Home Forums Discussions General Discussion Final Development Poll

Hey Bert,

In Utah, and I think most states have similar laws for stimulants, we can write for three scripts. When I post date under the refill area is translates into the note that the medication was discontinued and I have to manually change it.

If you have a better way for post dating add rx I would love to know.

Thanks

We do two here. Plus, that gets them in every two months.

We don't put them in the actual script. We have a stamp that we put on the second one.

Bump

*tiptoes in*
Could we have the letter the doctor prints for pt visits have more than the plan on it? Sometimes they take the notes to their specialists. Or rather, I'm asking if the note can be printed but we can toggle the ICD-9 explanations off as that actually caused one of our pts to sue us for defamation of character...

Also for usernames to allow a space. We have two staff members with the same name spelled the same way.

And the ability to say when the last health maintenence was done, even if it was years ago and to calculate the next one according to pt diagnosis/time frame. That's one thing our doctor has been very frustrated and focused on.

Bump

Fix the practice Rolodex.
This is another topic that has been brought up by an assortment of people over a period of years. I suspect that it would be more of an issue, but many of us just abandon the AC Rolodex and use another contact manager, so we don't bother to complain about the limitations of the AC version.

James and maybe Indy will take me to task if I minimize the effort involved, so I will put it in the form of a question: Is it difficult and time-consuming to create a database program to function as a contact manager within an EMR?

jill:

defamation of character for the icd-9 codes? now this is seomthing that i am dying to know what u guys used!

it would be nice to have a flagging system so that whoever last "touched" the patient can tell the others where the patient is.

He had been previously diagnosed with paranoid schizophrenia from a hospital psych stay, and Dr. diagnosed him with bipolar disorder which then printed out on his progress note, along with the MA's name because I had originally set up the timecode stamp system so doctor would know who brought the pt in, etc. He called us immediately after leaving and began to threaten staff (specifically the MA) with physical harm and then sued us for defamation of character when we discharged him from the practice. He has three other suits going against two previous PCPs and one hospital for the same reason. All this happened in one month's time, too. He's a character!

I would like to second having the rolodex be tweaked. I love it as it saves me a bunch of time from looking up names/numbers in our various binders, but it would be nice if the provider number came up in the plan section for patients to call. It would save even further time for everyone in the office. We normally tell our pts to call provider and get the address from them as to where they're located (sometimes they move and we don't have the new address yet or they're no longer associated with certain facilities) so having the addresses pop up isn't that neccessary. Numbers would be *great* though.

I would think that Bipolar is a helluva lot better than Paranoid Schizophrenia.

I think he should be blaming his parents.

One thing I think should happen especially if they lose the case, is their name should have to be put on a registry that they sued a doctor for what reason. This way we could all look these patients up and say, "Sorry, you have sued one too many doctors."

Bert,
That would be nice, wouldn't it? We'd have avoided a few more characters that way. Should be a national list broken down by state.

Sadly this gentleman isn't even the meanest/weirdest of our patients.

I think I would rather have someone be mean to my staff (not really) rather than just fax me a release form. And, I am like, huh, where did that come from?

Jill:

Even if this doesn't come up on the letter, you know the patient can always ask for hte diagnosis. . .so either way you are in trouble with the patient...but really i wouldn't worry too much about it. . .

The letters can be altered to include whatever you want on there. You just check the stuff to the left.

A diagnosis is a diagnosis. If they have it, you should put it in their chart.

As far as writing things like "suspect child abuse," that's different.

We used to just print the progress note because the letter requires all the sign offs (if I'm remembering correctly). Now we just print pt instructions as it doesn't have the codes and details on there. Also I agree with Bert--if they have it, that's just it. I've gotten yelled at by numerous pts for some of the more common diagnoses because their plan doesn't cover it or because they were offended. Can't change what you actually have. It's fraudulent and the doctor (who has a degree in this and continued education) thinks you have it. You have it. Deal./rant

Can't predict human behavior 100%. Just live, learn, and move on.

It would break my heart to see child abuse in the office. I would have a hard time not socking the pt's parents in the face for that. Bert you must be amazing to be able to deal with that. We see elderly abuse (still breaks my heart) but with children...I'd be incredibly fired.

Doctor was wondering: is there a way to link up diagnoses with Health Maintenence so that it'll show the need for screening based off past diagnoses? I forget, was that a suggestion?

I agree, diag is diag, we shouldn't fear patients suing us for it. As for the letters, I was just saying that if you wanted to curtail your letter that you print you can do that with check offs. And I think the letters should have the diagnoses in there. My letters are all two lines saying hey saw your patient for [X] and i fill it in and then add the notes to it. if the other docs want to keep the note thye can, if not they chuck it.

A lot of this is brought on by the medical establishment: e.g. somehow calling gastroenteritis the flu, so that patients don't know the difference between "stomach flu" and Influenza. Drives me crazy to hear it mixed up in the room.

So that led to making HIV this horrible thing, so that one had to sign a special form just to have the test.

It kills me when I see a release form and the patient checks off you can't send mental records. Why is mental illness considered so bad? And, then you have the four year old girl whose only illnesses were the common cold and an ear infection, and the parent checks off the box saying can't send mental illness.

Jill, you should have a form when they first come in and fill out the demographics, et. al. that says:

1. If you have an illness, do you want your doctor to diagnose and treat it? _____ Yes _____ No

2. If you answered yes, they you agree that your doctor can only do so if he/she is allowed to write the diagnosis down in the chart. If you do not want that, then please change your answer to No.

I am not a lawyer, and I don't even play one on TV, but...

Defamation of character only occurs if the statement made is false. So if the patient's prior doctor did in fact give him that diagnosis, then writing it in the chart is totally legal (and some would argue, necessary).

Though I would guess that you are not too worried about losing the case.

I had a patient yell at me because I put down a diagnosis of "morbidly obese". I told her I would change it and instead put down "morbidly fat". Needless to say, she is no longer my patient.

@leslie ROFLMAO!!!

You know, you could use the new code that just says BMI> whatever the number is for morbidly obese. But don't put it in your claims--insurance companies will reject the claim. Use the code for morbidly obese.

@Leslie: You are officially my hero. Also our doctor is exactly the same way.
@Bert: I like that form idea. I'll run it past my manager and then the doctor.

Also I have a mental illness (chemical and emotional depression and anxiety). Pop some cymbalta and I feel great! No more panic attacks or insomnia, no more feeling like I have to sleep all day. I like that my doctor diagnosed my problem and I no longer feel like as awful as I did a few years ago. This had been an ongoing problem for me in my youth because I started showing signs at 12 and wasn't diagnosed until I was almost 21 (that was four years ago). I can't begin to say how much my quality of life improved on the day to day. And I owe that to the doctors who treated me (and later my dad, the doctor I work for). I don't understand why someone with a legitimate problem wouldn't want it treated, no matter what it is.
/rant

Also sorry for going off there.

I am glad you are doing better, Jill. Takes a lot to share that way. I hope you are going to the ACUC.

Bump

Bert,

Do you ever sleep?

What is that?

Before I used computers and EMRs, I went home at 6 pm. After having a network and what comes with it, it is more like midnight.

Out of the blue, Exchange Server had errors, and I had to go to my guru to fix it. Only took an hour. Then two computers had issues, still working on them.

My public certificate needs renewal, and it has been a nightmare. It never stops, but, without the network and the "fun" it brings, I wouldn't be in this field anymore.

Bert--Thank you. Sorry, I sometimes just give lots of random personal info. It's like a verbal tic (though typing isn't verbal, I guess). Our patients like it when I share which kinda reinforced it. >.<

I do often wonder if the EMR makes it easier or harder for the docs. Easier on patient recall/writing notes. Harder on personal life?

Yeah, for me the EMR makes it easier. It's the networking and obsession I have with it which makes my personal life worse.

Bert, what you are saying echoes our experience to date, and my continuing concerns. It is not AC that confounds us, it is the network, printers, and total environment. There is enough electronic "stuff" happening at any given time that we are still still troubled by distractions caused by the computers. All of us in my group have found something we missed medically because we were distracted by something or another related to electronic recordkeeping. Gratefully, those issues have been small, but scary.

We have now been on AC for one year, and I cannot blame this on inexperience any longer. I am not sure what else to do to turn this beast into a servant rather than an icon that must be worshipped properly to be allowed to do my job.

I love the EMR as once we started getting used to it the improvement on communication and finding files, etc. became so much easier! But I'm terrified now of a power-outage or anything like that...

In the process of converting the paper charts into electronic ones, which is scaring the piss outta me. We have about 900+ charts...and those are only the *active* patients...and we're PCP/IM. Some of these patients have been coming for 20+ years. I am seriously envious of Bert right now...

I agree! AC is awesome it is all the other networking, server garbage!.

How about a cloud or online product that would spare some of the networking concerns?

Thoughts?

The cloud has been talked about forever on here and most users want complete control of their data. I like it on my computer as well.

It is ironic, though. I absolutely love doing the networking thing. Guess I would have gone into IT if I did it over again.

@Jill, First, you should have an uninterruptible power supply for every computer, especially the server. We use CyberPower 900s on each computer and 1500s on the server and switches. We have an extra 900 in case we need to start the server after the others have drained. The key is to get AVRs which are Automated Voltage Regulators. It's the up and down voltage spikes that kill your PCs and monitors.

Others may disagree, but APC are horrible. I used them in the past and replaced them all the time but never with the CyberPowers.

The cloud has always seemed attractive... right up to the point (like today) when the internet access is down. One more worry.

I, too, am terrified of power loss, etc. My approach is a really big standby power supply and battery bank (1200 amp/hours) with small secondary UPS's with regulation behind that for the servers and network gear. The client machines are laptops. It is one more hole that I plugged after yet another bad experience.

They do make these gigantic battery backups for an entire network. It would be cool to have your server and backups and that with air conditioning to keep everything at 71 degrees. Hopefully, it would run for 12 hours. And, of course, you could lock it. Or lock your medical student inside if he/she is driving you crazy.

@Bert-LOL about the med student! Also that setup sounds great except we might not have room for it, but I'll show Doc and the manager and see what can be done. The problem is that everything is desktop based except for the two laptops doctor takes into the rooms, so even during a surge or something they're okay. It's mainly the server I'm freaked about--that goes down and we're screwed. We're going to be moving the server to a different room so that might help instiagate a new set-up...

@Dr G-that sounds good too. I like the laptop idea (I had voted for this originally as it would take up less space and be portable). How do you keep your patients from playing with the computers? We can't get them to keep their kids out of the biohazard lock boxes (honestly, there are needles in there! Watch your children!) so there was a concern that they'd play with our equipment and break it. Did you used to have towers in there before the laptops?

Laptops are our initial plan. We take them with us in and out of rooms, and use docking stations at our desks. Our style is to do a lot of the charting during breaks, less so to chart in the rooms, so computers and patients don't spend any unescorted time together.

LOL Sounds like what we do for the same reasons. Thanks!

Bump

I just listened to a talk on disaster preparations. Of course we had the big earthquake in Japan, and they say Alaska is due for another big one. I'd like the option of staying open to treat people. I am planning to buy a gas electric generator so I can at least keep the lights and computers running and keep seeing patients if desired. Has anyone else done this?