Patient Chart Guide- Annotate and eSign Clinical Reports and Documents

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What is the Annotate and eSign feature?

The Annotate and eSign feature allows users at your practice to annotate and electronically sign clinical reports and documents directly in Elation EHR. Annotations and eSignatures can be added to documents that are filed into patient charts. All users can annotate documents, while Provider Level Users can annotate and electronically sign documents.

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Why is the Annotate and eSign feature valuable?

The Annotate and eSign feature is valuable because it allows you to annotate and electronically sign documents directly in Elation EHR. This feature saves your practice time and streamlines your workflows by enabling you to complete all annotations and electronic signatures directly within Elation. With this feature, you do not have to navigate to another platform, or print the document, to add signatures and complete other necessary markups.

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How to use the Annotate and eSign feature

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Overview

To annotate and/or electronically sign clinical reports or documents, the document must be uploaded to Elation and filed into a patient chart as a Report. These documents can be uploaded from your device into Elation, or faxed to you. There are two ways to upload documents from your device into Elation, either through the Fax Inbox on the Practice Home page or directly into a patient chart. Please reference these guides below for instructions on these workflows:

• File the Report from the Fax Inbox
• Drag and drop the document directly into the patient chart

If the document is faxed to you, you will first need to file the document from the Fax Inbox into a patient chart. Once filed to the chart, the document will be located in the Requiring Actions queue awaiting further action, annotation, and eSignatures as needed. Once annotations to the document are saved, it will replace the original, un-annotated version of the document. You can continue to add annotations until a Provider Level User clicks the “Sign Off” button. After a document has been signed off by a Provider Level User, no additional annotations or eSigntaures can be added and the annotated version of the document will replace the previous version in the patient chart. If users at your practice need other users to follow up on the annotated version of the document, they can send an office message directly from the document in the Report Panel or the Requiring Action section of the patient’s chart by clicking the “Actions” dropdown located in the top right of the document and selecting “Office Message”. The “Office Message” button is also available at the bottom of the annotated document in the Report window. The annotated document can be shared with external entities via a Referral, Provider Letter , or Patient Letter .

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How to start an annotation

To annotate a document, please follow the instructions below:

1. File the document to the patient chart through the Fax Inbox or by dragging and dropping the document into the patient chart.

• File the Report from the Fax Inbox
• Drag and drop the document directly into the patient chart

2. Locate the document in the Requiring Actions queue of the patient chart and click on the name of the document to open it in the Reports Panel
3. Begin annotating using one of these 2 options:

• Click “Actions” -> “Annotate”
• Scroll to the bottom of the document in the Reports Panel and click “Annotate”

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How to annotate a document

The annotation options toolbar will list all the annotation options. We will describe each annotation option in more detail in the ‘Annotation Options’ section below. To insert an annotation, click on an annotation option from the toolbar and then click on the spot in the document where you want to place the annotation.

• Hover your cursor over each annotation option for a few seconds for the tooltip to appear. You will also see the keyboard shortcut key that you can use to select an annotation option (e.g. the shortcut key for ‘Signature’ is ‘S’). We will list each annotation shortcut in the ‘Annotation Options’ section below.You can always move, resize, or delete any annotation as long as you do not click “Save annotation”.

Any annotation can be edited, duplicated or deleted prior to saving.

• Move an annotation by clicking and dragging it to a new spot.
• Resize an annotation by clicking the circles on the perimeter of the annotation and then dragging the annotation to the desired size.
• Copy and paste an annotation by clicking on the annotation, pressing ‘Control/Command’ + ‘C’ at the same time on your keyboard (to copy) and then pressing ‘Control/Command’ + ‘V’ at the same time on your keyboard (to paste).
• Delete an annotation by clicking on the annotation and then clicking the ‘Delete’ or ‘Backspace’ button on your keyboard.
• Undo or redo an action by clicking on the ‘Undo’ or ‘Redo’ buttons in the annotations toolbar or pressing ‘Control/Command’ + ‘Z’ (to undo) or ‘Control/Command’ + ‘Y’ (to redo).

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Annotation Options

Option Button Keyboard Shortcut Description Signature S Provider Level Users can add their eSignature (the one that is stored in their Elation Account Details settings) to the document. Staff Level Users cannot e-sign documents.

• If you need to update your signature, go to “Settings” -> “Account Details” -> “Edit Profile” and then click on your existing signature to change it.

Signature with Date X Provider Level Users can add their eSignature (the one that is stored in their Account Details settings section) to the document along with a date. The date will default to today’s date but you can adjust it to your preference. Staff Level Users cannot e-sign documents.

• If you need to update your signature, go to “Settings” -> “Account Details” -> “Edit Profile” and then click on your existing signature to change it.

Text T Any user can add text to the document. Date D Any user can add a date to the document. The date will default to today’s date but you can adjust it to your preference by double-clicking on the date to open the editable state. Checkmark C Any user can add a checkmark to the document.

• For convenience, you can continue adding check marks to the document until you press the “ESC” key on your keyboard.

Undo CTRL + Z (PC) CMD + Z (Mac) Any user can add undo the last action they performed while annotating. Redo CTRL + Y (PC) CMD + Y (Mac) Any user can redo the last action they performed after clicking “Undo”. Select All N/A CTRL + A (PC) CMD + A (Mac) Any user can select all the annotations on the page. This comes in handy if you need to move or delete your annotations in bulk. Delete N/A Delete Backspace Any user can delete annotations on the page. Copy N/A CTRL + C (PC) CMD + C (Mac) Any user can copy annotations on the page. Paste N/A CTRL + V (PC) CMD + V (Mac) Any user can paste annotations into the page. Exit annotation N/A ESC (Escape) Any user can press the “ESC” key on their keyboard to exit annotation mode.

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Page Navigation Options

Page navigation options will appear at the top of the annotate window if the document has more than one page. You can use these options to navigate between pages.

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Zoom Options

Use the zoom options in the top right corner of the annotation window to Zoom in or out of the document page while you are annotating or move to different areas of the page.

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How to save annotations

Once all of your annotations and eSignatures have been added to the document, click the “Save annotation” button at the bottom left of the window to save your work and close the annotation window. To view an annotated report, click on the report from the Reports window again. You may need to click the “Refresh” button at the top right corner of the Reports window to see your updates.

• Saving annotations and eSignatures will permanently add them to the document. You cannot remove or edit annotations and eSignatures once they have been saved, even if you go to annotate the document again.

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Annotation Tips

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Exiting an annotation

When you have finished typing text or editing a date in the annotation, press the “ESC” (escape) key on your keyboard to exit the annotation.

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Canceling an annotation selection

If you no longer want to add the annotation you selected from the annotation toolbar, press the “ESC” (escape) key on your keyboard to cancel your selection.

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Inserting text that is all the same size into different areas of the document

Each new text box you create from the ‘Text’ button will be a standard size. If you want to resize the font and re-use that font size for other text annotations in the document, we recommend copying (‘CTRL’/’CMD’ + ‘C’ on your keyboard) the first text box you added (the one you resized) and then pasting it (‘CTRL’/’CMD’ + ‘V’ on your keyboard) to the next annotation spot.

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Moving annotations in bulk

To move multiple annotations:

1. Select the annotations using one of the following methods:
2. Click and drag your cursor over all the annotations you want to highlight
3. Using your mouse/trackpad and keyboard
4. Click on one of the annotations you want to move
5. Press and hold the ‘Shift’ key on your keyboard
6. Click on the next annotation you want to move
7. Repeat steps 2 & 3 until all of the annotations are selected
8. Click on the highlighted annotations and then hold and drag them to the desired location on the page
9. Let go of your cursor

To move all annotations in bulk:

1. Press ‘CTRL’/’CMD’ + ‘A’ on your keyboard
2. Click on the highlighted annotations and then hold and drag them to the desired location on the document
3. Let go of your cursor

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Deleting annotations in bulk

To delete multiple annotations in bulk:

1. Select the annotations using one of the following methods:
2. Click and drag your cursor over all the annotations you want to highlight
3. Using your mouse/trackpad and keyboard
4. Click on one of the annotations you want to delete
5. Press and hold the ‘Shift’ key on your keyboard
6. Click on the next annotation you want to delete
7. Repeat steps 2 & 3 until all of the annotations are selected
8. Press the ‘Delete’ or ‘Backspace’ key on your keyboard

To delete all annotations in bulk:

1. Press ‘CTRL’/’CMD’ + ‘A’ on your keyboard
2. Press the ‘Delete’ or ‘Backspace’ key on your keyboard
3. Alternatively, click the “Discard” button at the bottom of the annotation window to discard all annotations you made during the edit session

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Frequently Asked Questions

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I need to find the original, un-annotated document. How do I do that?

If you need the original, un-annotated document, please click the “I need help” from the Blue Navigation Bar at the top of your page and select “I need help from an Elation Team” member to open a support ticket with Elation’s Support Team. Please indicate that you would like the un-annotated version of the document and share the following information with our team:

1. Patient chart ID number (located at the top of the Demographics Window)
2. Date and title of the report

Click here for more details on how to contact our Support Team .

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Can staff annotate documents, or only providers?

Both Provider Level Users and Staff Level Users can annotate documents, but only Provider Level Users can add their electronic signature to documents.

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I assigned the wrong reviewer for a document. Can someone else annotate it?

Yes, any user can annotate the document from within the patient’s chart. However, Provider Level Users can formally change the reviewer for a document by clicking the “Actions” dropdown located in the top right of the document in the Report Window and selecting “Reassign to Other Provider”. This option is also available directly from the Requiring Action section. Reports Window Requiring Action

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Can I annotate a document that has been signed off?

After a document is signed off, no additional annotations can be added. However, users can use the “Actions” dropdown for the document and select “Remove & Refile Images” from either the Report Window or the Requiring Action section to place the annotated version of the document back in the Fax Inbox and then file the document back to the appropriate patient chart to add additional annotations. Report Window Requiring Action

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Can I edit my annotations after they are saved to the document?

No, annotations cannot be edited after they are saved to a document. However, you can add additional annotations to the document before it is signed off by a Provider Level User.

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Can I edit my annotations after a document has been signed off?

No, annotations cannot be edited after a document is signed off. Please reference what to do if you need the original, un-annotated version of a document if you need to start the annotation process over.

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Related Articles

• Patient Chart Guide- Uploading documents directly within the patient’s chart
• Fax Inbox Guide- Managing inbound electronic faxes and uploading documents
• Letters & Referrals Guide- Sending messages to patients & corresponding with third party professionals
• Support Guide- How to get help on Elation