Home Forums Discussions Problems Note disappears !!

I tried to search solution but could not find one here.

Biggest problem I have now is disappearing progress note.
After I finish writing today's note, then forward to myself.
But more than 20% of cases, if I open the forwarded note, it is blank !!
Not once, very often. I am afraid to use amazing chart now and do print all data as a back up, which is a tedious job.

Anyone has solution?

Dr. Kim

Does your note only disappear from 10-pm to midnight?
If so, get an update (or use a previous edition).
I almost ditched Amazingcharts because of a glitch in programming that made forwarded progress notes disappear from 10pm to midnight. There's a whole thread on this.

If you have updated Amazingcharts, then this may be a new program glitch... which is why I will wait on getting my updates until there is a very good reason to do so.

Dr.Kim,
I have never had this problem so I can't offer a solution. I trust you've asked Tech Support if they have any solution?

When you open a chart on your desktop, do you select "yes" or "no" to the question: do you want to remove the selected item from your desktop?; you are presumably selecting "yes" and you should do so if you are not. If you are not, this will create multiple versions of the note you are working on to appear on the desktop.

Dr. Kim:

I would like to understand the situation a little better. If I understand you correctly, the following occurs:

• You open the patients chart and start a note.
  • Do you open it from the schedule,
  • Or was the note forwarded to you by your staff?
• You complete your note and forward it to yourself for later review/signing.
  • Do you use the "Forward" button, The Alt-C shortcut, or the Ctrl-D shortcut (Save as Draft)?
  • Is it possible that you are sometimes forwarding it to the wrong account -- possibly an unused account?
• You open the chart up again and it is sometimes blank.
  • You are opening it again from your Inbox -- correct?
  • Is it completely blank? Is there any trace of the previous activity?
  • How much time passes before you open the note again? Does this ever happen when you open the note instantly after forwarding it to yourself?

It would also be helpful to know how long you have been using Amazing Charts. Give us some more information and we'll try to help!

Thank you for replies.
To answer Dr. Cotner's question,
1) I sometimes open note from schedule, but also sometimes I do type in new patient rolodex, right click to pull chart to start writing. Majority of notes are forwarded from nurse.
2) After I finish note, I forward to myself. I hardly use Alt-C button(have used couple of times only). I never used Ctrl-D (I did not know its existance!). I do not think I forwarded to others. I always forward to myself.
3) I open the chart from my inbox, yes. And it usually(?) is completely blank. The problem list is there but today's encounter note is blank. It happens immediately after I finish the note. Yes, it happens immediately.

I have been using AC since I opened my new practice on early February/2008. I use windows vista

Thank you so much.

Dr. Kim

Alan,
I'm going to forward your post to Bert. He's the top poster and a LONG time AC user. He's a friend of mine and prob knows how to resolve your issue. Your prob is definitely not what is supposed to happen, and I can't figure it out. I've tried to reproduce the issue but cannot.

D'oh! Ctrl-D was not the correct command.

I meant Ctrl-S (Save chart to your message Inbox). This is a handy shortcut, or would be if it did not occasionally cause you to lose the last bit of typing you did before you hit Ctrl-S. I used to use this all the time to send incomplete notes back to the Inbox, but switched to Alt-C on Bert's recommendation in this thread:

http://amazingcharts.com/ub/ubbthre...l-S&topic=0&Search=true#Post3855

Ctrl-D = Print Current Note as Draft, which is also an excellent function as it can double as a Print Preview. I use this function all day long to look for typos. It enlarges the text and changes the layout, both of which make errors easier to see.

Alan,

Roy is correct there was a ghost situation awhile back with the 10PM to midnight thing. It didn't affect me (I am immune to ghosts), but I think it is fixed now.

Brian is definitely onto it. It most likely boils down to one of three things:

1. Someone is forwarding charts to the wrong user. It can happen easily, but it wouldn't explain your situation from YOUR end. I am sure you don't screw up your forward 20% of the time.
2. Part of the crossing in mail would possibly be pulling from the scheduler. Brian and others can help better there.
3. The key is to see how many of the same name charts are in your inbox. If there are two, then possibly your nurse pulls a chart and does the subjective on the left and forwards it to you with nothing on it -- as he/she should. Then you open the chart from the patient list (something that should never happen unless you are working by yourself). You then fill out the entire chart including the physical and forward it to yourself. If you then opened the nurses' chart, it would appear as if nothing were in there.

Now, I realize this doesn't all make sense, because you would probably try both charts. For lack of a better phrase, this sounds like the charts are crossing in the mail. If you were to open a chart (from the patient list), type in it, then forward it, when you open it; it should all be there.

Hopefully, you can become confident in it so you don't have to print out a sheet of paper each time.

I just have to put a shout out for the following method, although Brian and others will kill me, althogh Adam won't. The sooner you can get to where you finish the chart AND sign it off in the room the better. Just my two cents. Good luck.

PS: There is almost always user error involved. There is probably something which would explain it. You have to remember if you are using the scheduler and you have MAs forwarding charts to you AND you are pulling some from the patient list, you have a chance and probably will have two to three different versions. After thinking about this, my suggestion (especially given my bias where I am not used to the scheduler), why not:

For one day, do not have the nurses do any charting or forwarding. ONLY pull charts from the patient list. After you are done with them, forward them to yourself. Stay away from charts on the scheduler. I am willing to bet if you do this that all charts at the end of the day end up having everything you wrote in them.

Bert,

It sound very possible that I may have duplicate patient.
Your suggestion seems very possible solution. To have an appointment(schedule), patient must be entered first. This may be causing the problem. I will try your suggestion of pulling out chart only from the patient list !

I will update you the result.

I feel better now...

Thank you.

Dr. Kim

Thanks Bert,
I knew you could help.
YOU DA' MAN!!

Well, we shall see. My answer is only a variant of Brian's.

Follow up report...

I tried your recommendation. But still the note was disappearing.

The disappearance happened when nurse pull up chart from patient list --> write nurse note, then forward to me --> when I opened the note from my inbox, it was opened. I forwarded to myself, then opened it again from my inbox then the note is gone. Totally blank note was up.

Thank you.

Alan:

That is astonishing, but since your problem is so repeatable, that also makes it potentially very fixable (small comfort I know).

Call Technical Support tomorrow, and they can watch this problem take place on your computer using a program called GoToMeeting. Once they see you demonstrate the problem, they can figure out how to fix it.

I am very mystified by your problem. Please post and tell us what you find out!

It is mystifying. My bet would still be that it is something explainable. One piece of information which would help is:

When you open the chart form the Inbox where the nurse forwarded it, a window will pop up asking you do you wish to delete the note from your inbox. Are you choosing to delete it or not delete it?

I know this would be weird, but is there any way you could be going to deleted items and retrieving them? I would doubt it.

Again, other than calling support, which is a very good idea, when troubleshooting, it is always best to start at square one. How about on every patient who is added to the schedule tomorrow, don't put them in the schedule. Just ask your receptionist to write the appointment down on a sheet of paper. On those patients, don't ask you nurse to write the vitals or subjective stuff, just let yourself do it. Just see John Smith in the room, choose his chart from the Patient List, do the note and forward it to yourself. When you go back later, see if everything is in there. It would have to be. I do this every Wednesday anyway as I have no nurse on Wednesdays. It isn't hard to do the entire note yourself.

Until you find the answer yourself or from support, this is an excellent reason to finish the note in the room and sign it off.

OK, here is another thought. Just in case we are talking about different things. Again, doubtful, but possible.

Is it possible that the nurse brings up the chart and enters his/her data and forwards the chart to you. Then, you open the chart from your Inbox and choose to not delete the chart from your Inbox. Then you work with the note and then SIGN it off. This would be hard to miss, because you would have to go through the entire process of coding, but...

For me, that would be the end of it. But, maybe you are thinking of adding to the note. So you go back and open the nursing note which, of course, would be blank.

Of course, when you say blank, I am not sure if you mean blank from the standpoint of what you wrote in the exam, etc. or if EVERYTHING in the chart (PMH, MEDS, etc.) are gone.

I will agree w/ Bert about completing notes in the room.
I am FP, and see a lot of complicated pts, I can still complete all notes when in the room. I'm doing a lot of 99214's and some 215's. I can still complete the notes when in the room.
To top it off, I'm converting from paper to AC, and I'm entering a lot of data PMHX, FMHX, Med Lists, etc. I can still get it all unless rare circumstance.

The best way to ensure no lost notes, sign off at end of the visit.

However, if you are not able to sign off the note at end of visit. Please follow Bert's recommendation because I think this is the best test to figure it out. ***(I think the nurse is doing something wrong) Enter a few visits (or all visits) for one full day all by yourself, from start to finish. Forward them back to yourself and you should never lose any notes.

Try this and let us know what happens tomorrow.

Adam, are you entering all PMFSHx yourself on a new patient?

Yes Brian.
I am doing it myself 50% of time (or having my medical students do it the other 50% of time), because I don't want my M.A.'s entering in the data incorrectly or w/ spelling errors.

I feel PMFSHx is critical because I will rely upon this during admissions, or in writing consult letters. I DO NOT want stupid/silly spelling errors plaguing my works.

My old med lists and problem lists were HORRID.
examples:
Flexuril stroke
Cureg A.feb
Toprolol heart attack
vicoden colin cancer
ibuprofin hydrocodine

I hated the fact that copies of these lists were going out to the E.D. and consultants. So I'm making sure it gets done correctly, the first time.

My staff are doing the labor of scanning in charts. In this way, we share the load. They do what they are good at. I do what I am good at.

What do you think? Any better ideas? I'm open to anything.

No, my friend, I agree completely, but I don't want to derail this thread entirely. I may create a separate post on this topic if I get time later.

We did get off Topic. A thousand appologies to the original poster. We should create a new topic.

Bad Adam! No treat!

I think the term we learned, thanks to EMRUpdate, is that you two hijacked the thread. Not good.

I figured it out.

It happened when we close the current note before signing.

Not to lose current note, either forward to myself or signing must be done. Otherwise, in case anyone(if forwarded to others) close the window, the note disappears.

Recovering note was not effective as erased blank note is saved.

I think it will take a while for me not to close window before signing.
I still have to print out draft progress note until I sign it in afraid of losing note.

Thank you so much for advices and suggestions.

Alan Kim

I'm amazed that none of us every thought to ask you this. This is a part of AC we regulars are just so used to, I think it just skipped our minds completely to even ask. Well at least you got to the bottom of it. This is why you must either complete the note or send it to someone like yourself in your own in-box.

Paul,
I am not quite what you or he are saying. It sounds like Alan was simply opening the chart and then closing it? Is that the case. That isn't what is quoted above. There would be no way for anyone to understand that.

AlanKim wrote:
I am glad that AlanKim was able to figure out the problem.

Paul wrote:

It was implied in the original post that these charts were being forwarded. I think this led to confusion as to where the issue was originating from.

Bert wrote:
Since it sounds like Alan was simply closing out of these charts, why did he only have problem with just 20% of the charts? I would have expected 100% of charts to be blank.

Furthermore, why was A.C. not opening the "pop-up" window that warns the user they are about to close an open chart without saving it? Was this window opening but Alan did not understand this would delete his work?

At any rate, I am glad he figured out the problem. Perhaps Alan would like to use the keyboard short cut for this:[Alt]-C to open the "forward chart" button. I use this shortcut when I cannot complete the note during the office visit.