With Soapware there was a section on the virtual chart call interventions and as things came in you could quickly document specialist seen, hospitalizations, procedures, labs and ect. so when patient came in the data in interventions section could easily be copied and pasted into the note. Also it allowed you to run a tally of everything patient has done all kept in one area very visible. This allowed you at a glance to know what the patient has done...
I carry a laptop from exam room to exam room, and a desktop, well, on top of my desk. Between patients I sit at my desk with both screens side by side and tackle my inbox in AmazingCharts of interfaced labs and imaging reports, and my inbox in Updox of faxes from consultants and non-interfaced labs and imaging centers. I open the patient chart on my desktop, and the incoming communication on my laptop. For each incoming document, I create a File/Addendum/AppendToSignedNote to my last office visit note that looks something like this:
YYYYmMMdDD cardiologistSmith: changes in dx, changes in mgmt, f/u x wks
YYYYmMMdDD hgbA1c8.8 "[context: metformin1000bid Lantus20 before augmented]"
YYYYmMMdDD CXR2v 4cm mass RLL <copy and pasted from desktop report if interfaced>
YYYYmMMdDD colonoscopy giDrJones: several polypectomies
YYYYmMMdDD inpt.Hospital.XYZ: discharged new dx, changes in mgmt, whatever else
These might have been added one line at a time on five separate dates. Most of these are a single line, but if there is a lot of meat in the data it might be a paragraph. I only include what I think may impact my management at the next visit or thereafter.
Now when I next see the patient a week or 5 years later, a new note opens by default with the Plan containing that of the prior visit ready to be amended (or not). At the end of the Plan section is appended everything that has transpired since the last visit. I copy and paste it into whatever section of the new note I feel like, or delete it.
1.) I never have to look anywhere else for information. I never look up Imported Items during a visit. I never look anywhere else to see what has happened since last seen. Whatever I feel might be relevant for future notes I copy into the PMH field. Whatever I never want to see again gets deleted.
2.) I may not even keep the source document. I gave up long ago trashing my hard drive with megabytes of other providers records that take forever to backup. I refuse to be a librarian for specialists' medical records, or for that matter imaging reports from other providers. If I order lab or imaging, I store it, but consultants' dozen page notes almost never. If someone else got paid to produce the document rather than me, let them store it themselves. Occasionally if I sense a liability potential, I'll keep it myself. When insurers request all the patient's hospital records, I tell them they can ask the hospital, we don't have the resources to keep a duplicate copy of someone else's records.
3.) I do make an exception for other providers documents that earn my practice revenue - believe it or not, we sometimes get paid at the end of the year if we can fax someone the ophthalmologist's dilated diabetic retinal exam.
4.) I can validate the charting elements supporting a higher CPT E&M code if I have interval lab, imaging or review of outside records documented in my note (occasional level 5 after any serious ER or inpt encounter).
5.) I'll reconcile the med list as each document is received deleting meds stopped and adding any I think are likely still be in use whenever the patient might next be seen, so I don't have to recheck the source document, or tax forgetful patient's memory.
I tend to eventually move my one line document summaries into the PMH, and every few visits try to do some housecleaning. If I've ordered them by type (eg all the BMPs) then I can save the peaks and valleys [annotated for context of any decompensating events], and most recent, and delete all the rest. One day I hope someone comes up with a clever EMR that will sort the lines by data type and date, and parse out the no longer relevant lines - for now I try to do a little of that by hand every few visits.
And finally to any developers who haven't already read my Recommend Improvement pleas:
A.) It would be nice if AmazingCharts played nice with Windows and stayed in its own resized window so you could see another application window of data alongside AmazingCharts - alas, Amazing Charts has an ego and fills the screen no matter what.
B.) It would be a big plus to allow multiple windows within a patient chart to be displayed simultaneously - if I understand correctly this is the original poster's lament.
C.) The Original Poster's Soapware feature would be welcome enhancement - appending to the end of the prior note is a work around and the prior note can get ugly when it is sent on to a consultant later and has a dozen appended notations.
...and thus what was due.
I keep this in PMH toward then end. e.g.:
HCM:
YYYYmMMdDD mammo BIRADS1 negative
The next year's mammo result is appended to the prior note Plan, when patient is next seen it gets cut and pasted on top of the prior mammo result in PMH above. Alternately there is a way to do this in decision support, but it take more clicks, and can be a bit unweildy, and I tend to reserve that for just the IZ summary.
Hope that helps.
