Home Forums Discussions Feedback and Recommendations SOAP FORMAT S*CKS. P.S. I LOVE AC!

I REALLY APPRECIATED THE NEWSLETTER I JUST GOT.
HERE IS MY FIRST SUGGESTION FOR MODIFICATION OF AC

DO YOU ASSESS A PATIENTS PROBLEM AND THEN PLAN ON WHAT TO DO?
OR DO YOU ASSESS A PROBLEM, TREAT THE PATIENT(MEDS, DX TESTS, INSTRUCTIONS,EDUCATION,REFERRALS ETC), AND THEN PLAN ON WHAT TO DO NEXT, DEPENDING ON THE PATIENTS RESPONSE TO THE TREATMENT YOU HAVE PROVIDED?

ASSESSMENT
TREATMENT
PLAN

ONLY ONE PROBLEM?
HOW OFTEN DOES YOUR PT HAVE ONLY ONE PROBLEM?
IN THE ASSESSMENT(PROBLEM)/TX/PLAN BOX, THERE SHOULD BE AN EASY ONE CLICK OPTION FOR;
ASSESSMENT(PROBLEM) #1,
ASSESSMENT(PROBLEM)#2
AND SO ON.

IT WOULD LOOK SOMETHING LIKE THIS
ASSESSMENT(PROBLEM#1)
TREATMENT
PLAN
ASSESSMENT(PROBLEM#2)
TREATMENT
PLAN
and so on and so on

Sam,
Nicccccce. Great idea for FP's and others with many issues per visit. Folks?

Sam:

It is nice to break up the blocks of text into organized sections, and it can be difficult to do in Amazing Charts because there is no bold text, and no tab stops. All-Caps and special symbols are about all you have.

I break up my HPI into sections using capitalized headers like so:

Now, it sounds like you are wanting to take this to the next level, and have each Assessment and Plan grouped together under a heading.

There are several "rules" of Amazing Charts that make this a little difficult:

• When you prescribe a medicine, they all float to the top of the "Plan" section.
• When you write an order, they all sink to the bottom of the "Plan" section.
• When you right-click and activate a template, it sucks up all the white space between the template and the next line. (I don't know why it has to do that!)

If you want to start organizing your data in this Assessment/Treatment/Plan format, here's what I would do:

1. First, plan on using the "Assessment" field as your canvas, and the "Plan" field as your paint palette. In other words, you are going to be constructing each of your little treatment plans in the "Assessment" area only.

(If you try to use "Plan" as your main area, then every time you add a new med or order, it's going to fly away off-screen, and you're going to have to go look for it).

2. Next, create a template with the following format. Make sure to include the colons. You will see what they do in a minute:
3. Now, choose a diagnosis with the ICD-9 selector (I am assuming you use this feature). After it pops up, right-click and select SAMSPLAN or whatever you decide to call your template.

4. Order all your meds, labs, x-rays for that problem. Call up all your treatment templates. They will all appear under "Plan." Now copy and paste that info from "Plan" into the appropriate areas of the "Assessment".

5. Pick your next diagnosis and repeat the above process.

I will admit this is not "one-click" but it may be the best workaround you are going to get. If this doesn't work for you, or if I missed the whole point somehow, just let me know.

p.s. - I checked and this looks good when printed.

@Brian: Wow, that seems like a lot of work. Fortunately, pediatrics doesn't have as many problems. You never did explain the colons, although that trick looks vaguely familiar .

@Sam: This is a great thread and a great idea. If I may make one request (and please don't take it personally)? Can you not write in all caps? It is very difficult to read. Thanks.

Bert;
No offense taken. I should have know better about the caps.
I am in general responding to the e-mail newsletter from AC announcing the delay in release of 4.0 and the request for improvements as we move on.

I am currently getting around the problem by organizing under ASSESSMENT as follows;
#1 assessment
treatment,
#2 assessment
treatment,
#3 assessment
treatment
I do by the way list here Rx*** and ORDER*** in short hand under treatment in addition to it being listed under plan.

Then, under "Plan" I am numbering #1,#2, #3 and listing what I plan to do on follow up visit depending on response to treatment.

My other issue is having an ongoing list of what has been done for the patient in past visits. How many times did I inject that heel spur? When did I do it? When did I do that surgery? Didn't I treat this patient for a wart last year?
The cumbersome way I am getting around this (but better than looking thru each past encounter note)is copying every injection or strapping or surgery into the past medical history box, listing for instance "inject heel spur right 3/3/09" "Bunion surgery right 4/5/09" etc. When I start a new note, I have a history on the left of what has been done.
I was wondering if anyone else is having this problem and if there was a way to automate it?
Everything I say is with a large grain of salt. Dollar for dollar, AC offer the best ROI of any EMR out there by a factor of 30 (as in $30,000).
Thanks for the comments
Sam

Bert:

Creating that post was a lot of work, but the process it describes is not so complicated, and seemed like the quickest way to get the kind of note Sam was looking for. I could be wrong.

Sam,
Great suggestions!
Please consider attending the Amazing Charts User Conference
http://www.amazingcharts.com/acuc/
and providing your input.
Jon has informed us that he is depending upon the input at this conference to assist in his modification of AC and he will be there all three days along with his AC Staff. Bert and Brian will be the headline speakers.
Best,
Jim

@Brian, Oh, I know it took a lot of work. I can relate, trust me. I will probably never benefit from it, because there are such few patients in pediatrics, although there are some. Never intended to be critical about it.

@Sam, Many people have brought up this issue as far as what you have done in the past, etc. There is one possible workaround or not even a workaround actually that I have brought up many times. If done correctly, especially with the help of an Excel guru, it can be quite effective.

First, you set up a very comprehensive Excel spreadsheet that can be used for AlL patients. That's the nice thing about the tabs on the bottom. You can name them anything such as Labs or Procedures or Surgeries or whatever. You then make each sheet custom made for your practice. Excel has many powerful features for working with data. Once completed, you back up this file in about ten places (just trying to indicate how important it is not to ever lose the master copy).

With each new patient visit, your receptionist can open a master copy, type in a few demographics: Name, DOB, Age, etc. then save it to the desktop with the name of the patient. Import that file into ImportItems and now you have a spreadsheet of all data needed. Anytime you open that patient's chart, you can click on the Import tab and click on the spreadsheet. You can view data, add data, delete data. You can even send a copy directly to a colleague via email.

Just a thought.

Bert:

No offense taken. I was just pointing out that the post looks long and daunting, but there is a lot of philosophizing in there that makes the procedure look more involved than it really is.

By the same token, Bert, I know from experience that your Excel spreadsheet technique is a simple and powerful tool that may not sound like much when you just read about it in this Forum. I hope we can find some way to work in a demonstration of this technique at the User's Conference.

What a great thread. Brian has a terrific solution for those of us, (like me!) that us a "modified" SOAP format. Every item in the plan should be attributed to the appropriate item(s) in the assessment. AC scrambles that completely the way I have been using it. I am going to try Brian's work around. The staff need the match up in order to get the proper ICD-9's onto lab slips, x-ray orders and so forth. (This past Monday I had a request for a PET scan going out with Acute Bronchitis as the DX because the MA didn't recognize Actinomycosis or Hemoptysis as lung related.)