Eye Exam Form Questions


(Henry Alvarez) #1

Hi Ray,
Finally updated to 5.0.1 and am now able to pull up the Eye Exam Form you created. I was never able to figure out why it would not work with 5.0.0.

It is truly fabulous!!

These are some questions/comments that I hope you can help me with.

  1. Vitreous not showing anything placed in the box when printed or saved as pdf.
  2. How do you add and delete click (POH, POS, PMH, Meds, Surg, Allergy) items?
  3. Do not see what patient is dilated with even though proper boxes are checked.
  4. How does one change the defaults?

I am really excited to start using it in a production environment.

As an aside I would be interested in knowing how you handle the calendar/ scheduling of patient appointments. My patient’s come in to the office, fill out paperwork, get screened, then tested (VF), then are placed in a room for me to examine, get dilated then have the dilated part of the exam. I created 2 additional providers called paperwork and screening in order for those times to be accounted for and color coded separate from my time. Dilation time is also color coded red. This was done so that a preplanned schedule did not have to be created. The staff complains that this is unwieldy and requires too much input per patient scheduled.

Thank you,

Henry


(R Magauran) #2

Glad you can use the form.

  1. I will add the vitreous field to the report.
  2. The PMSFH box was adapted from another openemr form and embedded in the eye form. You have to press “Save” when you have filled out the entry. If you access the PMSFH from the sidebar, it will scroll the main form to the PMSFH box and fill in the data for the entry clicked - alter the entry and “Save” it.
  3. I have found that no referrer cares what we use for dilation. If you want it there (in a report) to satisfy some regulation I can add it. CMS does not care about it and in fact with the new coding schemata, soon we will only need to hit level 2 documentation. Do you really want it cluttering your report, as long as it is present in your EMR? A print out is not the legal chart but part of it, the electronic version being the definitive chart. The Eye Report leaves out most of the PMSFH too. The goals was to make the outgoing reports be a single page. Who wants to read through our Greek stuff? Just the pertinent facts. However, you can customize it any way you like…
  4. Defaults for all providers are found in Administration->Lists->“Default Values for New Providers”
    Once a provider uses the form, he/she will get their own list automatically from this list. You can then customize defaults on a per provider level — Administration->Lists->“Default Values for Dr. X”.

Scheduling. Very personal decisions. I would lean towards making your staff happy. Take a look at the appointment statuses options. You can use these to track where a patient is and the flow board will track times at each stage. It may be easier to just book limited/extended blocks depending on how much testing they need and use the flow board features for the rest.


(Henry Alvarez) #3

Hi Ray,

Thank you so much for your response. I find it helpful to document the meds used to dilate and time, especially for Neurology, when I copy and paste the report into one of the Baptist South Florida Hospital’s Cerner EMR systems. These are patient’s seen in the hospital when consults are requested. Other specialties can be very disoriented by the dilated non-reactive pupils.
I will look to change the defaults per your suggestions.
I am blown away by your eye exam form’s versatility and how quickly and easy it was to adapt to it with just the first few uses. Still not using the shorthand method, but will give this a try once I resolve the more pressing issues that have surfaced with permissions and claim transmission due to this upgrade.

Thanks again,

Henry


(Henry Alvarez) #4

Hi Ray,
I mistakenly edited the default values of the eye form “ eye exam default values for new providers” instead of the one labeled with Dr X as you suggested. The form continues to show the same defaults as before if the form is brought up, but shows the new defaults in the list. I’m concerned that My mistake may have broken the eye form as I do not see eye exam default values for Dr X.
The following Eye lists exist:
Eye coding fields
Eye coding terms
Eye contact lens brand list
Eye contact lens manufacturer list
Eye contact lens supplier list
Eye exam default for new providers
Eye exam defaults
Eye lens material
Eye lens treatments
Eye orders Alvarez MD
Eye orders defaults
Eye QP list Antseg for Alvarez
Eye QP list Antseg for new providers
Eye QP list EXT for Alvarez
Eye QP list EXT for new providers
Eye QP list Retina for Alvarez
Eye QP list Retina for new Providers

Can you please advise.

Thank you,

Henry


(R Magauran) #5

Delete the Eye orders Alvarez MD list. The next time you open the eye form you will find the list for Dr Alvarez is recreated from the values in the Default for New Providers list. The new personal list is available to edit and personalize. No new changes made to the Default list will appear in the Eye orders Alvarez MD list.
You now see how we could extend this for a generic default for each sub-specialty, rather than a single one, so it would be easier to use out of the box. It may matter if there are two different sub-specialities/ists in the same office.


(Henry Alvarez) #6

Deleted Eye orders Alvarez MD list. Eye Orders Alvarez MD List was recreated, but Default Values for Dr. Alvarez is not there. Not sure how to proceed.

Thank you,

Henry


(R Magauran) #7

I think we are talking about different things and if so I apologize. You should delete the list with the name “Eye exam defaults”. It represent a bug we are tracking…

Let’s try to make it clear what is happening so I don’t steer you wrong again.

The first time you open an eye form for a new provider, the Eye Exam default values, QP lists and Orders lists are created for Dr X from the defaults. When Dr Y starts using the form, Dr Y will have his/her own preferences to choose from too, and so on…

When Dr X is seeing a patient and the Eye Form is opened, if “Defaults” is pressed, the values are drawn from the current provider’s list, Eye exam default for Dr. X (or Dr. Smith, etc).

The lists starting with “Eye QP…” contain the terms that show up in the Quick Pick lists for each sub-section of the exam.

The list “Eye orders defaults for Dr Alvarez” contains the items that appear in the “Next Visit Orders” area, after the coding is done “Coding Engine”, before letters are sent out “Communication Engine”.

When an Eye Order is made, the order also appears at the top of the next visit so the tech knows what to do - what has been ordered for this visit, and it appears in the report if generated.

Hope that help clarify things.


(Henry Alvarez) #8

Hi Ray

I deleted Eye exam defaults. After using the form again I checked and as you said there is now a list labeled Eye Exam Defaults HENRY ALVAREZ, MD. If I check that list , I see that it has all the same defaults as the Eye Exam Defaults Values for New Providers that I previously altered by mistake. However, when I use the Default button on the form nothing is inputted into the Eye Exam Form.
Any ideas as to how to get it work?

Sorry the for the hassel,
Henry


(R Magauran) #9

The defaults are not marked activity=‘1’. They are in 5.0.2 on install…

Assuming Dr. Alvarez is PID = ‘1’ and using phpmyadmin or mysql cmd line:

UPDATE list_options set activity=1 where list_id like ‘Eye_Defaults_for_General’ OR
list_id like ‘Eye_Defaults_1’

OR

Using OpenEMR:

  1. Delete the list Eye Exam Defaults HENRY ALVAREZ, MD
  2. Open the list “Eye Exam Default Values for New Providers” from Administration->Lists.
  3. Check off “activity” on all the fields you would like to populate as a default.
  4. Save.
  5. Open the Eye Form and Dr Alvarez’s list is repopulated with ACTIVE defaults.

If you just made Dr. Alvarez’s Defaults active, the same problem would occur when adding another provider, so best to change base list and build from there.


(Henry Alvarez) #10

Hi Ray,
Followed your instructions and checked all the Active boxes in Eye Exam Defaults HENRY ALVAREZ, MD. The Default button now works again! However, the ID RUL is not showing any default output (blank) in the Eye Exam form despite it being checked off and as before there is no ID box in the list for Vitreous and thus blank What are your recommendations so as to fix this? What is the proper way to add to the list? What is the Default check box in the the same list for?

Thank you,

Henry


(R Magauran) #11

What is the proper way to add to the list?

In the list area, you will see at the bottom 3 empty rows. You can fill these in to add a default for any field.
For example, to add ODVITREOUS (which will be in 5.0.2):

The first is the name of the field (look at source code of form to identify fieldname).
Second is the default value (Clear)
Third is not important but I tend to increase numbers by ten.
Activity is checked.

When you click “Defaults” at the top of the clinical section in the Eye Form, all defaults are filled.
If you click defaults in a specific section of the clinical exam, only the defaults for that “Zone” are filled.
So for vitreous, we want it filled in when we click the “top” defaults button, and when you click defaults in the Retina/Vitreous area. These ODVITREOUS and OSVITREOUS fields are in the “Retina” zone, so the 2nd to last field enter “RETINA” . You do not need the code field for any of these defaults.

The code field is used for abnormal findings. In the list “Eye Coding Terms”, you will find a bunch of pre-filled “abnormal” findings.

If you enter one of these terms in the field listed in “Notes” in the list in a chart, the Coding engine will auto add the ICD-10 code found in the “Code(s)” field of this list and make it available for your Impression Plan and the Billing Engine. It does the same for items in the POH and PMH.

So if you type “Dermatochalasis” into the RUL field, the “Exam” section of the Impression/Plan builder will look like this:

If you drag this over to the Imp/Plan (ie. the the panel to the left of this), or click it, it will be added to the Impression/Plan:

If you , click the left arrow next to Impression 14%20PM
it will replace everything in the Impression/Plan with the selected entries in this list.

However, the ID RUL is not showing any default output (blank) in the Eye Exam form

I will look into this…

Have fun building your system!


(Henry Alvarez) #12

Hi Ray,
The form is functioning much better. The more I use it the more I appreciate the nuances that you have included into it. I followed your instructions and added ODVITREOUS and OSVITREOUS to the Eye Exam Defaults HENRY ALVAREZ, MD list and the values are being shown when the Defaults button is clicked. There is still a problem though. If you close the exam form and reopen it the vitreous field is blank again. If you try to generate a report the vitreous field is blank.
Also I do not find the individual section Default buttons that you described.

Thank you,

Henry


(Henry Alvarez) #13

Sorry Ray. Found the individual default buttons.
How do I customize the Imaging -Eye folders so that they work with the Eye Exam form? Can you just add a folder as you normally would?
Would like to add Biometry folder.

Thank you,
Henry


(Henry Alvarez) #15

Experimented with the 5.0.1 demo and was able to add Biometry - Eye and Topography- Eye folders. These appear added to the Eye Form and looks just like the native folders in the Retina section and Anterior Segment sections respectively. It appears that new folders are added in the usual way as long as you specify which “zone” and that it’s to upload documents (similar to the native ones). Adding these Teo folders however, caused a shift in the form wherein some of the blocks have shifted obstructing the vue of Vision (expanded MR, AR, CTL, ADD and Visual Acuity) as well as External (Hertel) , Anterior Segment (dilation with) and Neuro (Amplitudes) sections.

Several other questions. Is there an easy way;

  1. Add a seperate Ocular meds from systemic meds.
  2. Add comment section or Radio buttons in Refraction section to note if refraction is better, worse or same than current Rx.
  3. Add last dose time to Ocular meds. This helps sort out irregularities in IOP for glaucoma patients.

These changes would be fantastic.

Thank you,
Henry


(R Magauran) #16

IDEAS for new folder names and how they look on the form:
There is room in RETINA. When adding the folder to the Documents section, put “RETINA” in the value box. There is no room as of now in EXT, ANTSEG or NEURO sections. You could rename one of the other document folders and use that. You can change any folder name and shorten it.

Several other questions. Is there an easy way;
Add a separate Ocular meds from systemic meds.

Yes. When adding meds through Eye Form, note this check box:

If you check this then the meds will also appear in the Glaucoma Flow Sheet where they are tracked as current/old meds (provided you also fill in the Start/Finish dates).

Add comment section or Radio buttons in Refraction section to note if refraction is better, worse or same than current Rx.

Use the comments section in refraction area (AR)
You also have the acuity fields - usually better acuity tells the story…

Add last dose time to Ocular meds. This helps sort out irregularities in IOP for glaucoma patients.

Where do envision this? At present you could use the “Comments” section on each drug but that doesn’t really stick out if this value is important for you to know. Maybe the techs can add this in for you in the HPI?