Electronic Signature Saves Time and Generates Revenue … When Done Right

By Michael Blackstone, MD

Physicians know well and despise the proverbial "rat race"—five patients waiting to see them, each deserving personalized attention, and the likelihood of lunch fading fast. Undoubtedly they've also seen the ensuing paperwork bulldoze its way into their personal lives. It's no surprise that, according to the Physicians Foundation, physicians spend one of every five minutes on nonclinical paperwork and 58% cite "regulatory/paperwork burdens" as the least satisfying thing that they do. With EMRs now being the norm, physical paper presents even more of a challenge in our fast-paced lives, and the use of the electronic fax falls short.

Most of our patients utilize some third-party service, whether it is home health, hospice, medical supply, or infusion services. Each of these services requires its own set of paperwork that needs our signatures, and the service provider usually exacerbates the problem by habitually sending duplicate documents. The struggle will soon intensify in the home health industry, which is currently undergoing payment reform under the Patient-Driven Groupings Model, as the model will require them to get documents signed even faster. Physicians should prepare now for the onslaught of signature requests.

Can electronic signature help? While it's certainly not the "silver bullet" that will single-handedly rectify our work-life balance, it's a piece of the puzzle, and when done right it can and absolutely will do the following:

• transform paperwork into revenue;
• increase working capital per provider;
• reduce the paperwork burden;
• improve job satisfaction and productivity; and
• reduce burnout.

However, no single EMR does electronic signature well, so a third-party tool will likely be needed for the most benefit.

To understand the solution, it's first necessary to understand the problem with outside paperwork. Faxed paperwork usually comes in bulk, out of order, and mixed with cover letters, restaurant menus, and other fax trash. The fax machines do not assign the documents to the correct patients or document types or route them to the correct providers; someone in your office has to do that. Since the sender has no reliable feedback loop—there's no guarantee that your office actually received their paperwork—they likely will send it multiple times. (A fax confirmation says nothing about actual receipt by your office personnel.) Finally, someone from your office must fax it back to the original sender. Physical paper suffers from all the same issues, and, worse, has to be scanned into the EMR.

Not all electronic signature platforms are the same, and there are some key factors to evaluate when choosing the best one that will reduce your burden and not add to it.

Must Haves
• A health care focus. Business-purpose electronic signature tools simply do not cut it. Not only do they focus on documents that do not change except for a few fields (ie, contracts), but they also lack any meaningful patient associations or clinical workflows. You do not want an e-mail every time you get a document to sign. A typical businessperson does not have nearly the volume of documents that you or your providers sign.

• Revenue capture. Reviewing and signing documents takes time, so the system should help you capture your signature-related revenue. This is only possible with systems that understand health care, and electronic fax does not have the intelligence to know which documents are even billable.

• Aggregate documents from all outside providers. Many postacute providers may offer you access to their portal. Logging into multiple portals is simply not a viable option.

• Clinical workflows. Providers rely on their staff to review, prepare, and perhaps approve documents for signature, so the system should enable those tasks. Ideally, it should also enable the provider to sign directly from the staff person's workspace for greatest efficiency.

• Unique patient records. Without these, you can forget meaningful reporting and searching.

• Document intelligence.Each individual document should come with the metadata—patient, provider, document type, effective date, and diagnosis code if relevant—so you know exactly how to process it and whether it's billable. Without document intelligence, much of the value electronic document delivery and signature offers is lost.

• The ability to offload patient and provider assignment to the sender. If the system requires your staff to assign the correct patients and signing providers, it's no more useful than fax. These tasks should be offloaded to the sender.

• The ability to prevent duplicate documents. Electronic fax ensures you will get duplicate documents. Your e-signature platform should intelligently identify and prevent duplicates.

• The ability to automatically send signed documents to sender. You or your staff should never have to do anything to send signed documents back.

• The ability to reject documents with a reason automatically sent to sender. Not everything sent for your signature should be signed. If you elect not to sign, you easily should be able to tell the sender why you're not signing and have that message communicated to them automatically—unless of course you want them to send it again … and again … and again.

• The ability to let you sign from anywhere. Providers never stop moving, so they should be able to review and sign orders from anywhere, including mobile devices.

• Interoperability. While not required to get started, interoperability is desirable given the number of electronic systems used today. The system must be capable of interoperability, even if isn't yet connected to your electronic medical record (EMR).

Game Changers
• The ability to sign in bulk.A busy provider may have 50 or more documents to sign each day. Bulk signing makes the task easier. While an EMR system may allow you to drag your signature onto an outside document, you typically can sign only one document at a time.

• The ability for providers to sign from staff workspaces. Mimicking the process of a staff person handing a provider a paper to sign (the "old-school" way), the system should enable the provider to review and sign from the staff person's workspace.

Other Important Factors
• Summary notifications.Rather than sending an e-mail as each document comes in, notifications should give you a count of documents awaiting signature along with document aging, so you know when care is being delayed. It should also give you control of notification frequency.

• Support to outside senders. The solution should support and train outside providers, enabling you to require them to send all documents electronically.

• Easy attachment of documents to the EMR.In the absence of an interface with your EMR, your staff should be able to easily attach documents to the patient record.

It is past time to kick the use of outdated faxing to the curb, even electronic fax, as it can't provide the intelligence needed to optimize practice profitability and efficiency. With electronic signature, you can eliminate fax machine chaos, the signing of duplicates, and the account reps interrupting your flow. Start capturing your signature-related revenue, regain job satisfaction, and reclaim a little sanity. It just may change your life.

— Michael Blackstone, MD, is the founder of Suture Health, Inc, whose core product is SutureSign, the leading electronic signature platform used by physicians and postacute providers across the United States.