Home Forums Discussions General Discussion opening multiple charts

Hi: New user in trial period. I like what I've seen so far. Interface is not cluttered and navigation is straightforward. I've searched the forums briefly but haven't seen any posts about this.

How can I open multiple charts on my desktop at the same time? When I tried to open a second chart, AC warned me that I had to save data on open chart or data would be lost when it closed. Are there separate examining rooms that can be used? There are many scenarios that would benefit form having several charts open.

You are quite correct this would be handy, but it is not possible. Similarly, you can't write a letter and have the chart open at the same time, which is really annoying when you can't remember the lab values that are prompting the referral in the first place. The best you can do is forward the chart to your inbox, then retrieve it when you next need it. It is like having to put your shoes on the shoe rack every time you want to put on your slippers or need your mud boots to go for the mail. It may look tidy, but it is a PITA.

no mud rooms in my part of brooklyn, shoes lined up on staircase and exchanged w slippers when at home. Just us
How do I request this feature, or multiple exam rooms, though?

You can click on the "HELP" at the top of Amazing Charts then click "RECOMMEND IMPROVEMENTS".

I know about the HELP option, but I have difficulty imagining a medical office w/o multiple exam rooms having patients in various stages of H&P and procedures. I'd think that this would be a necessity rather than something to first request now.

What do you mean by this statement?

This is just one of many compromises that happen when adopting an electronic record. There are real technical reasons for this... for example, record locking is necessary because two people editing a record at once gives a database a nervous breakdown... but it does not make it happy for us. However, we are adaptable creatures, and I found eventually I stopped grumbling and altered my practice pattern to accommodate these sorts of things. I do wish I had more of the feeling of being the master and not the slave to the computer.

I think he may be asking about multiple exam rooms, each with a computer.

You can only open one chart at a time on a single computer.

You can have other charts open on other computers.

that is essentially what I was asking. However it should be possible for the database to, instead of closing a chart when another is opened, instead, lock the open file but, leave it available for future edits.

I think whether you can or not is immaterial.

My guess is Jon has always intended that one can only open one chart at a time.

I hope that is not true. We are still in the trial period and this may be a game ender.

I think forwarding the chart to yourself does the same thing. That's what we do in our office as well.

It's nice that AC allows a free trial period. It gives people like pa_marc the chance to see if this program is going to work for their office flow. It sounds like it won't work out. I'm glad he isn't stuck with a program he is unhappy with. Good luck, and we wish you well in the endeavor to integrate an EMR with your practice.

i haven't given up yet. pardon my rant
thanks to all for your input

I guess I did not understand. Exam room A can have patient A's chart open, Exam B can have patient B's, etc. But Exam A can't have both A and B open simultaneously. And, I don't understand an office flow where that would be really necessary; you can only see one patient at a time. It would be nice to have two charts open when back in my office finishing up the day, but again, I can't do two tasks at once and that would increase the risk of entering data in the wrong chart, so it is not really essential. Can you explain further?

Yes, I agree you should not give up. Not quite sure if it should be a deal breaker. AC just won the KLAS awards for small offices, but it isn't for everyone. The reason it has grown so quickly is the price. And, if you end up with AC, then you will need to develop a few workarounds.

I still think you haven't made it completely clear what exactly it is you are trying to do as evidenced by Marty's statement that you can forward it to yourself. I suppose he is correct if that is what you mean, but I think you mean have it open on your desktop, open another chart, have it open if you want and then one you are working on. I would guess that the last one opened would be the "live chart" while the others are locked for read only? You can have John Smith's chart open in room 1, while your nurse has it open in another area. You just can't have two charts open on the same desktop in the same application.

You can get around this with VMWare, but I don't think anyone has ever taken that suggestion.

I think, though, in order for us to help you, you should take us step by step as to what you are trying to accomplish.

I think that EMRs have spoiled us. All the date, like the Internet, right in front of us. Why can't I get a message from my MA about John Doe and look up his lab while seeing John Smith. But, I always like to compare the EMRs to paper. I can't recall ever seeing a patient with a paper chart in front of me while my MA handed me someone else's chart so she/he could then ask me a question.

Very ironic. Same post and same question, although David's was more succinct. The only thing I would add is that you can have A open in 1, and B open in 2 and but not A + B in either room together, you can have A in 1 and 2 and your MAs desk and your computer.

When I first moved to AC I thought this was a bad thing too...not being able to open two charts at once. Now it does not bother me at all. In fact I prefer it. If a family member I also see is in the room with the patient I am currently seeing and they start asking me things about themselves, I can very politely tell them that I cannot access their chart until I finish with the current patient. I may then ask them to go to the front desk and ask Ann their question. She can then triage and see if it is something that they need to be seen for and tells them that and then has the back office person set them up in another room with another superbill....e.g. another charge. I despise the "two-fers". If it is a simple question that she can answer then I can finish with the current patient and move on.

I've never had occasion where I required two charts be open at once.
I close one, then open the other. It's not hard to get used to.

the workaround, forwarding the chart to myself, is reasonable. Data is not lost and one can resume working on the chart when it is re-opened.
as for the multiple chart scenario....
our office is a very informal, but busy office. we often find ourselves addressing 2 or 3 patients needs at the same time. for instance, if a patient is waiting for results of rapid strep test, we might start the next patient. If an infant requires a u/a/c and we are awaiting the specimen before finishing the exam, we would want to open another chart, and start the next patient. we don't have many examining rooms and it is sometimes more efficient to have the 1st patient sent to the waiting room until the test is ready.
I can describe other similar situations, such as urgent phone calls while tests are brewing etc.

In each one of those cases, with a paper chart you would probably want to close the chart of the patient who is "on hold" before opening the next one. This minimizes the chance of entering the information in the wrong chart.
In the physical world with a paper chart you would close it and put it in a pile. Think of your message box as that pile. Just close the chart and forward it to yourself (ctrl-s). Just as easy as closing a paper chart...but better because you always know where to find it.

Actually, the way AC does it is better than any other way. It should work perfectly for your system. You can type CTRL + S in less than a second.

We have a similar setup. Two rooms. Patient triaged with a strep test. Both rooms are occupied. The chart is forwarded to me, and the patient returns to the waiting room to watch The Incredibles. Room 1 leaves. Incredibles patient goes to Room 1. I walk in, strep is +, give penicillin, and the entire visit takes five minutes.

thanks again all,
the community is great!

Is that a 99211?

CONTROL-S, I didn't know that shortcut!

SWEET

You aren't serious?

CTL + C will get you a Coffee Coolatta

CTL - B keeps the bats away from my understanding.

I also heard CTL + M will get you your MU check in the mail within the week. Is this true?

Although I try not to be the one to bring things back to a more serious level, I would suggest the following:

In AC go to Help...contents...search, and put in "shortcut keys". I suggest printing the list and passing it around. Even if you think you know them all, usually someone is pleasantly surprised by one that they find useful.

Today I am changing my signature to reflect my latest quest.

Sorry, here are examples that come up for me all the time.
1--entering new demographic information for each of 4 siblings; At the moment, I print out one and data-enter from the paper.
2--being asked,'What was that medicine you put her brother on? It worked great.' Now I have to forward the current chart, pull up the other chart, then pull up the first chart. If it were paper, I could open the second, get the needed info, then close the second and put it away without ever closing the first chart.
3--examining twins. How do I compare one growth chart to another except on paper or printed to pdf?
4--comparing lab results for siblings. If I do the comparison for hemoglobin and the parent then asks, 'OK, but are the white counts similar?' Again quite tediously I have to close one and open another, then close that one to get back to the patient being examined.

For me, it is an ongoing pain and disadvantage to be able to open only one chart at a time.

Here's an important addendum that I forgot about, but it just happened again: telephone calls. I'm working on a chart, but get a call about a prescription, lab result, or something else. It's annoying that I have to interrupt my note to fetch this stuff.

Another reason why I love F.A.P. for a solo practice. Can see a patient and pull 10 x-rays and 20 labs all at the same time.

Understood. But, when you used paper, did you actually bring all the charts in with you in case you needed to access information from it?

How do YOU do a mom with 4 kids, Bert? With adults, I only ever see one patient at a time, and never am called on to compare one patient with another. Sounds like my worst nightmare!

As Leslie says, I hate two-fers, three-fers are worse. Plus, with Mainecare, you get a lot of "Can you just check his ears or her throat, etc.?

My biggest problem is they are just in the room. But, I mainly have to keep telling the mother, "We are doing Joey now. We will do the others later."

Don't the parents fill out a form with the demos on it? Maybe just use that form instead of printing one out. Have you considered having a staff person put in the demos?
Actually you don't. Simply go to the patient list on the main page, right click on the sibling, and pull up the medications and eprescribing tab. You can do this with the first chart open.

As to 3 and 4...as David suggests, seeing multiple patients at one time has got to be quite a challenge! I can imagine that if you are seeing 4 at once, you would like to be able to have 4 charts open at one time. Out of curiosity, why would a parent want to know if two kids had the same white count and hemoglobin?

Well, this is another issue of making the practice to fit the computer. drwolffe has evolved a practice pattern that suits him. Granted, it would make me nuts and I could not do it, but that is my issue. But, the computer does not like to do it that way. So, about all I or any of us can really say is "Stop doing it that way. Do one patient at a time. Close out. Then do the next patient. Comparisons have no place in our world. The computer does not want you to do it any other way."

My partner and I have spent more time than I can quantify railing about things the new system won't let us do, or forces us to do a different way. Since we are also married, these discussions bleed over into the dinner table and beyond, not infrequently with significant emotional overtones. In the end, it is usually easier to change our practice patterns than to figure out how to fudge the system. I just get tired of that smooth, monotone voice in my head saying "I'm sorry, Dave, I'm afraid I can't do that...."

When I first started using AC, I thought it was odd that I couldn't open more than one chart at a time. It took some getting used to, but I'm over it. CTL-S is my new friend. And no Bert, I didn't know about that shortcut.

I had looked at the short cut list a while back but had forgotten about it. Thanks to Jon, I printed it out and stuck it next to my desk.

2001: A Space Odyssey is still an incredible experience. Thankfully it's 11 years after that movie was set and we don't have computers "thinking" and taking us over maliciously. But the sentiment of this post is: computers have taken over our lives, just in a different way.

I agree with the logic of Dave's reply. The program can't have multiple charts open, end of story. So a user would really have three options: 1) get a different EHR, 2) change the practice style or modify in some capacity to bend to the limits of the EHR, 3) continue beating one's head against that ethereal brick wall.

In my FP practice, I've never once had occasion to enter demographic information. I have staff that do this. But maybe not all AC users have staff? That is sad, and I wish for their sake they could get some help.

Also when patients bring one family member and ask me to look at several other family members "real quick," I politely explain that I'm happy to work them in but we have other patients who called ahead and scheduled. then I explain what we'll do is happily work them into the schedule, but since they didn't call ahead for the other family members we'll see other people as they show up and i'll see this family in between those other scheduled pts. I further explain it may be a while but I'm happy to get them all in. Simply explaining that I can't do a two-fer or three-fer on the spot helps people lower there unrealistic expectation. They always understand. Then I send a staffer in that room to collect their copays, get me encounter forms, get vitals, and start a chart on each one. Then I can move on to the next scheduled patient and come back in a few minutes to talk the -fers.

It's rare, but sometimes people ask me to compare one child to another. For example with growth charts, I would explain "Ma'am my EMR lets me only be in one chart at a time. I'm printing little Johnny's growth curve and we'll continue working on him first. When we are done w/ Johnny, we'll move on to little Suzie and compare growth curves at that time." We live in a consumer society where people are so impatient they want everything done yesterday. People need a reality check, and I'm happy to politely explain when reality doesn't conform to their fantasy about what my EMR can and can't do. Afterall, this ain't McDonald's.

Have I ever closed one chart and opened another to look at someone else? Yes all the time. But it just doesn't seem like a chore. CTRL+S is a wonderful thing. Snap, it's closed. Very quick and easy. In fact when the parents bring in Suzie and Johnny for the exact same illness (sinusitis in this example), I love it. I will document Johnny's illness. do his prescriptions then close the chart and move on to Suzie. But before moving to Suzie, I opened a notepad .txt file on the desktop. It takes 15 seconds to copy and paste each section of Johnny's note to the .txt file. When I'm in Suzie's, I copy and paste those sections into her chart in 15 seconds. Wow that was WAY faster than hand writing her separate note or dictating her note separately. That visit was also short b/c mom said "Suzie's symptoms are exactly the same as Johnny's." ERx her meds, boom, done. I'm outta there.

So I guess what I'm saying is that I've done what Dave is suggesting. I conformed to the limits of my EMR so much that they don't feel like limits anymore. It's just the way it is, and actually the limits when compared to alternative ways (dictation, hand writing) slower methods of charting are not limits at all.

I hope drwolffe can find peace with this EMR or some other EMR and not feel limited by what it can't do. I hope rather he can see that the EMR allows such other amazing capacities to save time these slight inconveniences are still leap years ahead of the old paper methods of charting.

I completely Agree with Bert on this One and even Told Jon the same thing. It's great to be able to bring up well labled PDF's of "Anything" practically in multiple catagories and have them all there for clicking, opening reducing and looking at, reviewing all without bouncing around the patients chart. My wife Nancy (our Doc) LOVES FAP and could never image having to work or live without.... Great Product and Great Addition for us AC users all the way...

Thanks Bert and Ed!!!!
Paul & Nancy

I give up, what is F.A.P.?

You don't want to know what Google returned.