A Complication of Paper Faxes?

Received any recent faxed consultation reports from a colleague or diagnostic imaging reports from your local hospital? Most of these are accompanied by a cover sheet. Great in the paper world, however a real challenge when using an EMR. Cover sheets are very useful at separating one fax from another when multiple faxes are received on a single fax machine. They ensure that critical reports are not mistakenly mixed with other faxed information and make the sorting of these reports more efficient and more accurate. Once the fax is correctly sorted and ready for filing in the paper record, the cover sheet can be discarded, leaving just the important information in the patient chart.

However, this is not as simple a process in an EMR. Many EMRs now used fax modems to send and receive patient information. In the majority of cases, the faxed reports are electronically converted into PDF files which can then be tagged and attached in a patient record in the appropriate section or file folder within the EMR. Electronic snapshots of PDFs can also increase the speed with which one can review multiple documents. A miniature image of a PDF can make it easy to differentiate between the type of document you are seeking without actually needing to open the file. For example, EKG vs. Diagnostic Imaging report vs. specialist consultation. If a PDF has a coversheet (which generally is page 1 of the file), all documents look the same in snapshot view as the coversheet is the first to be presented. Removing the coversheet is not a simple process. Using a PDF document editing program (such as Adobe Acrobat), one needs to open the file and delete the cover page, resave the file and then attach it in the patient record. This is an unnecessary extra step that takes time and requires software and expertise.

As the majority of practices begin to use EMRs, could we dispense with cover sheets entirely as a relic of the paper chart? This will make attaching and viewing PDF files a much simpler and clinically more efficient process in the EMR.

This may seem a logical and easy step, however it will need a methodical action plan, contacting all providers and organizations that send faxes to electronic systems. Then convincing them that the cover sheet is no longer necessary and making the changes to the transmission software to ensure that the cover sheets are removed.

What worked well in paper does not necessarily translate effectively into an EMR-based world of clinical practice.

What do you think? Have you had similar problems with cover sheets? Do they get in the way or can you live with the current format in which faxes are sent and received? Add your thoughts by clicking on the 'Comments' link below.

Comments

[Jean Eaton]

Cover pages often act as 'dividers' to piles of paper - electronic or hard copy. Many offices still receive faxes by hard copy - and this remains the default assumption as the 'lowest common denominator'. I think that the dividers still serve a purpose.

Perhaps more importantly, there is a common practice that the cover page is the identifier of where the document originated, the intended purpose the information was provided, who the information is addressed, and who authorized the sending of the information.

Often the cover page provides clarity to the identify of the individual the information is about.

The receiver of the information needs this information in order to determine if they will accept the responsibility of collecting the information and the purpose for that information.

I don't think it is feasible to add the information to the source document.

Perhaps the better approach is to make the cover page more useful - to both the receiving and sending party - by improving the documentation and adding suggested indexing categories. This can be easily generated if the sending party is using an EMR.

[Dale Taylor]

Another problem with faxes being received digitally into an EMR is when the sender combines results for more than one patient in the same fax. When using paper it is easy to sort the two apart. However, when received digitally it is much less straight forward. Unless the MOA at the receiving office previews the entire fax the multi-patient fax can get sent to a single patient's chart. At that point it becomes even harder to split the fax up to the appropriate charts. It is far simpler if the sending office not group multiple patient reports in a single fax.

[Raymond Simkus]

The better solution would be to stop using faxes which in this day and age are retrogressive technology. A far better solution is to have documents come in formatted so that they can be attached to the appropriate patient and identified for what they are without the need for manual data entry. This has already been done in some places for years. What is had to believe is that physicians continue to tolerate outmoded systems.