NextGen Template Development

Mobile trends in the EMR market

2011-10-26T08:51:00.000-07:00

Why the need?

In the health industry, communication and efficiency are vital. A failure to communicate in a timely manner, in a thorough manner from provider to provider, or to communicate the correct information can mean the death of a patient, health complications that could have been avoided, lawsuits, and precious time lost. Lack of efficiency can result in drastic mistakes or oversights, wasted money for practices and hospitals, and poor patient turnaround, leaving other patients waiting too long to be seen and leaving patients unhappy with their care.

As EMR (Electronic Medical Record) solutions replace papercharts and forms, the potential for improvements in communication andefficiency is there, and doctors are seeking ways to make their chosen EMRsystem work for them. Currentlyrestricted to access/data entry from a desktop PC, many EMR users are seeingthe needfor increased mobility and instantaneous access to / communication with theEMR system that they use. As this needbecomes evident, it’s easy to see how the mobile trend that seems to overtakeevery market will spread also to the EMR world.

What’s out there?

Just because it’s not the standard, doesn’t mean it’s notout there. Software makers and thirdparty developers are already looking ahead, anticipating the need for a mobilesolution to EMR systems as the number of EMR users increases dramatically duenot only to the need for more efficient record-keeping in general, but also dueto new government mandates and incentives pushing EMR solutions for all medicalpractices and hospitals. EMR providerssuch as PracticeFusion, Epic,and GreenwayMedical focus on the Apple iOS platform, offering mobile access to clientsfor varying monthly subscription fees, often through secure remote accessutilities like Citrix. Though the directwindow to the EMR system and its capabilities is hugely beneficial, onceclients are ‘in’ to the system, the sophistication and simplicity that manyusers love about the iPad is lost, and forsome HCPs, that’s a huge drawback. There are native iPad apps that are, in themselves EMRs. Though there aren’t a lot of these options outthere just yet, apps likeDr. Chrono and Nimble can be attractive to those wanting to take fulladvantage of the iPad’s smooth functionality and interface. It’s a tradeoff,though, as current native iPad EMRs lack the complexity and functionality ofmore robust on-site EMRs. Currently,the most popular solution seems to be web-based EMRs that allow access from anyweb-enabled device. Most EMR providershave some sort of web-enabledor mobile optimized access as an option to their users. This is a start, though can pose problems asit depends on a secure internet connection. Without internet connectivity, access to the records are usually limitedif not completely restricted.

What’s not out there yet?

Out of all these options, what HCPs need that doesn’t seemto be out there yet are client server-based systems that work as a nativeapplication to the tablet operating system, whether that’s Apple, Android, orWindows based tablets, that also allow complete mobile access to the EMR systemthat the client has chosen. Many HCPshave already invested anywhere from thousandsto hundreds of thousands of dollars in their current EMR system, and areeagerly awaiting a sophisticated mobile solution.

Why I Blog about NextGen EMR

2009-01-09T10:22:00.001-08:00

For the past four years, I have been developing templates for NextGen clients all over the country. Template editing is a passion of mine; I've enjoyed learning the NextGen application and using the template editor to create templates that are being used by doctors today. NextGen has done a tremendous job giving their clients the power to improve and modify their current EMR environment, but developing NextGen templates can be a frustrating and time-consuming process. Once you understand all the features and functionality, and the way it communicates and works with the NextGen database, template development can become an art. It takes a deep understanding of programming fundamentals, user-interface design and intuition, and an understanding of the workflow of a medical facility to develop efficient and powerful EMR templates that can be easily used by office staff and medical providers. Template development is definitely not for everyone, a background in programming fundamentals (mainly, knowing when and how to use conditions, parameters, etc.) and SQL development is invaluable as the new working KBMs are released and more and more templates are dependent on stored procedures.

I encourage everyone with a desire to learn template editing to read my blogs, post comments, and use the NextGen user-groups as in excellent source for support. EMR Template Experts is probably the most powerful team of NextGen EMR experts in the NextGen consulting community, and we would be more than happy to help you and your medical practice with your EMR needs.

The purpose of my blogs are to provide a basic level of understanding of how to navigate and use the NextGen template editor. I will be going over all the icons in the toolbar, some good tips to know while developing, and some simple triggers that I use often. At this point I don't plan to blog on more in-depth and complicated subjects for the template editor because most people find that for most of their in-depth template development, an experienced NextGen certified professional template developer is better to customize their templates.

Template Editor: The Check Box

2009-01-07T11:10:00.000-08:00

Check Box

To add a Check Box to your template, select the Check Box button from the Fields toolbar and drag it onto the template design area where you wish it to be placed. Then from there you are given the Insert Check Box dialog pop up.

The first thing you want to do when adding a check box to your template, is to determine whether this check box has been used on another template or not. If it has been used before, choose the template from the Table drop-down list then select the field. If this is a new custom check box given a new field name, and use the prefix of chk_ at the beginning of all your check box field names. This is this is good development practice to get yourself in the habit of doing.

Select the data type that your check box is going to be.

Text:	Allows Yes (Y/1 value) or no(N/0 value) type of entry.
Numeric:	Allows you to check (1 value) or uncheck (0 value) to the field.

Below you can see that I am setting up a check box to find out of the user in involved in Scuba Diving activities. In the caption I have "Scuba Diving" and if the check box is selected the value recorded in the database will be "1", and if left uncheck the value will be "0".

Another way to achieve this would be to change the value type to "Text" and add the values of "Yes" and "No". Both method do the same thing, but as a developer I always prefer to see a consistant development method of 1's and 0's. Which ever method your pick - stick with it through out all your development.

I highly recommend to always use the numeric value as the standard selection for all your Check Box. It will make life much easier when going back and looking at the customized work you have done.

Then enter the X. and Y. positioning (if needed), the size of the Check Box, the style and alignment. Enter the caption you wish to be displayed on the template for the Check Box.
From the font and color tab you can change the appearance of the text that is entered into this field. On the Advanced tab, you have a Check Box to Copy Data Forward. The Copy Data Forward feature will only be used when you want them die you off this field to be copied from encounter to encounter. This is used in the OB office visit template under Initial EDD. When there are fields that don't need to be filled out for every counter such as the LMP, initial exam, ultrasound etc. you can click on the copy data forward to Check Box in this data will be copied from a counter to encounter.

Over the past five years of template development I have never used the Check Box for no zero decimals, or the action button drop-down, so I will not be going over these features.

Template Editor: The Edit Field

2009-01-06T17:39:00.000-08:00

The Edit Field

Next to the Label button, the Edit Field button is the most-used feature within the NextGen Template Editor. The Edit Field button is mainly for the user to enter data.

Using the same example as above, the patient's name will be typed into the Edit Field.

To insert an Edit Field, select the Edit Field button from the Fields toolbar and drag it onto the template design area where you want it to be placed. You are then given the "Insert Data Entry" dialog pop-up.

The first step is to define the Table if you are pulling an already-created Field from an existing template. From the drop-down menu, choose the existing template you're pulling from (if you're creating a new field then you can leave this blank). Below the Table drop-down, the Field drop-down is where you choose the field that you want to pull from the existing template that you selected to the new template you are editing. This can be a huge timesaver if used correctly. If you are not pulling from an existing template, you can type the name that you want for the new field you are creating. For example, on my new template I want to pull in the patient's date of birth. I know that the patient date of birth can be found in the "person" table by looking at the "Patient Demographics" template. So instead of re-creating that field I can select from the Table drop-down, choose the "person" table, and select the "date_of_birth" field.

If I want to create a new data entry field, it's good practice to first save the template with a unique name, then start the customization. To create a field, you have to give it a name. It cannot be more than 18 characters in length and cannot begin with a number. Since spaces are not allowed in the field name, use an underscore instead. It's always good template development practice to label your Data Entry field names with txt_ followed by the field name.

The different types of field types are:

Date:	A date. NextGen EMR verifies the validity of the date entered.
Decimal:	Decimal values. Only whole numbers can be entered into a numeric field.
Text:	Alphanumeric characters.
Time:	Time span measured in specific units. You must define the format of the time units to be entered. Click the time button to prompt the time format dialog.

You can also define the X and Y positioning of the data entry, the size, the style, and how the text will align.

The different style types are:

Normal:	A regular edit field where data is entered
Read-Only:	An Edit Field where data can only be read. No data can be entered via the keyboard; users may still enter data through the use of triggers.
Required:	A field that requires a civil action to be entered in order to save the entire template.

From the Mask field you can have the data formatted depending on what kind of information will be entered into it. If the field is going to be a phone number, social security, zip code, or a date, use the Mask field to have it automatically formatted correctly.

Select the Hidden check box if you wish to field to be hidden.

And finally, add comments about the purpose of this field when necessary.

Font and Colors Tab

Click on the font and colors tab at the top of the label properties dialog to change the label's font, size, style (whether you want it to be bold or italicized), and also the color of the label.

Template Editor: The Label Field

2009-01-06T15:02:00.000-08:00

Menu and Action Bars

When working with NextGen's template editor, the complexity of the work that you can create can be started at a very basic level by using some of the built-in editing fields, very few triggers, and no database custom programming. In order to get started with the template editor, it's important to know the purposes of some of the action fields that you can create. Let's go over how to use and when to use the NextGen field toolbars:

Label

Starting from left to right, the very first button we have is the Label button. A Label button is the simplest feature in the template editor to use. Basically, it gives a label to any element within the template.

In the example below, I've created a field for the patient's name. The label is what I've marked in the red circle. And as you can see, the purpose of this label is to let the user know that the field to the right will hold the patient's nam

When creating a label within the template editor, click and drag the edit button onto the template design area where you want the label to be placed. Then, you're given a pop up to define all the aspects of the label you're going to create.

The first box is the name that you want to give the label. In most cases, you can leave the default name that NextGen automatically assigns to a label. To the right of the name field is where you can apply a Mask to the label. The caption area box is what is going to be displayed on the label. In the example above, I have typed Patient's Name, and that is what's printed out on the template design area.

From this pop-up you can also determine the X and Y- positioning, the size, and the styles that you want to apply to the label. You can use a border, client edge, and modal edge.

Examples of each style:

Border:
Client Edge:
Modal Edge:

When the Tab Stop check box is enabled, it will allow the user's cursor to stop on this label as the user hits the tab key. The Hidden check box allows you to create a label that will not be visible when the template is opened on the EMR side. I use this feature a lot when I need to add comments to a template where I have done custom development, so I can go back and quickly know what work has been done. The Auto Size checkbox is used to automatically size the label to best fit the text inside the caption box.