Home Forums Discussions Problems PRINTING ENTIRE CHART

Is anybody else having trouble faxing out a patient's entire chart, including the imported items? First of all, the print button does not allow one to select the printer, e.g. the fax, and instead goes to the default printer.
Secondly, the imported items are not consistently being printed. Any help would be appreciated. As it stands now we are individually printing each item to the Paperport desktop, stacking them there and then faxing out from there. Pain in the long-eared equine.

Leslie

Not sure I can help. First, when I do it, I can choose whatever print driver I want including fax or Adobe.

I apologize in advance for talking about F.A.P., but with it, we can send the entire record in three steps.

I must say, I always pull up Visit History and Print Progress Notes only. We never print the patient messages. Maybe that is wrong, but no matter how much we try, we are bound to get opinions and comments in the messages that I really don't want others to read.

We have problems with this too. We did find that if all the imported items are done in PDF, you can combine them all in to one PDF under "print preview" rather than "print" and this let's you select how or to where you will print. However, the "print entire chart" option doesn't seem to really do that,as we usually end up going back and printing notes out separately. Then there are those annoying HIPPA rules where you need to be sure you don't send info they didn't want sent. Makes you wish for the "easy" button sometimes!

how are you able to combine all imported items into one PDF? are you doing this in the import items folder or are you using the "print entire chart" option from right-clicking within the patient list? Is there a way to combine all the progress notes with all the imported items in ONE pdf to fax?
thanks!

Well, because the "print entire chart" function does not let me choose my printer, which in more and more cases now is the fax, I am "printing" each entry to Paperport, stacking them there and faxing it all out as one file. I must pull up each individual document in Adobe and then choose the printer or the fax there but then have to dial out for each time for each file. By stacking them in Paperport, I can dial and send as a single file. It would certainly be nice if I could do this from within AC. And, as long as I am wishing for things, let me also wish that I could stack files within AC as well as drag and drop the imported items into other or similar folders within AC. As many of my patient's imported items list gets longer and longer, it would be great to be able to stack files such as 5 years of mammograms or a year's worth of allergist's notes. It is becomming burdensome to have to scroll through this ever-increasing list of imported files in order to find what I am looking for.

Leslie

If you are trying to combine everything in the imported items, the best way is to go to the imported items folder for that patient and combine them from there.

The "print entire chart" print preview will bring up multiple parts of the chart in their own window. Imported items will open in their native application so PDFs in Acrobat, letters you typed will come up in HTML (yuk!) in a browser, Word in Word, etc. Alternatively, you can combine all of the files using something like:

http://www.eprintdriver.com/combine-multiple-docs.html

If you Google "PDF combine files" you will see that and tons of pdf merge programs or you can Google "PDF merge."

There are many programs which will allow you to merge pdfs. No one really does it better than Adobe, but they are rather pricey.

Personally, I do it this way, which is certainly not the only way to do it. I definitely don't use Print Entire Chart. I bring up Past Encounters, Progress Notes Only and print those to pdf using a free pdf print driver. I then pull up the Immunization Record from the summary sheet and print to pdf. I then pull up their entire Imported Items (I get it from F.A.P., but you can pull them from the imported items folder -- everything is already in pdf for me) and merge them. There are tools that I mentioned on Google that will allow you to combine all files into one. That gives me three files. The progress notes, the immunization record and all of their records, consults, labs, etc. Using Adobe (you can use any of the others on Google), I then merge all three into one file.

This may sound like a lot of work, but I would estimate I can do all three in less than three minutes.

Leslie,

You have me a bit confused. You can choose your print driver in "print entire chart" however it is not practical given that everything opens in its own window. I dislike and don't use print entire chart, because it includes things that Jon likes that I don't need such as:

Lab History sheet: I don't have any lab history.
List of Imported Items: Why would anyone want that?
The EHR Summary Sheet: Would be great if I could control what was on there. I don't want a problem list that says URI, URI, Fever, Fever, Cough, etc.

It is so easy to make a PDF of the progress notes and the immunization record and all of my imported items from FAP. This is where FAP is so useful. All imports such as consults or mammograms can be merged at the time of import. When I need to send a chart, I simply do a search on Smith, John and ten seconds later there are 15 PDFs representing 300 pages of records, consults, etc. With one click called Transfer Records, the program combines them and sends them to the desktop as one record.

Leslie,

Can't you just print the progress notes to Adobe, then go to the imported items folder and merge all of those with a merge program?

http://www.eprintdriver.com/combine-multiple-docs.html

David (soundhealth) had mentioned that he can print everything in one pdf if he does "print preview" and chooses where to print something (to paper or to fax) instead of "print". Do you know what he is referring to?
-Jocelyn

Bert, yes you are right, I can choose the print driver in print entire chart but only for the non-imported items. As you said, the imported items each come up in their individual window. I use Paperport (free for me and already installed)to merge all of these documents into one file so I can fax them. Searching through the Imported Items folder I think, unless I don't understand how to do it, to me would be even more burdensome than printing the displayed imported items to Paperport.

I don't know, I would think going to the ImportedItems folder in the AC folder, finding chart 1372 corresponding to that chart, opening it, highlighting the files and combining them with something like ePrint driver. Now, you have combined all 30 files or whatever. Then, you can print to Paperport. Just an idea. Unless I saw your step by step, it's hard to say.

Jocelyn, I can't speak for David, but if you use the Print Entire Chart button, you have two choices. You can either simply print which means all of the things checked will print along with imported items minus the HTMLs if I recall. Or you can choose Print Preview. This brings up all of the individual sections such as Lab Summary, EHR Summary, Progress Notes, etc. If you check off Imported Items it brings all of these up in INDIVIDUAL documents. If you have 5 PDFs, it will open 5 PDFs. Therefore, I see no way to convert these to one file.

I could not follow David's post completely. In one sense, it seemed he was saying you can print to one PDF from the Print Entire Chart. The ONLY way I know to combine more than one file is with Adobe for PDFs or some other 3rd party program. There are other programs which can combine more than one type.

Personally, I would never use Print Entire Chart. It is rather simple. Get a free PDF print driver such as Win2PDF and print all of your progress notes from the Past Encounters under Progress Notes Only, then go to your Imported Items folder for that patient and "select all" then combine them with one of the many free merge programs. Then merge both of them.

Sorry for confusion. I was referring to the PDF's of imported items, not all parts of the chart. Using whatever version of Adobe we have there is a "combine" button on the toolbar. Pushing that will let you pick which of the open PDF's to put together. Does that make more sense? (I actually am just giving second hand info here as it was my wife who figured this out)

Wow, David. I searched and searched for a "combine" button on my version of Adobe Reader 9 but could not find one. That would be a tremendous help.

Leslie

I think, Leslie, that you need the full version of Adobe to do that.

Jim,

I assumed that was the case. I guess I will still print to Paperport and stack there. It would still be great if we could drag and drop and stack and unstack files within the import section of AC. I have had several occasions where two or more separate reports have been accidentally imported as a single file (e.g mammogram and colonoscopy). Once I discover this the only way for me to rectify it is to print the whole file to the Paperport desktop, unstack them there and re-import.

Leslie

Bert summarized this pretty accurately.

We do the same thing w/ Adobe Standard edition. The front staff have been taught how to go to pt # 1372 (or whatever) and select all, then they click "combine" and merge these into one PDF file they place on their desktop.

Then they select all of the office visits under Past Encounters and print these en masse, to Adobe PDF print driver, making another PDF file. They drag and drop this into the merged file on the desktop.....and voila! they now have a single PDF that can be burned to a CD to give to a patient, or faxed via our networked fax machine.

I never allow them to print these records because of the huge cost, unelss a patient requests paper. We usually just give them a CD ROM.

There is a program called PDF redirect that will print to PDF and combine files. We often use it to combine output files to a single PDF.

Did I mention it is freeware?

I use it for multiple output and usually use cutePDF for single output (less steps)

Nice tip Wendell

I've read this over and over again, while in AC trying to figure out how this is being done. So please excuse my lame questions...but I really NEED to learn to do this.

What do you mean you select all in a pts chart? What are you selecting? How are you merging into a pdf? I have Adobe Acrobat Standard, but don't see how I can pull the chart into it.


Okay, I was able to print to pdf all encounters, and I added the summary sheet. I then opened Adobe and said I wanted to combine the two into one document. It did. But I don't see the drag and drop.


I completely agree. I also want to start doing this with other practices. If I can somehow just make a pdf of the entire chart...life would be good. I'd also appreciate getting this from other offices. Less paper all around!

Thanks for any clarity!

Barbara

Barbara,
The fastest way (but a little more risky if you have computer illiterate staff), is to go outside of the AC program <<which the AC Staff will tell you NOT to do, but do it anyway>> into the main AC Folder on your main computer/server, then to Imported Items Folder, then to pt #1372, single click on the top file, press-hold <Ctrl> and single click the bottom file thereby highlighting them all, then right click anywhere in the highlighted field, then select "Combine supported files in Acrobat" which will start the Acrobat file merger program. Save this new file to their desktop, merge the summary sheet and PRESTO! Now burn this to your CD ROM and give to your patient. The whole process could take about 5 min. Consider it used to take 30min or more to pull apart a paper chart and photocopy it........wow!

And....I can't believe I spend my whole day thinking of these things....but here is an alternative way. I think everyone has to find their own way. Sounds like a Fleetwood Mac song.

Ok, first go open My Computer, select Tools, then Map Network Drive and browse to the Imported Items folder on your server. Now, you will have that folder directly in My Computer.

When you want to make a record for a patient, select that patient from the patient list, on the dropdown menu from the printer icon (it's just consistent with both things you need to print rather than choosing the menu from right-clicking), choose Print Progress Notes. Then select Print All Notes and choose your PDF print driver. (I use Adobe 9.0 Professional so I don't know what previous versions do or can't remember). When the window comes up asking you where to print it to, go to the mapped drive and find the folder belong to that patient. Open that folder and save it there.

Now, choose print summary sheet from the dropdown menu. Print using the PDF print driver. It will default to the same folder which is nice.

At this point, you have EVERY file you need right in the patient's folder. This is nice because all of the imported items are still associated with the patient's records, but the files you printed there are not. It's the best of both worlds.

Now, you open the mapped Imported Items folder in My Computer and guess what. The folder you need will be at the top of the window since it usually defaults to Date Modified. If not, click on the Date Modified tab and it will.

At this point, right-click ON THE FOLDER. You don't need to open it or highlight anything. The menu should allow you to combine the files inside if you are using Adobe. Again, my version does. Choose that, follow the prompts and combine the files into one and save either back to the folder or on your desktop.

I tried the PDF Redirect....sweet and free. But, you still have to gather the files from the Imported Items folder, something I really do not want my staff to do as i do not want them accessing the server like that. This is a major AC bug-a-boo that really needs to be fixed. One should be able to print the entire chart right from the patient's chart. There should be a built in way to combine files as there are too many people having to use too many different programs otherwise.

Leslie

Thanks for the pointers Adam and Bert. I have to say though...I'm with Leslie on this one. Seems to me to be lot of room for errors to be made.

Staff is not very computer savvy - actually not at all. I need the process to be simple and straight forward.

In additon to sending the disks to the patients, I also want to start sending our records to other providers and agencies on a disk rather than paper. (I live in the PNW and love my trees!) I know I'd rather receive records this way.

To be honest, with FAP, I don't have many of the issues, as I click on Make Records and it does it all for me nice and tidy and on the desktop. Of course that doesn't take into consideration the imported items.

No offense to Leslie or you, :), but it is a rather straightforward and simple process. These types of things when you read them prior to doing them seem very ominous.

Not sure how many of these you do a day, but here is how I solve the issue of letting my staff do it.....I don't.

I do them all and save them to a Records To Be Send folder on the server. I then send a message to by email which, when they click on it, opens the folder. I burn any of them myself, but I have delegated that not.

I agree a one-click would be helpful, but I have also found that most offices do not look through the records and say they can't find the intra-office messages. I kind of look at those as what lawyers call "work product." No matter how hard we try, there are just too many comments in there that I don't need or want a patient to see. Hence, the print progress notes, immunizations (summary sheet) and imported items. The perfect scenario would be if the summary sheet and the progress notes would print together.

But, I do have to strongly say (of course, this is only my opinion) that the process Adam talks about or what I talk about is very safe and accomplishes the goal.

Hope this helps. I hope no toes got stepped on.

Okay, I admit...I have not tried it. Maybe I'll have a moment this weekend.

What is FAP?

Bert,

I am so offended!! Yes, I agree with you it is straight forward and the PDF Redirect program simplifies it even more. My contention, however, is not whether it is hard or easy but that it requires going to the Import Items folder on the server to gather the files. I do not want my staff messing with that folder. So, I too do it myself. Now, with PDF Redirect I can print the assimilated file to the Paperport desktop where it can then be accessed by the person in my office who deals with the actual sending of the records. We do not send them until we get paid for them (per Indiana law we have the right to charge for records). I have not tried burning them to CD but that would be a nice option.

Leslie

Agreed. I in much the same way, do not allow anyone to import a file into FAP. Of course, that is also the same way you and Adam do it, as you look at the files first before dispersing them.

CDs would be the perfect option, but I had a staff member from another office call and tell me they don't know how to use CDs. I asked her if she had a CD player in a computer? Yes. Is it connected to a printer? Yes. Well, put it in the CD player and then open the file and print it. (Your paper, not mine)

CDs,like people paying for records, is so new to the system (as far as record transfers, etc., that we are never sure who will take them or not. I have made a few proponents of them, and they will accept nothing less. Gees, it is the best of both worlds. Print it, save it. Whatever.

I did have a mother tell me the other day, "I work for a doctor's office, and it is illegal for you to charge for records." Nope, sorry. And, here is the statute. And, I can also send a letter summarizing the patient's record. She then told me she send the letter to the MMA and the insurance company. Now, that made me give them to her for free. It was the MMA that sent me the statute and told me how to bill for them.

It's just another case of doctors getting walked all over. Try calling your lawyer and asking him/her to make a copy of your will and send it to you. I am sure it will be free.

Leslie, CD's are so cheap (about $0.30-$0.50) I find it to be less expensive in most cases than printing to paper.
Right click the folder of PDF printed files you created, select "send to CD" and it will burn in a matter of a few minutes or less.

And, if you don't like the patient who is transferring, you can burn a virus on it. Wouldn't that be cool? Do you have any viruses floating around your office? I think a good Trojan or Parvovirus would work great. lol

Bert,
YOU BAD!!!
I actually print very little any more. We fax most stuff now to the requesting entity.

As regards your comment about lawyers...One of my patients is the "premier" malpractice lawyer for most of the docs and hospitals in my area. He has had a health problem recently and talked to me and my staff on the phone on several occasions this past week. He left a message on my machine one evening telling me to bill him for the phone call. I called him back to tell him I was not a lawyer and if I did that he would be defending me in court. He had no idea that billing Medicare patients for phone calls was illegal

Leslie

So, did he have Medicare?

Bert you are evil. I like you.

Barbara,

FAP is an excellent program that my software consultant designed which uses the demographics from AC, but saves all files categorically as a standalone program.

I have offered it as a Beta program, it is actually past Beta (just no charge). You are always welcome to try it. It is on the Internet for download.

I have lost interest in promoting it, because I have sent it to about ten users and have offered to do remote training, but all, EXCEPT HOCKEYREF -- PAUL, have kind of let it go. So, I kind of gave up as well. If you were interested, please PM. Thanks.

Yes, he has Medicare.

Leslie

@Wayne I think one has to be a little bit to get by in this business.

@Leslie I don't know much about Medicare. So, if you are a certain age, you just get it no matter what your income. Sorry for my ignorance.

Thanks Bert...I'll send PM

I'm fuzzy on HIPAA regulations. I know sending files over email is illegal, but what if the files are zipped with a password. Is emailing records legal if they are zipped with a password?

No.

Hey folks, it has been okay to bill Medicare patients for phone calls or emails since January 2008. Medicare does not pay anything for these (and never has) but it has codes now (99441-99444) to report these encounters. The patients don't need to have signed an ABN form, since Medicare essentially treats this as an out-of pocket expense. You can't charge if the patient is seen within the next 24 hrs for a face-to-face encounter, or if the "non-face-to-face service" is provided in the seven days following a face-to-face visit. There is a good summary at: http://www.acpinternist.org/archives/2008/04/ten.htm

Another question that comes up with Medicare patients is charging for missed appointments. This is also "legal", as you can read here: http://www.aafp.org/online/en/home/...ctice-management/20080131missedappt.html