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Ahlta

Discussion in 'Military Medicine' started by BomberDoc, Feb 27, 2007.

  1. BomberDoc

    BomberDoc ex-BomberDoc
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    Anybody else love the newest milmed productivity enhancer? My favorite are the contractors who keep explaining how much easier it is to use than a real chart. I wonder how much medicine they practice.
     
  2. colbgw02

    colbgw02 Delightfully Tacky
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    Agree that it's a pretty poorly designed system. It appears they did not consult a single clinician when designing it.

    Strangely, I've actually gotten pretty good at using it, but the real trick is to develop templates. With the right template, writing notes can be relatively easy. Unfortunately, I think it takes an act of God to get a new template put into the system.
     
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  3. i want out

    i want out Member
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    AHLTA (acronym for Ah, H#%$ Lets Try Again)

    I just love it when they tell you that the system isn't slow...

    or when they tell you that all you need to do to fix the system, is keep sending trouble tickets in. since when did software testing get added to my job description?

    i want out, and as far away from ahlta as possible
     
  4. USAFdoc

    USAFdoc exUSAFdoc
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    I remember watching the PGUI instructor (similar to AHLTA) show us how "wonderful" that system was. He pretended the pt was there for an asthma appt. I kept track of the time it took just for him (the specialist) to enter the info and the time the computer was "thinking" (hourglass sign). It took 7 1/2 minutes !!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    Now that is slightly more than 1/2 of the time alotted for an appt and that was only one problem (typical FP patients have 3-6 problems per visit).

    Now part of the problems was explained to me in the "hardwiring" of the system. But in the end, it does NOT matter what the cause of the problem is, the doc ends up having to deal with the result and the adverse effect on timely care.
     
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  5. DiveMD

    DiveMD Giggity giggity!!!
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    Well, in my command they apply "critical" patches every other day. HA!
     
  6. Gastrapathy

    Gastrapathy no longer apathetic
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    Yes, for coding purposes, they get pissed when I dicate notes and paste them in.

    BTW, just found this forum today, interesting read. Agree that AHLTA is a disaster, quality of housestaff is declining, not quite so glum about caseload (IM subs are still pretty darn busy, I'll have >2000 procedures before the end of fellowship). Kinda surprised that the xmilmd folks are so quick to jump on the studs, this is their forum after all.
     
  7. kzjonez

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    This is where the beauty of ALTHA lies , the system was NEVER designed to be user friendly to the Docs , it was designed to do away with transcriptionists and coders and to make it easier for the bean counter on top to keep close tabs on the slave workers in the clincs, of course seeminly saving some $$$ in the process. In the end the Doc becomes the coder/trasncritionist/Doc du jour with only one salary !! Now that's smart!!Separating in 2007 and will not miss a single thing including this 5 billion dollar monster called ALHTA.
     
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  8. OP
    OP
    BomberDoc

    BomberDoc ex-BomberDoc
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    BINGO! Yeah, I started this thread at work this morning while waiting 10 minutes for a template to load while the contractor stood there looking dumbfounded. We switched from paper charts to PGUI sometime in 05 as a bridge to AHLTA. I was the last holdout and management basically had to come down and hold a pistol to my head to get me to stop writing 600s. I still order things in CHCS and document it later in AHLTA when I get around to finishing notes in the evening. This is the biggest turd of a program I've ever seen.
     
  9. Mirror Form

    Mirror Form Thyroid Storm
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    Actually, it's a common misconception that the clicking is what's important for coding. But it's really not, all you need of clicking is the coding a/p and dispo. Then as long as the scanned note has whatever is necessary to back it up, it's fine.

    Basically, AHLTA works well as a data retreival tool. It comes in very handy when I get shipments of OIF soldiers w/o any hard records, but then find detailed notes on AHLTA. However, it's just too frickin slow to pass as a data entry system. They need to find someway to speed it up ten fold. Otherwise it'll just continue to be an abysmal drain on milmed.
     
  10. Mirror Form

    Mirror Form Thyroid Storm
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    One contractor explained to me that the reason doctors didn't like it was b/c they were just older doctors who didn't know how to use computers. They were positive that the newer generation would love it! Sad but true.
     
  11. AF_PedsBoy

    AF_PedsBoy Stuffed Animal Overlord
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    I really like how my one page notes now span 5 pages of crap. When I read other peoples' AHLTA notes I read the first few sentences which may or may not describe the problem, and then skip to the last paragraph with the assessment and plan. Everything in between is just pure crap.
     
  12. USAFdoc

    USAFdoc exUSAFdoc
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    can you say that the contractor was WRONG on all accounts !

    how many "older" docs does he think are still in the military seeing patients?
    Just about every doc I know/knew was on his/her first/last tour in the military waiting for DOS.:laugh: yes, sad but true.:smuggrin:
     
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  13. OP
    OP
    BomberDoc

    BomberDoc ex-BomberDoc
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    I'm not exactly an older doc. I've been out of med school 4 years and consider myself fairly computer savvy (started with a TRS-80 and have been playing with computers ever since). This is why I know AHLTA is unacceptably slow among other complaints. I haven't met an AHLTA contractor yet that I would hire to help anybody program their VCR. The sad thing is that they probably believe the garbage fed to them in their training on the system.
     
  14. Capt_Mac

    Capt_Mac Member
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    There is actually a way for you to do your own templates, and yes, this is the way to go. We have been getting AHLTA savy in our program b/c with BRAC comming down the line they will be allocating funding and space based on RVU's. We have found several legit ways to maximize RVU capture through AHLTA and hopefully this will translate into more $$ for our department.

    It is just like any other system you have to learn how to play the game, once you do, make it your boy!
     
  15. USAFdoc

    USAFdoc exUSAFdoc
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  16. Milrad

    Milrad Junior Member
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    I love it...Radiology...don't have to use it....
    Everyone else hates it.:D
     
  17. kzjonez

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    This is what I have been doing to save some time and keep my sanity.I use the add note function type my note in, enter the dx in a/p do my own coding in disposition and out it goes !! For entering orders/ consults and the likes I use CHCS1. It sucks!! but it saves me some time and my notes make sense to me and the next provider seeing my patients. No clicking my way to a 99214/5 . I have plenty of templates but I find they carry no info and have no meaning. Just my two cents.
     
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  18. AF_PedsBoy

    AF_PedsBoy Stuffed Animal Overlord
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    My only issue with entering orders in CHCS1 is it is WAY faster but then my A/P gets lonely without an attached order...

    Oh and for new users, if you're trying to add a consult and it keeps kicking it out, 95% of the time you can fix it by adding a med first (I like rectal tylenol), then adding the consult, then go and delete the med. Ha ha of course the fact that I have to do this to work around the bug lets you know how screwed up AHLTA is in the first place...
     
  19. Out in 2008

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    It's like a game where the more stuff you click the more points you get so all the useful info is buried in a bunch of gobbledegook. Maybe if + findings automatically came out in bold or red or something. I free type most of my notes except in the few cases where I have some good templates.

    I also never log off my computer because every time AHLTA gets updated, it freezes up for 2 or 3 days.
     
  20. OP
    OP
    BomberDoc

    BomberDoc ex-BomberDoc
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    Make sure your techs close out of the encounter after entering their portion, vitals, etc. If two users have the same patient encounter open, stuff disappears and nothing synchs up. I hate getting to the "Sign" module and seeing a lot of blank space where my note is supposed to be.
     
  21. ToeCutter

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    I gotta tell ya I may be in quite a small minority here but AHLTA is working just fine for me. I enter my S/O free text - maybe with the DX Prompt - then enter a diagnosis, code and go. It is in some ways easier than the EMR at my civilian hospital. Still miss the dictation days though :D
    A good point was made about AHLTA and bean counting - it really isn't for us - it's for future data mangement mining.
    Everybody's going this way. Paper charts are just going the way of the buggy whip.
    The speed of AHLTA is pretty quick where I am but not at my last command. I've been told the command "globbed on" to AHLTA's T1 line. This line was put in during implementation solely for AHLTA usage but many commands also use this for their inter/intranet and it gets jammed with everything from streaming media (my ITunes...sorry) to interoffice e-mail shenanigans.
    Also, I can't work CHCS1 to save my life - that black and white screen mocks me like my wife does when I try to sexy dance.
     
  22. Perrotfish

    Perrotfish Has an MD in Horribleness
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    Isn't there some off the shelf software that could replace this program that most everyone seems to hate? I know my HMO doesn't use paper charts anymore, and it just seems sorta strange that the military would insist on inventing their own systme.
     
  23. a1qwerty55

    a1qwerty55 Attending
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  24. a1qwerty55

    a1qwerty55 Attending
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    But your HMO doesn't have a global system. So far I know of no system where let's say a doc in Kaiser California can see your note from Kaiser in another state. The VA can't do this either.

    The military also has their own agenda, data mining, information security etc.

    Lastly, there is a lot more money to be made by the big military corporations when you have to build something for scratch. Congress likes corporate welfare.
     
  25. i want out

    i want out Member
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    Another part of why AHLTA is such a pain in the @$$ is that it was designed to be able to work with several different pre-existing military programs like SAMS, CHCS, and DEERS, among others.

    The requirement to make it backward compatible with so many old systems was and is a really difficult if not impossible.

    Then you add that it came to market before it was ready which means its being beta tested in the marketplace...

    i want out (of IRR)
    happy that AHLTA and TMIP are only a memory for me.
     
  26. Mirror Form

    Mirror Form Thyroid Storm
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    Are you a physician? What field are you in? This is just such a strange thing to hear any provider say. BTW, what do you do for notes where the standard of care would be to document the information as a picture? For example, as in procedures notes? Do you scan in all your ancillary studies? If you do you'll find those patient's charts getting VERY SLOW soon.

    Also, do you follow any patients for long periods of time? Do you really think it's easy to use AHLTA for data retrieval? It's useful for OIF soldiers and for patients you've never seen before. But it's 10x slower than a hard chart for looking up information for a patient that I see regularly.

    And oh yeah, I've seen wonderful civlian EMR systems. Fast, well organized, error free. AHLTA is an F'ing nightmare. I spent 4 hours today just doing charting half of my already written notes from last week.

    Of course EMR is the future, but it's going to be nothing like AHLTA. There are plenty of well written EMR's out there that aren't a huge threat to patients like AHLTA. And no, in real hospitals coders don't call all the shots and get to pick out the EMR. Coding is important, but the systems are designed around efficiency for the doctors, which leads to more productivity.

    Well it's abysmally slow at all four hospitals I've used it at. I don't see how it possibely could be fast when it frequently takes up 800 MEGS OF RAM. And my F'ing computer only has a grand total of 500 megs of ram. So you can imagine how well it runs. What a fcking poorly programmed POS!


    CHCS1 is incredibley fast once you learn it. And if our front desk staff can learn it (these aren't brain children) you should be able to pick it up too.
     
  27. Mirror Form

    Mirror Form Thyroid Storm
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    you mean alpha tested
     
  28. OP
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    BomberDoc

    BomberDoc ex-BomberDoc
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    I asked for a CHCS terminal in my office. The systems weenies promptly refused. I have a CHCS interface still on my desktop from before PGUI and AHLTA were rolled out at my facility. Since CHCS is soooo much faster, I use that for the vast majority of my orders and for looking up labs. Because AHLTA relies on CHCS, it is valuable to learn and become proficient at CHCS as it isn't going away anytime soon.
     
  29. ToeCutter

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    I've used the Dragon Natually Speaking program for my notes and don't really think it's any faster than typing free text. The novelty is quite cool at first but if you can type at all - Dragon will slow ya down. You also have to program the thing to heck and back - but I do know some folks that swear by it.
    Maybe the speed of AHLTA is better here 'cause we have 2Gigs 'o' RAM on our computers.....I dunno. 500Megs is not a lot - if you use AHLTA and have anything else on (even e-mail), I think this goes over the limit of what 500Megs can handle.
     
  30. Heeed!

    Heeed! On target, On time!
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    I'm glad it's pen & paper for anesthesia!
     
  31. Mirror Form

    Mirror Form Thyroid Storm
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    That's what all the computers in my dept have (and in most other dept's in my hospital). AHLTA doesn't just use up more than 500 megs when you have both it and something else open. AHLTA uses up well more than 500 megs when JUST IT is open (this occurs the second i open a patient's previous encounters and click view all). How many other programs use 800 megs of ram? AHLTA is just horrendously written.
     
  32. ILUvRVUs

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    I hate AHLTA for so many reasons....

    Today I hate it because another HM? gave another patient the wrong diagnosis.
    These "diagnosis" stay on the "problem list" forever. Where is the accountability? "Hyperthyroidism" for someone who got screening TFTs 2 years ago (normal). WTF. Many many many minutes of staring at a blank screen in between each and every note looking for the answer!
     
  33. Perrotfish

    Perrotfish Has an MD in Horribleness
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    It's funny, I think AHLTA is the most universally despised part of military medicine. Anything else: GMOs, Base Locations, volume of procedures, whatever, you'll find someone who had a good experience. AHLTA the opions just seem to vary between 'it's pretty bad' and 'I'm armed and hiding outside the programer's house'.
     
  34. Mirror Form

    Mirror Form Thyroid Storm
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    LOL, if you're writing an ortho note, which consists of about 3 lines, then sure, AHLTA will be fine. It's well known that if you have a patient who's otherwise healthy except for one common chief complaint, then AHLTA works okay. That describes the vast minority of patients in most fields.

    My patients virtually never fit into any template b/c they have too many different things going on. Furthermore, my field frequently requires documenting things with drawings, ancillary studies, etc., that AHLTA is horrendously slow with.
     
  35. ILUvRVUs

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    I am happy that it is working for someone somewhere. Really some clinics are great to work in.

    For the GMO's in the understaffed MTFs it is the nail in the coffin. A 20 minute double booked time slot was hard enough with paper records. In my clinic it is VERY slow. Sometimes it just shuts itself down in the middle of a patient encounter which then takes 5 minutes to re-start. Even the IT guys just shake their heads at it.

    We have non-providers making inaccurate diagnosis. Yes, they can be erased and should be. But as a GMO/PCM evaluating a patient for duty each problem has to be addressed. The patient may not know what their medical history is/should be. 20 minutes is not enough, not even close.
     
  36. FutureNavyFP

    FutureNavyFP Newbee
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    I wonder why they just didn't use the VA's electronic record system (CPRS). I used it for a few months and I thought it worked great. :confused: They could have expanded the contract, and the pts records could seamlessly shift over when they got out/retired.
     
  37. Mirror Form

    Mirror Form Thyroid Storm
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    I've seen EMR's specifically designed for my field that have fast, wonderful, and very accurate tools for drawings. These are used by the private sector very efficiently. Even other public hospitals (I've worked at several) have MUCH better EMR's than AHLTA.

    If I hadn't seen how much better and faster these other EMR's are, I might be a bit more tolerant of AHLTA. But it's just a complete POS w/o any excuse.
     
  38. edmadison

    edmadison 1K Member
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    Using Ahlta is like swimming with a 10 lb weight belt on.

    As primary care docs, we already have too little time to do what we need to. 20 minutes for a well child check, including counselling? I hate having to bring people back to give them advice on minor things like toilet training. I depend on easy visits like ear infections and URIs to catch up. But I can't if I'm using AHLTA. AHLTA costs me time. I once used a stopwatch to time documenting an entire easy encounter -- toddler with AOM. It took 7 minutes for me to complete it. I had an AIM form, but AHLTA gets hung up between screens. I sit there with my thumb up my butt waiting for it to go from the S/O screen to the A/P screen. I could dictate the same encounter and still hit all of my 13 or 14 requirements, but it would only take me 3 minutes. This may not seem like alot of time, but when you're doing 24 appointments or more daily this can result in an hour or more time.

    As someone already noted, however, If the patient has more than one problem, you really have to free text it. I type fast, but I can still dictate much faster. Oh well. I'm glad that the Army could save some money by getting rid of transcriptionists.

    Ed
     
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  39. a1qwerty55

    a1qwerty55 Attending
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    If it were fast, it would be much much better. Supposedly this will be better, but I'm not holding my breath. The speed thing is a killer for me as well.

    On a positive note, I've seen some screenshots of the 3.3 version coming out this summer and many of the above criticisms are addressed examples being addition of a drawing module, the ability to do T-Con's on one screen, among other improvements. I'm not selling the thing but it is, very slowly, getting better (I hope)
     
  40. deegs

    deegs Member
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    I've seen optho notes that look a lot like scans (complete with what look like pen and ink drawings) of their clinic overprint. not sure how they do it. i've also seen neurologists and ob/gyns that are doing their notes in Word and cutting and pasting them into the note (shows up as a different font). Helps with the speed/spelling......
     
  41. i want out

    i want out Member
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    They didn't get rid of transcriptionist, they are just using you to do that job.

    It doesn't cost them anymore money because your already bought and paid for, but it allows them to cut your support staff and then you have to do their job also.

    i want out (of IRR)
     
  42. NavyDMO

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    Its true! Even the corpsman are suffering too. It has doubled their work load as well. I have done paper versus AHLTA at my clinic and paper was by far better for everyone involved. AHLTA is the ATARI EMR while MAC OS EMRs are on the market.
     
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  43. Mirror Form

    Mirror Form Thyroid Storm
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    A few good ones are NextGen, MedFlow, MdTeknix, Medinotes, etc. The ones I've seen that are the best for drawings allow you to just drag and drop everything you want onto your picture. Of course they're designed by smart people and customized to each individual specialty. Therefore they work very well. Whereas, AHLTA initially had some horrendously slow drag and drop feature that took 30 seconds of watching the hourglass for each item you dragged. And b/c it was designed by idiots the pictures never looked any good anyway.

    Also, the good EMR's allow all pictures, scans, and ancillary studies to be immediately uploaded into patient's chart. With AHLTA you have to scan each image in individually, and then copy them into a notes individually, and pray that AHLTa doesn't generate some random error message when you go to save the note. Unfortunatley, this takes forever, and worse, there are multiple errors when you do it. And even worse, the system has a systemic flaw in the way it loads patient's files. So the more scanned images, the slower and slower it runs until it crashes.

    I scan my notes in myself. AHLTA was supposedly designed to allow things to be scanned in, but it only accepts very random formats. Also, if you try and scan too much it just crashes and erases everything. I've had multiple times where I scanned notes in, and it appeared to go well. And then the next day the scanned images had disappeared. Go figure. Half them time they'll later magically reappear.
     
  44. edmadison

    edmadison 1K Member
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    As long as we're ranting here about AHLTA, I'll tell you another huge defect. There's no pediatric immunization module. I'm a former computer programmer, I can tell you that a module to track immunizations would be trivial to design and program. Do we have one? No. I've spent much time reviewing records to find out what shots kids have had. We give quite a few and, of course, they can't use on post day care without updated immunization records. Peds makes up a pretty big chunk of the outpatient visits in the military. Oh, and don't even get me started about growth charts.....

    Ed
     
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  45. Mirror Form

    Mirror Form Thyroid Storm
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    If you don't it only accepts very random formats, wait until you try and save your note with the scanned image. You'll just an inexplicable error message.
     
  46. BigNavyPedsGuy

    BigNavyPedsGuy Junior Member
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    No kidding - most palm pilots can give you a growth curve why not an 8 bajillion dollar computer program?
     
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  47. a1qwerty55

    a1qwerty55 Attending
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    From what I am told, growth charts, drawing tablet, and a single screen t-con interface is in the new rollout which is coming this summer.
     
  48. IgD

    IgD The Lorax
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    We are all part of an experiment that was created by mice. The mice purposely rolled out a flawed EMR (AHLTA) in order to assess our responses and problem solving ability. Could there be any other explanation for why it exists as it does???
    :)
     
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  49. J-Rad

    Physician Moderator Emeritus Verified Expert 15+ Year Member

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    OK I am NOT an AHLTA fan, and I have already encountered some things I hate about v3.3 (just rolled into my clinic, and I'm sure I'll find more things to hate as time rolls on), but:
    Yes, growth charts and a drawing module are included in 3.3

    And in the old AHLTA there is a place to follow imms (at least at my facility): under the immunizations in the tree on the left and then under the "vaccine history" tab (which is not the first screen you see). When I looked at my own record it had everything back to 1995, given by AF facilities and Navy facilities (I mention that because USAF uses there own tracking system as well)
     
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  50. edmadison

    edmadison 1K Member
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    Hmmm, it sounds like that may be linked to MedPros. In any event we didn't have anything for kids at MAMC. I remember what they told us to do for growth charts. There was a module that would plot some points on a scanned in chart, but you had to type the data from each visit every time! Meaning you had to totally reconstruct the chart from scratch on each visit. I'll just keep my hard chart thank you very much. I also whether the new module will let me correct for gestational age of premies -- oh that's too much to hope for.

    Ed
     
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