Examination Editor Addition Requests

Need an "Add" or Add More" button, so that if you forget something, and need to simply add it to a particular system, you don't have to start all over with that system. In my screenshot example, under HEENT I recorded a TONSIL exam, but oops, I now want to add a MOUTH exam to it. The way it stands, I have to regenerate the whole HEENT exam.

The Examination editor needs a "clear all"
button. If a patient has prior exams using Exam editor, upon launch of
Exam editor the last exam will be displayed. You can either find an
old exam using the << button that's closer to what you want (no
description, only a date to guide you), just start the new exam and
clear the elements you didn't change but don't want either, but it
takes 3 clicks per system to do that. Would be a lot easier with a
"clear exam" or "clear all" button.

Hmm. If you want to add something, just click on the system and it fills the box with the current exam. Then just continue. That's what I've been doing.

I think this idea will make it easier and more "modular" to use Examination Editor.



Currently in the Examination Editor there are three levels of
organization, i.e., System Name (CVS)-->Anatomy (Heart)
-->Adjectives (regular rhythm, etc.)



I think what is often needed is four levels of organization, i.e.,
System Name (HEENT), Anatomy (Ears) -->Second level of anatomy
(TM's, or EAM's)-->Adjectives (bulging, erythematous, etc.)



Fortunately, you can do this with Examination Editor already by simply
making the adjective a word substitution. The word sub won't get
replaced until the examination has been saved to the consult, then
"Replace Text" applet is run, but that's OK with me.



This schema makes it easier to make shorter and more natural sounding adjective lists.



So the thought loop for designing things this way is to go to the
"atoms" first, i.e., think of the smallest "anatomy" for a given system
you are trying to template. I would suggest often making
lymphadenopathy a second level anatomy item, so you can make all sorts
of adjectives about it. Then make word subs for these second level
anatomy items.

You're right, I must have been doing something "wrong" at first, as I would do that (click on the system, fill the editor box), but then clicking on more anatomy/adjective items would not append to the end of the text in the editor box, it would replace it (I wasn't ticking "Clear" either). It works for me now.

How did that prior exam get there? Did you load it and decide you don't want it anymore?

No, I'm using SOAP. If I save a SOAP exam, load a different patient, then load the first patient again, the last examination I saved with Examination Editor will still be present and loaded upon launch of the applet.

I think this all requires a high degree of familiarity with the system ... so perhaps start with three levels and move to 4 as you get used to it??

Yes, users will rapidly get more sophisticated. This is just an attempt to wrestle with the theory of templating within the confines of the Examination Editor. Users should have the benefit of some theory and as many examples as we can all share. Initial attempts at efficient templating can be pretty overwhelming. Even second and third attempts can be a little challenging..... [:#].

[quote user="jparkdo"]

No, I'm using SOAP. If I save a SOAP exam, load a different patient, then load the first patient again, the last examination I saved with Examination Editor will still be present and loaded upon launch of the applet.


[/quote]

Yes, that's by design. If you return to the same patient in the same session, then the exam data will still be saved in Synapse so that you can edit it or whatever.

But once you restart Synapse it will be gone unless you restore the examination.

This is fine now that you have made a "Clear Examination" button. I like the "Previous Physical Examinations" popup. A useful (but possibly tedious) refinement would be to make a description column, so that it's more apparent what's in those exams. Since the "Previous Physical Examinations" popup is patient contextual, however, this description might be a little over the top, since you can quickly click on each one to see what it does in the Examination applet, or go back and look at a consult from a particular date to see if that's what's needed.

I thought so too which is why I didn't add a comment facility.

I'm guessing you mostly only want the last exam anyway.

It works if you do it in the right order.

In the anatomical list or phrase, enter "optic disc" in the bottom left field, and then hit "enter". And then click "save". It's now saved.

To remove an item, double click on it to remove from the list and then click "save".

To add choices per anatomical item, click on it, and then enter phrases in the middle column in the same way.

No, they're not users specifc ... this allows you to share. Otherwise each user has to configure all of these systems themselves .... too much work for a multiuser practice

Most of us have specialties ... the way the system is currently designed, there is no way to enlarge the text generation area. But it's a scrollable region... just keep adding text to it.

And note that the << button allows you to recall a previous examination by date.

When it becomes a real issue as opposed to a theoretical one, then I can look at it again.

But my experience todate is that too much customization is actually a hinderance to a successful implementation.

Remember that the internist can now use the neurology specific "macros" that you create ... is that bad that he/she can learn what a neurologist does in an examination?

I wonder if we are talking about the same thing.

The examination applet creates a list ... you choose from that list what you want to use. And each item on that list allows you to select something else.

There's no pressure on someone to use your choices ...they can create their own.