copyright 2005, Welford Medical Computing, Inc. All rights reserved

AUTOMATIC RENAL FAILURE DIAGNOSIS (User's Manual, pgs. 866-867)

One handy new feature in version 4.7 is the ability to have the program automatically add a diagnosis of renal failure if you record a high serum creatinine or a low creatinine clearance for a patient who does not already have that diagnosis. The program will also automatically show you relevant Drug-Disease Alerts and record the diagnosis in the patient's Past History Expander as well as in the Diagnosis Editor. This feature helps to assure that each patient with renal failure is properly identified and treated.

The program allows you a great deal of flexibility in using this feature. Let's see how this works. First, we'll activate the feature:

1. Press System\Diagnosis Options or System\Lab Book Options.

2. Press the Automatic Renal Failure Diagnosis button.

3. Suppose you want the program to assign a diagnosis of renal failure whenever a patient has a serum creatinine above 2.0 mg/dl. In that case, check if serum creatinine is greater than and enter "2.0". (You may wish to use a more stringent or less stringent value; it's up to you). Using this is especially useful if you generally don't set the Abnormal Flag when using the Lab Book.

4. Suppose you want the program to assign a diagnosis of renal failure whenever a patient has a creatinine clearance below 50 ml/min (even if the serum creatinine is at or below 2.0). In that case, check if creatinine clearance is less than and enter "50".

5. Suppose you want the program to assign a diagnosis of renal failure whenever you record a serum creatinine in the Lab Book with an Abnormal Flag that is Moderately, Extremely, or Panic High (but not for just Slightly High), regardless of what the serum creatinine is. In that case, check if serum creatinine is at or above: and select Moderately High. This option is useful if you use the Abnormal Flag and set it based on the patient's expected creatinine clearance rather than purely based on the value of the serum creatinine. (For example, you might consider a serum creatinine of 1.5 Moderately High in an elderly woman and warrant a diagnosis of renal failure).

6. Suppose you want the program to assign a diagnosis of renal failure whenever you record a creatinine clearance in the Lab Book with an Abnormal Flag that is Moderately, Extremely, or Panic Low, but not Slightly Low, even if the clearance value happens to be above 50. In that case, check if creatinine clearance is at or below and select Moderately Low. This option would be infrequently applicable but you might want to use it in some cases.

6. If you want the program to ask you each time before it records the diagnosis of renal failure in the patient's Diagnosis Editor, check Confirm each time. If you would prefer to have the diagnosis added automatically without your being asked about it (provided the patient meets one of the criteria you have checked on this screen), then uncheck it. Most users will probably prefer to have it unchecked, but if you like to double-check what the computer is doing before it does it, check this option.

7. Press Ok to store your settings. (These settings are specific to each user).

If you want to see Drug-Disease Alerts when the diagnosis of renal failure is added, you need to have this feature activated. (Most users will already have had this activated). To set this feature:

1. Press System\Global Options.

2. Set Alert Severity to a level above No Drug Disease Alerts. You can choose whatever level you feel shows you the alerts you want to see without overwhelming you with so many alerts that you ignore them. Most users prefer Mild or above or Moderate or above.

3. Press Ok to store your choice. (This setting is also specific to each user.)

If you want to have diagnoses automatically added to the Past History Expander when they are recorded in the Diagnosis Editor:

1. Press System\Diagnosis Options.

2. Check Add to Past History Expander.

3. You can also choose whether you like seeing the diagnoses as a list of numbered items (Numbered List Format) or as a paragraph of text (Paragraph Format).

4. Press Ok to store your choices.

Now, let's see this feature in action. We will enter a high serum creatinine on a patient who did not previously have a diagnosis of renal failure.

1. Press View\Lab Book.

2. Enter a patient not previously recorded as having renal failure, e.g. Kelly Erickson.

3. Press Add.

4. For Test, enter CREATININE. For Result, enter 2.1. For Abnormal, select Moderately High. (Note that if you have previously specified a normal range for this test using Utility\Vocabulary\Range, the Abnormal Flag is filled in for you automatically).

5. Press Ok to store this result.

6. If you had checked Confirm each time, you are now asked if you want to add a diagnosis of renal failure. Choose Yes.

7. If Kelly has any active medications in her Medication Editor for which there is a drug-disease Alert with renal failure (e.g. probenecid) at or above the threshold you set in your Global Options\Alert Severity, then these alerts are now displayed for you. You may wish to contact the patient and change doses or discontinue contraindicated drugs, or arrange for a drug level if indicated.

8. Press Write\Diagnoses. Note that renal failure is now listed in Kelly's Diagnosis Editor. Press <ESC>.

9. Press Write\Expanders. Select Past History and press View. Note that renal failure has been added to Kelly's Past History Expander (assuming you had checked the Add to Past History Expander Diagnosis Option).

POP IN A TEMPLATE (User's Manual, pg. 865)

A handy new feature in version 4.7 is the ability to insert a Template into a document in the Writer without having to use the menu system and pick the name of the Template from your list (which can take some time if you have a very large number of Templates). To do this, simply type @Template followed by the name of the Template you want to use. If the name of the Template contains any spaces, replace them with the underscore (_) character. For example, to use a Template called "Male Physical", type "@TemplateMale_Physical" inside the Writer where you want the Template to appear.

Even better, to save yourself typing effort, define a Contraction to stand for the @Template<Template Name>. Then, all you need to do is type the Contraction, and it will be replaced with @Template<Template Name>, which in turn is replaced with the Template itself. For example (assuming you have a Template called Male Physical):

1. Press Libraries\Contractions\Edit.

2. In the Type in a Contraction you wish to insert/delete/change, type in "mpt" (for "male physical template").

3. In the Meaning box, type in "@TemplateMale_Physical" and press Ok.

4. From now on, if you simply type "mpt" in your note in the Writer, the Male Physical Template is instantly inserted in place of it.