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Hello All,

As part of my history taking, I ask all patients regarding DM. IF this is present, I then ask 8 more questions regarding retinopathy, neuropathy, glucose control etc., but these are only conditional on the first answer. I'm trying to minimize my template clutter and also keep the printed format easy for me to read.

Is there a simple work around?

Chuck

Hi, Chuck.

Post your eight questions, and I'll take a stab at it. The nature of your questions will make a difference.

Hi Brian,

HTN: Y/N, CVA Y/N, TIA Y/N, MI Y/N
DM: Y/N if Y then progress to
I/II
Regimen
CBG range acb
retinopathy?
last saw optho when?
DGE?
sweats with meals?
neuropathy?

Nephrolithiasis Y/N if yes, I expand each episode
Hematuria Y/N
UTI Y/N
Pyelonephritis Y/N
NSAID/Acet use

Chuck

This is gonna be a good thread!

First let me point out that there are a couple of factors you have to account for when you try to create a form like this with Amazing Charts templates.

One is the fact that you can't use tab keys. The other is the idiosyncracies of the templates, like how new templates jump to meet the old ones, no matter how many lines you separate them with, or when they leave funny little white spaces at the beginning for no apparent reason.

For this reason, some people use other programs like "QuickKeys" or "Dragon NaturallySpeaking" to create templates.

But I digress.

If I was me, in your shoes, I would create two templates.

The first would be called "5-point Screen" or something like that:

Hypertension: [YES] [no]
CVA: [YES] [no]
TIA: [YES] [no]
Myocardial infarction: [YES] [no]
Diabetes: [YES] [no]

The second would be called "Diabetes In-depth" or something like that:

Type ######
Regimen: ######
CBG range: ######
last saw optho ######
retinopathy: [YES] [no]
DGE? [YES] [no]
sweats with meals? [YES] [no]
neuropathy? [YES] [no]

Here's how it would work: let's say that you're ready to do your initial screening. You right click in your HPI or ROS field or whatever, and up pops the template menu. Now, select "5-point Screen", and up pops:

Hypertension: [YES] [no]
CVA: [YES] [no]
TIA: [YES] [no]
Myocardial infarction: [YES] [no]
Diabetes: [YES] [no]

Great. It's like a mini-questionnaire. You quickly go down the list, double clicking on the yes/no answer you DON'T want, and hitting backspace or delete, leaving your list looking like this:

Hypertension: [no]
CVA: [no]
TIA: [no]
Myocardial infarction: [no]
Diabetes: [YES]

You now right-click and select "Diabetes In-depth" and up pops that template. The first line of the new template will insist on jumping up and meeting the last line of the previous one, but that's okay in this case. We planned for that. It now looks like this:

Hypertension: [no]
CVA: [no]
TIA: [no]
Myocardial infarction: [no]
Diabetes: [YES] Type ######
Regimen: ######
CBG range: ######
last saw optho ######
retinopathy: [YES] [no]
DGE? [YES] [no]
sweats with meals? [YES] [no]
neuropathy? [YES] [no]

The ###### is your cue that there is a numeric field that needs to be completed. Double-click on it, and fill in the appropriate number(s).

Then, once again, quickly go down the list, double clicking on the yes/no answer you DON'T want, and hitting backspace or delete, leaving your list looking like this:

Hypertension: [no]
CVA: [no]
TIA: [no]
Myocardial infarction: [no]
Diabetes: [YES] Type 2
Regimen: metformin 500 mg bid
CBG range: 123-234
last saw ophtho ?May 2006
retinopathy: [no]
DGE? [no]
sweats with meals? [no]
neuropathy? [YES]

You can see that by making [no] in lower-case, it really makes positive [YES] responses stand out.

The brackets are not really necessary, but help to identify questions which need to be answered.

That's the best method I could come up with. Try it out and see what you think.

i think brian's idea of using sequential branching templates is great, however, as he so correctly states, if one is limited to templates.
there is another method, which if it were to work, would allow even more flexibility in data entry, and that's the creation of a fully operational word document, importable as a template into AC.
in other words, if one were to create a template in word, with drop-down boxes, selectable by keystroke, and therefore also with voice command and control, one would have both navigation through the template with a variety of selections, AND navigation through AC.
one would still use sequential branching, however it would be to additional templates, with further drop-down boxes.
the REALLY neat feature would be to have selectable options in the drop-down boxes tied to chronic & preventive care disease registry indicators, in addition to the labs, programmable to any parameters one wanted, eg AHRQ, HEDIS, whatever.
and sequel will make all of this possible.
howzat sound?

I hate every writing this, because:

1. Brian's answer is so good and took so much time to do, and
2. Because I have been fairly critical of the program I am about to talk about. But,

If you REALLY want to do what you are saying, then get IMH. If you could configure it mor easily, it would be a great program, but I would contact the author of the program and DEMAND that he help you set up templates. They can do them for you, but I don't think that is unlimited. Personally, though, I would say for the amount of the program, I want a template a month done for me.

But, it is exactly what you want.

http://www.medicalhistory.com/home/index.asp

And it works directly with Amazing Charts.

Ah, I just looked on it as a challenge.

My way would totally work for somebody who didn't want to shell out fifty dollars a month.

On the other hand, IMH might be perfect for someone who was really into P4P and had the logistics of patient input worked out, especially if they were willing to get on the phone with IMH and get the kinks worked out.

I tried incorporating IMH into my practice for about a month. I had a few issues with it, including increased crashes, and formatting problems, too-invasive questions, and I could not figure out how to easily create custom templates (and I am not ignorant about computers).

I would love to hear about other users' positive (and negative) experiences with IMH.

IMH is one of those programs that has the POTENTIAL to an incredibly useful program. But, like most programs including some Microsoft has made, it is way too bloated and way too expensive. The ability to make custom templates can only be done by Steve Jobs or Shawn Fanning. And, I agree, as I have told you before way back then during that month, $50.00 per month is ridiculous. When an addon costs most than the entire program.

I don't know almost CCHIT about this, but our old program ChartWare used this supposedly powerful program for the imaging printing, form side of things called "Crystal Reports". From what we understood it allowed the users the ability to have lots of control over the forms involved with the program.

Again I know little about this, but with AC taking on a real change might it be time to examine lots of possiblities to allow us more and better control over these things. Although I also undestand CR cost out the ears as we only used things in their most basic set-up.

Is there any program that would allow us the ability to scan in something like state forms and then enter data in the fields as we want them? Again there is a cost benefit ratio to be considered and many great solutions are not practical in our little AC world, but I thought I'd jut throw this out there for the rest of you to chew at it.... Be good.
Paul

I wonder if Special Ed could write a little IMH program that would cost a hundred bucks and not $50 a month?

Go for it!!! Special Ed, huuuuh? Does he know that you call him that? Or is this a name he wears like a badge??? Be Good and do it.....

He seems to be the man for the job. Speaking of which, either get him my contact info or send me his..... Thanks.

Will do.

FAP!

I don't think F.A.P. would work well for this.