michaelke wrote on Saturday, November 09, 2013:
Perhaps this question has already been addressed. Is it possible to create a lbf form so that when you open a new encounter, it has pre-populated fields from the most recent encounter? If this would require intense coding, I am open to paying for that feature. Thank you team.
Michael
fsgl wrote on Saturday, November 09, 2013:
Are you asking about a static text Layout Based Visit form or Components in a NationNote?
Depending on the complexity of your needs, this may be a DIY exercise; in which case, upon completion, you may wish to contribute to the funding of the MU Stage 2 effort.
mdsupport wrote on Saturday, November 09, 2013:
If you are looking for a specific LBF to have that feature, we have provided an enhancement which lets you add a field that will be processed by custom plug-in code. In your case, plug-in can provide a simple button which will copy data from last encounter in few lines of code and it will give you control over the copy process.
There is need for feature to copy all or selected forms from one of the prior encounters. But that is bit more complex.
fsgl wrote on Sunday, November 10, 2013:
An alternative to the LBV form with static text is the CAMOS module. There is a multitude of pre-fabricated H & P’s that can be searched and copied readily, in parts or in toto.
Static text LBV forms are not that easy to construct and have less flexibility than CAMOS.
Experimentation in one of the Demo’s will help in the decision making process.
openemrdev wrote on Sunday, November 10, 2013:
Hi micheal
It needs some customization,If you are paying,i will glad o do this
Please let me know
yehster wrote on Sunday, November 10, 2013:
The Office of the Inspector General (OIG) has targeted cloning as one of its top management challenges of 2012, and is aiming to reduce the practice in the future. In addition to affecting patient treatment, or propagating a hidden mistake across multiple charts, the practice can produce incorrect or fraudulent billing requests and may trigger an audit of suspicious activity. In September of 2012, a Medicare administrative contractor stated that it would not reimburse providers for services documented with cloned information. “Cloned documentation will be considered misrepresentation of the medical necessity requirement for coverage of services due to the lack of specific individual information for each unique patient,” National Government Services said.
If you are in the US, you might want to reconsider this idea.
fsgl wrote on Sunday, November 10, 2013:
Kevin raised a very good point, not only from a reimbursement perspective but also in consideration of quality of care.
Static text clinical notes tend to dull clinical skills and observation. During residency training, one of our attendings would critique our “wnl’s”. It was quite embarassing that we missed all those abnormal findings.
Most U.S. medical practices are pressed for time and have the additional burden of transitioning to EHR’s. They don’t have the luxury of typing all the entries into the medical record. As Sam Bowen noted, many physicians don’t touch typing, which adds to the time pressures.
If all the findings are normal, i.e., a 20 year old patient with no refractive error, a visual acuity of 20/15 O.U. and absolutely nothing abnormal on physical exam, if this note were copied, is it “cloned”? I think not. As I am typing the clinical note and choose to use AutoComplete, is this copying and cloning? No, again.
As with any other time saving device, it must be used judiciously.
NGS is a subsidiary of Wellpoint, who is not exactly the Mother Teresa of that industry.
yehster wrote on Sunday, November 10, 2013:
Dr. Lee,
What would that 20 year-old paragon of ocular health be doing in your office in the first place though? Getting fitted for the IOL version of Google Glass perhaps?
I hear what you are saying about “short cuts” to help with the ever growing burden of documentation, but situations where carbon copied notes are appropriate seem like the exception, rather than the rule.
fsgl wrote on Sunday, November 10, 2013:
They are tethered to their electronic devices and are wondering why they have eye strain and the start of Carpal Tunnel Syndrome.
In the old days of paper records, we zipped through entry into the medical record with our own version of shorthand (chicken scratch to everyone else).
Beginning in March of 2015, in our state, we will be required to e-prescribe. No more paper Rx pads after that. Coupled with Meaningful Use and the corresponding penalties, our colleagues must have alternatives if they cannot type faster than 30 words per minute. We cannot just whine about regulatory burdens.
Your link is very helpful as an advisory so that Forum members can avoid the pitfalls. More importantly it reminds us to maintain a high standard of care for our patients.
I made that oblique comment about Wellpoint because, among other things, I watched a Congressional hearing where the CEO of Wellpoint was unapologetic about the practice of rescission despite the testimony of a policyholder that she was dying of Metastatic Adenocarcinoma as a result of her policy being cancelled on the pretext that her initial insurance application did not list Acne Vulgaris. We should take their words with a grain of salt.
michaelke wrote on Sunday, November 10, 2013:
In our practice, there is a specific class of patient we see on a weekly basis for ulcer/wound care and the majority of the fields for diagnosis and treatment are identical from week to week. The information that changes from week to week, may be the wound size, color, pain intensity, etc, but all other details remain the same. Some of these patients also have multiple wounds. The copying feature would be used just as a starting point as it does become quite burdensome to type out / fill out the same form over and over.
fsgl wrote on Sunday, November 10, 2013:
Have a look at the CAMOS module. Harley Tuck explained very well in the beginning of the Wiki article how to register and activate the module in any of the 3 Demo’s. Try it out before installing on your local machine. It should fit the bill.
If not, we can have a discussion of either a static text LBV form or a NationNote tailored for your practice.
All of this stuff is DIY, requiring no advanced Computer Science skills.
bradymiller wrote on Monday, November 11, 2013:
About 25-40% of my clinical notes are the Past Medical History, which is simply cloned from prior notes and updated (which is very helpful for other physicians covering the patient). I do remember during my training days at a particular VA seeing several signature stamps from the days prior that were inadvertently copied since was very easy to copy/paste. Haven’t heard of any bad outcomes blamed on this stuff (aka. bunch of hype and definitely not a reason to not include a useful feature).
Rod (Sunset Systems) just committed a feature that uses the “description” to default into the field. Probably wouldn’t be too tough for him to extend this and grab it instead from most recent form:
-brady
OpenEMR
fsgl wrote on Monday, November 11, 2013:
Hi Brady,
Thanks for your imput. Perhaps now Michael won’t be so discomforted by NGS’ pronouncement.
Any insurance company that has no qualms taking coverage from a dying woman deserves no respect in my book.
Description would be a lot easier to handle than static text LBV forms.
While we have your attention, please have a look at the Case of the Missing Standard Measures Report. Don Lewis has agreed to donate to the project if we are able to successfully resolve the problem. Moola is alway good.
michaelke wrote on Tuesday, November 12, 2013:
I took a look at the CAMOS module. I like both the functionality of the CAMOS module and Nation Notes but I wonder about the effectiveness of searching through the database in the future, by having large groups of text as the encounter description for each patient. I had originally thought that breaking out individual diagnosis, descriptions, and procedures into separate fields in the array structure would allow for easy searching for all of the patients that had purple bruising (just an example). Maybe that is a bit of a lofty goal??
fsgl wrote on Tuesday, November 12, 2013:
CAMOS would give you that degree of specificity. NationNotes don’t have a search engine built-in, that I can recall.
Demo 4.1.2 has CAMOS installed with an encounter for Jane Seymour just now. Look under the Clinical tab of the encounter.
For now, experiment with Purpura and see how you like it. Can’t imagine that there will more than 10 exams for it, so Purpura can be a Subcategory. Customize the rest. You should get a good feel for it with this small experiment.
Nice thing about CAMOS is that there is no form construction as with NationNotes. You can pretty much use it right out of the box.
mdsupport wrote on Tuesday, November 12, 2013:
Not sure if you are looking for something like this code fragment except in our case we pull options from database dynamically or new ones are created automatically during data entry and best of all, it is not limited to LBF.