Help : Quick Charting

You can access MD HQ's quick charting tools (Quick Add, Chart Parts, and prompted templates) simply by typing in an encounter note's main text block, helping you to chart faster than ever before. And the system searches for potential matches as you type, so there is no need to memorize lots of complicated shorthand to use these tools.

Help: Quick Add

The Quick Add function provides a way to search for and add any diagnosis, prescription, order, alternate plan item, vaccine, facility, or charge to the text of the note AND to the relevant encounter note block (Assessment, Plan, Charges) AND, if applicable, the relevant part of the patient's chart (Medications or Supplements List, Vaccine Chart, Preferred Facilities, etc.).

To search the database for the entry you would like to add, first type the applicable two-letter prefix (see table, below, this which tells the system which database to search), followed by an underscore.

Immediately after the prefix and underscore, type in one or more search terms, separating multiple search terms with underscores, not spaces (a space ends the search). Once you've typed in the prefix, underscore, and at least three characters, the system will display potential matches to the left of the main text block.

Select an entry using your mouse or, to select an entry from the list without using the mouse, press the up arrow to select and add the topmost entry or toggle to the list by pressing the left, right, or down arrows on the keyboard. Within the list, the down or right arrows move down the list, and the up or left arrows move up. Press enter to select.

This will information about the selected entry to the main text block, and add a Suggested Action above the Assessment block on the right hand side of the note. Click on a Suggested Action to take that action (adding the item to the Assessment, Plan, or Charges section of the note and/or updating the relevant part of the patient's chart), or click on the red x to dismiss.

Quick Add Prefixes

Category Prefix Search By What Happens when you Select an Entry?
Actions dx_ = diagnosis Diagnostic name, nickname(s), ICD-9 code 
- Text added to main text block: diagnosis name and CPT code
- Suggested action: diagnosis

Accepting the suggested action (by clicking on it) adds the diagnosis to the note's Assessment block.

or_ = order

xr_ = order (x-ray)

Title, subtitle, category, nickname, description
- Text added to main text block: order title
- Suggested action: order 

Accepting the suggested action (by clicking on it) adds the order to the note's Plan block and pops up the Add/Schedule Orders" dialogue.

rx_ = drug Drug name, brand, ingredients, strength, delivery method, form - Text added to main text block: drug name
- Suggested action: prescription

Accepting the suggested action (by clicking on it) adds the prescription to the note's Plan block and pops up a "+ Complete and Add Rx" dialogue.

ap_ = alternate plan item
Name, nickname
- Text added to main text block: alternate plan item name
- Suggested action: supplement prescription, recommendation, etc.

Accepting the suggested action (by clicking on it) adds the supplement prescription, recommendation, or other alternate plan action to the note's Plan block and pops up a "+ Complete and Add" dialogue.

vc_ = vaccine Name, nickname(s), brand
- Text added to main text block: vaccine name
- Suggested action: vaccine

Accepting the suggested action (by clicking on it) adds the vaccine to the Plan block and pops up an "+ Add New Vaccination" dialogue. The vaccine will be entered into the next open dosing for that vaccine in the patient's vaccine chart.

ch_ = charge Name, nickname(s), CPT code
- Text added to main text block: charge name
- Suggested action: charge

Accepting the suggested action (by clicking on it) adds the charge to the note's Charges block.

Facilities lb_ = laboratory Name, street address, city, state/province, postal code, phone number - Text added to main text block: facility/specialist name, address, phone number
ph_ = pharmacy
sp_ = specialist

rd_ = radiologist

Help: Chart Parts

Chart Parts is MD HQ's flexible, accessible answer to a traditional templating system. A Chart Part can be used to auto-complete a commonly-used phrase, add a set of text prompts, add a combination of actions, or add any combination of text and actions to the note. You type the name or nickname of the Chart Part that you're looking for into the note's main text block, the system searches as you type, and potential matches appear to the left. To select an entry from the list without using the mouse, press the up arrow to select and add the topmost entry or toggle to the list by pressing the left, right, or down arrows on the keyboard. Within the list, the down or right arrows move down the list, and the up or left arrows move up. Press enter to select.

The system comes pre-loaded with commonly-needed Chart Parts or you can easily build your own.

Help: Using Chart Parts

A Chart Part is accessed by typing all or part of its name or nickname in the main text field of an open encounter note (or another free text field that supports this feature, such as email notifications and reminders in the Calendar). Matches will appear to the left as you type. Click on one to select it. To select an entry from the list without using the mouse, press the up arrow to select and add the topmost entry or toggle to the list by pressing the left, right, or down arrows on the keyboard. Within the list, the down or right arrows move down the list, and the up or left arrows move up. Press enter to select.

Once selected, any text from the Chart Part template will be added to the main text block (or to the applicable free text field). In an encounter note, actions will be added as "Suggested Actions" above the yellow Assessment block on the right. Click on a suggested action to add it to the note. Click on the x to the right of any suggestion to remove it.

Help: Custom Chart Parts

Create or manage Chart Parts via the Admin drop down menu at the top of the page. Select Manage... >> Chart Parts, then click on +Add New to create your own. Note: highlighting text in an open encounter note will also give you the option to create a custom Chart Part with that text.

You must give the Chart Part a name, and may give it one or more nicknames. A name or nickname can contain any combination of letters, numbers and certain special characters, but not spaces or any of the following special characters: \ ^ % & *. Multiple nicknames should be separated by spaces.

The scope of the Chart Part refers to who may use it: just the doctor who creates it or anyone in the practice. Restricting the scope of a template makes sense, for example, when one user takes a different approach to a certain type of encounter than does the rest of the practice.

Add text that you want to appear exactly as written when the Chart Part is called. Or you can add one or more text variables, which will add patient- or encounter-specific information when the Chart Part is used. Variable names are enclosed in double brackets, as in: [[variable]].

Text Variables

Variable Text that will be Inserted in the Note
[[date]] Date the Chart Part is added to the note
[[time]] Time the Chart Part is added to the note
[[dateandtime]] Date and time the Chart part is added to the note
[[soap_time_elapsed]] Time elapsed since note created
[[doctor]] Name of the user that is logged in when the Chart Part is added to the note
[[pt_allergies]] A list of all of all allergies listed in the patient's file
[[pt_bp]] Patient's last blood pressure reading on file
[[pt_bps]] All of patient's blood pressure readings on file
[[pt_dob]] Patient's date of birth
[[pt_dxs]] A list of all of the diagnoses that have ever been added to the patient's file
[[pt_name]] Name of the patient
[[pt_pharmacy]] The patient's primary pharmacy
[[pt_pmh]] A summary of the patient's past medical history
[[pt_rxs]] A list of all of all medications in the patient's file, past or current, with a notation for any that are expired or discontinued
[[pt_note_social]] The text that appears in the Social Notes block on the patient's dashboard page
[[pt_note_basic]] The text that appears in the Need to Know block on the patient's dashboard page
[[pt_note_admin]] The text that appears in the Admin Notes block on the patient's dashboard page

Some Chart Parts are likely to consist of just short, commonly-used phrases, so that you don't need to type the same things over and over when charting, but can instead type in the name or nickname and then press the up arrow to select and add the topmost suggested match.

To add a diagnosis, drug, order/lab, vaccine, or charge or alternate plan option (supplements, recommendations, etc) to the note, select the type of action to add using the drop down menu, and search for the desired entry in the search bar. As usual, type in whole or partial words or numbers in any order, and the system will search as you type.

Remove any action by clicking the [x] to its far right.

When finished, click +Add New Chart Part.

Help: Prompted Templates

MD HQ also has a small set of prompted templates (fillable template forms) for various common encounter types, including Chem 7/Chem 8, well woman, well adult, and well child exams. More can be developed upon request.