USER’s Manual USER’s Manual v 0.9 July 2017
Installation
LEXeNOTES does not need installed. The latest version runs in your browser in any device connected to the Internet without any configuration. Just direct your browser to lexenotes.com to bring up the Login page.
Login as guest
As a guest, you can login with username guest, and password password. As a guest, you can generate a complete note ready to send to your printer or cut and paste into your EMR. You cannot save the note or access your previous notes, and you cannot save preferences, letter head or signatures. The guest login is intended as an introduction to enable you to explore the system, not as a working application.
Register as a User
To use the full power of LEXeNOTES, it’s best to register with us as a User. We’ll need your name, licensure, specialty, areas of practice, telephone numbers and institutional addresses. Your user name should be either first name-last name, or your name as you use it for your institutional email (the characters before the @ sign). Your password should have at least eight characters, including an uppercase and a symbol. If you cannot recall your password, you can call us (800-LEXeNOTES) from one of your listed phone numbers (with caller ID turned on) to request that we send you a temporary one.
We use the term User to describe an individual customer who wants to use the full power to LEXeNOTES to create clinical notes. We hope that Users will eventually become Authors, getting involved in editing and writing Lexemes, but there is no necessity to do so.
The Easy stuff
Once you are logged in, you will see the logo top left. To the right of it you will see buttons for Tutorial, FAQ and Contact. Below these you will see Home, eNOTE, Authoring and Admin. Home is where you reopen a previous note, or start a new one. You can add an identifier to a note at any time it is open but you don’t need to – your work is automatically saved whether you label it or not. LEXeNOTES will append an encrypted identification code in small font to the footer of each completed note. If you want to use the previous note as a template start a new one note, you can copy this code from the footer of a previous note in your EMR and past it into the Search box of LEXeNOTES.
When you start a new document, you will see the Lexeme Query box below the logo. The first time you use LEXeNOTES, this line will read “Welcome…”. Below the query line, you will see a series of Responses.
As you work, you will repeatedly select the best answer to the questions posed in the Query line by clicking or tapping on its line. Some Lexeme Queries permit multiple selections, in which case you will need to click on “>>> No More” to move on to the next Query. You can Omit a query, or Omit and Skip on to a new topic, or Undo to reverse your prior selection.
Editing the Response Text.
If you wish to edit the output text associated with the Lexeme Response, you can click on the right-hand end of the selection line, and then slide the mouse into the Edit box to the right. You can then edit the text in this box. To make complicated edits, you can click on Source to enter standard HTML codes. When you use the editor, the changes you make will be encrypted and sent to our editorial office, so that we can keep track of the changes you felt were necessary to generate the document you need. We will be constantly updating the database in response to the information you send us this way.
You should use this mode of editing only to amplify or clarify the text after you have selected the response that is closest in meaning to what you want to say. If you add additional text not relevant to the lexeme response, the program will not be able to keep track of the logical flow of your document, and it may fail to offer you an adequate set of lexeme queries later.
Patient Identifiers
All practitioners are duty-bound not to reveal information about their patients to any third party. The power of LEXeNOTES is that that the clinical note it generates has no patient identifiers, and is stored as a stream of coded Lexeme Response identifiers. LEXeNOTES can therefore be aggregated and submitted for down-stream analysis without violating this trust. When you edit the Response Text, it is very important that you not to insert any patient identifiers. HIPPAA lists 18 types of identifiers all of which are big no-no’s for LEXeNOTES. These are:- name, address (except whole state), any date (except whole year), telephone, fax, email, social security, medical record, health plan, account, license number, URL, IP, finger or voiceprint, photograph, any other characteristic could uniquely identify a person.. LEXeNOTES looks for patient identifiers when you edit a Response Text, and may alert you if you inadvertently enter one. Obvious patient identifiers will be removed from the text before the changes you make are sent to the editorial office. We will contact you if you do appear to have inserted a patient identifier.
If you do wish add patient identifiers, you can do so after the note is saved to your EMR or after you have saved it to your browser’s print engine. Changes you make after the note is pasted into your EMR or is sent to your print engine will not be saved in LEXeNOTES, and will not appear in future revisions of the note.
Many EMR’s expand special character strings from their protected patient data files. For instance “.age” might be transliterated as the patient’s current age in years. You can enter these special strings into LEXeNOTES as you choose, but they may not transliterate correctly in all EMR’s.
Document Identifier
Above the selection box to the right you will see the Document Identifier box. You do not need to enter a label – your work will be saved using a time code that you can read if you don’t. Do not use a patient identifier in this box (see above). A clinic appointment time (e.g. Hemophilia, 10:15) can be used, so that you can see a particular patient by looking up the appointment time in your EMR.
Correcting the Output text
At the bottom of the screen is a panel displaying the output text, either in a grammatically correct Normal form or in an Abbreviated form. If you hover your mouse over the text, the underlying Lexeme will be highlighted. If you click on this Lexeme, the system will erase it and all the following lexemes, and invite you to select a different Response.
The Accept button
If you have gone back to change a lexeme Response, the system will rebuild the note forward from that point. You can do this quickly by repeated clicking on the Acceptbutton, which reselects the Responses you had previously selected. This enables you to start with previously completed note concerning a patient, erase it back to the beginning to make a few changes, and Accept all the unchanged selections.
The completed note
At the end of your note, your will select your signature block, and accept a series of ICD10 codes, prescriptions etc which are appended to the note, as well as an encrypted note identifier. You can Copy the completed note to clipboard ready to paste into your EMR, or Print it. You do not need to save the note: all your work is saved automatically.
All done!
If that’s all you need to do, you can just close this page.
But wait . . . . There’s more!
You too can become an Author, and therefore become a prime mover of healthcare.
Glossary
The issues addressed in medical record tend to follow a defined order. This can be proved by excising a fragment of text that encompasses an issue and observing that clinicians tend to replace it in its original location. The principle of Coherence holds that:
Every lexeme query has one appropriate location in a professional report.
The implication of this is that all lexeme queries can be organized in coherent order.
The context within which the report is written determines the layout and major headings of the report. The context consists of the type of medical interaction, the role of the author of the report and the characteristics of the patient. An orthopedist seeing a child in an emergency treatment center needs a radically different set of major sections in the report than a radiologist reading mammograms. The context generates a starting set of predicants.
Some lexeme queries deal with topics in fine detail. They have a high hierarchical level. Other lexeme queries are more general, and have a low level. Each lexeme query has an associated level. Each time a user selects a lexeme response, it sets the system’s level. The system only presents lexeme queries if its level is equal to, or lower than the system’s current level.
is the least unit of information, generally expressed as a fragment of meaningful text. Lexeme refers to the information itself, not to the text used to express it. Lexemes are most usefully regarded as the combination of a lexeme query and a lexeme response.
Is an issue or topic that is addressed in a professional report. It can be framed as a (hypothetical) question. Professional reports can be analyzed as a stream of lexeme queries. Each Lexeme query is associated with its own handful of relevant lexeme responses.
Is an answer to its associated lexeme query. Lexemes responses can expressed in any number of styles and languages, including computer codes.
Refers to the computer program that enables the user to add or revise entries in the lexicon.
Loop-back. Special programming enables the system to process though the same set of lexeme queries more than once. For instance, suppose a patient comes in with both an arm and leg injury. Each injury needs to user to assess the injury for bleeding, pain and signs of fracture. On completing the consideration of the arm injury the loop back procedure can send the system back to address the leg injury. The lexeme response that initiates the loop back will start the loop at the lexeme query which has level one lower than its level.
Every well written report exhibits the phenomenon of predicance. The Principle of Predicance holds that
No issue is addressed in the professional report unless called for either by the context of the report, or by responses lodged earlier in the report.
For instance, in a medical report, the consideration of treating gout is only explored in detail if the clinician selects a lexeme response raising the issue of gout. In the absence of this selection, the issue of gout would only be raised if the context of the report suggests gout (such as a rheumatology consult for a patient with arthritis).
Are computer tags that are associated with relevant lexeme queries. Every lexeme query has at least one associated predicant. When selected, a lexeme response may issue new predicants. The computer system maintains a list of the predicants set during the creation of a document. It adds to this list when new predicants are issued by selecting lexeme responses or by the context.
No lexeme query is presented to the user unless at least one of its associated predicants has a match in the system’s predicant list
Some lexeme queries deal with topics in fine detail. They have a high hierarchical level. Other lexeme queries are more general, and have a low level. Each lexeme query has an associated level. Each time a user selects a lexeme response, it sets the system’s level. The system only presents lexeme queries if its level is equal to, or lower than the system’s current level.
Refers to the computer program that enables the user to prepare a report by selecting lexeme responses.