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Clinical Summary |
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When you first see a patient, or when you start begin using ComChart, you
should be able to enter the date that a medication was started as "<" or
"prior to." Otherwise the initial note is deceptive, as if you started the
medicine on that day. |
Unfortunately, the date field will only accept dates in the format
1/23/1954. We recommend that you use the first day of the month or the first
day of the year to indicate an approximate date. If you are concerned about
the medico-legal issues, put a note in the patient's Progress notes
mentioning that the start date is an unknown date occurring before the
indicated date or a notation in the "comments" area alongside the entered
date.
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Many patients confuse allergy with side effect. I am entering Demerol
which caused vomiting. Do you leave this under allergy, with a comment
alongside the medicine name? |
Yes, we recommend that you use the comment area to specify the nature of
the drug allergy. |
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I tried to add a name to the associated clinicians list and couldn't. Can you
only add a name if it is in the physician addresses? |
Yes, you are correct. The purpose of the "associated clinicians" list is to
automate the communication process between you and other health care
providers. ComChart will be able to fax or print progress notes (along with
envelopes) only if the provider is listed in the Addresses file.
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When you are seeing an initial patient and want to put past things on the
old problem list, how do you enter a date that it will accept? |
All dates in ComChart must be in the format: 1/2/1987 or 12/31/1999. All
times in ComChart must be in the format: 3:05 PM or 15:05. These dates
can be manually entered by click in the respective fields.
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Can I print out just the problem list and medication list? |
Yes, go to the clinical summary and click on the underlined button
"problem list" or "medicine list." Alternatively, you could click on the
“print clinical summary” button and this will printout a 1-2-page summary
of all the patient’s information. |
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On clinical summary, under “old problems”, the current date gets entered
automatically under "to" column. What is this for?
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The "from" date on the “old problems” is the date when the item was
placed on the “current problem” list. The "to" date is the date the item was
placed on the “old problem” list. The user can manually change these dates. |
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General |
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Why, when you are typing the progress notes, does the TAB key get you
into another field? This is a quite tedious, as I am accustomed to using
TAB to start a new paragraph. |
In FileMaker Pro, the tab key moves your insertion point into a new field.
To insert a tab character into a field: Click where you want to insert the
tab, then press Ctrl-Tab (Windows) or Option-Tab (Mac OS). FileMaker
sets the default tabs at a fixed interval, however the user can change this as
per the FileMaker instructions. |
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In many places the column headings are underlined. What does this mean?
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When a column heading is underlined, it implies either
1) that the button has a second, less obvious function which can be
initiated by holding down the shift key when you click on the button or
2) you can sort the data by clicking on the underlined heading
For example, the lab results layout has three of the headings underlined: the
patient name, the test name, and the date of the test. The data can be sorted
chronologically by clicking on the date, it can be sorted by patient name by
clicking on the patient name heading, and it can be sorted by test name by
clicking on the test name heading.
In the clinical summary layout, the name “Medicine list” is underlined.
When you click on it, it will print the medicine list. Throughout ComChart,
you will also see the patient’s name, underlined. When you click on it, you
will be taken to the patient’s progress notes. If you hold down the shift key
when you click on the patient name, you will be taken to a progress note
layout that shows all the associated diagnosis. |
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How do I get ComChart to print my envelopes to one printer, prescriptions
to a second printer and other documents to a third printer? |
The underlying language of ComChart is FileMaker Pro 5. The selection of
your printer is controlled by your computer's operating system and cannot
be controlled by FileMaker Pro 5/ComChart. The solution is to use one
printer for all of your printing needs. ComChart can then be set to
automatically select an envelope (from the envelope tray) or plain paper, as
needed. This can be accomplished using most laser printers and with some
ink-jet printers. It will require that you have access to the scripting
language (which is only available to those who have purchased ComChart.)
There are also inexpensive commercial plug-ins that you can buy to work
with ComChart that will allow you to work with a second printer. |
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How do enter EKGs? |
Go to the patient's progress note, click on the "options" button and then the
"create graphics" button. Using a drawing or painting program, “copy” the
entire EKG then "paste" the graphical image of your EKG into the large
empty space in this newly created progress note. |
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Where do you put pathology reports, stress test, PFT results,
echocardiogram reports and imaging reports?? |
Currently, progress notes can be given a “classification” as either dietary,
email, graphics, in-coming letter, labs, referral, pathology, progress notes,
reports and stress tests. The user can modify this list at ComChart>
Administration> Lists> Pop-up lists. This data can only be changed using
the master password (password protection is disabled in the demo and
single user versions). Once you establish you own classification method,
your progress notes can be stored and examined by classification. For
example, you may ask ComChart to show you only all the patients
“pathology” reports or “Hospital discharge summaries.”
We recommend that the imaging reports be stored in the x-rays file. |
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My 14-inch monitor is too small to use with ComChart. How come I can
not see the entire screen on my 14-inch monitor? |
ComChart recommends you use a computer screen with a resolution
of at least 600 x 800 and preferrably 700 x 1000 (or greater.) |
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Prescriptions |
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Does ComChart check for drug interactions or cross-drug allergies? |
It is our belief that it is impossible for an EMR to maintain a truly accurate
and up-to-date list of all cross drug allergies and drug interactions, as new
medications are being brought to the market on a daily basis. Therefore, we
have decided not to add this feature, as it will likely become out-dated very
quickly.
We suggest that you purchase a separate program to check for drug
interactions. The Medical Letter Drug Interaction program is inexpensive,
cross platform, easy to use and it comes with regular up-dates. |
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Will ComChart warn me of a drug allergy? |
Yes, ComChart will look for an exact match between the prescribed
medication and the medications listed on the patient's allergy list. It will
warn you of a drug allergy only if it finds an exact match. For example, if
the patient’s allergy list contains "amoxicillin" and you prescribe
"ampicillin," ComChart will not notify you that the patient is allergic to
ampicillin. Similarly, if you list “sulfa’ on the allergy list and prescribe
Bacterium, it will not warn you. However, if you prescribe
sulfamethoxazole, it will warn you of a possible drug allergy as the word
“sulfa” appears within the word “sulfamethoxazole.” |
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Where do you list the pharmacy that a patient uses? |
In the demographics under "pharmacy" or in the prescriptions are under "pharmacy". |
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Where do you list the patient’s pharmacy? |
In the demographics under "pharmacy" or in the prescriptions under
"pharmacy." For this information to be useful, the pharmacy must first be
entered in the Addresses file. Ideally, you should include a phone number
so that you can fax prescriptions directly to the pharmacy. |
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Progress Notes |
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Can one write macros and text blocks that can be use as templates in the
progress notes? |
Yes, this is already built into ComChart. You can create progress
notes/consult notes using macros and prewritten progress notes (template
progress notes.) These can be added by clicking on the title of the template
progress note.
In addition, you can use macro programs (e.g. TypeIt4U on the Mac) to
automatically add text to your progress notes. |
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What should I do with letters, x-ray reports and consult notes that I receive
by mail? |
We recommend that you dictate a 2-3-sentence summary and place it into
your progress notes. Alternatively, you could scan in the letters using
optical character recognition or you can store the letters as scanned images.
This latter option has some problems because the data is not easily
searchable and will result in a very large database. For example, a 5,000
patient ComChart file, with no scanned letters is about 350 MB whereas the
same 5,000 patient file, in which all incoming letters are scanned is
estimated to be about 2,600 MB (2.6 GB). As a CD-ROM currently holds
only 650 MB, the latter option may be difficult to backup and slow the
operation of a database. As backing-up is essential, and should be done
frequently on a defined schedule (at least twice daily), it should be as easy
to do as is possible.
It is our experience that the 2-3 sentence summary option is the most cost
effective and easiest to implement. |
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When you are entering the data into the progress notes file (such as vital
signs), it is not obvious how to change the date of a progress note. It should
be difficult to change the date, but not impossible. Case in point, you see a
patient but do not enter the data until the following day. |
You can change the date of the progress note. When you are on the
progress note, click on the buttons options > Alter date, time classification.
Not all passwords will allow access to this layout. From here, you can
delete the note, change the date of the note or reassign the note to a new
classification. The original date that the note was created remains stored in
a second location, which can not be altered and is not easily accessible. |
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How do I update my problem list, medicine list, and allergy list without
retyping the data? |
ComChart can automatically add text to the problem list, medicine list and
allergy list and old problem list, so that you do not need to re-type the
information. When you are on the progress notes, highlight the desired text
and click the "+" button located to the right of the "problem list," "medicine
list" or "allergy list" buttons. This will put the highlighted information into
the respective list. If you hold down the shift key when you click on the
“+” problem list button, the data will be added to the old problem list.
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I have my patients complete a history form before the first office visit.
Could this be scanned in or must I keep a separate paper chart? |
ComChart can automatically add text to the problem list, medicine list and allergy list, so that you do not need to re-type the information. When you are on the progress notes, highlight the desired text and click the "+" button located to the right of the "problem list," "medicine list" or "allergy list" buttons. This will put the highlighted information into the respective list. |
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I have my patients complete a history form before the first office visit. Could this be scanned in or must I keep a separate paper chart? |
You could scan it and then paste it into one of the "graphics" progress
notes. However, you will probably find the scanning process time
consuming and it will markedly increase the size of your files. Thus, we do
not advise that you scan-in all of your documents. We recommend that you
modify the "ROS" options in the "List" file (ComChart > Administration >
Review of Systems) so that it closely mimics your history form. Once this
is done, the “comprehensive history ” form within ComChart will closely
mimic your paper form and the data could easily be entered into ComChart
by a nurse, NP or PA.
If you need a copy of the history form which is the basis of ComChart's
ROS, email a request by
If you need a copy of the history form which is the basis of ComChart's ROS, email a request to info@comchart |
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What do you do with inactive records of patients who have transferred or
died? |
We recommend that you remove the address and phone numbers from their
respective fields so you don’t accidentally call the patient about their next
appointment or send them a letter about a past due test. Also put a note in
the "contact comments" field and in the last progress note that the patient
has expired. There is no reason to remove their records from ComChart. |
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How to you print a complete record when a patient leaves/asks for a copy
of his/her record? |
To print the chart, first go to the patient's progress notes, then click on the
"print or fax" button. This will take you to the print/fax layout. On this
layout, you can choose which sections of the chart you want to print, e.g.,
clinical summary, flowsheet, labs, x-rays, (some/all of the) progress notes,
etc. When all options have been selected, click on the button “Copy for:
patient" then click the "Print" option. Finally click on the "start printing
process." ComChart maintains a record of all printed/faxed progress notes. |
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How should I handle the signed consent forms for vaccines? |
Although documents can be scanned into ComChart, this will eventually
increase your file size dramatically. We recommend that your save consent
forms and health care proxies in a file cabinet. |
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Where is the spell checker? |
Built into Filemaker is a spell checker. To access this, select “Edit” from
the menubar, then “spelling,” then “check record…” You can direct
Filemaker to access a medical dictionary by choosing the “select
dictionary” option. |
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I am doing something wrong with some of the template progress notes that
I have written? For some reason, when I use some of them, they
automatically start a new note, rather than getting added into an existing
note. |
If the date of the progress note you are working on is not "today's" date,
ComChart will automatically create a new record when you use a
"template" progress notes. If you want to change the date of this newly
created note, select “options>Alter date…” This feature is only accessible
with the master password.
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Is there a timer that can document face to face contact time? |
Yes, it is located in the lower left of the progress notes. Click on “timer” to
start the clock and “T.ON” to shut it off and record the elapsed time in the
progress note. |
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Can my Transcriptionist type notes directly into ComChart? |
Yes, if you give them password access.
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How do I change the "classification" of the progress notes? |
From within the progress notes, click “options” then “Alter date, time
and/or delete progress note.” On this new layout, you can reassign the
“classification” of the progress note. You may create as many
“classifications” as is desired. To do this, click ComChart >
Administration > Pop-up lists. This layout is only accessible with the
master password, Accurately classifying progress notes can be very helpful
when you are looking through the patient’s records for a particular piece of
information. |
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