Multiple Instances in the Browser

(Robert Down, BSN, RN) #1

I know we have this functionality which allows you to open up separate tabs/windows and login back into OpenEMR so you could view multiple patients at any given time.

From a clinical perspective this seems rather dangerous. Clinicians and providers are already at risk for charting on the wrong patient just because of human error but to have 2 windows with 2 different patients seems like a risk without much benefit. Additionally, this adds a layer of complexity to the code that only makes updates more difficult.

Why was this introduced and can anyone give a strong defense for why it would stay? I think it is a risky feature that creates unnecessary opportunities for error and we shouldn’t even allow a clinician this option.


(R Magauran) #2

Please give us some time to ponder before removing this functionality.
There are at least three different issues:

  1. opening more than one patient at a time
  2. opening a given encounter/form in more than one instance at a time, by the same or multiple users
  3. ability to write to multiple forms at the same time.

In the “back office” I often have several instances open in different windows. Sometimes different browsers even. Maybe one is a billing issue I need to track down, another finish charting, another needing a letter to go out, another to take a peak at the next patient’s chart. So as an “admin”, I open multiple instances as I work.

Then I leave that machine and move to the exam room. As a “clinician” actually seeing a patient, I only open one chart - for the patient in that room. It is entirely possible that I will open the exact same encounter/exam form that is actively opened on another computer in the “back office”. In fact that is the typical scenario.

From a form perspective, the eye form only grants write privileges to one instance at a time, no matter what machine or browser you are working from. That is tracked in table “form_eye_locking”. Maybe you can create a similar, more object-oriented method for ownership/write privs for all forms? This would address the privileges at the form level (number 2. in the list above), but not the ability to open and write to more than one patient/form at a time. This would probably need to be tracked at the user level to prevent a user from just opening a different browser and having two charts opened also.

(Robert Down, BSN, RN) #3

Certainly not looking to just up and yank this without solid community discussion first. Just wanted to raise my concern as a clinician that there’s room for error, though I do see value in your “back office” example

(James Kay) #4

My version of OpenEMR does not have this support, but we desperately need it. We currently have to have separate instances of OpenEMR open in Chrome, Chromium, and Firefox. I’ve been thinking of installing VM’s to allow for multiple instances of web browsers to allow for more. Here’s some scenarios that may help explain why:

  • You are in the middle of charting on a patient, but get interrupted to take care of a phone call from another patient, and you need to look the other patient up to be able to answer the family’s question. Also, you need to document their phone call. After you are done, you need to be able to go back to where you left off with the other patient.

  • Staff are working on referring a patient to a specialist, with requires lots of documentation and access to the chart. These staff members also must answer phone calls and wait on families at the front desk. They need to be able to continue their work on the referral, while opening the chart of the patient at the front desk so they can update their insurance and contact information, and mark that they have arrived. Then, a phone call comes in, and they need to open the caller’s child’s chart.

Other EMRs have the ability to open multiple charts, like Epic. Admittedly, users must look carefully at the name, etc., at the top, to confirm which patient they are working on.

Does that help?


(Robert Down, BSN, RN) #5

Hi @drkay What version are you using? In our latest release (and quite a ways back I believe) just opening another tab in Chrome or Firefox will get you a brand new session.

I wasn’t aware you could have multiple charts open in Epic. I don’t believe Cerner supports this (though I could be wrong)

I wonder if there is enough justification to keep this that the responsibility is with the user to not mess up. A “with great power…” kinda thing. Seems risky, but I see both sides of the argument

(James Kay) #6

We’re on Version Number: v5.0.0 (8). I didn’t know new sessions would open with new tabs/windows now. I’ll try it.

I can’t imagine a busy outpatient office not needing multiple EMR windows open. The name of the patient is always at the top of the window in the tabs view, so I think this helps a lot. It’s more confusing the way Epic does it, with different patients in different tabs–it’s less obvious which patient is the active one. With the OpenEMR tabs view, it’s very clear.

(James Kay) #7

Funny. I didn’t intend to post a large image of our business card to the above post!

I tried this today in Safari on an iPad. I’m disappointed to report that this does not work in v5.0.0 (8). I was charting in tabs view with the name of one patient at the top, clicked Save, but the documentation went into the chart of a different patient (a patient I had open in a different instance of OpenEMR in a different tab.) :disappointed:

(Robert Down, BSN, RN) #8

Haha I was wondering what the image was for :slightly_smiling_face:

Can you try this from a regular PC (or Mac) using Firefox or Chrome? I’m curious if it’s a limitation on Safari on iOS

(Jerry P) #9

Hi, At some point this was an issue but I can’t remember if 500 or 501. Brady and I both scratched our heads for several tries at a fix and I believe Brady finally fixed in a patch for 501.
This feature worked and was broken at some point. Looks like maybe 500.
I’m sure though we have several users that use this feature which I haven’t seen anymore complaints since Bradys last fix/patch.

(James Kay) #10

Thank you for the info. I’m looking forward to trying it again when we upgrade to 501. We could use it.