Medical records and the upgrade
Hi,
We are finding it frustrating that when we add a new 'note' to an animals medical record that is not associated with an actual visit (ie a client communication or update) it adds it to below the last visit, not above, no matter how old the previous visit. To get it above in correct chronological order the only way I have worked out how to do it is add a visit, then edit the visit to add a note - this means we are taking 3 steps to do something that used to take one step. Not really an improvement in my opinion.
The concern is that clinical records are not going to be in chronological order, which is potentially dangerous and confusing because important information may be not be read.
We have at least 20 staff and I need to find out what to instruct them regarding this as soon as possible.
Thanks
Sarah
Re: Medical records and the upgrade
Hi Sarah,
I n Patient -> Medical Records the current selected visit is highlighted by an arrow on the left hand side of the summary view. If you add a note, or any other entry, then this will be the visit it adds to. If this is not the correct visit click on the correct one and then add the note.
Adding a new visit mimics this as the new visit becomes the current visit but you prbably won't want to do this as you most likely have an exsting visit from the check-in process and don't need or want a new one.
I ma not sure why the most recent visit is not the current visit when you navigate to Medical Records so we can definitely look into this to save having to select the correct visit first.
Please remember this is a beta 2 release so any feedback we get just makes the final release better. We definitely do not go out of way to make things harder :-)
Cheers
Tony
Re: Medical records and the upgrade
Hi Tony,
Thanks for your quick reply.
I disagree with editing old visits with new updates to them IF the update is BELOW the old visit. Its just too confusing. We are used to reading histories/medical records chronologically, from start to finish, and this is very important when you are busy consulting and need to have a quick read of a history - to have to jump back and forward is annoying and illogical. And imagine sending a history that is all over the place to a specialist. They will certainly not have the patience to be skipping back and forward when reading histories.
Every day we will add new notes to many animals medical histories where they have not been in for a visit that day - follow up phone calls, medication repeats, communications. My point is that in the old version you clicked one button 'New' and could add a new note. To have to add 'new visit', save and finalise, then click on that visit, then add new note - as I said 2 extra steps. Its frustrating.
It will be interesting to see what other feedback you get from this matter. Otherwise the changes seem to be going down well.
Thanks again for your time
Sarah.
Re: Medical records and the upgrade
Hi Sarah,
I don't think I am really understanding the issue from your description then. I may need some more information and possibly some screen shots and a step by step work flow that reproduces the issue.
I did the the following workflow:
1. Checkin. When displayed summary view the new visit was highlighted and I clicked New Note and added a note. Displayed visit and directly under the visit the new note
2. Consult. When summary displayed the most recent visit was selected. I clicked New and added a new note. The second note displayed under the first note. etc
I assume I am definitely not understanding the issue. :-)
Cheers
Tony
Re: Medical records and the upgrade
Hi Tony,
Its so hard to explain what I mean.
I'm not sure how to to screen shots, but I will try to explain a step by step process with an example client (that I am making up!).
Scenario - cat on long term medication, with client reducing the dose every 2 weeks and ringing in to the nurses to give an update on the cat response to the reduced dose.
1) - Cat comes in on 1st June 2011, has a visit, a check up. A record is generated, and dated 1/6/11. The client is instructed to telephone in 2 weeks later to give an update and be advised of a dose change.
2) Client telephones on 14th June 2011 - in old system nurse would have added a note, dated 14/6/11 giving update. Cat has not come in, therefore a 'visit' or invoice not generated but a new note is added because it is an updated piece of information. We never edit or add to old notes. To read medical history each piece of medical information is in reverse chronology with 14/6/11 information (ie most recent information) added as a new note.
3) 4/7/11 - New open VPMS!
4) 5/7/11 - Client telephones in on 5th July to give update. Nurse adds a note, types in information and saves. Now this note is BELOW that of the 14/6 (despite being dated 5/7) and older information, with older dose notes etc above it. And a busy harassed vet trying to read the animals recent history before a consult is more than likely going to be really confused! And more seriously important information could be missed.
So my what my gripe comes down to is that to ensure that each new piece of information in an animals history is in the correct chronological order we need perform one extra, seemingly superfluous step, of adding in a 'Visit' first. If this is unchangeable then we just need to know that, so I can let all the staff know.
Hope this is more clear for you!
Again thankyou for your time.
Sarah
Re: Medical records and the upgrade
Hi guys,
I think I understand the issue.
Issue 1: Medical record items within a Visit are in chronological order.
I think this is a preference issue. We send lengthy histories to Specialists and our histories are not jumbled.
This perhaps would be a useful user configurable option. Ie. Visit items = Order Chronologically OR Order Reverse Chronologically.
Issue 2: When directly editing a Patient record, you need to 2 steps to add a new note.
The workflows you describe Tony still work fine as the a new visit is added (and selected by default) so adding a new Note is really easy (better imo compared with 1.4). Just click "New" and press "Enter" (as Note is selected by default).
What Sarah I think is finding frustrating is the editing of records when not in a workflow. So in Sarahs example when the client rings back, the staff member jumps into the Medical record directly just to add a quick Note.
Doing so in Version 1.5 beta requires you to add a new Visit (Click 1), click "OK" (Click 2) then add a new Note (Click 3).
In Version 1.4, you clicked "New" (Click 1). This would create the New Visit. Then click "Add" (Click 2).
In both cases a new Visit is required. We take advantage of this by making the reason of the visit "Phone communication" (typed as "pc" and expanded as a macro) then adding our notes to that.
There was some discussion regarding this point in early testing Sarah. Part of the reason these changes came about was to deal with a Visit locking issue where we lost typed Notes due to the old Visit editor.
So the issue boils down to is there a clever way to automatically add a Visit without having to go through the 2-click process described above?
What about if the top of every medical summary there was a Visit entry "Add to new Visit". If this "Visit" was selected, any New item (say a note) would be added to an automatically created new Visit.
Matt C
Re: Medical records and the upgrade
Hi Matt and Tony,
Thanks for your reply.
I am sure you will work something out that is a good solution - the new visit entry sounds like a possible solution. I really am more concerned about the mucking up of history chronology, rather than the inconvenience of taking the extra steps! Thanks so much for taking my comments and concerns on board.
Sarah
Re: Medical records and the upgrade
Hi everyone,
I've been watching this issue and have also found that at times notes, etc get added in the wrong places or at least not where I magically wish them to appear.
The ordering is a bit confusing because the order of visits and the ordering or items within a visit are in reverse order (see attachment 1). I think it would be better if they both flowed the same way.
The second issue is that if you add a note or other item after the visit it will be added to the previous visit and as it has been mentioned requires extra work ie add a new visit and then add the item. I think that this would be solved by adding a new visit if the date or the visit item is greater than the previous visit date. (see attachment 2)
Matt Y.
Re: Medical records and the upgrade
Hi Matt,
Firstly there is no issue with changing the ordering of of visit entries as long as everyone can agree. In the 1.5 beta we cannot introduce any user option to set this. It has to be one or the other. A JIRA can be raised to have this customisable but only for 1.6.
If you add entries directly in Medical Records they will be added to the current selected visit which makes sense. I think any change to this would need to go through a formal discussion process and therfore cannot be in 1.5.
It is worth noting that if you bill out medications and investigations they will create a new visit if there isn't a current In Progress visit (the algorithm is a bit more complex then this but the idea the same).
Also I am concered about new "dummy" visits being created from a reporting perspective. This may skew future visit analysis reports.
As far as 1.5 is concerned here is a list of JIRA's (bugs) we are currently completing for the final release. If you guys want theordering changed then JIRA it quickly as I am pushing for final release in the next week. People have been waiting for 1.5 tool long.
Cheers
Tony
Re: Medical records and the upgrade
Hi Everyone,
You really need to have you say about this and have it quick. Do you want the summary medical record items ordered chronologically or reverse chronologically. No response by Sunday will mean it stays the way it is (chronologically) for the final release. :-)
Cheers
Tony
Re: Medical records and the upgrade
Hi to all,
We would like the medical record listing to stay chronological. If it is possible to work towards less steps for a new visit that would be great and we would also find it benefical if when you manually create a visit - not through the workflow - if it could make the status completed as you close the new visit screen.
Cheers,
Bernie
Re: Medical records and the upgrade
Hi Tony et al,
I think this needs to stay as it is currently as there are many users not in the forums who might resent such a significant change with no option to reverse it. I think the solution I would advocate here is a choosable option in 1.6
Cheers,
Matt C
Re: Medical records and the upgrade
Hi Matt,
I think you explain the issue well. It is both confusing and frustrating when notes appear out of order especially when reviewing a history. When are we looking to get this problem resolved?
Re: Medical records and the upgrade
Hi All,
There has been no decision on order so have discussed with developers and we can add a practice wide option to stipulate whether visit items are in ascending (current 1.5) or descending (1.4) order as well as a button on the summary tab to allow this order to be changed by the user at will.
Cost is $550 so all we need to do is get some funding and we can get it into 1.5 final. No funding before Monday next week and will need to wait till 1.6.
Cheers
Tony
Re: Medical records and the upgrade
Hi Tony,
I couldn't find this JIRA. You haven't created a user project for it have you?
Thanks,
Matt C
Re: Medical records and the upgrade
Hi Matt,
Sorry no JIRA or Project defined yet ..
Cheers
Tony
Re: Medical records and the upgrade
Hi All,
There has been no decision on order so have discussed with developers and we can add a practice wide option to stipulate whether visit items are in ascending (current 1.5) or descending (1.4) order as well as a button on the summary tab to allow this order to be changed by the user at will.
Cost is $550 so all we need to do is get some funding and we can get it into 1.5 final. No funding before Monday next week and will need to wait till 1.6.
Cheers
Tony
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Re: Medical records and the upgrade
Hi if the option is still available can we start a project to try fund this change?
Thanks
Re: Medical records and the upgrade
Hi Everyone,
I have added a devlopment project and associated JIRA here.
http://www.openvpms.org/project/medical-records-display-order
Cheers
Tony
Medical Records display order: Funding Update (20%)
A user has pledged $100 funding for this project!
(20% funded. $450 remaining)
Public pledges can be made to this forum topic or email me directly by clicking here (link only works in the forum).
Development will not commence until fully funded.
Re: Medical Records display order: Funding Update (14.6%)
Hi everyone,
Please be advised that this project, previously reported as costing $550 will cost $685. Consequently the % pledged has been reduced from 20% to 14.6%.
Apologies,
Matt C
Re: Medical records and the upgrade
Hi all,
I agree with Matt C and Bernie above. Initially when I first started using OPEN (1.5 beta), I had the same confusion about why new notes are not placed as I intended to even I changed the date of entry because I didn't know I have to start a new 'visit' first before adding the new note to it. So the note would went into the 'wrong' visit that was highlighted by default. And the dates were all over the place.
I don't think the problem is about whether medical records are listed in ascending or descending chronological order. It is about the steps / logics when adding a new note (other than when created through a check-in and then consult process). Is there a way in future versions to simplify the process of adding new medical note without going through the extra step of adding a new visit first because it is too many clicks to go through at the moment?
Anthony (Activet)
Kind regards,
Anthony (ActiVet)
Re: Medical records and the upgrade
I think Anthony has summarised this well. We just upgraded to 1.5 & found the same issue with having to add a new visit to be able to insert a history comment when not going through a workflow.
I agree that it is cumbersom to do this now and should be fixed at some stage, but at least we know how to get around this for now, we can avoid errors in date order at least.
Glen
Re: Medical records and the upgrade
I agree with Anthony completely. It would be great to be able to add " just a new note" with todays date, without adding a new visit, for example to report an owners telephone conversation or observations, or to add other relevant comments, when in fact the animal did not attend the clinic, and so in fact "it was Not a new visit"
Paul
Re: Medical records and the upgrade
Hi,
This is still an issue for us and I believe will not be entirely solved with the new "visit + note" button in the 1.6 release. Accordingly are we able to contribute $150 to adding the medical records sort order option.
Thanking you,
Adrian
Re: Medical records and the upgrade
Sure. On the project page at http://www.openvpms.org/project/medical-records-display-order there are details for how to contribute funding.
Re: Medical records and the upgrade
Quite a number of you have made comment about the need for a more logical way of ordering histories in the summary tab and this is your opportunity to have the changes incorporated into version 1.6 which will be released in beta form very soon.
A donor has very kindly pledged 35% of the funding requirement for this to go ahead which leaves just 435 tax-deductable dollars to be shared by all of you who would like to see this happen and get the ball rolling BUT you have to be quick as we are just about to complete the release development process.
Re: Medical records and the upgrade
We have another $150 pledged to this project so now there is just another $285 to find. Around 4-5 of us have written in favour of change so if we all pitch in $60-70 each it will get it over the line. Of course if you pledge more then Wayne Swan will contribute more as well via the tax man.
Peter
Re: Medical records and the upgrade
A very kind supporter has pledged the final $285 to get this project started. Thanks very much to all three supporters for helping push this through.
Of course this will be available to us all now so we should all be very grateful.