Monday, April 24, 2006

Scanning and working with electronic faxes

We are still having difficulties with electronic faxes. The faxes come into a fax folder on the computer; they get transferred to the scanning software on the desktop. The filing clerk then has a look at them on the scanning console, files them electronically (both under the patient's name, and as a category--diagnostic imaging, consultation note etc), and uploads the report to the EMR.

At least that is what is supposed to happen. We're not quite sure where the faxes actually go; sometimes faxes stay in the fax folder, and sometimes they appear both in the fax folder and in the scanning console software. I found reports for several patients attached to a single patient this morning, so this was uploaded incorrectly. Clearly, the software is problematic and we're having trouble with this process.

Our IT lead has talked to the company, and they told us that a software fix is on the way. As well, I have to minimize the risk of misfiles from scans or faxes. If something is electronically misfiled, it is going to be very hard to trace.

What we decided to do is to print all faxes for now. I will look at them without chart pulls, to make sure that I've personally seen them, and will initial them. We have a "to scan" box, where I will then put the printed faxes. Once scanned, the print will be put into a "pending shred" box. I'll have a look at that box every few days, and if I'm satisfied that I've seen the report electronically and that it is OK, then I'll transfer to the "ready to shred" box. Then and only then will they be shredded.

We found that it is too difficult for my secretary to scan and upload while answering the phones and doing several other things; that is likely to lead to misfiling. What we decided is to leave scanning for the filing clerk, who will do nothing but take care of scans and electronic faxes when she first comes in in the afternoon. I can see that it will be difficult for the clerk to decide what is "DI", what is "cytopathology", etc, so she can allocate the scans properly. I will spend some time reviewing that with her, and explaining it. If that is done properly, it will be easier for me to find things in the electronic chart's sections, but this will not happen by itself. For scans, like for faxes, I told her to put everything that she has scanned into the "pending shred" box; it will only be shredded once I've reviewed it and transferred it to the shred box.

Sometimes patients have documents that need to be copied to the chart, with the original returned to the patient right away. I thought that this could be scanned, but the problem is the scan has to be filed, which is hard to do if my secretary is very busy. What she will do is just photocopy the document, and put the copy in the "to scan" box for later scanning. If, however, it is quiet(er), then my secretary will scan and file it on the spot.

This whole decision process happened this morning, during Monday morning madness (phones ringing incessantly, patients checking in and out). Sometimes you really do have to solve problems on the spot.

I expect the whole fax/scan issue to settle down eventually; however, I want back-up systems until I'm sure we've got the whole thing right. You have to figure out how to minimize the possibility of errors while all your office processes are changing--not that easy to do on a Monday morning.


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