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I have not even had paperless charts for a week and have already lost 3 patient encounters!! Previously I commented on how I will forward an unsigned chart up front to have the office staff add dates and time of scheduled tests, etc to a note. They are then supposed to forward it back to me for review and signing off. However, on 3 occasions, the chart has apparently been inadvertently closed rather than forwarded. I assumed that if a chart were closed before signing off, one saw a pop-up warning that data would be lost if closed. This is the case if I simply open a chart and then try to close it after adding new info. However, this is NOT the case if the chart is opened after being forwarded. One can close it without any warning pop-up. I suspect the girls simply got busy or in a hurry and closed rather than forwarded the chart and "POOF", there went the note. Going to have to come up with a different system.

Leslie

The same has happened to me when I would forward a chart to my nurse with orders in it. Somehow it never made it back to me. I stopped doing that and just print the orders.
Dave

Somewhere in there the data is not being saved.

There really does need to be a way to close and yet remember what was there without the finality of the "signing" that locks it all in forever. Some kind of a compromise or solution really needs to be found...

Wow, I don't think I would feel very comfortable sending a chart up to the front and then back. When you send it up front, do you have to wait for it before you can complete the note in the room?
I think I am missing something.

But, if I do understand somewhat: Let's say you have written a novel in the note and wish to send it to the front, but you do not wish to risk losing it. Why not prior to sending it, hit CTRL - S and send it immediately to your inbox in a nice safe place. Then open it but don't choose to delete it form your inbox and send it anywhere you wish. Once you get the chart back and save it and finish it, then you can delete the backup anytime you wish.

HTH

Bert,
In the ideal setting, my note should be able to be saved after I complete it. But being saved and being signed are not synonymous. I still finish everything I have to do while in the room. The only things left are for the scheduled tests, consults, etc. to be added to the patient's printed papers. (We used to write all of this out for the patient on different pieces of paper as well as hand-write it on the progress notes). I did not send the chart up front prior to having the ability to print the patient instructions. But, as long as I am printing those instructions, why not also be able to add the places, dates and times of the tests being scheduled, as well as the date and time of the return appointment to those instructions? If I could SAVE my note after I am finished (the same way I can save any new data added to my Excel Lab Flowsheet which, if I try to close it before saving will give me a warning box), the only things left would be the final sign-off AFTER the above has been added. I have a very efficient staff. For the most part, unless they are waiting on a preauthorization, the patient leaves the office knowing where and when they are to show up for their tests or consulting doctor's visit. If a preauth is pending, the girls simply put "pending preauth" next to the test. This also gives us documentation that the tests WERE scheduled. Whether the patient chooses not to show for these is then their problem. If the patient says they will schedule it themselves after they get home and check their calendar, that info is added and I can then request a that they be put in the reminders for us to check back and make sure they made the appointment. Or, if the patient refuses to have a test, say a screening colonoscopy, that is documented right beside my request for one and the patient gets this "printed patient instructions" paper which says I requested such-and-such but they refused to schedule. I then can see this when I sign off the note and then ask for a certified letter recommending this test to be sent. (Gotta keep the lawyers off the front porch!!) If I forward the note to myself then reopen it and then send it to the front, that is just another time-consuming step. All I want is a way for each user to be able to SAVE their entries without necessarily signing off.

Leslie

Leslie,

Thanks for clarifying. I, too, via a really cool intraoffice email system, really like it if the referral to a specialist or a procedure is documented before the patient makes it to the front desk. How cool is it when they get there and find out that they have an appointment made for both.

I guess I would offer the following. Now, if the chart is going to multiple places, then having a save but not sign feature would be helpful. I would argue that this would leave multiple chances for screw ups as well. I think if I attached a Word document (which of course you can't do) and each opened it and then saved it before passing it along, this would give multiple chances for problems.

I guess even sending it your inbox doesn't change the fact that they still can't save it along the path they are sending it. I would say though as far as risk/benefit goes the three seconds it takes to send it to your inbox would be worth the risk of losing the note altogether. If prior to Brian's discovery of the shortcut key one had to use the button at the bottom right and put their name in the dropdown window, it would be a hassle. But, CTRL - S and then clicking on the note before sending it seems like a small tradeoff.

Even Microsoft Word has a rather complicated system of saving a note. You can actually save the note in which you can NEVER go back to a certain point in a document or it has the autosave fetaure which saves it but also allows you to go back to multiple points in the document. It would probably be hard to save the note along the way as far as code goes.

But, having said all this, I will now gracefully stop giving my opinion as it sounds like you have a very good system in place. Good luck. I do see your point.

It does seem like a good system. I'm trying to work this out now. I would like to suggest on the subject that it would be nice if you could save a DRAFT copy to send to the front. Since so much of AC seems to be .html this would save an html file on a specific folder in the AC folder, and a flag could be created in the database to look for a draft when pulling up a pt from the db. ...I'm just not sure how long it would take check the flag before pulling a pt.

Sound ok to any doctors and programmers here?

...Actually, this would still leave a need to differentiate between what the doc wrote and what the office wrote.