This record has been updated by another user. Please cancel your changes and reapply them
What causes this warning
Clinical Item Lists For clinical items (problems, meds, allergies, etc), the application uses an optimistic locking approach. Most activities with a patient record will not conflict with any other activities on that same patient. This allows the system to be as permissive as possible with concurrent activies on the same patient.
How this works in the application is via a comparison of internal IDs. With every clinical item saved, the system generates a base ID and current ID. With every edit to a clinical item, the systems maintains the same base ID but generates a new current ID. This allows the system to maintain a history of edits for auditing purposes. If you edit an existing item and commit the change, the system will compare what it knows about the item to what is currently in the database. If the current ID stored in the database does not match the former current id (the current ID before the edit) - it means that some other activity edited the same item and your edit is based on different information than what is currently stored. The system will abort this change and notify the user "This record has been updated by another user. Please cancel your changes and re-apply them."
This clinical item comparison logic is exactly the same in v11 as it was in v10, but there are some capability differences. In v11, you can accumulate a series of changes (meds, problems, allergies, etc) before you have to commit. If a single item in the list of items to be saved is flagged as having an old ID, the entire list can not be saved. In v10, each of these items were in their own workspace and required a commit before leaving that workspace. Another difference is that with v11 Note, the cited lists (current meds, orders, etc) are active. These active lists support many of the same actions that can be performed from the clinical desktop. In v10 Note, the cited list information is static with no action possible. This may increase the potential for concurrency conflicts.
Note: For both v11 Note and v10 Note, the application uses a pessimistic locking approach. While a note is being edited, no other user can edit the same note. A database table entry is made whenever a note is started or edited. Any attempt to open an existing note will check for a lock record entry before permitting an edit. This logic is the same for both v10 and v11. One difference is how locks can be cleared. In v10, if the session was not properly saved and a note lock was orphaned on a document, the only way to clear it was through an administrative page. In v11, we allow the same user that held the previous lock to clear the lock by accessing the document.
Recommendation to avoid this warning
At this time, there is no preference or system setting that will change this from an "optimistic" locking approach to a "pessimistic" locking approach (as in Note). The recommendation is to validate that your workflows prevent users from being in the patient's chart modifying these clinical items at the same time.
11.3 Clinical Item Contention Enhancement
In version 11.3, an alert now appears in the patient header of the details pages if you open a clinical item another user is already editing:
- Allergy Details
- Health Management Reminder Details
- Immunization Details
- Medication Details
- Order Details
- Order Details - Results (including Vital Signs)
- Problem Details
The alert lets you know to cancel out of the details page and wait for the first user to commit his or her changes before you make additional changes yourself. Hover your pointer to display a tooltip stating which user is editing the item and how long the item has been a work in progress (WIP). WIP is a temporary status for data that has been added or edited and has not yet been saved. In other areas of the application, WIP items are displayed in magenta and are also shown as unsaved items in the Encounter Summary. The user's site also displays when it is stored at the item level (all items except Problem, Allergy, and Health Management Reminder.)
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