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Chart problems - signed notes but thinking unsigned clinical list changes

Bugs, Known Issues, Open Cases

Last Post by Anonymous 1 second ago

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joeg1962

(@joeg1962)

Posts: 843

Noble Member

Topic starter

Post SP11, we are seeing more and more charts where although everything is signed, GE pops up and says the current office visit cannot be completed because of phantom unsigned clinical list changes.

Curious if this is related to the announcement a few weeks ago about 'hidden items' even though notes were signed. And, isn't there supposed to be a fix out for that by now?

For us, this is really beginning to significantly impact our ability to treat patients. If you can't sign the current visit because GE erroneously thinks that there are unsigned items, you are stuck until you have GE work through the matter for you.

I know CHUG asked for guidance on next project steps. But, GE needs to invest the resources and get these current operational matters resolved now. And it may be getting to that time for GE to step up with some 'mea culpa' statements, including what they are doing about this long-running mess.

Signed,

A customer who always thought GE had a decent product, but it was at least stable. And now, no longer even stable.

Posted : March 21, 2016 3:29 am

lrcarver68

(@lrcarver68)

Posts: 14

Active Member

The patch has been released and is available, we had ours applied last week.

Posted : March 21, 2016 3:34 am

dorotheatrusty

(@dorotheatrusty)

Posts: 148

Reputable Member

Based on the town hall meeting this is what GE said:

1. The patch would put the database back to previous state. Meaning we would not get as many pop ups stating the chart had unsigned clinical list changes. Just like how it was before where we would occasionally get a few. Possibly 1 every 3 or 6 months like we used to.

2. GE is also working on a script that we would need to run. the script will go out in the database and find the charts that were locked with SP11 and unlock them. If the script finds ones it cannot unlock, then we would have come up with a manual process to do so. Just like what we are doing now. At least the script will find them.

I reached out to GE for the script and was told it would possibly be available within the next 2 to 3 weeks.

Hope that helped.

Posted : March 21, 2016 4:40 am

dorotheatrusty

(@dorotheatrusty)

Posts: 148

Reputable Member

Just wanted to add we applied the patch and are still getting them daily. Apparently, Those are the ones we need the script to find.

Waiting patiently for the script.

Posted : March 21, 2016 4:41 am

jcollins

(@jcollins)

Posts: 107

Estimable Member

Doctor perspective: My notes look incomplete even thought the DB has been populated. I refer to my notes to make treatment decisions not the DB. This problem must be fixed immediately. Has been a scourge since SP 11. This is a major patient safety issue.

As for the dream directives on product development, no way to think into the future until stability and reliability become a current reality.

Shame on GE development team. Previously a very reliable product. Stewardship is a real responsibility to the current install base.

JJC

Posted : March 21, 2016 7:36 am

Palko

(@palko)

Posts: 132

Estimable Member

We are also in the same boat. We applied the patch but what has it done? Restored the db to what previous state? We need the script now. I keep checking here as I was told but no news yet.

Posted : March 21, 2016 9:40 am

Palko

(@palko)

Posts: 132

Estimable Member

We have applied the patch in our test environment but no script to my knowledge.

Posted : March 22, 2016 2:41 am

blackmanb

(@blackmanb)

Posts: 268

Reputable Member

Is this locked chart issue also a problem with EMR 9.8 sp 11 ?

Or only with the CPS 12 charts ?

Posted : March 22, 2016 8:54 am

Palko

(@palko)

Posts: 132

Estimable Member

I believe there are more clinical locks and locked charts in EMR Oracle than in CPS with SQL. That has been my experience in any event.

Posted : March 22, 2016 9:06 am

dorotheatrusty

(@dorotheatrusty)

Posts: 148

Reputable Member

Also, some of your orders may not be crossing over because of the locked chart issue. Clinical lists changes not being signed off.

Posted : March 25, 2016 7:48 am

justinbelcher

(@justinbelcher)

Posts: 130

Estimable Member

This appears to be a bug in the signing process. It is a major problem. When a note is signed sometimes associated data does not get signed. This leaves it in a dangling state, and depending on the data, can result in the "unsigned clinical list changes" message. Here are a couple examples I've seen:

1) OBS entries remain unsigned when the document is signed. You can see that Change=6, pubuser=0, and pubtime=0 in the OBS table. In a correctly signed document, the values will be Change=2, Pubuser=(document pubuser), and pubtime=(document pubtime)

2) I have seen a Problem fail to get signed. In this case, the entry in the Problem table has the same status as the OBS rows in the above example when the document is signed. But in this case, the problem ID remains in the masterlock column in the PatientProfile table. To fix this one, you need to fix the Change, PubUser, and Pubtime values on the PROBLEM row, as well as set the PatientProfile.masterlock value to zero.

I expect this might be happening with every type of chart data that is signed with the same process. That could include Medications and Allergies as well as Problems and OBS.

Posted : March 31, 2016 6:50 am

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