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PDF Editor FAQ

Is there room for a new company in the EMR/EHR space?

STOP RIGHT THERE. You're going about this problem the wrong way.You're starting by asking about shiny features that other companies might not have yet, hoping to win the EMR war using a features list that's longer than your opponent. Forget about that. Get the basic mechanics of UI/UX right first, because no one has even managed to do that yet. A highly-customized version of Epic is somewhat close, but even that is a failure in my book.Step 0: Architect the patient data structure carefullyI mention this because you're going to need to be able to pass this patient data around for clinical use, billing, research, auditing, etc, so design for flexibility and expandability from the get-go. Too many EMRs make it painfully obvious that things were thrown in as afterthoughts. The theory around how this initial step should be done is worth a few pages on its own, but we'll save that for another time. PS: your EMR should probably be web-based. After having used a web-based one and a non-web-based one, I have to say the colossal advantages of the former completely demolish the latter.Step 1: Decide on your market......because you need to do everything possible to totally kill it. It's the only way to go. If you're going to take on group practices, great, take on group practices. If you're going to work the hospital scene, fine, work the hospital scene. Stop trying to make something that does everything everywhere. This is not a feature, it's a horrible bug. For example: having the input interface for a SOAP note right next to the input interface for a regular note is stupid, as it's confusing two entirely different patient scenarios.Step 2: Analyze what your market doesIf it's a hospital, you need multiple classes of user, ranging all the way from student to nurse to physician to administrator. You'll also want a competent notification system, because inpatient things tend to be more urgent and if the ICU patient's potassium is critically high, you probably want to warn the physician immediately instead of waiting for the physician to check on it manually, because gee, the patient might code and die before that happens. An ordering system with good auto-suggest is probably also a good idea; I find it absurd when a system requires that I type "Start and Maintain Intravenous Access" instead of just suggesting appropriate options when I quickly type in "IV". Ugh.The concerns are different for an outpatient scenario: you don't need a lot of the stuff that hospitals require in an office. Less orders, more scripts, greater throughput in terms of number of patients, scheduling functionality, etc.Step 3a: Abstract workflows to a very high level firstIn other words, they are as follows:1) read data2) interpret data3) input dataThere's really not much else to it. Every workflow is a permutation of those three. For example: a physician orders a lab, and it's performed. The result is read by the tech who provides the input to the system, where it is then read and interpreted by the physician so they can go from there. Figure out how each workflow revolves around these three abstractions.Step 3b: Design for the specific permutations in your chosen marketPhysicians mainly want good ability to read and interpret data. We hate having to click millions of different tabs to get to the data. This is also a patient safety concern: when you the designer scatter data in multiple places, you lower the chances that it's seen and acted upon. I hate it when you do this crap, and all EMR designers seem to love doing it.For example: in a primary care provider scenario, make it easy to track vitals (particularly blood pressure) over time. Show when prescriptions for chronic conditions were last issued, and when the patient might need them renewed (you'd be amazed how many times patients forget to ask).The billing department, on the other hand, primarily needs to read data to figure out what they can bill for. Make it easy and highlight keywords for them like fever, headache, nausea, etc.Step 3c: Design for a 5-year-oldIf a five-year old couldn't use your UI, you screwed up. Period.Step 4: Maximise signal-to-noiseEvery EMR I've used thus far provides a ton of noise, and not much signal. The signal is almost always buried under a pile of junk that's also presented. Hint: I probably don't care if the blood pressure is 115/70, because that's within normal range for most people. When it suddenly dips to 75/48, though, I probably have cause for concern. But when you present the latter side by side with a ton of normal values in the same font, size, and style, it's easy to gloss over and miss what might've been a very important event.Step 5: Simulate & iteratePay physicians in the market you've chosen to be your consultant and take your EMR through some mock patient scenarios. Iterate accordingly. Nota bene: ignore all the small details they request (e.g. "Oh could you put a small button here for X?", "Could we make these lines blue?", etc). Instead, record all comments and tag them with meaningful feedback categories, such as "difficulty with creating patient note", "unclear data visualization on X lab", "failure to receive notification in timely manner", etc. Then rank the feedback. If 8/10 people gave feedback indicating "problem creating template", it obviously needs work. If 2/10 people gave feedback indicating dissatisfaction with patient demographic display, this is lower priority.In terms of features, the big ones that will likely be in high demand in the future are better notifications, data visualization (i.e. not just an excel sheet of numbers, like Epic usually does), customization through well-supported APIs (literally no company has done this thus far, amazingly enough), and calculation/decision-support tools that are embedded in the background (an ABG that comes back with an interpretation automatically, for instance). These are things to think about, and potentially lay the groundwork for initially, but the first and foremost concern should always be basic functionality first. Don't go feature-nuts until that's solid.I'll add more comments/thoughts to this answer as requested, feel free to comment.

How do I prepare for the final year MBBS exams with just one month left?

Here are few pro tips for Cracking The Examination Code :)1. Making charts and comparative tables will help in remembering the information. Even non comparable topics in tabular form will be quite easy to remember. Eg GERD, Achalasia Cardia & CA Esophagus. You tend to remember the image of grouped data as a whole. (Only write the keywords. No grammer. Just the keyword or phrase.)Making charts will also help for case presentations. You can make tables for various long/short cases and highlight important points of clinical examination for each one.Use Keyword, Association, Linking and or Substitution techniques.Let me elaborate on that- while studying a topic, choose specific Keywords or phrases. Next, associate those words with something you are already aware of. Then, link all the keywords together like a chain in an imaginative way.For example, I made a list of Autosomal dominant and Autosomal recessive diseases. Then I thought about an elderly couple known to me- a certain Mr and Mrs Gupta. Mrs Gupta was a dominant lady while her husband was a meek (or recessive) gentleman.I associated all the autosomal dominant diseases with Mrs Gupta, the one with the power! Example, Gardner syndrome- (Imagine Mrs Gupta doing gardening in her bedroom!! – ridiculous and weird associations! ), Treacher Collins syndrome- (imagine Mrs Gupta teaching couple of blue donkeys from a Collins( a brand) dictionary). Just use your imaginations- make weirdest associations!!For complex names/ drugs/ terms- substitute those technical words with nearest rhyming words you already know of! Example- Just imagine an autistic child eating a large asparagus- ASPERGER SYNDROME!! (the word “asparagus” will remind you of “Asperger syndrome!”)Similarly, one of my relative had carcinoma colon. I used to imagine him while reading about ca colon and made various weird associations.Glycine is an inhibitory neurotransmitter in the CNS. I imagine myself pouring glycerine on a huge glowing brain which causes a short circuit - a negative or inhibitory thing!! (I know this sounds weired but it works!) Visualize!This can be applied to almost anything. (Imaginative people will surely have an edge here!)2. If You have donated your Anatomy and Pathology books and became a good samaritan to some poor soul, time to get them back!! At the MBBS level, most of the time your viva revolves around anatomy and pathophysiology of a disese in addition to demonstrating clinical methods.3. You should have a clearcut understanding of common diseases endemic to your region.Divide your syllabus into MUST read, SHOULD read and COULD read. Allocate time to each in that order.4. Remember, as a thumb rule, “ Rare manifestation of a common disease is conmoner than common manifestation of a rare disease.” This approach will help you during your case presentation.5. Frequent FAST revision is the Key here. Just do a fast reading of the topic but do it at regular intervals. It might be a game changer for you.Annotate your main text book with facts and information you gather from other sources (Textbooks, Teachers, Seniors) so that you just have one and only one book to read in the end.First reading takes time, however every subsequent reading takes less than one fourth of that time. So a topic which took you more than 3-4 days initially can be revised in few hours. Suppose you read Endocrinology from Harrison’s and took 7 days and end up confused, its perfectly normal! During subsequent reading of the same chapter, you will start correlating the facts. It is only during the final FAST reading of the topic , which you should be able to do in couple of hours, you will get the complete picture!Only 2 days left for exam and more than 70% syllabus remains? DONT PANIC. Rather then planning to sleep, aka depression somnolance, pull yourself together and try to go through whole syllabus within 24- 48 hours of exam just by fast reading it.Under the influence of catecholamines your mind becomes 10 times more powerful. You will be more confident after this as things will last in your immediate memory. I think I could pass biochemistry exam just because of this.Same holds true for Case Presentation.Similarly, by following a template and doing frequent Mock Clinical Case Presentations among your friends will eliminate the fear of viva voce.6. Dress decently. This is an exam, not Haute Couture. Nails should be trimmed( It will save you from that embarrassing moment, when you are asked to demonstrate palpation)7. Do not try to charm your examiner during viva-voce. Do not smile unnecessarily. More often than not, it goes against you.8. Try to Speak fluently while presenting a case. Well articulated people have an inherent advantage. Be ready with differential diagnosis and points in favour/ against of each d/d. Knowing the diagnosis of case beforehand will not help you. (Infact it supress the thinking process and would prove counterproductive!!)Remember, you will be judged on how you have “arrived” at a particular diagnosis, and not for making the right one!Another trick for clinical case presentation is- Go Retro ( ie Make differential diagnosis first, investigations next, followed by clinical methods specific to a particular differential and then elicit specific points in patients history. You can make retro charts for 15-20 case scenarios eg for lump abdomen in all quadrants, PVD, Neck masses etcDo not forget to take allergic history.9. While presenting a case, if you can manage without reading from your answer sheet, BONUS MARKS!!!10. Be direct and honest. Else say, I don’t know. Do not evade the question asked by examiner by digressing. Most of the examiners are good at spotting the manipulative behaviour.11. Dig some information about your examiners if you can. Try to find his/her favourite topics, research work he/ she is involved in etc. through peer networking/ googling etc.12. For every question asked, be succinct in your answer. Do not reveal all you know at once! ;). Also, give a direction to your viva by leading the examiner to a particular topic you are thorough with, as a bait, which may lead them to the path of your choosing. You may get lucky. I got Ca Breast as a long case and I dropped BIRADS Classification cleverly. It worked. I screwed my paediatrics viva though!!13. There can be more than one investigation/management protocol for a particular medical condition. A teaching hospital may have different protocols than a pvt sector/ corporate hospital because of difference in experiences of doctors, patient volume , variation in patient demographics, diseases and local expertise.Like - cholelothiasis with choledocholithis can be treated with -a) ERCP and Lap cholecystectomy in a single admission at hospital Ab) In two separate admissions at hospital B ( ERCP followed by Lap chole after 4–6 weeks)c) by Lap CBD exploration and Lap chole at hospital C - with no gastroenterologist available.Although I agree that sometimes examiners, especially the senior ones, expects same old treatment strategies which they believe in. They may not be convinced by new emerging Inguinal hernia- open repair or laparoscopic repair?? There is no right answer to that. However, as a medical undergraduate you should be thorough with currently accepted management protocols. Have knowledge of history of medicine as well. Also , be ready to quote reference source or Level of evidence, if asked!Well, remember just because you’ve been practicing a certain management protocol does not imply that your examiner will always agree to that. Sometimes “truth” is a function of “time”, “place” and “person”. (Ask Galileo, whose truth was considered a lie because of the times he lived in!)You should know pros and cons of a particular investigation/ treatment modality. Be Humble. Be flexible in accepting his/her beliefs. (As if you have a choice!!) Acknowledge, if your examiner shares some information/ personal experience.14. Remember, best way to learn is to Teach. So once you grasp a particular concept, try to explain it to a 10 yr old kid. You will be amazed to realize the gaps in your knowledge by doing so.15. During Viva/Interviews- usually every question you answer will be followed by 2 whys/Hows/whats! Example-Q. Most common site of amoebic liver abscess? A. Right lobeWhy 1? Ans- due to vascular anatomy! (You are a borderline candidate!)Why/How 2? Ans- Right lobe portal laminar blood flow is supplied predominantly by the superior mesenteric vein, whereas the left lobe portal blood flow is supplied by the splenic vein. (Dont worry, You are safe by miles!)Why/ How 3? Ans- E histolytica trophozoites present in the lumen of cecum must adhere to the underlying mucosa and penetrate the mucosal layer leading to invasion of E histolytica into mesenteric venules. Amebae then enter the SMV circulation and travel to the liver where they typically form large abscesses. (You are a Dude!)So in depth study/ conceptual study, helps you in the long run!!16. The Kindly Brontosaurus posture– You must stand quietly and lean forward slightly, hands loosely clasped in a faintly prayerful arrangement with a subtle grin. —but you must keep your eyes fixed placidly on the examiner’s face at all times. Nod empathically from time to time. The body language of the Kindly Brontosaurus is respectful and nonthreatening. There’s a humility, so you allow the other person to feel empowered. Since you’ve made them feel like king of the jungle, they’re more receptive to you….. LOL. (Ref: Personal experiences)17. Remember only one thing can bring confidence- KNOWLEDGE! So read well!! ( I am yet to have that confidence, by the way!)18. If you seriously believe that you can rock in your practical viva/ case presentations by watching plenty of youtube videos or revising your notes/ pnemonics, get a reality check.You need to practice/ do mock presentations of at least 100 cases on real patients just to get the hang of it.Try to present cases to your colleague, seniors as well junior and senior faculty members to cover various possible questions you may be asked.Dont just keep on presenting the cases to just one teacher. You may be biased by his/ her views.19. Unfortunately, the medical viva exams (MBBS, MS, MD) have not been standardized yet at most of the places. So there is always a possibility of observer bias! If you feel that you are a victim of bad luck, return with a vengeance!!And finally- Is performance in your medical exams a marker of your professional success? That is your food for thought !20. Upvoting and Sharing this answer will help you remember what you just read!! ;)Wish you best of luck!

What is the best electronic medical record for a psychiatrist?

With hundreds of EMR (electronic medical record) software out there in the marketplace, psychiatrists may find it hard to choose the most suitable and best software for their practice. Also, considering that most psychiatrists operate private and small practices, so the EMR software they select must be affordable and easy to use. In addition, the software must offer the basic required features and functionalities such as patient charting, e-prescribing, patient scheduling and medical billing.Based on my article - 5 Affordable EMRs for Small Medical Practices - published on Software Advice, below are the fives most affordable EMR systems and suitable for psychiatrists. In addition, the size of a psychiatrist’s medical practice, patient demographics and existing technology may also play a critical part in the decision making process.Kareo Clinical EHR: Offers a complete range of tools such as EHR, practice management and medical billing. Offers useful features such as patient scheduling, appointment management, customized dashboards, data tracking, visualization and reporting and analysis. The solution offers a free demo.Patient chart in Kareo Clinical EHRNueMD: Similar to Kareo, NueMD also offers EHR, practice management and medical billing. The system offers features such as e-prescribing, charting, patient scheduling and a patient portal. The solution offers a free demo.Practice Fusion: It’s a cloud-based EHR software that offers features such as patient charting, e-prescribing, patient scheduling, lab integration and voice recognition. The vendor offers a free trial to new buyers.Patient scheduling in Practice FusionPrognoCIS: It’s a cloud-based and fully-integrated EHR, practice management and billing solution that offers features such as patient charting, e-prescribing, appointment management, handwriting recognition and a patient portal. The vendor offers a free trial to new buyers.Praxis EMR: It’s a unique EMR software that uses artificial intelligence technology, and completely eliminates the use of pre-defined templates. It offers a free demo as well.Praxis EMR patient windowPlease note that the EMR software solutions mentioned above are suitable for all medical specialties, and not just psychiatry. For more details on these software, regrading pricing and user reviews, read my article - 5 Affordable EMRs for Small Medical Practices.

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