MediNotes e Electronic Charting EMR Software
MediNotes e Features
Electronic Patient Folder
You'll
never have to hunt for a patient's folder again. The entire patient
history, copies of every document and more are all completely accessible
from the electronic patient folder.
- Allergies
- Past
Medical History
- Treatments/Diagnoses
- Multimedia links to images, etc.
- Alerts for the patient
- Remarks about the patient
- Patient Overview and Patient Summary
Default-based WYSIWYG Templates
MediNotes e™ templates are color-coded to reflect the current status of
the text.
Black Text - This is simply text which has been hard-coded into the
template.
Blue Text - This is a default
value for a pop-up window.
Red Text - This is an optional
pop-up window that can be clicked if needed.
Green Text - This signifies
that the user has activated the dialog and made a change.
MediNotes e™ templates also, in many cases, contain predefined values.
"Default phrases" provide the text for a "normal" note. This
reduces the time necessary to create a note because the majority of a
"routine" case is already charted.
Our
notes reflect a "What you see is what you get" philosophy. All of the exam
charting is done from one screen. There is no need to switch between
screen to enter each section of information. The note is laid out as you
write it.
New
Note from an Old Note
Routine
charting or documentation for follow-ups are a breeze with the New Note
from an Old Note command. Simple choose a patient's past note to use as
the basis for the new visit. Typically these notes are very similar to the
previous visit - so very little extra work is necessary to complete the
documentation for the new visit.
ESP (Electronic Statistical Planning)
MediNotes e™ can analyze all of the treatments for a certain diagnosis
and rank order them for you when you are writing a note. This ranking
makes the common treatments easier to find and improves the speed of your
charting.
Common/Topic/All History Elements
MediNotes e™ revolutionizes documentation with a simple and effective
way of handling your medical content. Each history dialog contains a tab
for Common, Topic, and All.
Common - This tab is user-definable. For Allergies, you are able to show only the
allergies that you use frequently to make your list more manageable.
Topic - The Topic tab is simply a categorized tree diagram that allows you to pick
your specific history items from the category headings.
All- Type in the first few letters of the item that you're looking for, and the
"All" tab will search the database for the history item that matches your
description.
MediNotes e™ includes History dialogs for: Medical History, Social
History, Medications, Allergies, Family History, Surgical History.
Appropriate disciplines will also include: Immunizations, Growth Charts,
OB History, Menses History, and Genetics History.
Integrated Office Tasks
MediNotes e™ can improve the flow and efficiency of your office by
creating additional documentation based on the information in your note.
Physician Referral Letters
In only 4 mouse-clicks you can create a professional letter to refer a
patient, or thank another physician for their kind referral. The letter
includes either the full patient note, or just the impression and plan
sections for their reference.
Patient Instructions
Customized Patient Instructions can be printed and sent home with the
patient regarding their care.
Patient Letters
Similar to a referral letter, the patient letter is simply a letter
template that can be printed and sent to your client.
Physicians Orders
When an order has been documented in the note, a worksheet can be
printed to show what the physician has ordered.
Prescriptions
Create a script right from the program using the extensive medical
library. The information for the script is also included at the bottom
of the patient's note, and in the patient's medications folder for easy
and consistent reference.
Superbill Statements
The Billing Wizard pulls the billing codes from the dialogs used in the
exam documentation. Simply associate the Diagnoses with the appropriate
Treatments, and print the Superbill Statement. (Some of the billing
interfaces allow a direct transfer of this information to their program
- see Import section.)
Flexibility
The
most important distinction for MediNotes e™ is the flexibility. It is, by far, the most flexible and user-definable program
on the market today. Our templates are composed of customized dialog boxes
that each have a different set of characteristics. Some are simple text
macros, while others have dynamic slider bars for quickly entering
numerical values or anatomical graphics for describing the location of the
condition.
Immunization History
The
Immunization History dialog is used in General Medicine to complete a
immunization record for the patient. This includes childhood immunizations
and travel boosters.
Graphic
Annotator
The
Graphic Annotator allows the physician to write or draw on the MediNotes e™ graphics and then store them in the patient's multimedia folder for
future reference.
E & M
Wizard
The E &
M Wizard makes short work out of the tedious challenge of E & M coding.
Exam elements in MediNotes e™ have been specially "tagged" so the
program can easily count the number of E & M bullets that have been
documented, and then list the appropriate codes for the visit.
HotSpot Editor
MediNotes e™ utilizes many full-color graphics to quickly describe an
anatomical location. The HotSpot Editor allows the user to define and
modify these areas, and the text descriptions. With this tool, existing
graphics can be modified by the user, or new images can be added to the
program.
History Repopulation
Information that has been added to the patient's history (from a note, or
by adding the information directly to the patient's folder), can be pulled
into the history section of a note.
History and Physical - Information available in the patient's history will
automatically be repopulated.
SOAP - History information can be added to a SOAP note by simply pressing the
HX button in the toolbar.
Office Text Messaging - NEW
MediNotes e now offers a secure way for medical personnel to discuss
confidential patient information or offer reminders regarding patient
care. MediNotes Messenger is a text-based communication system that is
stored and distributed through the program database. Since it is contained
within the secure program, only the recipient (MediNotes e user) is able
to access the message.
Daily
Patient List
The
daily patient list can pull the scheduled appointments into a manageable
list for quick access by the physician. The patient list can be updated
manually by office staff, or can automatically pull in scheduled patients
from your current schedule in programs such as Medisoft or Lytec, as well as Appointments Pro and AppointWare electronic scheduling programs.
Additional Interfaces
MediNotes e 5.0 now offers several new interfaces with Patient
Accounting packages (click here for a full list),
as well as, HL7 and XML exporting capabilities.
Accepts Voice Recognition
Many of the new voice dictation software packages can dictate into MediNotes
e™. This is true with the popular Dragon NaturallySpeaking™ and IBM
ViaVoice programs. These programs can be purchased separately from
MediNotes e™ through national or local retail electronic chains.
Other
programs that have the ability to dictate into other windows can be utilized
with MediNotes e™ directly as well. Programs without this ability can also
be used, but would require the user to cut and paste information.
Note - When looking at voice systems to use in conjunction with
MediNotes e™, realize that the minimum hardware requirements for these programs are
usually higher than those for running MediNotes e™.
Discipline Specific Features
Growth Charts (Primary Care)
 A
growth chart can be completed for pediatric patients based on the age,
height, weight, and head circumference. This feature creates a dynamic
line graph representing the charted values over the lifetime of the
patient.
Prenatal Explorer (Primary Care/OB-GYN)
Several
dialogs have been bundled together in what is referred to as the Prenatal
Explorer. This feature of the program includes:
- Estimated Due Date Calculator
- Prenatal Visit Dialog
- Fetal movement, position, and heart rate
- Prenatal lab values
- Mother's weight, blood pressure, and
height
Contraception History (Primary Care/OB-GYN)
The Contraception
History dialog is used to keep a historical description of contraceptive
methods used by the patient. Includes detailed lists of barrier types, and
oral contraceptives.
Genetics (Primary Care/OB-GYN)
If your
patient has a known genetic disorder, this can be documented using this
dialog.
Obstetric History (Primary Care/OB-GYN)
The
Obstetrical History dialog allows a physician to track all of the past
pregnancies for a patient. This dialog includes:
- Birth weight
- Length of Labor
- Duration of Pregnancy
- Complications
- Delivery Method
- Gender
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