Home Forums Losing Notes - dummy proof default note save feature needed

Ok, I've been using AC consistently for about a year now and I am still having a major problem. I'm loosing notes because I don't quite get around to formally signing off on the note. I realize that the EMR does require some attention to the task at hand but I can't believe that I'm the only dummy that for one reason or another, doesn't have a chance to formally sign-off on every note before a medical assistant inadvertantly clears the note to move in the next patient. Sometimes, I get called away to a phone-call or leave to check on another patient or leave the note open to look up something, or I'm wating for the the medical assistant to finish the something (EKG, eye exam, PFTs, whatever) so I can complete the documentation on the patient before I sign off. Whatever the reason, I am always horrified to return to see the screen back at the message page or set to the next patient beacause I know that I will have to reconstruct the note. When I started using AC, this happened at least once per day. Now, with more focus, I'm down to a once or twice per week. I realized this means that my EMR IQ has just barely moved out of the double digits but it still seems almost impossible to get through the week without loosing at least one note this way. I can't image that I'm the only one with this problem. I just think that there should be some way to recover more than the meager back up text file that the system creates. I've started having the staff do a complete note inventory after every clinic session to try to reduce my losses. Even so, it is so painful to recreate these notes when the patient is no longer in front of me. Does anyone have a way to deal with this problem? Can't the sign-off feature be made a bit more dummy proof?

Are you locking the screen when you walk away? Could someone be closing the note without saving it?

I have never had this problem with AC.

One thing I do is if I think I need more time and are about to go to another patient just forward the chart back to myself. Hit the forward button and your user name initial and it will bring the name up (unless there are 2 users with the same initial) then hit save. Takes 2 seconds.

If I step away to check on something, I hit windows button and L and that locks the screen.

These are things that may alleviate the problem, but since I have not had the issue or even seen it, I am at a loss beyond those 2 items.

I have learned to hit control-s to save back to my inbox. Takes half a second. I don't try to finish notes until later, so always plan to save it. It is the same knee-jerk reflex
I learned from my earliest experience with a word processor; never leave unsaved more work than I am willing to lose, and same command.

It looks like he is mostly having difficulty with charts being closed by other people and the saving methods may help. Maybe you need to offer a reward to employees for going a week without losing a chart thereby encouraging them to hit forward chart instead of just closing them.

Thanks for all the suggestions. I suppose I will have to start forwarding all these notes to back to myself. I had been trying to avoid that solution because I detest leaving significant amounts of work till later -- oh, well.

Ron,

I either lock the screen as Wendell does when I have to walk away or CTRL-S to forward it to myself (my most used keyboard shortcut). How many computers do you have in your office? Where are you at in Southern California?

You don't really have to leave them until later. I will sometimes forward the chart from one child and switch back to the another child (often sibling) finish the note and go back. Doesn't really take that long. It just protects your note. If I walk out of the room and will be back in say 30 seconds, I will lock the screen. Kids like to play and can change a lot of things. So can your staff I rarely leave the office with unfinished notes. It may take 2 seconds to save and 2 seconds to open, that's a lot better than having to restart a note, or pull it from the deleted catagory.

Wendell Ctrl-S is identical to foward to yourself, and is faster than click to foward, etc.
But either is a lot better than losing your note. That said agree that protection from lost notes is very important and a minor programming issue

I agree that saving notes is the best.
we had a problem with occasionally losing notes. [for various reasons]
One of the solutions that we found is to consider that when opening a chart, the field that is automatically highlighted has to do with if you are starting a note new or from a previous note or not.
inadvertently if the mouse scrolled to a previous note, the current information is gone [from the screen], unless you realize that and scroll back to the current note.

Absolutely true, this is a habit thing, I always did it that way so I still do. Actually I don't forward that much, maybe 4-5 times a day. If you are already in the plan section the mouse is right next to forward, so it's not a big deal, but I agree Ctrl-S is faster.

This has been a chronic problem with AC

Sometimes notes are deleted but are saved in the deleted tab folder on your sign in screen. (This selection is at the top of the page where you first log in where you can choose LABS, CHARTS TO COSIGN, IMPORTS TO SIGN, DELETED ITEMS.)

I have also saved charts to other mailboxes.

Hope that help. I still lose one or two a month. I have my medical assistant double check to make sure the notes are done

Rick

Ron,

Please forgive me, I can't say I feel that bad for you. You simply have to come up with the habits above. Listed:

1. FINISH THE NOTE IN THE ROOM. A progress note never saved a patient, it doesn't have to be perfect.
2. CTRL - S as everyone has said.
3. Lock the screen. I can even send you a shortcut so that F3 or F9 or whatever locks it.
4. If the chart was pulled from your inbox and then closed, it should go to your deleted items.
5. How big is your office? Maybe you can have triage areas so the MAs use a different computer to send charts to you. My MAs NEVER touch my computers. They have no reason to.
6. Why would your MAs see a note up and close it? Especially given your history.
7. If the note is open when they put a patient in, that would be 15 to 25 times per day a patient has the chance to say, "Does he keep my chart open like that?"

You said it yourself. This is the best time to do the note. When the patient is in the room. There is at least 40% of the time that I have a script, lab, x-ray, instructions, letter to do. I have to do these in the room, so I am done.

No, I don't think it can be more dummy proof. Why don't you commit to one day completing every note in the room. I am not bragging, but I do every note, every set of instructions, every letter, etc. before leaving the room. Sometimes I get behind, but I finish 30 minutes late, and I am done with work.

Give each MA a laptop and set up wireless just to connect to those computers. Let them triage with those computers.

along the same lines , I have sometimes lost a note when AC suddenly shuts down after a run time error . When I open up AC again, it asks me if I want to resurrect the partially finished note, however, the note is resurrected without a patient name on it and there does not seem to be a way to add the patients name. So I end up having to re enter the info anyway. This needs to be fixed by AC.
Bala

Ron,

Bert has some good advice. I try to finish the note in the room as well. Sometimes when they are getting dressed, I'll finish up the note at my desk. By the time they are dressed, the note is done, rx's are sent and the lab orders are sent as well. It took a bit getting used to doing things this way but now it's all second nature.

I rarely have any work to do in the morning when I first get to the office anymore.

I agree that it's best to finish the note before the patient leave the room. However, sometimes it's just impossible to finish the note during the patient encounter. For some of the worker's comp patients the report is 5 to 10 pages long! I just started using the amazing chart last week, and I lost the HPI for my very first patient. I learned very fast to save the note afterward. I agree with Ron that dummy proof default note save is a nice feature to have.

I was thinking about this thread today.

I had a new patient with spina bifida, that had a 30 minute slot, but for them, that's just about enough time to get the their current issues.

I did put a few things in the computer, I put a more things on a piece of paper. I forwarded the chart at the end of the meeting.

Then I had a few minutes later and I worked on the chart, but got a call from the hospital, the portable phone was not working well, I had to leave the room, forwarded again.

Came back, started working on it again and something else came up. I must have worked on this chart 4-6 times before I completed it.

I automatically forward it at the end, kinda like locking the screen when you walk away... forward chart, lock screen.

Just keep repeating forward chart, lock screen, forward chart, lock screen, forward chart, lock screen. The force Will be with you, the chart will not be lost.