Home Forums Discussions Problems Please fix Updox and AC interface!

Ok, so I've been waiting a few years, hoping this was going to get better, but alas it has not. How do other practices send lab results and communicate with patients? It's so clumsy to go back and forth between Updox and AC. Especially sending lab results. So a patient comes in with syphilis and I want to send them a note and their lab results. Should just take a few buttons to do this. This is how we have to do it:
1. Lab comes in through lab interface.
2. We review in AC, but we have to "print" to Updox.
3. It sits in Updox until an MA reassociates it with a patient (it doesn't keep the patient attached and errors occur constantly). On the weekend instead of it just being sent, again it just sits there until Monday usually.
4. It has to be sent by Updox to both the portal and back to AC.
5. Then I want to send a letter. Same issue. It has to be "printed", reassociated with patient, then manually sent by MA.
Such a waste of time and very error prone. It is frustrating when I get emails from AC about what may be improved in the future about moving buttons on the homescreen. Seems to be more pressing issues to fix. Is anyone looking at how these interfaces work together and working on this???

Rant over.

David Lee, MD
IM
Dallas, TX

And one more thing, why do you have to manually save everything to EMR in Updox? Wouldn't it be better to opt of of saving it to AC, since 99.9% should be saved to AC???

David Lee, MD
IM
Dallas, TX

David,
I will respond,but as you know,every one has their own workflow/physical space challenges. Also, I have the purchased,not free Updox version.
I will describe how I use the interplay of AC/Updox with my only employee that manages the Updox inbox workspace, my nurse.
However, if I understand correctly how you describe your workflow, it seems a bit redundant, but I may be misunderstanding your approach.
With direct HL7 lab import to AC and letter writing in AC, there is no reason to send back to AC to save it from Updox.
With that said, I will walk you through my process, which may or may not work for anyone else. I also have my nurse's workstation right outside my office door so can give her quick verbal orders quite easily, or she can ask questions or give me orders too.

First think in AM's manually directly import the labs by hitting AC file tab, then labs/radiology. The labs then show up in AC inbox.

I double click on labs, click clinical pdf report under left column, then double click "See lab report" hover cursor over top of page and print to updox.

Then close tab of lab report in AC, click on "reconcile to order"tab (version 9.1) reconcile, not reconcile & sign, then go to letter writer, click on selected template. I use two for labs, either stable or pre visit lab letter template, then hit save to AC then send to updox.

At that point my work is done. My nurse will then see the pdf lab report & letter for this patient, and do the rest. Send to the portal. She then archives into updox. All activity is archived and saved and easily accessible by clicking on name in address book and selecting messages. The labs and letter are already
saved in AC.

This sounds terribly complex, convoluted, but rather simple and easy to do on a daily basis.

Let me know with any questions, and I realize this may not even work for you, but this is how I use Updox and AC together.

Also I checked with updox and everything is saved for 7 years in their archived system.
Thanks again,

Jimmie,
Thanks for your reply. We're basically doing the exact same thing, but I do want confirmation in AC that we sent items. It's only an extra click or two. Does she ever make a mistake and send to the wrong patient though? I think this should be more automated. There is no reason she should have to find the patient again in Updox and "reasssociate". If it is Saturday and I'm doing labs, I think when I hit send, it should just go directly to patient. Maybe I'm asking for too much... Nonetheless I'll keep complaining, because when you do hundreds of labs a week like we do, it is simply too error prone.
David Lee, MD
IM
Dallas, TX

David,
You bet!
Not very often, but it has happened, and if the mistake is caught before the patient opens the message, it can be cancelled. Click on address book, enter name, click on messages, put X on the specific message sent and click on Delete selected.

Also, I like having her manage the Updox inbox, because she decides whether the labs/letter will go by way of portal or snail mail. I do very little of this work, and find she does a better job at remembering who has a portal and uses it regularly and who uses the mail. We have about 800 using the portal now, so there has been some savings in postage.

Thanks again David.

David,
I think your points are well-taken. Improved, efficient electronic communication with patients should be a benefit of any good EMR. From what I have seen (observing more than one EMR) this is generally not the case. Unfortunately, portals are usually an "add-on" rather than a fundamental part of the EMR itself. This is certainly the case with AC, where Updox is coupled with AC to provide a portal. These remain two separate programs that are connected; they are not fully integrated. Having said that, many people (and Jim is a prime example) find ways to use Updox in creative and valuable ways. The nature of our practice is such that we rarely use the portal (though we love the document management aspect of Updox). I think it is appropriate for us to encourage the developers at AC to re-think workflows as docs try to communicate with their patients efficiently and electronically. I will bring the topic up at a future CAB meeting, and would encourage you to take the time to send an email or letter, addressing the way AC integrates with Updox.

Here is one way this could work: After hitting the first "sign off" button on a lab, the second box opens (the one with buttons for orders, meds, letter, print, msg/reminder, etc). You can currently type a message there (which could be for your own use OR to the patient). Add a button for "send message to portal" with a check box for "also send copy of labs to portal". Would that accomplish what you are looking for?


Now for a practical suggestion which does involve rethinking your workflow a bit, but might help a little right now... I would think of it this way: your job is to review the labs and decide what to tell the patient. Your staff (and the program) should do the rest.

Here are the steps I propose, with the program as it stands now:
1. Lab comes in via interface.
2. You review in AC and decide what you want done.
3. Hit "Sign Off". Communicate what you want to a staffer via "Msg/Reminder/EMail" button.
The text of your message (which of course can/should be templated) might include things like "tell pt all labs are normal; follow-up in 3 months" AND "send patient this message with copy of 5/19 labs via portal".

You are done.

Your staff gets the message, and they send info to the portal.

A few points about this approach:
1. How your staff accomplishes their part can vary, depending on your priorities and what you are sending to the portal, but I think efficiency (especially for you) would increase, and number of errors would decrease.

2. Your staff starts by viewing a message on the patient so they can quickly copy your message (hit ctrl-A and ctrl-C in the message they get), then click the "open chart" box and print the labs to Updox.
They either type the message in Updox, OR just paste (ctrl-V) from your message to them (as I said, this can be a template with as much or little verbiage as you want).

3. You want documentation in AC that you sent the items... on the message box you are sending to your staff is a check box for "also document reminder to patient's chart as addendum". You then have documentation that you asked to have the info sent to the portal. (If it is ever an issue, you can go back later and confirm this in Updox, as Jim describes). Nothing has to be resent back to the patient's chart.

4. If your staff likes to keep their Inbox empty, they will tend to do these as you send them (rather than letting them pile up in Updox, as you describe).


Letters are a bit different, and it would be helpful to have a button in the letter writer, "send to patient portal". Meanwhile, you do have the (default) option to save the letter to the patient's chart, so you print to Updox and your staff just has to send it to the patient. Not as good as a "send to patient portal" button, but a heck of a lot better than addressing and stamping an envelope.

Jon,

Thanks for the thoughts. We have 6, soon to be 7, providers, and almost every patient gets labs done when they come in. The current system "works". My biggest issue is how error prone it is. Relying on staff to send confidential HIV labs, having to find "John Doe" in the system when there are 5 Jon Does, errors are just going to happen. Yes they use the ID number, but then if you're off by one and don't check closely, mistakes happen. THIS SHOULD BE AUTOMATED! You can now send messages in AC, so the interface is there.

Another thing that bugs me on this matter, patients get a copy of their labs which say "Your provider has not yet signed off", even though we added a note and have reviewed the labs. We have to send before the actual sign off step. Otherwise I'd have to pull them up, sign them off, then pull them up again to send to Updox. Either take this phrase off, or ideally change the whole system to automate it.

Now that MU is meaningless, why doesn't AC focus their energy on more clinically relevant things like this?

David Lee, MD
IM
Dallas, TX