Some general templating pointers

1. What is the best way to go "template shopping" from the Greenway library? Do you go directly from the "CHOOSE TEMPLATE" command in a note, and if so, which user/library do you choose? (I used to know how to do this, but can't remember now).

If you plan to use a template a lot or modify it I'd suggest importing it to your user name. See below. This means a user has to export it to you or you have to get it from the Greenway library. Greenway has hundreds of templates that are searchable. Unfortunately many are bulky but if you need something we haven't touched up yet it's a great resources (burns, injuries, even many viral infections, etc.)

To simply use a template for one note you can create a note, then choose the select template option. On the right side of the screen that appears select an appropriate user then choose their template you wish to use.

Unfortunatley to my knowledge you can't access the Greenway library unless you are in the template administration section.

2. Is there a way to perform a general search by title for a template, ie search for "circumcision" across all users to find one?

I don't think you can search for templates made by other users. You would have to However, let's talk about searching hte Greenway library of templates!

Once you're logged in choose TEMPLATE ADMIN from the CHART menu.
This will open a screen that shows your user's templates. From here you can create your own templates (for you only), import or export templates to/from others and search the Greenway library.

The next step is to click IMPORT on the left of the screen. This by default opens you to the Greenway library of templates. At the top you will see that you can either browse thru them by category or search them out by keyword.

TO browse thru all you have to do is click on the plus signs of the appropriate specialty and then subject areas. For example try clicking on the plus next to PEDIATRICS then next to DOCUMENT TEMPLATES then VIRAL INFECTIONS then click on COXSACKIE VIRUS

You'll note this last step adds the name of this template to the list on your right. This right hand list is what you'll "import" into your user for future use. Open other categories and add more templates to your list then when done click IMPORT in the lower right.

These templates show up in your list.

3. I know we can import templates from Tank Template, and from the Greenway library. Are those the only "open" users?

The Greenway library is the only "open" place you can grab templates from. Any other user can share them with you by exporting their templates. We are asking that all share these templates under the shortcut to templates that is placed on your computer desktop.

To import a template from another user or Tank Template, follow these instructions from Template Admin and choose the appropriate user's folder then the template you want.

Remember you have to have someone export their template before you can bring it in for yourself so ask politely:)

Actually, if all of us can export our most updated templates once in a while and place them in our user folder this will allow others to share them.

HERE's HOW TO IMPORT FROM ANOTHER WASATCH USER:
Open TEMPLATE ADMIN from the CHART menu

Choose IMPORT on the left then from the upper middle of the screen that opens choose File System BROWSE.

Then double click on desktop --> double click on Shortcut to Templates folder --> double click on Tank Template folder (or the folder of any other user)

Then choose any of the saved (exported) templates that you want from the items there

Once you choose one they will open in the left side of the window. Click on anyone (or all) in the left side to move them to the right and select them for import.

Then just click import in the lower right corner and they should show up under your user name.

Cleaning House and Past Medical History

Moving to EMR is like moving to a new home-- it's a big change and can be painful at worst, and a lot of work at best. But it also gives you a great opportunity to clean house, I mean really clean house, because who wants to move all the junk you never use, right?
So, when you are entering in Past Medical, Family and Social History, I recommend that you clean house from your old chart. Chances are I really won't need to know birth weight on a 13 year old. There's a lot of stuff on my old problem list that won't be relevant anymore. Instead of taking charts home and working for two hours each night to get all the details in, just pick the most important history items and enter them in during or after the visit as needed. (See my previous post about entering diagnoses through using a quick note for another way to do this.)
I'm not suggesting that EMR is like a shiny new house, but it's at least a lot less cluttered than a tattered old paper chart...

Good Luck to Group Two

Good luck to all you Group Two folks today, as you start diving into charting! Take it slow. If you get too frustrated, switch to paper. And keep smiling!

A Shortcut for Getting Diagnoses onto the Problem List

I was going through letters from specialists about some of my patients, and I had a bunch of diagnoses that I wanted to enter in for the various patients, (in this case diagnoses that the specialists had made after I had referred the patients). I find it cumbersome to open the PMHx and search through the different categories in such cases, especially since they are often quite specialized.
So I tried something different. I opened the patient's chart, then started a new note in the Quick Note category. In the HPI section, I just typed "New diagnoses from evaluation by Dr. ________" (on some others, I just left the HPI blank). Then I just went to the Diagnosis section, clicked on the wizard icon, and searched for the diagnoses I wanted. Once the diagnoses were added to the note, I had to click on the icon to the far right that adds the diagnosis to the PMHx.
It says it adds it to the problem list, but it doesn't without this extra step: You need to click on the Facesheet, then go to the Problems section, then click on the boxes of each of the diagnoses that you want added to the Problem list (these are the ones you added to PMHx by clicking on the icon in the note). Once you've done this, they'll appear as active problems.
This still isn't quite as straightforward as I like, but I think it's probably the simplest way to add complicated diagnoses when you're reviewing your mail or old charts.

Idea for Simplified Well Visit Template

So, after two months on Greenway, I think I've formulated what I think would be a good approach to a well-child template. I'll post it here with the first sbulleted response as the default response; the other options would be multiple-select. The idea is that for a normal child, all you would have to do is select the template(s) and sign, so you could do your visit without being glued to the tablet.
So here is my template:

SIMPLIFIED WELL VISIT TEMPLATE
HPI SECTION

GROWTH CHART REVIEW:
• Interval growth is normal.
• Percentiles are: weight (#) %, length (#) %, OFC (#) %, wt/ht (#) %
• Percentiles are: weight (#) %, height (#)%, BMI (#)%
• Growth is concerning because:

CONCERNS:
• There are no concerns today.
• Parent(s) are worried about: ________
• NAME is ill today with ______
• (free text)

PROBLEM LIST REVIEW:
• There are no active problems.
• Active problems are stable.
• Active problems are: (import active problems)

MEDICATIONS
• There are no ongoing medications.
• Medications include: (import active medications)
• Changes in medications since last visit include: (text)

EATING
• (Name) is eating normally for his/her age or developmental level.
• (Name) is nursing every (#) hours.
• (Name) is drinking (formula) (#) ounces every (#) hours.
• (Name) is taking baby foods, stage (#).
• (Name) is eating table foods.
• (Name) is drinking (select type) milk.
• (Name) has excessive calorie intake due to (field).

SLEEPING
• There are no problems with sleeping.
• (Name) is sleeping (#) hours per night.
• (Name) is taking (#) naps per day.
• (Name) is waking (#) time a night.
• (Name) has trouble falling asleep.

DEVELOPMENTAL MILESTONES
• Developmental milestones are appropriate for age in all areas.
• (Name) is not reaching the expected GROSS MOTOR milestones because (field).
• (Name) is not reaching the expected FINE MOTOR milestones because (field).
• (Name) is not reaching the expected LANGUAGE milestones because (field).
• (Name) is not reaching the expected SOCIAL milestones because (field)
• (Name) passed/failed the MCHAT screen for autism.
• Parents are concerned about: (field)

PMFSH:

ROS:
(insert my short ROS admin defaults here)

PE:
(Leave blank; create separate physical exam templates that can be overlayed or can be set as exam types)

DIAGNOSIS:
• (Name) is a healthy (age) (sex) who is growing and developing normally.
• Developmental delay (provide details; or “name” each type (gross motor, etc) but link it to the general DD code)
• List common chronic problems to choose from, such as ADHD, asthma, atopic dermatitis
• List common acute illness diagnoses that would be seen in the course of a well check, such as URI, OM, diaper rash, atopic dermatitis.

PLAN:
(If doing separate templates for each well exam, pre-select the appropriate vaccines; if using a master template, then make separate plan-only templates based on age to select for age-appropriate vaccines and anticipatory guidance, as well as billing codes. I would avoid long checklists on anticipatory guidance, instead using general terms or limiting to one or two things. If there are age-specific templates, they could also include Denver 2 or Bright Futures developmental milestones if desired in the HPI section, although I prefer a generic “normal development” statement.)

What are your suggestions/comments?

Advice for Group Two

So, Group Two's training date is fast approaching. Do you have any advice for them?

Here are a few things I would suggest:
-- Try to start patients two months and under on EMR. Make them your priority in your first few weeks.
-- Learn to navigate your way around Greenway BEFORE training starts. Get with your Super User and set up your preferences, learn how to pull up your schedule, search for a patient and their demographic info, and how to schedule an appointment. This will save you wasting an hour or two of time with your Greenway trainer doing stuff that your super user is more than capable of doing.
-- Don't get too frustrated. If it's slowing you down, go back to paper for the rest of the morning, then try another e-patient in the afternoon.

Did you survive the slowdown?

Those of us on EMR faced a new challenge this week-- a big decrease in speed due to problems with the main server. Luckily we weren't shut down completely, due to Brock's plan for built-in redundancy.
Speed at our office was slow enough that I went back to paper charts for a day. I was surprised to find that it was a real pain to chart on paper again-- way too much writing.
Luckily we're back up to reasonable speeds.
How's everyone doing on EMR?

And for some GREAT NEWS-- Earl is a Dad! His daughter was born on Friday night, 7 pound 2 ounces. Mom and baby are doing great.