Here is the process I'm following to import a new patient from urgent care into synapse, and generate an AcroFrom consult note. Any ideas about ways to cut things down/speed things up? Ignore the first 2 steps if you are not using importuc (likely to be only me!!), and enter patient "manually" as usual. PROCESS: 1. Run importuc script to import a patient 2. Set title and race for new patient (not done by import script) 3. Set pharmacy preference for patient 4. Open consult note in full screen mode 5. Make and send prescriptions 6. Enter Vitals as wanted 7. Generate consult 8. Tick "2SOAP" when finished, and save 9. Open AcroForm 10. Edit staff information, Add MA CC and Physician CC 11. Tick yes/no boxes 12. Make sure any custom boxes are filled out 13. Print, then "Submit"
Graham, Since this process is not hard, but when in the "heat of battle" at urgent care is easy to get rushed and forget a step, is it possible to make synapse macros or scripts (like Word macros) that would automate this process, and present the user with screens that carry out the action at each of the 13 (or whatever it turns out to be) steps, and has the user click "Done" or something to advance to the next step? Maybe that would be too tedious?
can't think of any easy way to guide this thru .... I know some EMRs force you to follow a particular documentation path but I want freedom! Maybe some type of checkout visual path? Like a online shopping experience? Since your screen dump does not have title and ethnicity data, perhaps you can add that in the importuc script?
Looking at your list again ... steps 1 ... 3 are one time steps only. They can be done by reception. step 6 could be done by a nurse, or MA. step 8 - I could make the 2Soap button create the outline if the document is empty step 9 - 13 are all really just one step. So, as the physician, you really only have 3 steps 7, 8, 9-13 ...
I like the idea of a "visual checkout" ... any ideas how to do that? Just a file up to refer to? I think just leaving the 2SOAP button the way it is is OK, as I want to be able to use all of the synapse macros, chaining, and so forth, and I guess that's only possible in full screen mode. Yes, eventually I may convince urgent care that synapse is a good thing, and will have a receptionist and MA enter their stuff. Wireless maybe? Stuff to think about. But at least I have a pretty definite overall process... now I can start running some calculations. Our mandate in urgent care is to see 2.6 patients per hour average .. more is better. We may see a real performance increase using AcroForms for more complex occupational visits that involve a lot of repetitive paper.
Since Synapse doesn't force you to follow a particular path, I need a series of checks to advise where things are incomplete. So, I am imagining a line of thin boxes above the full screen consult which change to green when completed. So, if demographics are incomplete, that color will be another color to indicate that. So, once a prescription has been written for that day, the prescription indicator will change color to green etc.
Wow!! That would be cool, though I feel a little queasy about requesting a change to add boxes that would only be for me. Maybe other folks using AcroForms like this would benefit too? A box that turns to green once an action is completed like other places in synapse would work well I think, although as you say, the box should only advise the user, not make the action a must. Might not need every step every time.
I'd imagine the following checks: completeness of demographics PCP assigned Pharmacy assigned Diagnoses ( have some recorded ? ) Prescription ( for today ) Superbill ( export or printout ) Any Acroforms submitted for today ?? What else?
[quote user="Graham"] I'd imagine the following checks: completeness of demographics PCP assigned Pharmacy assigned Diagnoses ( have some recorded ? ) Prescription ( for today ) Superbill ( export or printout ) Any Acroforms submitted for today ?? What else? [/quote] For most uc notes, just today's diagnoses are needed, so the comment box-->drag wanted diagnoses from total diagnoses method is OK. I'm assuming that the PCP would be the logged in doc, but might not be? So good to make sure? The prescription is a good case in point, as you just want the checkout script to make sure you said prescription today yes or no, not force the issue. Hmm...interesting you should mention a superbill. Until recently, I would have said for US HealthWorks not needed. They recently *gasp* l<u>owered</u> fees significantly for most services for self-pay patients, and made all self-pay office visits new or established a single flat rate of $120, skip the E&M coding ... shocking, I know! Trying to stay a step ahead in this...ummm.. interesting economy, I guess. So, they have a published self-pay superbill, and I could make that an AcroForm too, 3rd or 4th page, maybe. Note: US HealthWorks does not accept Medicare or Medicaid. This superbill is about 3 pages long itself, in fairly small font. Tough one to check for, but as long as we are on this topic would be for physical therapy, chiropractic, massage tx, durable medical goods (like special splints/braces), imaging studies, and consultations. If we didn't do inhouse imaging (and other inhouse stuff), and ordered it from somewhere, probably the way to do it would be to add as a tickler with reference to what was ordered in consult note? Next visit want to check with the patient and see if they got this stuff done, and if not, why not. Ticklers would be the obvious way for doc to check on outstanding stuff next visit. Maybe don't need to add anything new to checkout process for that... or maybe?
I was more imagining something that made sure you had done the basics for the consultation. So, for most people, they don't want to know about the medical goods, referral for physical therapy etc. I think I need to see how this evolves, and take it from there.
In a multicare Synapse installation, the PHCP is the person who looks after that patient. So, HL7 results go to the right person. And the nurses can look up due ticklers for a particular PHCP.
Looks like we will have lots of space available for other items if we do it like this. But I need a different color scheme for the red/green colorblind amongst us.
Jerry I've now made a partial implementation that you can try. Does the above + vitals. Not foolproof though. If you click on the [Print Script] button and don't actually print it .. it still will make it go green.
This appears to be working well for me ... It only applies to new consults... maybe I should disable the display if you bring up an old consult?
Would it be possible to make it so the user could voluntarily stop-start the status buttons, either in a new or old consult?
By "stop-start" I mean just enable or disable the status button display ... like stop could be just graying the buttons out or something. I'm not sure a user would need to "start" them in an old consult for any reason other than for reference if they couldn't remember if, say, demog was green or not just as they hit the "Submit" button. Or maybe could use an accordion widget to make the status buttons slide on/off the screen at will?
I guess there are some which are relevant all the time ( demographics ), and others which are consult specific which could be hidden if you are looking at an old consult
