(We already use NextGen for scheduling and billing, so those tasks have already been worked out. Now that we are adding EHR, we have a few things to tweak with check in and billing, but these things are mostly pertaining to the electronic health record.)
Chart Abstraction
Scan Insurance Card
Sign policies/consents
Input information from the Health Questionnaire
MA to room patient
MA document Biopsies / Procedures
MA document Excisions
MA document Mohs
Provider to review history (abstraction information)
Provider to review Health Questionnaire info
Pathology review
Standard patient exam
Manage “my phrases”
Biopsies & Requisitions
Destructions pre-malignant and benign
Excision & Requisitions
Excision with Frozen Section Margin Control
Mohs
KOH and other in office labs
Injections
Body map (mark lesion locations) – supplemental documentation
Pictures in chart
Order labs & Requisitions
Order studies (MRI/CT/PET) & Requisitions
Prescribe to internal pharmacy
Document medication given as sample
Prescribe to Pharmacy
Prescription refills and matching refill requests
Input medication prescribed by outside MD
Pathology input
Pathology manage
Tasking
Signing Documents
PAQ (provider approval queue)
Billing E/M
Billing Procedures
Billing Cosmetics
Cosmetic Quotes
Self pay patients
HMO patients – authorization allowed
Diagnosis – lookup/custom favorites
Send referral thank you letter general derm
Send referral thank you letter excision/mohs/etc.
Request Authorization
Request Authorization procedure
Laser General documentation
EVLT documentation
Cosmetic documentation (injectables)
Consent – Sign and input into chart
Printing
Faxing
Patient Education
Wound Care Instructions
Schedule Follow Up
Check out
Billing to take over charges submitted by EHR
Run reports
Track Meaningful Use Measures
Copy chart for chart request
Give Patient exam summary sheet
Let me know what I missed…
As a fellow dermatology practice that also performs MOHS and a user of NextGen, we have discussed multiple times putting photographs in the charts for several reasons. We have wanted to use the photographs to ensure we were doing surgery in the correct spot, eliminating the issue of incorrect documenting by staff, and also to see the results of cosmetic and medical procedures, before and after. The main reason the idea has been shut down thus far has been the amount of space the photographs would take on the server. What did your practice decide to do about putting photographs into the EHR?
We use photographs in our charts for both Mohs and General Dermatology patients. Our concern wasn’t about storage space, as we use a hosting service that does not bill by storage used but rather by users, but the time it takes the staff to upload large files. I know there has been talk by third party developers that a separate program could be created to automate this process, so that a staff person wasn’t sitting around waiting for pictures to upload, but to my knowledge that program does not exist.
What we did decide to do was batch resize images to a smaller file size. This accomplishes both storage space as well as upload times for those that use hosted services. The compromise is resolution. Files that have been compressed don’t retain the same quality and therefore the picture isn’t as valuable, especially in medicine/dermatology when all the details are important.
We decided as a practice to have two compression settings. One setting allows a pretty good picture to be added to the chart for quick reference, the second setting has a pretty poor picture quality, but allows three pictures to be added horizontally to a document without having to manipulate the image in the document. Then when these pictures are viewed in the NextGen chart and it is deemed that they are not good enough for our purposes of evaluation, we then can quickly find our locally stored full resolution image.
To resize our photos we use a free batch photo resizer, that allows the user to drag photos to an icon and the program automatically creates re-sized versions of the photo. It is very simple and doesn’t require the user to open a piece of software.
See a picture of our icons and setup.
In KBM 8.0 and using TxText document editor I’ve heard there is a way to have the document autmoatically pull in patient images as long as they are always named the same thing. So if you always name your Mohs images “preop” “intraop” and “postop”, you can have the document automatically pull in these images into a grid, instead of having to add them to the document after it has been generated. We only care about adding photos to referring letters. I don’t know if this process will automatically re-size images so that they fit in the grid (taking three large images and scaling them down appropriately), or if the images must first be re-sized, as we do prior to the document being generated.
I hope this helps.
Kyle