What's wrong with my converted codes from v4?

Nothing is necessarily wrong. The v4 “expander codes” served you well in many ways in the past and they may likely do so in the near term. But, they are nothing more than free text globs and can't really function in any fashion other than to be readable by medically trained humans. Just be aware the codes that come over from v4 will not be functional as you start to take advantage of opportunities that better medical documentation creates. In the near future (i.e. 1 to 5 years), use of free text to document prescriptions and diagnoses will be considered as obsolete by a majority.

When there is a choice, it is better to replace the old v4 free-text globs with structured ST items from the on-line library. Likewise it is preferable to use previously created ST items from the library rather than create you own.

It is in almost everyone's best interest to start using structured Dx items for most diagnoses and use structured Rx items for most medications. In other words, start by structuring most of the Assessment and Medication fields of encounter notes. Start to more efficiently structure parts of the plan field. For the most part, there is not an great return on time investment to structure the subjective and objective portions of encounters or several summary fields. it will likely be 5-10 years before a majority will consider completely unstructured subjective and objective as obsolete.

We suggest a gradual shift from free text to structured documentation, but it will always be best to have a combination of both. Today, it makes sense to structure perhaps 10% of the documentation (i. e. Assessment and Medications). Starting with these offers an opportunity to begin the transition to the structuring of relevant documentation. Tomorrow, it will make sense to structure more. This shift will accelerate as industry standards evolve and as more SOAPware tools are released to ease the transition.

Again, it will never make sense to struture all medical documentation. That is why it is important to have very flexible medical record tools that facilitate the use of both structured data and free text. This is the core reason for SMARText's existence.

Hopefully, it is understood that the text strings Amoxil or Wymox are not data items that can be dependably shared between 2 different systems electronically. However, using a unique identifier such as d00088 (from Multum, Inc.) can allow for dependable sharing. In practice, the user rarely even sees the unique identifiers in systems as they are hidden via a pick list selection or are hidden in the background as we do in our SMARText.

Note: it is usually wiser-easier to edit an existing workflow (i. e. those within existing structured ST items or docuplates) rather than to build from scratch. Also, building from scratch usually causes information to be in a framework such that it can’t be integrated with information technologies in the future. It is preferable to download and duplicate existing ST items rather than creating new ones when possible.  Downloaded, unaltered, structured ST items will be able to contain more unique identifiers over time (even when duplicated). The unique identifiers are not maintained if items are altered or created de-novo.

The greater the number of unique identifiers used in documentation, the more valuable the documentation becomes. It makes it possible to accurately search and retrieve the patients that meet very specific criteria. For example, if you wanted to retrieve all patients having encounters with a diagnosis of sinusitis that were treated with amoxicillin, this is not possible without using structured (uniquely identified) data elements. This type of information retrieval is going to be critical in the next phase of health care. When users chose to use a unique, structured ST item, it is then possible to uniquely identify it for retrieval and reporting in the future.

Any information that is freely entered in any fashion is not uniquely identified, even though it makes perfect sense to clinicians if they read it. It is gibberish to information systems.

On the surface, it is a lot easier to type (or reuse previously typed) prescriptions that are “pretty’ to the clinician. However, they are worthless for electronic prescribing or any type of quality research or reporting.

What is unique in SOAPware versions after v4, is the creation of an environment that allows the user to use either free text (in a v4 fashion) or structured text (as in the more "robust" systems) almost anywhere and everywhere. SOAPware has gone a step further than the typical "more robust" systems. Most electronic medical record systems force a certain amount of structured text via very straight-forward, but inflexible pick lists. While these are more intuitive and easy to learn and use at first, they are very inefficient, time consuming and often maddening for busy clinicians over the long haul. In contrast, SMARText allows for far more flexibility and efficiency. The SMARText learning curve is slight in comparison to the degree of power and flexibility that results.

What is often not apparent in the beginning is that, over time and day to day, using uniquely identified SMARText items does not have to be less efficient than using the old free text style of v4. However, one has to go through a process of setting up one’s preferred, unique items. Yes, this takes more effort, in the beginning, than just using the old, free text, but the return can be huge!

IN THE SHORT TERM, YOU SHOULD BE ABLE TO GENERALLY FOLLOW THE WORK FLOWS YOU USED IN V4.

However, after conversion, most v4 converters have to re-invent some of the shortcuts or change their workflow to include use of the F11 key, double clicking, etc.

AGAIN, how to customize, is the NEXT step after one understands the suggested pick list structure and work flows.

ST items converted from v4 are nothing more than globs of free text which are completely unrelated, individual characters to the computer. Everything in v4 (and most medical documentation, in general) is nothing more than globs of letters with no relationship of one letter to the next (to the computer). This concept is difficult for humans to understand as your brain can see the logical relationships, meanings, and sections in what is a formless, meaningless glob to computers. The computer (i.e. information technology) can’t read like humans do and understand the meaning in groups of characters the way the mind instantly does. The challenge of getting clinicians to understand this was also demonstrated in a recent forum post where a user seemed flabbergasted that it is not possible to convert free text prescriptions into structured text that has information value to a computer. For example…

Amoxicillin 250 mg., Disp-30, take one tid, 3 Refills …

...is nothing more than 50 to 60 characters to the computer. One character has no association or relationship to the next in the computer brain. Yes, there is data here consisting of 50-60 characters, but there is no inherent information to anything but a human brain that is trained to immediately recognized the relationships (i.e. information) in this string of 50-60 individual characters. The human brain can instantly create separations (sections) and meanings that the computer is unable to do. So, the computer has no means to know what is a HEENT section or a GEN section that is within a glob of free text. It can’t separate or differentiate one set of characters from the next. Once this very basic concept can be understood, then it is possible to learn how to create documentation that looks like it is a glob of free text to the human brain but is actually built from a collections of building blocks that the computer has been told how to recognize as well. We are giving you the blocks to build more useful information and not just data. If you are using v4, you have a database full of data (lots of individual, unrelated characters). But, it has very little useful information (according to the computer and information technology). In summary, to do anything really useful, you need to start a migration away from all the ST item types that have (us)  associated with them as they are the old, worthless globs from the past. They only have meaning to human brains that have had medical training.