Monday, May 15, 2006

Flow sheets and lab requisitions

We had a "booster" session at the company last Friday, where we could go over things and ask questions. I wasn't sure how to start my flow sheets, and found out how. It's always a problem setting up new things, but once it is done it becomes routine.

I now have a flow sheet for my INRs; the lab test automatically goes into the sheet, and I have a blank area to enter dosage changes and timing to repeat the blood test. This is accessible both from the clinical area and from the demographic area so my staff can see it. I was keeping paper INR flow sheets on the back of the charts, and some of my colleagues use binders where they keep all INR flow sheets for easy reference. This electronic version replaces both; once we have VPN established, I'll be able to do it remotely.

I have been sending electronic messages about labs to my staff; for example, if a blood sugar comes back slightly abnormal (between 6 and 7--a pretty common occurrence), I'll notify my staff. There is a button on the lab report that I use, and they may get a message such as "fasting sugar 6.3, pls let pt know. N is <6,>7. Repeat FBS; req left at front". The electronic INR flow sheet now makes it possible for me to do the same for coumadin dosage. I have 15 patients on coumadin. All of them now have an electronic flow sheet, with the last coumadin dosage entered in. Thyroid dosage is managed electronically as well; if the TSH is our of range, I send a note from the lab result, and I print a synthroid prescription at the front to fax to pharmacy or mail to the patient (along with a lab req for repeat TSH).

I also made up a diabetes flow sheet, with all the required lab tests, vitals (weight, BMI, waist circumference, Blood pressure), and areas to fill in for eye tests, flu vaccines and foot tests. Most of the information (lab, vitals) gets entered automatically from the chart, so I don't have to do duplicate entries anymore.

I did my first electronic pap smear requisition today. Maybe I should send that to the front printer as well, since it is handled at the front.

I sign prescriptions and lab requisitions on the Tablet screen. That allows me to send them to any office printer. Today we had our first "signature" complaint from a pharmacy: they told us that they would not accept an electronic signature. This was not for a narcotic (it was for synthroid and blood pressure meds). We asked them to fax it over, I signed it in pen below my electronic signature and faxed it back; the two signatures are not distinguishable. This must stem for a College policy, and really does not make sense to me. It is probably time for a policy update.



Jean-François Rancourt said...

Cannot send fax with electronic signature is really bad. American physician send prescription by fax 90% of time. If you have a good relashionship with your pharmacist they can take your fax in a verbal prescription. The provincial policy accept it !

The 83 law in Québec, vote in nov 2005, will permit electronic prescription in 2007 when Consentment register, client register and physician will be create...A lot of work to do before... with Infoway $$$

Michelle Greiver said...

Yes, you are right. There is certainly a lot of variability in terms of what pharmacists will accept. They are probably just as confused as we are.

I've started signing narcotic prescriptions in blue pen below my electronic signature. I figure that those are the ones that are most likely to give pharmacist trouble. The rest continue to be signed on my tablet.

Anonymous said...

my office is planning to implement this program soon. Is there anyway to share templates or flowsheets so as to not reinvent the wheel

Michelle Greiver said...

There are many pre-set templates in the "master templates" list, programmed by Dr. Scot Mountain. I share the templates I've made with the physicians in my group via the "enterprise templates" list. I don't think there is any way for me to share those with others; however, I can see that if everyone's templates went to the "master templates" list, it would soon get too bloated to be useful. I don't know if there is any way around that.

It looks like I can't share my flowsheets. That might be a useful thing to do; I'll ask to see if it can be made as an enhancement. Maybe what I'll do is scan a diabetic flow sheet and upload it so you can see what it looks like.