Longitudinal Experience in Doctoring 3
Using an Electronic Medical Record System to Manage Chronic Disease
SOAPware
Expectation of Students
As a part of the longitudinal experience of Doctoring 3, build a complete medical record in
SOAPware on 6 patients in your longitudinal panel.
Students will work with their faculty to develop a panel of 8-12 patients who have chronic
diseases and select from panel of patients 6 patients that have the same chronic diseases,
preferably from the following list:
• diabetes, asthma, hypertension, hyperlipidemia, CHF, osteoarthritis, depression, obesity,
ADHD
If the longitudinal faculty member is not in a specialty that treats these specific diseases, the
specialists can choose 6 patients with chronic illness typical of their specialty. For pediatrics,
well child care of a newborn to 3 years will qualify. For OB, prenatal care for an entire
pregnancy will qualify. Keep a paper list of these six patients in a secure location in the clinic
and indicate on the list the fictional name you assign each patient.
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When you have an encounter with a patients that seem to be likely candidates for
a member of your panel, create a chart in SOAPware using the demographics
and document the encounter in SOAPware. After their second visit, confirm the
patient as one of your 6, then populate the Summary page. The Summary page
should be living document that gets updated with every subsequent visit as
medications, problems, etc. change.
Pick one chronic condition per patient to track in the EMR. List this disease
first in the Problems List, indicated with a *. Mine chronic patient’s chart for
information pertinent to their chosen chronic illness.
We will attempt to determine if this patient was one used by a student last year,
and import their chart into your records so you can use the data they collected.
Utilizes the health maintenance reminder systems, disease flow sheet, vital
signs, etc. to manage the patient’s chronic condition.
a. Identify the elements that will need to be in each patient’s reminder system
(both disease specific and health maintenance) and set up the patient’s
reminder system. Consult with your preceptor and guidelines to determine
the frequency with which these should be done, then check for the dates last
performed in the patient’s record.
b. Select a pertinent Flow Sheet to use with this patient’s problem. Modify if
needed. If a Flow Sheet does not exist for the problem you have selected to
follow, let us know what you need on it and we will help create one. Find
historic data from the patient’s chart (labs, vitals, meds, notes) to complete
one column dated prior to your first visit for comparison purposes.
Document each encounter with these patients by creating a new Encounter Note,
updating pertinent parts of the EMR throughout the year.
Remember that we will be monitoring your entries so you can not use patient
identifiable data (name, birth date, address, SS number)
All other chronic disease panel patients seen during longitudinal clinic will need
their encounters entered into CDCS at the beginning. Do not document patients
with acute problems who are not a part of your panel in CDCS. Once a patient
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has been identified as one you will document in the EMR, you can stop doing
CDCS entries on that patient.
Once per month, during the first week of each month starting in September,
export your medical records for patients that you are sure will be in your pane of
6 from SOAPware (see directions) and upload the file to the SOAPware intranet
site for your regional campus.
Each Visits with Patients on Panel:
1. Create a new column on the Flow Sheet for the chosen disease and complete with
findings, labs, etc for visit.
2. Create progress notes for each visit. We will use these progress notes as evidence of
continuity with the patients in your panel.
3. Update appropriate health maintenance reminder system, medication, problems lists and
so forth based on new information that has come in since last visit.
4. Deal with specific delinquent health maintenance items with your faculty member’s
supervision and approval.
Bring your computer with you to your longitudinal and use it while seeing the patient to help
guide your care. You can also load M-Business desktop on your computer and use it to
document in the CDCS system.
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Starting and Stopping SOAPware
Close all other running programs prior to starting SOAPware
as it needs all the resources on your laptop to run.
Run StartSOAP icon on your desktop.
If it asks: your UserID is your FSU CoM account UserID; ie,
nbc05a
The password is also your FSUCoM account UserID—not
your normal network password; ie, nbc05a
Click Login
Once you exit SOAPware, click the StopSOAP icon on your
desktop to stop the MSDE SQL database from running to
save memory.
Create a New Patient Chart
To Create a new patient,
1. File Menu
2. Chart Rack
3. Create Chart
HIPAA compliance measures: Due to the lack of
encryption of SOAPware patient data to be stored on
the student laptops, we will have to make sure that
there are no patient identifiers in the medical records.
When a New chart is created, the Demographics
screen comes up. Complete the form in the following
manner:
Chart Rack
1. Last Name: Use the last name of the
student.
2. First Name: Use one letter or name starting
with A for the first patient, B for the student’s
second patient, C and so on.
3. SSN: Either leave blank or put in a fake one.
4. Chart#: There is space for 11 characters.
Use this to help you identify your patient.
Start with the initials of the student followed
by the age of the patient, a letter that stands
for race, and a letter for gender, and the
number of the month and day of your first
visit. Example: NBC30WF0914 This would
translate to the student being NBC, the
patient being a 30 year old white female
whose first visit with the student was
September 14th. We need to try to avoid
Demographics
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having the same patient number assigned to two patients. That would mess up the
system when the patients are synced back to the server.
5. Date of Birth: Use January 1 of the year that the patient was actually born in. This
helps the program assign the correct age to the patient for health maintenance
purposes. If this is a child, it may be necessary to pick either Jan 1 or July 1, so that
the age is close for the health maintenance immunizations tracking and growth charts to
function correctly.
6. Gender: pick the correct gender of the patient
7. Primary Physician: Make sure student’s name is there.
8. Marital Status: Select the patient’s correct marital status.
Remaining fields can be left blank or filled with made up information. Do not put the patient’s
real information in these areas. Click OK when finished. You can come back later and add
information to the patient’s demographics.
The new Chart will open automatically. HIPAA mandate: In the chart, no text entries
should/will contain the patient’s name, real date of birth, city, or the name of the clinical faculty
in whose clinic the patient is seen. Students will be cautioned to only refer to the patient as “this
patient” or “This 30 yr old white female…”
Tabs
Summary side
SOAPnote side
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SUMMARY SIDE
Second Visit with Patient on Panel
The student should obtain from the patient (and
confirm with paper/clinic record) a complete
history and complete the following sections in
the medical record Summary:
 Active Problems List
List chosen condition to track first and
indicate with a *.
Identify STABLE PROBLEMS: and
UNSTABLE PROBLEMS. (note: select
diagnoses from the Assessment Codes list
with ICD-9 #s. See Assessment Quick Keys
below.)
 Pertinent Inactive Problems
 Surgeries (include dates)
 Medications List (confirm with paper/clinic
record) Identify RX:, OTC: and
Suppliments/herbals. Can be picked from
View > Codes List > Medications. Make
sure that there is an appropriate problem in
the problems list for each medication listed
in the medications list. (medicine
reconciliation) Also identify any potential
drug/drug interactions.
 Family History Use Family History Template: quick keys FHx followed by a space
for adults, GeriFHx for geriatrics, and type in who, relationship, at what age, etc.
 Tobacco indicate smoking status
 Alcohol there is a quick key for CAGE
 Interventions These are items like immunizations, diagnostic tests, health
maintenance reminders. See example in sample at right. Indicate here if an
advanced directive is on file. Documents can like a living will can be scanned and
added to the record under the Reports tab, Misc. Reports.
 Social History Use quick key sochx for adults, GeriSHx for geriatric patients.
Common Assesment Quick Keys (type words on left and press space bar to unlock)
Quick Key
Description
artost
ast
bacpai
cad
chf
copd
cysfib
dep
dm2
gerd
hamig
herlos
htn
hypl
obe
Arthritis, osteoarthritis #715.90
Asthma, unspecified #493.90
Back Pain #724.2
Coronary Artery Disease #414.9
Congestive Heart Failure #428.0
Chronic Obstructive Pulmonary Disease #496
Cystic Fibrosis, staging not determined #277.00
Depression #311
Diabetes Mellitus Type 2 #250.00
GERD – Esophagitis, reflux #530.10
Headache, migraine #346.90
Hearing Loss NOS #389.9
Hypertension, #401.9
Hyperlipidemia #272.4
Obesity #278.00
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obemor
ost
ra
Obesity, Morbid #278.04
Osteoporosis #733.00
Rheumatoid Arthritis #714.0
See all Assessment Codes under View Menu, Code Lists.
ROS: Use for a complete past medical history. As review of systems changes often, not
required to be a ROS. (quick key rosextend). For pediatric patients, this is a good spot for
things like birth history.
Physical: Document a complete baseline physical in this section once you have had the
chance to perform one. Several quick keys bring up templates for a complete physical
exam: px is an extended physical exam template, GeriPE is a geriatric physical exam.
Using (+) (-) and __
The underscores are designed for easy completion of templates. You can use F12 to jump
from underscore to underscore to type in findings. Also, by clicking on an underscore, it
changes it to a (+) or (-). The (+) will print as either “reported” in the Subjective field or
“noted” in the Objective field. The (-) will print as “denied” in the Subjective field and “ABN
not detected” in the Objective field. One should replace the under lines with either text
(typing) or change to a (+) or (–) if addressed in the visit.
Delete All Underlines
When the documentation is complete, to delete unused sections of the expanded quick keys,
under the Edit Menu is a “Remove All Underlines” command which will delete all text
between periods where an underline appears unchanged.
Entering Vital Signs
1. Click the Vital Signs tab,
2. New Column,
3. Enter Vital Signs for that day in the
format specified.
4. BMI is calculated from the Height
and Weight of the patient, so always
enter the height of the patient.
5. Click OK.
Vital Signs Window
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Create a New Encounter SOAP note
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
File Menu
New Encounter.
When the new note opens you will see a blank
encounter note
Complete the note. There are a lot of quick keys
that will make completing the note faster.
Save typing meds and problems list
 Under Edit menu are the commands
SOAP to Summary and Summary to SOAP. This
sends the contents of the Meds List, Problems list
and physical exam to the note.
 Cut (CTRL-X), Copy (CTRL-C) and Paste (CTRL-V)
SOAPnote
work in SOAPware just like Word or PowerPoint.
 Right click in any area to get the Codes List of
quick keys for that section.
 Do not use the comlete SOAPware templates for
encounter notes. If you want to create a template,
however, it is allowed for you to use your original template.
Print
Printing the note shows you how the note looks with the (+) and (-) replaced by the words either
denied, reported, observed, etc. You can choose to Print Preview the note and not send it to
the printer, but store it instead.
Signing the Note – Recommended to Not Sign Notes
Electronic Signatures: Once the note is complete, you have received feedback from your
informatics curriculum director and made modifications to it, you can electronically sign then
print the encounter. Signing the note finalizes the note and changes cannot be made to the
note after you sign it. This is under the File Menu. You can leave a note open and sign it
days later if you wish, even close and reopen the chart. The note will be there waiting for
you in your To Do list (under File Menu) with all other documents needing signatures. So do
not sign until you are through with the note. It will sit in the record unsigned.
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Chart Browser
All Messages, Reports, Encounters and Flow Sheets tabs on the Summary side of the screen
open the Chart Browser shown here, which organize these entries and saves them by
date/time.
Chart Browser
Flow Sheets:
Flow sheets allow you to follow all the aspects of a chronic disease in one place. Here is where
the patient’s disease progression can be viewed and graphed. They can pull data from different
areas of the record like vital signs and health maintenance items. We will use Flow Sheets
instead of the Lab Reports used last year to record
patient pertinent labs.
To insert a Flow Sheet, in the
1. Chart Browser tab
2. Flow Sheets
3. New
4. Pick from list of available Flow Sheets.
a. Pick the Chronic Disease of your
patient you are choosing to follow:
ADHD, Asthma, cystic fibrosis, CHF,
HTN, hyperlipidemia COPD,
depression, diabetes, obesity,
osteoarthritis
b. lab panels: lipids, LFT, CBC, basic
metabolic panel
c. growth charts, etc.
5. Be patient, these are slow to come up.
6. In the chronic disease flow sheets, if you have
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entered vital signs, a column will be created for you. Complete the column with findings
for current visit.
7. If no column is there, click Add Col, putting in the date of the visit, and complete with
findings for current visit. Use this same flow sheet to follow the patient’s progress,
adding columns with each visit.
Hyperlipidemia Flow Sheet
You can select from one of the Flow Sheets for each of the diseases. There are some pediatric
growth flow sheets, diabetes, hyperlipidemia, and several other chronic diseases.
Customizing Flow Sheets,
1. View Menu > Customization Wizards > Edit Flow
Sheets.
2. To Add or modify items on an existing flow sheet,
a. Click on the Flow Sheet you wish to edit, then
click Edit
b. Pick an item on the left that you want to
remove and click on it. Click the -> button.
c. Pick an item on the right that you want to add
and click on it. Click the <- button.
d. If the item you want to add is not on the list at
the right, click Manage Items.
i. Click New
ii. Complete the form at right. This can
be a number, a pick list in which case
you will need to add items to pick from
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at bottom, Start/Stop which gives you only those options, or just a text
box to write in.
iii. Click OK
e. Then add the new item to the existing Flow Sheet.
3. To create a new Flow Sheet, on the Edit Flow Sheets screen
a. Click Add
b. Type in the name and description of the new Flow Sheet, and click
c. Select items on the right and click the <- to add them to the new Flow Sheet
d. Items that start with Lab are pulled from the Lab Reports section. This would
require you to complete a Lab Report on each lab finding. Use lab tests that
don’t start with the word Lab. Those labeled VS are pulled from the Vital Signs
flow sheet.
e. If you need items not there, follow the instructions above to add new items.
Sample Flow Sheet Items
Diabetes
Vitals
Wt
BMI
BP
Pulse
RR
Labs/tests
HbA1c
Lipids
Fasting Glucose
Microalbumin
Meds/doses
Comments
Mental Health
Diet
Foot Exam
Exercise
Hypoglycemic
episodes?
Compliance
Asthma
Obesity
Vitals
BMI
BP
Pulse
RR
Vitals
Wt
BMI
BP
Pulse
RR
Labs/tests
Lipids
Fasting Glucose
Labs/tests
Peak Flow
PFT-FEV1
PFT-FVC
Spirometry
Meds/doses
Comments
Compliance
Exacerbations
Inhaler Use
Nebulizer Use
Mental Health
Meds/doses
Comments
Diet
Exercise
Lifestyle
Mental Health
Body Image
Compliance
Sleep Apnea
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Reminder System (Health Maintenance):
SOAPware will remind you every time
you open the patient’s chart if they are
overdue for any procedure, lab,
counseling, or screening. You will need
to set up the patient’s Reminder System
(Health Maintenance) schedule. First
decide what items you need to put in this
patient’s reminder system.
To set up a patient’s health maintenance
schedule, with the patient’s chart open,
1. View Menu,
2. Select Health Maintenance. The
first time you will see the blank
Health Maintenance box (right).
3. Click Add
Blank Health Maintenance Form
4. Where it says View by, change from Protocols to Rules.
5. Click on an item to add to the patient’s reminders, then
click OK,
6. Set the Frequency this item
a. Beside the Frequency box click Add
b. Complete the Interval Definition box. Click OK
c. Then enter the Date Performed and click the
Perform button.
d. It should automatically tell you when the next one is
due. If overdue, a Red Check will appear next to
the Active Item on the left. If within the Variance of
the due date, the check will be Yellow. Adjust the
variance accordingly.
List of HM Rules
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7. Continue adding rules until your Reminder System is complete.
a. If your preceptor handles this patient’s health maintenance issues, add these
items based on USPSTF recommendations for a patient this age and gender, like
colon CA screenings, flu shots, pneumovax, etc.
b. Add items for the major disease you have chosen to follow for this patient: i.e. if
diabetes add A1c, retinal exam, microalbinurea, etc. Do not repeat items on the
flow sheet as the flow sheets will remind you of these items.
If you address an item during a visit,
 click on the item in question, like Cholesterol,
 Under Date Performed, select today’s date, then
 click Perform, which will tell the system that this was performed today.
To Customize Health Maintenance Rules and Protocols
1. View menu,
2. Customizations Wizards,
3. Edit Health Maintenance Protocols
4. To create a protocol that contains many rules like the immunizations protocol,
a. Click on Unfiled then click New Protocol
b. Now you must expand Unfiled, click on the new protocol and click Edit Protocol.
c. Give it a name and description, then click OK
d. Click on one rule at a time at right and click the Add button to add it to the
protocol.
5. To Add or edit existing Rules
a. under Unfiled, pick All Rules,
b. Click Edit Protocol
c. To add a new Rule, Click on New Rule, fill out form with name, description,
frequency and variance and click OK
d. To Edit a Rule, Click on a Rule under Available Rules and click Edit Rule.
Change the name, description, frequency etc and click OK
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How to export your patient charts to a ZIP file and place on the Sharepoint
SOAPware site so that they can be evaluated by faculty.
1. IN SOAPware: The patients must be in the
PULLED charts rack already. They will probably
be there already. You are only dealing with 6
patients total. Select the FILE menu and
EXPORT …
2. Backspace over the SW_Exported_Charts
default filename and use YOUR NAME as the
file name in this format: firstname_lastname
(Use the underscore character, not a space)
3. CLICK on SAVE….
4. The next screen brings up the list of patients in the
pulled charts rack. Select the patients in your
final panel of 6. If you do not select the patient
names, no files will export.
5. You now have a file with your
firstname_lastname.zip on your desktop or in My
Documents or wherever you saved it.
6. Next, you need to upload this file to the sharepoint
SOAPware site.
7. Go to FSU Med School Website
8. Click on Intranet
9. Click on SOAPware Information
https://mcintranet.med.fsu.edu/sites/academicaffair
s/ome/Informatics/SOAPware You can click on this
link to take you to the same place.
PLEASE NOTE: If you are NOT on campus, and you go to the Sharepoint
Portal, you may be prompted for userid and password … MAKE SURE YOU
PRECEED YOUR LOGIN NAME WITH “med\userid” You must include the
domain name preceding your login name.
10. At the SOAPware Sharepoint site, on the left you will see document
libraries for each Regional Campus … click on the correct RC, and
then UPLOAD the zip file containing your patient charts.
11. As the year goes by, to save your Informatics Curriculum Director time,
each month send an email with a list of patient charts that have
changed so he/she won’t waste time reviewing data you have not
changed since the last month.
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