Home Forums Discussions Feedback and Recommendations Referring Provider

I don't understand why this does this but... When adding a new patient, there is a place for "where did you hear about us" but the referring provider window isn't on that screen. Once the patient is entered and you save it, you can then re-open it to put the referring provider in the appropriate drop-down menu.

So what happens is that my staff don't put in the referring provider because the forget since it is not on the main screen. Drives me crazy.

I'm confused. I see the same window in both screens. Also, in the screen where you say it doesn't exist, where does it say, "Where did you hear about us?"

On the add new pt screen - it asks you how the did the pt. find us and you bring drop down to Doctor (who?) - I think you are supposed to highlight this and type in Dr. Name, but the better way is to go down to Referring provider tab and use rolodex to enter it......

I thought I just said that. I must be in a time warp. Either screen shows the drop down window. I don't see how using the Referring Provider tab works. If I am a consultant, sure, if a PCP refers to me. But, I think this is a generic, "Hi, I am here for my new visit, and I am here because:"

My sister goes her.
You were recommended to me by a colleague
Dr. Smith told me you were a good pediatrician

Doctors send me patients all the time, but they are not "referring" them to me.

I think Bert and Steven are saying the same thing here. I am jumping in because I have a minor issue (related to Travis') which I would like to voice.

My understanding is that the "How did patient find us" box wants you to answer with free text. So you can say an advertisement, a doc, or the patient's astrologer, as in Bert's example above. We find it helpful only if someone OTHER THAN a referring doctor sent them.

Lower down is the "Referrals and Consultant" tab. This serves a dual purpose depending on who YOU are. If you are a primary care provider, you can enter the docs to whom you referred the patient, and keep track of the number of visits you authorized. If you are a specialist, you can click the little box and name the referring doctor.

Travis, you might want to have your staff pay less attention to the "How did you find us" box and MORE to the "Referrals" tab. You can save both at once without closing and re-opening the page.

As a specialist, like Travis, it is important for me to know who referred the patient so I can send copies of notes and reports. My staff puts them in the "Referrals" tab, but my minor complaint is that tab won't stay on top. We always use it, and rarely use alerts, miscellaneous, or the other tabs in the box, so I have to click that tab for virtually every visit. It would be nice if we could set it to keep that tab on top, or have it stay on top as you close and then re-open the page.

The other thing I noticed (although I don't use it so I could be way off) is that when you click on referred to or referred from, the same names are listed from the Rolodex. So what good does it do to choose consultant or referring provider in the Rolodex other than its ability to filter them there?

One of the shortcomings of AC for a long time has been the very few options and preferences. But, I suppose those are difficult to code. But, my programmer puts them in our programs all the time.

O.K. You guys are right. I'll be honest, I haven't spent as much time on the demographics screen as my office staff so I never even saw the referring provider at the bottom. I had always seen it at the top after the patient was already put in. The "how did you find us" (sorry about screwing that up Bert), is what my staff were using as a referring provider.

So we'll use the Rolodex at the bottom. It was intertwined with all the insurance info so I never it saw it since we don't enter much insurance info into AC.

Another dang easy answer. I guess it was just odd that it moves around depending on if it is an established patient with established demographics or a new patient.

I do wish that referring provider would be visible on the letter writer, or on the input page at all times so I don't have to click back and forth to remember who sent me the patient.

I think that if AC ever fixes the letter writer, the number of posts will drop by 50%, at least.

And if along with that, they made auto-refresh for the inbox, there would be no more message board.

Travis,

Do you initially put the patient in or do you have an assistant do that?

What exactly is it you want to accomplish? I am thinking you see the patient, you sign it off, the window comes up to write the note, but you don't recall who the referring provider is. Correct?

Then you have to close that window and go back into the chart to see who referred the patient.

Please let me know if this is correct, and who puts the patient in.

My office staff put in the patient initially.

Exactly Bert. That's exactly what happens when I sign the note, the window comes up to write the note, and I can't remember who the hell referred me the patient. I then have to close the letter writer because you can't go back to the note or chart and look with the letter writer open. Drives me nuts.

I've worked around it currently with paper that the patient or my staff write down the referring doc on new patients. Still doesn't work on recurring patients. I just have to remember to remember

Well for starters, if you're going to have to close the window anyway, you can save a step, and click on the little, almost not visible check box at the bottom left, and it will not appear anymore. You can click it again to make it appear. As an aside, I have suggested at least 50 times that one be able to click a button on that window and bring up the patient's chart. Just makes sense. Especially, when they say, "Oh, by the way, I need a refill on this med."

Now there are a number of workarounds. Let's say, you go to the addendum window. In the text area, type Dr. Smith. Do an Alt-right click and name it "Smith." Do this for all of your consultants.

When your MA comes in and pulls the chart, the first thing she does (assuming she knows who referred the patient), is open the Addendum, right click, and then double click on the template named "Smith" on the left hand side. This will put the name of the provider in the field, and she closes it without making a superbill or anything.

Now, when you sign off the note and you are ready to write your letter, all you will need to do is click on View Saved Addenda. The last one with today's date will be the one you click on. Instantly, the window will open, and the name will be there.

The beauty of this is you don't have to just put Dr. Smith in the field for the template, you can put: Dr. Smith. Really likes a call from me. Would prefer that I refer the patient on if I need to. Anything you want.

So, obviously, once your MA opens the Addendum with the pre-populated names and clicks on them and saves it, you will only have to click once, to get all of the information you want.

In my trial workarounds, I tried to do as few mouse clicks as possible, therefore, I left it as addendum and did not use a subject line. Of course, this will be saved to the patient's chart, but there won't be many consults on that patient, and I don't see an issue having an addendum that states the patient was referred by Dr. Smith. In fact, it is just that much more documentation. You could change Addendum to Other, but again, one more click.

I have other workarounds. Just thought I would run this one by you first.

That is a workaround that does work. That being said, I'm not a fan of anything that makes someone repeat work that's already been done. Takes away the efficiency of an EMR (if there is some efficiency). Why even worry about putting the referring provider in the correct place if you're going to have to do it again as an Addendum?

Oh well. I've lived with it this long. It's just the little things about an EMR that can make things so smooth or rough and simply being able to access the chart from the letter writer would be invaluable.

Having easy access to the referring provider would also be great for me as it is used EVERY SINGLE TIME I write a note. Just one little corner of the note that, if the patient was "referred" to me, it would be easily found in the letter writer and "most recent encounter" page. It would be nice that if that field were filled in under the demographics page, the referring doc would automatically be on display in the upper right hand corner of the page (or somewhere where there is some space).

Oh well, just whining some (that's what surgeons do). I know we specialists want/need different things. Before I want a PM module, or a Health Maintenance module, or an order module or whatever, I want the basic stuff that I use every single day to be easy and intuitive. This includes the scheduler (color coding anyone?) and the letter writer.

Thanks for your efforts Bert

Travis,

I couldn't agree with you more. There are at least a few of us if not more who feel the same way. Fix the little things and make it clean and smooth. I don't know how many times I have brought up the letter writer thing.

Also, other than bugs, I think if I were Jon (and clearly I am not), I would look for those who do workaround. A workaround means we need to change it so it doesn't take a detour anymore.

Part of the issue is there is no perfect way to inform HQ of our ideas, plus if we do, there are hundreds. But, it isn't like Jon is scouring the message board looking for tips.

Anyway, have your MA write the name of the referring provider in the chief complaint. When you open the letter writer, check the box next to CC, and the name will appear. You can uncheck it to get rid of it.

As one whiny specialist to another....
Travis, I actually made this request (plea) to Jon at the ACUC and he seemed receptive. My argument is that the program should provide basic options to make our (specialists) lives easier, and that this need not make the program overly complex for the pcp's. We may want to "turn off" health maintenance, and "turn on" a robust letter writer. Yes, priorities must be established by Jon and his programmers, but they are not mutually exclusive.
I admit that since starting to use AC, I send fewer complete letters and more "substantial" notes. This may have a negative impact on my referral base; if so, I hope it is minimal. Honestly, I think they really look for my "assessment and plan", not the letter. Nonetheless, I would write more letters if the writer were better.
To your specific issue: not sure if this works for you, but at the end of every note on a referred patient, I put "cc: Dr. X" (after the recommendations). Do this on the first note (even if there is an accompanying letter) and if you template from that note, the referring doc is always at the bottom for you to see. AND, if you go to the letter writer, and still can't remember, click the box on the left to "Include plan" and the docs name shows up. Then un-click the box to take the text out. Two extra clicks.
By the way, after signing, I print to our fax program and the referring doc has the note before the patient leaves my office. I think that means more to them than a pretty letter (no offense to the letter writers out there).

Would that help?

One of my pet peeves w/ AC, and I love the program overall, is that the letter writer does not automatically include the phone number of the physician you selected--even as a check-box option.

This is the opposite of what the specialists want--I want a quick and dirty referral form that I can do on the fly, and not need to save a bunch of templates.

Example: Patient comes in complaining about a strange new mole. They have a PPO plan, so no "formal" referral (translation--authorization) is needed. But I want to send something, if only "strange mole on arm."

So, go to the letter writer, pick the derm consultant you want. The letter will have your name, the specialists name, the patient's name. BUT CURRENTLY NO PHONE NUMBER. So, you can write in "Dr. Skinsosoft, please see Martha Molearm to evaluate etc." or you can just write "reason for referral, suspicious mole on r-arm." But I'd like to just give this to the patient and let them use it for the referral. It needs the specialists phone number. Currently, I have to keep a plethora of forms I've made up in MS Word and give it to them....after I remember to scan it in....if I remember.

Thanks all for your workarounds. Good to see I'm not the only one frustrated with the little things. Don't get me wrong, I praise AC at every turn and I'm the most "technologically up to date" physician at my small hospital due to AC.

But AC with the CCHIT stuff has missed some of the forest for the trees (or maybe missed the little trees because of the forest). These are "small potatoes" issues that consume these support boards.

I agree Jon. I complete my note and send a quick letter to the referring provider just with the Assessment/Plan as well as a canned intro on the same day as the patient is seen through my fax/printer. I truly believe that promptness has increased my referrals from many docs.

Maybe 6.0 will have a better scheduler and letter writer. I've actually adapted my practice to the letter writer and scheduler so much now that if it was changed too much, I'd probably still gripe! Doctors are never 100% happy.

Guys,

As a referring physician, I personally do not really care that much about what an "interesting patient" I sent to you or, as Bert says, "blah, blah, blah". The parts I read are the assessment, what you recommend and what the patient agrees to. When and where any procedures will be performed are also important to me as is the operative note and any follow up plans. Having your encounter note from AC is enough for me. No formal letter is required. I love it when I receive a faxed note the same day the patient was seen because, many, many times, after leaving your office the patient will call me and ask me what I think. Want to make me mad? Have the patient call me and tell me I need to send you a note giving them surgical clearance for a procedure I do not even know they are to have.

I agree. Yesterday, I called our GI specialist about a patient. While on the phone I asked him about a patient that he MUST have seen a few days ago. Had to, because I read his consult note three hours earlier. So, I was describing the patient to him when he said, "Oh, that patient, I saw him this morning!" Now, that is incredible. Appointment at 10 am, consult note by noon.

And, this surgical clearance. I suppose it is more important in the FP world, but I get 10 year olds all the time for physicals for a tonsillectomy. I would think taking a bleeding history would be all that is necessary. It's all CYA. But, I sign the form and talk to the patient about Lebron, listen to the heart and lungs and charge for the visit.

The one that takes the cake is the one where the patient was having fairly significant surgery. So, I did a complete history and physical and wrote on my note, "Past physical, OK for operation."

We received a phone call back stating that wasn't sufficient and that I needed to send a letter stating, "Cleared for all procedures." Well, being the passive aggressive person that I am, I refused. (Of course, I would always acquiesce for the good of the patient, but please). So, they called again. I refused again.

I finally called the surgeon who happened to be in his office surrounded by all of his staff who couldn't come close to seeing the forest for the trees. I told him I didn't see why my H & P with the statement, "Normal H & P, OK for operation," was not sufficient. He agreed and asked what the problem was, and I told him about the request for the exact quote. I was so elated when he told his staff in a voice that was not normal, yet not shouting, but somewhere in between, "What the hell is wrong with what he wrote? It is perfectly sufficient. Can we focus on other more important things?" He then apologized.

I told the story to the mother, and I guess her take on the whole thing without stating it was you were so focused on your passive aggressive attitude, that you would put my daughter's surgery in jeopardy. I never got the chance to tell her I would have given in. The surgery was two weeks away. She left the practice. I should let it be known that this is a very prominent Boston surgeon, and we jumped through multiple hoops to get the appointment in a week and not six months. What I learned:

1. Always write "Cleared for procedure." (The word 'cleared' seems to be the buzz word)
2. You can be passive aggressive. Just share it with your staff and not the parent.
3. Just send the damn letter stating what they wanted.

Nope, can't do it, Bert. The best I give them is (and this includes those stupid forms that have to be completed before someone can take an exercise class at a gym or the Y) is, "based on the information provided by the patient, the information in my chart and my most recent physical exam of (date), I see no obvious contraindications to the proposed surgery (exercise)." My arse is just as important as the surgeons' and the Y's.

I like that. Can, I use that line or is it copyrighted. I guess I still would have lost the patient.

My intent when I told the patient's mother was not so much to brag about my great PA prowess, but more to let her know that I had held up my end of the bargain and sent the proper documentation, and the surgeon's office (that she had selected), was being at best unreasonable and, at worst, sh...heads about it.

My referring providers get exactly what Leslie said: A/P and date of surgery.

For the record, I have never asked the primary doc for a "letter of medical clearance". What the hell is that anyway? What is that supposed to do? I don't know when that started or who started it. Some lawyer probably asked for it. It's total CYA and it doesn't CYA. Our orthopods do it ALL the time. Of course, I don't think they deal with anything medical so asking the patient if they have chest pain would be too much questioning about non-orthopedic issues.

There are two specialists who I've asked for clearance and that is a cardiologist and a pulmonologist. Not really to see if the patient is "clear", but to assure that the patient is on the optimal medication and recommendations for anything special post-op. A wise cardiologist said that medical clearance has never stopped a post-op MI. True. It's simple risk assessment and I can usually do that.

And, I do love to be passive-aggressive...

When I have to do those preop things (and I get exactly the same nonsense as Bert) part of me wonders what the heck I an saying, anyway? I have NO IDEA if a patient is going to survive anesthesia; all I can offer is an assessment of the risk involved. I know the surgeon wants to be able to pin it on me if things go wrong, but I just don't have those God-like powers, and I wish they'd stop asking.

Good topic. Wish everyone could all get together and talk about this. I never see these anymore, but in medical school (maybe it was Vermont) the consultants would always do an APSO instead of a SOAP note. I think Larry Weed got it a bit wrong or maybe there needs to be another Weed for specialists. At first when I read them, I was questioning my medical school faculty, but it made sense:

Assessment: Cholecystitis

Plan: Remove gall bladder

Then all of the the patient presents with two weeks of RUQ pain and vomiting after drinking chocolate milkshakes at Dairy Queen, etc.

We get these 30 page neuropsyche reports on our patients. 15 pages of it are the testing results of the Woodcock Johnson, etc. I just scroll down to the Diagnoses of: Mood Disorder, NOS, the rule out this and rule out that. Of course, here it takes literally seven months to get this consult probably due to the report taking four of those months.

On the same subject, one of my pet peeves is, "I saw your adorable little 3 year old... "I saw your patient is fine." And, then the consultant always ends with, "It was a pleasure taking part in the care of your patient." I know my patients, and I know that it would be a pleasure with around 30% of them, but the others are anything but pleasurable to be around.

Then there is the anesthesiologist who calls me for instructions on how to manage the patient with adrenal insufficiency. It's basically, give tons of steroids before the surgery, give tons of steroids during the surgery, then give tons of steroids after the surgery.

I could be wrong here, but I don't know how many of my patients have had surgeries for ear tubes cancelled due to a cold. I mean you can intubate the child. I doubt a Rhinovirus is going get by an ETT. I don't know, maybe they are at higher risk. And, it is elective.

I also love it when my patient sees a consultant, and they do a great job with the consult, but then they tell them they have this disease or should be on this medication and now the patient comes back demanding these things.

Finally, it would be great if all of the doctors and pharmacists, etc. could meet in one big area and decide which of two islands they want to work on.

The ones who want to answer phone calls as they come in so we don't both play phone tag would go to the Efficient Island. The same island would be home to consultants who give a consult date at the time of the call. I don't care if the consult is a year away, I just want to tell the patient February 15 at 2 pm. Half of the people we refer to (these are usually developmental psychology groups) always say, "We will call the patient, and they call them two weeks later," and we never get told when the appointment is.

For the pharmacists who want to be on our beautiful efficient island, they have to actually say to the patient, "Oh, I never got that script -- maybe ePrescribe didn't work -- let me call your doctor." Or, "ou are self pay, and Dr. so and so prescribed Vigamox. That will be $85. Let me call your doctor and see if he or she will prescribe Polytrim drops." Instead, the patient call me from a cell phone, and I have to call back the pharmacist, etc. etc. because the pharmacist can't actually take the cell phone from the patient. Or, for some reason, patients like to drive all the way back home before calling me.

Wow, I didn't mean to go into all that. Not really a rant, just some points that I wonder how others deal with them and to get the consultant's viewpoint. I am sure the pharmacist is thinking, OK, this is the 30th patient today who has come in claiming there should be a script waiting. I could see how it would be hard for them to call every time.

This won't make sense to those who haven't been keeping up with the other thread about the iPhone 4 vs HTC Evo YouTube video. But, I couldn't help but think about the consultant's receptionist telling us that the consult date will be February 15, 2011, and we would say, "I don't care." But, that is over seven months away! "I don't care." Your patient's appendix could explode. "I don't care."

Just in case you didn't see that thread:

http://www.youtube.com/watch?v=MvA8Hdmit-U

It's rated X for vulgar language.

I always love it when we schedule 15 minutes for the visit so I can check the box that says all is well, and the patient says, "Can we go ahead and make this my annual physical?" Uhh... No.

So Bert, I tend to do a lot of upper GI endoscopy and laparoscopy. So I see a ton of esophageal spasm, esophagitis, simple GERD, etc. I often recommend medical therapy such as nifedipine, hyoscyamine or prilosec bid or whatever. I usually write the initial prescription but many of these patients are going to be on this long term. I send their doc a note telling what I recommend as well as the medication the patient will need to be on. Do you think I should refill this medication for the patient forever or allow their primary doc to take over prescribing it after my initial prescription is out? I like the primary doc taking over long term prescribing for most things and sending the patient back to me if it ain't working.

I'm with you. If you call my office, you get a time and date for the patient immediately. Everytime. That's the way it should be. One of my referring docs offices does everything by fax because of the problem with sitting on hold forever at multiple doctor's offices and still not getting an appointment. His office sends us a fax requesting an appointment, we fax back the appointment time/date, they send the patient the appointment date/time. Not quite as efficient as calling my office and giving the patient an immediate appointment but I have a small office and you talk to a person usually on the first ring who is sitting in front of the AC scheduler. I'm also rare in that I like to get all patients in within a 2 week period from the request date (usually I get them in within a week).

So every office we deal with does it differently. Some call with the request and tell the patient immediately. Some give us the patient's info and ask us to call the patient with time/date. And others do the fax-a-thon. If I know one thing it's this: you can't make everyone happy...especially doctors.

That's perfect! Want to move to Bangor? Of course, I don't think you do peds.

My perfect referral is where I am in the room, the child has a hernia, I message my front desk he needs a surgical appointment after asking whether they prefer morning or afternoon appointments. I can usually tell by the appointment time in my office.

My receptionist calls the surgeon. She is given an appointment. She fills out the appointment card and faxes the demographics and referral. I type a letter while the patient is in the room and print to fax and send it to the surgeon with a cover letter that thanks him for seeing my patient.

The parents walk to the front desk to check out and get the sticker, and my receptionist hands them the appointment card. They are completely in shock. Of course, it doesn't always work that way, but it's awesome when it does. I guess I have no life.

But, they walk out the door with the appointment. The surgeon's office has all of the referral information, and the surgeon has my referral letter on the great AC letter writer.

*****************
One good thing about the surgeon calling the family is it avoids this. And, it can be any consultant, and from what I am reading, I doubt you do this. But, it drives us crazy.

I call the consultant, and they hear the story. They tell me they are booking out a month, but it sounds like this child needs to be seen within the week. They tell me they will tell their staff..."What is the name of the patient?"

We generally give it a few hours to give him or her time. But, at least 40% of the time, they forget to tell their staff, and the appointment we are given is five weeks away. Of course, we tell them we talked directly to the consultant, and it gets fixed.

I do think if I have a good relationship with my consultant, I can sometimes get patients in more quickly. Especially, if I call him or her directly. So, that means quick and thorough referral letters, sending the notes (especially the pertinent ones -- not the plain ones or fax cover sheets or upside down pages), the referral being sent quickly AND the patient actually showing up. I completely despise patients who no show to consults.

I do simple peds. Send the umbilical hernias, inguinal hernias/orchiopexies, appys to Arkansas. I'll take care of them!

If a consultant calls me to get a patient in soon, I send a text message to my office staff immediately. They take care of it. I just say, "hey, Dr. Bert has a patient that needs to be seen this week. Call his office and make it happen.". Done. Hasn't failed me yet.

My obsession in life is the goal of outstanding efficiency. Doesn't happen all the time but that's why it's a goal.

So you actually examine the patient for appys or wait on the CT? Are they opening walk in clinics in Wal-Mart down there.

I agree with you about the make it happen thing. I don't know how many times my staff will say, a patient called with a cough and fever, where should we put them?

Ummm...in the schedule?

But, we are completely booked.

When is the last patient scheduled?

6:15.

So, put him in at 6:30.

But, we won't be here.

I will.

***
I don't say that to come across as a martyr or anyone special. It just kills me that they haven't figured that out yet.

Love the appy question: I've almost got my E.R. and primary care crew to understand my appy preferences. Only women of child-bearing age get a CT if the question is appendicitis. If the lab and history of anyone else looks like appendicitis, they don't need a CT...they need me to come push on their belly.

I'm not a fan of kids getting radiation unless something is goofy. I've found that I am old fashioned and most of the surgeons want a CT every single time. So Bert, your patient population would never get a CT from me until I actually touched the patient...heaven forbid.

No Wal-Mart clinics yet, even in the land of Wal-Mart.

Good answer.

We have two Wal-Marts. Neither have a real fax machine.

They both have Walk-in clinics. There are two ironies here, if you want to call them ironies.

1. They give the patient/shopper pagers to wear while they are shopping until the provider can see them. I guess that solves the problem of patients' getting upset with the wait time. But, it also means that the patient is spreading H1N1 all over Wal-Mart, because, as you know, it's never crowded at Wal-Mart.
2. Child gets diagnosed with otitis media. If I dx that, it's a 30 second half-page AC note. But, they use Logician (Centricity). Go figure. Oh, and by the way, cerumen removal: $116. What a bargain.

I hate it when a consultants office tells us they will call the patient and make the appointment. Or worse yet, when they tell us to tell the patient to complete the patient packet they have given us to give the patient and then have the patient call to make the appointment. The largest GI group in town does it this way and it is one HUGE reason why I do not refer to them unless the patient insists. I cannot count the number of patients I have advised to have their first screening colonoscopy done and they then return to me the next year for their annual exam having never gotten around to calling the GI's office to make the arrangements. And, why should my staff have to mess with handing out their crap and explaining it to the patient?? I have even called the office manager there and told them how my patients were dropping through the cracks because of their system. Their response sounded a whole lot like "I don't care". The other solo GI doc's office is terrific. We call and the patient leaves our office with an appointment to be seen in her office so that her staff can go over all the details with them, the doc can meet the patient and determine if anything else may need to be looked at, and the procedure is arranged. In my opinion, there is nothing worse than being told to show up somewhere at sometime after having gone through one of the most unpleasant evenings of their lives to have what they fear will be the most humiliating thing of their lives done by someone they have never met and won't remember after the procedure.

Bert, Alice told me she never ever writes "cleared for surgery." She will write "the benefits of the surgery appear to outweigh the risks." or something pretty close to that. NO office has ever pushed back at her. I see Leslie has a similar tact. Something about "cleared" leaving you open for a suit if something in fact does go wrong.

@Wayne Good to know others have the same mindset. Of course, I get the same thing with sports and camp physicals. I had a 200 lb 11 year old with a pulse of 88 who wants clearance for two-a-days in football. You would think the coach would just say no.

I have always thought that an echocardiogram to rule out Hypertrophic cardiomyopathy and an EKG without the exam would make more sense, but my cardiologist says statistically you would get too many false positives.

@Leslie Well said. By the way, what constitutes a large group in your town? Two GIs? LOL. J/K.

We have a Developmental Evaluation group who takes the referral from us. They then mail a packet to the patient at address A. They then mail a packet to the school AFTER they receive a release form from the patient at address A. The patient gets the packet two weeks later and throws it on the table underneath all the bills and the TV Guide and probably doesn't even look at it for a week. IF, they fill it out and send it back and after the school sends theirs back, the Developmental Pediatric place mails them a date and time. Well, by this time, the address is B. Or the phone is disconnected. I hope no one takes this the wrong way, but there seems to be a correlation between the patients I send for developmental testing, Learning disabilities, etc. and families that are doing their best to keep things afloat. And, the chances of change of address or phone issues are greater.

I then receive a letter six weeks later stating "We are looking forward to seeing your child, blah, blah, blah..."

Then six weeks later, I get a copy of a letter to the parent stating we didn't receive your packet or you didn't return our confirmation call, and therefore we can only assume you have decided not to meet with us.

So, after a consult that was put in motion four months ago, we receive a letter stating it isn't going to happen. And, in 13 years not one of my patients on the waiting list get in early.

Crazy.

Well, I started playing with v5.029 again tonight (haven't gone with it in the office yet).

I decided to make sure that the "referring provider" drop down list was unchanged and just as easy. Well crap, it isn't. Instead of adding a new patient and there is a drop-down on the same screen, it takes 5 mouse clicks instead of 2. I guess this was done for PCPs who can document sending the patient for consults but it made it a little more work for the consultant.

oh well. eRx and meaningful use may get me to step up to the dark side of CCHIT if I can eliminate all of the crap I won't use.

Oh, and it takes too long to start v5. I'm impatient.

1. Travis, I am not sure what you are referring to. I think you have talked about the referring provider before. And, given there is a referring provider drop down list right on the demographics window, I always think I have no idea what you are talking about.

2. I haven't started up AC in ages.

I have a bunch of Pentium 2.4s (fairly old and slow but good), it takes about 30-60 seconds to start from not having AC logged on , but sometimes at the beginning of the day the computers are a little "rusty" and they take a minute to "warm up" from sleep with it running frozen from sleep.

I do not generally log out or shut down(which is probably why Bert states the hasn't started it up in ages) but rather just lock the screen.

All I do is unlock my windows login and it is there for me to use. I do, at the beginning of the day, go to each computer to make sure they are "awake" and ready to roll, it takes only a few seconds.

Bert, I always close AC completely and restarting v5 takes some time on a pretty quick computer. Not terrible but noticeably slower than v4. I'll just get in the habit of logging out instead of closing it.

The referring provider is still on the demographic screen but a little more complex. But on v5, you have to click on "referrals and consultants" when adding a patient, then click add, the click "referred from", the click the drop down box, the click the doc who referred the patient to me, the click "Save". I guess that's 6 mouse clicks. v4 was 2 clicks. Just more time.

I'm getting closer each day to upgrading the computers to v5. Mainly because the new version has an HL7 interface with my PM system now. And some of the initial bugs have been worked out.

I kind of wanted to wait until next year because the next version will be out early next year (likely) but I may have to get the crew to start learning the newer version.

Re: learning the new version. AC support will do hour long training sessions for your staff and they are SUPER. We had two and learned so much we had to stop for a while and absorb it all.

We hired a care manager for the clinic and she has saved us far more than the cost of her position in time freed up for everyone else, appointments made and kept, reports received from consultants, family happiness.

Over half of our patients are children with special health care needs so it is a different demographic but I think the model works well.