Canonical Sentences (Dr. Barker)

Another way to add items to a note is to insert options to specific paragraphs.  PowerNotes are divided up into “Paragraphs” and “Sentences”.  The Paragraphs such as “Visit Information”, “Chief Complaint”, and “History of the Present Illness”.  Paragraphs are separated by a clear space (that you can free text into).  Within each paragraph are a number of “sentences” separated by horizontal lines.  Below is the paragraph Visit Information and its five component sentences:

If you click on a paragraph’s name – an icon in the upper left appears.  You can also get this icon by clicking on a paragraph name in the light blue navigation pane on the left side.  Click the icon.

 

Close up of this icon:  

I am in the Physical Examination Paragraph, if you click it this “Insert Sentence” popup opens: 

These are sort of “developers tools” that were not used to build a particular note, but are available if you want to insert them.  They are called “Canonical Sentences”. Let’s choose the one that says “Feet” and click it – it will highlight in red and a check mark will appear.  Then click the single arrow at the bottom of the box (this is a scroll down one line).  Click the “Lines and Tubes” line it will highlight in red and a check mark will appear – the check by “Feet” will remain.  Now click OK.  The double arrows scrolls the choices by one whole page ~12 choices.  

Now what you have is the original Physical Examination Section with the two extra sentences “Lines and Tubes” near the top and “Feet” added near the bottom.

 

If we click on the chevrons to expand the Feet sentence content you get this which would allow you to document a lot of foot findings. 

 

Keep in mind that each paragraph has its own menu of canonical sentences – eventually you will get familiar with what is available.  Here for example is the second page of choices under the “Review and Management” paragraph.  When a canonical sentence has a chevron (right pointing arrowhead) as “Sleep studies” does here it means it has sub-sentences available.

  

You can, if you want insert more than one of these into the note. 

  

At this point you may be saying that this is an impossible amount of stuff to try to remember.  The logical thing to do is explore this as a tool – pick out the things that may be useful to you in your role and insert them and save it as a pre-completed note.  In this example if your work included reading sleep studies you would insert these sentences and then save the expanded template as a Pre-completed Note called maybe “Sleep studies”. 

These are just tools available to you.   You don’t have to use them.  But the best and swiftest craftsmen make the best use of the available tools.  

Dealing with Resident Notes- Comment Dr. Judy Neafsey

Jay, Thanks for the description for resident supervision.  I will pass it on to a few people and I agree if others find a better way--let everyone know.  My only question and I will also try tomorrow when I am in clinic--I didn't know you could strike through parts of the resident note already signed.   I thought you could only add the addendum.  Have you done it?  Also, if you just go to the patient chart in your list and open it I believe you can add the addendum even if they don't "endorse" it to you. This may mean more searching on the attending's part by sticker or patient list but still an option if not endorsed.   If this works well I would share it with all the teaching clinics and the specialists. It is possible to save an autotext of a couple different general attestations as well to put in the addendum. Judy

Dealing with Resident Notes (Dr. Jay H. Mayefsky)

Once a resident signs a note, it cannot be edited any longer (i.e. fields clicked on or text entered into the text of the note). All you can do is modify the note. This allows you to free type an addendum at the end of the note and to strike through parts of the resident note you want deleted.

 So this is the way I recommend to deal with residents:

1.       After the resident finishes seeing the patient, before he presents, he needs to “save and close” his note.

2.       The resident then comes to the attending to present.

3.       The resident should log on to PowerChart at the attending’s terminal (as well as the terminal in his exam room). The reason for this is so that the note may be edited if necessary and/or signed by the resident at the time of the presentation. If the note is opened in the attending’s version of PowerChart, the attending will become the author of the note and the resident’s name will be deleted.

4.       When the attending agrees that the note is complete the resident can sign the note. Upon signing, the resident in prompted for an “endorser”. He should type in or select the name of the attending to whom he presented. The note is then automatically sent to the attending’s “inbox” in PowerChart.

5.       The attending clicks on the inbox icon, double clicks on the note marked “pending”, and opens it.

6.       The attending clicks on the “modify” icon, adds the attending note, and then signs the note.

7.       The note is still attributed to the resident and contains the attending’s note and electronic signature as an addendum.

If you find a better way let everybody know.

Jay H. Mayefsky, M.D., M.P.H.

Professor of Pediatrics and Preventive and Family Medicine