It is easy to wait until the ed of the day to finish the chart, it is harder to actually finish them. Every time I think I will come in early to finish charts something else causes me to get side tracked and continue to be behind.
I have thought about a scribe but feel that this is more of a cost and also wonder if the pt's will open up like they do now when it is just the 2 of us in the room. I think the cost could be offset if you could increase the pt count for the day.
Are scribes in consultation settings and ED settings in the room or behind one-way glass. Scribes must be like court reporters. They take pretty good notes, but the conversation must be much faster. I don't know how hospitals do it. Or consultants. A good scribe must be at least $18 to $20 an hour.
Don't take this the wrong way. But, everyone always says I will just see an extra patient. We see everyone who wants to be seen. And the total of the patients I see in a day is almost always depends on how many patients make appointments.
I think directly in the room would be hard. Especially with my style which is very Patch Adams like. Well, not quite so clownish, but crazy.
I agree with you about the need to see pts. We have a same day appointment policy of the person is sick. If they are not sick and we have an opening I (actually the staff) will get the pt in to be seen and listen to me gripe later about how busy I was.......
I am with you about the style, we have a more informal, get to know each other slower pace for a family practice but both myself and the pts seem to like the interaction and the time spent.
Scribes here are about $15/hr last I checked which would take at least a couple of pt's more per day to justify. My problem is when I have had students working with me and kind of tried the scribe thing using the student (MA, Nurse, whatever) I didn't like what they typed and redid much of it myself. I guess a scribe would get used to hat you write but I still feel like it is not my words. My neighbor's daughter was a scribe while in college and waiting to get into PA school. She enjoyed the experience but again I think she was with a specialist group.
Sad thing is most specialist usually use cookie cutter language (templates) and are in and out of the pt's room much faster than I ever get out of a room and get paid more for the visits.
True on all. Got a little nervous last week, but I ended up with 25 today with 5 high acuity plus a couple of high acuity labs requiring calls to specialists. Today was actually hell. But, what makes a day hell is the messages. Phone calls and triage messages. Kills the morale of the staff and just swamps me.
I have one thing I want to put into place. And, it would work off caller id. Your smart phone has the capability so why not the landline or VoIP. But, you know how you type your password in wrong three times at sites that are secure like the portal to the labs etc. at the hospital? You get the message. You have attempted too many times. You are locked out. Please call the help desk to reset your password.
I think I am going to set that up in my office. So, the patient would call and get the message: this is the fourth time you have called about the same message. As the staff told you the first three times, they will call you back when the doctor replies to the message. You are now locked out of the practice for one week. Please call the office manager to reset your child as an active patient.
Or, this is the fifth time you have called in less than four hours. Please pick up a release form at your convenience so we can transfer your child to another practice that has nothing better to do than answer your phone calls. Your child is permanently set to inactive.
Ok, so I have successfully hijacked the thread. I guess I am becoming a softer admin at least on myself.
****** OTHER ADMINS ARE MADE OF STERNER STUFF ****** FUTURE OFFENSES WILL INCUR SERIOUS PENALTIES ****** READ THIS AND TREMBLINGLY OBEY
Last edited by carlfogel; 05/19/20223:28 PM. Reason: post cried out for admonishment
Just to get us back on track with prescribing problems.......
I have one patient and every time I send in Benazepril 20mg to his pharmacy they try to fill it with 5mg. They are telling us it is coming across electronically as 5mg. I have never sent in 5mg for this guy! I did send in 10mg in the past but never 5mg. Crazy this is a recurring problem with the same pt and pharmacy!
Sad thing is most specialist .... get paid more for the visits.
Actually this is generally not true. No argument that compensation for some procedures is more than it should be (in relation to the work pcp's do) but I generally am paid on the same fee schedule as the primary care docs, with few exceptions.
(And not complaining, but the procedure compensation is not nearly as out of proportion as it used to be).
Another prescribing issue, back to the italicized "uncodified" med thing, this time with Warfarin. The warfarin has been in the pt's chart for a long time and today go to refill and now it is in italics.
here is a problem I have seen over and over but had a hard time proving, this morning had to refill a medication (controlled) and add the UOM although I know it was there before, so I change the UOM in AC, save and then go back in to the EPCS system to send to the pharmacy and the UOM is different, went from tablets to milliliters; HOW JUST HOW CAN THE SYSTEM DO THIS????????????
I am probably missing something unless the big thing is that the UOM in NC changes randomly. But, even so, if milliliters is wrong and tablets is correct, can't you simply change it in NC and not worry about AC.
I also think but could very well be wrong that what you do in NC changes AC to match.
Yes it is the fact that the NC changed what was in AC from tablets to ML. Yes it can be changed, if you pay attention and catch it. I just don't see how NC put ML in the UOM, I didn't put it there so it is very random. We have this type of problem with AC to NC all the time. Will go to the pt chart to refill a controlled med, say adderall, the UOM will be tablets in AC and then when you go to NC (med list is supposed to carry over) the UOM is missing. It is just a trivial time consuming process and an annoyance.
How is the testing going? I am ready to try it and see how it is, not sure if they need another beta office or hopefully it will just be a full release soon.
There are going to do another build likely in a couple of days due to a bug. Yes, I am sure they would always want new beta testers (just my guess) especially since you are active on the board and show a lot of interest in how well (and how not) it works.
Today our EPCS is totally wacky. Several tries to get one to go through. Often the Authy app never appears on my phone. Over the last 2 months AC freezes switching screens, anything to do with prescribing, can take up to 2 minutes to respond. Tech support worked on it, didn't really change much. Getting pretty worried that prescribing is getting too difficult. Guardian Angels don't answer phone or chat. Left a message 30 minutes ago.
Last edited by Shrinkrap; 05/31/20225:34 PM.
Lane Cook Psychiatrist, Knoxville, TN "Experience is NOT doing the same thing over and over"
Bert, they may get tired of getting responses from me!
Shrinkrap, I did not have problems with EPCS today but did find a couple of more bugs. I did not use the phone app, used the Exostar code generator (key chain thing). I have not had the freezing thing except for occasionally, once a day while trying to print an order AC will freeze and have to be restarted. The bug today is hard to figure out. I am not even sure how to explain it. Will try in the next post. Wish I would have had time to take some screen shots!
I just get the chat box pulled up and refresh often to try and get to support. I have never had a problem after several attempts to get someone online. I have also not had good luck trying to get them by phone!
This is no complaint. Just a suggestion. It would be very cool if after you hit #2 Prescribe and the script is ready to be sent and you just have to click on Transmit to Pharmacy but don't, (which I have now done 1,000 times in the past month), you would get an error message saying something like, "You had a prescription(s) ready to send but you did not transmit them. Do you want to go back and transmit them to the pharmacy?" Or something, like, "Hey idiot. That script ain't gettin' filled anywhere." The bad part is you don't realize you didn't send it until the next day when you hear from the patient that there was no script there. And, the other bad thing is you can swear you prescribed it. But, you didn't.
Or am I the only one who does this or has done it.
PS I called for support on the weekend and Nick called me back within 20 minutes. Kudos to Nick and support.
"Or am I the only one who does this or has done it." been there done that but my patients usually call me that night about 15 minutes before the pharmacy is to close and want me to fix it right away!!!!!!! SO if you get until the "next day" be thankful!
I sometimes wonder how many don't actually go through vs me not sending vs someone on the other end just deleting the script and never realizes it or says anything.
Not to be too critical, because I am dependent on tech support this weekend, but the prescription writer could use its own development team. The medication log could be better. But, say you did get to that last screen and didn't hit transfer to pharmacy and just closed the script writer, your med will not be sent, but the list of scripts on the left will show sent 0 days ago or 1 day ago, when in effect, it wasn't sent. That should change until you hit Transfer to Pharmacy.
This is no complaint. Just a suggestion. It would be very cool if after you hit #2 Prescribe and the script is ready to be sent and you just have to click on Transmit to Pharmacy but don't, (which I have now done 1,000 times in the past month), you would get an error message saying something like, "You had a prescription(s) ready to send but you did not transmit them. Do you want to go back and transmit them to the pharmacy?" Or something, like, "Hey idiot. That script ain't gettin' filled anywhere." The bad part is you don't realize you didn't send it until the next day when you hear from the patient that there was no script there. And, the other bad thing is you can swear you prescribed it. But, you didn't.
Or am I the only one who does this or has done it.
I am not sure I follow. If I hit prescribe and "you just have to click on Transmit to Pharmacy but don't"... I can't go anywhere else. At least not in AC. Nothing else opens (e.g. no other chart or the scheduler or anything else). Maybe we have some different setting than you?
I like the idea but sometimes I add in a medication for the pt so it will show up in the med list (easier than adding it in the med list part of the chart). I also will change a dose and mark it as prescribe but not transmit because the pt just needed a dose change and has plenty of medication at home, example insulin. I wonder if the would be a way to note this as a separate entry? I am no programmer.
I am trying to remember to get pt's a copy of their med list before they leave the office. I feel this is an area that patients need more education and reminders. Currently the med list is printed in the summary tab, time consuming. I would love to be able to print the med list from the prescribing screen. As long as we are now talking about changes!
Well, first, it may only be 500 times. And, I don't accidentally hit it. Somehow I am going through the appointment or way more likely a telemed because I tend to multi-task more during a telemed and just simply forget. Maybe I don't do that. I don't know how it happens; I just know there are times I can recall checking what pharmacy it was or going through some process that would have been that particular script and then it isn't sent.
With new medications coming out all the time I wish the prescribing module could keep up. There are 2 medications I have found that are not in the system as of today.
Ozempic 2mg, new dose but not new medication, I have several pts that are Diabetic and use the GLP1 class in a majority of them.
New medication for insomnia, Quviviq for insomnia, scheduled drug, there is a program to get it for the pt for free
New problem this morning: Medication is Horizant (a gabapentin prodrug) for RLS. Patient swears it works when gabapentin and Lyrica have not. It is not supposed to be a controlled drug. I can not get it to go through in the electronic refill window, if I pull it up from the pt chart or if I try New Crop screen. I will just print and fax but really weird I can't get it to go electronically no matter what I try.
Saw a pt this morning, started her on a new medication while in the room and sent via the laptop, come back to the office between people, click on refill request and guess what there is her name with the new med looking for a refill already, wow she took 30 pills before even getting out of the parking lot!
Not the 1st time this has happened where I prescribe something and same day get a refill request but I think this was the fastest episode of this happening I have been able to catch.
Saw a pt this morning, started her on a new medication while in the room and sent via the laptop, come back to the office between people, click on refill request and guess what there is her name with the new med looking for a refill already, wow she took 30 pills before even getting out of the parking lot!
Not the 1st time this has happened where I prescribe something and same day get a refill request but I think this was the fastest episode of this happening I have been able to catch.
this is usually walgreens sending an automatic request for 90d supply
@beagle I had one pop up again this morning where I sent in a prescription for a med and came back to my refill box. You're right it was Walgreens and they increased the quantity to #90. Thanks for noticing, I had not realized this was what was happening.
Why does it take Amazing Charts the prescribing portal so long to add new medications!!!!
Can you explain more of what you mean by taking so long to add new medications?
Also, you are where i was with the script writer two years ago. It was a complete love-hate relationship with the emphasis on hate. But, I have come to co-exist with Mr. Writer. You have to let the anger go and just let the two of you flow....
The fact that it shows it was prescribed zero days ago even though I never actually prescribed it...well I just learned to live with it. The fact that my signs simply disappear....I've learned that sometimes I catch it before I try to prescribe it so I don't get an error message. And, if it happens once, do a CNTL + Copy so if it disappears again....
And, the fact that once it is loaded and ready to be prescribed on the next click (you know the point at which it is now 0 days) you can't tell which pharmacy it is going to just makes call more fun when you get paged learn you sent it to the wrong pharmacy.....
These are all things that cannot be changed. It is like the Serenity prayer.
Oh, and I got the instant refill as well. And, it was Walgreen's. But, Walgreen's also automatically requires a PA for any ADHD drug and nearly all other drugs. Anything that comes from Walgreens gets deleted before I even look at it.
"In May 2022, the FDA approved tirzepatide (Mounjaro) for adults living with Type 2 diabetes"
here is an older medication with an increased dose:
"Bagsværd, Denmark, 28 March 2022 – Novo Nordisk today announced that the US Food and Drug Administration (FDA) has approved a 2.0 mg dose of Ozempic®"
I have had other examples but these 2 stand out because in South Texas we have such a high prevalence of Diabetes. These are similar in make up but each has their place for Type 2 diabetes care and can be a game changer for some people. I have been able to use this class of medication to get many Type 2's off of insulin.
I don't think I am in a love hate relationship yet but I am in the frustrated and want things changed stage. I do hate the process of having to use the NewCrop screens and was excited to see this will be changed in the next version of AC.....................
.png "ACUF Donor I")
What you describe is a minor annoyance. PHARMACISTS are annoying.
