I think the following is more of an an enhancement request than a bug.
The current Patient and Reminder center has the fields displayed “From”, “Patient”, “Type”, “Date” and “Status”. As a practitioner the current order causes the Message Center to organize messages by the sender alphabetically which has no reasonable clinical importance. Simply listing the “date” and better yet a date:time in reverse order and in the first column would allow us to prioritize the messages from oldest to latest. I like to do the oldest messages first. Its like rotating stock at a grocery store. It helps me to focus on the messages that have been outstanding the longest.
We have a large practice and literally dozens of different name middle initial combos that are identical. The Message ans Reminder Center should list a pid or date of birth (or both) so that it is not so hard to figure out which patient is being refrred to. Currently I have 6 people named “David Jones”. I have to go search and find each one of them until I finally find the one who was the patient with the message.
Prior to the security sql injection improvements, we could click on the note and go directly to that patients chart. This is an action that we perform literally hundreds of times per day. It would be great if we could somehow go back to the original behavior of clicking on the note and going directly into that patients chart.
Currently, non-authorized staff members can give a status of “done” to notes. From a liability perspective only authorized users should have this authority.
Even worse, additional notes can be appended to a note with a “done” status. This causes the note to functionally disappear. While giving a note a “done” status should cause the notes to be dropped from the active que, appending information to a note with a “done” status is really bad.
We have already lost several patients because the practitioner never got the message on a note appended to prior information that had already been marked “done”. I also have had one patient injured because I never saw the note to call the patient that when they were in severe trouble. My first clue was I received an operative note from a hospital in a different city as the new doctor saved the life of my previous patient. When I finally called the patient a week later she was already out the other hospitals ICU, at home and very angry with me.
I think being able to allow anyone to add information to a closed note with a status of “done” is a very serious bug.
Hi Sam,
In 4.1.1-dev(not in 4.1.0) can go to patient’s chart from a note by clicking on the Patient label, which is a hyperlink to open the patient chart on the top frame.
-brady OpenEMR
Hi Sam,
Also agree with your suggestions. Would place them on the tracker (ordering and piud/dob column to feature request tracker and the editing of a DONE note to the bugs tracker) and try to convince(or sponsor) somebody to do them (should take minimal resources to complete these).
-brady
Almost all commercial EMRs that I have seen have a feature where the author needs to “Sign” the note to close it. After it is “Signed” the note can no longer be modified, unless the administrator goes back to “Unsign” it. I believe that this is very important from a medical legal perspective. Plus, only the author can “Sign” their note. Also, users can be set up to authorize a “CoSigner”.
I consider these features to be very important, if not essential.
Currently, in OpenEMR allows anyone to go back to a note to modify it, and to modify it well after it was written.
Suppose there is a lawsuit, someone can go back to “fix” what was written in the past and no one would know. These could lead to serious legal implications.
There are currently more pressing programming projects for me. However, if no one addresses this before I get around to it (perhaps in the 6 month time range), I will definitely be addressing this (as long as I don’t run out of money by then).
I would need this addressed before I can fully use OpenEMR for my medical practice.
Dr Eschelbacher, you seem to be talking about progress notes, versus the “Message and Reminder Center” notes that Dr. Bowen was referring to. This thread will get very confusing if we are not precise with our terminology. That being said, I think both issues need to be addressed: better control over the Message and Reminders so important messages don’t get hidden, and the ability to electronically sign progress notes.
Personally, I can’t see myself reading each progress note and signing it, locking out any further changes. Very often, as I am reviewing old notes, I find typos that I would like (and do) correct. I believe there is an audit log that tracks such edits, but there is probably nothing that would prevent you from altering that log, especially if you have direct access to the database files.
It is also worth pointing out that it is entirely possible to tamper with a paper chart, as well. Our malpractice carrier has us take Risk Management courses from time to time, and they include the story of the practitioner who tried to alter progess notes after a copy had gone out to plaintiff’s attorney! Another good one was the progress note written on a form that had the date the form was printed in small print at the bottom, and the progress note was dated earlier than the paper it was written on. They describe such situations as being “damaging to your credibility”.
Very common for EMR’s to have a ‘Sign’ and ‘Review’ feature for notes/labs/messages/etc; After signing a note, the most common way to add information is via an addendum. My quick thoughts are to have a generic signing table (could also hold reviews I suppose) that holds id, type (form/note/lab/document/etc), type_id (of the form/note/lab/document/etc), sign flag, md5sum of signed content, date of signed content. Then could also have an addendum table simply with a TEXT column and a column pointing at the signing table id (and when the addendum is signed, will also get a entry in the signing table for it. Just thinking out loud; but would be very nice to have a feature like this (ie. as generic as possible).