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#41615 - 02/22/12 02:39 PM Orders
stylnchris Offline
Member

Registered: 06/25/11
Posts: 47
Loc: Upstate NY
AC 6.1.2 anyway to include an "image" of your signature that was signed from a tablet on the "Orders" that can be printed to give to a hospital for blookwork, etc. Right now it has Doctors Name with "(Electronic Signature) underneath. I think it would look really slick it if just had the doctors real signature stored somewhere in AC and then when you print it its presigned just as an "Electronic Signature".

Anyone find a way do to this?
_________________________
Christopher

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#41616 - 02/22/12 03:34 PM Re: Orders [Re: stylnchris]
todd Offline
Member

Registered: 10/26/11
Posts: 229
Loc: Findlay, Ohio
Correct: My hospital wont accept an electronic signature for anything, except prescriptions...funny...you could make a mistake and kill a patient with a drug...you can sign that electronically, but you cannot get a simple urine test without a true signature..
_________________________
Todd A. Leslie, D.O.

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#41619 - 02/22/12 04:37 PM Re: Orders [Re: stylnchris]
Leslie Offline
Member

Registered: 02/15/05
Posts: 1965
Loc: INDIANA, SOUTHERN
There is no reason for them not to accept it. I would threaten to send patients elsewhere, say to Labcorp or Quest.
_________________________
Leslie
Hospital Employed Physician Who Misses AC

"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "

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#41648 - 02/23/12 05:18 AM Re: Orders [Re: stylnchris]
LauerDO Offline
Member

Registered: 12/31/07
Posts: 1242
Loc: Brewer, ME
this excerpt is from an article in Medical Economics which discusses the forms of electronic signature that CMS deems acceptable.


Quote:
The Centers for Medicare and Medicaid Services (CMS) recently updated the Medicare Program Integrity Manual, Chapter 3, Section 3.4.1.1, through Change Request 6698 to include these acceptable electronic signatures:

chart "accepted by" with the provider's name,
"electronically signed by" with the provider's name,
"verified by" with the provider's name,
"reviewed by" with the provider's name,
"released by" with the provider's name,
"signed before import by" with the provider's name,
digitalized signature handwritten and scanned into the computer,
"this is an electronically verified report by John Smith, MD,"
"authenticated by John Smith, MD,"
"authorized by John Smith, MD,"
"digital signature: John Smith, MD,"
"confirmed by" with the provider's name,
"closed by" with the provider's name,
"finalized by" with the provider's name, and
"electronically approved by" with the provider's name.
_________________________
Adam Lauer, DO (solo FP)
Twin City Family Medicine
Brewer, ME

Beer is living proof that God loves us
and wants us to be happy
<<<Benjamin Franklin, great American>>>

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#41680 - 02/24/12 12:18 AM Re: Orders [Re: stylnchris]
sambo Offline
Member

Registered: 11/06/07
Posts: 25
Loc: Buffalo, New York
when i preview the order requisition slip, all that it says is ordering physician, and my name is in that section. none of the verbage as mentioned above exxists to make it cms compliant. i am having a lot of flack from the hospital lab about this , i wish ACwould have a fix for it in their next update! what does everyone think??

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#41682 - 02/24/12 12:35 AM Re: Orders [Re: stylnchris]
todd Offline
Member

Registered: 10/26/11
Posts: 229
Loc: Findlay, Ohio
yes we need a quick document that we can generate that doesnt need to be hand signed. Then I can send it to the local hospital through updox/fax
_________________________
Todd A. Leslie, D.O.

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#41691 - 02/24/12 06:01 AM Re: Orders [Re: sambo]
LauerDO Offline
Member

Registered: 12/31/07
Posts: 1242
Loc: Brewer, ME
What I do Sambo is create a template under the orders section.
I create all labs from the custom order section, I do not use the AC labs at all.
when I right click in the custom order field, one of my templates is called "aaadocsignature" thereby pushing this to the top of the alphabetical list.

The template reads "electronically signed by Adam Lauer, D.O."

I have added this line to all lab order sets that we created. So the only time I actually have to add the signature template is when I free type an order, then I add this line.

We have two hospitals in Bangor, ME. One does not require any "electronically signed by" verbiage. The other one however does require it. By adding it to all custom orders, there is never a question and never a call back. I also have patients who live as far away as 50-75 mile radius from Bangor. We routinely deal with 6 other hospitals in those other towns. They all seem very happy with this line added to all of our lab and radiology orders.

It works very nicely for our office.
_________________________
Adam Lauer, DO (solo FP)
Twin City Family Medicine
Brewer, ME

Beer is living proof that God loves us
and wants us to be happy
<<<Benjamin Franklin, great American>>>

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#41719 - 02/24/12 08:53 PM Re: Orders [Re: stylnchris]
JBS Offline
Member

Registered: 09/20/09
Posts: 2106
Loc: Baltimore, MD
Perhaps I am misunderstanding, but I think the original issue has gotten lost. We started with:
Originally Posted By: stylnchris
anyway to include an "image" of your signature that was signed from a tablet on the "Orders" that can be printed to give to a hospital for blookwork, etc. Right now it has Doctors Name with "(Electronic Signature) underneath. I think it would look really slick it if just had the doctors real signature stored somewhere in AC and then when you print it its presigned just as an "Electronic Signature".

In Admin options, under "User Accounts"..."Edit an existing user"...you have the option to put in a signature. Having done this, when I print an order (for blood work, imaging, etc) it is signed with that signature, just as a prescription would be. Is this not what you are looking for?
_________________________
Jon
GI
Baltimore

Reduce needless clicks!

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#41785 - 02/27/12 03:01 AM Re: Orders [Re: JBS]
LauerDO Offline
Member

Registered: 12/31/07
Posts: 1242
Loc: Brewer, ME
Not all labs will accept the digital image of a signature, at least not the 6-8 hospitals that we deal with in our geographic locale. It might be worth investing in a short phone call to your local labs before pasting the digital image to everything.
_________________________
Adam Lauer, DO (solo FP)
Twin City Family Medicine
Brewer, ME

Beer is living proof that God loves us
and wants us to be happy
<<<Benjamin Franklin, great American>>>

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#42198 - 03/08/12 02:03 AM Re: Orders [Re: LauerDO]
sambo Offline
Member

Registered: 11/06/07
Posts: 25
Loc: Buffalo, New York
right, most labs in my area do NOT accept the electronic image of my signature. i tried to do that initially, but it did not solve the problem!

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#42222 - 03/08/12 05:46 AM Re: Orders [Re: sambo]
LauerDO Offline
Member

Registered: 12/31/07
Posts: 1242
Loc: Brewer, ME
It's dumb rules they won't take a scanned image of your signature, but they will take the words "this is my electronic signature."
_________________________
Adam Lauer, DO (solo FP)
Twin City Family Medicine
Brewer, ME

Beer is living proof that God loves us
and wants us to be happy
<<<Benjamin Franklin, great American>>>

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#42225 - 03/08/12 05:54 AM Re: Orders [Re: stylnchris]
Bert Offline
Administrator

Registered: 09/27/03
Posts: 9803
Loc: Brewer, Maine
OK, here are some ideas for digital signatures. Again, as Leslie says, if you have options, meet with the president of the hospital and tell them you will go elsewhere:

First, this has been around for over two years. You can browse to your own signature and it should show up in most places you use a signature. It's been a while and some things have changed. Best when used with a trasnparent signature.



Make a "digital doctor" We gave the username zsignature, so it would fall to the bottom of the sign on. It's what you put in the name that counts.



When you go to choose what signature you want, rather than choosing yours which will not count, choose the Digitally signed by... (this has to be the last thing you do). Nice thing about this is everyone can use it.



This results in the following digital signature:



Finally, it is always good to make a transparent signature. There is a new program out, cheap and easy. You can use Adobe Photo Shop, there is a user on here than can help and then there are those on the Internet where you email your signature, they do it, and email it back. I have my transparent signature everywhere including in my PDFs. One good thing and one bad thing. Good: I always make sure I overlap something in the PDF so it appears like a real signatuer, Bad: Since you are trying to do it right, you as I tend to write a very good signature rather than your usual scribble.



Radiology vs Lab. In general, the lab is always more accommodating. In fact the alway have been.

Radiology: MUST have "Digitally signed by..." Also, must have faxed order, you can't call it in and then fax it. Likely to to their not getting paid. Also, if they wanted x-ray of hand and wrist and you wrote write and hand, they make you do it over. I usually just write x-ray of whole body with digitial signature and wait for them to tell me what to write. And, if I write x-ray of left hand, but the patient's right hand is hanging on by one tendon and bloody, they won't believe the patient.

Lab, you can write your signature with a crazyon. But, don't know a BMP from a LDH. And, they refuse to ask their signature. Also, if you just biopsied someone's liver in your office but you put the name down wrong, they will call you and throw away the specimen. They have no idea what VPA is, and they make you write down Valproic acid. So, I just write Depakote.

But, my newest and greatest pathetic "what makes medicine cost money" is you can no longer write "Nebulizer for asthma" the diagnosis being necessary for over a year here. But, you can write for Vincristine and Methotrexate just like that, but you must write Face to Face Encoutner of whatever date you saw them last.



_________________________
Bert
Pediatrics
Brewer, Maine

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#42233 - 03/08/12 11:43 AM Re: Orders [Re: stylnchris]
Leslie Offline
Member

Registered: 02/15/05
Posts: 1965
Loc: INDIANA, SOUTHERN
Wow, Indiana must either be much more progressive or way behind the times. None of the labs, radiology or hospitals still require any of the verbiage Bert mentions. They all take my regular old digital signature. The only ones who do not are mail order pharmacies in Arizona and DMEs billing Medicare. All of those are told to mail me the original papers if they want an original signature. When everything first went digital, the local hospital tried to make us hand sign orders which the patient had to hand deliver to them. I told them I would then refer my patients to Labcorp. It did not take long at all for them to change their minds. They said they had to "run it through legal". Maybe it helped that their "legal" is my patient smile
_________________________
Leslie
Hospital Employed Physician Who Misses AC

"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "

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#42236 - 03/08/12 12:45 PM Re: Orders [Re: stylnchris]
Bert Offline
Administrator

Registered: 09/27/03
Posts: 9803
Loc: Brewer, Maine
I think it was that Bob Knight was head of the hospital association.
_________________________
Bert
Pediatrics
Brewer, Maine

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#42237 - 03/08/12 12:46 PM Re: Orders [Re: stylnchris]
JBS Offline
Member

Registered: 09/20/09
Posts: 2106
Loc: Baltimore, MD
For us it is basically like Leslie. A "transparent" signature in AC is pretty hard to differentiate from a regular signature, especially once it has been faxed. Maybe they don't know, or maybe it just gives them plausible deniability ("it looked like a real signature to us"), but they all accept them here.
_________________________
Jon
GI
Baltimore

Reduce needless clicks!

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#42245 - 03/08/12 02:03 PM Re: Orders [Re: stylnchris]
Leslie Offline
Member

Registered: 02/15/05
Posts: 1965
Loc: INDIANA, SOUTHERN
Bert,

Don't ever give up your chair here in Indiana!
_________________________
Leslie
Hospital Employed Physician Who Misses AC

"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "

Top
#42249 - 03/08/12 02:52 PM Re: Orders [Re: Bert]
Wendell365 Offline
Member

Registered: 11/09/05
Posts: 1870
Loc: Chicago, IL
Originally Posted By: Bert
There is a new program out, cheap and easy. You can use Adobe Photo Shop,

What program is that?
_________________________
Wendell
Pediatrician
Member of the Amazing Charts Clinician Advisory Board
Chicago

The patient's expectation is that you have all the answers, sometimes they just don't like the answer you have for them

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#42275 - 03/08/12 08:35 PM Re: Orders [Re: stylnchris]
Bert Offline
Administrator

Registered: 09/27/03
Posts: 9803
Loc: Brewer, Maine
Aren't chairs safe there? I have never seen one thrown.
_________________________
Bert
Pediatrics
Brewer, Maine

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#42276 - 03/08/12 08:37 PM Re: Orders [Re: stylnchris]
Bert Offline
Administrator

Registered: 09/27/03
Posts: 9803
Loc: Brewer, Maine
Wendell, I can't remember. frown
_________________________
Bert
Pediatrics
Brewer, Maine

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#42288 - 03/08/12 09:37 PM Re: Orders [Re: stylnchris]
ryanjo Offline
Member

Registered: 11/02/06
Posts: 1791
Loc: Central Florida
I can't remember the last time I wrote just one Rx for a patient, or signed only one page for the monthly facility MARs, or a single place for the home care orders. And if you use an electronic transparent signature, it looks perfect & identical on the forms at each area. So it's obviously not "signed". So I just use the pencil tool on Updox for forms, and I sign the Rxs by hand.
_________________________
John
Internal Medicine

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#42304 - 03/09/12 03:32 AM Re: Orders [Re: stylnchris]
Bert Offline
Administrator

Registered: 09/27/03
Posts: 9803
Loc: Brewer, Maine
I don't think I am doing any more .pngs or .jpgs.

I'll just write, "Make a new doctor called....then click on him and you will see the digital signature where it would says Electronic Signature. You could see it if I took the trouble to make a .jpg, but I don't want to go to all that trouble. Kinda like the SharePoint thing. At least I can admire Sandeep's efforts. Now those are some good .jpgs.
_________________________
Bert
Pediatrics
Brewer, Maine

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#42326 - 03/09/12 05:44 PM Re: Orders [Re: stylnchris]
Sportsdocchicago Offline
Member

Registered: 04/30/10
Posts: 457
Loc: Chicago IL
You guys are making it too hard on yourself. I had this issue with all the mri/xray things that I would sned out of my office for. THey wouldn't take it at first because it said electronic signature...

I simply called the head of the labs/xray/radiology/hospitals (yes it took me a bit initially but worth it)..i simply told them, here is how much i send you, in today's age we aer all electronic...if you aren't up with the times, i will send to your hospital/lab which is your competitor becuase they take the script and order the way it is. let me know what you want to do.

it was that simple and was fixed in a week.

_________________________
Ketan R Mody MD
Elite Sports Medicine Institute, Ltd
www.ELITESMI.COM
Westmont IL

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#42333 - 03/09/12 05:59 PM Re: Orders [Re: stylnchris]
Bert Offline
Administrator

Registered: 09/27/03
Posts: 9803
Loc: Brewer, Maine
Simple and fixed if you have a competitor to send to.
_________________________
Bert
Pediatrics
Brewer, Maine

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