Re: Question on RX type button, procedures, and forms

[Guest guest]

Jerry,

I am taking the liberty of cross-posting this message

to the list, as I

would like to show them an example of where we are at

with the Tkfp EMR/Practice management app. as I think

Tkfp fits the type of practice many of them are

endeavoring to develop. I thought this discussion was

a good example. I won't regularly cross post to avoid

netiquette issues. Hopefully if it is of interest to

them, they will join the Tkfp mailing list at

http://lists.topica.com/lists/tkfp/

--- Jerry Park D.O. wrote:

> ,

>

> I have been rather systematically working my way

> through the stuff I need to work in Tkfp. Today, I

> ran across one that is of sort of medium importance,

> but would help if there is a quick fix. On the

> prescription page, for the type of prescription

> (new, refill, etc.), I need the added selections of

> " dispensed " and " samples " . We dispense at our

> clinic, quite frequently actually, so we have to

> document on the chart if the source of the Rx was

> " dispensed " , " samples " , " called in " , etc. (under

> Tkfp " called in " should be a thing of the past!!).

> We have Rx label stickers, torn off of the Rx bottle

> to stick on the chart and document brand, lot#,

> etc., but everyone in our system is used to the

> abbreviation before each drug of (D)ispensed,

> ©alled in, (Rx), or (S)amples. Is there a list

> file somewhere that can be edited to add these

> selections?

I put those in the Recipient area instead of the Rx

type. This may not make a lot of sense, but if you

look at the drop down menu for the recipients, you

should already see ones for " Samples " and " Dispensed "

in there. The get highlighted in a different color

instead of just grey so you can find them quicker. I

also use

" Printed " for ones I write on paper Rx's but want to

document for the patient record. You can add other

categories of your own choosing by right clicking on

the menubutton and adding whatever you want at the end

of the list and saving the file. That will add them to

the drop down menu. For ones that you will use as an

actual fax destination, follow the name by a phone no.

on one line like:

Walgreens 555-1212

If it is one you are using that will not be faxed

anywhere like Samples, or Dispensed, put 000-0000

as the phone no. This signals the fax program to

ignore those for purposes of trying to fax them

somewhere.

The Rx " type " button is more for keeping track of

whether it is a new prescription, a refill or a short

term vs long-term or a dose change or discontinuation.

This field is used when compiling a summary list of

the patient's medications when you want to insert it

into a progress note or and H. and P. It is also used

if you want to submit the list of meds for a drug

interaction check to Medical Letter or Multum drug

interaction check. Because of that function, I don't

want to add a value there for printed vs dispensed. It

would be better to add another field altogether and

maybe separate it from the recipient and the Rx type.

>

> Another thing I am noodling is the best way to

> document procedures, such as cyst I & D, laceration

> repair, and the like. The best would probably be

> main templates or toplevel templates under .exam, I

> think, but our coders are used to a " treatment "

> section, just after the physical exam. How do you

> document procedures?

I like to put procedures like the description of the

I & D under the plan. I believe Weed puts it there. I

think he has diagnostic plans and treatment plans - I

like to put the I & D procedure template in the plan.

> I usually treat X-ray interps

> as a procedure. We shoot our own rays, and usually

> just send off CXR's and the like for overread. The

> docs at our clinic just overread each other's

> extremity and other " simple " xrays. It is important

> for the coders that we document the exact film, how

> many views, and our interpretation in the procedure

> section. I have also put X-rays under labs in the

> past. If I were using Tkfp for reimbursement,

> something tells me that would be the section to put

> X-rays in. What to you think?

I usually put an Xray I actually did at the time of

the visit or am reviewing from an order I did from the

last visit in the " Objective " part of the note. I put

a sort of marker on it like:

<br />XRAY:

then I discuss it. The E & M coding function scans for

this marker and gives you some brownie points, since

discussing labs or xrays gives you some E & M coding

credits. I think the marker for labs is <br />LABS:

If I am ORDERING an Xray that I will not see the

results until later, as opposed to reviewing one that

has already been done, I put that in the PLAN part of

the note under diagnostic plans.

For coding Xrays, since I am doing my own billing, the

CPT codes for the Xray go in when you put in the

charges after you save the note. A charge window comes

up automatically when you save the note and there are

codes in there that I use for CXR, ankles, wrists etc.

The CPT code does not show up in the note, of course,

since it's part of billing, although the ICD9 code for

the diagnosis is included with the note. It would be

important to the 3rd party payor that the ICD9 code

made sense for the type of Xray you ordered. Like they

will balk if you only coded Acne for the visit and yet

you charged for a CXR. The CXR would be linked on the

claim form to the ICD9 code to which it applied. If

you

get into the billing part you will see how that works.

>

> I generated my first real Tkfp patient chart note

> using my new Debian-Win2K system today. It was a

> self pay with strep. Chart notes from self pays in

> our system are immediately faxed to the coders (in

> Seattle) to determine charges. Our head coder is

> very well trained and I talked to her on the phone.

> She is actually excited (hard to imagine) about my

> new chart note system. This is very cool. When you

> have the coders behind you in our system, you're

> really winning the war.

Maybe you can enlist her help for making sure we have

the right ICD9 codes for the problems we are using in

Tkfp! That would be a big help to me. I have reviewed

the AAFP " Long List " and the " Short List " of ICD9

codes and refer to that often when putting new codes

in Tkfp. I also use an on-line list free ICD9 code

site at http://icd9cm.chrisendres.com/

Once I have the code in Tkfp, I no longer need to keep

looking it up unless something changes. I have a lot

of the codes now, since the Iowa docs have been using

the program for 2 years for billing and I have been

using it for about 6 months now for my own billing.

>

> I developed a little different tact to handle forms.

> Instead of using Mozilla composer to print chart

> notes, I developed a discharge form and a chart note

> form using OmniForm. That way I can have precisely

> formated and printed forms. All I have to do is use

> Win2k-Internet Explorer to open the Tkfp patient

> note, and cut and past the appropriate parts of the

> note to the appropriate OmniForm. It sounds a bit

> clunky, but in practice it's quite fast. It really

> only requires 2 or 3 clicks per form.

>

> Jerry

OmniForm sounds like a very useful program, I would

like to have an open source version of it. There is an

open source project called " OIO " - " Open

Infrastructure for Outcomes " http://www.txoutcome.org/

by Ho M.D. of UCLA that allows you to develop

your own Web based forms without programming. They are

using it at UCLA for tracking patient data in certain

clinics at the Harbor Hospital and some other places.

It is also being used in some other projects world

wide. It automatically links the forms into a back

end relational database. That is the closest I've

seen, but it doesn't have the precise control of what

the form will look like on the screen or when printed

that it sounds like Omniform has.

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