EMRs are supposed to tract and produce reminders for followup, appts, procedures, labs, imaging etc. Unless a specific patient is pulled up for review manually, there is no current means in AC2 to automatically send the staff or doc(s) a reminder. This is a criticl missing part and really needs to be put on the high end of the priority list.
We have made a new provider on AC, "Dr. Reminder". Dr. R's schedule is the list of people due that day/week for follow ups, labs, etc. When we pull up Dr. R's schedule, we call all those people. Haven't really implemented it yet, and it means adding another schedule entry, but I can't think of another way yet. Nancy
I did this as well, but it requires someone to look at the schedule and figure out what needs to be done. We didnt continue this way as it is a violation of the license unless you pay more money for the extra healthcare provider, and it would give a non-doctor user(s) access rights at the security levels higher than good practice would support.
I find it a bit amazing (pun intended) that a EMR of any type would not have the ability to create automatic reminders, recalls, tracking of pending tests, tracking of referrals, etc.
AC may reduce the need for paper charts, but it does not automate much of anything that most would expect of an basic 'EMR'. It seems that much of what is/was promised for 2006 has little to do with these features.
and I do a lot of procedures, labs, medications that need tracking and repeated on a lifetime basis. I am sure that reminders for tracking labs, vaccinations, follow-up appts, referrals, and surveillence is routinely required in all primary care specialties as well.
THis is why I find it both odd and increasingly frustrated that these basic features are not in AC and dont appear to be on any meaningful timeframe of a list to get done in 2006. Much of what was supposed to be done for q1 2006 appears to have been shelved in discussions in forums elsewhere on the net, but not mentioned by the management on this BBS or AC web site. :?
There are way 2 ways to place a reminder in the patient's chart. One is in the assesment area which is seen only when the chart is opened. The other is a pop-up note that can be entered in the patient's demographics so that when that chart is selected, a small yellow highlighted area becomes visible to all users. I recently started using it and it is helpful to create reminders for individual patients. If such a note could be tagged to a date and "pop up" on that designated date, it could serve as a way to proactively track test results, patient follow up and so on.
One workaround could be to book an appointment as the reminder. Either set up an appointment slot outside regular hours, eg 15 minutes earlier than first patient, or just use first appt time. Overbook any number of reminder in that spot and staff will see the reminders on the right day.
there should not have to be a 'work-around'. filling up the schedule with reminders will bog down the scheduler a lot. having to open the chart of an individual to get a reminder is not really a reminder. this is a real problem with AC2 and a critical issue on usability and utility as far as I am concerned.
We have made a new provider on AC, "Dr. Reminder". Dr. R's schedule is the list of people due that day/week for follow ups, labs, etc. When we pull up Dr. R's schedule, we call all those people. Haven't really implemented it yet, and it means adding another schedule entry, but I can't think of another way yet. Nancy
I agree with all this is a very important tool, especially for cancer screening, vaccinations, chronic illness follow up.
I thought about this issue and so far seems to be that a "Dr. Reminder" type of thing is the only work around. I haven't implemented it though.
It would be nice to have this reminder feature in the patient summary section which includes tracked items. As long as you put the info For instance: 2006-3-17 / Mammogram / Normal/ Follow up 2007-3-17 with the alarm or reminder option.
i use a simple program called windates as my reminder tool. i use it mostly for pt/inr reminders currently but it could easily be used for other reminders. i wonder if amazingcharts programmers could find a way to license the program and incorporate it into the emr. just a thought.
The WinDates calendar software is no longer available for sale. I have accepted a position with Trumba Corporation, the developer of the online OneCalendar service. In order to avoid a conflict of interest, I must discontinue development and further sale of the WinDates calendar software.
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I agree with all of the above. Tracking the need to re-check labs, etc. is a vital piece of what we do as PCPs, or specialists for that matter. An additional button below the Order Tests button called Send Reminder (or whatever) that has a default timeframe of your choice 6 wks, 3 months, etc. Which sends a message to the default person of choice, would be Fantastic :!: Definitely a top slot on my wishlist.
We need to be able to have the program "get in your face" with a reminder system.
These reminders should be about the things you want to tell patients. Due for TSH in 12 weeks etc, but should also be pre-set with common USPTF list of suggestions.
For example, every diabetic should have a Microalbumin annually and an eye and foot exam annually. Women should have annual mammograms. These reminders should "jump out at you" when you open their chart to see them for a cold.
I completely agreed - we almost abandonned A.C. because of a serious lack of lab tracking ability....what we ended up doing is ordering labs from the email screen by right clicking....then we send the automatically generated email to a fake "nurse" account called "OUTSIDE TESTS"...or for consults "CONSULTS" etc. Each day one of the nurses reviewed this account (since it's not a provider, it doesn't violate the license thing). Then, when results are received, the nurse replies to the provider and it is saved to the chart with the values in the email.
Not perfect, but works for us. Would LOVE an integrated system.
...and don't get me started about the immunizations! (i'll save it for another message.
Jim Feiste, MD Carolina Kids Pediatrics Seneca, SC
From what I understand, Jon is supposed to be working on this, but the how and when is sort of up in the air. As I have probably said before, we had an old program that for many other reasons, it and it's company drove us nuts, but it had a pretty good reminder system in it. I've told Jon and company about it so they can scope it out if they want to at a trade show,but who knows. Nancy and I have posted that we use an extra provider (AC knows this and is not giving us any grief) called Dr. Raymond Reminder and we just go forward in the Calender how many weeks or months and enter the Patient in question in his side of the schedule and use the Note area for a brief reason for the reminder. It's not perfect, but for now it's working fairly well for us. But yes, we shouldn't have to use creative work arounds. And it should attach to the chart for proper record keeping too. That we listed the reminder and that someone attended to it and what was the final outcome of it, Right???
Within the pt's lasts encounter you can use the yellow box on the R hand side to remind yourself of an upcoming procedure that is due such as DEXA scan or colonoscopy. However, it would be great to have these reminders pop up in the message center once they were assigned within the pt's chart.
I completely agreed - we almost abandonned A.C. because of a serious lack of lab tracking ability....what we ended up doing is ordering labs from the email screen by right clicking....then we send the automatically generated email to a fake "nurse" account called "OUTSIDE TESTS"...or for consults "CONSULTS" etc. Each day one of the nurses reviewed this account (since it's not a provider, it doesn't violate the license thing). Then, when results are received, the nurse replies to the provider and it is saved to the chart with the values in the email.
Not perfect, but works for us. Would LOVE an integrated system.
...and don't get me started about the immunizations! (i'll save it for another message.
I like your use of the internal email, but it still requires a human to log onto a 'fake' account they do not log onto for their reqular work and look at the email list.
Scrolling thru an email list that is sitting there to remind a follow up test that is due in 1, 3, 5, 10 years from the email entry on 6000 patients is going to get pretty darn tedious.
We created a limited database of pending tests and reminders, that runs a report a couple times per week, but it is not integrated and requires seperate data entry and responses to the report.. It is simple and reliable (to the limit of uptodate and accurate data entry), and runs on the MS access database engine. It really should not be hard to implement in AC-? by the company as AC uses the access database engine too.
with the beta 3 versions of AC, there is a potential for x-linking to office management systems. I have not purchased any of these (we outsource billing), but in looking at the ones that AC suggests are 'compatable' via an x-link, they all have schedulers with the capacity for creating recalls. Has anyone used any of the listed PMs, used any of them with AC3 in x-link in a multiuser/network topology and actually work?
Yeah us too. We're considering a PM Module, but are moving slowly for a number of reasons, including how to use a private contractor for billing. I would be very interested if anyone out there has started any of these x-linked connections up and what their experience has been. Perhaps a new line on just this would be a good idea...so here I go Paul
We have a external billing company that has does a good job and priced well for both of us. We do not use AC's billing component. With x-link being added to AC3B, if this works, then we are investigating and testing and will buy a pm for demographics, scheduling, recalls, various printing options, PDA support, hospital rounds and offsite procedure automated billing entry, connection to automated calling, reducing repeated entry of the same data, etc.
Billing companies often use one of the PM systems as their tool for billing, or have developed their own software to do edi and other direct bill or clearinghouse operations, etc. Some of the PMs appear to support sharing the database across the internet or generate files that can be sent (with the appropriate securities) back and forth between the provider and the biller systems. (This happens with the billing companies formally supporting transaction with AC's billing system) Our biller is adding MicroMD and MicroMD seems to have many of the features we are looking for otherwise in a PM. MicroMD web blurbs say it is HL7 compliant and supports the X-link transaction process.
Most PMs, listed in AC3B and others, claim HL7 and X-link compatability (may use different verbage though..). The ...small problem... is that it appears that the X-link program needs to be written specifically for each pairing, as it is not 'smart' enough to know that a phone number in one location in the data string of one record in Lytec is not a phone number in Medisoft, MARS, MicroMD, AltaPoint, etc. This is good for X-link, and not so good if a specific version needs to be written for a pairing not yet widely marketed by the two products (ie EMR and PM). I was quoted $5000 (by the PM) to develop an X-link.net derived program for AC3 not in AC3's current list. Of course the PM thinks 30K purchase price, minimum of 12K plus travel/housing/food for the 2-3 trainers (more than my staff size) and the discounted 19% annual maintainence fee of total sales is a fair market price (if the trainers drink, then maybe $60K? :roll: ). Not exactly in keeping with the AC philosophy (50+% maint fee, modest purchase price)....
oh, yeah, "this" in last message is tickler/reminder file. Entering in each chart is daunting to find. Entering in an outside calendar program seems possible but totally obnoxious (cut and paste, etc) and is not exactly automated
Jon and Carlos are aware that we are using Dr. Raymond Reminder in AC. I gather they're OK with it even though he is set up as a seperate provider because they know until they add the reminder thingy to these new versions of AC we all need something. They know we don't have an extra guy on staff like that. Although not perfect, Dr. R really works pretty well. If you want to see a patient back in three months, book 'em with Dr. R three months from the present visit. Not only that but Dr. R's scheduled visits become part of the record so you can show you did your part. Everyday and at the begining of the week our medical Assitant Tammy looks at Dr. R's schedule and makes appointments and calls and so on based on the little notes we add to the "appointments". "F/U BP and Rx's" or what have you. It's not perfect but the schedule is sort of right there in everyone's face everyday. You just need to assign someone the task just as you normally would, so you know that it gets done. We want the reminder thing too, but for now this is alright....I could see eventually calling the new reminder thingy, Dr. Reminder or something like that, it's got a strange catchy ring to it.... Paul
I recently spoke with Carlos, he said the billing/PMS program hopefully will be available before the end of year. Jon had mentioned by winter the billing software would be ready.
From what I gather, there is extensive testing involved with various EDIs as they have to accept the electronic transmissions from billing software. This of course would be the difference when compared to EMR, where presently all you do is maybe print or fax and send to external world.
I would wait for AC PMS and look forward to this exciting feature of AC.
Yeah, I know about the new PM coming out soon. I just wish that some of us beta folks could catch a sneak peak at it, so we can kind of know whether or not we want to wait for it, or choose something else from the x-link list now. Obviously, we like the way Jon thinks and designs his software, that's why we went with AC and assist as a beta site. But our present billing situation is awful now and we need a way to correct that ASAP. Some features, screens, demo's interface and internet info would be very nice right about now. We want to be able to track and control our info here at the office but still outsource the work to a small mom & pop billing service so connectivity is an issue as well. If we could only get a good peak at it.... :idea: Paul
:idea: