Home Forums Prepping charts in advance

New user here. How can I prep charts before the day of the visit? I would like to add PMH by going through old paper chart. Do I create an encounter, fill in the data, then forward it to staff, then on the day of the encounter, staff can open it to add vitals and change the date? Or do I change the date by entering the future appointment date when I am adding the PMH and creating the encounter, even though it may be the day before the visit? Sorry if I'm not explaining it well.
Thanks very much.

If you want to do this - create the chart - forward to who will check in the patient and then have them open and change date, etc.

I actually find it easier to just do in the room with the patient - gives you a chance to go over their history with them - review surgeries, smoking, alcohol, etc - only takes a few minutes and find it amazing how inaccurate old charts are - have them bring in med bottles, start fresh.

We prep charts before the visit. We have front desk staff input information from the paper chart into PMHx, Fam Hx, Soc Hx (using specific templates), Medications & Allergies sections of the chart in AC if this is the first time they are in the computer. The chart is then forwarded to the doctor if she has anything to add. Then when the patient comes it, more info is added or edited as the patient is seen. Then when the doctor goes to sign the chart for that day, it always pops up a warning message saying the date doesn't match. The doctor then always changes it then to make sure the date is today.

If the patient cancels, we sometimes sign the note with "Cancellation" in the CC section so the information gets saved and we don't have to keep the chart in somebody's inbox.

Thanks Steven and Samantha. I just want to enter the 20 years of old chart data without having to ask the patient, 'now which ovary did I take out in 1998?' I think your suggestions will work.
Thanks.

We put the data in and enter vitals =1 on everything except sbp. There the sbp has to be greater than dbp so we put 2. We close it and then the person prepping the patient on the day of the visit can just use that info
I like the ideas that others are using. We may try one of these other approaches. The flexibility of AC to try things different ways until you find one that works for you is one of its greatest assests.

I have myself signed into all the exam rooms so what do (rarely anymore but a lot there for a while) is open the summary and add problems, allergies and tracked items, then open the encounter and put in the PMH, immunizations, etc. If they show up in the assessment section by default I just delete them. Then I forward the chart to myself. On the day of the appt I just tell the staff to open the chart from my messages and I am good to go. Just change the date to today. It is a fair amt of work at first but in 6 months you will hardly ever have to go through this. Don't be afraid to use the tracked items for important items in their history because other than the PMH on each encounter there is not a good place to keep them. I find it very useful and saves me time to just flip to the summary sheet to see if they have had a treadmill test recently, for example. Hope this helps.

When converting from paper, we had the staff pull the paper charts for the scheduled patients for the week. Then in free time, evenings, weekends, we made a new encounter, called it "Initial data entry" for the CC, put in all the old stuff including diagnosis codes, vacciations, pmh, fh, sh, and anything else we wanted, signed off and did not enter a charge.

It was a lot of work, but it reduced the degree to which each initial EHR patient visit turned into a new patient visit which is what happened if we waited until we saw the patient. Our population just had way too many problems we needed to track to get away with any of that in a 15 minute slot. It was bad for 2-3 months, easier after that, and gone after a year.

Did it the same as Dr. Grauman. Hired a smart college student, trained them where to look in the old chart for the info and along with my regular office staff working in their idle time got this done pretty quick. No way I would budget my $300 per hour employee (me) to do data entry when it could be done by a $12 per hour premed who is thrilled to get a chance to work in a doctor's office.

Initially, I wanted to do the same but my INBOX would get rather full!

The week before (or day before) I would go thru the paper charts and glean the info I needed to enter in the chart. Rather than enter it directly into AC, I created a TEXT file with patient name and DOB as the file name and in this file I re-created headings similar to AC headings (HPI, ROS, Past Med Hx, Surg Hx, Family Hx, Social Hx, Allergies, Medications, etc.) and just typed in free form all that I would want to have added.

On day of the appoitment, I would go to the folder where I kept these summaries, sort the files by last name so that I could find the patient I wanted and if it existed there I would open it and start to copy and paste into AC's different sub-sections.

This way, my INBOX would not be cluttered with these types of charts. I could also type many more things that I could use to remind me to do or to ask the patient on the day of the appointment.......high risk for falls, so ask about rearranging furniture in the home, etc.

I always felt it would be garbage in garbage out unless I entered the PMH,Sochx, Fmhx, and meds myself. I took the next days paper charts home with me and mined the data the evening before office hours and sent the chart to my mailbox. It did not clutter because it really wasn't more than 20-30 charts and they would be gone the next day. It made for much more efficient office hours during my implimentation period. I really only had to do this for about 6 weeks. By then all of the "frequent flyers" with extensive histories and long drug lists had been entered.

I am doing it just as David noted above. I am in the throes of this now. I take charts home ahead of visits and use LogMeIn to office computer.

I enter all PMH, MEDS, etc. Rather than saving the note, I forward the charts to Providers box, so they do not clutter my Inbox. On the day of the visit, I forward that day's charts to my inbox, and they are gone at the end of the day when visits are finished.

It is a lot of work, but visits go much more smoothly by having charts ready ahead of time.

We are scanning in charts 1 -2 days ahead of time and scanning old records and marking as non-medical info and then in the subject box stating what it is (chart note, labs, x-ray etc.) that way the providers don't have to sign off on old notes and records they have already reviewed and keeps their inboxes from getting full. After the paperchart is scanned it is given to the MA or nurse who inputs the med list and problems list. When the provider is in the room with the pt. she is updating the PMH, Fam Hx * Soc. HX. It seems to be working so far pretty well. It is a lot of work no matter how you do it but a good scanner is also a big help. We just ordered a 2nd one. So far we haven't had to take anything home. Working through lunch is becoming a regular thing lately. Just started 2 weeks ago but so far going pretty well.

(This might be a bit of a Rant, so feel free to skip, sorry, but now I feel better!)

I also felt the best work around was to have 'an encounter' just for data entry. It worked very well, (until meaningful use). I liked it so much I expanded the concept for orders that are the result of labs, or to document phone calls. It works like this:

I open the chart and hit "Control N" to get a fresh encounter page. In Chief complaint I open the templates and select:
-The patient was admitted to the hospital on this date:
or
-This entry will record the following call.
or
-This entry is for consolidation of the medical record:
or
-As we leave the room, the patient relates:
or
-As a consequence of labs reported the follow action is taken:
or
-The Mammogram requires additional views.

I believe each of these is self explanatory. It began as a means for me to add family/social/Past Medical or Surgical history to the chart and have a means of recording the data with the least trouble or extra work.

When I admit a patient to the hospital, a simple note: Hospital Admit with HPI just, "GI Bleed" allows me to SET THE DIAGNOSIS CODES IN ORDER so that every subsequent day, when I use an addendum to record "Patient seen by Sechrist" the superbill will have the pertinent ICD-9's in the right order!

Likewise if I record an encounter for "a consequence of Labs" and the HPI is routine labs with UTI, I have a record dated and timed of when I set treatment in motion. I enter the diagnosis code, send an order, (now documented) that says, "Susie please call Mrs. Jones to let her know her labs came in, and there is a UTI that should be treated, she can get her Rx at the Pharmacy, I already sent it". And of course the transmission of the Rx, all is documented.

LIFE IS WONDERFUL.

And so of course everyone of these encounters is without vitals, because they are a sort of virtual or cerebral encounter, not a 'meaningful' one.

Now on the subject of vitals I am really serious. EVERYONE EVERY TIME, even the tearful member of weight watchers who refused to be weighted gets walked back to the scales by me personally so we don't get sloppy.

SO IMAGINE MY SURPRISE when I printed our "meaningful" report and found I was only hitting 91% on vitals!!!

(Of course what I take this to mean is that I am doing to much for free, and should make every one of these patients come in, (get vitaled) and sit down for a chat while we treat that UTI or order those extra views on that Mammogram.)

Or.....we should be paid for the work we are doing just like lawyers are. Why should we not be paid for work done just because there is no face to face "encounter"? They would most certainly sue us if we didn't do the work. Maybe this could be coded and signed off as something that won't be counted as a visit despite it being an encounter with the patient.

I really like your rant and the way you approached this but as you say, it screws up your MU numbers. But just doing an addendum doesn't get the information you want added, where you want it added, for meaningful care of the patient.

MU is meaningful only for financial and actuarial data. It is not meaningful in the care of patients or the work flow of physicians. Here and there something useful is popping up but this is all about trying to standardize something that is very individualized.

I need to check, but someone advised that if you did not code the visit with an E&M code that it would not show in MU numbers - if this is still true just sign off all these visits with noE&M and it will not matter - I need to do one on a day and then run the MU wizard for that day only.

If you omit the CPT code, it will not count the CQMs.
The core and menu set measures are counted irrespective of CPT coding, so it won't solve the vitals problem.

Thanks for all the suggestions. I am slogging through it now. It just makes every patient like a new patient but it is great to find some interesting things by really reviewing everything in the chart. The funny thing is that after all this typing in the office, I have very little interest in goofing off on the web afterhours.
Now here's an issue that came up. What should we do for a patient who misses her appointment after the chart has been pre-filled with PMH etc? I don't really want it hanging out in a mailbox unsigned until she comes in. Maybe erase the cc and HPI and use those fields to document the no show or cancellation, then sign it off? What do you think?

You could put "NO SHOW" in the CC and sign it off but not create a superbill.

We signed everything off immediately after adding the initial data for everyone, then added no CPT charges. Then when the patient came in for the appointment, we started a new encounter and saved the PMFSH from the initial data entry. It kept our inboxes from getting cluttered, and made sure the information was saved to the patient's chart. Otherwise, after the first few weeks, I would be several weeks ahead on data entry having oodles of unsaved entries cluttering up the mailbox.

Hi all.
Getting AC on Tuesday, very excited. I read thru' the 'prepping charts in advance' thread since I am considering having MAs enter past, family, social history on everybody in advance by creating a 'sham' encounter. Is there a way however, to enter old growth data (for Pediatrics) so I will have at least a few points on the growth chart when I go live?

No way that I know of...I just put in the date (as if) I was the doc and enter the old data as an encounter...that is the only way I know how to generate data points in growth charts...I do it all the time...

Wrote a VB6 utility that pulled all of the old data out of Access Databases (that I have been using for my "EMR" for 11+ years) into text files
Then wrote AutoHotKey scripts that "plays" the data from text files into the AC chart for the patient.
Meds require a little more hand holding. Likewise problem lists, but the data comes from my "old charts".
Voila: fully populated PMH/PSH, FM, SocHx. Meds entered on visit day, semi-automated as above, confirmed with pt.
I know, I am a geek, but it works for me.

Wow Roger, very impressive!