Home Forums Discussions General Discussion Signing off on documents and saving comments.

So I just installed v4 of Amazing Charts to tinker with it. I love the new sign off process. However something concerns me and I wonder if I am missing something.

For example... Consider a case where I am signing off on a Chest CT scan that has multiple nodules. I want the patient to undergo a PET scan and see me within 1 week. I type these instructions to the nurse in the box and send it off to my nurse.

Next, I login as the nurse to see what it looks like. It arrives via e-mail, but it is in no way saved to the chart (yet). It would be up to the nurse to save it to the chart. When I pull up the original scan it isn't even attached to the comment section on the scan. So now my nurse can say "I never liked Mr. Jones anyway" and hit the delete button. There is now no legal record of my order for that CT scan.

I did this a couple times (7 in fact) to see if I was missing something.

Any thoughts?

All e-mail messages are not saved to chart until done - either they save or you do. All my messages are sent to reception, nurse, etc and then when they answer me I hit save. I guess this is like a paper note that isn't saved in chart unless someone manually saves it.

Hmmm... That's a problem. When I give an order, it needs to be a permanent part of the chart. Right now it is permanent only if my nurses decides it should be permanent (by saving it to the chart or by replying and letting me save it).

Right now this is the only thing detering me from switching over to Amazing Charts when version 4 is ready.

Does anyone have any suggested work-arounds (other than writing on the document before it is scanned in)?

I guess I would need to know what you are trying to do a little better. When you "give" an order, do you mean when you right click on the patient name and select Print Orders? At that point, you must print the order, correct?

Who gets the printed order? Is it printed to your nurse or your desk or up front? If it is printed to a place where you know the person responsible will see it, then you can just save the order that is in your inbox to the chart.

Next scenario: You print the order somewhere, but then you forward the order that is in your inbox to your nurse. That forwarded message can't be used as the actual order, only to alert the nurse the order needs to be done. So, does she have the order printed out already? Or does she print a new order? (not too logical). So, IF the reason to send him/her the email of the order is to let them know it exists, then why couldn't you "copy" the email to yourself and save it then?

Actually, by orders here I'm talking about putting orders on imported documents. So in the above example, for Amazing Charts v4.x, I would pull up an imported document that I need to sign off on and type "PET scan, see me in 1 week" in the instructions field that I would then send to my staff.

Unfortunately, that box where you write your instructions isn't saved to the chart anywhere (i.e., it's not saved in the note and it's not saved on the imported document itself). Rather, your orders go to the nurse's inbox as a message. The only way the orders you wrote get save to the chart is (1) If the nurse elects to save them to chart by hitting that icon on the message screen or (2) If the nurse replies and then I select to save the item to the chart. Essentially, the nurse could just delete your message thus losing the orders forever.

Make sense?

Gregory,
I'm not using v4 yet, but the way my office handles it currently in v3x, and you might consider:
1. Item imported, and messaged in my inbox to sign off
2. I right click that message and open imported items
3. I right click on that item and open in default program (adobe)
4. I mark up (with adobe standard, but there are others) the imported item with all sorts of checks and circles and whatever I would've done with a paper result in the old office.
5. I enter a text box, with my comments and instructions clearly stated
6. I highlight the text, right click and copy it.
7. I stamp my signature on the imported item and save the PDF file.
8. I sign off on the message via AC
9. I open a message to my nurse/MA with the patient's chart.
10. I insert a templated text, one that says something like "please call/contact this patient and give them the following message:"
11. I right click below that and paste my saved text (my comments from the imported item)
12. I send the message
13. Nurse opens her message and notifies the patient of the results and orders
14. Nurse then clicks on the forward message button, but only so that she can enter text, and writes that patient was notified and yada yada plans made for f/u
15. Instead of actually forwarding the message she saves it to the chart.
16. Nurse then opens the imported item PDF and stamps a bright green "NOTIFIED" in the top right corner, and saves the file.

So, in the end, I (and everyone else) can easily see what my comments were on the previewed imported item (it's bright red text in Adobe), can see that they were NOTIFIED, and the message is permanently saved to the patients chart with details of the notification found there (read in the Past Encounters tab).

Though 16 steps may sound like a lot, it is actually very quick, most steps being only a click or two on a mouse.
Again, this is not version 4, but those steps will likely still work, right? I hope so, 'cause I kinda like my flow.

Another, maybe simpler way: when writing that order message to your nurse, CC yourself, and save that message to the chart... though for many reasons I prefer to not save those messages until orders are given to the pt (one being if the patient for some reason no longer needs the addtional testing I ordered... already had it done, or I want to change the test... it would cause much confusion, and many more addendums and messages to be saved to the chart). The message saved in the 16-steps flow above will have the time and date of my message to the nurse, along with the time and date of her message being saved.
Good luck,
chris

Gregory, I couldn't help but reply to you on your statement above. I hope you can take it in a good light. I think allowing this "issue" to keep you from going to Amazing Charts would be in your detriment.

You are correct in that your nurse/MA could simply delete the message. Again, comparing to a paper chart, an MA could do the same. They could even write that they talked to them and give the opposite information.

I think we have little control, unfortunately, over many medical issues. Hopefully, we do have some control over those we pick to work with us. Trust me, I have been completely fooled by some staff members whom I thought I could trust. However, having said that, if we can't trust our MAs to do what is in the best interest of our practice and our patients, then why even do this. This may sound like a cliche` but we do have to work as a team.

In your situation, I would ask the nurse NOT to save it to the chart but to ALWAYS document what he/she did and send it back. I would think that the fact that she would even have to worry a little about how she/he would explain it to you that the message no longer existed would be rather problematic.

I'm new to AC, so I apologize if this is a dumb question, but as most know, often the apparent dumb questions result in the greatest learning.

I created a sample patient and imported a faxed lab report. It was formatted as a pdf. It imported well and I can view it in AC - within the browser.

However, it never asked me to sign it, nor can I use adobe pro (which I have on computer) to mark it up. I can open the file before I uploaded it and could add comments/stamps with adobe, no problem. Within the browser window in AC, I get a basic dropdown list of Adobe toolbars (BAsic, Edit, File, Find etc). My advanced editing tolbars (Advanced Editing, Basic, Commenting, Drawing markups) are not there. If this something to do with my preferences. I don't understand how the author below was able to mark up his imports like he suggests. Thanks.


1. Item imported, and messaged in my inbox to sign off
2. I right click that message and open imported items
3. I right click on that item and open in default program (adobe)
4. I mark up (with adobe standard, but there are others) the imported item with all sorts of checks and circles and whatever I would've done with a paper result in the old office.
5. I enter a text box, with my comments and instructions clearly stated
6. I highlight the text, right click and copy it.
7. I stamp my signature on the imported item and save the PDF file.
8. I sign off on the message via AC

Sorry. I got my nurse to import another item and it asked me for sign off, but when I view the item, within AC, I still can't mark up the document. I think that would be a great feature. Can someone verify this is possible. Obviously one could review imported docs in a folder, and mark them up with paperport or adobe, but once you import into AC I can't do the same??

Dave,

Hi, not sure why you are having that problem. I can't speak for other PDF editors, but with the actual Adobe, I have no problem marking it up when I open the file in its native application.

Are you using only Acrobat Reader? Are you opening it in its actual application or trying to edit it in AC on the right pane?

Thanks. I was trying to edit it in the right pane. Works good now...

Welcome.