Home Forums Discussions General Discussion Blog of a Newbie II: An Unfolding Tale

Hi guys,

Today I WENT LIVE !! I wasn't totally prepared, as I was running late to the office. At 7AM (1st AM phsical awaiting in room--40min apt), I backed up my office management system (Emedware). Then I used Amazing Importer, quickly installed my patient demographics.

At 7:20AM, I had to get started with the physical, so I charted that one by OLD method...paper. After the physical, I went to each computer and linked to the AC database on the server.

At 7:55AM the 8AM physical was ready to go, so I started it... again via paper.

At 8:40AM I was done with that physical, grabbed my laptop and started charting all remaining visits of the day in AC. I went back at end of day to document the first two physicals via AC.

I made one newbie error, I forwarded the unsigned charts to my desktop each time I opened them....but I clicked "NO" to the question "Do you want to remove item from your desktop?" Which left several copies of the same charts on my desktop.

Once Bert helped me figure out my mistake, the rest of the day was very smooth. I'm even managing to update meds lists and problem lists at the same time....whew....a long day.

It was all easier with AC. I figure 3-6 months to be completely converted over, maybe less. But I'm relocating my office by June 30, 2008 so that may interfere with best laid plans.

Thanks J.B. for a wonderful product so simple and easy to use!

Congratulations, Adam.

Excelsior!

Congrats. I'm still getting to know the software, and playing with it. I've started to use it for some patients. How long does it take to do a patients note?

I guess it depends on how complex the patient. In pediatrics, a good portion of my visits are fairly straightforward, i.e. OM, Bronchitis, conjunctivitis. It also depends on the setup. My MA does everything on the left except for the medications at the bottom -- she will type in meds at the top, i.e. patient taking Tylenol and Dimetapp for colds (depsite FDA warnings), lol.

When I come in the room, I may add a bit to the history. I will also ALWAYS click on the medication list at the left so I can update the medication list which allows me to make sure I know what is going on with the medications.

So, after examining the patient and making a diagnosis or assessment, my actual charting of the note could take less than 30 seconds if a templated PE fits, and there are no labs or meds to write. If there are labs, meds and a more descriptive assessment and plan necessary, then it may take up to two or three minutes. But, for me, I always finish the note in the room, and it usually doesn't take that long. But, for a FP or Internist who may be updating five or more problems per visit, that could be altogether different.

I use templates and Short Keys heavily. I have templates set up for routine diabetes follow up, HTN follow up, cholesterol, etc. I also have them for the acute illnesses such as bronchitis. A simple "Also," typed before each new template is sufficient. And, I delete or add pertinent info as it pertains to that particular patient at that particular visit. I may use 2-4 different templates in the history section of the same note. My physical exams are also templated according to problems. I probably use the diabetic one the most for most routine follow-ups and just delete parts like checking their vibratory sensation if they have returned for bp follow up. I can be charting in the room while the patient is giving me their complaints and 90% of the time my note is finished before they are. While I am personalizing the note, they can feel like I have taken the time to really listen to them. After the exam, I "correct" any items I need to in the physical template, list the problems in the assessment, Short-Keys a plan, fax scripts, orders and notes to colleagues, print the note up front and I am out of the room. Again, I do all of this in front of the patient. I really believe they benefit from seeing the work you put into their encounter. By the time the patient gets to the checkout desk, the staff is already making their return appointments and setting them up for any special tests or referrals.

Leslie

Here is a small tale unfolding. Our Quest lady Cindy went ahead and paid our interface fee and got that rolling for us. I hadn't realized that she had gone that far. I went to the interface section of our Admin and there it was ready to be finalized.

So we just had tech support come in and install Quest's little Auto Recieve program so we can download our test results directly into AC. He was going to install it to run all the time in the background, being started at start up, but I had him make it a manual thing. One of us will simply check for labs a few time a day, so that the program is not always running on our little P2P tower eating up some extra RAM. If and when I get some more RAM or purchase a new and faster main computer. As a test I had the guy download some old ones as well so we could immediately see what it looks like and how it works.

There they were (the results) in Nancy's Inbox ready for review. I had her play with those for a few minutes. She says that the program (AC) even prompts you thru things like "do you want to set a reminder?" or "Write a Letter" and the like. She says it will even let her send us staff people an interoffice message so she could ask us to have Mr Jones come in for a visit because of these labs and the like. I still have a few questions and as I get some answers I will post what we have learned. Perhaps we should start a "Lab" thread???

All very cool. Now hopefully my doc will be more ahead of her lab reviews and now this is one less set of papers for our MA Shel to have to handle every day. We have opted not to have the Bi-Directional Bridge installed for the moment, but we can always go back to that in the future. As far as I'm concerned this other half is more for that Lab and not so much for the office, so that the lab can get our Demographic data and save themselves some data input time. I would think that they would want to double check this data anyway and see the patient's card and make sure it is correct for their own billing.

We are going to see how resistant or cooperative our patients are about going only to Quest for their labs. Then in a few weeks to a month or so we can evaluate whether or not we need to add the LabCorp one as well. I just never felt as good about their reps and support people. And their contract was very weird too as Wayne and I knocked around a long time ago. So I hope that we can avoid them. But remember folks that all UHC patients should or have to use LabCorp to get their labs covered... What insurance carrier bull. Anyway, I think we are going to like this one. Thanks Jon and AC for making this one less paper headache around here!!!

Paul and Nancy

UHC and Oxford, Paul. Don't forget Oxford.

Hey, by "bi-directional" do you mean filling out labs requests on the Quest Computer? Or do you mean a bi-directional interface w/n AC such that you can make the lab requests directly from within AC? If you mean the latter, I'm gonna have to ask you a ton of questions 'cause I didn't think they did that. But it might be nice.

Paul,

Sounds cool! We still have AlI here, and I don't picture that being a choice anytime soon. You could tell the patients that they may get their lab results quicker if they go to Quest.

As far as in the background vs manual, I agree with everything you are saying. But, just for giggles if you are able to control it, set it for all the time and see how much of a performance hit you take. It would be good to know for all of us out here.

Bert,
It's not too bad of a performance hit but our old 512 of Ram tower needs a few extra chips here, so for the moment I want to just look for labs a few times a day. If I had a more modern amount in my slots I would probably just let it run. Yes I will keep the gang informed as we go along. Unfortunately until today most of our labs went to LabCorp and not Quest so it will be a few days/weeks before we truly realize its potential.

We have a lunch scheduled with our rep for next week and at that meeting I will talk to her more about the bi-directional part. It is a "Bridge" as they put it. Any insight or thoughts or explaination there? I think this will be like x-link and help take out of AC our Demographics when we write the orders. Again with so little RAM I hesitate to have too much runnning on the main tower right now. I spoke with the tech who installed the first part this morning and the nice part it is on a case by case, order by order basic. So it won't just let Quest go rumage thru our server anytime they darn well please.

Our Quest rep says that they are accepting UHC claims at in-network rates and that they will not be banging the customers for the difference, so that they can keep their relationship and business with UHC patients. We may send a few patients thru (with a warning) to see how this really plays out, but we shall see. If their claims go thru and it is no different to the patients then I would have no need to look at the LabCorp interface. For NYSer's she did say that the Empire Plan (a NYS employees plan, admin'ed by UHC) was being problematic and those patients would need to go to LabCorp probably.

Anyway, I've got to go get my kids and get ready to officiate the men's league tonight, so let me run. Have a great night and we shall see how this all plays out.

Paul

The interface with LabCorp is bidirectional, but it's not like there's an integrated Amazing Charts control panel or anything.

We have a LabCorp computer in our lab. It is connected to my server via a "bridge". When the patient comes in, we enter in their Amazing Charts ID number into the LabCorp computer and it pulls up their demographics from the Amazing Charts database. This really does speed up the process of ordering lab. Once ordered, the results you receive will be associated with the patient's file in Amazing Charts.

Laboratory results are downloaded periodically through the day, via a program called Hypersend, which runs constantly in the background on my server. I have not noticed it to degrade performance.

Each morning, I just hit Ctrl+Ins on the server, which transfers all the downloaded lab results from Hypersend to Amazing Charts. The results appear in your Inbox. Double-clicking on the message opens a little program which allows you to sign off on labs, and also allows you to write letters to your patient's about their results, and send reminders to your staff about the results you are looking at.

The LabCorp computer program also has some nice bonus features, such as an estimated price list for each lab tests, and an index of the proper tube(s) necessary for each phlebotomy task.

Ok, this is similar to the Quest bridge that we have. We go tothe Quest computer, input the patients chart number and it grabs it from teh AC database.

We have our Quest system configured to also print out Labcorp lab requests. And we have Quest and Labcorp (hypersend and ,oh, I cant remember the Quest program name) that checks for labs to download to a folder on the PC every 15 minutes.

If anyone wants to know exactly how much system resources a particular program consumes across time, I would recommend using Systrack software from Lakeside Software. It does many more things but it certainly would answer the question about how much system resources a particular program executable uses. This will give you the exact memory footprint of each application running on your computer along with CPU, disk, and other stats. Free to try out too.

Main web page:
http://portal.lakesidesoftware.com/

The demo page is found here:
http://portal.lakesidesoftware.com/DemoRequest.aspx

I have used it in several situations since 2004 and it works extremely well, especially on older, less loaded computers.