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Electronic
Medical
Record
 

Top Enhancement Requests: 2004 CHUG Meeting


Adult Primary Care

Specific: Short, Meaningful Title

Problem: Articulate the problem (not the solution); what is the desired "outcome," what is the "pain" point; why is this request important?

Example: Provide an example with actual user names that describes how the problem could be better. Include very specific workflows.

Link from any text string to UpToDate

There are many places in Logician where one needs to access additional knowledge resources but for which immediate access is not available. Dr. Jones is documenting information from a consultant physician's report regarding NASH syndrome. She wishes to know more about this condition, so she highlights NASH syndrome, right clicks, and left clicks on the UpToDate option, which takes her immediately to UpToDate, and the topic of nonalcoholic steatohepatitis.

New Chart Tab: Past Medical History, Past Surgical History, Family History, Social History

Past medical history, past surgical history, family history, social history are important elements of the patients total health information, or not easily accessible. It quickly views these without opening a chart or looking through a document is desirable. Dr. Wilson is reviewing a laboratory results on Mrs. Atkins. He notices that her serum cholesterol level is elevated and is interested in quickly checking to see if she has a family history of coronary artery disease or a past surgical history of coronary artery bypass grafting. He clicks on the appropriate chart tab in quickly notices that her family history is negative for heart disease and her surgical history is negative for CABG, but that her social history is positive for lipid poisoning by her husband.

Full Boolean Searching Capability in Inquiries

 

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There are many situations in which users would like to combine search items in some combination of and/or categories but are currently limited in doing so. Nurse Tucker is interested in identifying patients that have orders in process by a specific location of care or set of physicians. She initiates an order or structured as: Patients AND
Orders in-Process AND [Location of Care OR Dr. Jones OR Dr. Anderson]

Pediatric Primary Care

Immunization input and display

View of immunizations is cumbersome - need to have easy access to display and also have input be able to be done without needing to update (such as old immunizations) Instead of Alerts and Directives (which are not important in Pediatrics), have ability to put immunizations on that tab. Or, have ability to have a macro that can quickly open up the immunization list - hot key

Social Context of pediatric patients

Pediatric patients have very complex social situations, and the registration has no means of accounting for that. There needs to be a way to quickly access social information (who they live with, etc) without having to open a new update Consensus of the group is that it should be a registration function - something that can be changed and viewed without having to go to an update. It is critical information in pediatrics

Registration Maleable/ expanded

 

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Similar to #2 - need to have the ability to pick and choose what is viewed in registration for a given clinic and allow more information to be viewed Cell phone, nickname, family situation, refugee status, language spoken, all need to be quickly accessed in different clinics. This is not a standardizable thing, so it should be maleable

Medical Specialties

Legal electronic digital signature (nonnarcotic prescriptions, faxes, letters)

Doctors cannot create and sign prescriptions in the EMR in a manner that is acceptable and avoids the need to print a prescription, retrieve it from a printer, and then manually sign and give it to the patient. Extra steps and the risk for error or omission are consequences. Dr. Smith is writing a prescription in Logician. A scripted, digitized signature is created (method not specified, but could include a secure digital ink signature file inserted as a graphical image.

Enhanced order sets with time-limited diagnoses and with associated order sets

Entering/removing new problems to associate with specific orders Not provided; example of prenatal labs at 28 weeks; diagnoses drop off after gestation has passed "closed loop orders" (warning alerts when orders not resulted)

Signing enhancements, including signing without completely opening a chart but rather only opening the document

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The problem is the time required to open the chart While working on his desktop, Dr. Smith would like to sign documents. He double clicks on the document and opens it quickly without opening the chart, which takes longer. He signs the document in returns automatically to the desktop.

Surgical Specialties

Track patient flow

Unable to tell which patient is in which exam room or if they are in the lab or x-ray. At this time you can only tell they have arrived in the office. Within the doctors schedule, have icons that would identify the exam room the patient is in or if they have been sent to the lab or radiology. Then at a glance the doctor knows who is behind the closed door or if she must wait for the patient to return before the visit can be completed.

Put the histories on the summary page or easily accessible site

Can't get to Past Medical History, Family History, Surgical history, or Social History without going into update and opening an encounter form. At the desk top, go to a history tab to review this information.

Bring ultrasound data for pregnancies into the flowsheet

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Can't see the biometric data in the flowsheet. The obstetrician could go to an ultrasound flowsheet to see the data portion of the abdominal ultrasound.

Small Office

In flow sheet views, display unsigned data (labs, vitals, etc.)

Having to toggle back and forth between update and flow sheet to see trends and not be able to overview new data with old. Mr. Jones comes in for his diabetes appointment. Vitals are taken by the nurse. When Dr. Smith comes in the room, he would like to see how the patient's weight and blood pressure are trending. He has to remember what it was today and then toggle to flow sheet to compare old values.

True Boolean searches (inquiries)

See Adult Primary Care See Adult Primary Care

Ability to change orders after signing them but before signing the document.

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Orders may change or not be performed that were originally intended. Baby Julie comes in for her four-month shots, normal immunizations are ordered but then the mother declines one (or you run out of medication, etc.) after they have already been signed.

IT Management

Improved DTS Functionality

Repeat item on LinkLogic with additions: Provide the ability to sort when manually, handling LinkLogic errors. Provide the ability to pass through files that error because the data in a field is out of range. When you receive an HL7 file that has a field that contains too many characters, for example a performing lab name, provide the ability to make a setting in LinkLogic that would automatically truncate the field to the appropriate length. When searching patients while clearing LinkLogic errors, provide sort capabilities for the patient list.

Improved Database Management Capability

Provide the ability to take multiple CPO EMR databases and merge them into a single database and also the ability to take a single database and separate it into multiple databases. When you started with a multiple database environment and want to go to a single database environment, you should be able to easily merge the databases. Also, if you have a single practice and a provider leaves, for example and wants to take the data, You should be able to easily separate the database into the data that is staying and that which needs to go.

Database Integrity Checking

 

 

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When it is time to upgrade CPO EMR, the upgrades affect the Oracle database and its contents. This upgrade process can be hampered if there is corrupt data, tables, indexes, etc. You should be able to run an integrity checking routine against the database which will find and correct errors. The upgrade from 5.5 to 5.6 also upgrades the version of Oracle. A database with continuity issues will hamper this upgrade. The integrity checking should be an integral part of the upgrade process and included in the upgrade software.

Nursing

Desktop management - highlight changes and sort out pending work

1) Bold summary line info when content has been changed after you have read it; 2) Create a "my folder separate from the all view to identify "works in progress" so they can be filtered out of or sorted to the bottom of the "All view". This would be a separate attribute from document type that is user-specific.

Separate add new pharmacy from "Change registration" privilege

Don't allow users to add pharmacies, but allow them to add other contacts and registration info. Make this a separate privilege. Keep the ability to associate an existing pharmacy when adding a medication.

User errors create clutter when viewing clinical lists

 

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1) If incorrect order added, need to remove wrong order and add correction. Removed order creates unnecessary "noise" in orders tab.
2) Another example would be incorrect Rx, or printer errors which result in multiple reprints being logged.
At the time an order is removed, indicate the reason and choose whether or not it should appear on the orders tab and the current note (if the original order was in that note). Some removed orders could be important to show (i.e. test was ordered, but patient declined)

Link in Page


Adult Primary Care
Peds Primary Care
Medical Specialties
Surgical Specialties
Small Office
IT Management
Nursing