Home Forums Discussions Problems delegating tasks

I am now trying to delegate more post encounter tasks - in the past I selected labs, hit print - typed a specialist's name, phone fax and reason for referral etc, hit print - selected an imaging study typed indication and location, hit print - then handed these to the patient.

makes no sense continuing this - I am having difficulty forwarding these tasks - I select a staff and forward the task - they get a memo and when they print it - it prints as a memo from me to them - not as a order/requisition or referral.

What am I doing wrong here?

I am not sure if I understand your problem.
In my practice when I want to send a referral letter to a specialist, there are 2 ways you can do it
1.After completing my letter I hit the print button and save it as a PDf file and send to my MA's folder with a message thru AC messaging
2 The second way to do it is to hit the EXPORT button next to the PRINT button and save it as a txt file and forward it.
3 I do the same with Labs, Correspondence etc- right click, copy and SAVE to the MA' folder
She then has the ability to combine the Labs,Imaging,Letter as a single PDf file and Fax it to the specialist
Grenville

I appreciate your comments in "the emperor has no clothes" discussion. It seems you use an Adobe product as your primary document management tool... I have been using Updox and AC... perhaps that needs to change.

with AC, I can print a requisition/order form however I havnt figured out how to have my staff do so without their names appearing at the bottom ... and if I forward mine to them ... they can not print it and have it appear in the same form as it would if I printed it.

I have targeted 3 areas where I spend more time now than before EMR adoption:

1. at the begining of the visit (entering hx otherthan HPI or ROS), updating medication list

2. at the end of the visit - finding the ICD-9 code,selecting grouping and printing labs, determining which lab facility based on insurance, providing that GI docs name and contact info for a colonoscopy and do they need a "universal form" etc... etc.

3. Medication renewels, Referals for HMOs, preop consultations, handling any form requiring a signature.

these are the areas i intend to either delegate or significantly improve.

for #2, I'm finding AC difficult... everything was easy when I did everything ... and now I'm swamped in "electronic paperwork" so I want to delegate.

I was hoping I simply was not properly utilizing group tools or functions native to AC - it seems you and others have found work arounds with other document management software.

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.

1 My Ma's do my Hx, HPI and ROS - s Bert says jujst edit what you need -be careful and read what they write in the CHIEF COMPLAINT
2 For ICD 9 codes I have a CHEAT SHEET for most common ICD 9 I use and at times I quickly jump on the internet and google the ICD 9 .The rest of your question in 2,I message my MA through AC regarding the Labs,Specialist,Imaging results etc and they find them in the respective folders I have created on a shared client commputer.
3. As bert says I have created a TRANSPARENT!!signature -Bert calls it TRANSLUCENT. Some are created neatly and some not so neatly and I use different signatures at different times to give them an authentic handwritten appearance!!
I honsetly think AC has made my life so much easier - we are all here to help each other and learn.
Do not get dismayed - you will find it easier once you delegate.
Grenville

Grenville is correct. I hear it both ways on the transparency. One of the keys of making a signature stamp or PDF stamp is write it as poorly and illegibly as your other sigs. I tend to write it much nicer and THAT is what makes it look unrealistic.

There are quite a few sites that will explain how to do it. Adobe Photoshop is the easiest, and I think you can trial it. Otherwise, it costs more than your mortgage.

There is also a website where this guy not only shows you how to do it in a video, he will also do it for you professionally for $35.00. Sounds pricey, but you will have it forever. Grenville may even do what I do. I purposely place it so it overlaps some words on the document to make it look more real.

Benjamin Serrato had a thread with a really cool way of doing ICD-9 codes where you template them in the assessment and with one click, it puts in the real ICD-9 code. I, too, look it up online, but that takes up time.

What kills me is that the ICD-9 module on AC is horrible and yet we talk about the PM. But, maybe Jon will contract with a much better one. This is where Praxis shines. (the EMR).

You may find it easier to delegate with an intranet IM such as IPMSG. Download it. It is free. Also, if everyone has Outlook (a huge advantage of a real server with Exchange you can send a lot of things that way. Don't limit yourself to just AC. There are a lot of third party tools that work.

Finally, you are even doing everything as it comes to ideas. Have your staff think out of the box. Give a DD gift certificate for $5.00 every time they come up with an idea you accept.

Change one thing at a time.

Bert, does this work for the staff doing eRx under their account (with your name filled in)?

A couple of practices I know use a scribe... an actual hired person to go into the room with the provider and do it all. That sounded so counterproductive when I heard about it... after all, the whole point was to REDUCE staff... but maybe you can convert a chart filer into a scribe. As I said in starting my "Emperor's new clothes" rant, maybe the reduction in work load theory is a fantasy, just like "computers will eliminate the need for paper"...Perhaps the increase in productivity makes up for the increase in labor costs.

Good question. First, all of my MAs can ePrescribe. I did a test, and I ePrescribed and then they did, and it all turned up with all of my information: Name, NPI, DEA, etc. Then, again, all of our accounts are identical anyway with the exception of rank. (can't think of the word, lol)

I sent one with their names in it, and I haven't heard back from the pharmacist yet, but my guess it will show her name at the bottom, which probably isn't great.

ANOTHER THING THAT I FIND VERY DISCONCERTING:

I was under the impression that when a med was codified and was in bold and not italicized, when you ePrescribed it, it was ePrescribed. But, the two that I sent were practically identical. One went by ePrescribe. The other was faxed. If this is the case, it needs to be straightened out if Jon is paying NewCrop for this.

That's brilliant. I thought about doing that (hope that doesn't make me sound like I am brilliant -- I didn't do it). Because using different signatures would help give the illusion that the signature were more real.

Thanks - very helpful and specific ... lots of good ideas to keep me busy for the next few weeks.