mukoya wrote on Tuesday, February 22, 2011:
One way I have seen some vendors approach it is to have a button for, say, “Submit for Senior Review” if longed in physician is grouped as “Junior Physician” or “Registrar”.
Each encounter record has to be verified before permanent record and only senior physicians are cleared to verify.
This preliminary visit record can be send to a specific physician e.g. chest physician, thus appearing in his “My Items” or to a pool of senior physicians appearing as “Items for Review” from which any senior physician can pick.
In current state of OEMR, this can be partly achieved though not in a very structured way.
Example:
Clerical staff enters demographics.
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A nurse, if first visit, enters the history (or edits if necessary for subsequent visits). She also attaches any necessary documents e.g. radiology report, medical records etc. and takes vitals.
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The first doctor reviews history, documents. He could even summarize history, say in a “Past Medical History” field of an encounter form. He takes his “History of Presenting Illness”, examines, and suggests a diagnosis, investigations and, maybe, prescription.
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The Big guy then reviews all these and endorses with or without changes.
Other Considerations for OEMR.
Prescription/procedure order cannot be tagged as “Preliminary” and will therefore be indistinguishable from a “Final”. This may not be such a big problem as the patient will be directed to next office and will only be directed to pharmacy/procedure area after seeing the physician at the top of the chain, preventing performance/dispensation of “preliminary” procedures/prescriptions.
If procedure performer has access to clinical encounter notes, then he can view procedure status. This list can be altered to include “Preliminary”, “Verified” etc.
New statuses can be entered in the “Appointment Statuses” list e.g. “At Reception”, “On Level 1 Queue”, “In Level 1”, “On Level 2 Queue” etc. Each provider changes statuses appropriately on the calendar e.g. a level 1 provider changes patient status from “On Level 1 Queue” to “In Level 1” when client enters his office and then to “On Level 2 Queue” when patient leaves office to go to level two queue etc.
All physicians can then be updated in real time by refreshing calendar. This will need physicians to be allowed to view calendar for all providers and/or creation of “virtual providers” like “Diabetic Clinic”, “Room 6”, “Thomson Clinic Downtown Branch”, “Level 2 Physicians” etc.
To make sure this works fine, one may need to play around with ACL.
About signatures, the user level security can be relied on to assume that if changes are made under a certain account, then its user/owner must have made the changes. However, it seems Brady, Julia, Shameem are taking it to a new exciting level!!
You can also make use of office notes and messages.
Hey, I am not a developer, so I am used to twisting software to suite my needs without having to code. This issue might be better fixed development.
Mukoya.
