3GeronimoPA Posted March 29, 2013 Share Posted March 29, 2013 Ok, these Army people are on crack. For those not in the know, the DOD uses AHLTA as it's EMR. In that EMR is the ability to + and - signs and elaborate in free text over a multitude of history and physical items. You can check 100 boxes for each part of the body or you could just check one box and free text. Not great but I favor the check a box and free text option because it allows me to do what I have to do, saves me from fishing for specifics etc. There is also an option to use templates. So if you have a standard H&P for URIs you can ask your questions, do your exam, select the "+" mark on what is positive and "Auto Negative" all of the negatives and essentially "Wham-bam-thank-you-ma'am" the common things as to not get hung up. I also am a fan of this system but I am told "only relics use that" and I don't consider myself a relic. For the not so relic-ish there are these things called AIMS forms which is a super-template apparently that has a special screen or some crap that allows you to free text in certain boxes and presents you standard "yes" "no" boxes and can be generalized to include your standard History and JHACO mandated items so you can keep the man off your back. These forms can also be made specific to address body parts or specific complaints. Again, I don't hate it but it is the second most (behind deployment) reason for providers getting out of the military. This is the EMR context. So Western Region Medical Command has decided that it is now an order to use "TSWF AIM forms" (a specific type of AIM form) specifically the "Core" form for all patient encounters. The TSWF Core has things like Advanced Directives, living wills etc... You know the stuff my 18 year old infantryman with knee pain really wants to talk about in his 15 minute appointment:O_O:. The cited reason is, "Everyone is switcching to this so providers all across the DOD can "Copy/Forward" your note". This is a coder's wet dream because it has all of the *** pain associated that is required to generate a high coding value and then providers can go back to being their lazy selves and "Copy Forward" someone else's initial *** pain. Thus, not only are they mandating a one size fits all template for babies, dependent spouses, geriatric retirees, and Airborne angry axis II Hooahs who want their knees to feel better so they can go kill something, they also are encouraging fraud and malpractice by way of this "copy-forward" business. I share a patient load with a General Medical Officer (A Doc who hasn't performed a residency yet) who is a smart dude but I don't even "copy-forward" his notes when I see a follow up from a patient he initiated. Why would I trust a provider across the US or maybe even the world and steal their note!? Worse yet, when you use the "mandatory form" you get garbally-guck about living wills etc all mixed in with your history. Its totally irrelevant and stupid. Then, to my chagrin, we got the "Soldier-Centered Medical Home" training which is the Army's stupid version of the "PCMH" which of course they inseminated it with their own idiocy so they could ride stupid ideas under the umbrella of national law. Then we got hit with the patient satisfaction stuff.... You guessed it, 20 year old Joe infantryman up here in Alaska who doesn't want to walk 10 miles in snow shoes at -20 degrees with 100lbs on his back up a mountain comes in for sick call is no longer allowed to be assessed and released to do the maximum amount he safely can do because his job is hard and he will complain as he always does that this PA didn't coddle him and encourage weakness. Now I must "delight him". Where in the world do they find these people with no idea what they are talking about and convince them that they should be the front runners on changing our system? Resignation letter is in the works.... Link to comment Share on other sites More sharing options...
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