Home Forums Discussions General Discussion Bad Dragon

I purchased V9 Dragon Naturally Speaking (DNS) Medical a couple of weeks before purchasing AC last September. The first couple of weeks I dictated my DNS into my AC during typical busy days. I finally got back to carefully reading my AC entries and found many goofy mistakes (my wife is my receptionist and calls it "Bad Dragon"). It was during this period that I discovered, for the first time, that, once signed, you cannot edit your AC entries.
I then began to forward my charts to myself and proof read everything in a quieter time after work. This, coupled with improved accuracy of DNS with time, seems to work quite well. This week I have begun to complete each chart in the patient room via typing and templates. This is something that Bert attempted to persuade me to do months ago.
I must say that this is more accurate and much quicker. The patients do not seem to mind this activity if I allow them to watch the screen as I complete their charts. I also print out their Rx's in the room, sign them and then give them to my receptionist to fax to their pharmacy.
I now regret that I spent $1,000 for DNS, but I guess that I can still use it for longer dictations in special circumstances.
My buddies have Centricity and Epic Care and are having a difficult time with both. I prefer AC.
I would be interested to learn if anyone else uses DNS with their AC.
Jim

I wuvs my Dragon. I developed tendinitis in my wrists this year (my right wrist and thumb are killing me as I type this). I couldn't operate an EMR without Dragon.

Furthermore, my exam rooms are too small to allow me to settle down comfortably with a computer in the room.

I started out using some templates in the HPI, but I found I was spending a lot of time customizing them anyway. It seemed like a wash.

Now, I use only one, and I use it every time:

"%Mr %FNAME %LNAME is here" and then I Dragon-dictate from there.*

This saves me a lot of trouble with misspelled names because so many kids these days have names like Destynee and Brailer.

I do use templates for some left-screen entry. If I am on the phone, I can mouse around and click-click-click through Chief Complaint, most of the Family History, Social History and Allergies.

Templates work well for Physical Exam elements and frequently-used Plan elements. They are great for Orders, and of course I am making extensive use of them for the Instant Hospital Orders in the Letter Writer.

However, I really don't see how I could do without Dragon for the HPI, PMH, and Plan sections.

I feel your pain about accuracy problems. I wandered in the wilderness for a while. I will tell you that I probably did everything wrong with Dragon to begin with: wrong version, wrong computer, wrong mic, and I tried to "customize" it with flawed data.

I started over with Dragon Medical 9.5, fed it a spell-checked patient name list and about a year worth of my old spell-checked clinic notes (not necessary, but I think it helped).

I will tell you plainly that you need to lose the mic that came in the package with Dragon. Dictate the sample paragraph in the "Adjust Sound Levels" section, and hit "Play Back". It is really dismal sounding with the mic they send you. I have a little $20 Digitek headset from WalMart that plugs in the USB port and sounds like a dream in comparison.

You do have to put a little into it, but I think I get I get 98-99% accuracy now. I have posted links in the past to websites devoted to increasing Dragon accuracy (there are many).

Here's a good old thread on the topic:

http://www.amazingcharts.com/ub/ubb...Cen&topic=0&Search=true#Post3126

The more insidious problem relates to the nature of Dragon dictation errors: they aren't spelling errors, they are misstatements. A spell checker won't find them. You have to read them over. The best way to do that is to click Ctrl-D when you are through dictating, and look over the "Print Preview" that comes up. It forces you to read it with fresh eyes.

Gotta put the wrist on ice now! Sweet dreams. See you all tomorrow.

Brian

* P.S. - For those who don't know about Vinny's MR% template parser, here are the relevant threads:

http://www.amazingcharts.com/ub/ubbthreads.php?ubb=showflat&Number=4478&page=2#Post4478

http://www.amazingcharts.com/ub/ubbthreads.php?ubb=showflat&Board=3&Number=1114&Searchpage=1&Main=253&Words=%5C%25FNAME&topic=0&Search=true#Post1114

Jim,

Is your fax machine connected to your network? If so, you can set up and fax your scripts directly from the room...no need to even print them out. If yours is not, consider a relatively inexpensive MFC from Brother. I love mine (8840D). And the faxing software is already there for you.

Leslie

I am jealous of all of you who fax your prescriptions directly, and yet I am frightened to follow suit.

It seems like it would save time 95% of the time, but at least one or two patients a day change their mind about a Rx, or remembers an allergy, etc, and then what do you do? Call the pharmacy, wait on hold, explain the situation, refax the prescription.

I like the feedback I'm getting when I hand people their nice typed Rx's and they read them, and confirm that they have the right medication in their hand when they walk out the door.

Brian,
In preparation for faxing directly. I faxed a couple of scripts that had my "electronic signature" only on them (non scheduled drugs) and we immediately received calls back from the pharmacists saying that they had to be signed. Although this may just be an educational opportunity for the pharmacists, it did give me a chance to reflect on your final comment. I agree that the physical exchange of the typed Rx to the patient has its advantages; not the least of which would be for them to consider where they want to have their script filled.
Currently, I am prescribing over half of my meds off of the Wal-Mart, Target $4 list ($3 for Price Cutter).
Jim

Yeah, I prescribe a lot of generics, too, and I have stopped dispensing many samples, especially since some of the statins went generic.

Why go through the process of getting a patient stabilized on a medication that they won't be able to afford eventually?

When I began faxing scripts, I faxed a note with a sample script to all the regional pharmacies, informing them of my plans to fax scripts. I asked each pharmacy to fax a reply saying they had received this note. I did not give them the option of refusing to accept it. Since then, I have not had even one pharmacy refuse to accept my faxed scripts. How would this really be any different than you or a staffer calling in a script or a refill? I am not sure what your state laws are but, if it is legal (except for scheduled drugs) to call in a script why would it not be legal to fax one in? And, do your local pharmacies not fax requests for refills to you? The biggest problem I now have is that, many other docs in town have followed suit and are now also faxing scripts. This means fax machines on the pharmacy's end may be busy a lot more than they were when I first started.
As far as the reaction from my patients.....they think it is way cool. I simply ask where they want it to go and it is gone. Most of the time, their script is ready for them by the time they get there to pick it up. Of course, for those who are uncertain where they want to take it, or those that have to mail it off, I can easily print for them.

Anyway, try it, you'll like it.

Leslie

I'm a little late to the party, but what about using an internet pharmacy service such as allscripts(or something like it)? It would be nice to send it directly from the patient encounter without having staff take the time to fax the script.

I have a little differnt setup in that my AC computers have never been connected to the Internet (My IT guy is worried about confidentiality and I am worried about viruses).
However; for this topic, I tend to agree with Brian:

"I like the feedback I'm getting when I hand people their nice typed Rx's and they read them, and confirm that they have the right medication in their hand when they walk out the door."
_________________________
Brian Cotner, M.D.
Solo FP, Arkansas

The other plus for me is that I am attempting to keep Rx costs down for my patients by prescribing off the Wal-Mart, Target $4 lists. I always tell my patients this when I hand the Rx to them, but I want the final decision for their pharmacy choice to be theirs and, by handing them the Rx, they have time to decide. They also have the option to hand the Rx to my receptionist on the way out to have her fax the Rx to the pharmacy of choice. From my perspective, this also conditions me to electronic prescribing so that, if I do decide to go the e-prescribing route at some point, it will not take any more effort on my part.
However; my mind is open and I would like to hear your viewpoint on the benefits of e-prescribing.
Jim

Wow! How did I miss this thread. You know I just can't resist posting on this one. Not to mention by conversation I had with the DEA in Boston about prescriptions and faxing.

DISCLAIMER: These are just my opinions and experiences. Please don't angry with me. Well, I guess you can.

Jim, as far as pharmacists who accept faxed scripts, I would simply point out to them that it is perfectly valid. We even fax CIII and above scripts. But, that is only because some pharmacies take them. Not all do, so I am stopping that.

But, like Leslie said, we sent out our scrips by fax in the beginning. NO pharmacy has said no. There is a lot of competition here -- tons -- so a simple letter to the owner of the pharmacy will probably make a big difference.

I have to say, seriously, in over three years of faxing scripts, no one has called back to say they have changed their mind. No one. I thought they would at first, but most don't in the ten minutes after leaving the office. And, as cool as it is to hand them the script, they like the fax much better. They don't always have the script ready, especially meds that need to be made up and can't easily be put back, but the perception is that they will.

@Brian -- I may be misunderstanding. How is giving the hard copy and different than faxing when it comes to their realizing an allergy. If they did go somewhere else, we would refax the script. We practically never call in a script. We always fax them, which gives us a better record of the transaction.

@crestondoc -- You are correct about the pain it would be to have the staff fax the script. Besides, it defeats the whole purpose of PC faxing. The saving of paper. I probably fax at least 20 to 30 scripts per day. So, that saves paper. The problem with the free or pay eScripts online is they don't interface with AC so you have the medications documented in AC unless you document it twice, and the ones I have seen are cumbersome. When I used RingCentral, about 8% didn't make it through. Most of the users here who fax from the PC, do so with a networked, digital PC to Fax and Fax to PC fax machine.

That was just an example, but there is a little difference between our patient populations that might change the equation. Namely this: a lot of my encounters involve little old ladies that take six to twelve chronic medications (which are often altered by specialists who then fail to write and appraise me of the situation).

These ladies can't remember what they take, and they cannot comprehend a computer screen. My experience has been that handling the scripts allows them to say "I don't take this anymore" or "where's my nerve pill?", or (as in the example you name) "I can't take this medicine! (usually followed by "I'm deathly allergic!").

Also, they often take their prescriptions to a caregiver who calls me with corrections. I'll leave the corrected prescription up front for them to pick up.

I despise playing phone tag with a pharmacist. I don't want to be called out of a room for the call, and calling them back through the phone menu is a nightmare.


I have never done a census, but I would estimate that I prescribe at least double that in a day, which is another thing that may change the equation.

The difference we experience may just be an innate difference between adult and pediatric medicine. Or, I may not be giving it a fair shake. I am still contemplating it. It sounds like it works very well for you, and I am a little envious.

Thanks for the explanation. I understand your plight better now. Maybe Adam can shed some light as he gets going as he probably will fax some scripts, but he uses the same fax machine I do (which does make a difference).
As to the phone tag, I would rarely know as my MAs would deal with that. They know I tend to be too passive-aggressive with them, something I regret, oh, three seconds after I hang up the phone. One of my many faults, which I need to fix.

Thanks Brian.

Hi Bert,
I am very appreciative for your input and promise to keep an open mind on this issue.
Currently, I print out an Rx at the end of our patient visit and hand it to the patient. This does have the advantage of allowing the patient to comment (e.g. "You do realize that I am allergic to penicillin, doctor?" etc.). It also gives me the opportunity to tell them that I have written the Rx from the Wal-Mart or Target $4 list; it seems that most of my patients go to Walgreens and I do not want to make them uncomfortable (think that they are going to hurt my feelings if the do not allow me to fax their Rx to Wal-Mart) if they still want to go to their current pharmacy rather than fight the crowds at Wal-Mart.
Currently, I have laptops in my exam rooms with scanner/copier/printers in each room as well. None of my computers are connected to the Internet or to a phone line, but I guess I could run phone lines into each room. I would also have to insert the various pharmacies into my AC to allow me to fax from the patient room. All of this is doable, but, I will admit that it is rather user friendly for my situation at present to just have my receptionist fax the Rx for me (she always also hands the hard copy to the patient in case the pharmacy claims they did not receive a fax from us).
I will tell you that I have finally taken your advice and stopped Dragon and now complete my charts at each visit (templates help a great deal). I still forward the chart to myself for proofing later and I still print a hard copy for the chart, but I anticipate that this will go away soon. I am coming along slowly; thirty years of habits are difficult to change, but you are winning me over. I do also back up my charts daily with an external hard drive and a flash drive; I leave the external drive in my desk drawer and take the flash drive home every evening and download it into my home computer for reference if I receive a call from a patient at home; it works great. Your advice and Brian's have been invaluable in accelerating my learning curve on AC and has increased my experience with AC immeasurably!
Please check out the posts on the Wish List concerning the possibility of an AC conference; we would love to have your thoughts on the topic. It would be great to meet you face to face and the expertise you would add would be immense.
Best,
Jim

Jim,

Those are excellent comments. Just goes to show you that the more each person listens and explains, the more understanding and learning goes on. Wow, that was way too mushy, lol.

One of the things I am learning from Brian and you is the reliance on the $4.00 generic drug list. I guess with my pediatric population and the fact that MANY are Medicaid, I haven't had the opportunity to use that much. Plus all the meds that are on the approved side of the med list are covered anyway. My other patients are generally private pay, so they have only the co-pay. So, that explains a big difference and why printing works better for you and Brian. I should say, that I still print quite often. It is quicker and has its advantages. The federal government back in October passed a law requiring all Medicaid scripts to either be on tamper proof paper or be called in or faxed. This moved us to faxing ALL scripts at that point as I didn't like asking what insurance they were on (although it is usually on the Superbill). That law lasted about two weeks I am told, although I adhered to it for weeks. Your reasoning about the allergy would even be more helpful if the allergy were populated during that visit. But, I do see the advantage there. Another difference I think between peds and FP/Adult medicine is that the parent(s) grab the script and then have maybe five seconds to fold it and stuff it in their pocketbook before they have to tend to their energetic child (being nice here). So, they don't even look at the script.

I'm impressed and jealous that you have printer/scanner/copiers in each room. I am stuck with only a printer. Just to be accurate, when I was with old practice, we had a network and Internet, but the fax machine was basically a standalone so we didn't fax from the desktop. Here we have a digital, networked fax so that every computer is connected to it. Since it is networked with IP address and all, you connect to it via a web interface and enter all of your fax numbers. So, nothing has to be done on the AC side. Not sure how your network is set up, but you must have some connectivity given you are sharing a database. There may be a way to connect to an Ethernet port with a networked fax machine. It's nice to get faxes in to a computer where you can save, print or delete each. Saves a lot of paper. And, by the same token, it's good to be able to fax anything from any computer.

If you are ever interested, I found a couple of decently priced fax machines which are networked and can do PC to Fax and Fax to PC. These are over at Tips and Tricks.

http://amazingcharts.com/ub/ubbthreads.php?ubb=showflat&Number=4556&page=1#Post4556

I'm happy to hear about your backups. Thanks for the kudos, and I am hoping we do have a get together. If so, and I can come, I will probably just crash it and not let anyone know who I am for awhile.

I agree with Bert, maybe because he's my best friend or maybe because he mentored me through residency as one of my attendings, or maybe because he continues to mentor me through my transition to a computerized office.

AT RISK OF OFFENDING THE AUTHOR OF THE THREAD OR SOME REPLIERS, I HAVE FOUND COMPUTER FAXING INVALUABLE!!!

Prior to AC, I received faxes on the computer, used Adobe Acrobat 8.0 Full version to add text (date, number of refills) then used the signature feature to digitally sign the Rx. I would then use my fax machines computer faxing interface to PC-fax directly back to the pharmacy. The whole process takes a few seconds longer, but the time is made up in the distance walking from my private office to the fax machine, AND infinitely made up for in saved paper.

If you think I'm joking about saved paper, talk to your office managers about how much paper costs, and how much you save by computer faxing....it's significant dollars per month. I'm saving over $150-$250 per month in paper costs! That's more money in my pocket (well, my X-wife's pocket but hey I'm a good guy and look out for her better interests, right?)

I'm using AC to PC-fax while the patients are in the room. They love it. I combine all Rx's onto one page, PC-fax it and I'm done. For the "oh, by the way Rx," I can simply use the Rx Writer and send another Rx, no big deal and it takes only seconds. The digital signature works just fine and the pharmacists are not griping about it.

I actually had ONE pharmacist refuse the AC Rx because it wasn't SIGNED, so I used my Adobe, circled the "this serves as an electonic signature" statement, used the typewriter feature and wrote directly onto the fax that he must accept the Rx, then digitally signed my comments with Adobe, and PC-faxed it right back at him.......he accepted it without griping, not even a comment.
Respectfully

Hi Adam,
Don't worry about offending. You point out several definite advantages. Currently, I have just made the step from hand written Rxs to printing them in the room which, of course, simultaneously enters them into AC. The patients then carry them to the front desk for my receptionist/office manager/wife to fax them to their favorite pharmacy. As a backup, she then hands them the hard copy I printed in case the pharmacy claims they did not receive the fax.
Ours is a relatively new practice (last September) and it may well evolve into faxes from the room as comfort levels increase.
I have already morphed into a far more paperless practice than I first imagined thanks to Bert's encouragement.
We do have a paper saving advantage in that we have a turn key contract with our Ozarks Technical College board of directors and so there are no insurance filings paper or otherwise. Sure simplifies things - our office visits, labs etc. are provided as no cost to the full time employees and their dependents.
Best,
Jim

That's an interesting arrangement Jim.

One question: Do you have a networked fax machine?
If the answer is yes, you need do nothing more than simply print any document to the networked fax machine, rather than a networked printer.

You can fax Adobe .PDF files, Word .DOC files, AC Rx's, etc. You can even print emails to the fax machine, and forward them to people who don't have email.

Give it a try. Let me ask you this, if it is a networked fax machine then try pc-faxing a document that is not AC Rx. Just play with it and try it out. Once you are comfortable and trust that the fax will actually get from the PC to the fax to the destination, you may feel better about using AC Rx faxing.

My fax number if you want to practice is 207-992-2754, OR 1-866-878-4806.

Once you try it....you'll love it!
Adam

Adam, Bert or anybody else,

I have finally got Nancy slowly building a contact list on her laptop and trying the network faxing thru our HP AIO. Today she hit a busy signal on one of them, that's a drag. Any suggestions on how to handle that?

Also, she commented and I agreed, that other than "faith" in the fact if the little print icon went away, so it must have gone thru, or faith in that if it failed to print it would have given us one of those failed print bubbles, with the option to click it and look at the print cue, there really isn't any good feedback except opening the door to try and hear if the darn thing is ringing, connecting and going thru. Is there a way to put some sort of an audible or visual type of conformation thing so as to know whether or not the darn thing went thru?

Lastly, I don't know if this was just one pharmasist busting our chops, but this one guy called back and said, "It wasn't manually signed". It says electronically signed on the darn Rx, isn't that enough already??? I was not here for this as we had an ice storm and so Mr Mom had to take the kids to Grandma this morning because school was closed and so I missed it. He was making mention to some other thing that other docs use, with a pin number, that then enters a pre-printed (E.Stamped???) signature on the Rx's. This just sounds like this guy wants to try and make us use some sort of service like e.scripts or something. Any NYer's know what is the deal here verses anywhere else??? I think he is just a chops buster or a newbie himself working for the large national chain. FYI, This was NOT a contolled Rx because those have to be done on official NYS paper only here in the wonderful Empire state.

Thoughts, feedback???

Paul and Nancy,

The HP AIO is networked, which is good. However, is it enabled to send fax from PC, and is it enabled to receive fax to PC? This is critical to know, because the features you are asking for will be present or absent based upon the software features of your equipment.

Bert and I would like to know the model number of your HP AIO. I think we can help you if you can give us this information so we can look up it's capabilities.

For example, Bert and I have a all-in-one fax/copier/scanner made by Muratec, called the Muratec 1430. We lease ours for a monthly fee from a local supplier, which includes copier toner and monthly service/cleaning, etc. Ours has a menu that is accessible by any PC on the network. We have entered in all the fax addresses to all the local and regional pharmacies.

Ours is truly Internet-Fax and PC-Fax capable. The menu allows us to modify all kinds of settings and options in regard to faxing from PC or internet faxing.

For example, ours will work every time. If a fax does not go through for whatever reason, an image of that fax will print out from the scanner, it will beep several times indicating an error. Then we have written confirmation that the fax did not go through. The pharmacy/fax number is written on the top of the page, so we know where to resend the page.

We can also archive all faxes onto our server, so that we have copies of all faxes that ever go through our machine.

I'd be happy to spend time with you on this issue, because this is extremely helpful to have.

Yours,

Adam (FYI, that's our son's name),
You are going to be as bad for me staying too late talking tech as well as BULLCCHITT as Bert was.... lol. None the less thanks for your kind offer. We have two, one for Rx's only with the NYS paper in it and the main plain paper one for everything else. That main one which is a better and stronger model in terms of monthly duty cycles as well as lower costs per page because of bigger tanks is the HP OfficeJet 7780 AIO. It prints at a cost that is promoted to be a bit cheaper than the average laser. Whether that is true or not I'm not sure but it sure is pretty good on supplies for an inkjet.

It comes with a bundled HP software for pictures and other features that should cover some faxing. But unlike most middle to upper level Brothers I'm not to confident in it's ability to really do real PC faxing. The software is called the HP Solution center. We've always liked the longevity of HP's and until the install issues I had (Bert can clue you in) their quiet reliablity.

I bauked at buying the Brothers because the seemed to be not as good on supplies and in the end this is where they all try to get you. It's the cost of ownership over time thing. But yes having the real PC faxing would be sweet. The format the Brothers talked about for recieving the faxes also seemed a bit odd and so I wasn't sure that was such a good thing for something as important as medical information. The thought of getting a separate smaller Brother or something similar just for faxing has crossed my mind. It would take traffic off the all in one and if it would allow for most faxes to be digital instead of printed and in need of filling or scanning, then that kind neutralizes the long term cost thing if we were to purchase a modest cost one that would probably have only small tanks.

But if we can make the AIO work well for our purposes that would be great. Lastly, the packaged software although the quality it gives on scanning is fine even at low resolutions (200-300 B&W, not gray scale) like our get old charts in kind of things, it is slow as all hell and frequently one has to wait this really long time to re-open the software for scanning as you bounce from chart to chart to import various items. This is why we are still half paper which stinks. The idea of breaking down to finally get a decent scanner is probably more important than the faxing to some extent. We need to get rid of the paper once and for all. I also wish I had more nights to stay late and finally play with Bert's little program that he is so fond of.

But Nancy needs to stay late a couple of nights too to do her doctor, charting end of things. And that leads to the AC conference to finally have her sit with all the gang and watch how they seem to be able to chart at time of visit and point and click away. I sometimes wonder if she is just too annal about the details of the charting, but I am not a doc and I can not really tell her much about this. I get the feeling she could still benefit from more and better templates. It might be a pain for a week or two, but in the end it would help her win the war. I think I hear the sound of Branson a callin' us...... Hee Haw Doggie!!! It really would be great to have some of the other rocket charters sit down with her and review her way of doing things and give her pointers. Again, I'm not a doc so I'm not even sure where to begin on half of this. I also feel that she just can't bring herself to point and click, and type a bit in front of her "needy" patients. Female FP's really do get draining, needy patients that just are much more time consuming. I dare those AMA coding idiots and the CMS P4P A-holes to come up with a system the fairly and properly compensates folks like my wife for all of that.... BullCCHITT!

Anyway it is getting late, I need to get out some personal bills done, go home, eat some real food and get some rest. Thanks again and try to keep it simple if you can. At some point this old analog audio tech starts to be a deer with it's eyes caught in the headlights.... Thanks again for the kind offer. And I've got games to do in the late afternoon and early evening both days. And the NY Giants in the SuperBowl to run home for!!! Go Big Blue!!! Have a grea weekend.

Paul

Wow, much food for fodder. First, a couple of important notes. One of the reasons Adam and I talk like we do a lot of the same things is the following: We both started our employ (yes that means employees) with hugh hospital-owned practices which cared about the bottom line, cash, and not about the patient. The providers did, but were always hindered due to these situations. And, you finally do get out, these "great backers of healthcare" do everything they can to insure that none of your patients who have come to know and trust you, knows where you are. Adam credits me with a lot of mentoring, but it was he that got me rolling into my own practice. And, as most of you on here know, while solo practice won't get your rich, it is something that makes you proud.

Adam, like many on here and for good reason, is rather cautious to take the leaps that I and others on here have taken. At least for Jim and Adam, it isn't a blind leap. But, I must say two things: Once Adam decides to take that leap you best get out of his way. 24 hours a day until done. The other thing that while I know the ins and outs of PC and networking, no one and I mean no one picks it up faster than he does. From clueless to a totally guru with Cisco PIXs. So, it's been exciting to see him add the AC to his office. It's refreshing, because all of us make these great suggestions (read complaints ), but I think he sees it as a paper-saving, time-saving and documenting improvement.

As to the pharmacists with problems with the digital signature. One has to remember that there are 40 very competitive pharmacies here, all of which have an average of three pharmacists. So, that is 120 having to accept the script. Most will with some eduction. So, for paving the way for Adam, I, like Leslie, have already done the blazing. Now, I don't know if the phamacies look at TCFM (Adam's office) as, cool, finally a pleasant guy to work with or, oh no, another Bert.

Actually, the only issues I EVER have are the CIII to CVs. The reason it got confusing was Federal law was trumping state law so everyone had no idea. Plus, we have a locally owned pharmacy that is incredible, and they are willing to live on the edge, so to speak, when it comes to these things, and they do accept Vicodin, etc. with an AC, not personally signed script.

@Adam, do you think you can just send a few rheams of Xerox paper per month to the "X," and call it good?

As far as the netowrked printers, I haven't looked at them all. My sense is that "most" networked printers that have an Ethernet port will be able to do PC to fax and vice versa. But, I would make sure. I threw the Brothers on there, because they seemed reasonable and Brother has a good name. Muratec and, I am sure, other fairly pricey machines work well, but even they have designers and engineers that must have been not thinking when they designed it. For instance, you can put all of the contacts in the computer (those you grab when faxing from your PC) in alphabetical order. And, even those those same entered contacts go into the fax machine so you can manually click on them when actually physically faxing, those cannot be put in alphabetical order. You can make them alphabetical for a moment, but after the fax, they are back to numerical. Plus, no matter how much RAM you have, you only fax around 50 sheets or so many Megabytes of paper from your PC, so if you are sending a 200 page file, you have to break it down into four sections. Annoying.

@Paul, I am not sure I can completely help you, but at least try this. When you go to print dirctly to the fax macine (if I am understanding you), whatever print driver you are using -- click on properties and see if it is set on "to spool" or "not to spool." There are aobut three settings. Spooling is where the printer or fax macine will immediately store the job as well as other print jobs. It is usually the way to go, but sometimes printing "directly" to the fax machine is the better way if there are issues. This is another benefit of a client/server with the server actually having a server OS. The server can actaully manage the faxes and things will go more smoothly. As Adam says, though, unless the fax is critical, I wouldn't worry if it went. If it doesn't go, you will hear about it soon enough. The other nice thing about the slightly more expensive digital and networked fax machines is they do have the browse interface so your receptionist can check in a minute or so to see if it went.

@Jim, Keep it up. And, remember, you don't have to be completely paperless. Everyone has their comfort level. I suppose if I crashed and lost all my backups, etc.; I wouldn't be as gung ho on paperless. I read somewhere that if you went to the main office of an EMR like Logician or eMDs or whatever who all tout being paperless, they would all most likely have a good deal of paper on their desks and filing cabinets.

Paul,
I looked at the specs on the HP website, and I don't believe your HP is truly PC-Fax capable. It's worth meeting with a local vendor to have them review specs on some fax machines that are PC-Fax capable.

I used my Muratic 1430 as an all in one for about a year. Since it only printed at 12-15pg/min, I bought a dedicated printer HP4250. The Muratec is used as a quality scanner/fax machine. The Muratec is very quick at PC-faxing, and if the receiving fax is busy, the sending fax will stay in the que until it is received. If there is some issue with the receiving fax and it doesn't go through, then an image of the fax will print from the Muratec. Finally, it will automatically archive any fax sent or received if one desires.

Hopefully Nancy can make a number of templates and learn to be less A.R. about documents. I finished week #1 and I am completing charts within the time frame of an office visit. I have a lot of complicated elderly patients, almost all 99214's requiring lab orders, imaging studies or referals. All is done with AC and I'm complete by visit end. I'm doing much more complicated charting than a lot of Bert's typical patient types but still manage to get it done.

IF we have an AC Conference, some work shops on charting/documenting would be very helpful to show some of these tips and tricks.

Hey, my patients are very complicated.

Sorry Bert,
pharyngeal-Conjunctival-fever syndrome is not complicated.

No, I must agree with you there. But, the tricky part is differentiating it form KD. Ahhh, how adenovirus can masquerade as anything.

Must I remind the board of the certain day in the office and the kid with the otitis? Complicated is relative my young FP.

Mastoiditis?

LOL. Either you misunderstood or that is a very low blow

I am referring to the day you and I saw the child with OM on your pediatric rotation in my "other" office.

Ouch Bert. The one and only true "Bulging eardrum" you ever saw, and I missed it....well I was only a second year resident....and we all make mistakes.

Sorry, I thought you were referring to the mastoiditis case. Was only joking.

Paul...this sounds like me. I am very anal about getting everything correct, and it's taking its toll on me. I've been thinking of returning to paper charts because I know I'd get done quicker. I thought dragon would be a good fit for me, but it never worked (there is a conflict somewhere on my office computer that made it too inconsistent).

That said, I believe this AC really is better, but I have yet to crack the code on how to get me out of the room and be done with the chart at the same time.

I'm still not sure if we can get to Branson because of costs, kids and time away from the office. But I'm feeling more and more we can also "not afford to miss it" either if you catch my drift. Perhaps I will post this in the other tread, but a session on charting itself with AC, tricks, tips, templates and the like. Especially from a few difficult multi-issue, BP, DM, psycho social, so on and so forth FP's (no offense Bert) would be a great idea too. How to really get the most out of the charting.

Now we are starting to use the AIO for out going faxes and that is working out fairly well although Nancy and I are both getting this weird problem with the software from time to time. Check this out, she writes a good old regular AC Rx and goes to preview the Rx so she can have the window pop up that allows one choose which printer to use. We have the AIO as two separate printers, one as a regular printer and one as a fax machine. So she'll just choose which one she wants, although in reality if she is printing for real, she will choose the other HP 6300 series AIO which has our NYS paper in it at all times safely away from all patient in the back room. None the less, she clicks on 7700 fax and usually the "pick your receipient" window pops up and then either choose one or enter one. Every now and again (like just a few minutes ago) we will choose the fax one, and that choice window to pick the receipiant just won't pop up!!! And so the process just stops there dead in its tracks and so we can't go any further. Tomorrow the main tower will have this issue and her laptop will be able to pick and choose just fine. Go know.... I just can't figure out this intermident, works sometime, won't the next kind of thing. AAAHHHHH!!!

Bert, as you know we had to re-install the software more than once because of all those weird install issues that are now for the most part resolved but not entirely. This is one of my biggest pet peeves. MS and HP. How can two of the largest vendors in the country, in the world for that matter, be so messed up as to not make sure that their products play nicely together. MS Windows with an HP printer is almost like baseball and apple pie. How come they can't talk to one another and make sure that their products work smoothly together. I spent the better part of a week install a stupid network printer and not for a lack of understanding the process. Now where is my FTC on such important, affects millions of Americans type of issue???

Now as for incoming faxes, we could have them all go electronic to some assigned file on any working computer on the network, probably the tower. But the question are HIPAA like, combining lots of patients in one folder first off. Is this OK as a temporary holding place, yes, no? Two, what format would they be in and will the format the recieve in be medical business OK and AC OK??? Like I said, the Brothers seemed better at this, but they only seemed to recieve in two formats, neither of which was like PDF, but some weird old fax like one and I think TIFF. The thought had crossed my mind to use any machine to receive in almost any format, if there was a convenient and data safe way to convert them after they come into the main holding folder. Thoughts, opinions???

Bert and Adam,
How does the machine you have bring in, hold and then assign the faxes you receive. How much is manual and how much is automated? Is this one of the main things you use that neat little Bert file program for??? On scanning in old stuff, should I just scan not in AC with the TWAIN import stuff and instead just scan a whole lot of patients and their stuff into separate little files and then later go to the charts to import those scans back into the individual patients charts? What is your basic method and system? Again our software on the AIO is good in terms of quality, but what a time waster to get it to come up over and over again with each and every TWAIN import. I could grow a second beard. Again is this the reason for the Bert file program? Is it the intermidiate step in the process, scan using the Bert program which sort of files and orgainizes the scans via patient and or type of thing, and then use the import feature to bring these now typed and sorted scans into the imported section of the chart??? I think that you Bert are not even importing them, Yes? Instead you simply just use your program to look for you labs, old results, old charts and the like, keeping your AC folders smaller???

Again these types of questions and answers would all be awesome for the ACAC. I could see a "Getting Rid of Your Paper" as being one session unto itself. And boy could we use it. "Help I'm Drowning!!! blup, blup...." I'd also love to hear from Jon and AC how they originally envisioned these features to work and play. Perhaps they had a totally different idea of how to work some of them from what any of us are doing. This is one of the great reasons to finally get us all together in one place to discuss this kind of stuff.

Hi Barbara,
I just made the plunge to completing my charts in the room last week.
Prior to this I took my paper notes into my office between patients, dictated my Dragon Naturally Speaking into my AC and forwarded the chart to myself. I then came back when the patient visits were over for the day, proof read the AC charts, corrected the goofy mistakes I made with DNS V9, printed the patient visit and placed them into my paper chart.
I took some time a couple of weeks ago, deleted 90% of the stock templates in AC (did not sound like something I would say, too many abreviations etc.) and constructed a dozen or so of my own templates (it is unbelievable how much we repeat the same things over and over to our patients daily). I must say at this point that Bert attempted to persuade me to do this a couple of months ago. I now have developed a pattern of interviewing my patient, examinining them and then, with the patient looking over my shoulder entering the data into AC using templates at will when appropriate. I then solicit my patients' assistance in updating the preventive portion, fill out the Rx if needed and I am done!
I no longer back up my charts with a printed copy (I do it with an external hard drive and a thumbdrive daily) and I save myself a couple of hours daily. I think that I am as fast now with AC as I ever was in my 30 year divided career in emergency medicine and FP (with the possible exception of the "T" system which is of no use to anyone after completed).
Please check out the Wish List and the upcoming AC meeting in Branson; I think that many of us will learn a great deal and there is no doubt we will have fun.
Best,
Jim

@Paul, I have to admit I have never tried the Brothers fax machines. Just figured they were pretty good. It would seem, though, that the two I put on Tips and Tricks would have to save in PDF format. I can't imagine any fax machine that costs more than $20 not be able to save in the most universal format. I dont think you have any HIPAA issue with any file coming to your computer. If you bring faxes to your desktop, it is the same as bringing paper onto the fax. You still have to put it somewhere. Same as the digital files.

Yes, I use File Assistant Pro to manage my faxes. I can't imagine myself using anything else. It's a program designed from the ground up to handle medical faxes and images. Personally, I just can't see importing into AC and having to go to a patient chart everytime I want to find data. Besides, it takes way less time for my staff to name a document than it would if they have to import it, and I do not have to play the game of signing them in my inbox. I can import tens and tens of documents while in the room if I choose.

@Barbara, I don't know if I can help. There is no way to really change if you are so used to documenting perfectly. My hat goes off to you, because I am most likely not like that. Of course, most of my visits are OM, Abdominal pain, Med checks, Colds, etc. Simply takes me about 30 to 60 seconds to chart in the room. Of course, I can code for three diagnoses, give a CPT of 99215, place two referrals in Sharepoint/Company web, and write two referral letters, four prescriptions plus a script for Oxycodone, two lab orders, and two AC Lab Labels and a partridge in a pear tree all while in the room. I guess it's a mindset. I simply will not come out of a room until everything is done. Now, I do not even want to say I even come close to the amount of problems an FP has.

I think I had the advantage of using AC back in '03 before I set up my new office. I was able to set up my network as I wanted, my rooms the way I wanted and had a good idea of how I wanted the work flow to go. With Sharepoint, I go into our intranet, click on referrals, click on new referral, type in the name and the diagnosis of chronic abdominal pain, click on notes and select referral letter done. I click save and talk again with the patient. By the time they get to checkout, my receptionist, who instantly received an Outlook email of the referra, has made the referral and given the date and time to the patient.

Jim, I am glad you are making the transition to a paperless office.

Rainy:

I just want to say again, for the record, Dragon can and does fit magnificently with Amazing Charts. It is a very powerful combination. However, you do have to set it up properly.

I do not have super-exotic equipment. My computers are off-the-shelf. I use a headset from WalMart. When fatigued, I tend to fall into a fairly thick Southern drawl. And I still get 98-99% accuracy from Dragon.

However, when I started out with Dragon, I used the wrong version, on a weak computer, with an even crummier headset and had the same problems you are having.

If you want to write detailed notes, and you can't type fast enough, and templates aren't doing it for you, I suggest you take another shot at Dragon before you give up on EMR altogether.

Tell me about your equipment, and I will try to help. You can PM me if you would prefer. Or, you can pose your question to Tom from KnowBrainer who has started posting here.

As to the question of finishing the chart before you leave the room, it would make me feel awkward to DragonSpeak in front of them. That is a hindrance, I admit. However, I have lots of patients who will continue to feed me problems as long as I stay in the room. I feel that I have to be able to make my escape at some point, as I do not have unlimited time for each patient.

My method presently is to step out of the room, print Rx's and orders, etc, and then dictate my note before moving to the next room, much as one would have used a dictaphone or pocket tape recorder in the past.

And I always, always, always, hit Ctrl-D and review the note before saving.

Always?

Always.