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I do have one thing I would like. I don't know if it should be a change in the design of AC or if someone has already been using a suitable workaround.

In a paper chart I would write a list of orders, (things to do) and give the chart to a medical assistant who would then document what was done, and finally hand the chart back to me with the notes added that told what was done, and I would initial this off below their signature. This was only really necessary sometimes, such as I order a Tetanus shot and get the chart back noting that we are out of vaccine and the patient is returning on Tues when the vaccine is due to arrive.

I tried to do this by forwarding the charts, unsigned, then having them forwarded back to me, but it was very slow and prone to messages being lost. Addendum's sort of work, but I save those for the important things, (like the tetanus example). But I would like to have a routine where every task is documented and accounted for. I would like the MA to chart the date and time of the next appointment and so forth.

Do any of you have a practical workaround?

I actually use e-mail with pt attached. Staff can reply with whatever they did - date,time,etc and then I e-sign and save

Oh mi God. I am embarrassed that I couldn't see that. I didn't think that would solve the problem because I didn't think you could open the chart and keep the message alive, or read all the items to be done in the plan. That solves it for me, to a T. Thanks! :-)

I am still so new, I don't understand how this works.

We are dealing with this by the nurse manually entering info on the superfill so we don't miss out on CPT charges. She puts a templated message in my note and then fowards them back to me because I am still so far behind-.

Once I get where I can keep up, I would like to find a simpler way- Thanks vr

I have to say I am impressed by the documentation. Can I give another perspective from someone who is not as good as documenter.

I simply don't know how I could keep up forwarding the chart back and forth to the MA. She is usually putting in another patient and giving shots or triaging and on the phone. Wow. Now she does document things that need to be documented in an email that she saves directly to the chart. And, immunizations are documented in the proper places whether they are given or not. But, most things like nebs, etc. are documented by coding on the Superbill.

I have not started using the messaging yet as outlined here, but I did a trial with our 1'st patient, MR # 1000, "Just Testing" and it looks like it is a snap. Bert if you don't document a breathing treatment do you ever get any trouble getting paid? If it isn't written it wasn't done? I am interested in using this more for an internal audit, I give the job to a specific MA and I want to track what is done. Especially with regard to referrals and follow up appointments. I will of course use it for treatments also where needed. A breathing treatment deserves a note, with the lot number of meds etc. An EKG does not, (res ipsa) the presence of the EKG in the chart is documentation enough.

Our MA will document right into the note with her initial following so we know that something was done (glucose, neb's, etc).

I capture those codes when I sign off the chart.

Hello All,

I currently use a "to do" list on my paper chart. After seeing a patient, I circle the tests and processes I want done prior to the next appt. This requires no extra documentation being generated to the worker bees. While AC generates lab orders that I can print out, I'm having difficulty thinking of how I would communicate:
1. Get CT result from Seattle Grace Hospital (SGH)from sometime this year
2. Get chem 7 records from referring consultant and PCP and SGH.

My staff can then prep charts 2days prior to the next visit by using my "to do" list as a checklist to see if everything I (and they) requested, found its way to the chart.

Any workarounds? I think the idea of sending email to staff is silly. Using the chart forward feature disrupts my charting.

In the new version, there should be a field where staff can check off each item in the plan to signify they did it or what problems they encountered.

Chuck

Have you tried the reminder feature?

I use Yahoo Messenger. Granted, it is not secure but I do not put in any last names or other important info. In each of my exam rooms, I have a different Yahoo Messenger identity..."GardenDoc, BeachDoc and CabinDoc". The staff, who each have their own Yahoo identity know who is in that room. I can messenger up front and say "Please find Susan's CT from FMH from Oct". The patient isn't even aware I have sent the message to staff. Within a few minutes, here comes the report under the door. Or, I can message back to billing..."Susan will be out in a minute and has a question about her encounter date 2/2/08". The billing staff can already have everything pulled up and waiting on her. I can also ask the staff to "rescue me please" if I get stuck in a room with a chatty patient. Within a minute or so there is a knock on the door telling me the ER is on the phone and needs to speak with me. Works great, especially because as soon as a message reaches someone, there is a highlighted bar on the toolbar letting them know a message is there and who is messaging them.

Leslie

Hello all- just joined- been a user for nearly two years now. Love AC.

On another forum, I read about importing an excel file for use as a flow sheet or problem list- it can be updated regularly and accessed out of imported items. I realized the same could be done for a word doc for the purpose of nurses notes-- Chuck could pull the document up- write out what he needs the MA to do and print if needed- the MA can complete and document what was done in the word document and if needed, one could cut and paste into an addendum for more permanent documentation.

Carla

I document in the A/P that I gave a neb. I am certainly not going to put in a lot number of the albuterol. We also circle the neb on the Superbill which is kept indefinitely. I hate to say it, but being a doctor is hard enough without worrying about being audited. I am just not. If I do, then I do.

I agree. AGAIN, I am not disagreeing with anyone's method. As I said, I am impressed you can do that. My MA would never see my message. She is just all over the place. Besides, we click on 99213, then on 94664, etc. and everything is captured.

@Leslie,

I agree with you about Instant Messaging. I have used over 15 (literally) LAN or network IMs which are HIPAA compliant. The best I have found by far (and it's free) is IPMSG. It can actually track four things for computers automatically and manually: Computer name, IP Address, Nick name and Log on name. It's awesome in a domain, because you will see Checkout, but you will see that Lisa is signed into that computer, so you know you are sending to Lisa on Checkout. The IP address is nice, because it maintains connectivity very well. I was getting frustrated and thought about Yahoo, but I just figured it would be too difficult with initials and everything. Plus, my staff already hangs out on the net too much. I find that would be too tempting unless you just laid down the law. You may want to check it out. It's not hard to configure, but it is better with ultra-configuration.

Thanks for the suggestion, Bert. Actually though, Yahoo is working very well for me right now so I see no reason to change. It allows me to send to whomever I want, wherever they might be. As mentioned in earlier posts, my staff is cross-trained so they may be up front one week, in the back the next and then in billing at other times. They can sign into their Yahoo account at any station and I can find them. And my office is small enough that I know who is where. As far as being HIPPA compliant, we just have rules as to what one can and cannot put in a message. The same as if we were carrying on a conversation in the waiting room. The issue of hanging out too much on the computer...that is what my staff tells me I do I can be back in my office and they can message me and tell me to get off my duff and get to work. Oops, there's a message now...see ya!

Leslie

Thanks for the update. And, if it works for you, that's all that matters. Just want to make sure that you and anyone else who reads this understands that most network IMs and definitely this one, allows one to be up front or back at any given time.

Talking in ways that are HIPAA compliant is a way around that. It is nice though to be able to talk freely without worrying about that. The other drawback is the patient's perception that their info may be going over the Internet, although I guess one could say the same for an intranet version.

I am glad your staff doesn't IM friends. Mine definitely would. Again, being right up front with that policy would nip that in the bug.

A big vote for your system is that after many programs and becoming frustrated before I found this one, is I did decide to go to MSN or Yahoo. This one just made it under the wire.

AGAIN, I think your solution is a great one. Not being critical at all, just pointing out the pluses and minuses. I will say that you are 100% correct in thebenefit of an instant messaging system. Ours was down for two days, and my staff nearly walked out the door.

And, your story about how a patient can talk about an xray from an outside hospital, and it can miraculouosly show up on your desktop within minutes, blows patients away.

It's funny, becaues when I get a new employee (something I don't want to happen too often), it definitely takes them a little bit of time to figure out what message goes where, i.e. Outlook, AC or IM.