Our family clinic is using AC for the trial period. We will begin using AC in partial capacity for our adult appointments soon, but there are a couple things we need to work out.

1. We are in Dallas Texas and in a low income area. Texas requires a Vaccine Information Statement for the free vaccine program we are in. What solutions have you come accross to avoid entering data in both AC and scanning official documents?
We could simply have the parents sign a pdf using a signing pad.

2. The head nurse wants to be able to mark data on our standard growth charts the same as before. It seems this is something that should be generated. Can AC do this?
I could build an excell file that would look similar to our growth chart.

3. Our practice has thirteen rooms 2 MA's 3 NP's and 3 receptionists (office manager and backup MA's). During the winter we see about a hundred patients a day.
Our MA's and NP's rotate around where they're needed. If a family is waiting to be triaged for a room on side A but the MA for that side is busy assisting the NP we'll float our free MA over there. After a patient has been triaged we que the charts for the first available room and nurse.

We can't (currently) know which nurse will be available first or which MA will be available, they may be called back for assistance. So, what has already been done about this? It would be nice if AC had a que patient charts could be placed in, then those with acceptable security levels could pull the chart from the que or put it back in. That would be in line with our current practice and I think it would work nicely in AC.

Just leave the patient and their chart alone. They are in the schedule and that's it. Whomever starts the patient simply right click on their name in the schedule and all these choice pop up including pull chart or demographics, MA or Nurse pulls the chart, starts the visits and notes what ever, forwards chart to the proper doc, doc pulls chart from inbox when he/she logs in, in whatever examroom and BOOM, chart passed just fine, no needing to stage them. Just grab 'em, pass 'em around, as you need 'em...

Does this help?

As a walk in clinic this is the problem. Most of our patients are not scheduled. Sure we could schedule them when they come in but we do not choose at the desk wich nurse will see them. The choice varies with the load of patients currently being treated.

So th MA will pull the chart and start the visit, but fowarding to the free NP will be a problem. On very busy days there isn't a way to decide which NP will treat the patient. If a patient takes longer than expected what would you do. Suppose an MA needs to forward the patient to a doc, but the only preference for which doc is the one that becomes free first.

We are considering putting a laptop in the hall with a dummy account to which we can forward all patients. Then the free NP can check the messages to see what patients are waiting and which room, then they will forward the chart to themselves.

A fine solution I think.

We used to have a dumby provider as a work around for no reminder system ourselves and AC knew about it and was OK with it. Dr Raymond Reminder... We would schedule him for the 3 month, annual follow ups or whatever. Sounds like it might work. Let us know how it works out for you...

1) You probably have to scan the consent form each time. We do this on paper in chart and have not imported it into AC yet. The immunization system in AC is about to be improved, I currently do not use it.

2) You can print the growth curves out rather than manually

3) I like the two solutions above.

For this scenario, the fake staff doesn't even need to be a doctor. Just forward it to "Nurse Chapel" (ok, I'm a Trek freak") your Medical Assistant Ivana Humpalot.

Hey, how come I can't put in an emoticon? (little smiley face)

So does that make you Mr Scott or Jordie LaForge???

Oh no pardon me... "Make it so Number One, Engage!"

Think I'll be Austin Powers! He has MUCH more fun. Well, as long as he can find his mojo.

Hi Benjamin, welcome to AC.

I may have a solution or at least an idea. I was hoping you could elaborate a bit on your CURRENT system that you do or had done with paper. In other words, would sending it to a laptop in the hallway be a change in your workflow. Where was the que before? In other words, if you only had one NP, where would the MA forward the chart? The room, the triage area?

Also, sounds like you are good with Excel. That would be helpful around here.

Here MoJo, here boy, come on, nice MoJo....

Hi Bert thanks for the reply. I would have seen it sooner but I thought this forum would foward to my email and just realized I have to set threads to watch.

We currently have our MA's triage the patients then see the patient to an empty room or back to the waiting room; depending on room availability. The MA then drops the chart in a vent by the room so the nurse for that hall will know the patient needs to be seen. The NP's seem to do a lot of their documenting and superbills in the hall on wall mounted writing stations. I hope that's clear and helps.

So, placing a laptop in the hallway, if done right, might cause them a smaller change in their workflow than forcing them to do the whole note in the exam room.

I'm very interested in hearing your solution.

We have a new problem now though. Before I can get the office manager to push some of the new patients through to using AC I need to coordinate with the billing office. Our billing manager is concerned that when the superbill is generated that the name of the clinic on the CMS-1500 is not the same as the one for billing. Also, and more importantly, the name for the signed provider will be wrong when most of the NP's sign off on the charts because we only bill under the head NP and our doctor who isn't present every day. Maybe the solution is to require the co-signer to sign? But, that seems less than ideal.

It isn't that I'm good with Excel, it's just that I knew it could be done in excel because I had generated a chart that looked similar before. This was before I saw the growth chart looks the same as the one we are using.

Thanks for the replys. I'm going to call AC and see if they can help.

Boy, there are a lot of variables there, so I am not sure if I will be able to help much. I am a little confused because of the sign off by the head NP. If that is the case, why isn't every chart sent to the head NPs account since she will be showing up as signing the chart.

So, are you saying that the practice name doesn't match with the billing name? Please give more details. I know we tried the Superbill from AC but went back to the paper version, which is the only piece of paper we use. Not sure why they are different though.

The idea I had was one that I thought may work before I remembered you had 13 rooms. Therefore, it would be a lot of computer work. If you had less rooms, and the NPs always went into a room without knowing which patient was sent to which NP, you could use Virtual PC or VMWare to run AC in with a fake account. But, it's probably much easier to set up a couple of laptops. Cheaper though to run VM give that they are free.

I know what you mean about the notification system. It's opt in rather than opt out. I have been squawking about that for months, but as I was told by a user board guru on the UBB boards, if everyone received emails that wrote on a thead the server would get bogged down with posts. I am not sure if that is true, but that is what I was told.

That's a good idea to use VMWare. I haven't looked at it before because I assumed it would be a hassle and, more influentially, I didn't have any need for it. Still, I think we'll go with the hall laptops solution. That will go along with what they currently do.

I don't know about the notification system. It's probably true but if you go to physicsforums.com they notify you of every post...I beleive.

Since I feel the three topics for this thread have been roughly resolved, though not necessarily idealy, I'm going to let it die and start a new topic.

1. We're just going to have to scan those documents in. We should only need to scan them in once and when Texas moves ahead with a statewide childrens vaccine database we will only be required electronic verification that we have recieved consent.

2. AC does this for us. It would be nice if we could add extra plots from old visits, but it good and maybe I just missed something.

3. Laptops in the halls should work.

Thanks for all the replys and Bert I'm going to follow up on the other issue in another thread.

Oh, and it turns out the Head NP does review most of the charts. However there are days she isn't present and that would cause an inconvenience. At least one other NP seems to be trusted roughly similarly, the only thing is she doesn't have her own Medicaid connection.
I'll go over this more in the other thread..

Yes, I belong to a few other message boards where it is opt out rather than opt in.