Medinotes

Richard Hom

ODwire.org Supporting Member
Mar 19, 2003
11,322
392
83
School/Org
UC Berkeley School of Optometry
City
San Mateo
State
CA
I think one of the most troubling and nagging duties of a clinician is charting and it doesn't seem to be getting any less important in the near future. From both a medico-legal and efficiency standpoint, creating electronic medical records ("EMR") is something that may lessen the pain of retrieval and analysis of patient data. EMR, of course is distinctly different from practice management software (PMS). EMR's focus on the examination data and PMS software usually involves the order processing, billing, etc. of the patient.

Medinotes, a 7-year Iowa firm, may answer this "necessary evil" in an efficient, yet elegant way. Its product, Charting Plus is HIPAA compliant and has just under 200 optometry and ophthalmology sites with some sites supporting multiple doctors or clinicians. Charting Plus' strength may lie in its broad appeal and use amongst medical professionals of other specialties. Up to 1800 sites now use Charting Plus in one form or another. This broad base of users may insulate Medinotes from depending upon a single market for its survival.


With a client server architecture, Charting Plus is well suited to a centralized model whereby data is stored in a centralized location within one or more computer servers (hereafter called "server") and networked client workstations attached via a local area network (LAN). In such a model, the Medinotes program resides in a networked workstations and saves its data to the central server. In some instances, clinicians may use Charting Plus' synchronization feature to make a copy of the server data for off-site use. A clinician can, therefore, travel to another office with all of th eir patient records, make necessary additions or edits to the data. Synchronization can then occur to ensure that all data whereever it may be is current. This is ideal for satellite offices, on-call rotations and finishing up charting at home.


Charting Plus works effortlessly on most modern computers. A minimum configuration for a "client workstation" could consist of a processor of at least 1 GigaHertz; 256 Megabytes of main memory (RAM), hard drive of at least 10 Gigabytes in size, a video card capable of 1 megapixel, and a Fast Ethernet (100 megabits/sec) network interface card (NIC). The server can likewise be modest where most of the investment should be devoted to storage and redundancy. The server should, therefore, have larger hard disk drives and a duplication of important components to prevent breakdown such as hard drives and power supplies. Currently, the client workstations must use some version of Windows but the database or computer server can either be Windows- or Linux-based.


Of course fast computer equipment don't necessarily make you "chart" faster. What Medinotes capitalizes is what I call report by exception. As clinicians, we may look at a lot of eyes and note those phenomena or structures which are unusual. In this way, the clinician can almost go through a whole examination without stopping to write down each bit of data everytime but can do so at the end.


Rather than being a forms-based product, Charting Plus is a narrative-based. The screen presents either as a list of headings or as a narration (like a letter or a report) in which the user has prepared a default style and can change each aspect of the record by right clicking a heading or word for customization or for uniqueness to the patient. Medinotes call its the words or headings on the screen "templates". It is these templates that undergo customization by each user when they first buy Charting Plus and as they continually use it.


In use, the clinician may see the "object": "...the anterior chamber is deep and quiet without cells or flare in either eye..." but may right click on the word "eye" and can modify the object to say: "the anterior chamber is deep and quiet in the right eye and deep and mildly inflamed in the left eye with +1 flare."


Other clinicians have discovered short cuts that group chief complaints by location. Or they can customize the pre-defined templates for such conditions as glaucoma, conjunctiviitis, foreign body, etc. For example, other EMR's may have a drop down list that ranks the choices in an alphabetical order and the clinician would have to go through the whole list to find a particular complaint. With Charting Plus, the chief complaint can be grouped by location. If there is a corneal problem, you would only see the relevant corneal complaints such as " the right cornea has foreign body sensation".


Charting isn't quite complete without proper coding. Here, Charting Plus provides a "wizard" that tracks the number of completed elements in each of the following areas: history, examination and decision making. At the end of the chart, a popup box will suggest a CPT code that is relevant for the diagnosis code.


Charting Plus comes complete with a license of the client software and the database server portion (Sybase's Adaptive Anywhere database) under a single price. For most private optometric practices, this package is sufficient with the license cost of the client software varying with the number of users. For much larger number of users (over 50), the backend database server must also be upgraded.


Satisfied users like Al Bundy, OD and John Scibal, OD, both of North Carolina, have each found lots to rave about Charting Plus. Dr. Bandy gives high praise to its flexibility while Dr. Scibal likes its ability to generate referral reports almost immediately after a visit. Both feel that Medinote' installation procedure and their customer support are amongst the best in the industry.


Charting Plus is a step in the right direction in following the workflow and thinking process of most clinicians. With more familiarization and use of the product, the clinician will be rewarded with a true companion in charting.
 
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