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Doctor Guide

As a doctor using SecureHealth, you have full access to patient data and medical records. This guide will help you navigate the system efficiently while maintaining HIPAA compliance and providing optimal patient care.

Doctor Dashboard Overview​

The doctor dashboard provides comprehensive access to:

  • Patient Management: Complete patient records and medical history
  • Clinical Decision Support: Medical knowledge base and drug interaction checking
  • Appointment Management: Schedule and manage patient appointments
  • Medical Records: View and update patient medical information
  • Staff Communication: Communicate with nurses and other staff members
  • Audit Access: View relevant audit logs for compliance

Patient Management​

Searching for Patients​

Basic Search

  1. Use the search bar at the top of the dashboard
  2. Enter patient name, ID, or other identifying information
  3. Review search results
  4. Click on patient to view full record

Advanced Search

  1. Go to Patients → Advanced Search
  2. Use multiple search criteria:
    • Patient name
    • Date of birth
    • Medical record number
    • Insurance information
  3. Apply filters to narrow results
  4. Save search criteria for future use

Viewing Patient Records​

Patient Overview

  • Demographics: Name, DOB, contact information
  • Medical History: Past diagnoses, treatments, surgeries
  • Current Medications: Active prescriptions and dosages
  • Allergies: Known allergies and adverse reactions

Medical Records

  • Lab Results: Blood tests, imaging, pathology reports
  • Vital Signs: Blood pressure, heart rate, temperature
  • Progress Notes: Clinical notes and observations
  • Treatment Plans: Current and past treatment plans
  • Referrals: Specialist referrals and consultations

Updating Patient Information​

Medical History Updates

  1. Navigate to patient record
  2. Click "Edit Medical History"
  3. Add new diagnoses, treatments, or procedures
  4. Update existing information as needed
  5. Save changes

Progress Notes

  1. Go to patient record
  2. Click "Add Progress Note"
  3. Enter clinical observations
  4. Document treatment decisions
  5. Save note with timestamp

Prescription Management

  1. Access patient's medication list
  2. Add new prescriptions
  3. Modify existing dosages
  4. Discontinue medications
  5. Document medication changes

Clinical Decision Support​

Medical Knowledge Base​

Search Medical Information

  1. Go to Clinical Decision Support
  2. Search for medical conditions, treatments, or procedures
  3. Review evidence-based information
  4. Access clinical guidelines
  5. View treatment recommendations

Drug Information

  1. Search for specific medications
  2. View drug information and interactions
  3. Check contraindications
  4. Review dosing guidelines
  5. Access safety information

Drug Interaction Checking​

Check Interactions

  1. Select patient's current medications
  2. Add new medication to check
  3. Review interaction warnings
  4. Check severity levels
  5. Document interaction assessment

Interaction Types

  • Major: Significant risk, avoid combination
  • Moderate: Moderate risk, monitor closely
  • Minor: Minor risk, minimal monitoring needed
  • Unknown: Insufficient data, use caution

Appointment Management​

Scheduling Appointments​

Create New Appointment

  1. Go to Appointments → Schedule Appointment
  2. Select patient from list
  3. Choose date and time
  4. Select appointment type
  5. Add appointment notes
  6. Confirm appointment

Appointment Types

  • Initial Consultation: First-time patient visit
  • Follow-up: Routine follow-up appointment
  • Procedure: Scheduled medical procedure
  • Emergency: Urgent care appointment
  • Telemedicine: Virtual consultation

Managing Appointments​

View Schedule

  • Daily View: See today's appointments
  • Weekly View: View week's schedule
  • Monthly View: See monthly calendar
  • Custom Range: Select specific date range

Appointment Details

  • Patient Information: Basic patient details
  • Appointment Notes: Purpose and preparation
  • Medical History: Relevant medical information
  • Previous Visits: History of past appointments

Rescheduling Appointments

  1. Find appointment in schedule
  2. Click "Reschedule"
  3. Select new date and time
  4. Update appointment notes if needed
  5. Confirm rescheduling
  6. Notify patient of changes

Medical Records Management​

Documenting Patient Care​

Progress Notes

  1. Access patient record
  2. Click "Add Progress Note"
  3. Enter clinical observations
  4. Document assessment and plan
  5. Save note with proper timestamp

Note Templates

  • SOAP Notes: Subjective, Objective, Assessment, Plan
  • Progress Notes: Routine follow-up documentation
  • Procedure Notes: Documentation of procedures
  • Discharge Notes: Patient discharge documentation

Lab Results Management​

Viewing Lab Results

  1. Go to patient record
  2. Click "Lab Results"
  3. View results by date
  4. Compare with previous results
  5. Document interpretation

Lab Result Types

  • Blood Tests: CBC, chemistry panel, lipid panel
  • Imaging: X-rays, CT scans, MRI
  • Pathology: Biopsy results, cytology
  • Specialized Tests: Cardiac, neurological, endocrine

Prescription Management​

Writing Prescriptions

  1. Access patient's medication list
  2. Click "Add Prescription"
  3. Select medication from database
  4. Enter dosage and instructions
  5. Set duration and refills
  6. Send to pharmacy

Prescription Monitoring

  • Active Medications: Current prescriptions
  • Medication History: Past prescriptions
  • Adverse Reactions: Documented side effects
  • Compliance: Patient adherence to medications

Staff Communication​

Communicating with Nurses​

Patient Care Coordination

  1. Go to Staff Communication
  2. Select nurse from team list
  3. Send message about patient care
  4. Include relevant patient information
  5. Set priority level
  6. Send message

Communication Types

  • Patient Updates: Changes in patient condition
  • Care Instructions: Specific care requirements
  • Medication Changes: New or modified prescriptions
  • Appointment Updates: Schedule changes or updates

Team Collaboration​

Multidisciplinary Rounds

  1. Access team communication
  2. Review patient cases
  3. Discuss treatment plans
  4. Coordinate care activities
  5. Document decisions

Case Conferences

  1. Schedule case conference
  2. Invite relevant team members
  3. Prepare case materials
  4. Conduct conference
  5. Document outcomes

Audit and Compliance​

Viewing Audit Logs​

Access Audit Information

  1. Go to Audit Logs
  2. View your access history
  3. Review patient data access
  4. Check compliance status
  5. Export audit data if needed

Audit Log Details

  • Access Time: When data was accessed
  • Patient Information: Which patient data was viewed
  • Action Taken: What was done with the data
  • Compliance Status: HIPAA compliance verification

HIPAA Compliance​

Patient Privacy

  • Only access patient data when necessary
  • Maintain patient confidentiality
  • Use secure communication methods
  • Document access appropriately

Data Security

  • Use strong passwords
  • Log out when finished
  • Report security incidents
  • Follow security policies

Best Practices​

Patient Care​

Documentation

  • Document all patient interactions
  • Use clear, concise language
  • Include relevant medical information
  • Maintain accurate records

Communication

  • Communicate clearly with patients
  • Explain treatments and procedures
  • Answer patient questions
  • Maintain professional relationships

System Usage​

Efficiency

  • Use search functions effectively
  • Organize patient information
  • Update records promptly
  • Use templates when appropriate

Security

  • Protect patient information
  • Use secure passwords
  • Log out when finished
  • Report security concerns

Troubleshooting​

Common Issues​

Patient Search Problems

  • Check spelling of patient name
  • Try alternative search criteria
  • Contact IT support if needed
  • Review search help documentation

System Performance

  • Check internet connection
  • Clear browser cache
  • Restart browser if needed
  • Contact IT support for persistent issues

Access Problems

  • Verify user account status
  • Check role permissions
  • Contact administrator
  • Review audit logs

Getting Help​

Documentation

  • Review user guides
  • Check troubleshooting guides
  • Consult system help
  • Access training materials

Support

  • Contact IT support
  • Escalate technical issues
  • Request additional training
  • Report system problems

Doctor Checklist​

Daily Tasks​

  • Review patient appointments
  • Check urgent messages
  • Update patient records
  • Review lab results

Weekly Tasks​

  • Review patient progress
  • Update treatment plans
  • Communicate with team
  • Review audit logs

Monthly Tasks​

  • Review patient outcomes
  • Update medical knowledge
  • Participate in training
  • Review compliance status

Next Steps​