Home Forums Discussions Problems Portal Doesn't Have Option for of Documenting Correspondence With Pt

Concerned that the portal doesn't document our correspondence with the patient.

Jimmie or someone who has been using it a lot, do you have any tips?

Vicki,

My understanding is that all of the "Updox traffic"-faxes, secure messages is kept for at least 6 months on the Updox server in the archive/trash section and can be readily accessed.

However any secure messages sent or recieved will be copied and pasted by my nurse or myself and saved to AC. Just so I can remember for future reference.

Hope this helps.

The items are there for 6 months, but have you ever tried to search updox? Nightmare.
Knock on wood, have never been sued, but the old addage, "if it's not in the chart, it wasn't done"
I guess what it needs is an option to save the correspondence to the chart at the same time.
What I have ended up doing is copying my note at the bottom of the labs to the note in updox-which means I might as well go ahead and it myself.

I guess I could write "copy of this being sent to patient by secure portal". Wouldn't stand up in court if you couldn't prove you sent it.

If you want to send something to the patient, and to the chart at the same time, you click on the Send-to-EHR as well as the Send-to-portal.

Let's say it is Lab results and you want the staff to set a follow-up or a consult, you can also use the send to contact and message the front desk to set the follow-up.

Vicki,

You probably already realize this --but on each individual patient if you go to the address tab locate their name and click on message tab you can look at any and all messages ever sent, opened or not by patient which makes the job of searching quite a bit easier.

Also, it seems to me, from a medical legal perspective, the portal is much easier to document and record messaging by my nurse (as she handles 95% of the "chatter") compared to voice mail or phone conversation. Her desk is about 15-20 feet from mine so I observe this every day. At noon or whenever she has a break, she will listen to the 5-10 messages on voice mail, take notes, type me a message on AC, or if not tied up, converse on phone take notes and type message to AC and send to me. Now that we have about 2/3 of my patients actively using the portal, the voice mail and phone calls have considerably lessened, and it is much easier and more accurate for my nurse to copy and paste from the Updox portal and send to AC. I noticed this improved way of documenting "chatter" early on and my nurse finds it much easier and my patients are less frustrated and feel empowered "electronically conversing" and prefer this method for the most part. In general the secure messages get handled more quickly, since I have an OCD nurse, when the message is in the Updox portal it gets done more quickly than the voice mail.
Now I have about 1/3 of my patients that will never do the portal, so we will continue doing things as always.

I realize this is getting lengthy, and your original question about correspondence was not addressed--sorry.
I will take a short break and address that in a bit.
If this sounds like I am being too simplistic or condescending, it is not my intention, but just trying to convey some of the subtleties I have noticed over the old way of doing things.

Duh, Thanks Indy.

Duh is only in the eye of the beholder. Glad to help. :-)

Vicki,

For correspondence I have 8 templates that were created by my wife based on good Up to Date data, on low chol diet, diabetes, exercise, smoking cessation, end of life, alcohol use, mammo letter, pap letter.
At the end of each summary I will indicate which particular handout to send with the summary. For example if discussed low chol diet and the Polst form, I will add at the end of the summary that the low chol diet handout and end of life handout was sent by secure portal, then my nurse will click on the template tab, the 8 options drop down, she clicks and attaches the appropriate ones to the summary.

Compared to what I do for the 1/3 of my patients without the portal-- she will paper print the summary, get a paper copy of the handout get a stamp, address the envelope and send to patient, so from a medical legal perspective I see no difference in either approach but from a practical approach and patient satisfaction the portal allows instantaneous transfer of patient information and those postage stamps saved pays for the 80 dollars per month I would rather pay Sean at Updox as a way of saying thank you.

Now there has been a learning curve, and some patients do not open their message, and my nurse has typed up an instruction sheet on how to access the portal that she will send by snail mail with thte summary and handouts, and most patients, once hooked do not want to go back to the former way of receiving correspondences.

Also with the pap and mammo letters, my nurse will automatically send the actual report and the templated letter of normal results as soon as the pap results or mammo crosses the updox portal site--or send by snail mail. Of course the abnormals come in for appt to discuss.

My nurse will put at the top of the mammogram report/pap report that the letter was sent as well and if you look up in the messages sent in Updox there is a record as well of the transmittal of correspondence.

Hope this helps--

Great idea Jimmie, Thanks so much.

Vicki,

You bet!!!

I forgot to mention how I handle labs--I try to get the patients to get their lab drawn at least 2-3 days before their annual, and send those with a generic letter, that I will discuss the results at their upcoming appt.

Most of the labs are imported from quest, so first thing I do in AM's is download labs into AC, Print to Updox, and then send the letter from AC, print letter to Updox, and then close out and sign off on labs. I am done at that point, My nurse will then send the labs attached with letter to patient portal.

If they do not have portal, I do not send the labs or letter just discuss at appointment.

Quite a few patients have really liked having the labs before the visit so they can compare with last year and come up with questions before appt--some do not realize they have the labs in their portal, so I am training folks to start to watch for the labs before next year's appt.

This may sound like a lot of extra work, but really takes little time. I am of the opinion that patients choose to see me because they want to, not have to. I do not give a rat's behind about meaningful use and all of the other governmental mandates, however the patient portal idea seemed to me to make sense on so many levels, business, practical, patient satisfaction, improved efficiencies, so that in retrospect has been one of the best practice improvements in 20 years that I have implemented. I believe it is just one of the extra things that I can do to keep patients coming back and happy.

Vicki,

You also may realize this, but you can also send the office note to more than one doc at a time, so what I do is put CC: Dr X, Dr Y, Dr Z--and my nurse will type in the first letter or two and the Specific Dr name pops up and in one click can send all 3 docs the summary. Much preferred over the old fax days.

And like Indy says you can do, I do once in awhile. If a test result comes in through the Updox fax, I will send to patient, but put in a portal message such as "Your Dexa scan showed showed normal bone density, so no need for a medication such as Fosomax at this time." So when I also send to the EHR I will label as DEXA/Portal message and place under radiology section. So in one click of the send, you will have the DEXA results with a message sent to both the patient and to the EHR--So when I look on AC imported items under DEXA/Portal message the message is there as a reminder what I sent.

So there are a lot of options. But since my nurse does the scheduling too(on Lytec), I have found that having one person as point of contact with the Updox works best (for me). So she will do the scheduling as well with a combination of Updox messaging requests, voice mail, phone and direct patient requests, but since she knows who the talkers are knows to put "Mr Smith" at 11:30 or 4:30 and not at the beginning of the day to screw up the schedule.

Ok--I will quit stalking.....

I should qualify this with the fact that I am not a Doc that sees 30 plus patients a day. I have no desire to do that. I typically will see 12-15 patients per day with no more than 3 annual exams per day. That is how I roll. So these suggestions may not work for those with much higher patient flow needs.

Maybe we are saying the same thing, but I import the Quest lab, print to UpDox, send to the portal with comments. Do a "Cntrl-A, Cntrl-C" to copy the comments, then click send to the portal. Then sign off the lab, do a "Cntrl-V" in the comments section, and I'm done. For things like mammograms, I simultaneously send to the portal and the EHR.

For incoming correspondence, I may do the copy and paste into an addendum if it looks really important.

Hi Jimmie,
How many percentage of your patient messages are from Updox vs phone? And how did you get lots of people to use Updox instead of calling?

Serene,

I would say 25-33% of messages from the Updox and the rest from phone. Even though we have 2/3 of patients using Updox, the frequent flyers tend to be older needier and not using the portal and will likely not. Education, Education, Education. My nurse will educate and compare to on line banking and will open up their portal account and show them how to message us. I will tell them to look for the summary and message us once they get on their smart phone or computer, and save the portal site to their favorites site, so we are easy to find. It is a bit labor intensive upfront but the efficiencies in the long run definitely pay off.

Also on the Updox website, when a patient opens up their portal I have a reminder and walk them thru how to message us too.
I anticipate as my practice evolves in the future the trend will be less phone traffic and more secure messaging for the mundane stuff like appt requests, refills and simple questions.

Dr. Roberts,
Here are a couple of ways to document correspondence with patients.

1) If you send an item to the chart and the to portal at the same time a MetaData page will be created at the end of the PDF in Amazing Charts called Additional Actions Taken that states what else was done with the document, including any message sent to the patients portal account.

2) If you have a dialogue with a patient and want to import it into the chart just click on send item and then choose SEND to EHR. You will now see an INCLUDE HISTORY check box at the bottom of the screen right below the date of the item. This will create a PDF of the conversation and put it in the category you choose in the patient's chart.

Hope this helps,

Regards,
Sean Ramsey
Updox

Don't know if that helped Dr. Roberts but it sure helped me. THanks

Sean,

Regarding #2 I have found there is more than one way to skin a cat, but if you do it your way the conversation has to be placed in the Imported Item section, under the progress note heading (or whichever title one prefers). I prefer to copy and paste, and my nurse labels the encounter and it shows up under the past encounter section in AC. I think either way is fine, but for tracking information, I prefer to have under the past encounter section as it is easier to review with the other messages in a structured organized fashion instead of in the Imported Item section. Thank you for your tips.

Thanks Sean and thanks everyone.
Sooo helpful