Home Forums Discussions Problems Getting started with Updox issues

We just started using updox for incoming faxes. There are some things about it that are great, but others which seem very cumbersome. It would be fine if I cut my practice volume in half and did all the updox work myself...but can't do that. I'm trying to figure out how to streamline the process and delegate as much as I can.

Here's an example: "Apple-a-Day" pharmacy sends me a form they want signed for a patient. In the pre-AC era it would go like this: fax comes in > paper fax gets put on me desk in the inbox > I sign fax and put in outbox > staff faxes it back to pharmacy. It takes me all of 3 seconds.
With updox I'm trying to have my medical assistant handle all the documents that flow in. Should I have her "tag" documents that I need to sign with a special color? Is there another system that people have found simple?

Another more complex (but routine) example: Lipid profile comes back on a patient. In the pre-AC era it would go like this: lab report comes in by fax > my MA pulls the chart and adds the data to a paper flow sheet and puts chart on my desk > I review lipid profile and write any instructions on the flow sheet > chart goes back to MA who calls the patient. With AC/Updox: Lipid profile goes to updox > my MA sends to EMR > I open message and "sign off" > I sent message to MA to add data to Tracked Labs flow Excel file in Imported Items > MA sends me a message to check the Tracked Labs file > I open chart and check results, record notes > I send message to MA to check Tracked Labs file > MA opens file and calls patient with results/instructions. Meanwhile we have 10 patients fuming in the waiting room.

Anyone found any ways to streamline these sorts of tasks?

John,
For your first example:
What I tend to do is sign the document in Updox and fax it back, putting a copy in the patient's chart. Takes a few seconds, but it is quickly done without transferring or messaging back and forth. Lately, I have been using eRx for the refills, so I just delete the Updox fax. If you allow your MA to e prescribe (in V6) they could just do this for you.

Note that if you are faxing it back to a regularly used number, you can put that into your Updox contacts (by pharmacy name, for example) so it is quick to send it back without re-entering the number.

For your work flow, you could follow your "paper" process exactly as you wrote it above. The only difference is that after you sign the prescription, you reassign it to your staff (within Updox). They can then fax it back, just as they would with paper.

Hopefully I described that in a comprehensible way....

Thanks Jon. Do you review all the incoming documents in updox or have staff do that?

John,

I do it the same way that Jon does as well. You get three users in Updox. My staff filters out only what I need to see and forwards it to me in Updox for review/signatures etc.

Do you have separate users set up in Updox?

Yes, I have myself and my MA. How do your staff "forward" stuff to you in updox?

Under "Options" (to the left of the item) you can chose "Route Item" and then have the MA put your Updox user name when she sends it. It will show up in your Updox inbox.

Make sure you have your filter set so you only get your personal stuff and not all the faxes that come to your fax number.

Standard Updox subscription comes with up to three users

In our office, we assign different color tags to each provider. An office staff member reviews the incoming faxes, and then changes the tag to the appropriate color. Each user then filters by tag color under the "filter" tab. We find it easier to have prescription refills, etc. just printed. I find the Edit function in UpDox very cumbersome. Labs, etc. I import myself into AC so I can sign them off.

Even with that, I have to say I am doing a lot more clerical work than in the "pre-AC" era. I do make up for it somewhat in increased efficiency in other areas, but it sure is not an electronic Nirvana.

David,

We started using the filter tabs today--very helpful. Thanks.

I'm reassured to hear you say: "I am doing a lot more clerical work than in the "pre-AC" era. I do make up for it somewhat in increased efficiency in other areas, but it sure is not an electronic Nirvana."

When I thought about adopting an EMR somehow I thought I would be able to delegate more or at least as much as with paper. The reality is that the level of documentation with AC or any EMR is much greater than with paper systems. Inevitably this means more work. There are also some tasks which are more efficient with paper and others with an EMR.

I was talking with my staff this week about the transition and they found it helpful to hear these realities. We're a one doc office with two staff members. This shift to AC is a HUGE adjustment for us as it is for everyone switching to an EMR. I sometimes joke with patients and say, "I just play computer games all day." :-)

John, in designing workflow, I often think of how we did it with paper, and go from there. Instead of going to check the fax machine throughout the day, the staff goes to the "practice workspace" in Updox. (It is nice, but not necessary for at least one of the staffers to have a two monitor set-up, so both AC and Updox are open and visible at the same time). The filter on their machines is set to see both personal and practice items. They make the initial "triage". They handle faxes that you never need to see (e.g. auths or referrals), trash the junk/spam, file labs, results, etc in patients charts, and route the rest to you (or another staffer). Most of the time they are on top of things and the practice workspace is empty, just as the tray on the fax machine would be.
David uses a color system which some find helpful; in an office of our size we have not found that to be particularly useful (though we may revisit the issue). By the way, our office size and staff is similar to yours. I tend to keep my "filter" set to personal. I feel comfortable letting my staff make the call as to what I need to see and what I do not; others prefer to see it all first. Again, I would go by what you did with paper; were you always the one to empty out the fax machine each day? If not, you don't need to look at everything that comes in.

Prescription refills and forms requiring a signature are worth mentioning. We have not yet switched our eRx in 6.09 to permit refills; that will significantly reduce incoming fax refill requests. For now, I sometimes fax back a refill; otherwise I just go into AC and use eRx to send it, then trash the fax. Forms to be signed are routed to my personal box. It is easy to sign them in Updox, and then send them both to the recipient and put the signed version into the patient's chart as part of the record.

David was one of the first to clearly identify and articulate an unintended effect of EMR's: the shift of clerical work from staff to provider. It is clearly a significant issue and an ongoing challenge.

I also agree that the EMR transition is a MAJOR project with significant effects on you and your staff. I think it is important and helpful to acknowledge your awareness of this to them on a regular basis.

Thanks Jon! Your post is beautifully logical and enormously helpful. It must be the gastroenterologist in you!

In many ways, once we get the workflow set up it will be a big improvement. Hearing you speak about the fax machine reminds me that my staff had been putting all the incoming paper faxes on my desk--I should have had them triage years ago!