Cancel DC Renew Complete... What's the diff?

I am frequently asked how best to manage the Medication List. So often, we find meds that are duplicated, obsolete, or have simply run their course and no longer belong on the list. What's the best what to clean up the list? Well, there is no right and wrong for dc’ing meds. This is the way I like to think about it:

• Renew (think magazine subscription): The renew start date picks up at the last stop date
• Cancel/Reorder (think dose increase): the reorder start date is today and the canceled Rx is no longer in play, i.e. this is used for any dose/sig/pharmacy routing change
• Cancel/DC (think flushing the meds): this is the general way to dc any med, rendering it inactive and no longer visible on the active meds list
• Complete (think Z-pak): this is the way to dc a med that had a finite course, like an antibiotic.
• Maintenance v. Acute: maintenance will leave the med on the active list regardless of whether the stop date was reached. I find this useful, even in acute situations, to allow tracking at a follow-up visit. For example, I gave that Z-pak for acute otitis in March and the patient comes in today when I can ask about efficacy and tolerance. On the other hand, using the acute setting allows the med to complete and fall off the list of active meds. Many would argue that this is the proper and best way to manage the Medication List. We have left this up to the user.

Thanks to Rob Smith for the succinct question this morning!

Mac workaround identified

Many many many of us realize that, in spite of the institutional dominance of Windows-based PCs, Mac really is the way to live. Unfortunately, this can create connectivity issues when trying to connect to Baystate's network. In the past, I've suggested that using the Firefox browser might help. But since the release of the Snow Leopard OS, this is no longer surefire.

Well, I learned something new after co-presenting at medical grand rounds last week. Ted Hartenstein, 4th year med-peds resident, said he found that if you log in to the network via baystatehealth.org and then, instead of clicking on the eWorkplace prompt, click on the ESA prompt. Let this begin to load, but rather than entering in your EN# and password, X out and return to the eWorkplace icon and open the application for login. I've already checked on my own Mac and have heard from a few previously disgruntled Mac users that they are now gleeful.

Thanks Ted!

Patient-Centered Medical Home PowerNote

Many of you are already aware of the NCQA Patient-Centered Medical Home project that has been underway since last summer. While the definition of PCMH is pretty vast (see pp. 1-2 Standards and Guidelines for Physician Practice Connections®—Patient-Centered Medical Home (PPC-PCMH™)), we are working to develop tools that will enable you to more effectively meet the level 3 criteria for NCQA certification.

A group of us (Diane Russell, Julie, Gentes, Glenn Alli, and I) have been working on a Medical Home PowerNote template that provides cues for optimal documentation of a variety of chronic medical conditions. While the template itself is essentially just a "refurb" of the Med Office Note template, the HPI and Impression & Plan have been juiced up with both monitoring and treatment terms for each of the following conditions: Type 2 diabetes, HTN, hyperlipidemia, CAD, CHF, asthma, and chronic pain.

We are pretty happy with the design and believe that, if you know how it works, you will be too. Here is a video I created covering the essentials. Given the length of the template, this was tough to keep under 5 minutes. I suspect that if you are familiar with PowerNote use, though, this will be old news.

(If you are unable to see the video in full view, use the following link: Medical Home PowerNote)