I have an idea for making the use of templates (macros in synapse, not GUI templates) for different diagnoses usable in the same consult note. First, the problem. Let's say you are seeing a pt with a UTI, but suddenly remembers to tell you about an odd rash before today's visit is over. You use Graham's UTI macro, and you have a rash macro, but how to merge the two, making a merged ROS, merged Objective with exam elements in the correct order, and merged plan elements? This would be possible if we first defined a "consult map" and used a parser to find pre-set tags, then place the tags in the order we have defined in the consult map. So to use the function, a synapse user would have to first (and hopefully only once) define in detail the exact order in which they want a detailed consult to be printed, e.g. (consider the below non-exhaustive example): CC HPI PMH PSH SH OCCUPATIONAL ALLERIES MEDS ROS VITALS GEN HEAD EYES EARS NOSE THROAT NECK CHEST HEART LUNGS ADB BACK EXT: R HAND, L HAND, R ARM, L ARM, R LEG, L LEG, R FOOT, L FOOT, NEURO IMP: PLAN LAB CONSULTS As long as the user created the above tags in a consult, the consult parser would (upon invoking the command via button or whatever) take all the elements of multiple macros that have been added to a synapse consult and organize them according by tags. One problem is what to do if two different macros address the same exam element, say GEN or LUNGS? Some EMR's actually attempt to intellegently merge exams from different templates about the same exam element. I suggest to just make a rule that only one template (macro) in the same exam is allowed to add text for a given exam element.
So, if I have a patient who comes for followup for RA, and I use my whole visit chained macro template ..and at the end of that, she mentions she has some UTI symptoms, I would also then run the chained UTI template, and when saving it, they would merge on the basis of the headers or tags in each consult? This would require some strict adherence to guidelines for macro construction ..
Yes, that's exactly what I'm suggesting. You could still make, shall we say "free form" macros, but you would have to realize that if you want them to behave correctly with other templates that adherence to a set of rules (mainly just adherence to header tags, I think) is necessary. This would be really tedious for a detailed rheumatological exam of the hands (19 IP/MP joints of one hand?). You could still just type in free form text instead of a template in some areas if the template is just too tedious. I think this method of parsing by consult and exam headers would work pretty well for the average FP consult.
I'm concerned that the time taken to create such templates is beyond most busy clinicians. So, I'm going to look at some ways of doing phrase building again just for the HPI.
