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I am a new user. How do I get the pt to sign treatment consent forms, HIPPA forms, refusal of vaccine form, etc. Do I write these in PDF, store in a folder then import into pt chart? Do I need signature capture device to get pt signature digitally? Should I get the pt to fill ROS on a scannable form, then scan in or should I give them a tablet/kiosk in the office to fill in? Also, any suggestions re a robust scanner. What if it is SCSI, is it difficult to use?
Thanks a lot
Umesh

SCSI scanners are a bit outdated and may not get you the speed and resolution you will want. I recommend a USB 2.0 compatabile scanner. Which one depends on what you will be scanning - I use a FUJITSU SCANSNAP duplex (scans both sides) scanner which handles up to 8.5 inch width. It is screaming fast with pretty good resolution. All papers can then easily be saved as PDF file. You don't need a signature capture device if you sign paper and scan it. To go completely paperless you would need electronic forms and signature capture - but of course, it costs money to get computer interfaces for your patients - especially if you are considering kiosks. yikes. Consider having a nurse or MA do the ROS and they can input the ROS into the computer (even med lists, PMH, or whatever) and then forward you the chart which you can then open in the room with all the populated data. I think the patients may prefer talking to someone rather than inputing the data themselves in form or kiosk. But, that is because I prefer live people and real service like at a restaurant or full service gas station.
God luck with your choices.
-Santos

Santos gives very good answers. I guess one first has to decide what actually has to be signed or not. Personally, we simply document in the summary that a patient refuses vaccinations.

The Scan snap is basically considered state of the art for scanners in that price range. You can try Scanaway, which is extremely good software for document sorting. I have been using AC for over three years and do not yet feel comfortable with its Import feature.

We receive everything digitally and/or scan everything such as demographics and use our own company's software, Fax2Files to sort all the documents. We find this much more efficient and safer than Import. Every single file is at your fingertips. Sometimes, I think you have to decide what actually needs to be in the AC folder and what doesn't.

As for the ROS, I agree with Santo, the nurse can enter the ROS when she puts in the HPI and vital signs, etc.

Finally, as to what you are trying to with a patient filling it all out, Amazing Charts has an interface to a company called Instant Medical History will allow a patient or a provider/nurse to answer a series of questions which then are formatted and entered into the correct fields. It can even be maximized to cover the entire computer screen, which can only be taken down with a password and, unfortunately as a bug, through task manager.

Instant Medical History is used by some AC chart users. It is an algorithm-based tool to gather information but is no substitution for taking the information yourself or having a trusted aide do it for you. It relies on discreet data (yes, no, sometimes, rarely...) and assumes some medical sophistication on the part of the patient (not to mention computer literacy, and well, plain old literacy - which is a stretch for some of my patients in a bilingual rural community). It also further distances the practitioner and staff from the patient, in my opinion. I am not a fan, but I encourage you to try for yourself and decide for yourself. Check out the website at www.medicalhistory.com to see sample output. But please, please - try it for yourself as if you were the patient - I did that through a fellow AC user's website http://www.drcoghill.yourmd.com/ click on instant medical history and try it for yourself. (I hope posting that link is not a no-no.)
-Santos

haha. Its not a nono, but we really dont want to get alot false patient IMH downloads either.

We have temporaily stopped using IMH, but I suspect we will restart it in the future.

There goes my desire for that TEMP side of things and another place for False pts. The more you think about it the more it just makes sense. Bert, please tell me us more about that program of yours. Can this lower end user impliment it and use it "easily"? Could it also allow us to still put a copy in the imported items section easily if we wanted to.

I also need to finally set up an easy fax out the Rx thing and get a quality scanner. You guys all seem to really like the one scanner. Exact Model name and number please? Do most of you use the software that comes with it or something else. Right now when I try and use our all in one, I have to wait for nearly forever while the HP software to load. And with each scan I have to wait for that software load all over again. Also what formats are you guys using and why? There are a number of formats to pick from in the twain control import function. Which are better for what, so on and so forth. To me this is one of the frustrations. Why does every basic user have to reinvent the wheel here? I would really like some "guidance" as to which to use, how to set it up. For guys like Bert who likes to play and has the ability to play it must be very nice, but to me it is just confusing and keeps me from getting the most I can from the program. Lead me please, teach me please....

Thanks much...
Paul

Paul:

I am just getting started with all this, but I have heard the Fujitsu ScanSnap recommended again and again. So, I bought the s510 and there is a lot of scanning power packed in that small package.

I have been using it to convert my old charts into pdf format. It is pretty fast, and I have not had any jamming problems, but I am careful to smooth pages and remove staples. If I had any paper charts that were in bad shape, I would put them through the copier, and then scan the copies.

I was planning to import these scanned files into Amazing Charts, but now I'm not sure I want to. The ScanSnap comes with some software for organizing scanned material, and I'm thinking I may just leave my pdf's unimported, organized by patient name. That will save a step, and I won't have to worry about software conflicts.

As far as faxing Rx's, I'm not sure I want to mess with that either. I like the idea of printing the Rx, handing it to the patient and having done with it, not worrying whether it came out on the other side somewhere or not (a problem I have with traditionally faxed prescriptions).

As to the other questions raised:

We are currently having patients sign forms, and then we are scanning them in.

I am currently experimenting with Amazing Charts, and hopefully will have some impressions to share in the months to come.

Brian

Brian,
Here I am asking you and we've been live for about a year and a half now.... I just want this stuff to work smoothly and easily so we can get back to running our office. And to allow these tools to do what they should....Make our lives around here easier, better, smoother. Anyway, thanks for your feedback and have a great weekend.
Paul

I bet I'm the only one who isn't impressed with the Fujitsu. Wait, I may have the wrong one. I have a $400 bugger. Its Fujitsu, and it MULTI-FEEDS like all Get-Out! I keep finding new uses for Acrobat now that I have it, but I wish I had bought a cheaper Scanner and just bought Acrobat separately.

OK, I've got to chime in again here. The Fujitus scanners are definitely well designed hot items. Color duplex scanning at 18 ppm is pretty hard to beat for the price. The only problem Paul, and I don't have one so someone correct me if I am wrong, but I don't think they can fax. When I first opened, I wanted a robust standalone copier, standalone fax, and standalone scanner. I already have tons of printes. But, it seems like they all came as one. So, you could get the Fujitsu if you want to.

I don't think the s510 is networkable, though. The site said it was USB 2.0, which is fine and you can share it out via the computer it is connected to. But, I only have one rule I NEVER break and that is to pay the extra cash and always get networked. You will usually not be sorry. It just makes everything easier, and you don't have to worry about a workstation managing your printing, which slows down that PC. And, if it is off, you can't print or whatever. I guess with scanning it is less important.

Two fax/scanner/copiers/printer (I know -- I hate all in one), but you can just use the fax/scanner if you already have the other:

http://www.faxsuperstore.com/brother-7820n.html

http://www.faxsuperstore.com/brother-8860dn.html

These are networkable and most importantly fax to PC and PC to fax. So, Paul, this would make your faxing scripts idea easy.

Unlike Brian, I love the ability to print scripts. It used to be for two reasons; now for three.

First, when I am at the office (which is all the time) and I have to call in a script; I can fax it. I hate calling in a script. Plus it insures that the script I fax in is in the chart. Second, the patients like it, because they PERCEIVE it will be ready faster. And, the new thing is we wil fax ALL scripts now and will give NO ONE scripts now since the Federal Government has mandated that even Tylenol and Ambesol has to be on controlled substance paper. The only way around that is to fax or call in the script.

As far as IMH goes, I would be using it except AC's never got back to me when I asked for a new trial. My first trial period was when IMH didn't allow customer algorithms, so for a 7 year old with headaches, I had to use their 35 question adult questionnaire, which is ridiculous. So, when they come out with their customizeable one and nicely give me a new 30-day trial, AC wouldn't. I think I use it differently than others or woudl have. I wouldn't let the patiet fill theirs out. I would ask my MA to ask the questions but only on chronic or even acute issues that require asking questions I may forget. Besides, doesn't it cost quite a bit?

Bert,
So IMH gives you a 30 day trial (which sounds interesting), but AC does not. Why do you need AC? You have to pay both IMH and AC? Double taxation?

Hi Folks, we are using the fujitsu snap scanner. Can't recall the exact model...I think it is the 5120c. We scan into TIFF format. Through my less than scientific testing, it seemed to create the smaller file to be imported. Importing through AC created a larger file. I am still not totally satisfied with our formatting but haven't had (taken) time to persue more. The scanner is super fast and easy to use. Cost about $800. It is ethernet abled so it plugs right into our network. Our MA scans and then imports into patient's chart in AC.
Dave

I use the 5120 (maybe not the "c" for color though). I've elected to scan using postscript since Dr.C liked the ability to put notes on scanned items like labs. We're scanning less now that we have lab import. If only we had the Midmark EKG....

Roy,

Yes the way IMH worked it is took the raw data that was entered and put it into the proper places, i.e. HPI, ROS, etc. So, at first I had both trial periods, but IMH didn't play right, so they both ran out. IMH was gracious enough to allow me thirty more days (makes sense if they want a customer, right), but I got no reply when I wrote to AC. But, that's just how it has been lately. My programmer could make an IMH, but that would probably take a month or so, and I would have to come up with the questions.

One could make a template and enter the questions one wanted for chronic headaches into AC or do it from Addendum so you could at least see them. But, I think having a nicely formatted paragraph after the nurse took the history would be helpful. It's just so easy, as humans, to forget to ask about abdominal pain when someone presents with headaches in a seven year old so what would obviousl be abdominal migraines and easily respond to Periactin would then get a further workup or CT/MR, etc.

"I was planning to import these scanned files into Amazing Charts, but now I'm not sure I want to."

This is one of the reasons why in our office we are still using paper charts, printing our notes and filing the documents in the physical chart.

Seems you have already decided of how to scan your documents though.

It will be interesting is AC users will elaborate in the way they handle documents. The "flow of the document" is important, in this sense, every practitioner has a different style.
In my opinion, one could do it probably in 2 ways:
1. Do all the, flow of the document in paper and then scanned to imported Items. Some of us would find this way faster. You take the paper read it, write some notes and instructions and then pass it to the staff for patient notification if need it.
2. you can decide to scan every single document which need to be filed and then do all the flow. In this option you most likely will need a third party software. I have read in prior posts succesful implementation with paperport (nuance.com). Other options I heard are Updox.com.

Any good experiences with paperport or updox will be appreciated.

The quotation were making reference to the post by bcmd (Brain)

We just last week trashed all of our paper folders. Not that many, maybe 900 or so. We are lucky because 99% of everything which comes in is digital from fax to PC. That's records, labs, x-rays, H & Ps, Discharge summaries, etc. Every so often a patient will hand us something or we have the release and HIPAA forms, etc., and they are scanned in immediately. Some other forms like WIC forms or PAs, etc. are scanned after they are faxed so we have a record either way -- fax from desktop leaves a log and physically faxing leaves a log.

We fax out records and forms directly from the PC so we almost never use our own paper. And, we never, ever import to AC and never will.

Of course we use our own software for all this, but I am fairly tired of talking about and trying to give it away, so I won't. <G>

I was just re-reading this thread and noticed the mis-type. I meant of course to say that I was experimenting with Instant Medical History (although the mis-type is also true, if you think about it).

Bert makes many great points earlier in the thread about faxing rx's. I am rebellious on this point because I deal with a major chain pharmacy that can't ever seem to recieve a fax the first time we send it (so the process is: fax, get message from patient that their Rx wasn't sent in, call pharmacy and/or re-fax, etc).

However, I must admit that if the fax was digitally generated, that would at least make it easier to re-send. And, in truth, putting a Rx in the patient's hand is not foolproof: they lose them and then return for us to re-write them, and printed Rx's are subject to other forms of abuse as well (photocopying, etc.)

As to the above, Bert, you are fortunate. My outside data is obtained via outside lab from LabCorp (but we're about to try out the interface), and my hospital lab comes in via some kind of HyperTerminal interface (possibly there could be some way to import this kind of data directly?).

I do want to try out your software, Bert, and see if it could solve some of our issues here.

I am an Amazing Charts beginner, and I am actually still wrestling with the problem of how I want the new paperwork to flow through the scanner.

Really, the big problem I have been trying to solve with the scanner is the problem of old charts. I have been solo for four years, and already I have thousands of paper charts, some of them fairly large. I just really didn't want to lug the paper chart and the computer into the room.

My solution has been to select the charts we need to scan, quickly audit them (picking out duplicates and non-essentials), drop them into the hopper in one or two biggish stacks, and make make it all into one big pdf.

We are then converting the "graphic" pdf into a *searchable* text-type pdf with the software included with the ScanSnap. The program can be scheduled to convert the pdf's during "off" hours.

The idea is that I will be able to use the <ctrl>F "find" feature to locate old "allergies" entries, old "plan" entries, old "potassium" levels, or to see if a kid has ever used "cefzil" before. It is not foolproof, because the text recognition is not foolproof, but it seems to be working very well so far.

When I want to look through the old chart, I just minimize AC and look at the old stuff with Acrobat (which also came with the ScanSnap). To populate the new AC charts with the old data, I key into AC on my laptop, while looking at the old data on a stationary PC that's connected to the server where we are storing all the scanned data.

I will keep everybody posted on how this works out.

The searchable feature seems pretty cool. Keep us posted. Sounds like you're busy.

Have you considered sitting down with the owner of the store/pharmacy, explaining the new federal guidelines on prescriptions and therefore forcing you to fax everything? Then tell him or her that if we can't fix this faxing issue, I will be forced to at least encourage my patients to go elsewhere.

I certainly believe you but it makes no sense that all of the other pharmacies can receive your faxes, but it can't.

Brian,

I can't forget if I mentioned the software "Scanaway" www.scanaway.com. Never used it, and it sounds as if what you are doing wouldn't work with it anyway, but it's just something you may wish to look at for your SOAP.

Scanning Organization and Archiving Protocol. You could even make a verb out of it as, "She soaped it into Amazing Charts." Scanning is just generic.