Me again... I've been trying to digest all of this as we continue to wend our way towards an EMR. I think I am beginning to envision how our workflow would operate - and I do understand that there are multiple ways to do this. But what I want to know, is, is what I have outlined below a doable process? And if not, what step is not, and is there a workaround?

To make it easy and avoid redundancy, please look at the summary of what I need to do, in the last paragraph; and then if you need further clarification as to what I am asking, refer to my outline.

I have outlined everything in stepwise fashion not only for myself, but also because I want to be crystal clear on what I can and cannot do. From my reading so far, this is what I understand to be possible:


1) I CAN have a system that will import BOTH faxed/scanned items AND scan BARCODED items into a searchable PDF format (i.e., in OCR format). We do many in-house labs, and the machines are just old enough that an interface is not supported - so we will have to print them out, barcode them, and then scan them to import them in PDF-OCR format into the chart.

Is Abode Pro X a good choice for this? Does UpDox import barcoded files? Can every file uploaded in UpDox be in PDF-OCR format, or will they only be in non-searchable PDF?

2) The file can be directly uploaded into a pt's chart in AC.
Is UpDox the only program that will do this? Remember, it must be in PDF-OCR format.

If the PDF-OCR file is able to be uploaded directly to a pt's chart, is a message then sent to my mail inbox telling me that there is a new file in "John Doe's" chart for me to review? If not, how am I to know that any file has been newly uploaded into a given pt's chart?


3) I can then use Adobe Pro X to annotate that document (in PDF-OCR format), in such a way that my comments are overwritten on the report and become a permanent part of the report - (no temporary sticky notes.)

Q: Is Adobe X Pro the most efficient program to do this with? Can Paperport do it, and if so, what is the advantage with Adobe (remember, files will be generated from barcoded items as well, and I want to be able to search the file, so it has to stay OCR). Does Paperport convert both barcoded and faxed/scanned items into PDF-OCR?


At this point, my workflow will go in one of four directions -
a) I will want to forward the document to my colleague, who has been seeing the pt., as an "FYI."
b) I will just "sign off" on a document that needs no further action (like a consult report).
c) I will want the M.A. to call the pt. with advice ("stop all alcohol and repeat LFTs in 4-6 weeks).
d) I will want the M.A. to call the pt. with a question, and get back to me with an answer (did the pt. run out of their thyroid meds before the last lab was done?)

This is where I get really confused.... In the case of the latter two, HOW do I review the pt's chart along with the report? Has the report now been directly uploaded into the pt's. chart, or is it a separate item, requiring me to look up the chart in another "window" so I can see what was going on at the last visit? If the report is actually IN the chart, what is getting emailed back and forth to the M.A.? The actual chart and report???

I would then plan to do this for each scenario:
a) Simply send the document to my partner via email.
b) Sign off on the report, and send it to the M.A. to file in the pt's chart. (Or is it already attached to the pt's chart?)
c) I will sign off on the report, BUT ask the M.A. to contact the pt. with my advice.
d) I will NOT sign off on the report, and ask the M.A. to contact the pt. and ask my question, etc.


4) At this point, let's say the M.A. receives my email, and has to contact the pt. - either to simply advise them, or to ask them a question. In either case, she will then annotate the report further, with her own notes that she has contacted the pt. on such-and-such a day/time. Again, this will be a permanent part of this particular report.

5) Now, the M.A. now has to let me know one of two things - either she has contacted the pt. and advised them of my recommendation, OR, she has an answer to the question I had her ask the pt.

6) So - she emails me back...

In the case of advice, she emails me that she has contacted the pt. and has filed the chart (remember, I already signed off on it).
OR, she emails me with the pt's. answer to my question. If I am satisfied at that point, I can sign off on it send her a message to file the chart (do I really have to go through that, or can I sign-off and file it myself with one click?)
OR, if I have a further question, I again annotate the lab (because I want all this to be a permanent part of the record AND to have the info stay with the report I am referring to) and send it back to her again.


LOTS and lots of questions, I know!!! But I seriously have to get a handle on how each step of the workflow would go, in practice.

If there is a more efficient manner to do the same thing, I'm all ears.

BUT, the things I MUST be able to do are:

1) Have faxed/scanned paper AND BARCODED documents imported into a pt's chart in a searchable PDF (OCR) format.
2) Understand exactly how I can review the document vis-a-vis the patient's chart - once it is uploaded into AC, is it actually IN the pt's chart? Do I get a message that a given pt. has a new lab report for me to review, and is the chart "right there" for me to refer to, or do I have to go and pull it up?
3) Have these documents be easily annotated in such a way that the annotations are a permanent part of that particular record ("overwriting" the record with comments is best)
4) Have an easy way to pass these documents back and forth, again being able to annotate each step of the way, if necessary.
5) Know how and where to look in AC for these documents -is there a particular folder in a pts. chart where I will find them? Can I make my own folder (one for consults, one for labs, etc.)?
6) Be able to easily generate a report/list of all of my pt's who (for instance) have an A1C above 7%.


Whew! That's pretty much all of it.
Melanie