Thursday, 16 September 2010

Keyboards!

Use the Keyboard

To use any clinical computer system with a modicum of success in General Practice you are going to have to learn to type. Worse than that, you are going to have to learn how to use a computer keyboard and then learn and use some Vision 3 specific shortcuts and keystrokes.
Do not despair!
Well, unless you have never really used a keyboard at all, in which case your ‘learning curve will be steep’. A euphemistic way of saying you have a lot of work to do...

I’ve never typed before!!!!

In this scenario you have two options, maybe three but the third is a little desperate.

Option 1

Learn to type.
OK, not to be facetious but really, unless option 2 below is possible for you, spending some time actually learning to type and use a keyboard is what you will have to do. You need to plan for this, get the time and, of course, in the brave new world of re-validation and appraisal, you can add all the hours into your PDP. Not that that necessarily cheers you up.
There are free online typing tutorials and lessons - use Google. Or you can buy commercial computer assisted learning packages, or you could go to night school. You do not need to know how to touch type, just enough to find your way around a keyboard and do more than one finger typing. Touch typing is a bonus, but not something I have ever learned or been taught.

Option 2

Can you retire? Seriously, the input device for your computer system is a keyboard and, in one form or another, this is likely to be the case for many years to come. If you cannot learn to use a keyboard, then you cannot use your computer.

Option 3

Wait for technology to do something better.
This is a bit of a stretch. Voice input needs you to be competent with a computer, able to navigate documents and, in fact, to be able to type. It also requires significant training to increase the accuracy, and this takes time. Further, talking to your computer is not always easy, especially with the patient in the room.
Perhaps new technologies and innovations will suddenly make the QWERTY keyboard obsolete. Perhaps, but not very likely. I would not pin your hopes on option 3, though it may make for an interesting debate as part of a procrastination strategy until, eventually, you can do (2) or face up to having to do (1).

Can’t I just use the mouse anyway??

Well, mousing is inevitable in pretty much any Windows application but using Vision with mouse and keyboard is slower than just using the keyboard, at least for the tasks that can be achieved with keyboard alone. Further, using your computer in front of patients is much more discreet if you can surreptitiously type ‘ALT, L, B’ to get the blood pressure listing up, whilst still paying them some attention. Mouse distracts the hand and the eye. Keyboard alone is better for rapport.

What can I do with Vision and the Keyboard?

Lots. Most of Consultation Manager can be navigated, and most of the functions accessed, via the keyboard. Although built as a Windows graphical interface program, Vision contains keyboard accelerators and shortcuts to let you do most of the work without ever touching the mouse.
It is definitely worth making the effort to learn. Force yourself to start using the keyboard today, and within a week you’ll never look back!

Windows Shortcuts

I got stuck on this section for several weeks for no more reason other than I think you could find these out yourself! However, the things that help are knowing how to manage text in documents, and how to navigate round forms and documents using the keyboard. So, FWIW, my to ten important ones would be:
CTRL+C: Copy
CTRL+V: Paste
CTRL+X: Cut
TAB: That’s the key on the left of the keyboard with two arrows going in opposite directions. You can use this key to move forwards through fields on a form. If you press SHIFT and the TAB you will move the ‘focus’ on the form back one step.
Arrow keys: Up, Down, Left and Right. Up and down often let you select new options in a list, e.g. in Vision Read term select. Left and Right will move back and forwards one letter in text, whilst up / down will move one line up / down in text. If you use CTRL+ an arrow key it will move one word right / left or one paragraph with up / down.
CTRL / SHIFT +CLICK to select: If you hold down CTRL and click on lines in Vision it will select them as you click. If you hold down SHIFT+ click it will select everything between two lines.
HOME: Moves to the start of a line.
END: Moves to the end of a line
Page Up: Moves a whole page upwards, and I am guessing you can work out what Page Down will do :)
Windows Key: if you have a Windows keyboard then the key between ALT and CTRL bottom left is the ‘Windows key’ and this can assist with a few shortcuts. Is use this key + L to Lock my PC when moving away from my desk.
ALT: The ALT key generally opens menus in applications, and is one of the mainstays of navigating round Vision with the keyboard.
More: Have a look at http://support.microsoft.com/kb/126449 for more information...

Vision Shortcuts

Function Keys

Traditionally new Vision practices are given a little keyboard overlay for the function (F) keys. This has some value :) The function keys generally do these things in Vision:
F1: Help. Should be ‘context sensitive’, in other words open at an appropriate place for the tast you are doing
F2: List Medical History. Just not so useful now we have the Vision 3 views, this was the default access to medical history list in early Vision versions and possible VAMP Medical.
F3: Find!!. It finds stuff, or opens the Find / Search form again depending on what you are doing. So, it should open the Find Patient form, or Find Read Term, or Find Therapy.
F4: Opens the ‘Scripts’ list
F5: Opens the ‘Repeats’ list
F6: (with CTRL) cycles through open Vision windows
F7: Starts a consultation and with SHIFT closes a consultation
F8: Opens the Add New Therapy form
F9: Once to create an issue of selected repeats, a second time to send them to the printer or ETP
F10: Expands the tabbed data display pane, hiding the others. F10 again to bring them back.
F11: Opens the Medical History Add form. Useful when you do want a specific SDA.
F12: Display the practice Guidelines Index.

ALT+A+?, ALT+L+?

Open Vision Consultation Manager and a patient record. Press ALT once (don’t keep it pressed down!). If you look at the menu across the top, that is the words ‘Consultation Summary Guidelines...’ you wills ee that some of the letters have been underlined.
Pressing the underlined letter will open that menu.
So, to ADD stuff, we can do:
ALT, A, the letter in the menu e.g. ALT, A, B will open the Add Blood Pressure form; ALT+A+W will open the Add Weight form.
ALT, L, the letter in the menu e.g. ALT, L, B will list the blood pressures.
So, the magic keys are (and I have only listed the most useful ones):
P: Problem
L: Medical history
G twice: Gets you to Allergy add.
I: Immunisations
B: Blood Pressure
H: Height
W:Weight
A: Alcohol
K: Smoking

CTRL+K

Does the same as OK or ‘Save’ on many, many Vision forms.

ALT+A for ‘Another’

On Medical History Add use ALT+A to add another. This lets you speed through Read data entry using keywords and keyboard. e.g:

srt, ALT+A, okthr, ALT+A, advrx, CTRL+K

Would record:

1C92. Has a sore throat
2DC4. o/e Pharynx NAD
677B. Advice about treatment given

CTRL+letter on tab

This lets you move to the tab in consultation manager that corresponds to the underlined letter in the tab title.
It works reasonably reliably, but not if you have a form open or if the focus has moved to another pane.

ESC for cancel

Don’t press ‘Cancel’, hit the Esc key instead! In the above (CTRL+letter for tab) if a form is open press Esc to dismiss the form, then the CTR+ combination to get to the tab you want.

Ok, I am done with keyboard shortcuts. Let’s move on!

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