Lost histories

We have noticed a problem that is becoming a bit annoying. Once the invoice is completed and the receptionist is checking it out, if there is a purchase of an item that is listed as a medication (eg worm tablet or flea control) then this will get inserted into the hx (which is what we want. But if the vet has gone back into the hx to write up the case whilst the receptionist is checking out, then the hx will be lost. Is there any way a prompt message can come up or there is a security block on editing hx if someone else is in it, or some other solution? I get around it by hitting Apply every so often, but the associates are getting tetchy!!!!

Amanda

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Re: Lost histories

Hi Amanda,

Might be good to explain what is happening here for other people so they can circumvent issue and also have some information so we can discuss how best to resolve.

When doing a checkout if additional medications are sold during the checkout process the medications are billed but also medication entries are entered into the current visit. This effectively changes the visit record as it adds links between the visit and the new medication entries.

If while checking out another user starts editing the same visit by adding notes etc and then tries to save after the checkout process has saved the medications then the system detects that the visit has been changed by another user and tells the user and exits the edit without saving. Hence the loss of information that was edited by the vet at the time (no other history is lost).

Hitting the Apply button circumvents this as it saves the edited histories as you go but still may error if the Apply happens post the checkout process.

The issue is OpenVPMS does not detect that someone "may" edit the visit at the same time and uses an "optimistic" locking approach. I.e. I will not lock everyone out of doing something on this record on the basis that someone "may" edit it but rather handle this when it goes to save.

This allows greater flexibility in many cases i.e. you can edit a history while the customer is being checked out which is a common requirement that is often not allowed in many packages. The issue is the "handling" part needs some work to make it cater for this and other scenario.

One option is to capture this error and then tell the user that the record has been modified by another user and give them an option to Merge the changes. It may even show the changes that have occurred as it may have been that both users have edited the same notes and a merged result may not make much sense. In this case it could allow the user to pick one or the other version. There are probably lots of other options we can discuss ...

Also how many people are experiencing this issue and how often ?

Cheers Tony

On 22/05/09 1:45 PM, "Amanda Hulands-Nave" :

> We have noticed a problem that is becoming a bit annoying. Once the invoice is > completed and the receptionist is checking it out, if there is a purchase of > an item that is listed as a medication (eg worm tablet or flea control) then > this will get inserted into the hx (which is what we want. But if the vet has > gone back into the hx to write up the case whilst the receptionist is checking > out, then the hx will be lost. Is there any way a prompt message can come up > or there is a security block on editing hx if someone else is in it, or some > other solution? I get around it by hitting Apply every so often, but the > associates are getting tetchy!!!! > > Amanda > _______________________________________________ > OpenVPMS User Mailing List > users@lists.openvpms.org > To unsubscribe or change your subscription visit: > http://lists.openvpms.org/listinfo/users > Posts from this mailing list can be viewed online and replied to in the > OpenVPMS User's forum- http://tinyurl.com/openvfu

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Histories which don't get saved during checkout.

Hi everyone,

I would like to bring this topic up again as I am having major issues with it. I have found that in order for me to enter my histories accurately I need to do them as soon as I finish the consult. ie. while they are being checked out.

Unfortunately with openvpms this creates major issues for me because of the previously posted problem above. I have now had to modify my approach and record the history later as I found I was wasting too much time entering histories only to lose them. But this isn't really working very well for me.

I don't know what the solution is, but I really need to be able to enter a history while a patient is being checked out. Did you end up finding a way around it Amanda?

Matt Y.

Lost histories

Hi Matt,

Can you confirm that thsi only happens when reception add other medications or notes during checkout ?

I think we have offered a solution.  i.e.  prompt to Merge

Lets get it on the development list and JIRA'd and funded and we can get it developed for version 1.5.

Cheers

Tony

Lost histories

Thanks Tony and Matt C,

I can confirm that this definitely only occurs when reception adds medications which add a medical record entry or when reception edits the visit notes. I have been trying unsuccessfully all day to reproduce it by any other means and I think I have covered all options.

Prompting to merge sounds great to me.

Matt Y.

Lost histories development project created

Hi guys,

The following development project has been created. 

www.openvpms.org/project/merging-medical-records-when-another-user-changes-visit-being-edited

Speak up if the merge option doesn't suit your practice.

 

PS. Would suit our practice fine if the "Merge", "Keep original" options are keyboard shortcutted.

Cheers,

Matt C

 

 

Lost histories

There's a couple of approaches we can take to this:

 

1. Prevent editing of the same history by 2 different users

If a user attempts to edit the same history already being edited by someone else, a dialog would be displayed stating that its already being edited.

The dialog would prompt the user to wait until the history is no longer being edited, or to cancel. 

 

2. Discard and reload

Here, the user's changes would be discarded and the history reloaded for editing.

This avoids aborting the workflow.

 

3. Manual merging

 

Here,  the saved and edited history would be displayed side by side so that the user can manually update the saved history with their changes.

 

4. Assisted merging

 

The saved and edited history would be displayed side by side, with differences between the 2 histories highlighted.

Where there is a conflict, the user can select which change should be applied to the saved history.

 

Of these, 2 is easiest to implement, followed by 3, 1, and 4.

Lost histories

I don't exactly understand how option 2 is different from what is already happening.

Looking at the list I think that option 1, then 3, would suit us best. With option 3, would there be the option to "copy and paste" some of the text to perhaps facilitate a true merging of the file??

Lost histories

Hi,

I think with option 2 the history that is rejected is reloaded into an editor so you can try to save when the other user is finished. (rather then losing the whole lot).

 

Tim can probably clarify.

Matt C

Lost histories

Actually no. You'd lose all your changes, but the instead of aborting the workflow, you'd get the option to re-edit and continue.

In hindsight, may not be that useful.

 

Merging locked history options

I think option 3 would work best in our hands. I would see us using copy and paste.

 

Matt C

Lost histories

Quite often this is not arising because of the same note being edited but because an extra item (such as a medication, an extra note field or investigation) has been added to the patient's medical record.

With that in mind I think that option 4 would be best as the difference between the 2 visits could be difficult to locate manually.

If the correct changes were on both sides, would it be possible to select parts of each? Not sure if that makes sense, but for example, if 1 user is editing a patient note and the second adds a medication:

on the left hand side would be the medical record with the new patient notes highlighted with corresponding older notes on the right also highlighted.

On the right hand side would be the new medication highlighted with no medication listed on the left as it was not there when the first user was editing the note.

So now it may be appropriate to select the patient note on the left and the medication on the right. Would this be possible?

Matt Y.

Lost histories

Option 4 would give you the ability to selectively apply your edits to the saved history, as well as edit the saved history directly.

Assuming that the left hand side represents the saved history, and the right hand side the edited history, you would be able to:

  • see differences between the two versions highlighted
  • apply a change from the right hand side to the left
  • ignore a change on the right hand side
  • make additional changes to the left hand side

In your example, assume that user 1 saves the history first, with a new note. When user 2 goes to save, they will get an error, and be prompted to merge their changes.

The saved version will be displayed on the left hand side, with the note user 1 added. User 2 then has the option of adding their medication to it.

 

Lost histories

Definite vote for option 4 for me.

Lost histories

We've had this happen a few times too, but in a different scenario: in particular, with hospitalised patients.  On busy days I often don't get my histories and diagnostic findings written till the end of the day, if I sit down in the office to write them, and one of my nurses is writing up an evening hospital update or phone call to the owner if is often very frustrating to suddenly find out that my information is lost!  Usually the nurses notes are shorter than mine, and it seems to be that who ever gets their data saved first "wins"!

A merge option would be great!

 

Kimberley

Merging histories

Hi guys,

In the style of the Brownlow count, we currently have;

Option 1 - One vote

Option 2 - No votes (And Tim doesn't like it anymore)

Option 3 - One & Half votes

Option 4 - One vote

 

Matt C

 

Development Update: Merging histories

So,

With the options listed here by Tim we have the current breakdown.

Option 1 - One vote

Option 2 - No votes (And Tim doesn't like it anymore)

Option 3 - One & Half votes

Option 4 - One vote

 

I'll give it another week and then we will put option 3 to the developers for costing. Speak now or forever hold your peace!

 

Matt C

Lost Histories

Version 1 for me on the KISS principal.

 

Nick

Lost histories

Hi Guys,

I was thinking about this issue yesterday and after some discussion with Tim to see whether my ideas where valid I think have a different solution to this issue which may simplify the development and at the same time make the whole history editing functionality a bit more friendly.

Currently when you edit a visit in Patient Medical Records or in workflow the visit editor appears and when you click Ok the whole visit is saved.  As people may be adding medications to the visit indirectly through invoicing at the same time this is what causes the majority of the locking issues.  In reality though when a clinician is editing the visit he is really only modifying a specific note entry in the visit, not the whole visit and the problem would not manifest itself if only the note was saved rather than the whole visit. Even if he modified other existing items as well these could be saved individually rather than en-masse as part of the whole visit. 

The other issue I found was the editing of information on the Patient Medical records workspace was actually not that intuitive.  I think this has been discussed before on the forums.  Firstly you have to click on an entry in the visit you want to edit and then when you click edit the whole visit appears and you then have to select the item you want to edit or add a new entry etc.  You then save the visit as a whole.   The other issue I know is the list of items in the visit edit screen just displays Name (i.e Note) and description (usually blank) which is not very helpful if you multiple notes in a visit and want to find the one to edit etc.  Overall needs improvement.

Based on this I thought we could actually make a change to the way visits and visit details are edited to circumvent the issue rather than go into the more complicated merging option and at the same time make the editing more intuitive.  Heres my suggestion.

  1. Direct editing of individual visit entries.  In the Medical Records workspace allow users to double click a medical record entry to edit it.  A dialogue will appear for that entry alone and when saved only that entry is saved and we have no issues with visit locking. To edit the actual visit details double click on the line with the visit and do the same.  Obviosuly if you do this you may get a lock situation but less likely as only usually done to change clinician or status and is a quick edit so less chance of contention with someone else.  Also much less to loose if you do get a lock situation not like loosing all your notes .
  2. Workflow Visit Editing.  The visit edit approach works well for workflow as it needs a visit edit dialogue to work its way through the check-in and consult process.  We could maintain the current visit editing approach here but change the save process so if only changes are made to visit entries only the entries are saved not the visit and therefore get over the majority of locking issues.   My other thought was to change the visit edit dialogue to display the summary instead of the table of visit entries and provide the same double click editing option as above.  The summary woudl be displayed just like the summary tab in the current visit dialogue.  We could make it so the filetr is set to only include the current visit and allow user sto remove the filter so they can see all clinical records, filter by type etc.  Essentially a merge of the current two tabs and changing it so editing is much simpler. 

What does everyone think about this alternative approach.

Cheers

Tony

P.S.  We believe this will be a significnatly easier development task so from a cost perspective would be preferrable.

Lost histories

Hi Tony,

This sounds like a much better approach all round to me.

Regarding workflow visit editing I think keeping it consistent by merging the current tabs so that it is displayed as a summary view would make things much better. This is generally where I find myself having to sieve through multiple notes to find the one I want.

Were you thinking of the editing being in place (ie. in the summary) or as a pop-up for just that entry?

Matt Y.

Lost histories

Hi Matt,

Simplest for developers would be pop up I think but will defer to Tim who would have better undertanding of in place editing approach.

Cheers

Tony

Re: Lost histories

Hi guys, I like the idea of in place editing (allows seeing other history at the same time), but if pop up is easier, I think this approach represents such an improvement I reckon it would still be awesome.

Matt C

On Fri, 12 Mar 2010 02:36:35 +0000 (UTC), tony@openvpms.org wrote:

> Hi Matt, > Simplest for developers would be pop up I think but will defer to Tim who

> would have better undertanding of in place editing approach. > Cheers > Tony > _______________________________________________ > OpenVPMS User Mailing List > users@lists.openvpms.org > To unsubscribe or change your subscription visit: > http://lists.openvpms.org/listinfo/users > Posts from this mailing list can be viewed online and replied to in the > OpenVPMS User's forum- http://tinyurl.com/openvfu >

_______________________________________________ OpenVPMS User Mailing List users@lists.openvpms.org To unsubscribe or change your subscription visit: http://lists.openvpms.org/listinfo/users Posts from this mailing list can be viewed online and replied to in the OpenVPMS User's forum- http://tinyurl.com/openvfu

Re: Lost histories

The pop up is easier as all of the code exists to do this already.

In place editing would be a nice feature to have, but requires new development work.

 

-Tim

New medical record editing

Hi Tony,

In my opionion this is great. The visit editor has never been my favourite screen. I avoid it to be quite honest. It is also interesting that intuitively, new users will try and edit from the summary view.

I think a simple summary view that allows you to edit any item (Note, medication, attachment) is a brilliant idea. It has been raised in the forums previously for a different issue.

I think the consulting workflow should utilise the same interface. I often want to edit another visit during a consult, or clean up a medical record during a consultation workflow. Currently this involves ending the consult and entering via the Patient directly. In fact I often avoid the consulting workflow for this reason and manually change my schedule statuses.

 

My only additional requirement is that whilst editing the medical record in question, the summary should still be viewable. I have attached a very crude mockup.

Matt C

 

AttachmentSize
sshot editor1.jpg 74.79 KB

"New medical record editing " Project going to developers

Hey everyone,

This project which set out a new way to edit our medical records and simultaneously deal with the medical records locking issue, is going to the developers for costing (//openvpms.atlassian.net/browse/OVPMS-944">jira.openvpms.org/jira/browse/OVPMS-944).

Remind yourself of the discussion by jumping into the forum topic.

 

Cheers,

Matt C

 

Lost histories

YAY!!!!

 

Amanda Hulands-Nave Bellarine Veterinary Practice

Amanda Hulands-Nave

Bellarine Veterinary Practice

"New medical record editing" Project seeking funding

Hi everyone,

The project (www.openvpms.org/project/merging-medical-records-when-another-user-changes-visit-being-edited) has been costed ($660) and is ready for donations.

 

Just a reminder, no user active project gets the greenlight until fully funded. Act NOW if you want this in Version 1.5!

 

Cheers,

Matt C

Funding Update (Merging Medical Records)

A user has donated to the project!

Thanks for the support.

 

Remember all development must have 100% funding prior to developing commencing and only people who pledged will have the option to test the modifications prior to version release.

Funding Update (Merging Medical Records) 100%

This project has been fully funded and has been passed to the developers for work. It will hopefully be part of the 1.5 release.

Thanks very much to those who have contributed to this feature!

 

Matt C

Development Update (Merging Medical Records) More $ needed...

Hi everyone,

The  main work for this project is now complete.The improvements to the method of visit editing are very exciting. The developers tried mutliple different tweaks before settling on the current solution.

There is some left over work to do. Make sure you keep reading after this description :)

 

I have included this abbreviated description of the current solution

.

1. Direct editing of individual visit entries.

In the Medical Records workspace users can now double click a medical record entry to edit it. A dialogue will appear for that entry alone and when saved only that entry is saved.

We have no issues with visit locking.

To edit the actual visit details, the user double clicks on the line with the visit.It is possible that the user  may get a lock situation but it is less likely as this is usually only done to change clinician or status. This is a quick edit, so there is much less chance of clashing with someone else. Also there is much less to lose if you do get a lock compared with losing lengthy notes .

2. Workflow Visit Editing.

The Visit edit dialogue has been changed to display the summary instead of the table of visit entries. The same double click editing option exists as above.

 

OK, the work that is left over relates to how New visits are created. With the new  method of editing, the developers had to come up with a simple & intuitive way of adding new items. The solution will work as follows:

  1. If a visit is selected, clicking New brings up a "Select the type of Medical Record to create" dialog with the following options:
    • Visit
    • Note
    • Problem
    • Weight etc
  2. If no visit is selected, clicking New creates a new Visit and edits it as is the case now
  3. If a Note, Problem, or Weight etc was created, this would automatically be linked to the visit on save.

This final detail needs to be funded. We need to raise $580 for this final feature. We can't release the rest of the development without this.
Overall this improvement in editing is really significant and deals with the Lost History issue which is such a pain.

 

50% of this requirement has already been donated. We just need another $290. Everyone really wants this for 1.5 but we MUST get this $290 to get this feature.

 

Thanks for reading,

Matt C

Development Update (Merging Medical Records) More $ needed...

This addendum to this critical new feature for 1.5 now has it's own JIRA here

jira.openvpms.org/jira/browse/OVPMS-973

 

A reminder that $290 is needed for the funded development already done to be able to be released in 1.5!

 

Matt C

Development Update (Merging Medical Records) Fully funded!

Hi everyone,

We just got the remaining 50% funding required to finish this very critical 1.5 upgrade.

My sincere thanks to all those who contributed to this very important final step.

Ta,

Matt Costa

 

Lost histories

Hi all,

 

Haven't been on here in a while and this item is of particular interest to us. Will the solution above stop the issue of losing patient if 2 staff members try to add information to a single note at the same time? We frequently have vets who will lose their patient notes when another staff member (usually a nurse or reception staff) accesses the same note ie to add details of medication given or to record a follow up visit has been booked etc.

 

Not directly associated, but how do other practices manage the patient records for hospitalised patients? Currently we try to have a single Visit per hospital stay and a new Note is added for each day in hospital to record patient details, medications etc. Our problem with losing information comes about most often when a vet is making notes in the record, and another staff member goes into the same note in another part of the hospital to record medications given, weights etc. If there is a better way of doing things that would circumvent this problem I'd love to know!

 

I certainly like the idea of the summary screen editing and think this will make our lives much easier!

 

Kimberley

 

Lost histories

Hi Kimberley.

This solution will not solve this issue as the same record note is being edited.  This solution solves the situation where new entries (notes, medciations etc) are added to the visit while someone is trying to edit a visit entry through the current visit editor. 

In OpenVPMS you can have as many separate note entries as you like attached to the same visit.  It was designed this way to allow each note to be tagged with a different date and vet keeping a chronological and clinician based record of the medical records added.  It is not necessary to add separate visits.   It would seem that you are use a single note for each visit containing all the medical record notes. I suggest you add a new note entry for each day or even for each addition to the medcial records.  With the new editor in place I believe this will circumvent the majority of your issues.

Cheers

Tony

Lost histories

Hi Tony,

< It would seem that you are use a single note for each visit containing all the medical record notes. I suggest you add a new note entry for each day or even for each addition to the medcial records.>

We are definately using multiple notes under a single visit already. However, multiple different entries by various people may be made to the note on a particular day and this is where the trouble arises. 

 

The main issue is that we don't get any warning before the file is lost - just a message that the visit hasn't been saved - and no way to retrieve the information. A pop up window  that gives a warning and/or an option for you to copy and paste/save would be helpful.

 

Anyway, still looking forward to the new editing improvements, but may need to address this further down the track.

 

Kimberley

 

 

Re: New or updated comment for General User's Discussion Forum t

Hi Kimberely,
We also occasionally have that problem. How I get around the problem
is to always copy the text before closing the note. This seems a long
way around however with the hot keys it is just as quick as using the
mouse. Ctrl+A,Ctrl+C,Alt+O. Then on the off chance that the text is
lost it can be easily replaced.

Sam

Re: Lost histories

Hi Kimberley, We use one visit per hospital stay. To that visit we add notes (generally one per role - ie. radiologist, attending hospital vet, ultrasongrapher, surgeon), weights and medications.

We don't often get the lock issue in hospital, more for consulting when someone does something in accounts whilst we are writing histories. I do what Sam said with the occasional long history (Ctl-A, Ctl-C).

Matt C

On Fri, 30 Jul 2010 04:03:34 +0000 (UTC), kimberley@maclawcorp.com wrote:

> Hi all, >   > Haven't been on here in a while and this item is of particular interest to

> us. Will the solution above stop the issue of losing patient if 2 staff > members try to add information to a single note at the same time? We > frequently have vets who will lose their patient notes when another staff > member (usually a nurse or reception staff) accesses the same note ie to > add details of medication given or to record a follow up visit has been > booked etc. >   > Not directly associated, but how do other practices manage the patient > records for hospitalised patients? Currently we try to have a single > Visit per hospital stay and a new Note is added for each day in hospital > to record patient details, medications etc. Our problem with losing > information comes about most often when a vet is making notes in the > record, and another staff member goes into the same note in another part > of the hospital to record medications given, weights etc. If there is a > better way of doing things that would circumvent this problem I'd love to > know! >   > I certainly like the idea of the summary screen editing and think this will

> make our lives much easier! >   > Kimberley >   > _______________________________________________ > OpenVPMS User Mailing List > users@lists.openvpms.org > To unsubscribe or change your subscription visit: > http://lists.openvpms.org/listinfo/users > Posts from this mailing list can be viewed online and replied to in the > OpenVPMS User's forum- http://tinyurl.com/openvfu >

_______________________________________________ OpenVPMS User Mailing List users@lists.openvpms.org To unsubscribe or change your subscription visit: http://lists.openvpms.org/listinfo/users Posts from this mailing list can be viewed online and replied to in the OpenVPMS User's forum- http://tinyurl.com/openvfu

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