What’s New June 2010
	We have added some significant new features in the last few months that we have not had time to tell you about and some others are still in progress.
	The enhancements to the EMR are very significant and we'll describe them below.
	The electronic prescription writer is working well but there is important information for prescribers below.
	We have added a number of important features to the Appointments Scheduler for group bookings and other meetings that are applicable to larger offices.
	Please do an update. There is one critical fix for a loophole that could allow a user to unintentionally delete other clinicians non-patient appointments. Having said that, the known bug list is at a record low close to zero, which in a program of this complexity, customizability and inter-relatedness is pretty remarkable. We know that some of you are hesitant about doing an update because there is a new setting, or way of doing things, but that is a mistake.
	There are aspects that you may have to address after a current update. All users must have a unique user login and each user must be properly associated as a clinician or office staff at the Users Screen. The right to Lock notes is now required for users allowed or who need that function. Prescribers must select options at the Electronic Screen (see below).
	Please remember the Help Notes under Help since there are now approximately 800 of them. Use a single, singular keyword to search for a topic
	We love to hear from you but not if you are networked and were able to login yesterday but not today. The cause is probably physical such as server down, no ethernet, no internet, no wi-fi etc. First check that you can see the shared TheraManager/Main Data/Master Data folders on the server, if not please call your IT expert not us.
	We continue to be asked about "meaningful-use" and EMR certification. At this point in time there are no rigorous definitions of these terms, There are no officially certified softwares (CCHIT is not official) and no officially designated body to certify them or standards for certification or interoperability, which is supposed to be included. There is also discussion of interim standards, and a carve-out for mental health providers. We are watching the bureaucratic dance at The Office of the National Coordinator for Health Information Technology and will be ready to meet any necessary requirements as and when they are announced and in time for your meaningful-use as and when required.
EMR
	First a general note on using our notes screen. You can put any note in any of the subscreen notes by clicking on the space and then clicking on the note you want to put in it on the Tree List. The smaller subscreen notes can all be sized out of sight if you like and that is remembered when you exit the screen. The sub-screen notes can be renamed for all notes with a right-click. Spell check can be turned on or off and there is a search option bottom left. Dragon 9 works well for dictation. Dragon 10 requires the more expensive Medical version because Nuance has "fixed" it to recognize EMRs. Now for the new stuff.
	If you have Windows 7, there is built-in speech recognition that is very easy to use and works very well with TheraManager. Go to your Control panel, select Speech Recognition do the tutorial and training and Microsoft will let you run it.
	You can now open and save files in the EMR. These include files from Windows Journal, PDFs, MSWORD, and ACECAD. The beauty of Journal and ACECAD is that handwritten notes can now be saved in a patient's medical record with or without character recognition..Journal is the program available for editing on the TabletPC, Vista and Windows 7, but a viewer is available for XP, and ACECAD is a digital clipboard that allows you to write on paper and save the result electronically.
	With respect to the forms we have added more options in the Form Designer that make it easier to design the forms and include pargraphs and headings. One of our best kept secrets seems to be that we include in the Updates, forms that have been donated to us. These forms can be imported using the Import function on the right-click menu. There are now quite a number. Any forms that you have made or modified should be exported to a safe place. The forms are automatically saved into the database, but you or someone else could easily destroy the integrity of a form. There is now a right at the Users Screen that must be checked to allow access to the Form Designer. If you do not use a form our suggestion is to export it, if it is not already in the Templates Folder, and delete it from the database using the Delete Button. This keeps the list manageable and it can always be reimported..
	In use any Form can be checked and will be remembered from visit to visit. Additionally, a checked form can be put into history and a profile built up over time. Since the forms can be scored, the scores can be plotted as a function of time or as a function of dosage of a med eg depression score versus dose of zoloft over time. These plots are available from the right click menu on the Form History Screen. This capability to display Performance Evaluation/Outcomes will be developed further but we would appreciate your input. It can be used as a tool for honing your own treatments, supervising your clinicians in a group, reporting to whomever, but also as a non-intrusive research tool in clinical practice. I will try to include an example in this email.
	Remember that only limited editing is allowed for forms in history since the integrity of the form must be maintained for the stored data to be meaningful. It is not necessary to put the form into History for it to be preserved with checks and text from visit to visit. We are noticing that several people are putting forms into history without being aware of the ramifications or really needing them there. A Remove from History menu item on the popup has been provided. Hence it is easy to clean up. However if you are really trying to store a history of the patient's progress you could lose a lot of clinical research history in this way. A way to preserve the historical form is to export it, and then import it back again and give it a modified name, after which you can change the structure.
	There is a new screen called Selected, which is intended to mark up say a picture or profile with notes and forms specific to marks placed on the picture or profile. However it can also be used without an underlying picture to group medical records by topic with each mark representing a topic.
	We have developed a new means of generating notes that will be introduced very shortly. This will be a self-directed self-learning text approach that can be many levels deep and many lines long. A new capability is available that will be of interest to groups, teaching institutions or anybody supervising others. Notes can be marked as Done, Approved and Locked with rights assigned to appropriate users. The writer of the note might only be given the right to mark it as Done and it would have to be reviewed and locked by someone who has that right. The status of the notes can be seen by clicking the Binocular Button on the toolbar at the EMR Screen.
Popup Notes
	Popup notes seem to be a very popular feature, but remember if you want them to popup when there is content in the note then click the Auto-Hide Button else click the "X" Close Button.There are both Business Notes and Clinical Notes that popup depending on the Screen being viewed. From the User Note you can select text and "IM"/Send it to your colleagues. As long as they have Refresh turned on, the Notelet Button on the toolbar will become a red message light. Click the red button to read the message. This has been honed in the current update.
Electronic Prescriptions
	As we told all prescribers in an email, TheraManager is now certified for writing scripts directly from within the program to the pharmacy.
	As a reminder our electronic prescribing allows writing and renewals in the program or on our partners website or remote browser or smartphone. Direct writing and renewals directly in the program. The FDB database which fully populates the TheraManager Prescription Screen. Automatic creation of custom list of meds and regimens. Synchronization of all records. Interaction checks for drug-to-drug and drug-to-disease interactions, food and drug allergies. Patient Formulary, Drug Monographs, Patient Notes in multiple languages National List of Pharmacies
	We have added a feature that automatically calculates the daily dose from the Regimen and the total amount of the medication from the number of days selected.
	Another feature calculates the expiry date from the number of days and the number of refills.
	The current update requires information to be added at the Admin | Electronic | Prescription Screen to specify the users role as a prescriber, eg Licensed Presriber, staff etc.
	The DEA has now set the stage for electronic prescribing of controlled substances. All prescribers will require an additional form of identification in the form of a hard token, probably in the form of a keychain fob/USB device. They will have to register to obtain these with a yet undefined authority. Our partner is promising to have an interface available before you have the fob, or the pharmacies are ready!!
	Another complication for us and you is that Surescripts has a separate hub called Surescripts Benefit and Drug History. The hub provides access to the same formulary tables used by pharmacies. In addition, there is an all-doctor drug history that can be viewed/downloaded. We also believe that Surescripts Benefit and Drug History is required for Medicare "qualification" and Meaningful Use and it is required for some patients, particularly those using mail-order pharmacies. For you to use this capability on our screens, TheraManager will have to be separately certified. However, it will be available for you to use much sooner on the screens of our partner who is already certified. We will keep you informed as we thread our way through this maze.
Appointments
	A neat feature that we expect to be used by all offices is an SMS text message reminder capability. We have had phone, email, and letter reminders for a long time but the ubiquity of mobile phones makes texting reminders very attractive. You must first enter the patients' mobile phone providers and numbers at the Patient Data Screen. You can set everyone for text reminders under Actions on the toolbar or individually as you book them. Use the right-click menu on the Appointments Work Screen to get and send the reminders. In order for this to work in a net-worked environment the SMS.ADT file has to be copied to the shared Master Data folder on server.
	An option set on the Corporate Screen now allows the appointment week to start on a Monday if preferred.
	The option to book Appointment clashes has been refined and there are now separate options under User Settings to allow Clinician Double Booking, Room Clashes and Patient Clashes. Any double/overlapping bookings will be marked automatically in a pinkish color in an update to follow next week, but under-lying bookings may need to be viewed in List View.
	Several new checkboxes have been added to the Book Other Clinicians Screen that create different types of appointments. The default is for no checkbox to be checked, which creates a simple appointment for a clinician. The original checkboxes are the All Checkbox to create a meeting for all the clinicians in a practice, and the Special one to designate a reserved time eg. for emergency intake.
	The ability to book groups has existed for a while but the group capability has been honed, When you click on a Group Booking Appointment, the list of group members pops-up. Members can be added by dragging and dropping from the Patients Title Box. A checkbox shows whether members have been booked or not. The whole group can be booked at one shot by right clicking on the Group Booking Appointment. Double-clicking on this appointment opens the EMR Screen and there is a right-click menu item that allows a common note to be inserted for all the group members. Clicking on the names in the group list selects that patient and opens the note for that patient to allow individual comments.
	The non-billable appointment allows clinicians to keep track of their non-billable time and the sum in minutes is displayed in the List View.
	Case meetings are meetings set up for all the case workers associated with a patient. The case workers must be pre-selected at the Patient | Others Screen. The patient and the selected clinician will be booked automatically. The others can be booked with a right-click on the list that pops-up when you click on the booked appointment.
	There is also a checkbox for booking general meetings between selected clinicians. An appointment is booked for one clinician and additional participants can be selected by dragging and dropping from the Clinicians Title Box.into the list that pops up when you click on the meeting appointment. These additional clinicians can be booked with a right-click.
	As well as View by Room and View by Staff, we have now introduced View by Patient.
Managed Care
	There are now 4 views under View on the toolbar for listing managed care patients. All, With Expiring Authorizations, With Low Authorizations, With No Authorizations
Grids
	We continue to find that our users do not understand the power built into all Grids as described in the January email. Moving, Sizing, Grouping, Sorting and Filtering are all available in the Headers. Other functions, especially editing are available in a right click memo and the configuration can be remembered as your personal default.
	If you want to register, need further support or you have suggestions please contact support@theramanager.com or call 908-508-8900.