Patient Assessments templates in Clinical Notes (Physio)

  • 2
  • Question
  • Updated 4 years ago

Hello community, such a great idea! Anyway, I'm wondering whether anyone has been doing patient assessments in clinical notes using a questionnaire type template. We are finding that assessments can sometimes be very lengthy due to complexity and also can go off on tangents when the patient volunteers more information. Has anyone had success in building a template for this? or do your physio's a) just type in the info or b) do a hard copy and then have it scanned into either attachments or as a clinical note?

I was going to build one in excel and import it, however I was told that Smartsoft may be removing this ability to import excel documents so haven't pursued it. Any help would be great.

Cheers

Teresa

Photo of Teresa O'Donnell

Teresa O'Donnell

  • 40 Posts
  • 20 Reply Likes
  • hopeful

Posted 4 years ago

  • 2
Photo of Timothy

Timothy, Business Care Manager

  • 754 Posts
  • 220 Reply Likes
Hi Teresa. Thank you for being one of our early community users!

We're trying to move people away from the 'old style templates' which allowed for embedding OLE objects like an Excel spreadsheet. The main reason is these types of notes use technologies that are less efficient and may not be support by third party vendors in the future (Microsoft). The new style clinical note template types do allow for the adding of attachments that can be accessed directly from the clinical notes area, which may meet your needs.

This being said, we will not be actively decommissioning the old style clinical notes in Front Desk and they should keep working in the short to medium term. 

Perhaps some of your fellows users can offer their advice on how they best handle adding patient questionnaires into Front Desk.
Photo of Teresa O'Donnell

Teresa O'Donnell

  • 40 Posts
  • 20 Reply Likes

hi Timothy

Thanks for the reply, rest assured all of our standard letters and templates are in the new clinical notes templates format. However when wanting the ability to collapse or expand of a series of questions depending on their relevance, there is no clinical notes excel equivalent functionality..that I'm aware of

Cheers

Teresa

Photo of Kirsty

Kirsty

  • 49 Posts
  • 21 Reply Likes
Hi there. We have been using templates for clinical notes for many years. For Np we have a paper based copy which the patient fills out before seeing us. Then the treating physio Just adds the template and fills in the check boxes and text boxes. We also use templates for GP letters and treatment plans. We find that it works really well.
Photo of Teresa O'Donnell

Teresa O'Donnell

  • 40 Posts
  • 20 Reply Likes

hi Kirsty

Thanks for responding, I'm interested in how you combine the paper based copy with the electronic template the physio fills in, do you scan in the paper copy as an attachment, or add it into clinical notes?

We've got heaps of other clinical notes templates and fully use the quick buttons, but the Assessments I've built with tick boxes and drop downs the physios say is too long to go through, so they want to keep doing the assessment in paper

Thanks
Teresa


Photo of Kirsty

Kirsty

  • 49 Posts
  • 21 Reply Likes

hmm - yes - can be hard to convert existing practitioners. People dont like change. :) Surely it would be just a matter of the physios getting used to it?, rather than it being less time efficient? Sometimes , I personally find that typing in to text boxes can be quicker than using check boxes and drop downs, particularly with autotext and quick add. Personally, I would steer away from admin staff scanning and adding NP questionnaires as I feel that it is poor use of admin time and one of the beauties of e-notes is that they are easily readable, which you would lose. It would also limit the ability of the physio to start their consult if the paperwork has not been completed - ie if a New Patient is running late, or I am running early, I will grab them before they have finished their questionnaire ..... some of our physios were very keen to just scan the NP questionnaire, but I believe it is best if the CN entry is edited by the consulting physio as required - makes it easier to understand later - esp if another physio is doing the next treatment. Even the physios that were digging their toes in did get used to it in time. :)

Photo of david donkin

david donkin

  • 95 Posts
  • 33 Reply Likes
Hi Kirsty & Teresa - and any other user who is feeling generous,

We have looked a number of times over the years at using clinical notes and have some templates done which are similar in layout to our paper copies BUT what do you well hardware wise in the consultation  - are you using tablets, laptops or PCs, are you using touchpens are you getting handwritten notes converting to text and this is saved? In my mind I know what I thin k will work, but Smartsoft are still recommending use of a PC which in a physio setting to my mind is unworkable.

Your time in pointing out what works and some ptofalls to avoid is greatly appreciated.

Thank you in anticipation,
David 
Photo of Kirsty

Kirsty

  • 49 Posts
  • 21 Reply Likes
Hi David
You raise some interesting points and I am interested in hearing the thoughts of others.
My personal opinion is that for our situation, a monitor, keyboard and mouse are the way to go. We have a monitor, keyboard and mouse in each consulting room. Even our small rooms can fit a small desk with a monitor, keyboard and mouse - although a laptop would be fine....however, being an oldie, I find that I often even use my laptop with a keyboard and mouse if I have to do a lot of work as I find it faster and more ergonomic.
A note book or small laptop might be useful for Pilates, Gym, or hydro entries. Currently our gym and pilates notes are just done from a consulting room and hydro notes are separate and paper based so that they are done at the pool side.
I find that with auto text and templates for Clinical notes , that electronic notes are easy and efficient when using a keyboard and mouse.
We use a template with check boxes and text boxes for new condition assessments. I find this quick and efficient. We did have some practitioners that were initially quite resistant to the electronic templates for new conditions. We did have one practitioner that found electronic notes quite overwhelming and we installed Dragon Naturally speaking for her to use for her clinical notes entries. This was quite helpful for this practitioner, but it did take quite a bit of voice training. Admittedly, that was some time ago and I am sure that voice recognition programs are now more user friendly. - That practitioner no longer uses Dragon and types clinical notes.
I am not convinced that lots of drop down boxes and check boxes really make life that much more efficient with assessments . Often it is quicker to type, (even as a 2 finger typist like myself!!) - esp with autotext, than to use check boxes. my main reason for using checkboxes is that the patient fills out a paper based form of our new assessment template whilst they are waiting and the check boxes allow for ease for the clients and for easy translation from the paper based form to the electronic clinical notes. The check boxes also serve as a good prompt for our new graduates to ensure that they have covered all aspects of the subjective assessment.
I am currently considering using an electronic new assessment form that our more tech savvy patients can fill out. For portability, a tablet would be ideal, but I am concerned about how user friendly this would be. I am also considering whether we could have a laptop set-up in our reception area that the appropriate patients could use. My thoughts are that the plan would then be that upon completion by the patient, our reception staff would be able to add it to the patients clinical notes from the laptop or tablet, (WiFi), so that the assessing practitioner can then bring the client theu to the consulting room, ask further questions as required and modify wording etc within the clinical notes.....but I still have a lot more footwork to do with this one.
...... would be grateful for any suggestions or tips.
Not sure if this has helped to answer your query. We have been using electronic notes for at least 8 years. I love electronic notes - although in earlier years I was very sceptical!! I believe that for us, in our practise a keypad with legible notes is superior to touch pens and masses of drop down boxes.
Photo of Kirsty

Kirsty

  • 49 Posts
  • 21 Reply Likes
Hi David
You raise some interesting points and I am interested in hearing the thoughts of others.
My personal opinion is that for our situation, a monitor, keyboard and mouse are the way to go. We have a monitor, keyboard and mouse in each consulting room. Even our small rooms can fit a small desk with a monitor, keyboard and mouse - although a laptop would be fine....however, being an oldie, I find that I often even use my laptop with a keyboard and mouse if I have to do a lot of work as I find it faster and more ergonomic.
A note book or small laptop might be useful for Pilates, Gym, or hydro entries. Currently our gym and pilates notes are just done from a consulting room and hydro notes are separate and paper based so that they are done at the pool side.
I find that with auto text and templates for Clinical notes , that electronic notes are easy and efficient when using a keyboard and mouse.
We use a template with check boxes and text boxes for new condition assessments. I find this quick and efficient. We did have some practitioners that were initially quite resistant to the electronic templates for new conditions. We did have one practitioner that found electronic notes quite overwhelming and we installed Dragon Naturally speaking for her to use for her clinical notes entries. This was quite helpful for this practitioner, but it did take quite a bit of voice training. Admittedly, that was some time ago and I am sure that voice recognition programs are now more user friendly. - That practitioner no longer uses Dragon and types clinical notes.
I am not convinced that lots of drop down boxes and check boxes really make life that much more efficient with assessments . Often it is quicker to type, (even as a 2 finger typist like myself!!) - esp with autotext, than to use check boxes. my main reason for using checkboxes is that the patient fills out a paper based form of our new assessment template whilst they are waiting and the check boxes allow for ease for the clients and for easy translation from the paper based form to the electronic clinical notes. The check boxes also serve as a good prompt for our new graduates to ensure that they have covered all aspects of the subjective assessment.
I am currently considering using an electronic new assessment form that our more tech savvy patients can fill out. For portability, a tablet would be ideal, but I am concerned about how user friendly this would be. I am also considering whether we could have a laptop set-up in our reception area that the appropriate patients could use. My thoughts are that the plan would then be that upon completion by the patient, our reception staff would be able to add it to the patients clinical notes from the laptop or tablet, (WiFi), so that the assessing practitioner can then bring the client theu to the consulting room, ask further questions as required and modify wording etc within the clinical notes.....but I still have a lot more footwork to do with this one.
...... would be grateful for any suggestions or tips.
Not sure if this has helped to answer your query. We have been using electronic notes for at least 8 years. I love electronic notes - although in earlier years I was very sceptical!! I believe that for us, in our practise a keypad with legible notes is superior to touch pens and masses of drop down boxes.
Photo of david donkin

david donkin

  • 95 Posts
  • 33 Reply Likes
Hi Kirsty,

Thanks for taking the time to respond, much appreciated. 8 Years of electronic notes, I don't think I'll be much use in offering you advice, we have looked at them intermittently over the years and each time remained sceptical that the PC / laptop version was workable hence my being a 'little zealous' at questioning the tablet options. We have trialled Dragon, which has certainly improved - there is vastly less work on training the system to learn speech patterns now. My desire for the check boxes is similar thinking to your point about prompting the more junior staff to ensure the full history is garnered. I might do a couple of months of laptop and as couple of months on tablet and report back. I have templates from my past ventures into the electronic notes so some of the leg work is already done.
The new patient questionnaire being able to be loaded into clinical notes and then fleshed out by the practitioner is one I will look at too I think.
Thanks again for sharing,
Dave
Photo of Teresa O'Donnell

Teresa O'Donnell

  • 40 Posts
  • 20 Reply Likes

hi David

Our physio's are using desktops at the moment. When we set up our last practice in August we were going to go the tablet way and hope to have the physio's be more interactive as they're doing assessments. however at that time it appeared that Front Desk didn't have the tablet functionality and we chose not to go with another tablet software programme as the two databases didn't communicate with each other. So sadly our physio's are still doing a paper based assessment and then we're scanning it in.

So if Smartsoft read this thread as i'm sure they do, my wish list for clinical notes would be the following functionality:

ability to build Ax form into clinical notes that was fully expandable/collapsible

able to be used with a pen

chart that was less clunky that the pen could 'mark' in less rigid ways

some kind of handwriting recognition built in (happy to provide one we really liked and did it well)

at a stretch even voice recognition perhaps down the track

Sorry I've not been much help David

Photo of Timothy

Timothy, Business Care Manager

  • 754 Posts
  • 220 Reply Likes
Our general thinking is that clinical notes on a tablet device is not ideal though it is possible. The reason is that we are dealing with a smaller screen with no proper keyboard or pointing device. We see no problem using a tablet on a casual basis to access Front Desk, however it won’t be your go- to device if you have a choice. Tablets are excellent for consuming or viewing data, not so great for inputting data. 

The apps that run natively on many of these devices are generally simple function applications. I guess those flashy ads by companies like Apple (who do make excellent products) over promise what these devices can do and set an expectation that is not quite right when dealing with complex, demanding applications. We understand that we do have some competitors that promote that their applications work on tablet devices, but generally they are simple applications running in a web browser with very limited functionality. The most mature practice management industry in Australia is the GP market and we are unaware of tablet based clinical notes recording in the space that has any real traction. 

If you want to investigate accessing Front Desk on an Apple iPad, I would download and trial for free the Parallels Access product and see how this works for you.

Other tablet devices such as the Microsoft Surface Pro will allow you to install and run Front Desk directly on them, and provide you the option of attaching a keyboard, rather than using the onscreen keyboard. We have had mixed feedback from Front Desk users using the Surface Pro, some absolutely love the portability it affords and are happy with using Front Desk on the smaller screen, for others they find it cumbersome because of the tedious nature of inputting information. We cannot stress enough that you should trial the use of Front Desk on these devices prior to purchasing expensive new hardware for your practice.

My personal recommendation is to get a small light laptop, such as the new Apple Macbook and install Windows on it. Then you get the best hardware and the best business operating system in a great portable package.
(Edited)
Photo of Benjamin Muir

Benjamin Muir

  • 21 Posts
  • 1 Reply Like
I have a surface pro 3 and you can get a dock for it so that you can connect to a bigger monitor, full size keyboard and mouse. So potentially having the best of both worlds. I haven't taken the plunge with FD on it. I'll let others be guinea pigs...
Photo of david donkin

david donkin

  • 95 Posts
  • 33 Reply Likes
Hi Teresa,

Thanks for taking the time to answer, much appreciated. I will probably stick with paper files while ever the PC remains the input method of choice as that's not overly practical in physio setting - as you no doubt have found.

At least we know Timothy is reading this thread!

I would second each of the features Teresa has noted as desirable. Timothy, I would think these are becoming more necessity than desirable! The assertion that the GP market is the most mature practice management sector but not having a tablet solution product is indicative that a tablet solution in unworkable at this time I think is mis-placed . I would suggest that the lack of a product in this sector is more indicative of the workflow of a GP practice not calling for tablet functionality. The workflow of an allied health practice, however screams for it.

Not being tech savvy, I don't imagine that I will have the answers but the Medical Director model of splitting the software into 2 inter-related components - admin and clinical - might allow for the clinical component to be less demanding of computer power and therefore compatible with tablets. The other thing which occurs to me is that the tablet will have to connect to the server or computer via a remote desktop connection of some sort, hence the tablet having a high RAM is really all that is required as the back-end etc is happening back at the server (I may just have confirmed my lack of tech know-how).

That aside, thank you Teresa. Kirsty if you had any light to shed on how you have solved the dilemna over your practices that would be greatly appreciated. And thanks Timothy for your suggestions given the current constraints.
Photo of Josie Tropeano

Josie Tropeano, Product Manager

  • 64 Posts
  • 44 Reply Likes

Hi David

Tim's comments regarding the GP market was in regards to what is currently happening in demanding clinical notes environments that are mature and well funded. It is our opinion that it does have relevance, as no matter what your workflow you should have properly recorded and visible clinical notes. Several years ago we had lots of client feedback suggesting we needed to have clinical notes functionality described to us as "using the devices that waiters use to take orders in restaurants" on the newly available hand held PDA devices of the time. The problem was that recording proper clinical notes was more involved that picking a few items from several drop down lists used when ordering food in a restaurant.

Our short and medium term view is that clinical notes are best performed on a device that has a keyboard and pointing device.  If you want to take the device with you, we would then recommend a small light laptop as per Tim's comment. Casual use is fine using a tablet, again these devices are better for viewing data that for data input.

If you want to take you clinical notes in a more informal manner by just drawing and scribbling on a tablet surface, you may want to have a look at this Australia product from Enote File that I believe was developed by a physiotherapist.  Note that Smartsoft is not associated with this product and you need to make your own assessment to its suitability for your use.

http://enotefile.com/contact

(Edited)
Photo of Josie Tropeano

Josie Tropeano, Product Manager

  • 64 Posts
  • 44 Reply Likes
Funny, just corrected 10 typos in my last post written on my iPad.  Needed to go to my laptop (with keyboard and trackpad) as was too painful to do on my tablet :) 
Photo of david donkin

david donkin

  • 95 Posts
  • 33 Reply Likes
Josie,

Thanks for your input it is great to be able to see where the product is looking to head in the medium term. This forum provides a good opportunity for development ideas on your part but also different ways other practitioners are using the software that we as individual practices might implement.

Your point about properly recorded and visible notes is a good one, though I would suggest that any practice that has spent the money on your product is looking to run a professional practice in which the standard of notes is both compliant with professional standards and 'works' for the practice. Tim's point may well have been in "regards to what is currently happening in demanding clinical notes environments that are mature and well funded" but to suggest that the lack of a product even in this well funded environment is indicative of impossibility of it working is incorrect. I would suggest it is due to these well funded organisations noting that the workflow for a GP requires them sitting at their desk for 95% of the consult and hence them spending money developing a tablet based solution would be a ridiculous waste of resources. You, however, don't operate exclusively in this same space. From an Allied Health perspective the 'portability' offered by a tablet solution incorporating some or all of the suggestions that Teresa raised would be a blessing.

Your point about having more informal notes being scribbled on a surface and the use of enote to perform this is most appreciated, though this doesn't help my notes be integrated with frontdesk; why I am almost better just keeping my current "informal" non-integrated notes achieved by scribbling and drawing on the surface I do currently - paper!

On a more serious note, Tim has acknowledged that competitor products offering far less robust function than Frontdesk purport to offer tablet solutions ( I haven't tried them so don't know whether they provide it well or not). Is offering some of these features in a future release a possibility, with the practitioner choosing Pc / Laptop / tablet at the sign in screen. By choosing tablet the practitioner acknowledges that not all of frontdesk's features are available?
Photo of Tony Taddeo

Tony Taddeo, Managing Director

  • 76 Posts
  • 33 Reply Likes
Hi David

Tim's comment about other offerings on tablets was not about robustness but limited functionality running in a web browser. "Limited" to the point that it does not meet our minimum criteria for "properly recorded and visible clinical notes" as per Josie's comment.

We are looking at making some enhancements to make it work better on a tablet device, such as the programmable touch quick buttons in clinical notes that have been added recently.

Our short and medium term view is that clinical notes are best performed on a device that has a keyboard and pointing device.  If you want to take the device with you, we would then recommend a small light laptop as per Tim's comment. Something like the new Apple Macbook with Windows installed on it would work well.

Seems like your need to operate while not at your desk or on a surface you can use a small laptop on may be greater than putting up with some functionality limitations. If you have an IPad, you can always investigate accessing Front Desk on it, quite easily and for free by downloading a trial for the Parallels Access product and see how this works for you. It's certainly usable.
Photo of david donkin

david donkin

  • 95 Posts
  • 33 Reply Likes
Thanks Tony