Home Forums Discussions Problems Please help Re: PMH details of a patient

Hi all,
Is there a way to update a patient's PMH or any history pertaining to a patient in AC? Let me explain - say patient A's cardiologist called and said that he will need to see a vascular surgeon due to a right ICA stenosis. I want to be able to go in and indicated that Patient A now has PVD and right ICA stenosis. However, since my note for patient A was already signed on the last visit, I can't edit the PMH until the next visit or else I have to create a new encounter to be able to enter the new dx in the PMH so that AC can pull this new information into for the next office visit (or else I might forget). For now, we use a note pad inside the chart to remind us to do this. This is redundant and time consuming. Is there any other way to update a patient's history without needing to create a new encounter?

In other EHR, you have the ability to enter a patient's information (like demographics in AC) which can be updated regularly and it will pull that information into a patient's chart. Unfortunately, AC only allows demographics of a patient to be updated without the need to create a new encounter. Any suggestion is much appreciated. Please help!

Amazing Charts won't let you update patient history without having to create an encounter to sign it off. I agree this is a pain but currently there is no way to do it in amazing charts without creating an encounter. I agree this would be a useful feature.

You could always create an encounter and just make up a diagnosis "Updating patient history" or something to that effect after updating the history.

Demographics on the other hand can be updated without creating an encounter.

What's your name? Where do you practice?

Marty

Yeah, it can't be done without saving a note. I believe what our doctor does is write some shorthand of the relevant data she wants to see on the next visit in the yellow note area of the most recent encounter tab. If you click forward chart and then cancel, stuff written in the yellow note will be saved without having to save the encounter.

We use it for many things like "need HPV#3," "recheck hearing test," etc.

Not to be confused with the yellow note in the demographics screen. The doctor doesn't look at that screen very often.

I've been trying to figure out the same problem.

@serene, good tip i'm going to try it

Other alternatives are writing an addendum or a "pmh update encounter" and not bill it, but that's a bit messy.

This is not perfect, but especially during the annual wellness visit, when rehashing Past Med history, but can be done anytime, I have found that when projecting the AC chart on a 24 inch Samsung 1080 screen HDMI'd to my Chromebook, I can update the Past Med history along with the help of the patient. If the patient ended up in ER or another appointment since last visit, my nurse scans to imported item section as I am visiting with patient and can update right then and there. Has worked quite well.

I realize this does not address your issue but this work around has worked quite well in the past month since having the extra TV monitor in the exam rooms.

Serene, this does not seem to work consistently for me. I've been trying to set a reminder, but the option to save as a yellow sticky note is greyed out there. So if I try your way, My steps were:
Select patient
open chart
add whatever to yellow sticky note
forward
hit "cancel".. this leaves chart open on desktop
If I close, additions to sticky area are not consistently saved. What steps am I missing?

I also use the "yellow sticky note" method and transfer the info on the next office visit. In order to have the option to "save as a yellow sticky note" you have to open the chart, click send reminder (next to the yellow note on the main page, not the demographics page), enter whatever info you want to add to the yellow note, click "Save as sticky note" and send it to yourself. You can then close the chart (without signing off - the yellow note will remain) and delete the reminder to yourself in your messages if you want. The next time you have a new encounter you can add the new info to the PMHx.
I wish it could be added at any time on the fly.

This is a definite shortcoming with AC, and one we have discussed before. I wish they would change this somehow, that and imported items reconciliation, and a host of other things.

Jimmie: How often are you connected to a big screen with a patient encounter? Sounds interesting.

Boondoc,

Every encounter. Since it is a new experience for each patient I start out with, "My 13 year old computer genius figured this out, and everyone needs a 13 year old around to help figure all this computer stuff out....and I use this laptop (chromebook) to drive my main computer in my office where your data is housed, and it also functions to project your chart onto the TV screen, so this device is just a conduit...."

I end with, "Now, just so the next person roomed won't see your personal information projected onto the screen, I have trained myself to take the Chromebook wherever I go, and I have to detach this beast from this cable (HDMI port at the laptop).." Then the TV screen goes black and reassures the patient their information is indeed not residing on the TV for everyone's perusal.

I should mention, I have a printer in each exam room, so if my nurse has to send a report from the ER or another physician during the patient encounter, she will use Updox to send into the chart into the imported item section and print report onto my printer in my exam room, so I can sign off and get report in chart, and also use the printed report to input data under Past Med section, and then hand report to patient (if they want it).

You would think that AC would be able to fix this problem. I can't believe that such an important part of a patient's chart would be left out. I thank you all for your help and in giving us advise for the work- around methods. I like the yellow note area in the most recent encounter tab method as suggested by Serene. The yellow sticky note method is great as well but than it would create many reminders and that defeats the purpose of trying to cut down on our inbox (although you can delete the message but than that takes an extra step).

The other obvious thing not mentioned is that you can still update the list of problems via the summary page without creating an encounter. Not perfect but at least it shows up next time you open the summary page.

I use an addendum. I label the subject in a way to get my attention. Add quick note with new info, don't attach it to any other note. Then addendum will pop up next time chart is opened. Whenever I see a pt I do a quick click on past encounters which also shows these addendums.

David,
Those are the steps we take. It does seem to work consistently for us. Maybe it's the version? We are using 6.3.3.

Our doctor has another way of saving the yellow note. You can switch to the demographics tab and click update info. And what you wrote in the yellow sticky will stay there.

I'll try that also. Thanks.

Keep in mind, there are two different yellow boxes (well, actually, three) in AC. One is in demographics and one is in the encounter. They serve different purposes and show up in different places. Not sure which fits your purposes best here.

And now for something completely different.

I rarely need to update the way you all are talking about here, so I don't really do this, but here is an idea for you. (It uses part of AC for a different purpose than was intended, but that should not interfere with current workflow since I doubt many people use this part at all).

Let's take James' original example: you want to add "PVD and right ICA stenosis" to the patient's PMH.
Go the the patient's chart, summary page, and on the right side, use the "Alerts and Directives" section. Click "Add/edit" and in the window that opens, click "Add new", select Level "high". Under "Name" put "PMH" (or if you want, just type any symbol) and under "Details" put "PVD and right ICA stenosis". Save it and close the chart.

The nice thing is that when you go to the patient list and select the patient (presumably at their next visit), that box in the bottom left turns red and includes "PMH: PVD and right ICA stenosis" which:
a. is nearly impossible to miss and
b. can be copied and pasted into the chart at the next encounter.

Yes, it is a few steps, but not terrible. And as I said, that red box at the bottom is far more visible and less likely to be missed than the yellow boxes or flags.

neat trick, I like it

Why, in G-d's name, doesn't AC simply make the PMHx addressable in between visits?? (adding a new bit of data without completing a full encounter penalizes providers participating in MU . I can't figure out who is more culpable here, AC for not listening to its customer base, or the White House for believing utopia can only be achieved when enough rules (read: Meaningful Use)are enacted to completely manage each aspect of a professional's behavior (and leaving the AC running to play regulatory catch up instead of meaningfully improving their product to enhance the care of patients for its users (yes, the words "meaningfully" and "users" in this sentence is meant with some degree of irony)

. . . .And while we're at it, how about a meaningful problem list on the chart, or at least make the current one annotatable (in lieu of a stifling pre-fixed ICD drop down menu) so I can actually recall the details of why I am following each patient without consistently having to research my older notes.

It's Sunday morning in Colorado and I'm just feeling a bit more dis-inhibited than usual.

Missing paddy chayefsky

Bruce Morgenstern, MD (Neurology)
Denver, CO

It's probably not so easy. AC is not setup to have a real pmh database, just copied text from the last encounter. One can choose to start a new encouter from the last encounter or not.

I'll live with the inconvenience of updating the pmh during encounters only. A fully structured pmh would be more clicks and more complexity. We know how that goes ala Meaningless clicks and Use.