you want someone else to work on it, send it to their box. They will later send it back to you when they are done, and you sign it at that point.

I think this next paragraph is the key to avoiding a lot of confusion:
When you want to work on a chart, if you know it is incomplete, look for it in your message box. Open it from there and finish the note. On the other hand, if you aren?t sure if the chart has a partially done note or not, try to pull the chart from the patient list. AC will tell you that you have an incomplete chart; it will tell you that the incomplete (note) chart is in someone?s box. ***Some people think you have no option here and cannot ?back out?; but you do have that option. Usually at that point you do NOT want the version of the note that is about to open. Click ?ok? and the chart opens; the key here is to immediately CLOSE THAT ENCOUNTER. Now go to your inbox and find the same patient?s chart. The version there is the one that you want to work on. Work on it, and either save again, or sign.



Note that wherever the chart is, labs and other reports can be entered by anyone into the imported items area and they are saved to the chart; it is only the unfinished encounter that is in a temporary state.

Choc and solodocmom, are you aware of the way that you can filter and arrange your inbox? You can have it show only messages (since you sometimes don?t want to see charts there)?or only charts. You can also arrange them chronologically or by name (a little annoying since it is by first name, but still helpful). You can also toggle between these choices.

The issue of clearing out your backlog of old messages is perhaps a project for another day (or hopefully Bert, et al have already talked you through that).

Bruce,

I could not have put the recommendations more clearly and I hope you made them awhile back because the implementation of them could not come too soon.

I feel very much encouraged to continue with AC.

Chock Tsering, M.D
Neurology, NC

Bert,

Thanks for your clarifications. They do help.

I hope the recommendations from Bruce are getting some attention. I think they will definitely need to be included in the improvements in the future.

I don't tend to dwell too much on the legal issues regarding charting, as long as I am keeping my eyes on the patients.

I feel very much encouraged with discussions.

Chock

I feel a little awkward asking this question but how does one sign off on an imported item, that my staff has attached/imported into a chart and forwarded to my inbox? Basically to indicate that I have view the imported document.

Chock

When an item is imported by a staff member, it will ask them which provider will need to sign-off on it (an easy question if you are solo). As it is imported, a message is sent to the provider's inbox stating that you have a message on that patient to sign-off. Click on that message and it will open the "Sign-off" area and you will see the imported item. Click to sign off and you are done. (The message in your inbox automatically goes away).
Note that even before you sign off on the item, it is placed in the patient's chart. If you open the chart's imported items area you will see the item in red on the left side. Click to view it. You can sign off on it from there (right click on the item on the pane at left and "sign off" is one of the options given).

I have been saying this all along, and I can't agree with Jon more. I think one gets confused because of the two different places a chart gets pulled from. To reiterate a bit, let's look at the flow again. And, use the Jon analogy and another important analogy.

You pull the chart from your inbox (paper version -- the chart files), you chart...if you don't finish the chart and you sign it off, it is now considered a complete chart because you signed it and it is in the database. You can't put it back in your inbox. Signing it off puts it there. If a nurse triages, you had only a half-done chart. She can't sign it for multiple reasons, not the least it won't let her. So she has to park it somewhere. So, she sends it to your inbox. Your inbox is the same as the plastic doohingy on the door. Now, you pull the same chart but it comes from your inbox. The ONLY different than your pulling a virgin chart from your patient list and pulling from your inbox is that your nurse has entered vitals and whatever else in the subjective area you want to her/him to fill out.

Bruce makes a lot of good points and it has come up in the poll. However, in some ways we are trying to make this too complicated. Trust me, the letter writer issue and the II closed folder issue has been going on since time immemorial. This chart saving, changing, etc. is relatively new. Doesn't mean it is wrong.

You can always sign off a chart, realize it wasn't done and then do another chart again and state on it, it is a new chart. The addendum feature of ADDING DIRECTLY TO THE CHART IS INVALUABLE.

You can now add allergies on the fly. I still thing having the ability to add PMH to a chart without signing it off is dangerous. You could then also take off other data such as family history that you claim was invalid. The four family members with CAD in their 30s that you overlooked.

My guess is that new user are trying to learn a work flow too soon. When you buy a new car, it can take up to six months or more to learn where the headlights button is and the four different settings they now have.

Set up a dummy chart and chart on him or her 100 times until you feel comfortable. Tell yourself that you always pull a chart from your patient list, chart and sign off. If not done, forward it to your pile as Jon said until the evening except here it goes to your inbox. Play nurse and pull the chart, put in vitals and forward it to your inbox. She has to send it somewhere. Now, it is simple because it is right there and it says chart on it. Pull it, chart, sign it.

Do these things and practice. I think you will soon see it is fairly easy (I mean that in a good way).

No one on the board, and I mean no one, cares less about medicolegal issues than I. But, being able to change data after the fact, unless there is really good auditing, is dangerous. I can change from Access and beyond, and it is very tempting when that one month old comes in with a 102 fever and I didn't notice it.

You can make an addendum, which allows you to create an encounter. You should always have a note to go along with an encounter anyways. Addendum could just say, advance billing for visit on 3/3/11 but not finished. As long as you don't bill twice, when you finish the note, you will be OK.

You can only work on one chart at a time.

Amzing charts could not have made it any easier.I hope practice makes us perefect.
When you log in - your inbox/mailbox shows 1. Messages in brackets (Patient : XYZ) 2. Charts with out brackets : CHARTS as
CHARTS : Pateint XYZ.
You can click & open either your message or your chart. It gives you an option - 1. Do you want to DELETE the message or your CHART in your Mailbox - Yes or NO. If you choose Yes the Chart or your message is deleted from your mailbox. If you choose NO then you have the option of working on your CHART & signing off, but you will still have the CHART in your mailbox.
If you open that CHART , amazing chart displays the Date you completed the chart & signed off. The PAST ENCOUNTERS tab also list the date & time you completed the Chart.
Amzing chart has a wonderful feature that maintains the DATE & TIME the Chart was created that most EMR's do not have that option.
In you message box you have another AC feature to RIGHT click on the Patient chart or message & either write a script or an order to be sent to your front desk or your MA . The go head & reply to your message ( eg - Pt XYZ lab or script was done and where you forwaded it.
Grenville

I believe in all of you who have sung praise of AC. It is just that the conversion process, I feel, will take time and effort. Thanks for all the encouragement. I will certainly be employing all the techniques suggested.

One question:

Say, a chart has been forwarded to my inbox and I delete it. Does it go back into Patient List with inputs (hopefully undeleted) by the person who forwarded the chart to me? I thought this might help me deal the difficulty I am having as a newcomer.

JBS,

I click or highlighted a sign-off chart in my inbox but I did not see any imported item and there was no "sign off" option. I right clicked the highlighted item and saw no lead. Do I pull the chart containing the the imported data?

What is "task completed" box? This is not the same as "sign-off" is it? When I clicked this after highlighing one in the inbox, it asks whether I want to send it back to the sender? I said no and it stayed in my inbox. There was no reason that I wanted to keep it in my inbox or send it back to the sender.

Once you have delted it from yout inbox it is deleted.
You can still RETRIEIVE it by drilling down the INBOX and going to DELETED items & you can retreive it as long as you do not close or shut down AC.
If you do shut down or resart AC , I believe you wil lose the deleted items. Your MESSSAGES & CHARTS will still be there.

Just remember if you do not delte the CHART or the MESSAGE when you open them ,then it will stay in your inbox. If you want to know what was the last time you modified the CHART just look at the TIME you saved it(displayed at the side of the Chart in your inbox) & delete the rest you do not need.
Grenville

Chock, you are going to really hate me. But, as Grenville said, AC could not have made this any easier.

When you sign off on a chart, that chart is saved to the database. It is not sent to your patient list. This is actually saying the same thing, because since it is back in the database unchanged forever, you will be able to find it in the patient list. I just don't want you to think of it as its being sent back to the patient list as if it is separate from the database.

Again, this is not hard. If you are by yourself, pull the chart from the program's database by searching for the patient in the patient list. Pull the patient's chart, do a note and save it. DONE! If your nurse does this, she will pull it from the database by searching for it, she will do HPI and vitals or whatever you decide. She could just leave it as if you pulled it, but she is more likely to "park" it in your inbox. That way she can put as many there as she wants.

You now walk into John Smith's exam room. There is John Smith's chart in your inbox. Why? Because your nurse triaged him, did his vitals, and found out he has a fever and cough. You pull the chart from the inbox and do your note and sign it off.

Anytime you want to save a note without signing it, just send it to your inbox and "park" it there for later that day or week. When you have time, pull it and do the rest of the progress note and sign it off OR send it back to the inbox. 50 times if you like.

Why would you want to highlight the chart, then delete it unless it were the wrong chart.

1. If you delete it and retrieve it from the deleted items, EVERYTHING in it will be there.
2. The only exception will be (and it warns you), if you had opened the chart, added information, saved it back to the inbox. If you delete that one, you will lose what you wrote AFTER you pulled it from the inbox.

Let me tell you why you are making it hard. Do you see what I wrote in #s 1 and 2 above. I know this info, BUT I have NEVER done that.

I only pull charts that my nurse has done from my inbox and chart on it and sign it. That is so easy.

On a weekend I have to find the chart myself, pull it, chart and sign it.

Make a dummy chart, and this weekend, pull it and chart on it over and over and sign it. After you have done that 50 times, try forwarding it to the inbox. As SOON as you do, open it again, chart on it and sign it.

You are so making this too hard. You are worrying about charts that aren't finished and saving and losing data and where they are.

My secretary and I just waded through this thread. May we offer a suggestion that might appeal all:

1. When closing a chart, a dialogue box appears offering the option, "Close Without Signing"

2. All such unsigned charts are automatically forwarded to an "Incomplete Chart" box/pool/page (*independent* of the message box - though perhaps appearing as a separate field, or accessible through the drop down menu at the page's top.

3. All icomplete charts stored in this field are accessible to ALL security-cleared staff memeber (no forwarding back and forth!) Here the chart can be proofread, additions made etc

4. Only the provider (or perhaps staff with higher security-clearance) can "Sign off" the chart, which immediately renders it unlateralble and returns it to main file/storage area.


Bruce Morgenstern (and loyal helper)
Denver, CO

Not bad, but I don't see how anyone but a doctor and preferably the initiating doctor could sign a chart.

Bert -

I'm glad you think this may be a viable alternative.

To answer your question, when I had paper charts lying on my desk, no one ever came into my office, signed and refiled them for me without my permission. Unlikely someone else would go into my "Incomplete Chart" box and sign off my charts electronically either - I don't really see this as a potential problme and do not want to overly complicate a potential elegant solution.. But how about this idea: when a provider activates the "Close Without Signing" dialogue box, the chart can then be signed off ONLY by the provider WHO INITIALLY closed it without signing. (before then, however, it still remains accessible to the staff without forwarding back and forth)

Bruce Morgenstern, MD (Neurology)
Denver, CO

Bruce,

What you indicated are only suggestion, right? It is not possible to do it at this time. I think your idea is what I was thinking earlier, like a common pool of incomplete charts/encounters that anyone can add information to before a provider finally "Sign-off" on it/them.

Chock

Amazing charts is what it says - amazingly simple to use
So lets keep it that way (KISS).
I had the same problems what others have mentioned on this thread but working with AC I discovered how user friendly it is : 1. Keeps the date & time on the chart for completion whenever you decide to do it
2. Keeps messages in your message box until they have been addressed
3. The messaging system between my staff and staff works very well
3. The simplicity of the Electronic prescription
4. The ability to convert my scripts, orders to PDF files & send it your MA's. PA's etc helps me a lot.( Using the Preview Prescription button)

5. The restricitons of opening ONE chart at a time is really good as I can easily write orders, H&P, Labs on the wrong chart if too many charts are open at the same time.
Grenville

Hi Chock -

No, this was a brand new idea we came up with today after reading your entire thread. Unlike SOAP, AC may possibly be adverse to simply allowing non-Signed charts to be returned to the common pool, so the solution of an "Incomplete Chart" poolmay be more compatible with their philosophy. Probably like you, I also need access to complete a chart (and especially a dictated consult letter) AFTER the patient encounter has already been completed. This idea may be a good work-through. I've proposed it now to get some feedback before suggesting it to the Program Writers

Hmmm . . Neurology, and a previous soapware user - perhaps we should brainstorm . . .

Bruce Morgenstern, MD (Neurology)
Denver, CO

Choc, thanks so much for starting this thread. I'm also a newbie and struggling to figure out how to adapt our office workflow. Thanks also to Bert, JBS, and the others who contributed their experience.

It makes me wonder if there's a "Top 20 Threads for Newbies" list. I would certainly put this thread on the list.

Grenville,

Since you sing loudest in praise of AC, I hope you don't mind helping me with some simple(to you) questions.

What is "task completed" box for?

JBS wrote how I should sign off on "Sign-off" charts in my "Inbox" but I had no luck.
The following is what I wrote to JBS.

JBS,

[b]I click or highlighted a sign-off chart in my inbox but I did not see any imported item and there was no "sign off" option. I right clicked the highlighted item and saw no lead. Do I pull the chart containing the the imported data?

What is "task completed" box? This is not the same as "sign-off" is it? When I clicked this after highlighing one in the inbox, it asks whether I want to send it back to the sender? I said no and it stayed in my inbox. There was no reason that I wanted to keep it in my inbox or send it back to the sender.[/b]
Can you help me with this?


I think you mentioned something about arranging the names in "Inbox" in alphabetical order (even if they are with first names) How do you do that?

I think I am going to be posing a lot of questions, natural in someone new to the program. All help from anyone and everyone is appreciated.

Chock

I think I am going to revive my long dormant call for Bert to put up some "stickies" on the forum.