RE: Documenting Efficiently

[Guest guest]

Marie, thanks for the FPM visit-template reference. This can help in structuring templates

for any EMR.

I am surprised that Alteer seems so cumbersome for

documenting. With Praxis v. 3.0,

which I use, I can quickly recall my previous similar cases (whether I have 20

or 200 diagnostic varieties). I choose

an Assessment title from my accumulated Assessment list from all previous

patients and then just edit a few specific changes, and I’m done. I especially like Praxis’ ability to

blend multiple problems together seamlessly in the same visit note (typical

situation in primary care), because it has learned which findings I consider

abnormal for each type of problem and knows where to insert them instead of the

normals. I can combine any selection

and number of existing Assessment types easily (or devise a new one from the

most similar existing case if needed), even if I haven’t done that particular

combination before. Extra typing

is limited mostly to unique individual descriptions needed in the HPI (“Fell on

my driveway when returning from work yesterday”) and in the Patient

instructions (“Recheck your lipid panel after you return from your vacation,

but continue your present dose until then”). It can insert my old ROS and PFSH for that particular

patient if I choose, and I can edit any new changes, which it remembers for

future visits by the same patient (“Appendectomy 1992, TAH/BSO 1999”). It knows which portions of the note to insert

from the same patient’s previous visits and which portions to insert from

similar cases of other (unidentified) patients. I paste them into the current note by clicking on each grey

section of presented text. This toggles

that section’s font to black to show activation into the note (instead of searching

through multiple menus). This

would be even faster with a touch-screen Tablet PC, which I haven’t gotten yet.

The initial learning curve is steeper with Praxis, because

you have to teach it about 20 of your most common single-problem case types

before you can take off running with it, although each of those is an easily

modified subset version of the normal complete physical that you do first. This process initially takes longer than

just choosing every item in the note from a long list of pre-cooked menus. However, not having to go through a hundred

key clicks struggling through all those menu picks for each note soon makes Praxis

faster to document (unless you get an unusual and complex patient), and my notes

are in my own words instead of some programmer’s terminology. (It also works with Dragon Systems

voice recognition or recording for transcription referenced to the correct

locations in the note.) Praxis

follows a different philosophy than the all-menu-driven programs, but it has worked

efficiently for me after my learning curve, and it’s now faster and more

complete than my old paper notes.

I wouldn’t go back to paper.

It would be interesting to see a controlled study of how

efficiently various different EMRs can document actual cases, but I don’t think

that has been done.

Wes Bradford

-----Original

Message-----

From: Marie

Sent: Tuesday, January 25, 2005 5:58

PM

To:

Subject: RE:

documenting efficiently with Alteer

I found the form that I

based it on from Family Practice Management:

http://www.aafp.org/fpm/20031000/emvisitprogressnote.pdf

Marie

From: lawrence lyon

Sent: Tuesday,

January 25, 2005 8:22 PM

To:

Subject: RE:

documenting efficiently with Alteer

i'd like to

see those forms, too.

LL

Marie

wrote:

·

I have created 2 templates of my own based on a form I found in

the AAFP

journal, one for initial visit and one for established. Then basically,

all I type is the HPI, then just put checkmarks by either

" normal " or

" See note " for ROS and the exam. Then the only other thing I have

to

type out is abnormal findings on exam and anything I want to put in the

discussion part of the note. I can probably find the article in the

AAFP journal that I based this on if you would like. I think this

method is not the quickest possible but it doesn't seem to be slower

than what I was doing in paper charts.

Marie Christensen MD, Florida

documen! ting efficiently with Alteer

Since so many on this group use Alteer, I wanted to ask how everyone

documents their patient encounter notes. I am suprised that more

people have not mentioned the difficulty in documenting quickly &

completely with the current version of Alteer. I have used it now

for 9 months & I still find that aspect of Alteer very cumbersome &

slow (too much typing & free text entry, templates do not seem to

help a lot). That is the single biggest thing keeping me in the

office late every day. How do others create an encounter note?

Do

you complete the note during the time with the patient or after the

patient has left? I am seriously considering just going back to a

paper note (such as the T-System for primary care) & scanning them

in. They would not look as nice but I am certain I could complete

those quicker than the current free-text e! ncounter section in

Alteer. Is anyone using Tablet PC's with Alteer yet? I really

think that will be the ultimate best solution, but I was under the

impression that the Tablet PC softare was not compatible with Alteer.

Brock, D.O.

solo FP

London, Ohio

[Guest guest]

Yes, your EMR sounds nice. Alteer

really does not do any of that. Alteer is very good for the other parts

(ie, billing, a nice cohesive work flow, etc.) but I personally think it leaves

a lot to be desired in regards to the clinical encounter section. If I had

it to do over I would have looked a lot harder at some of the other EMR products

out there.

Brock, D.O.

documen! ting

efficiently with Alteer

Since so many on this group use Alteer, I wanted

to ask how everyone

documents their patient encounter notes. I am

suprised that more

people have not mentioned the difficulty in

documenting quickly &

completely with the current version of

Alteer. I have used it now

for 9 months & I still find that aspect of

Alteer very cumbersome &

slow (too much typing & free text entry,

templates do not seem to

help a lot). That is the single biggest

thing keeping me in the

office late every day. How do others create

an encounter note? Do

you complete the note during the time with the

patient or after the

patient has left? I am seriously considering

just going back to a

paper note (such as the T-System for primary care)

& scanning them

in. They would not look as nice but I am

certain I could complete

those quicker than the current free-text e!

ncounter section in

Alteer. Is anyone using Tablet PC's with

Alteer yet? I really

think that will be the ultimate best solution, but

I was under the

impression that the Tablet PC softare was not

compatible with Alteer.

Brock, D.O.

solo FP

London, Ohio