Home Forums Discussions General Discussion Paperless Offices: where to store countertop labs?

Hey, folks:

I'm creeping towards a paperless office.

One question I'm facing is where to store countertop labs.

For example, if somebody just walks in for a urine pregnancy test, or a fingerstick HgbA1c, that's going to be one line of text that I need to save to the chart.

I would like to keep it with the rest of my scanned/imported lab results (under Imported Items), but I can't think of a good way to do that. I hate the idea of scanning in one piece of paper, with one line of text on it.

I thought of doing an addendum, or an email, but I hate the idea of cluttering up my clinic note/record area with a lot of minor lab results. Also, I would again like to keep lab results together in one area.

In a similar vein, I'm trying to decide what to do with my INR and A1c flow sheets. I have heard of people linking Excel files to the chart (via Imported Items, I guess?), but then I would have to have Excel on all my computers to view that data, wouldn't I?

I welcome any and all input on this topic! Thanks!

Brian,

In general, we put those things in as a progress note. We also put them in the schedule. This lets us keep better track of them from a billing standpoint, not to mention at the end of your progress note, you have a super bill to bill for the procedure you are doing. This applies to any of the nurses visits for blood draws, urinalysis, hemoglobin, etc. for common procedures, they have templates. If the test is something I am tracking longitudinally, we put it under tracked items as well. The biggest downside is that it is one more thing in my inbox to sign off. However, it ensures that I have seen the results. Hope this helps.

Hmmm, wonder where you heard that?

My advice: Install Excel on every computer. Actually, you can go to www.openoffice.org and order the entire suite of office documents for free. Open Office Calc will completely interact with Microsoft Excel.

Entering this kind of data is probably the easiest way to keep track of this type of data and Excel/Calc will do calculations and manipulate data in ways you can't even think of. The ability to add sheets on the fly is helpful and the best part about it is you can save it and send it to consultants for easy viewing of data.

That was you, wasn't it?

http://amazingcharts.com/ub/ubbthre...cel&topic=0&Search=true#Post3729

It wasn't that long ago, either!

Bert posts so many good ideas, I can't remember them all.

That might make a pretty good obstetric flow sheet, as well.

Bert! I'm shocked! I thought you were a Microsoft man to the core!

Well, I can eat Lobster, Prime rib with a fine wine, but I can still recommend a good Burger King. Especially if you need six burgers. J/K.

Wait, gotta go. I have Bill Gates on line 3.

Suggestion: I'm no doc by any means, but would making extra tracked items make any sense for these things? I know Nancy has A1C's, lipids and a bunch of other stuff in there already. Can it work with just positive or negative with no values to be had might we say? I know she has Mammograms in there, so there must be some amount of flex in it... Just a thought. Again I don't play with these parts enough so this is where my knowledge runs a bit thin.

Paul:

I played with "re-purposing" the "tracked items", but couldn't make a really good flow sheet out of it. The date takes up 1/3 of the screen! Also, there is not much room for specifics. The kind of flow sheet I was looking for would need medication dosages and follow-up recommendations included.

I also played with "re-purposing" the "Directives/Summary" page, as per Jim's suggestion in this thread:

http://www.amazingcharts.com/ub/ubb...Jim&topic=0&Search=true#Post4915

and that was an improvement, because you can add a lot more data to the two printable sections, and the format is better, and there seems to be no limit on how many entries you can put in there. This actually seems like an ideal place to enter health maintenance items, especially if you would like a nice printed record of them for the patient (kudos to Jim for suggesting it).

However, I think that David's progress note suggestion has a lot more things going for it.

When I figure something out, I'll post it (I know everyone's giddy with anticipation over my office policy decisions).

Brian,

I think you EXCELLed in the above post. Nice link to Jim's suggetsion. But, can you link to David's progress note suggestion.

Well, you could just scroll up to David's suggestion, but here's a link to save you some strain on your index finger.

http://amazingcharts.com/ub/ubbthre...lth&topic=0&Search=true#Post4897

Just joking around, Bert!

Ahhh. Good point. The only problem is my browser is set to only scroll down. Why backtrack? I always move ahead.

Plus, I am almost more used to the nick names than the signed names. I never understood the progress note idea. Not saying it wasn't a good one, I just didn't understand it.

Yeah, the real names throw me off sometimes also. Also, if someone's real name is only in their signature line, and they someday delete their name from their signature, it will throw off later readers ("David who?")

On the other hand, it sometimes seems weird to refer to each other as "hockeyref" and "soundhealth" as if our fellow users are common nouns. Even action figures have capitalized names!

As far as the progress note idea, it makes sense if you are wanting to keep strict track of outpatient labs performed in your clinic. You just treat it like any other appointment, and any other encounter, especially if it's the kind of lab where you might charge a level I office visit.

Admittedly, that does not solve the flow sheet problem, where Excel might be the "very berry" (as mah ole gran'pappy use to say!).

Yeah, Excel is the way to go. I still don't understand the progress note idea. Mind you, I am not putting it down, I simply do not understand it. Maybe more detail?

Bert,

How about showing us a sample of your EXCEL sheet...how you set it up and how you manage it in each patient's charts. I am having trouble conceptualizing how best to do it.

Leslie

Will do.

We're waiting....

I have some Excel spreadsheets for PT/INR, Diabetes, testosterone inj, and b-12 inj. Someone tell me how to upload these to the thread and I'll do so. They are simple but would be very easy to use. These can be saved into the Imported Items folder, and the templates can be stored in a template folder in A.C.

To post a downloadable file, you would have to get Vinny Meyer's permission I would think, and post it on the "Helpful Download" forum.

However, if your Excel file was very, VERY simple, you could "export" the spreadsheet as a text file, copy/paste it to the forum, and we could copy/paste it to our desktops, an "import" it into Excel.

Uhh...that's easy for you to say, Brian.

Adam,

Vinny is involved, but you don't have to wait for him. You simply upload any file you think would be helpful, and he will automatically come along and OK it. As long as it's not SPAM or porn...

http://amazingcharts.com/ub/ubbthreads.php?ubb=newpost&Board=4

@Brian,

We are going to have to keep an eye on Adam's post count. It's moving up at a rather steady rate.

I have to get home. Have a patient in the hospital for tomorrow. Would have left earlier but Brewer's finest keeps circling the building and shining your five battery flash lights all over my office. I'm like, "Uh..the lights are on! You can see right in."

And, you wonder why Adam and I keep so many backups.

I'm going to bed too.

This is a good thread, several pages long.
Bert tends to write alot of posts. He doesn't stop....a machine.

Adam, thanks for sending me those Excel files. I am trying to figure out the best way to use them. What exact steps do you use to import a copy into the patient's file (I think you and Bert do it a little differently)?

AARRGGHH!! "alot" No, it's "a lot." Sorry, it's my biggest pet peeve. <G>

I think he drags and drops and I just import using the browse feature. But, it all gets the same place I think.

I've done it both ways.
Drag and drop from the common folder holding the templates to the "Imported Items" tab. Or you can use the "import" button and browse to the same folder.

Once you've imported the Excel template, you add the individual patient's information into the teimplated flowsheet.

I practiced it on my test patients and seems to work rather easily. Staff just needs to go to the imported items to add to the flowsheet.

Bert,

Sorry it took a while to give you more details. Pertussis outbreak here on the island has really bogged me down.

We do progress/encounter notes for things like blood draws, u/a's (if done without a doctor's visit) and other nurses visits (allergy shots,immunizations, etc.). This let's us keep track of these things better for billing sake not to mention covering liability issues. The nurses have templates for these so it is generally easy and quick for them. If a lab gets done during a visit with me, I just put the results in the note. If it is a lab I want to track for the patient, I make sure it goes under the tracked item section on the summary page. Clear as mud?

I would invite you out for a live demo here but you probably don't want to catch the "cough, cough, cough, cough, cough, cough, cough, cough, cough, puke" thing!

Well, I did get my DTaPs, but they aren't perfect for Pertussis. Thanks for the explanation. Sounds as if it works pretty well.

Be sure to get your TDaP if you haven't been immunized recently....although they now tell us it is only about 80% effective if you are immunized. I've learned more about pertussis than I ever wanted to know! But at least I can see the pertussis cases in my nearly paperless office (thought I better redirect the conversation back to the topic at hand).