Wow! First, I think most people on here use PDF as their electronic document. There are literally hundreds of PDF converters both to PDF and PDF to Word. Adobe is still the best but expensive. Some of the free ones however have features that Adobe doesn't have. Let's address some of your work flow. That is way too much for you to be doing. I, like Grenville, don't completely get your situation but here are some tips.
I too have my staff fax a lot of my documents. And, printing your letters to PDF helps with archiving as the letter stays intact. But, you could consider that this adds work as you have to convert to PDF, then have your nurse combine them. If you have PC to Fax, that could be done in one step. But, you would need a fax server and a good address book. So either way.
#1 Before AC, what did you do for your HPI documentation? How was it faster?
#2 I guess every place is different. Our lab and xray department doesn't ask for ICD-9 codes. I always use the other section and templates and not the rigid sections of the lab and x-ray section. Takes way too much time. I just type out what I want and print it. Unfortunately, unlike all of the other versions, I have to write in the diagnosis, but I am not going to waste all of my time looking up silly ICD-9 codes.
Why do you have to know what lab facility? Can't the patient take on that responsibility? If not, can't your staff help them? You shouldn't have to look that up.
Do they need a universal form? I bet your receptionist who does your referrals would know that.
3. Medication renewals - ePrescribe. But, I haven't done a medication renewal in months. My nurse does that. I just check them. I still don't understand why your staff isn't doing the referrals and preop consults. You may need to type a letter.
For a signature, make a TRANSLUCENT signature and add it to Adobe or other PDF as a stamp. But, it has to be translucent if you want it to look authentic. AC has the ability to add a stamp automatically, but it's more difficult to do the translucent stamp.
As far as your staff doing your reqs and letters, I would suggest what we have been doing for four or five years. Go into admin and edit the users. Set their username and password and their level, but that should be all of their info, no more. In the name section at the top, you should put the same info that you have in yours. What good does it do to put theirs? It just means their names go at the bottom of everything. We put my name and all of the medical demographic information in as well. This way your name always appears at the bottom. Before ePrescribe when we faxed from the desktop, pharmacies wouldn't accept electronic signatures. So, we changed my first name to:
Digitally signed by Bert, and made the last name Adams. So, it came out: Digitally signed by Bert Adams, M.D. Suddenly all 45 pharmacies who wouldn't take electronic signature, accepted the other. It looks a little strange on the bottom of the letter, but who cares.
Almost everything you mentioned above can be done by your staff. For me, it is easier to just print out the labs and hand them to the patient. By the way, my MA does the HPI as well. I do read it and edit and add.
I wouldn't give up on UpDox, though.
