Gil Carter: Hi Terry, … so how does DescriptMed’s Problem List show renal insufficiency x 1'05… with Cr 1.8 10'07 ? Is its problem list restricted to ICD generated terms? Is there a way to flexibly modify problems in it? It is not tied to ICD codes - It can be free texted. This is not supposed to be a coding screen, it is more of a screen to get a snapshot of the problems. ICD codes, while helpful in certain environments, are more clutter than anything in a problem list presentation. R Terry Ellis DescriptMED, LLC Get Done, Go Home! Tour The Chart! Filed under: DescriptMED | Post Points: 20
It is not tied to ICD codes - It can be free texted. This is not supposed to be a coding screen, it is more of a screen to get a snapshot of the problems. ICD codes, while helpful in certain environments, are more clutter than anything in a problem list presentation.
R Terry Ellis
DescriptMED, LLC
Get Done, Go Home!
Tour The Chart!
If you look at Gil's problem list, the patient is a diabetic but he has no A1c following the dx. Is this important? Does the pt have any diabetic complications? Is it worthwhile to note "without complications"? My point is, what Gil elects to put in the list is different than another physician seeing the same pt over time, would elect to put in the list. So when I look at Gil's problem list, the first thing I wish to do is generalize the list for all practitioners who might want that detail associated with any problem.
Currently, Medtuity allows freehand text to be associated with any problem on the problem list. The text is actually placed in a list with a date and who entered it. Hover over the problem, and the list becomes visible. Right click and you can add to the list. Currently we have an editbox to type freehand, but also we have likely items selectable with a click (acute, chronic, resolved, improving, worsening, stable).
It seems that other words or phrases may be appropriate for quick selection: referred for evaluation to..., hospitalized at ...., operated on by ....., developed complications of ...., improved with ...., diagnostic workup by ....., confirmed by ...., without complications, started on ....,
Can you think of any other phrases that might aid in modifying the problems in the list? For users who like the speed of point and click, having predefined phrases helps. I'm thinking that as these modifiers are added to problems, the additional text could be collected and placed into a dropdown. If 75% of the time, the answer to "hospitalized at " is one of 5 hospitals, then why not have a list automatically created by the answers? It would improve the odds of a physician using this tool.
I'm in agreement with Matt. eMedRec has tons of commentary locations and other interactions with the problem list. I think it important for the Physician to decide how much data they need. Simple choices and drop downs/check boxes/ai text adds can really improve the use of the system for some and be meaningless to others.The EMR software should not care about this.
>>> Hi Al, … Thanks for your snapshot. It gives me a sense of what you’re working with. Do you have a video clip of making a note and prescribing … or since we’re talking about Problem Lists, … how it’s viewed and modified while seeing the patient?
Hi Gil:
No video clip yet, but I'll do one as soon as I upgrade the 130 page manual. The problem list is modified mostly by typing, DNS 9 dictation, and by wizards brought on by double clicking the various fields.
The only diagnoses to carry an ICD number are the top 4 that are used in filling in the HICF form.
Cheers,
Al
Al Borges, M.D.
● Oncologist in a Small Group Practice in Virginia
● My website URL: http://msofficeemrproject.com/
We use a flowsheet approach as well... although our time is horizontal rather than vertical...
The vitals, labs, meds, etc flow directly from the EMR or lab interface. None of what you see here is typed in.
You might ask, what is BMD doing in a diabetes flowsheet? I participated in the CMS PQRP program last year and used diabetes LDL, A1c, BP as three criteria, and bone densitometry as the fourth. So it was easier just to stick it here, have a quick peek at the flowsheet, and pop in the answers.
I'm still waiting on the check from CMS......
Reddy
William "Reddy" Biggs, MD Endocrinology Amarillo, Texas
Unbiased and independent, YES!
"Live on eClinicalWorks since 2/1/2007" http://tinyurl.com/ywqd49
Reddy,
Its in the mail.
We use Lists. We can create a list for a customer on request and make it workflowable in less then a day or some lists may take weeks. The concept of a List is that it can be any amount of data from anyplace in the database presented ot the end user and easily editable in the same easy way they do other lists. The down side is that there is no Horizantal view, which some Physicians prefer.
I think as EMR's Mature or during desing time conideration where all the data goes is critical. For example, eClinicalWorks, your product has many 1000's of Physicians and overtime many recommendations have come into development. So they have built, and problably with some modules, rebuilt from the ground up the application software to make sure it works well together.
I cannot tell you the hundreds of man hours spent just looking at the Database Maps we have on our walls to figure out how to integrate Users Requests into current data so that it flows, and thinking of the many things this Physician Office did not think about that others needed from the same basic request.
I am sure that even with all this development and maturity even your provider of software has its issues. But thats okay, so does my wife, and like great software, she gets better with time also.
Regards,
Brendon
Brendon:I cannot tell you the hundreds of man hours spent just looking at the Database Maps we have on our walls to figure out how to integrate Users Requests into current data so that it flows, and thinking of the many things this Physician Office did not think about that others needed from the same basic request.
The eMedRec war room !
So what does the war room look like:
OR
???
Thanks Terry …. Your response was on point. Will you post a screen snapshot of your Problem Lists … preferably a modestly complicated one? :)
Other items are useful in a PMH as well. For example, where do the following show up in the usual PMH?
Gil,
And the thread is about problem lists and so I will repose the question Counselor: You did not follow your diabetic's problem list item with a hemoglobin A1c. Is the A1c not important?
That is my point. To you it is not important enough to list, but to another physician it is. So you decide what to list because it is your list and no one else's list. If you suffer a protracted illness and a partner takes over and he views that problem list, his first job is to either assume it must be normal, or that it's never been done, or it's been done many times and always > 9.0 and not worth posting because the patient will never do anything about it, or....
If your problem list is only for you, then you decide the relative importance of each modifier. If you alone decide, then it is difficult to make the modifiers automatic and computable. Thus, Medtuity allows just what you have now with one exception. Medtuity allows a user to hover a problem list item and add one or many modifiers to the list. These include simple point and click modifiers (acute, chronic, improving, worsening, stable) or an editbox for freehand typing. Medtuity adds the users name and date. It puts it into a table and reversed ordered by date. Thus far, it can do all that your list can do, except to see the modifiers you must hover over the list. That keeps the list clean for quick reviewing, but the modifiers are available for viewing without any click.
Regarding too many "hovers" to see modifiers on each problem list item, not every physician will want to review every problem list. Do you really need to hover over "wheelchair for weakness". Also, as long as any item in the problem list is editable, any user can make it longer and more descriptive. That alone will not make your style popular because frankly, most EMRs have an editable problem list, I would guess.
The thread's topic is the problem list and I introduced a thought with some recent anecdotal evidence that tracking a disease process, depending upon the specialty, might require not the problem list, but a longitudinal list of values. I don't think I trampled too much on your thread with that thought.
I wholeheartedly support your concept of seeing some key points (problem list modifiers, as I refer to them) in the problem list. I think that you add significant value to your charting. My problems are several fold:
So I ask, what is so awkward in the "right click to modify, hover to see" concept?
Perhaps we could add a facility-wide flag under Utilities: "Alway show problem list modifiers". Would that satisfy your criteria for usability?
I appreciate your thoughts and zeal for the topic,
Hi Matt, :)
I don't think this is necessarily what you may be asking for, but it should illustrate the use of the screens. Below is the Problem List screen. If you will notice it has 14 buttons that users may customize the button text which, when clicked, will enter the button text as a problem and insert a date. The user may then free text anywhere in the grid to add anything they wish. Once entered the data becomes available for alerts, modification or categorization as acute or chronic on the cover