Home Forums Discussions Problems Health maintenance

I am a new potential AC user and I currently use paper charts. When I see a patient for a physical, I have a form that has little reminders of what to ask/order etc. such as colonoscopy, mammo, pneumovax status, etc. How might I have a similar system in AC?

Thanks

Bill,

I think there are two ways you can do this, both basically workarounds.

One way is to go to any patient and click on Addendum in the top left corner of their chart. You could then type the list of questions in the open window for each specific visit. You could then do a Alt + right click and call the template 35 yo or whatever. Then when a 34 year old comes in, you can choose the addendum, and click on that template, and the list of questions will come up. You don't necessarily have to type the answers there; just use it as a list to remind you of the questions. That is one way.

Another way would work if you only had one list of questions you always asked. Some users misunderstand my suggestion here. You could right click in the allergy section (since you will most likely never use templates there) and make multiple templates, one for each question. So, if a question were "How many packs of cigarettes do you smoke a day," you could type in the window "cigarettes," but the title of the template would be the question. If you did ten let's say, when you opened this template window up, by right clicking in the Allergy window, you would see ten templates. You WOULDN'T use the templates, you would just have quetions with boxes next to them that could be checked. This is a little hard to explain.

Hope this helps.

Cheers!

That's very helpful. I think the answer is templates whereever I place them. Thanks. I will try it.

Bill

Bill,

I think that they're working on a health maintenance system for the next version.

V.

We have templates for each section of the chart labled "physical XXX" for instance, Physical SH (social history) and that template has the prompts for all questions to be asked in that section.

That works well. The decision is do you save the template to the chart and ask questions or do you just click once and allow the questions to populate the window attached to the template and just use the questions as prompt without saving the actual template.

That is one good reason to use Addendum, because you can double click the template and put the questions into the actual addendum window and still not save the addendum.

thanks for the suggestions.

Vinny, How do you know what is coming in the next version?

Bill,
Obviously you don't know Vinny. He is a mysterous man with many unique skills and ablities. Actually he has Jon's ear more than most because he used to be a high quality computer guy who can write some pretty good code. He is also the moderator of this board. He's a real gem for us AC users. Thanks Vinny.

Thanks Vinny and thanks hockeyref

Hi Bill,
I am relatively new to AC, but I currently place some of my health maintenance notes in the Past Medical History (e.g. Mammogram 10/3/06, colonoscopy 2001, PSA 2006 etc.).
I also use a section at the bottom of the Summary Page that allows you to record values and dates for cholesterol, HDL, HgbA1C etc.

Another possible approach was developed by David Ortiz, MD, a Texas family practitioner; he has written an excellent article on registries at
http://www.aafp.org/fpm/20060400/47usin.html
I plan to try his idea to follow my diabetics; it would be great if it would integrate with AC.
Best,
Jim

Hi Bill

You could also scan the same form you currently use into Imported Items as a Word Document (so you can edit it in the computer)

I personally use the Tracked data section for this. Putting this data her will show in the patient Record summary.
I have the A1C, Lipids, TSH, T scores, FEV1, and appropiate cancer screening test.
I have trained one of my MA to help me put and keep this info updated.
When the appropiate patient comes in I open the Tracted Item section and hit print, a new print preview window will open which allows better view.

From the article:


My thinking on this is that there is a HUGE cost involved here (labor sure ain't free, if the printouts I get every week from Paychex are correct). This is a typical case of "feeding the elephant's child" - data entry for data entry sake. There is very little return for the high direct cost involved - contrary to Dr. Ortiz's article. The use of a tool like this was mandated by the company who runs their clinics - and hopefully they were willing to pay for this high cost involved.

You could use AC's reminders and template features for this. It won't give you a pretty spreadsheet you can turn over to the p4p people, but it WILL let help you keep things on track.

If you're interested in a nuts-and-bolts on how to do this, let me know.

Regards,

V.

That sounds very interesting, Vinny.

Post! Post!

I do use the reminder for somethings, perhaps not as often as I could. I also using the tracking data, but it's not as useful for some of these things.

I do use the spreadsheet to track my numerous diabetics. I like being able to view it at a glance to see where we are overall, and who has fallen by the wayside.

What is "feeding the elephant's child."

Hmmm... could refer to this story:

http://www.online-literature.com/kipling/165/

The elephant's child had an insatiable curiosity.

One fine morning in the middle of the Precession of the Equinoxes this 'satiable Elephant's Child asked a new fine question that he had never asked before. He asked, 'What does the Crocodile have for dinner?' Then everybody said, 'Hush!' in a loud and dretful tone, and they spanked him immediately and directly, without stopping, for a long time.

By and by, when that was finished, he came upon Kolokolo Bird sitting in the middle of a wait-a-bit thorn-bush, and he said, 'My father has spanked me, and my mother has spanked me; all my aunts and uncles have spanked me for my 'satiable curtiosity; and still I want to know what the Crocodile has for dinner!'

Wow, he got quite a few spankings! DHS would be all over this one.

Of course, now I will hear the saying twice today. Or, I will use it, and my patient will give this look that shows they have no idea as well. <G>

Brian, you are absolutely right! The original reference was to Kipling. Ten point bonus question to all the AC community - can you recall a famous sci-fi book (a classic) where this term was used?

One fine morning in the middle of the Precession of the Equinoxes this 'satiable Elephant's Child asked a new fine question that he had never asked before. He asked, 'How many of our diabetics have had their HbA1C this quarter ?' Then everybody said, 'Hush!' in a loud and dreadful tone, and they spanked him immediately and directly, without stopping, for a long time.

By and by, when that was finished, he came upon Kolokolo Bird sitting in the middle of a wait-a-bit thorn-bush, and he said, 'My HMO's have spanked me, and the PPO's have spanked me; all my government overseers have spanked me 'cause they want me to tell them what the Crocodile has for dinner!'

This story is applicable to EMR's and the modern practice of medicine on SO many levels, don't you think?

Regards,

V.

Hey, in Massachusettes there is a proposed law to outlaw spanking. Yes, swat on the child's tush could be reported as child abuse. Well, I don't have the details 'cause I'm in NY, but that's what the sound bite on the TV sounded like.

Those lawmakers didn't have me as a child!

Hey, I was spanked, and now I own AmazingCharts!

Oh, by the way, today is my one year anniversary for Riverview Pediatrics!

Congratulations, Bert!

I got my butt whipped every day of my life, and I generally deserved it.

Vinny, that was awesome. I think that was what Rudyard meant.

I remember when I was with Norumbega, (yuk!). I can't remember how many meetings where we were forced to bring the USPFTF so we could decide the cutoff between 11.2 and 11.4 for anemia in a two-year-old. Hey, maybe during that time, I could be seeing a patient.

Now since I failed miserably on the feeding the elephant story, I may as well show my ignorance again. Shouldn't it be insatiable. I mean didn't the little elephant have a desire for knowledge that could not be sated or quenced?

not satiable; incapable of being satisfied or appeased: insatiable hunger for knowledge.

BTW, don't look up the words satiable or insatiable at

http://www.yourdictionary.com/satiable There seems to be a virus there. Click -- detected. I haven't looked at the virus yet to see if it is a prank, but I would think that YourDefinition.com would be rather reputable.

I believe that the term is indeed INsatiable, and the preceding apostrophe is to indicate that the speaker dropped, but meant, the IN part.

V

Well, I guess I must have missed to many British Lit classes. How would ' = In. Would it be 'dependence or 'justice. Why wouldn't Rudyard just say "insatiable?" Oh well, I shouldn't argue with Mr. Kipling.

As a former member of the Science Fiction Book of the Month Club, it pains me to admit defeat, but I must say I am stumped.

I created Health maintenance templates:

for female:
LAST MAMMOGRAM -
LAST PAP -
LAST BONE DENSITY -
LAST COLONOSCOPY -

for male:
LAST PSA-
LAST DRE -
LAST COLONOSCOPY -

I insert ithem into Social History, so I can see them right away when I open the chart. Then I update them. For example:

LAST PSA- 2/2007
LAST DRE - refused
LAST COLONOSCOPY - refused, hemoccult x 3-given 10/07

That's a good idea apricot.

I put these in past medical history. Great minds...

V.

This is a modified version of a template I have been using lately, called "PAP/BREAST".


To gain a full appreciation of this template, copy and paste that into Amazing Charts, Alt-rightclick and make a template out of it. Then select the template, and look at what you get.

This template incorporates a number of ideas and techniques which we have been discussing on the board lately.

1. It starts with a unique text marker, “# PAP/BREAST: “ which could be easily located later with a free text search.
2. It generates a brief, pertinent questionnaire which can be completed by physician or assistant. Just double-click on the wrong answer and hit backspace or delete.
3. The "wrong/bad" answer is written in ALL-CAPS, to attract attention, and promote action.
4. Each question has its own unique text marker (PB1, etc). This could aid in tighter searches -- if you could see the patient’s name and the pertinent line when you did your search, you wouldn’t have to pull the chart!

You could also have an associated "plan" template, with corresponding actions.