Home Forums Discussions Feedback and Recommendations Keeping Records Accurate

We have begun printing out the Summary Sheet on our AC and presenting it to each patient at each visit. This allows the patient to correct demographic entries along with their problem lists and current meds. A surprising percentage (almost half) have changes with each new visit (meds they forgot to report, med allergies, meds they have completed etc.); it has also stimulated such discussions as "I would like to work with you to get that Tobacco Use Disorder off my diagnosis by quitting".
The patients really seem to appreciate the opportunity to keep their records up to date.
As AC moves toward adding Health Maintenance to the system, it would be great to reflect Colonoscopy, last Pap, Mammogram etc. on the Summary sheet as well.
Jim

That's awesome Jim. Wonder if it would as well in pediatrics.

I think that it would Bert.
We just started adding the pictures to the Demographics and they show up on the Summary Sheet. The kids would love that. I did learn to crop the pictures to a square (to fit into the 2 X 2 spot without distortion) and to keep the KBs as low as possible.
It would be great if, for kids, you could include their height and weight on the Summary Sheet.
Jim

We have these templated and put them in past medical history.

V.

Jim,

So far it has never been an issue, but I always wonder if parents will object to having their child's picture taken digitally in this era of the Internet. Not that there should be any safer place. Plus, there is the issue that until 15 months or so, they aren't that helpful, and then you have to change them at, say, 3, 6, 12, etc.

Hi Jim:

We currently use the tracked item section which is part of the Summary to do this.
I have CA screening like Colonoscopy, Mammogram, PSA, DRE, Pap smear, Breast exam.
Also,Health maintenance like A1C, Lipid panel, FEV1, TSH, T score.
Yes you have to manually enter this data; however, we have our staff trained for this and It is very nice to have such a undated summary. It allows with one single click to have all the info quickly. In the case of Tracked items, Once I enter to room I click on it and hit print which allow a better view of all your tracked items.

Hi Romel,
We have begun to enter prevention items (e.g. Last Colonoscopy 2006, Last Pap Smear October 2007, Last PSA September 2007 etc.) into the Directives on the Demographic page. This is a section that is seldom used, but does show up on the printed Summary Sheet. We print the Summary Sheet and hand it to the patient on each visit to correct diagnoses, labs, addresses etc. to keep the chart current and accurate. The patient reviews the Summary Sheet, corrects and signs it and then hands it back to me. I estimate that half of my patient visits result in a significant correction on the Summary Sheet. By placing the preventive items in the Directives it reminds both the patient and me when they are due.
You do have to fill in both the directive and the description, but this is no problem - I simply place a couple of the preventive items in each. It works great!
Jim

Jim:

Do you mean you place some kind of preventative checklist in the Directives area, and in some portion of the Encounter Form, like the "Review of Systems" or the "Past Medical History"? How exactly do you have that set up?

Hi Brian,
I go to the Demographic page and click on Directives and then on edit. I then place one item I want to follow in the "Name" box (e.g. COLONOSCOPY 2007)and the others in the "Description" box.
You cannot go back and add more items in the "Name" box without causing the items in the "Description" box to be deleted.
I then click "SAVE" and I am done.
The primary reason I save my preventive list in this way is that they appear on the Summary Sheet and my receptionist prints the Summary Sheet for each patient visit. This makes the current diagnoses, current meds, and preventive items all immediately reviewable for me and for each patient on each visit. After 30 years of practice, I finally feel that I am being efficient in my patient management. A long time friend and internist visited me today and saw my Amazing Charts and my Summary Sheet protocol for the first time. He is a professor at our local FP residency program and uses their multi million dollar Centricity EHR. He was impressed with the simplicity of the AC and especially liked the Summary Sheet review protocol and the fact that we now have the patient's picture embedded in the chart.
Jim

I may have misunderstood this portion. It sounds like you are trying to put a lot of different preventative items all on one line, which I didn't understand.

It seems like the best way would be to put the name of the procedure under "Name", then the result of the test under "Description", and then to click "Add New" and enter the next one, and so on.

Again, I might have misunderstood and you may be doing this.

Whatever the case, this is a very cool idea, Jim! I have not been using that portion of the record at all. I'm going to fiddle around with this some more.

BTW, how do you handle photographing your patients? Do they put up much resistance?

Brian,
Thanks for the tip;
It seems like the best way would be to put the name of the procedure under "Name", then the result of the test under "Description", and then to click "Add New" and enter the next one, and so on.
I just tried this and it works beautifully!
We have no problem with the photos. My wife/receptionist takes the pictures when she checks them in. Barb has a very pleasant attitude and does not take a picture if the patient appears acutely ill. She also shows the picture to the patient for their approval and has been asked rarely to take another picture.
Jim

Brian,
We were able,thanks to your tip, to take the Directive/Summary Page a step further. We are now placing the preventive test and date in the 'Name' space on the Demographic page and the actual value in the 'Directive' space. For example, we will put 'Cholesterol June 2007' in the 'Name' space and 'Total 203; Triglyceride 333; HDL 44; LDL 111' in the 'Directive' space. All of this shows up on the Summary Page when we print it out for the patient's review at each visit. It can also be copied to give to the patient for their records. I love it!
Thanks,
Jim

Hey, the idea of using the Directives section sounded interesting, so I thought I'd experiment with Mr. Fake Patient.

We have trouble knowing immedialely if a patient is diabetic or has drug allergies. Or is due for a mammogram. So this seemed like a good thing to experiment with.

I added 2 HIGH Alerts: Diabetic Patient and Allergy: Pennicillin. I also added a Directive for a Colonoscopy for 01/01/2009.
Well, the printed out summary sheet is pretty cool. This stuff shows right up! My only problem is that the HIGH levels are supposed to pop-up. In a red box on-screen. Well, only one of my alerts will show up--the first one I save. Now, this may not have been the intent of how this feature is to be used, but we were barely using it at all. And if these things are there, it can prevent the doctor (or staff) having to check of it. I think it would be nice if more than one High level alert would show up in the box. Then I can stop putting these things in the yellow pop-up box since other things are there. Things like "do not schedule, owes $100 from DOS 11/15/2008 Immunization not covered."

Also, the red box is hard to read with the skinny font. That box needs a bold font for easier reading.

Maybe we should ask for an option to be able to print the tracted data with the summary in one click. As it is, you have to print the summary and then the tracked data; this is how we do it.

I agree with Romel. Would it not be easier to just be able to print the tracked data when one prints the summary sheet? I do use the Directives section, as it was intended to be used. But I would like to be able to send a complete summary section to a colleague, say a cardiologist, when I refer a patient. This would let them know that the patient is UTD on important labs, vaccinations, eye exams, etc. I would prefer to see a dramatic expansion of and a printable option for tracked data. I would also like to be able to simply and solely print out the medcine list without having to actually print a prescription. I like for patients to have a list they can carry with them.

Leslie

This is the reason that I really like the Directive section.
We print out a Summary Sheet with each patient visit for the patient to review and correct. Our Summary Sheets have the patient's picture, his/her demographics, the diagnoses, the current meds, the preventive parameters (Cholesterol with values of HDL, Tri, LDL and dates, the Pap smear date, the bone density date, the PSA date, the Colonoscopy date etc.).
We have stopped using the tracked data portion because it does not show up on the printed Summary Sheet.
We are paperless now except for the printed Summary Sheet, but I think that we will keep it that way. We also allow the patient to take the Summary Sheet home with them to review their record.
Jim

What I do is to go directly to Summary Sheet and enter each preventative item on the "name" and the exact date it was done on the "description". I do this one after another to start with, and eter one as it comes. I add the next date of the same procedure separated by a semi-colon.
It works great to see what I have done for that particular patient. I always check the result everytime, by switching to imported items where the results are saved.