Dr Welford's Chart Notes Program - Welford Medical Computing Inc.'s medical records software - Software Review - Evaluation

Journal of Family Practice, April, 1993 by Gary N. Fox

Dr Welford's Chart Notes Program (hereafter Chart Notes) is a computer-based medical records program designed for use primarily by physicians, both in outpatient and inpatient settings. The rationale for computer-based records is clear: they allow single entry of data into an integrated clinical information system that enhances care.(1) Chart Notes's numerous features, which fill a 420-page manual, clearly illustrate the potential of the electronic medical record.

Installation of the program is simple. Chart Notes's main screen presents multiple options on a menu bar. Options may be directly launched by pressing the option's first letter or may be selected by cursor keys plus Enter. The primary option is Writer, Chart Notes's embellished word processor, which is used to compose patient notes and "templates." Templates are repetitively used forms that can be placed into patient notes and appropriately modified. For example, templates for back strain, pharyngitis, and so on, would be useful in family practice. Marks may be placed within templates to facilitate customization. Users may jump from mark to mark with one key press. Multiple templates may be imported into one chart note.

Two of Writer's features, Contractions and Expanders, are especially helpful. Contractions are user-created abbreviations that, when typed, are automatically spelled in entirety. For example, after defining "history of" as "ho," typing "ho" (the space is critical) produces the phrase. Expanders allow easy insertion of patient-specific blocks of information, such as medication or problem lists, into notes.

Previous visits may be reviewed and, if desired, imported into the current note and modified to reflect the current visit. As notes are written, the program identifies key phrases and offers to automatically update allergy, medication, and diagnosis lists. Prescriptions may then be printed from the medication list. Routines for medication dosage verification and drug interactions are automatically performed as the drug information is typed into the office note. For frequently used medications, contractions can be defined to speed entry, for example, using "amo500" to produce "Amoxicillin 500 mg #30...."

The drug interactions feature is sophisticated and up-to-date, comparing favorably with other programs recently tested.(2) For each diagnosis recognized by Writer, the corresponding ICD code is listed in the diagnosis editor, invoked by one keystroke.

Chart Notes's numerous utilities facilitate charting patients' laboratory test results, producing automatic reminders, determining and entering dates, generating reports, timing follow-up visits, and finding ICD and CPT codes. Additionally, there is an extensive context-sensitive help system. A batch-file-like utility allows launching of other DOS programs from Chart Notes.

These features clearly show the potential of the computer-based record. However, version 2.13 still has some inefficiencies. Selecting and printing prescriptions require 5 keystrokes per medication: 50 keystrokes for 10 medications. If the medication quantity is other than a 1-month supply, additional keystrokes plus separate recording of the amounts dispensed are required. Additionally, obscure control-key combinations are used for word processing functions, such as marking and moving text. Chart Notes can be configured to run acceptably fast on a 80286-based computer, but users are sometimes forced through routines that can be annoyingly lengthy. After its title, menus, and windows for medications, allergies, and diagnoses, Writer's work area is 12 lines; an expandable work window would be a welcome addition.

Chart Notes fills a niche: it is affordable and DOS-based. However, it is complex, possesses a moderate learning curve, and, to suit my preferences and CGA laptop screen, it required notable customization. With refinement, Chart Notes may be useful to a wide range of users. The author is attentive to user needs and recognizes the realities of practice. With these attributes, Chart Notes should mature rapidly. Currently, I would recommend it for physicians who are comfortable with DOS systems and are interested in experimenting with electronic records at a reasonable price. Additionally, all who remain skeptical about the potential utility of computer-based records or do not understand how patient data may serve as the key component in an integrated information system owe themselves a session with Dr Welford's demonstration disk. Consider it 15 minutes of "future shock" prevention.

References

(1.)Dick RS, Steen EB, eds. The computer-based patient record: an essential technology for health care. Washington, DC: National Academy Press, 1991.

(2.)Fox GN. Drug interactions software programs. J Fam Pract 1991; 33:273-80.