Sign Off Multiple Documents, Multiple Patients

Signing off 3000 documents does not need to take more time than is required to sign off 2 documents.

There is often a need for SOAPware providers who are the owners of documents to need to be able to sign off large groups of documents in one action. For example, in most clinics, paper documents come to the clinician's attention prior to having been scanned. The Clinician signs off the paper document and then the paper document (with the signature) is scanned into the electronic chart. Unfortunately, the emerging rules for electronic signature and the standard for the "Legal Electronic Health Record" are potentially in conflict with this workflow because there are requirements to have an electronic log of the date/times associated with signatures. The solution is to implement use of the Tasks Manager in a fashion so that the documents can be signed-off in a group, all at once, with a single action.

Establish work flows so that any documents that need to be signed in bulk have a common characteristic in one of the Tasks Manager columns. For example, it could simply be to select Sign as the option in the Action/Status column. Then, clicking on the Action/Status header will group all the documents that need to be signed. 

Once the items that need to be signed-off as a group are clustered together, the next step is to select all of them. To do this, click on the far left of the first row. 

Next, hold down the shift key and click at the far left on the last item in the group. Doing this selects all the items between the two clicks (while holding down the shift key).

Once all the items to sign-off are selected, then click on the Sign-off button.

This results in all of the selected documents being signed off in one action.

In SOAPware-2008 and subsequent versions, it is a bit easier. Simply drag the Action/Status Column up to the location of "Drag a colum header here to group that by column" and the items are instantly grouped for selection and sign-off.

Also, In SOAPware-2008, there is a new chart section called "Financial" where non-clinical documents (i.e. those not needing clinician signature) can be placed.  

Important note: Before the scanning person or nurse sends the documents to the clinician's list for final sign-off, establish a workflow where that person changes the status in item in the task item so that the clinician can sort all the documents needing signing to all be in one place. This makes it possible to sign all of them in bulk without having to search around, etc. Over time, we will explores means as how to best automate the sorting of items needing sign-off and welcome suggestions.

For  example, it does not seem logical to many clinicians that a scanned document containing their signature can't  ensure EHR-S compliance. While this approach usually meets the state requirements for legal medical documentation, it is problematic meeting the emerging, national, legal, electronic record standards.  

Please understand we are not making the rules, and can only make a best guess as to their final requirements. However, we are being proactive, and doing our best to help our users navigate the rocks hidden in the rapids. Much has been done, much is in process, and the workflow will be fine-tuned over time.

Actually, not having the clinician's date/time stamps has already resulted in some rather unpleasant legal outcomes of records challenged in court cases. Specifically, plaintiff attorneys have been successful in creating doubts whether or not the clinician ever even knew the information existed. There have been cases where clinicians have suffered from liability that could have been avoided by implementing workflow to prove that existence of documents had been verified, electronically. So again, it is wise to now create workflows so that all clinical documents have a date/time stamp as to when the clinician was aware of their existence. Again, this does NOT have to create more work, but does require some workflow changes.

Unfortunately, some of the workflows we now have to suggest may not initially seem logical for clinicians coming from a largely paper-based record (or SOAPware v4) environment, but are necessary.

This workflow is also necessary to support the emerging "legal EHR standard" or EHR-S. This standard is intended to eventually ensure that records are admissible under "Federal Rules of Evidence" by...

providing documents that are consistently and universally date/time stamped and have a clear source of substantiation for all business and clinical processes. The legal EHR standard creates a system of detailed accountability (e.g., audit logs, digital signatures, data encryption) that cannot be efficiently matched or mimicked in the paper world.

Any document containing clinical information needs the final, responsible clinician's date/time stamp in the electronic log indicating the clinician has recognized the existence of the document. The clinician's signature or initials on a scanned document does not create an adequate date/time stamp (going forward, but it did in the past). If a clinical document in an electronic chart does not have a date/time stamp indicating when it was noted by the clinician, this will create serious problems in the future.

Do NOT use Pulled Charts (i.e. as most do/did in v4) to manage tasks or to track what needs to be signed/completed. Use the Tasks Manager. Pulled Charts will NOT be able to track either actions needed nor reflect the actions that have been performed.

The industry is on the verge of a major shake-up due to the fact that many electronic medical record systems are not architected in a fashion to be able to meet the eminent, federal requirements. We have taken actions that appear likely to avoid what is likely to prove extremely problematic to many products and their users.

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