SMARText for v4 Users

We strongly encourage v4 users to convert at least 100 to 200 charts to the current version on a testing server in the clinic, get familiar with the differences in workflows required, and go through sample encounters. The 100-200 charts are temporary and will be replaced (overwritten) at the time of the full conversion.

Here are some brief videos of the main differences from SOAPware v4

++++++++++++++++     Temporary, in process below    ++++++++++++++++++ 

For v4 SOAPware users - Getting started after converting from v4

A key advantage of the SMARText infrastructure is, and will be, the ease, speed and rapidity we can introduce new functionality and adapt old ones.

We are not forcing SOAPware v4 users to upgrade. Even SOAPware v2 is still in use in several sites even though it has not shipped since 1997. We still have dozens of sites still using SOAPware v3, even though it has not shipped since August, 2001. We will support v4 until at least 2011.

The problem users have with v2, v3 and v4 is that they are not going to be prepared for the MAJOR change in reimbursement that will take place over the next 2 to 3 years. Sadly,  most of the “easy to use” EMR software available today are about to be albatrosses. Soon, docs not participating in pay for performance (P4P) are going to experience a greater degree of income loss for the same amount of work. We have spent literally years attempting to design an interface that would be almost as easy as the more word-processor like entry “free text” style of v4, yet have the infrastructure to support any/all needs for more granular information. Most other EMR’s force all users to traverse multiple pick lists and screens for almost every task. Also, it is often extremely difficult to customize those lists and options. We set out with the goal of increasing the flexibility at the same time we allow for a greater degree of structured information. This is yet another unique aspect of SW-2008.

You should soon be able to initially use SW-2008 pretty much in the same fashion as v4. Over time, plan a migration to the more advanced features in SMARText. It is true that, in SW-2008, you now have to be more careful where you click and type, but it will soon become apparent why this is necessary. Very quickly, the new workflows become as automatic as your current ones in v4. Also, remember that anything that is unfamiliar appears less desirable at first, even when it is much better. After familiarity is gained, the improvement becomes more obvious. Today, what everyone wants is a fast way to chart all the needed documentation. But, what you really want is a system that does this AND meets requirements that are imminent!

About the biggest frustration for v4 users is that all the old shortcut codes are now potentially active everywhere in SOAPware. This often results in a lot of unwanted code expansion. If you convert (i.e. bring in) your code expanders from v4, do this next step as the first thing after the conversion. Otherwise, you will be very annoyed by words expanding when you don’t want them to.

This should avoid the unwanted expansions of words into code expanders.

-First go to the SMARText Manager (press F10)
-Click on the Find button with the find field being empty. This brings all your available ST items into view.
-Click twice on “Shortcut” to cause the ST items to all be sorted based on their shortcut.
-Then, quickly scan and scroll down the list of shortcuts. If you find any shortcuts that are actually real words or abbreviations used in charting, then each should have an “x” added to the end of it.

For example, if shortcut is “URI” then change it to “URIx”

For example, if shortcut is “sam” then change it to “samX”

This should avoid the unwanted expansions of words into code expanders.
Likewise, when using SW from that point, if one of your usual codes does not expand…
-Press backspace
-Type “x”
-then press spacebar to enter your old, familiar code expander.

Most find after doing this a couple of times, one gets into the habit of adding the x and it becomes automatic, just like the common, old code use.
It may seem like a setback in SOAPware ease of use and functionality to have to do this. However, it should soon be very apparent that what you have gained that is far easier and more functional than v4.

All items in the v4 lists during conversion have had an 'x' added to them. They also have a keyword added based on:

Various codes                Vxx
Dx codes                       Dxx
Rx codes                       Rxx
Plan Codes                    Pxx
Follow up Codes             Fxx

In addition to these keywords being added we will also add another keyword that starts with the item above and adds the first letter of the code. For example, if the v4 shortcut is “pne” and the expanded text is Pneumonia, then the new, converted ST item in v5 will have DxxP as a keyword. So, a search using dxxp as a keyword could present the same list that was presented when "P" was clicked in the Dx code list in v4.

The Templates also have a keyword added to them of the form Txx + the first letter of the code in the converted docuplates.

So, If you made a lot of customizations in v4 and did a conversion-migration to v5, your customizations should mostly be available in v5.  (The main exception are the pick list items from v4)

Going forward, we are longer encourage the creation of your own, new shortcut codes/macros for text entry. It will be wise to use those already existing in the SMARText library whenever possible.

There is no need to memorize a bunch of expander codes. New users simply "tap" on headers and select the data they want to enter. Users can go to any of the headers at any time (i.e. not forced into a linear sequence) and the items can be as few or as many as preferred. The items used most move to the top of pick lists automatically as the system tracks usage. Unlike v4 code expander macros, the selected items can now be coded in the background with SNOMED-CT, ICD, CPT or whatever. Headers not addressed can be automatically removed at the time of creation of the final document. This method of entry will offer the easiest means we can conceive to allow SOAPware users to be able to participate in P4P, etc.

Why did we change how lists or categories are organized? - Keywords are now how you create pick lists of common phrases or meds used.

All codes in SOAPware are available everywhere in the program. Mainly this is because additional fields and document types can be added to the program and it became necessary to provide a way to include code expansion in these custom items. In other words, because users can add any additional fields, chart sections and layouts, there is really no reasonable way to determine which codes are valid in a given context. So what we have done is recast the old code list section of 4.0 into a manager of lists of data items that are available. A very unique aspect of modern SOAPware is that there are no significant limits on the number of lists or the number of items.

It may be difficult to comprehend, right now, but since neither keywords nor code expanders given to a ST item are required to be unique, this really opens up some more efficient ways of packaging your code expanders that probably are not apparent now. For example, pre-built prescriptions are available for the generic drugs available for $4 at many local pharmacies. Most of these contain the keyword “f-!’  so entering these 3 characters into the medication field and then F11 (or Control + >) presents a list of all those prescriptions.  As you use these, they are ranked with the ones you use the most at the top. Putting this another way, There are other implications of SOAPware ranking items in lists based on the field you are in when you assign the same keyword to multiple items. When you expand these while creating documentation, a popup will appear with the available items.  After a few uses, the one related to the field you are in will be at the top and you can simply press enter to accept it.

Notice that using normal words as keywords ends the need to have to create and recall many different codes. For example, you may have a number of pre-built amoxicillin prescriptions with each having a unique shortcut (e.g. “AmoS2”). Some you can consistently recall and some you can’t. It is unlikely they will make sense to anyone else or to new or temporary persons working in your setting. If you give all of your amoxicillin prescriptions a keyword of amox (instead of including it in the shortcut), you can quickly view/select the list of amoxicillin prescriptions. By also adding amoxicillin as a keyword, any of the following will retrieve the list of amoxicillin prescriptions… amo, amox, amoxi, amoxic, amoxici, amoxicil, amoxicill, amoxicilli, and amoxicillin. The more letters you enter, the more specific the retrieved list becomes. But, because with usage, the items become ranked, fewer letters rather than more letters are necessary over time.

Another example of the value of using keywords to your ST items is the notion of being able to relate items (starting with many different letters in the alphabet) to a particular diagnosis. This is possible by giving all related items the same key word, such as influenza. Then when you are in any field and enter “influenza” + F11, you will see a ranked list based on your usage of the items in that field. So now you can package your dx, rx, plan and follow ups for a particular dx  or topic under one easy to remember/train word.

In v4 everything was only sorted by the Code/Shortcut. With the addition of keyword searching, items can be organized-related in an infinite number of ways so that searches may now return a result set with many different codes that start with different letters.

The change to keyword organization-searching was made because the old system really didn't work for a majority of clinicians. It only worked for those willing to spend many hours with the system and memorize a bunch of non-word codes. The newer system allows you to organize you codes, templates etc both by a code and by keywords which ultimately makes it much easier and faster to find what you’re looking for. In addition, this makes it much easier to share your creations with other users as anyone can simply type in “Influenza’” and see not only items on his/her system but items shared by clinicians around the world.

What we were seeing at sites having multiple users is that each user would prefix some text string to their code so that they could find their lists. In sites of any size this would quickly becomes too cumbersome. However, each user can add their name as a keyword to quickly find the items they prefer without making the list itself unwieldy.


So SOAPware now allows you to group your codes, docuplates etc any way you want rather then the single v4 linear approach of having to create a set of unique non-word codes that can only be sorted in an alphabetical fashion.

Remember, you can assign as many keywords as you want to put each ST item and docuplate so that the number of types of  groupings you can create is almost unlimited and the groupings can be based on either normal, medical words or your own mnemonic-codes.

It might be a surprise to successful v4 user that we got an amazing number of support calls and training questions related to why some codes show up everywhere and others only work in specific areas in v4. Additionally how to find items is a consistent sticking point with users. Most objected to having to memorize both a code and remember what code list to use. Hence, we added the ability to categorize with keywords.


Successful v4 users often find it difficult to believe that the approch focused on using shortcuts turned out to be limiting for the majority/masses and a downright limiting factor in the adoption of electronic record systems in general. Using a multi-axial grouping approach (keywords) combined with some predicative analysis (i.e. what you use and where you use it bringing your preferred items to top of lists) will provide a much shorter learning curve and much faster data entry for most.

That all being said, we are absolutely focused on getting the software out of the way of the user. Software should work for you not the other way around.



Tips on how to make using SMARText easier.

To address the removal of the alphabet tabs across the top of the list dialogs.  Note you can sort the list by the shortcut codes by clicking on “Shortcut” at the top of the far left column in the lists. Then click on any item in the shortcut column to activate the list. Now, if you press a letter on the keyboard, you will be moved to the first item that has a shortcut code beginning with the letter pressed.

Double click on any ST item to select it and then you can Drag Drop or Cut/Copy/Paste it to any other ST Document or Item.

More or less, all your existing codes and templates should work basically the same in 5 as in 4. (The exception is with Pen Palette items).

You can currently right click on an ST item and select Create new to make a new code from items newly created while entering documentation.  

You always have the option to search either within your own, personal ST items that are only in your local database or to also include the online SOAPware library. At the bottom of the SMARText Manager (i.e. press F10) is where you designate whether or not to include online items in your search. Also, items that are not local will have color coded arrows next to them to signify their availability for download.

SMARText has changed how the Tab key functions. In v4, it was used to move between fields.  In v5, the Tab key moves to the next “entry point” which can be either ST items or the old v4 double underscores (i.e __).  This allows you to stay in line with how one navigates through either ST dialogs or the old style in v4. Since a field is a SMARText item it does stop there.
However, to replace the functionality of the Tab key in v4,  we added  new key commands…

Control + Down Arrow move to the follow field like the old Tab key.
     Control + Up Arrow moves to the previous field like the old Shift + Tab key combination.

You can sequentially naviagte through all the document elements with TAB.
Ctrl + the Arrow keys will move you between fields in the same manner as the Tab key did in 4.x.

There are now multiple means to place default text in the follow up field. The first is to setup each Provider with the default Follow-Up text they want to see.  When viewing the provider information, there's a section to insert a SMARText item in the follow up on SOAP Note creation.  
If however you want to have some text appear no matter who the active provider is, you'd want to modify the docuplate being used when a new SOAP Note is created.

If you find the structured prescription format in SW-2008 to be cumbersome at this time, we want to emphasize that SOAPware will not be forcing you to change your prescription workflow and style now or in the future. However,  the government and other payers will likely force you to change. You can continue to generate prescriptions in the same fashion and in the same format as you do in v4 (as long as you are not using the Pen Pallet). The simple formats we all used and loved for so long do not allow for the capture of information required by electronic prescribing (i.e. SureScripts) as well as other more advanced medication management functionalities. Many requirements regarding prescribing are just around the corner. After studying the likely requirement scenarios, we have created our first version of tools that can adapt to just about anything imaginable, while allowing the option of continuing the simplicity of the past.
Any change such as this is going to seem worse, at first, even if it eventually proves to be far better and eventually preferred over the original style. Soon, the benefits, even within SOAPware, of making the transition are going to be more obvious. Until it is more obvious to you, don't make the change!
We are very eager to evolve our prescription interface in ways that will meet the need and be as easy to use as is possible. These are 2 challenges that are constantly in conflict. Hopefully, input from you and others will facilitate our ability to do this in a more optimal fashion over time and as the interface evolves.  

You are still able to assign the print function keys (F1, F2, F3, and F4) in the same fashion as was done in V4. In order to have a key commands to be able to print your 4 most commonly printed document types,  go to Tools; Options; Document Designer. The resulting dialog allows you to define which reports will print for the Control + F1-4 keys.



From Templates to Docuplates.

A significant change in templates is the ability to insert them anywhere in SW.

Keywords can now be added to your docuplates to make them easier to find.




NOTE: Not converted - Template Palette functionality

The v4 template palette pick list functionality never really worked very well, so few really did a lot with it. It is our expectation that this style of entry will actually be widely used once we can make it work as it should.

The template palette workflow is an exception in that it is not migrated. We are creating ST functionality to deliver this workflow. The conversion will bring over the individual items and then will require some manual creation of SMARText from the old pen palate codes. All of your v4 codes and templates should convert. Even the codes associated with the template palette ( i.e. #$Text Here$# ) should convert as the simple text strings that they are. With the exception of the workflow associated with the pen/template palette, your v4 workflows should be reproducible.

Again, SMARText capabilities for pick list creation greatly enhance the pen/template palette functionalities. Nothing should be lost, but it will likely be necessary to manually convert pen/template codes into individual SMARText items. The converted pen/template palette codes that are transferred should help make conversion of old codes into SMARText fairly manageable and straight-forward.