SynapseDirect for neurologists Q & A

These were message exchanges with Dr. Chiu from emrupdate forum. Repost here for people interested:<div class="ForumPostContentText" id="ctl00_ctl01_bcr_ctl00___PostRepeater_ctl01_PostViewWrapper"><p class="MsoNormal" style="margin: 0in 0in 0pt">My questions:<p class="MsoNormal" style="margin: 0in 0in 0pt"><blockquote><p class="MsoNormal" style="margin: 0in 0in 0pt">Dear Dr. Chiu,<p class="MsoNormal" style="margin: 0in 0in 0pt"><p class="MsoNormal" style="margin: 0in 0in 0pt">Allow me to start my wish list; I will let you know what I think as I go through the whole program:<p class="MsoNormal" style="margin: 0in 0in 0pt"><p class="MsoNormal" style="margin: 0in 0in 0pt"><p class="MsoNormal" style="margin: 0in 0in 0pt">First, questions about the database: Is replication possible? What program do you recommend to do basic management like automatic backup?<p class="MsoNormal" style="margin: 0in 0in 0pt"><p class="MsoNormal" style="margin: 0in 0in 0pt"><p class="MsoNormal" style="margin: 0in 0in 0pt">We have to do double entry since we already have a PMS if we choose to use your EMR. The doctors may have to do these inputs ourselves &ndash; we only have two secretaries and are currently really short staffed. So the less we have to type, the better. Hence I would like to see the following changes if possible:<p class="MsoNormal" style="margin: 0in 0in 0pt"><p class="MsoNormal" style="margin: 0in 0in 0pt"><p class="MsoNormal" style="margin: 0in 0in 0pt">"Add New patient" dialogue box: could you remove SSN field? Patient has the right not to provide SSN. DOB format: is it possible to type numeric only and have the program add / or &ndash; automatically? Like dd/mm/yyyy or dd-mm-yyyy, switching from numbers to letters slows things down.<p class="MsoNormal" style="margin: 0in 0in 0pt"><p class="MsoNormal" style="margin: 0in 0in 0pt"><p class="MsoNormal" style="margin: 0in 0in 0pt">Patient demographic page: the program doesn&rsquo;t accept a new record unless the left half panel filled completely in the right format. How about allow new entry as long as First name, Last name and DOB are put in? We already have the patient&rsquo;s other info in PMS, no need to type again here. Ethnicity default is Caucasian, it this customizable? Some people may want to leave this blank, if I have to guess from their look, I can easily make a mistake.<p class="MsoNormal" style="margin: 0in 0in 0pt"><p class="MsoNormal" style="margin: 0in 0in 0pt"><p class="MsoNormal" style="margin: 0in 0in 0pt"><font face="Times New Roman" size="3">Provider list: full names are more desirable instead of initials and surname only &ndash; I know I can put first name in initial field and get the same result, but&hellip; To add a provider as the patient&rsquo;s primary or referral, I have to go to provider page and click make primary or add CC. It took me q

Is it possible or easy to cooperate that into your application. I have experience setting up a similar system for an EMG department. A MSDE server supports several EMG machine that uses Access database (Oxford Teca EMG) and merges the data from each EMG PC. But each EMG PC can function independently, e.g. when taken off site for an bedside test without network available - later this EMG PC returns to the department, data updated on the server. In our case, my associate goes to other two offices for half day and one day, no internet. Ideallya database is also installed on the client so we can use a laptop to store new patients and merge the data to central database when we come back to the main office. This also takes care of senario like power black out, router failure, etc.

For a record to be unique, you don't need the users to do it themselves. Similar to demographic info, agreed these are NECESSARY to put in. But they should not be required fields. Scenario in daily practice: I have a urgent walk-in patient, two secretaries are busy with precert or on the phone with another patient. I tell them to let patient in an exam room and start to see the patient without waiting for the patient even fill in the intake sheet to allow uninterrupted work flow. Then I need the EMR immediately ready for me to start consult generation. I will not spend time fill in all the demographic myself at this time. The EMR should have this flexibility instead of be rigid. BTW, can you mark the required field with * or different color so the users know which fields have to be filled before moving on? It was a fructration to see all the invalid error messages.

I think it looks more formal to have a referring physician's full name on the envelope.

Please do. Many, if not most, physicians are not IT savvy. If it takes me 30 min to figure out how to do a basic task, I can't imagine how frustrated they will be. Did you see that post that one of e-MDs CSR wondered how did that physician customer graduated medical school? Some of the best neurologists I know are totally computer ignorant, because they spend all their time in neurology - instead of wasting some time in computers like me. I respect them very much. The principle GUI designer should keep these people in mind. So if you target them as your future customer, you need to make your program very intuitive - better then Amazing Charts. For the basic note generation purpose, it should require zero or minimum training. The patient comes in, I open the EMR, type in name, DOB, CC, click a few templates for ROS, PE, dictate the discussion and select templates for common management - the less popup windows and less clustered interface, the better. This is the part that's most important for an EMR - as Dr. Winn pointed out in his interview. However, when I see e-MDs screenshot that you have to go through four levels of popup window to get the diabetes template, I've already lost my interest. Well, unless you want to grow into one of those monster companies that provide days of training to wealthier practitioners. I h

Time to move on,

How about have an "add initial consult" button on the bottom for a new patient and "add followup" buttom for estabished patient instead of a popup window? These are two most often used functions. Use "add other" and popup window for other type of documents. Again, give system admin authority to delete an encounter in case of accidental click. The less popups, the better.

Similar to demographic, to put in patient's past medical history/diagnoses, surgery and medication, program should allow me add only names. The patient only knows the names of his medication but not the dosage, or I only care what he is taking for his diabetes or HTN but I am seeing him for his migraine, why should I spend time clicking everything single dosage? Flexibility here again.

For dictation, how about allowing attachment ofa predictated third party file, e.g. Sony dictophone file that we are using now?

This is one main reason that's holding me back at this time. Since I want to continue use our current letterhead format which has two physicians' names and our two offices' addresses. I saw one thread talking about postscript templates, is that possible for letterhead? For prescription print, can the paper size customized to our prescription pad size 4"x5.5"?

Internet access is not free, especially for high speed ones we need to run any EMR. We do need to pay monthly fee even if we only use that officefour half days per month. Well, if there is no alternative, it's not a large amount that we can't handle. Talking about civilized world, I do know practitioners here who don't even use a computer in the office.

How about your consult letter, you do put their names as recipient and they do read them, would it be better that they see their full names? And, we do have several Dr. D. Patel here and nurses always make mistakes mixing up.

Moving on to consult input:thebuttons on top are macros, theyappear the same as the button under macros tab on the left panel, redundancyon purpose? Again, for a user first looking at the ways of input, I had to look for while to find S button under templates tab contains forms for social, CC, etc. I am not sure what's a better way of arranging your window components, but I would want to see an arrangement that must-do things will be very obvious and accessable with a single click - when I open the consult input window, i expect buttons waiting for me so with one click I can open a form and start to put in PmHx, PsHx, Meds, Social, FmHx, Allergies, CC. Then with different CC, go to common HPI templates, then PE, mostly will use a macro here since in most cases I will have a normal neuro exam. Discussion and Plan will be templates or macro again. For HPI and discussion part, I may have to use dictation for complex cases. I don't have that sense of fluency in your layout. Many buttons on top appear distracting but I guess they are OK once I get used to them. But with buttons on top for diagnoses, surgeries, medications, and allergies, CC and social hidden in templates on the left - this arrangement seems interrupting common natural work flow.

The above said, I have to say I am very impressed by your hard work and I sincerely hope I can put your program into action. Once I know I can fix the letterhead issue, I will look into templates for neurology purpose - that's going to the most tedious part but can be done slowly. I do have a real big form - twice the size of your CVS one for neuro-exam, and of course, mini-mental calculation, etc. Very glad to see that your input forms are all customizable. Another thing in mind: can we produce text quite readable like the one in e-MDs rather than a whole bunch of phrases?

BTW, pardon me if anything I am trying to point out doesn't make sense to you - English is my second language[]

Now, a more difficult task for me. A substantial percentage of my patients are EMG patients. I usea Teca machine that save the test results in a Access database. I wrote an Access database to run parallell to my EMG application and pull demographic data from the EMG application, I put in history, findings and interpretion in my database and mailmerge to a MS word template to generate a formal report. I thencopy-paste tables and graphics from EMG application to the end of my report.A simple, straightforward case takes me about 5 minutes to generate a report. If I plan to use an EMR, I would love tomove the same EMG reporting functionto the EMR. So question: what program I can use to see your database tables and structure so I can explore the possible of transfering my existing patient data from Access, or even better from our PMS - a sybase database system ( I would needmore help for that)?

To answer my own question, an alternatesolution for the letterhead issue is to use pdfFactory pro from Fineprint.

I still get the same error message when I click the LaTex button in both consult and prescription print, not sure where is the problem:<blockquote>

Failed to print. Batch file failed with return code of 1.</blockquote>

No problem running the batch file, guess it's still an installation issue,I will try to reinstall everything and try again later.

Can the prescriptionpaper size customized to our prescription pad size 4"x5.5"?

Forms I did in the past for a complete neurological examination:deleted (don't want too many people laughing at me[]

but you got the idea

It doesn't have to tabed like this as long as the contents are there. I will probably build one form for each cardinal part, so it will end up with 7 forms.Rarely for a complex case the form will be used. For daily usage, a macro is enough.

LOL, thank god that form was never really used, I started in access and never finished. See, I am a chinese and should be excused for the spelling problems[:$]

Another thought regarding your data validation process. When a new patient calls for an apointment, our secretaries only takes down their name and phone number and put in the schedule. In your case, you have to get all the information to allow adding a new patient in your database, is that how your office work in real life?

You have two database download options: one for patient only, one with drugs. If I use the one with drugs and in the future need to update the drug database, how is that done? I would think you need to separate these for easier updating needs?

Fixed LaTex and PS preview issue at home. I use x64, I need to install x64 version of both ghostscript and ghostview. You may want add a link to x64 version of ghostscript on your download page.

Made the change, the postscript preview looks correct, but PS viewer changed the page size back agian. Is this the only way to print without a postscript printer?