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EMR's
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Mark
Tableteer


Joined: 05 Dec 2002
Posts: 30

PostPosted: Thu Jan 09, 2003 7:38 pm    Post subject: Reply with quote

Ken and Scott,

Thanks for going over ASP's and citrix. I have a rudimentary understanding of it and my brother has gone over it me before and I guess I should have known that it probably is secure and HIPPA compliant for security. Scott, although I don't want templates I am all for a mechanism to minimize handwriting recognition, voice recognition and typing to capture a unique note each time. I didn't mean to imply that your software would do that and hopefully what you have planned will have the desired flexibility to capture a note quickly. I have thought of using something with dropdown list of common choices with rapid taps for common things but always with the opportunity to add free text or a unique finding. The right combination is sometimes hard to find. I think the pursuit for a good EMR is well dicussed at this site:

http://www.elmr-electronic-medical-records-emr.com/

I hope this is not in bad taste to mention other software programs, but I have been attending a conference called "The High Performance Physician" each spring in Boone, NC which tries to encourage the use of technology in the office. One of the main speakers also has a software product called "Instant Medical History" which basically makes the patient fill out the Subjective part of the note. It can give you more than you want to know at times but it is a very novel concept. I think it is a reasonable cost and can be combined into other EMR products. If interested follow this link:

http://www.medicalhistory.com/

They also had discussed "Shorthand for Windows" that I am trying out which can help you use hotkeys and macros to get text in quickly and works with Microsoft Word. You can make your own dictionary of macros or hotkeys. This maybe too basic for advanced users of computers and EMRs but it is were I am starting. For anybody like me that is new at looking at technology and using it in the office some sites that have some beginning information that were at the conference can be found at these links:

http://www.crmef.org/aafp01/Bachmanrefs.htm

http://www.crmef.org/aafp01/index.htm

Hope these are helpful to someone starting out like me!

Mark

PS- I'm not sure but I think Digital-doc is the one that developed a interesting EMR solution for the PocketPC. I downloaded a demo and found it interesting but the limitations in screen size on my Ipaq seemed to make it not as practical for me to use. I wonder if it could be adapted to the Tablet PC with increased screen size and processing power and better handwriting recognition and voice recognition capabilities it may work great for some people on this type of platform.
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mitodad
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Joined: 07 Dec 2002
Posts: 39
Location: NJ

PostPosted: Fri Jan 10, 2003 2:48 am    Post subject: emr's Reply with quote

mark,

kind of sounds like you're trying to "re-invent" the wheel. should you end up with an associate some time, how are you going to teach all the macro's, etc. and do you have time to come up with all your definitions??

you may want to contact Danny (dmf@compukid.com) and get a demo of his E-med records EMR just to see how one works. a demo can be run over the internet, at each visit you will see which adults are behind in their dT shots (q 10 yrs), etc. can't rave enough about it when it comes to your pediatric patients (as it was built for kids first as CompuKID).

essentially, it's a database, where you customize in the physical section what you would write for normal findings based on age and ... for the following categories (age-related, developmental milestones drop out after 6 yr checkup)

general
skin
head
eyes
ent
neck
chest,lungs
cardio
abdomen
breast/genital
back/scoliosis
musculoskeletal
neuro
hearing
vision
maturity
psychological
denver developmental

once you define your normals (and you can populate the various databases with any text you want, including abnormals, etc), should you have a normal exam for that patient, all you have to do is click "all normal" and the physical is populated with all the text you put in. and as i've stated before, free text entry is there, too.

again, something you may want to consider before you embark on something that will most probably use up all of your free time. just my opinion.

ken
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Mark
Tableteer


Joined: 05 Dec 2002
Posts: 30

PostPosted: Sun Jan 12, 2003 9:07 pm    Post subject: Reply with quote

Thank you again for your input Ken,

What's wrong with "reinventing the wheel " .... Haven't you heard of Ford's problem with their SUV's tires? Wink Seriously though, I still believe there's an elegant simple solution out there that hopefully will not cost a lot of money. The program you have mentioned sounds good. I will try to check out when I have an opportunity to do so. I'm glad it is working for you and hopefully many other people out there. I guess you are right. From talking to my brothers it will require some handling of a database to get the type of product I think I want. Right now I'm not looking for a complete EMR, I am looking for a good point of care documentation tool and coding aid to get reimbursed fairly and get home decent time.

Thank you for your help,

Mark [/b]
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sallen83
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Joined: 05 Jan 2003
Posts: 7
Location: Ohio

PostPosted: Mon Jan 13, 2003 4:34 am    Post subject: Patient Subjective data Reply with quote

Ken,

Thanks for the input. We have looked at Instant Family History and are close to making a deal with them to license their application as part of our product (patients could enter their data from the Practice web site or from a kiosk in the waiting room). We also looked at a site called WorldDoc (www.worlddoc.com) which allowed patients to list complaints. My first impression was to use WorldDoc but we got feedback from our Physician Board that patients were self-diagnosing rather than answer the more general questions of IFH.

What do you think?

- Scott
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Mark
Tableteer


Joined: 05 Dec 2002
Posts: 30

PostPosted: Mon Jan 13, 2003 6:08 pm    Post subject: Reply with quote

Scott,

Where can you find info on "Instant Family History" and is it similar to "Instant Medical History"? Is it possible (efficient enough) to have the providers put in the history?

Just curious what your opinion is about providers using a product to document the Subjective even though I know it would be best if the patient did it to be most efficient.

Mark
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mitodad
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Joined: 07 Dec 2002
Posts: 39
Location: NJ

PostPosted: Mon Jan 13, 2003 6:53 pm    Post subject: emr Reply with quote

mark,

you hit the nail on the head, the emr i use is point of entry and does all the coding (you can even do the billing yourself if you don't want to leave it to people at front desk)!

as for ford's tires, they were firestone tires and not ford product. also was user error (letting them become underinflated). but here in this country, we never take responsibility for our own actions, just like that federal judge who decided to proceed with the latest mc d's case with 12 yr old and dm/htn at 12. too bad ronald kidnapped the kid, tied him up to a chair for 6 years and dished out nothing but mc d's meals by Force-feeding him. parents had nothing to do with it!!!

ken
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Mark
Tableteer


Joined: 05 Dec 2002
Posts: 30

PostPosted: Mon Jan 13, 2003 7:27 pm    Post subject: Reply with quote

Ken,

Kudos to you for remembering the details of the Ford-Firestone incident. I believe you are sold on your EMR software and I will check it out. Maybe after I down a couple more Big Mac Meal Deals and Super-sized fries and a Coke Wink I'm trying to bulk up for the class action lawsuit that may come. That way I might have a means of getting some of finances needed for any other hardware and software that wiill get me what I need to get the job done. It hard to think about return on investment when you don't have enough to invest in the first place. Wink

Thanks,

Mark
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mitodad
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Joined: 07 Dec 2002
Posts: 39
Location: NJ

PostPosted: Mon Jan 13, 2003 7:46 pm    Post subject: emrs Reply with quote

mark,

what's roi??? maybe that's why, after 4.5yrs of solo practice, not getting sufficient babies to grow the practice, i still can't get my head above water?? still waiting for first real paycheck!!!! My acer was the anti-depressant tablet that the physician ordered. Last anti-depressant was a first model year camaro in 1982 with t-top. had 4 transmission jobs in the first 5 months and in shop about every 3 weeks. (lemon law came out about 4 months after i bought it!!!!).

ken
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mitodad
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Joined: 07 Dec 2002
Posts: 39
Location: NJ

PostPosted: Fri Jan 17, 2003 10:34 pm    Post subject: emr's Reply with quote

oritinally posted by digital-doc under the Acer heading:
---------------
The Acer sounds like a fine machine. RAM peaks at 256, which bothers me with any XP OS.
Are you using Citrix because it obviates the lack of speed found in the native hardware?
Let me re-state that question. Have you tried running your chosen application without Citrix and if so is it too slow?

----------------------------------
going to copy this over to the emr topic to keep the acer topic clean for acer-related specific posts.

emr was developed to be a client app and not a stand-alone. as i'm not the developer of the system can't answer a lot of details, but simply put, as a complete emr that is networked, citrix was the only way to do it. app has been around since 1994 and if it was possible to do with plain windows nt-class os'es, it would have been done.

but again, let's try to keep this particular board limited to machine and not os/app-related issues.

ken
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sallen83
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Joined: 05 Jan 2003
Posts: 7
Location: Ohio

PostPosted: Sat Jan 18, 2003 6:30 am    Post subject: Reply with quote

[quote="Mark"]
Where can you find info on "Instant Family History" and is it similar to "Instant Medical History"?
[/quote]

Mark,

Sorry, I got confused. We are using "Instant Medical History" as well. I always get that name wrong.

Our physician advisory board recommended getting patient descriptions for the Subjective text if possible. Patients of our participating practices will be able to enter their symptoms via a web site or by using a kiosk pc in the office.

- Scott
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