Monday, 25 October 2010

Stop using the journal!

Fix the views - stop using the Journal

Yes, hello again. This is a slow and very occasional series. If anyone else wishes to volunteer as an editor / contributor please let me know.
Right, what is this about? It is the next step in using Vision with a modicum of success for consulting and it is mostly about telling you to STOP USING THE JOURNAL!
When, when you had paper records, did you ever lay each item in the record out in the order in which it was entered and make any kind of useful decision? It just is not how we use medical records - we use filters and structure (even in paper) to view the information we require. The Vision Journal is the TAB OF LAST RESORT. But, for reasons best known to INPS themselves, the Journal remains the first thing newbies see and the first tab most people are introduced to.
Well, stop it. Please. It is too much.
Here are some alternatives:

Patient Record Views

The ‘Patient Record View’ is the name for all the sections and tabs you see when you look at the patient’s record. That is all it is. There are some default system views available for you to use and, better still, you can make your own or tweak your current one. Most people seem to end up on View 4, which is not awful. View 7 will give you a Consultation Pane as well, into which you can manage Consultation Topics (also useful for Problems) but not everyone likes the loss of space to the Consultation Pane. (get a 23’’ widescreen monitor, it makes life so much more pleasant!)
You can change these from, where else but, Consultation Manager, Options, Setup. Then the ‘Patient Record’ tab:

So, you can select ‘Standard system distributed options’ from the topmost dropdown and this will let you select from system views. Try some out, it is easy to change back, and see if you find one you prefer. If a tab is missing or there is one you do not need, these can be changed so don’t panic if the view you look at is not immediately providing everything you require.

Some of these Views still Default to Journal!

Yes, they do. Lets deal with this. Depending on your role there will be different things you wish to look at when you first enter a patient record. As a GP I am more interested in the clinical narrative, i.e. the stories, rather than the test results or the prescriptions. Journal view fills up with results and scripts, and this is at least partly why it is not of value for everyday consulting. You can create an ‘Initial filter’ in Vision so that the first thing you see is filtered to only show specific data items. I use this to exclude scripts and results (and some other stuff). The feature for doing this is hidden away and not by any means immediately obvious, so listen carefully.
You will see on the top of this list are the words ‘Initial Filter’. As well as being words this is actually a control, i.e. a bit of functional interface that does stuff. Right click on it:
And you get this menu. You will see you can ‘Save selection’ - what selection, where? I will tell you. Also you can ‘Rename Initial Filter’. All this does is change the words ‘Initial filter’ in the navigation pane to say words of your own choosing. I will say no more of it!
When setting this up you need to first select ‘Show Items with no data’ as this will display in the Navigation Pane all possible data types that can be recorded and shown in the patient record. This will allow you to select them for the Initial Filter, even if that particular patient has no records of that type.
So, do that!
So now you can see all the possible items of data that can be recorded about a patient.

We need to select the ones we wish to use as our ‘Initial Filter’ - the data items that are displayed on our filtered tab. To do this, hold down CTRL and click on each data category you want to display. For example:

Happy with that? Now (R) click on the label at the top ‘Initial Filter’:

And select “Save selection as Initial Filter”. Then do the same again - (R) click, and deselect “Show items with no data”.

Next you need to set up the ‘Filtered List’ tab as your initial tab, assuming you want this to happen. As things stand whenever you first click on the ‘Filtered List’ tab it will now show you data items from the Initial Filter - i.e. the ones you just selected by CTRL+clicking.

To make it the initial tab, (R) click on the tab label:

to see this:

Select ‘View Options’, and this opens:

If you check on ‘Initial Tab’ here then whenever you start in Consultation Manager this tab will show first. And NOT the journal tab. So now you can begin to see the wood from the trees :)