Home Forums Discussions General Discussion Could this be the future Letter Writer?

Hi All

I?ve created a prototype of what an improved Letter Writer could look like. See the before and after screen shots.

To view screen shots close-ups click here.

Current (Old) Encounters Dialog:



Improved Encounters Dialog: What could be?



Current (Old) Letter Writer:



Improved Letter Writer: What could be?



Let the discussion and thoughts begin!

I think for a prototype, it looks great. I might add an ability to add a Cc. Now, you can add one, but it gets hidden in the edit, and you can end up Cc ing the same person over and over.

Thanks Bert, for your feedback.

Adding carbon copying (Cc) could be doable. Would this Cc-ing be to internal colleagues, or everyone in or out of office? How does the Letter Writer handle this now?

this looks much better, and would appear to be a notepad/wordpad based.

I would guess resource would let you choose the Providers info to be auto filled. One of the other pet pieves is that the telephone number should be included with the provider demographics.

It also needs to autosave to the patients import item folder automatically, as many docs to not know or care to take the time to find the proper location.

I don't use Cc, didn't notice it was there other than chief complaint. So I can't comment on that one.

There is no Cc, you have to add it under the signature line via editing.

It doesn't. This would be to other doctors. Many times I will refer the same patient to a dermatologist and an allergist at the same time. Seems silly to write the same letter twice. So, I Cc one of them.

Lawrence,
There is much that can be said here. Excuse me for being long-winded. Your preliminary layouts look great. Let me start by telling you how much I appreciate your work on this. I would assume many others feel the way. I only speak for myself in what follows though. Aside from addressing a major longstanding shortcoming of AC, you might be initiating a productive process that could lead to other significant improvements in the program.

A couple of points about work flow and the letter writer (henceforth, LW). Excuse me if some of what I am stating is obvious.
In my mind, the LW is a combination LW and note printer. The interface for the two functions is currently joined (which is fine, but not necessary).

It is important for the LW and note writer to open as each note is signed off.
The LW is accessible by right-clicking on the patient in the main patient list, in the scheduler, and in the message list: also all important.

One feature of the note writer is the ability to alter the content of the note and its format (SOAP note or detailed note, with various headers). I think it is important to retain that feature. Print preview and default options are also important. Ability to print addenda and messages is nice, but not essential (they can be printed elsewhere).

The ability to select the patient or a contact from the Rolodex (or other contact manager, if you have a better one) would be important. I also might like a "To Whom It May Concern" option, though this could be free texted. I see little need for the "Patients" and "Other" selections. These choices could take the form of the radio buttons as in your example. On the other hand, you could just have one "To" drop down with "patient" as the first choice, "to whom it may concern" as the second, and Rolodex contacts below that.

The ability to format the letter as indicated in your prototype is a key feature. We really would like to print letters (and notes) that appear to be on our own "stationery". The other check boxes you show seem appropriate. I would also love to see the ability to set (and change) many defaults, or at least a "last used" memory feature. This includes the "include patient demos" and "include CCD" boxes.

The current LW mandates some things some of us don't like: automatic use of the patient's first name in the salutation, a fixed closing with fixed spacing for the signature line. The latter cannot even be erased and changed.

Ability to template and save to the chart are important features to be retained.

Again, this is just my two cents. Thanks again for all of your efforts. If this plays out well, I would be happy to work towards helping you obtain some compensation for your efforts.

Jon,

I would go paragraph by paragraph, but when you are rested, can you be more specific. I am confused by the note writer vs letter writer and how they work together or don't. Maybe that is an unfair request given I am not pointing out what I don't understand.

Lawrence,

This is off topic but on programming. One of the things (according to my programmer) that makes programs faster and more efficient is for the next window to simply replace the other window or all windows to open in one framework. For instance, take Outlook. Yes, if you need to send an email, a new window opens and when you click on emails they open just the same. But, nearly everything else just changes the main window. If you click on inbox, you see inbox; if you click on sent items, it opens in one window. You don't have windows all over the place.

Now, you can right-click on Sent Items and choose open in new window, but the very option proves the point that the default is that it doesn't. It solves two problems. It is faster, and it doesn't give you windows all over the place, which also creates un-minimizable windows or windows that won't close or move when you need to see something on your desktop. With Outlook, you can even use it as a browser that you can move to Inbox and back to browser, etc. Of course, it is somewhat stripped down.

In AC, you must open five windows to print a script (if doing a note). Forgetting everyone's asking for a window or windows to remember where they opened before, five windows is a lot, and this doesn't even count the print window.

Thanks, Dr. Wendell.

Yes, it would start out as a WordPad based application. The application would be able to also, open and save MS Word (.doc) documents, and text (.txt) files. Yes, a chosen resource selection would auto-fill the text drop-drop with patients, providers, or other. This feature would come from the rolodex.

Adding a telephone # with a provider?s demographics wouldn?t be a problem.

That would be the beauty of it, to auto-save a patient?s document into Imported Items automatically. Yes, more than likely I could make that happen.

Hi Dr. Jon,

Thank you for your much appreciated two cents.

I will definitely comment more on your post tomorrow. I will let you respond to Bert's above post because this is exactly what's needed.

Doctors discussing together using the same product is good for me to make since on how to standardize a product, if possible.

This is all preliminary phase, like you said.

I'll comment more tomorrow.

Bert,

Your programmer is correct with your analogy used. An application would be more efficient, and would probably perform better when it is running in a multi-view paneled window such as, MS Outlook. It also depends on how an application is programmed (are programmers using best practices and sound techniques). That's critically important with how the application performs and flows.

I begin most of my designs, by following MS Outlook standards. If a product's design and architecture is consistent, a product has a better chance with good performance (mainly with usability) and good GUI consistency.

The goal to good design is eliminate most multiple windows and mouse clicks. Granted, there will always be some standalone windows to open, like with your Outlook example of sending a new message.

As a specialist, when I finish a note, I want to send a copy to the referring doctor. After signing off, a box opens automatically to facilitate this. I am calling this the "note printer". (In fact, the interface, the box, is the same as for the letter writer, but since the letter writer's product is so poor, I rarely compose a letter with it.) The note I just did is selected by default, so I just pick the format, such as SOAP note, and header (which rarely if ever changes) and select a printer. The note is now printed (or usually faxed).
This "note printer" gives me a few more options than the standard print box in Word.

If I want to send a letter, perhaps to the referring doc or to an insurance company, I use the letter writer. The dialog box is the same one I just described; but the LW only uses the bottom right 1/4 of that box.

I have always thought it a bit odd that these two functions were housed in the same dialog box. I suppose in a way it makes sense, but they need not be.

Hopefully that made it clearer, and right now you are saying, "Oh, is that all he meant?"

Let me know if the rest of the post needs clarification.

Hi All,

Nice explanation, Dr. Jon. Also, I have answers to your post from last night. I've quoted your paragraphs. I hope you don't mind? This may be little long with the quotes, so I apologize.

I did notice this, and I created a prototype of the Encounters Notes? dialog as well. It might get a little tricky to code, if things do play out, for future development. If AC doesn?t allow me to see their source code (I don?t think they will) behind this, I would have to study and emulate the flow for this (Encounter Notes and LW) to work properly, which would take time.

This is very good to know.

I saw your response (explanation) to Bert about this. We?ll wait and see what others say about this one. I did create a prototype of the Encounter Notes dialog, to let folks see what it would look like cleaned up.

I like what you said here. That?s the whole reason why prototypes are good. You made some good points with what you saw from the prototype. Yes, contacts and patients should be pulled directly from the patient list and rolodex. I also, liked what you said with including a second drop down, for Letter Salutations, as your example ?To Whom It May Concern? exemplified. Nice!

Yes, formatting is considered a must have for any word processor, even if it?s basic formatting. I would start off with a standard formatting bar, as you?ve seen in the prototype. To set and change defaults would be good. It would be a little more work involved, but it?s still good. We would have to see what are others say about this. One of the goals is to not take a year to put out a product, for a feature that most people may not use often. Don?t get me wrong, I?m not saying that customizable defaults shouldn?t be included. They should, but, we?ll see.

I would make this more flexible, where a user has more control of the document.

Agreed. I would have to learn the flow of AC?s templates and their templates dialog window.

You?re welcome. Thank you for your feedback, and wanting to contribute toward making an improved LW. It would be greatly appreciated, and I hope others would join, too. But, for now we?ll take it slow and wait to see if others are willing to provide additional feedback. If things go well with this preliminary phase, we might ask Bert, if he?s willing to do another poll for contributors.

We?ll see how things go in September.

This is a bit on topic and a bit off. It seems like this would be very simple for Jon and AC to do, but I am sure 100 people a month say that. The window that JBS refers to comes up automatically when you sign off a note and allows one to print a note or a letter. It can be rather handy, but I chose the option to not have it appear because I don't need to print notes often and letters occasionally. One of the things it doesn't do which I put in "The 81" would make me allow it to open each time.

I simply don't see why, given it pops up right after the patient's note is signed off, you can't click a button and pull that patient's chart up. There are SOOOOOO many times that after the note is signed and stored in the database that the patient does the "one more thing," or "can you send this script." Now, if your nurse triages in the room, that patient's name is right there in the patient list. If your MA triages in an area other than the room and forwards the chart to you, that name is not right there. Therefore, you have to look up the patient, which believe it or not, is time consuming.

I am not really following totally, I'm afraid. I assume your letter writer will allow the use of letterhead by default? Will it be editable after saving? Will it allow me to have the chart note open so I can reference it while writing the letter? If the original is signed by a computer copy of my signature, will the signature still be there if the note is reprinted?

I really don't mind the windows that take me to the letter writer or select the encounter or recipient, and personally would not spend a huge amount of effort on them. Yes, yours are better, but the current ones work.

Like Bert, I don't want or need the letterwriter to open after each patient, so that option needs to be selectable.
It would be really nice to select what parts of the encounter get sent with a letter. When I refer a patient to Jon, he wants to know the HPI, exam, diagnosis, medication list and plan. Having the FH, SH, and ROS there obscures what I want him to know. "Complete" notes from the EHR have gotten so filled with textual diarrhea that when I import a note from many of my consultants I routinely select only the first and last page and toss the rest.

Hi Dr. Grauman,

Thanks for your feedback. It?s much appreciated. I?m going to try to answer some of your most important questions. I will be using your quotes to answer. I hope you don?t mind?

That?s ok. I will try and explain. First, this is just a prototype of what a future Letter Writer could look and be like. There is no current development from my end at this time. This is to get doctors to talk about what features they would like to have in an improved Letter Writer. That?s what the prototype is for. It is possible that I could develop a future Letter Writer, if that?s what the user board wants.

It could allow the use of defaulted letter heads. Yes, a letter would be editable after saving. I would need more clarity on what exactly is a Chart Note? Does the current Letter Writer handle referencing a Note with it being open now? I do not understand what you mean by computer copy? I?m assuming you are talking about a digital signature? But, I believe you are talking about a Note feature, and not Letter Writer feature here, right?

For Letter Writer purposes, there could be closing and signature lines, with an option of a digital signature to be added. I?m just throwing that up in the air of what could be. Your signature would be able to be reprinted from the Letter Writer functionality point view. I would need more clarity on a Note signature, or are they both one in the same?

You bring up a good idea. There could be a selectable option that would allow or not allow the Encounters (Notes) dialog to open, after finishing (signing off) with the Letter Writer.

Certain parts of an encounter would be selectable. We?ll see.

Man, I'm so pumped that someone is actually making an effort to make this thing better. I like the way it looks

I use the note maker/letter writer A LOT and exclusively. I love that they both are together. When I sign a note, I send a letter to my referring doc. I usually just send the Assessment and Plan with a generic intro so they know what I'm thinking/doing. Then, I have to print/fax a the H&P to the hospital/surgery center so they will have a copy for my operation. It works really well actually.

The main problem with the current letter writer is formatting. let me use WordPad imbedded like you have it and it's great. It would be nice to select defaults that are embedded in every letter so I don't always have to click on the assessment and plan to enter them in the letter but I'm not that stressed about it.

And could someone take the stupid default check boxes off the bottom of the current letter writer (the ones that say "include note with this letter" and "include demographics). I am sick of unchecking those after every single letter I write. I just wish I had the ability to choose whether those were checked by default or not. Silly annoyances.

Travis, thanks for weighing-in on this. I know there are lots of us who feel strongly about this, and hopefully many more will express opinions.

These few posts do illustrate one of the challenges of designing an EMR; take three people who feel strongly that a small element of the program needs fixing, and you get four opinions about what should be done. The good news is that I think we all agree on the need for major change and the basic elements of what we would like.

Lawrence, I think that if you can make this happen, we may not all love every detail, but we will see the result as a major step forward.

Always easier to add check marks than to remember to delete them. Kind of like all software now where the boxes are checked by default so you get all sorts of email you didn't want. Should be opt in, not opt out.

But, remember, this is likely to be 3rd party standalone connect to the demographics type of letter writer. I just don't see its ever getting into the program. Sorry to rain on everyone's parade. Just my feeling. Hope I am wrong. And, I don't believe in subliminal messages.

word word word word word word word

Dr. Travis, it?s good to know that you are pumped! I hope to make something happen.

As Dr. Jon (JBS) said, there are others who feel the same way. We could only hope others would express their opinions. I would say a few more opinions (from doctors) would be adequate. I agree, Dr. Jon. I believe we could all agree on the need for major change (with the LW) and the basic elements of what it should consist of.

What Bert said is also right. You are not raining on anyone?s parade my friend. You are being honest.

My approach would be to take the third-party path. There isn?t a partnership between myself and AC established, for me to have access to their source code (SDK). That leaves me no choice, but the third-party standalone approach. It?s not the easiest path, but I will do it if the user board wants this to happen.

I have much appreciation for Bert and Jon (JBS). Thank you both kindly for your support.

I also want to thank the doctors (Wendell, David, and Travis) who have shared their opinions. Thank you, guys!

We thank YOU for developing interest. Obviously this is not a large market and probably won't generate large sums of money, but a quality add on would be welcome.

Keep up the good work.

i really like the newer version of letter writing. i wish there was a way to make it so that once a doctor edited it, i didn't have to re-format the entire thing. where i work, i format the letter and the doctors want to read it before i fax it out. however, once i print it, i cannot get back to it should there be a correction.

Hi Patricia,

Thank you for your post. The new Letter Writer will be a standard word processor (more like WordPad), with Amazing Charts features. Yes, that means it will be interfacing with AC. You?ll be able to open standard documents (.txt, .rtf, and .doc) to edit and save them, like how you would with a standard word-processor (WordPad, Notepad, Word, OpenOffice, etc).

I?m currently working on finishing up the design documents and prototype, which I?ll discuss with the user board once everything is planned out for development. I?m also working with well RESPECTED doctors on this user board to help me make this a hit tool. More details will be coming soon!

Larry,

Question. Say you make this, and it is great and the bugs are worked out. Everyone is using it and all letters are better. Two months go by. Now as more people use it, they will find ways to make it better. Some ways will benefit all, some will benefit only them. Doesn't matter, it's all good.

So, you are getting one suggestion a day. A tweak here and a change there.

How does a developer decide how to deal with this? For instance, will my small programs and complete access to the developer, I can email him with an idea and it is done in a day. But, if I write to Microsoft with a good idea, it may get in when Office 2007 upgrades to 2010.

Do you wait for the next version? Do you just come out with a quite update. Or can you do one-click web installs and just let people know a new version is available?

Also, say there is a checkbox at the top where if it is checked, the date shows in the letter. Unchecked, it doesn't. Say in the current version, it is checked by default, but someone emails you and says it would be better if it were unchecked by default, and their logic made sense. How do you know if you should change it? The change may make 100 people happy, but upset 200 people. You can't make preferences for every single feature, can you?

Just wondering.

I will comment on Bert?s above post later this evening.

Bert, you have somewhat answered your own questions.

I?ll continue and start with this: ?human desire is never satisfied.? There will always be people with ideas and suggestions to make any product or service better. Making many tweaks here and there will only band-aid a product. Eventually the product will become more cluttered (bloated) and less useful.

The goal is to find a happy medium of what features gets put into an upgrade, or new version of software. It could also mean a separate product, or service is created to keep from cluttering-up, or losing usability of the original product. This takes time and skill because a developer or company will have to listen to what customers are saying, and not saying. This user board is a prime example. Again, this takes skill because a developer must know how to filter out the complaints and hear the suggestions (problems with a product or service).

In my humble opinion, a happy medium would be a repeated problem, complaint, suggestion, or idea from a group of loyal customers, not just an idea or suggestion, from a single person (unless something completely new is going to be created). Even if a person?s logic makes sense, a feature request or enhancement should still be based upon a group (customer base) idea or suggestion, which will in turn make a product useful or enjoyable to use.

I say this because a product could turn out with more gadgetry features in it, and perhaps, does make sense, but are not what the majority of the group is wanting at the time. I had to learn this the hard way. Of course, now I have much appreciated wisdom.

There should be and expect a lot of ?No?s? customers. This is to keep the sanity (reality) with the happy medium once it?s found. It could also vary depending on how large the customer base is, as you pointed out with Microsoft. Each company?s happy medium is different. Apple is the best example of this, in this day and age.

I would have to understand a customer base in order to know which deployment (quick update patch, click-once web download, etc.) approach I would use. Of course, either way, I would still have to provide some assistance (Tech Support) to them.

Also, all developers are not alike. You are blessed to have your developer to be top-notch, Bert. Certain developers have different skill sets, and work very differently, as the same with doctors. But, developers who think alike do have a special ability to join forces to create something quite radical (shall I mention Bill Gates and Paul Allen, or Larry Page and Sergey Brin).

One shouldn?t make preferences for every single feature, but one should make preferences for useful features that a group (customer base) is asking for.

Bert, I hope I answered your multi-question post? I?ll be clearer if needed.

Keep in mind folks, while I?m designing a new Letter Writer for Amazing Charts. Bert has been and is one of the doctors advising me. I can?t express in words of how blessed I am to know and work with an awesome person. I?m not saying this to kiss his behind, but I?m saying this because he really is a cool cat! He?s been helpful to me a great deal. Keep bringing those questions my way. I?ll do my best to answer every single last one of them.

If I don?t respond to your post right away, don?t worry, I will get to you.