The Vine: October 1, 2014
Okay, this may be too highly specific for The Vine, but Googling is totally failing me here.
I work as the coordinator for a clinical services department in a health center. I both see patients and also do the administrative stuff. One thing that I keep bumping up against in my clinical practice, and then is on me to solve from the administrative standpoint, is generating care plans for patients.
Currently what we have is, in our chart, two pages of possible actions for the patient to take based on a wide range of problems that they could have. We check off the ones we want them to do, and write additional notes to document the plan. Then we copy the plan documented in the chart to a separate piece of paper in a patient-friendly way. This is a lot of steps and takes a lot of time. Sometimes we end up photocopying the patient’s version of the plan to add to the documentation, which adds even more paper to the chart.
Anyone in health care out there is going, “Paper?? What about your electronic health record system?” We will transition to one sometime in the next year, but our department is small and what we do is not well covered by the EHR system our center is purchasing. For the foreseeable future, we will be continuing to chart on paper and scanning those in as PDFs to attach to the patient’s e-chart (yeah, I know).
Okay, that’s the background. So my question! In the absence of a helpful EHR system, I would like to find or create an e-something that would help us generate care plans for patients without this laborious process.
In my ideal world, you would start at a page where you see a whole list of problems with check boxes — for example, “wound infection.” When you check “wound infection,” it drops down with a whole list of suggested care for wound infection: use antibiotic ointment, wash with soap and water 2x/day, take oral antibiotics at this dosage, etc. You then check off the ones that you want the patient to do. If you check another problem like “regular exercise,” same thing — it drops down a whole list of suggestions (“walk 20 minutes 3x/day,” “use hand weights 10 min 2x/day”) and you can pick the ones you want. Even better would be the ability to modify these (so you could switch it to walking 10 minutes instead).
Then at the end you would click “finalize.” All the problems that you DIDN’T check would drop out, and would then print out in just the short checky-box version for our chart, and also a version in a pre-designed, patient-friendly way. “You have been diagnosed today with a wound infection. For this, we would like you to: clean the wound with soap and water 2 times a day. Use an antibiotic ointment on the wound 4 times a day,” e.g.
I am sure there are good EHR systems out there that do this. But I need a standalone version, either desktop or even better as an app for a tablet (preferably iPad). I also wonder if there’s a way I could learn to design something simple to do it for us — Microsoft Access maybe? I’m clueless about this part.
Again, even for the multitalented and vast hordes of Readers, this may be too specific an Ask. But if anyone has suggestions it would make a HUGE difference for us and to our patients!
Signed,
Another year of this and no one will be able to read my handwriting AT ALL
Tags: Ask The Readers rando workplace
This might be a long shot, but it’s possible that a survey created via an online survey software (like SurveyMonkey) could be reverse-engineered to do what you’re looking for. I’d have to fiddle around with it to see if or how it would work, but I think it’s possible.
A Google form might also be a possibility. I haven’t used that format extensively, but it might be worth considering.
Also, personally, I am of the mindset that if one had the time and energy to devote to designing it, Microsoft Excel could do basically anything, including something like this. But it probably wouldn’t be iPad-friendly, and IF it were to work, the front-end work creating the form would be extensive.
Good luck!
If you have Microsoft Access, I definitely think that could work. It’s been a while since I used it, but when I did, it was in a similar capacity, maintaining records for a university’s research protections office (which ensures that medical trials done through the university are in compliance with all legal/ethical/medical standards). My only other thought is maybe there’s a google doc for this kind of thing?
FileMaker Pro could definitely do something like what you’re talking about. I don’t know how difficult it would be from a programming standpoint–I would think making the dropdown checklists is a pretty straightforward database function. Customizing the resulting report so it only prints fields in which content had been entered might be slightly more challenging, but it’s a pretty amazing tool–and for someone who knows how to use it, very quick to add and adjust menus in fields once the setup is complete. (I am a user, not a programmer, but I am constantly amazed by how quickly our FMP guru is able to handle such requests.) There is definitely an iPad version (FileMaker Go, which I have not used–but I just discovered Apple actually owns FileMaker now, so I would imagine the interface works pretty well).
I was going to suggest Evernote, because it allows multiple people to sync to the same lists and the checkbox function is pretty easy. I just don’t think it’ll allow you to compile in the way you are talking about.
Coming from an EMR perspective though, the whole point of the hi-tech act was that all of this is supposed to get captured in the EMR. If you’re EMR is pretty basic, you might consider contacting other vendors that can beef up its capabilities so that this happens naturally. A requirement for the hi-tech act is a patient portal which would grant the patient access to certain parts of their records that they can update themselves that goes straight into their file. This would probably illeviate the problem you’re having. And it will help you be Meaningful Use compliant. Your EMR vendor should have one and if doesn’t, should point you in a direction of a vendor that does.
I use FileMaker a fair amount (Mac system in my office). You can customize to get pull-down menus, etc. And you should be able to run a specific report at the end, showing just the items that have been checked. No clue if there’s an iPad version; we use it solely on the desktops to share in the office.
This seems like a two-step deal to me, though. The first is inputting the relevant details and getting a specific report. Which you could set up ahead of time – you click one button to get the “wound care” report with the relevant instructions; another for “infection” or whatever if there’s discrete sets of information that go with each.
The patient-friendly version, though? I’m not sure FileMaker can manage that type of report without heavy customization, or someone setting this up ahead of time (with the ability to print it out in Word so that it can be edited as needed). I’d suggest putting together a Word doc template that’s customized for the specific needs (wound care, infection, etc) and then taking the report and either typing or writing it in.
I third the recommendation for FileMaker Pro. As people have said, putting in all the menu options you mentioned would be quite easy; customizing the printed report might take a little more fiddling. But overall, this project still doesn’t sound like a super advanced one. Anybody who knows the basics of building an FMP database could do it for you. Also, the Filemaker Go app is pretty great!
The thing about Google Forms and SurveyMonkey I think would be on the reporting end – they could definitely handle the options part, but especially for SurveyMonkey, I don’t think you could get to the reporting without multiple extra steps/hassle.
Good luck!
Check out Wufoo.com. It’s a form maker that does nearly everything you want, pretty much. You can set up rules to show and hide fields based on fields that came before, so the checkboxes can trigger other fields (or just blocks of text) to show. At the end, you click the submit button (which can be customized to say whatever you want it to), and it emails a summary of the form as filled out, which can be what you give to the patient (either via email or printed). Would probably require a paid account and would take some time to set up, but it’d work!
FileMaker Pro is definitely your best option. There are database designers who could build that for you if you couldn’t figure it out yourself but I basically taught myself FileMaker using their support materials and I am sure you could to. I built databases that did exactly what you are describing except for academic rather than health care purposes.
Are you a small clinical in a big health center (possibly university-based)? A good option for you would be REDCap (Research Electronic Data capture). Check out REDCap.org to see if your organization is a collaborator; if it is, you can use it for free, it’s easy to set up , and does a nice job. If that’s not available, try looking into Medidata Rave. Not free, but it has more bell and whistles than REDCap from what I understand.
If neither of those are an option for you, Access will work for what you’re describing. It’ll be a fair amount of up-front effort, but once you have it up and running it should meet your needs.
Survey Monkey will not meet your needs for this, and more importantly, won’t meet your HIPAA regs, so don’t even bother.
Finally, you could try downloading a free EHR and only set up/use the pieces that you want. Just be very careful about data storage arrangements if you go that route — Some EHRs call for off-site storage on their servers and that’s always made me cringe a bit. Again, check with your HIPAA person if you choose to go this route.
Good Luck! The work you put into this up front *will* be worth it in the long run.
I totally agree with Tyliag’s second paragraph. You might also ask management if they could hire another vendor to build something for you. That costs up front, but in the long run it saves money since it cuts down on staff data processing time and you don’t have to spend time learning to do it.
In an old job, I had a similar format need, but management refused to hire vendors to build it or to let me spend money on additional programs. I’ve had pretty good luck teaching myself to use MS Office by reading Microsoft’s online help and a decent how-to book (plus googling if I get stuck on something). You could definitely do this in Access. You could also create an Excel workbook with drop-down boxes and/or check boxes, and then mail-merge the selected info into a Word document so that you can add or modify info before printing.
Also, do you know how to use macros in your word processing program? That’s a quick and easy way to cut into your workload. For example, you could make a macro named ExerciseWalk that, when you hit it, inserts the text “Walk for X minutes X times per day” into your document. Then, you just have to change the Xs to match that patient’s info. It’s clunky but better than writing from scratch every time. Plus, check into free programs like PDF995; it lets you print from a document directly to PDF, which would save you the trouble of scanning printed copies.
OP here! Thanks so much for all the suggestions so far. In terms of what I could get out of the bigger health center admin, their budget is limited so it would possibly accommodate something like FileMaker Pro if I’m willing/able to do the work myself, but probably not hiring a vendor to do something custom. Same goes for a vendor to integrate this into the EMR. I agree with the people who are saying this should be part of our EMR! Suffice it to say, it should, but what we do is somewhat different from the rest of clinic; we’re kind of expected to make do with whatever bones the system tosses our way.
That’s an interesting thought re: downloading a free EMR – does anyone have suggestions for free systems that do this? REDCap we sadly do not have access to. I took a look at Wufoo.com – it made me wonder if Qualtrics would work (probably not?)
It sounds like I should take my first shot with Access though, which we already have. Any recs for how to teach yourself Access??
Long-time reader delurking to say this is exactly what my husband does for a living. Not sure if purely self-promotional comments are allowed, but the custom app he built for me a few years ago was so good, I married him! If there’s a modest budget, you could build a slick iPad interface that would do exactly what you want, meet requirements for data security, and would likely pay for itself in man-hours saved from time-sucking manual processes. Might be worth considering custom software, and if you’d be interested I’d be happy to put you in touch.
This would be a fantastic project for a college-level database course. I did something similar in my MS in Information Resources coursework. We had to find a real-world need for a database (which is what you need, regardless of what software you use) and then work with a client to build it.
I would try contacting IT or CompSci programs at local 2 and 4 year schools, copy and paste the description above, and see if anyone bites. It wouldn’t be THAT hard to do in Access but I don’t know if it’s quite “teach yourself” level — Access is kind of a step above the other Office products in difficulty.
Is it a problem that many of these suggestions involve turning over data to a third party (e.g., Google) with its own interests? Will the data that is entered be linked to patients in any way?
The tutorials on Microsoft’s site are actually pretty good for learning the basics. And even some advanced stuff, I’m sure. That’s how I got to be pretty decent with Excel.
From what I’ve seen about US health electronic systems you WILL HAVE TO SPEAK TO YOUR HIPAA PERSON about this. No ifs, no buts. If it involves saving patient information, then you’ll need to do it.
However, you will probably be fine if you use [magic program] to create the standard worksheets that you print out, as long as the [magic program] does not subsequently save these completed worksheets.
You could then scan the completed worksheets into your HIPAA approved system.
I bought “Access for Dummies” for a database subject in an MPH course. I found it quite useful in learning how Access worked and for creating databases with drop down menus. I think for what you’re looking at doing it should be straightforward enough to follow – probably see if you can borrow it from a library first though, just in case their instructional format doesn’t work for you. Also check which version of Access you have and make sure you get the right guide!
The Dummies books are good, but the hands-down best book (as in, I bought three copies and now have none because I lent them out and never got them back) was the MOUS Guide for Access. This was back on Access 95, though — I think they’re now calling the series “MOS”; it’s the prep guide for Microsoft Office Certification. My book took you through everything gently, step by step, and I whipped through it in a week and felt fully informed. If the new books are the same (and you can get them for a reasonable price on Amazon) that’s exactly what you’ll want.
Also, if you get fancy and start looking into adding VBA or doing things not in the book or getting bizarre error messages, the best Access forum (in my opinion, anyway) is utteraccess.com.
Excel is quite a bit simpler than Access and can definitely do what you need. The problem is tablet-friendliness – same with Access.
I have made a career out of cleaning up the messes made by folks who had a requirement to do their job and decided the only way it was going to get done was if they made a small/quick/simple form/spreadsheet/standalone app.
Please don’t make an app in Access or Excel or FileMaker. Especially if you have no experience designing such things. Trust me, even assuming that everything works out now, in a couple of years someone like me will be combing through dozens of files that do “something” (if not hundreds, depending how spreadsheet happy you get). No one will quite understand how it all works anymore, but they will need to spend thousands of dollars to sort it out. Sometimes they will do that in the form of employee labour because they can’t quite bear to fix it. So your coworkers will be cursing the guy who set up the “system” (and probably long since moved on)
Also, I’m Canadian so not familiar with all the US related health regulations but trust me when I say that there are definitely regulations around what you can save where. You might not even legally be allowed to create something where you enter care instructions on a third party survey, or without proper data storage.
The right solution is to talk to your vendor rep and find out what module you are missing that would do what you need. It might not be exactly what you are hoping for, but I don’t believe that you can’t enter the type of patient note you describe – that’s a pretty basic function (and I have evaluated dozens of these types of systems…) find out your price tag, assuming you have not misunderstood how you can use the system as implemented to do your job. Then make a business case for getting it implemented. But please don’t decide it’s going to be “cheaper” and somehow magically better if you as an admittedly non expert cobbles together a workaround solution, because I promise that never ends well.
Be VERY careful with stand alone homegrown products and anything involving the internet with PHI, and make sure that your privacy officer AND security officer are brought into the loop early in the process to guide you through the HIPAA quagmire that you are potentially creating. Any time PHI touches a computer system, the Security Rule comes into play. The Privacy Rule is already in play as soon as the patient becomes a patient.
MANY of the hosting companies do not know that they become HIPAA covered entities the second that PHI touches their systems. Others are inflexible in the language they will accept for a BAA, especially the larger companies.
I’m a privacy officer for a very large healthcare organization, and we will consider homegrown systems if the EMR doesn’t work for some reason, but the process can be very lengthy beyond the build to ensure that the privacy and security issues are handled. If you do hire someone to build it for you, invite the security people to every single meeting with that party so the security issues are addressed. If you’re not familiar with the security rule (or HIPAA in general) this is my favorite site to go to for the rule, since it’s broken down into sections: http://www.bricker.com/services/resource-details.aspx?resourceid=217