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Modernization and Improvement
Dermatology EMR for Dermatologists from RevenueXL

Dermatology EMR for Dermatologists from RevenueXL

Dermatology EMR Software from RevenueXL Welcome to “prognoCIS,” the most cost effective,
comprehensive EMR System for your Dermatology Practice today. In your typical busy day, you have a lot of
things going on and you need to have a system that gives you just the information you need
to see at the appropriate time. I have logged in here as Dr. Marcus Welby.
At a quick glance, I see a summary of my inbox, divided up into ToDo items, telephone messages
my staff have taken, just regular messages and then the system will also generate messages
if labs have come back electronically or perhaps my staff have attached some documents I need
to approve. Down here, driven off the appointment schedule,
I see the patients that are coming in to see me, the reason they are coming in and I have
a nice continuously changing status on the right hand side. If a patient has walked into
the waiting room, the front desk has checked them in on the calendar, I will see that they
have arrived on my tablet PC, I will know what room they are being taken to. If my medical
assistant is perhaps with the patient getting some preliminary questions answered, it will
automatically update the status, because it know the MA is accessing this patient’s chart. As I complete my encounters with the patients
and sign off on their charts, it will say complete, so at the end of the day, if each
one of these could say complete that would be ideal. However, we know that, that is not
always possible in a busy practice, so I can always refer to my open encounter list and
see all the charts that I still have open. These could be from earlier today, they could
be from yesterday, day before, couple of days ago and just simply by going back to any of
these patients, finish what I was doing when I sign of their chart electronically, they
will be removed from this open encounter list. Anything that is in this list is not being
billed, so obviously it is in our interest to get it as short as possible. However, anything
that I have completed that has already gone over to the billing side and has been submitted
as a claim. Couple of other items of interests on home
page. You will see that if the patient has been to your patient portal, the little red
icon to the left of their name indicates that they have filled out their forms online with
all of their review of systems, past medical history, surgeries, etc. You can accept the
data right into their chart. Also, if you are interested in meaningful
use, you will see the top these set of buttons, here my Aura dashboard. I can very quickly
see and get a snap shot of where we are in the practice in terms of meeting all of our
different measures that we need to track. As we move on to our second patient, John
Jackson, we can see he is coming in for a change in a mole, he is in room 4, currently
with the MA. As I click on his name, the first place that I come to is a nice clinical face
sheet, let me see at a quick glance everything that has been going on with this patient.
I would see all his allergies, past medical history, past surgeries, current medications
he is on, his social history, family history, personal notes and perhaps I would like to
see the details of previous procedure that we had done.
Anything with a yellow background indicates it was here prior to today’s visit, but you
will see the changes will occur and effect a different color change. If for example,
the patient says they had a surgery just recently, I can click on the past surgical history window,
I can see the details of the surgeries, when and where they had them and I can quickly
add something updating their file. So perhaps it was a Achilles tendon repair, I can easily
add that or multiple items if need to specify when that was, so maybe it was June of last
year and if we are to care about which side it is and what hospital and what doctor did
that and if this something important, we could also mark it as a relevant. As I come back,
you will see the Achilles tendon now shows in a different color. Now, we can also indicate
that we have quickly reviewed everything here if I click in this little button, notice a
little check mark that goes into each of these windows indicating we have reviewed it and
that will go towards my E&M details. So this shows us an existing patient. What
if we have someone brand new that comes to our practice and they have actually filled
out their information online. Let’s go here to Mr. Frank Oriole we can see the little
red icon indicates he has filled in his information. When I come into his chart, we notice that
all of these windows are pretty much blank. What I am going to do is I am going to pull
up the patient form that he has filled out and I can quickly review it with him. I can
see he has put in his past medical history, his skin history, maybe he forgot to mention
something, so we will just quickly update that. We can see his allergies, he is allergic
to penicillin. Surgeries and so and so on. These forms are completely customizable, so
very very easy to lay out and we have a good library already and he can supply also his
skin history and including his review of systems. So I am going to save the changes and now
I am going to use my accept button and it takes all of that information that he filled
out through our patient portal and pulls it into all of these windows for us automatically.
Of course, I can come in here if need to add or embellish on anything. Besides having a nice customizable clinical
face sheet, I also have a very customizable workflow list on the left hand side. If I
choose vitals, I can see my medical assistant has already entered the data concerning the
patient’s vitals here and if I am good with that, I can move on to the next thing by choosing
anything I would like on this list on the left hand side. However, you can also just
simply follow your workflow arrows. Down at the bottom right, I can see a green
arrow that is pointing me on to my history of present illness. Here, it pops up a list
of the common reasons patients come to see you and I can see over here the reason why
the patient is coming in. They are referred to us by another physician. We can ask the
patient perhaps more specifically why they are coming in. So it could be multiple items
and we can indicate there are multiple complaints if we need to. The system then gives me a
nice set of questions and if I want, I can use these excellent templates, we have very
good content for dermatology, but you can also always come down to the notes area at
the bottom. We would rather use that for a particular instant. You can check everything
instantly with one click if you want to and then you can also be very very specific about
each of the items. These templates are very customizable, allowing
you to easily add or create drop downs, multi-select boxes as we saw, certain questions where if
for example we want to indicate travel history, I might want to put a remark over to the right
hand side, but I can also save my typing just by choosing the little binoculars and I could
indicate that the patient has recently travelled to South America within the last month. If I choose the other complaint on the left
hand side regarding the moles, then we can we have a totally different set of questions
so we can easily check these off and be specific about each of these as well. If I am done
with this, then I have a green arrow at the bottom right, pointing me to my review of
systems. As we might remember the patient had actually
filled out their review of systems on the form, so I can easily see the questions they
have done and they had also indicated a problem with cardiovascular in terms of a murmur.
If I would like to combine this with my entire review of systems just to make sure they have
not forgotten anything, I can easily do that and I can check everything else as being normal.
As I continue on, notice the green arrow at the bottom right is pointing me to a physical
exam. As I come into the physical exam screen, I
can choose the specific exam that I would like or can automatically pull up for me and
again, I can check everything nice and quickly and then specify anything that is specific
to this patient. As I choose an area where we notice an abnormality, I can put in my
remarks or I can always jump into my phrases if I want to. At any point in time, if I would like to annotate
something diagrammatically, that is also easy to do. I can choose my diagrams, specify which
particular diagram that I would like and I also have these customizable icons. So I can
indicate perhaps a rash or anything that is abnormal on this patient or perhaps a skin
tag and we can also put in any notes if we want to, to the right on this table. Everything that we are doing is all going
towards creating our progress note. So at any point, if you want to see the note that
has been created, it is easy to see and you will see also that it can instantly be creating
a letter to a referring physician as well. We have all his HPI, we have his past medical
history, surgical history, current meds, we see the review of systems, any areas where
there is a positive, you can see in a darker color. We can also see the physical exam and
if we want to have the diagrams as well. As we come into our assessment, we can see
that the system can help us to choose a likely ICD code, but we can also jump into our preferred
list of diagnosis and choose an alternate if we want to. Very easy to search by description
or by code and if I do not see what I want, I can always jump into the entire ICD-9 database
as well and choose something else. If I am wanting to do any kind of assessment
and plan notes, I can just simply whichever of these complaints is highlighted, as I fill
in the assessment and plan, that will be nicely tied to each of those. I can always jump into
my favorite phrases. I can also indicate the appropriate followup for this patient. Perhaps
they should come back and see me again in one week and the reason why, so it could be
multiple items that we want to get done. This will go as a pop-up message to the front desk,
so before the patient even gets up there, the front desk will know what needs to be
done. E-prescribing is also built right in and when
I come into the e-prescription module, patient can tell me what their preferred pharmacy
is, I could just simply start to type it or I can jump into any pharmacy across the US
and choose for their specific hometown. Any of the medications that I start to type, it
will do an autocomplete, so as I type, I can specify, the exact strength that we want,
it will also remember the number of days, the frequency which you give that patient.
If the patient has any questions about the drug, I can click on the drug info button,
pull up all the data about that, precaution side effects, and I can instantly be aware
of any drug to drug interactions or allergy to drug interactions as in this case. At this stage, we may want to know what we
can code for on this visit. So, if I choose my E&M calculator, you will see here, it pulls
up a table with all of appropriate codes and it is keeping track of the bullets under the
HPI, the review of systems and the physical as we have been going along,. It is now just
up to me to make a subjective decision in terms of the complexity. Based on the complexity,
it will tell me what level I can code for and what I am missing to get to that next
level. You will see it highlights for me and I can go ahead and confirm it, I could over
ride it, I could go back and answer the additional questions that would get me that next level
if I forgot to do that or I can also use my time factor. Perhaps we spent 25 minutes with
the patient that automatically bumps me to the 99214 and it will also document that I
spent 25 minutes with the patient. As we close our encounter, they system will
give us a nice summary of what we have done and we can see we have our followup in one
week to review progress that has already gone as a pop-up message to the front desk and
I can just simply mark my encounter complete to sign off. As we come back to our home page, you will
see that our patient, Mr. Frank Oriole is complete and we are ready to move on to our
next patient. Thank you for taking a look at this demo of
the clinical side. Of course, you would be going through this in a much faster mode,
because you would go directly to the things that you need to do on a day-to-day basis
and I am just pointing out the scenery as we go along the way. As a physician, your job is done. You are
now ready to move on to your next patient, but you have the peace of mind knowing that
you are billing department has already gotten your charge, your ICDs ready to bill. Your
billing staff simply comes to the claims tab, view the incoming claims, approve the claim,
make any changes to the ICDs or CPTs and submit. Well your claim is on its way.

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