As far as EMRs go I was dealt a bad hand- I got stuck with E-Clinical Works (ECW). You may not have heard of ECW before and there's a reason for that- it's terrible. It's many inefficiencies make it difficult to get through a patient encounter- let alone an entire day of work. So I learned to use Auto Hot Keys (AHK) to overcome most of the inefficiencies imposed on me by ECW. One of the main issues with ECW is the rigidity in their macro system. It is limited to a single trigger for all macros (CRTL + Space) which requires some finger gymnastics when the trigger should be acessible as to not interrupt the flow of typing or the palcement of the fingers on the keys, especially when multiple macros are being triggered in a row. The biggest drawback is the exclusivity of triggers once selected. If someone maps their macro to the trigger "PVD" no one else can use that, which requires everyone to create highly individualized macro triggers which causes two problems. One, memory- if the macro doesn't have the most obvious trigger then it will be difficult to remember. Two, brevity. Practitioners are having to resort to using their initials or some other identifier before their macros (such as "MWPVD") which adds excessive keystrokes to a function that is intended to reduce keystrokes. A third issue (yes, I know that's more than two) is the lack of utility offered by these packaged macros. For example, if I wanted to have a macro that involved rich text (bold, underlines, italics), I can't. If I wanted the macro to include enters, tabs, or involve any complex series of keystrokes, or even mouse clicks- it cannot. AHK solves all of this and more. I've spent a great deal of time cultivating my own AHK script that I am making available for use, the code can be viewed and downloaded here.
Here are some features it offers:
No collision with other users macros (so long as different desktops are utilized or the user profile is switched).
Customizable triggers- no more getting locked into what your EMR thought was a good idea for a macro trigger.
A Contact Lens Rx Conversion Tool-just highlight the spectacle Rx, activate the trigger and get an auto-vertexed, and even change cyl form, without having to copy or paste anything.
A Contact Lens Reference Tool: quickly reference CL parameters with just a few keystrokes.
Macro Menus: build a custom macro on the spot with multiple choice answer menus to deliver a highly specific macro note in mere seconds. For conditions such as PVDs quickly select laterality to create a specific note. Or in the case of diabetic retinopathy select the laterality, severity, presence of CME and deliver a highly specific note to your chart.
AI-Naive: granular control and 100% confidence in the output.
Some bugs and developments that are up and coming:
Creation of user portals so multiple users can access their personal macros with a few clicks without colliding with other users using the same desktop.
An interface to view, add, or sort your existing macros without touching the code.
Text windows that support rich text (bold, underline, etc), so the assessment and plan can be built throughout the exam until it is time to dump it into the appropriate box in the EMR. No more holding onto information until you click into the right box, or constantly clicking in and out of the A&P box for every new detail or development. Just add to the floating box in the moment and keep the flow of the exam.
Integration of an AI summarizer for those rambling HPI's. Highlight the text and get a quick detailed summary that is easier to read.
Refinement of the CL tools, and additions to the CL reference.
Addition of more quick-reference items for easy and quick viewing. For example- "what were the norms for exophthalmometry again?"