New EMR September 2010
	The Electronic Medical Record part of TheraManager has been significantly revised and augmented. It is even more multi-modal and customizable, and can be used in different ways by different people and different specialties. A summary of all the features both old and new follows below. We do not pretend that you need all of them, but please spend a few minutes to read this summary (despite its daunting length). The best method is to print it, and read it with the latest version of the program open. (Please let us know if you need a new trial). Everything in the EMR is customizable for your specialty for Doctors, Dentists, Psychologists and Social Workers.
	As the trend towards using "EMRs" continues, our primary goal is to provide tools that significantly speed up your work-flow/note-writing and keep the information generated easily accessible.However we will in due course be providing the means for clinical decision support, electronic interoperablity, and the ablility to provide patients with their electronic medical records as will be required in the new HIT environment. Now is the time to jump-in if you haven't already.
Open EMR from the Appointments Screen
	If you have chosen "Open EMR with Double-Click" at the Tools | User's Screen, double-clicking on a booked appointment on the Appointments Screen will open the EMR Screen at the Medical Record/Notes Tab and create a new note with all the appointment information in a header namely time, place, duration, cpt code, patient's name and DOB, and the author of the note.
8 Types of Notes and the Layout of the Medical Records/Notes Section
	The Notes Screen has 8 panels where information and notes can be displayed. All these panels are adjustable in size and the settings will be remembered automatically.
	On the left panel is a list of the patient's notes with dates and cpt codes in a tree-grid that allows grouping, sorting and printing selected records. Red and blue font color shows whether a particular has been marked as "important" or has links to other documents respectively.
	At the bottom of the screen there is a panel that shows the patient's current meds but this can be sized so as to be invisible if preferred.
	Bottom right there is a panel that automatically displays the patient's diagnosis.
	The Medical Records or required primary records or progress notes are intended to be displayed in the central panel, although can be readily changed as will be described below.
	There are 4 other types of notes that can be named and used in any way you like eg Intake, Summary, Treatment Plan etc. These names can be changed to your preference. The notes primarily show in 4 panels with different colors but they can be moved around.
	2 other types of notes can be created and displayed in the left panel. One is private notes that only the user who wrote them can read. These are sometimes called psychotherapy notes and we believe that under HIPAA confidentiality is guaranteed as long as a Medical Record note is created for each visit.
	The other type of note is designated for Reports.
Using the Notes Section
	If you click on a panel and then click on a note record in the left-hand panel, that note will be displayed in the panel you first clicked on. This allows you to easily copy-and-paste from one note for a previous visit to a current one, or to synthesize reports from many visits etc.
	On all the panels there is a rich selection of self-explanatory menu items on the right-click popup to enable the functions that will be described below.
	There is a long list of convenience insertions eg patient info, your info etc. on the popup menu. The patient's diagnosis and the current meds can also be inserted.
	Links can be created from a list of records stored in a patient's list of documents or any link to files or URLs on the internet. A NEW feature is that the link is opened with a "Ctrl Click", which makes the behavior more closely resemble a browser hyperlink.
NEW "WORD" Editor, Self-learning Dropdowns & Files
	The editing functions have always had shortcuts shown in the corresponding menu-items, but there are 3 notable new ones, a double-click opens a full word editor, a "Ctrl D" opens a panel for dictation, and "Ctrl B" opens a self-learning hierarchical dropdown feature described below.
	Dictation can be done using Dragon 9, Dragon 10 medical version, or the speech recognition that comes with Windows 7, which we think is excellent. Nuance who sell Dragon, have deliberately disabled the basic Dragon 10 version in any EMR environment, so don't blame us. It is cheaper to buy a new computer with Windows 7 than buy their medical version.
	Different sorts of file can be stored in the database, such as WORD, PDF's and ACECAD (from an electronic clipboard) but of most interest to some may be the fact that Windows Journal files of hand-written notes created on a TabletPC can be stored in the patients record.
Using Templates including NEW Hierarchical Dropdown Ones
	Now we come to the use of templates. Templates created in WORD or the Editor, can be saved as .RTF files and inserted into the note. Once inserted a special template mode allows expansion of the area for typing, or modification or deletion of parts of the template as required for a given note.
	A brand new feature is that templates with embedded components can now be used. A sample Treatment Plan can be found in the Templates Folder. These templates can be modified or created in the Template Designer that can be found in the TheraManager folder. Available components are dropdowns, exclusive item groups, checkboxes and a scoring box. The dropdowns can be linked hierarchically. Use of the Template designer will be described below.
Using Checkbox Forms for Fast Note Creation
	The use of forms in the program has been available for a long time and is a unique feature of TheraManager. At the minimum, the program comes with a set of forms, mostly in Mental Health and they can be used for creating a prose medical note, with enormous saving of time. Forms can be selected and checked at the Forms Screen. Additional text can be added on the form as needed. The forms are also automatically scored eg for a depression inventory or progress assessment etc. The completed forms will be saved automatically in the current state for use at the next visit, but they can also be saved into history with a right-click. The result of checking a form is that a prose note can be instantly inserted, from the popup menu on the Medical record/Notes Screen into the note along with the extra text. If certain checkboxes are designated as normal, that item will not be included in the prose summary. However everything will be included in the Full Form Insert. The text that is inserted and new forms for any specialty can be created in the Form Designer to be described later.
NEW Automatic Body Mass Index & Vital Sign Form
	A new form that has been added in the update is "Vital Signs". This form can be added in the Form Designer and includes an automatic Body Mass Index calculation.
NEW Note Status Options
	Notes can be marked as Important, Done, Locked, Renamed and Re-dated as long as they have not been locked. Notes will be automatically locked at the next login unless an extension time has been set under Corporate preferences on the Admin Screen. Reports will be automatically locked after 30days. A new feature is available by clicking the Binocular Button on the toolbar at the Notes Screen and displays the status of all the unlocked notes. This is part of a new system for allowing monitoring, approval and supervisory locking of notes. This can be used to avoid having missing notes at an audit, supervising interns etc. posting of a visit can be inhibited until a corresponding note is locked.
NEW Self-learning Trees
	A new feature is initiated with "Ctrl B". This displays a dropdown. Typing into this box starts the top of a self-learning tree. Hit the Insert key to start a new entry, type the required text, and hit Enter, or select a previous entry from the dropdown. Click the Next Button or Tab Key to open the next dropdown and so on. Click the Back Button to return, or the Save Button to finish. The hierarchical tree can be unlimited and is remembered.
NEW Form History, Progress Evaluation & Outcomes
	Once a form has been saved into History, the structure of the form cannot be changed. If you are not interested in the ability to review changes of your patient's over time, do not save the checked form into History. (The current checked information will be saved regardless). If you have done this already, but want the freedom to restructure a form, you can remove the history at the Form Designer.
	A relatively new feature is the ability to plot history and show Outcomes as a function time or of meds and med doses. This capability will be developed further as we receive demand for it. Most clinicians seem to too busy treating patients to worry about the effectiveness of their treatments, or how to monitor the effectiveness, but we expect that to change, and we are ready with the tools. They give clinicians seamless access to capabilities that are generally only available to academic practitioners.
Form Designer
	The Form Designer allows you to modify and create forms for your practice. To access the Form Designer you must have the specific right granted at the Admin Screen. Forms such as those provided in an update can be imported using the popup menu. Conversely forms can and should be backed-up by exporting them. If you need to restructure a form already in history, it can be exported and re-imported as a new form. To create a new form, use the toolbar New Button and select the type of form you want. To add a new checkbox group or exclusive item group, click the appropriate menu-item on the right-click popup. Then with the mouse over the record for that item, click on "Add New Exclusive Item.." for as many items as you need. Repeat for new groups. You can also add paragraphs and sub-headings as you need them for formatting the text that is inserted into the medical record. There is a detailed Help Note about designing forms. You will have to add text for the groups and checkboxes etc, but also the text for insertion into the Medical Record. There is a wide range of names and pronouns, 'he', 'she', 'full-name', 'last-name', and 'first-name'. 's' defines the possessive cases and 'and' can be used for combining 2 lines. Each line can be assigned a score that is automatically tallied
NEW Patient's Linked Self-Check Program.
	We added a Patient Self-check or 'Kiosk' capability for patients. New forms can be designated as 'Self-Check' and then they will appear in the left-hand panel at the Self-Check Tab. A patient login can be created and selected forms transferred to the Patient's panel on the right-hand side, ready for the patient to check on the 'kiosk' computer running the TMSelfCheck program.
NEW Template Designer with Embedded Dropdowns, Checkboxes and Data-links
	Making templates with embedded features requires the Template Designer, that is in your TheraManager folder. Features can be added with the right click menu. A font needs to be selected for the first member of each class to be added. Drop-downs can be linked so they must all be given a unique name. The dropdown at the top of a tree will not have a parent, but one must be selected for all other dropdowns in the hierarchy. The required text then needs to be added corresponding to the selected field in each parent. 'My Treatment Plan' is in the Templates Folder as a working example, although the first version had an error that has been fixed in 'My Treatment Plan Revised'. Each component can be edited with a right-click 'Edit'. (The radio-groups require that the 'Insert' key be used to add a new radio-button.) Swiping over the component allows sizing and copying (Ctrl C) and pasting (Ctrl V). Copying also works with a selected bunch of components and text. Print Preview shows what the result will look like. There are also labels that populate automatically with patient and clinician information from the database and can be placed anywhere in a document. This capability can be expanded upon request.
NEW Notes Linked to Tags on an Anatomical Diagram or Photograph
	A very new capability is available at the Selected Tab. This is applicable to specialties that want to associate notes with specific parts of the anatomy. On the left-hand panel, a popup allows any image to be added to the patient's list. Several examples of body views and teeth, are available in the Templates Folder. An image can then be selected from the dropdown list. Right-clicking on the image allows a mark to be characterized and added. Notes can then be added that are specific to that mark although they are also viewable on the Medical Record/Notes Tab. Marks can also be used to group notes in some logical way.
Popup Notelets, Messaging and Followups
	Popup notelets have been in the program forever but not everyone realizes that at the EMR Screen they become Clinical Notes (they are business notes at the Appointments and Accounting Screens) and they will popup automatically if there is content for a given patient, so they can be used for reminders and also to set follow-ups. The notelets are also used for sending messages between users (flagged with a red message button) and reading them. Received messages are now appended to the Users notelet.
	NEW. Both business and Clinical notelets can now be bidirectionally synchronized with the TheraManager database via the OUTLOOK synching capability and then synchronized and displayed on your PDA or smartphone.
Overall
	Combined with the Diagnosis and Documents Screens, the EMR Screens now provide a very extensive capability that can be as simple or as sophisticated as you want and customizable to your needs.
NEW FREE DEAL
	We offer a free deal for each new specialty that uses the EMR program.
	For a trial go to our website at www.theramanager.com
	If you need support that's not in the Help Notes, or have questions or suggestions please contact support@theramanager.com or call 908-508-8900.