CONFIGURATION:

http://storeyquicknotes.wordpress.com/2009/10/31/how-to-the-configuration-page/

To use the schedule shortcuts, simple press the Windows key plus and Arrow key.

• UP and DOWN will toggle through the various locations you set within the configuration.
• LEFT and RIGHT will change days (left = back a day and right = forward a day).

These are very simple, but very effective shortcuts.  They are especially handy when using a laptop to speed up your day and make it a little less annoying.  These represent about 1/2 to 1/3rd of shortcuts used in our clinic.

Tweaks Include:

The package remains stable with a new shortcut to address how we are approving Simulations in our clinic.  The clean up and news updates come as a precursor to me presenting the package to my internal group now that more are looking at an electronic record.

I’m going to work on better documentation of configuration and features for the next couple of weeks with the focus being on the MD Package for the time being.

Quick Stat Summary:

Since 10/09, in my single MD clinic, both myself and my nurse have utilized over 13,000 StoreyQuickNote shortcuts apiece for a total of nearly 27,000 uses in about 7 months.  Nearly 100 per work day per person.

I can’t write a stronger testimonial for them adding productivity over the default UI than showing use of that magnitude.

The process has gone very smoothly, in large part I think to the StoreyQuickNotes and AutoHotKey functionality.  My clinic is one of 7 clinics and now administration has caught onto the progress that we have made and appreciates the time saving aspects.  So now, IS is looking at putting the code on the CITRIX client which would roll the shortcuts out to all the staff.  So usage on a daily basis would go from about 30-50 right now to 300+ patients and it would be a primary part of the global shift to an EMR for our 7 Radiation Oncology facilities.

As part of that move, I’ve spent some time consolidating the structure of the packages back into 2 packages.  There is an MD package and there is an Office Package.  The MD package is obviously oriented towards the physician workflow and the Office package contains shortcuts for Nurses, Therapists, and the Front Office Staff.

So I’ve posted a Nursing 97b to the download page.  I’m going to have it tried out in our clinic next week and make sure that I didn’t break anything in the merger and then I’ll roll it out as 1.00 Office once I feel like it has been through the paces.

I’m slowly putting together final release version and hopefully those will be up here in the next month. As you know, coding / CPT changes went into effect and we have been streamlining our documentation to keep up with those changes. This is stable and working as so it has dropped down my priority list a bit.

Overall point is that the code is stable and functioning with well over 10k uses in my single person clinic in about 3 months of consistent use.

Beyond that, the clinic schedule has been crazy busy for a couple of weeks and with the holidays, there is little after work time.

A second success story – 10 AM on Monday morning a nurse that was NEW to an electronic chart thought it was better/faster/easier than paper. That is a 3 hour learning curve. I can guarantee that would not be the case if we were not using AutoHotkey and StoreyQuickNotes to improve the workflow.

My current statistics are closing in on 5000 uses in 7 weeks of use. It is a huge time saver as our lives are filled with redundant tasks. I’m hoping to push non-beta versions of the packages in early January as I roll out the package to more facilities locally.

Over the last week or so, I’ve updated and refreshed each of the 3 primary packages of StoreyQuickNotes including the MD Package, the Nursing Package, and the General Navigation Package.

The main addition is far better configuration of the packages for using the IMPAC schedule shortcuts. They now have a configuration page which should mean that there is no need for any “end user” to open the code if you don’t want to.

The list of things that I want to get done keeps getting smaller. I have a few more tweaks to the MD package but the others are getting close to what I’ll consider a full-release non-beta version.

Over the next week or so, I’ll get up some images of the new custom tray menu with some additional “How To” articles.

The following is the list of Hotstrings or Abbreviations used in the StoreyQuickNotes General Package

::po::by mouth
::qd::every day
::q::every
::qhs::every night at bedtime
::prn::as needed
::nv::nausea and vomiting
::appl::apply to affected region
::tid::three times a day
::bid::twice a day
::qty::quantity
::fuw::Follow Up Weight:

:c:Amox::Amoxicillin
:c:Lor::Lortab 5/500
:c:Lot::Lotrisone
:c:Sil::Silvadene

::nlrcar::Carafate Suspension, 2 teaspons, swish and swallow four times a day
::nlrlom::Lomotil, 1 to 2 by mouth every 8 hours as needed for diarrhea (max 8 per day)
::nlrsil::Silavdene, Apply to affected region three times a day
::nlrlot::Lotrisone, Apply to affected region three times a day
::nlrxyl::Xyloxyline, 1 tablespoon by mouth before meals, after meals, and before bedtime
::nlrnys::Nystatin Suspension, 1 teaspoon, swish well for 2 min and swallow four times a day.  Take 2 days past symptom resolution.

::disc::“INFORMATION PROVIDED BY THE PATIENT, PHARMACY, OR OTHER HEALTH CARE PROVIDERS.”
::meds::MEDICATIONS:
::chemo::CHEMOTHERAPY:
::all::ALLERGIES:
::phar::PHARMACY:

::nkda::No Known Drug Allergies

::mlist::
(
MEDICATIONS:

CHEMOTHERAPY:

ALLERGIES:

PHARMACY:

“INFORMATION PROVIDED BY THE PATIENT, PHARMACY, OR OTHER HEALTH CARE PROVIDERS.”
)

MD Package Abbreviations:

The following is a list of Hotstrings or Abbreviations used in the StoreyQuickNotes MD side of the package. It is copied from the code so the format is a little odd, but really pretty easy to read.

For example: ‘po’ will automatically be turned into ‘by mouth’

::po::by mouth
::qd::every day
::q::every
::qhs::every night at bedtime
::prn::as needed
::nv::nausea and vomiting
::appl::apply to affected region
::tid::three times a day
::bid::twice a day
::qty::quantity
::fuw::Follow Up Weight:

:c:Amox::Amoxicillin
:c:Lor::Lortab 5/500
:c:Lot::Lotrisone
:c:Sil::Silvadene

::nlrcar::Carafate Suspension, 2 teaspons, swish and swallow four times a day
::nlrlom::Lomotil, 1 to 2 by mouth every 8 hours as needed for diarrhea (max 8 per day)
::nlrsil::Silavdene, Apply to affected region three times a day
::nlrlot::Lotrisone, Apply to affected region three times a day
::nlrxyl::Xyloxyline, 1 tablespoon by mouth before meals, after meals, and before bedtime
::nlrnys::Nystatin Suspension, 1 teaspoon, swish well for 2 min and swallow four times a day.  Take 2 days past symptom resolution.

; ------------------ ABBREVIATIONS ONLY IN THE MD PACKAGE ------------------

; C1 option - do not conform to typed case : See Hotstrings and Auto-replace

::met::metastatic        ; updated to remove issue with 'm' turning into something more
::mets::metastasis       ; changed
::adeno::Adenocarcinoma
::adp::Adenocarinoma of the Prostate
:C1:scca::Squamous Cell Carcinoma
:C1:nsclc::Non Small Cell Lung Cancer
:C1:sclc::Small Cell Lung Cancer
:C1:idc::Invasive Ductal Carcinoma
:C1:dcis::Ductal Carcinoma In Situ		

::l::left
::r::right
::br::breast
::wb::whole brain
::cw::chest wall
::abd::abdomen
::pros::prostate      ; removed pr is Progestion Receptors
::pb::prostate bed

::ha::headaches
::n::nausea
::v::vomiting
::f::fatigue
::di::diarrhea      ; Add 'i' due to the word "I'diarrhea" from "I'd" - funny bad typo 
::tx::treatment		

::sig::significant
::ca::cancer
::co::complains of
::pt::patient
::dz::disease
:C1:xrt::radiotherapy
::chemo::chemotherapy
::muc::mucositis
::ery::erythema
::desq::desquamation
::med onc::medical oncology

:C1:rtc::Return To Clinic:         ; Added in version 1.0
:c1:fu::Follow-up

::imf::inframammary fold region    ; Added in Version 1.01
::ax::axilla
::mdes::moist desquamation
::ddes::dry desquamation
::mdbr::moist desquamation in the axilla and inframmary fold region

Use:

Using Abbreviations or HotStrings with AutoHotKey is as easy as typing. If you type any/many notes into your electronic chart, it is very useful to have a number of abbreviations readily converted to longer text.

Below is my current list that I am using in the MD and Nursing Packages. If you need to turn them off, there are a couple of options.

• Exit the Program
• Use the Win-S shortcut to Suspend the script

Notes:

:c:

Means the case has to match exactly for the abbreviation to be expanded.  ie ‘lot’ will not expand but ‘Lot’ will.

:C1:

Means the abbreviation will be expand to the expanded version and it will ignore your capitalization.  For example, ‘l’ doesn’t have a C1 modifier so ‘l’ turns into ‘left’ while ‘L’ turns into ‘Left’.  ’RTC’ in contrast which has the C1 modifier, will always turn into ‘Return To Clinic:’ regardless of how you capitalize ‘rtc’.

Editing or Changing or Adding New Entries:

These are really very easy to change.  Simply open up the .ahk script by right-clicking and selecting ‘edit’.  From there you can scroll down to the bottom of the code and make changes.

The format is pretty easy and you can pretty much copy the format to add new ones or delete ones you don’t like.  As always, if you run into trouble the AutoHotKey Help Documentation is a great place to look.

Here is a picture of the current version of the interface as of the soon to be released version 0.98 beta.

ACCESSING THE CONFIGURATION PAGE:

On your first use, or if anything is blank, you will be brought to the configuration page.  The other routes are:

• Right click on the StoreyQuickNotes icon on the Windows Tray and select configure
• Use the Win-C Hotkey

In the example shown, we have read from an ini file that contains data so it pre-populated. If you are loading the program for the first time, this will all be empty but getting to this point is your goal.

IMPAC PASSWORD:

Pretty straightforward, enter your password that the shortcuts will enter when you use the shortcuts.

NAME FOR SIGNATURE:

Enter your name and I like to add MD to the signature. It is used to “sign” any notes created within IMPAC with a standard signature of:

Electronically Signed: Test Doctor MD

STORE PASSWORD/NAME TO INI FILE:

This option determines whether or not to write your name and password to a text file.  If you use the option, you’ll skip this step next time BUT your password is accessible on your computer so only use this if you alone have access to your computer.  The ini file is kept in your default directory which is C:\StoreyQuickNotes\ by default.

SCHEDULE NAV LOCATIONS:

Here is where you can build a list of various schedules that you check on a regular basis.  The IMPAC interface for switching schedules is poor and this feature allows you to quickly scroll through any custom list of schedules that you reference in your workday.

Obviously I can’t know the names of the various schedules you want to quickly jump through so you have to build the list.

To build the list, open IMPAC and figure out the exact name of the schedules you want to quickly jump to.

Type those entries into this box.  1 entry per line – no trailing spaces.  No extra returns.  To be safe backspace to erase any trailing characters so your cursor would end at the ‘N’ in STATION in the example above.

This list will always be written to the ini file since it isn’t anything that needs to be protected or secure.

NOTE: If navigating between schedules doesn’t quite work, and you are left at the screen where you select the schedule, try the following work around:

End your selection in ‘:e’ – two characters, semi-colon then ‘e’.

For me, depending upon the Citrix client and log-in, sometimes a trailing enter is required and sometimes it is not.

HELP:

Brings you to this page.

REGISTER:

Brings you to the support page for StoreyQuickNotes.

STATS:

Dumps an easy to copy text file of your current usage statistics.

OK:

Proceed.

EXIT THE GUI VIA THE (X):

Exits the configuration and will exit the program.

In the last two months, I’ve learned quite a bit with respect to the code and language and how it flows and the code was restructured.  In places, it runs so much better, I had to slow the code down as I run on a Citrix network and there is some lag.

So the package now includes the General Navigation Package, better support for .ini file configurations for end users and other behind the scene tweaks.

I expect to work on the Nursing Package this weekend for a similar roll-out next week.

Backing up, last week I worked on integrating a few common tasks shortcuts into StoreyQuickNotes and today, I’ve rolled those packages out.  The results are pretty impressive with me using the Schedule Navigation shortcut around 30 times in the morning alone.

Basically, the shortcuts allow you to use the arrow keys to toggle which schedule you are viewing and to alter the days.

It is a small quick addition to the coding side but on the user side, it is now something that I’m going to rely on many times throughout the day.

HOW TO HAVE IT FUNCTION  IN YOUR CLINIC:

You must customize the 3 schedule names to match the names of the schedule in your Impac version.  I messed with trying to get this into a configure screen but it wouldn’t fly with Impac, so you are going to have to edit the code.

• Replace the names of my 3 schedules with the names of your three schedules
• Go in alphabetical order from your own personal list.
• If you have trouble, you might add a slight delay like I had to for my sim schedule

Here is a snipet of the AutoHotkey code:

; ***************************
; Toggle Schedule - shared
; ***************************
ToggleSchedule(state)
{
	if (state<0)
		state=2
	else if (state>2)
		state=0	

	if (!state)
	{
		Send {tab 9}
		Send 21a-nlr    ; Customize '21a-nlr'
		Sleep 50
		Send {tab}
	}
	else if (state=1)
	{
		Send {tab 9}
		Send nlr-nurses station ; Customize
		Send {tab}
	}
	else if (state=2)
	{
		Send {tab 9}
		Send nlr-simulation ; Customize
		Send {tab}
	}

	return state
}

#Up::
count_c:=count_c+1
count_total:=count_total+1
state:=state-1
state:=ToggleSchedule(state)
return

#Down::
count_c:=count_c+1
count_total:=count_total+1
state:=state+1
state:=ToggleSchedule(state)
return

#Left::
count_c:=count_c+1
count_total:=count_total+1
Send {tab 6}{enter}
return

#Right::
count_c:=count_c+1
count_total:=count_total+1
Send {tab 8}{enter}
return