Users can annotate documents from three helpful locations:

  1. From Data Integration, before a document is associated to a patient

  2. From each labs, images, specialty consult, and uncategorized clinical document reports panel

  3. From the patient chart when clinical documents are being reviewed

This new functionality will empower users to have a seamless experience within Canvas to annotate, add comments, and sign documents before and during patient chart review.

Customers also have the ability to view annotated documents through our FHIR API, within the associated patient chart, or through Admin settings. These annotated changes also include details of the users who made changes to the document and when the annotations were made for audit purposes.

The PDF annotation feature can be enabled for customers starting on Thursday, June 29th 2023, via a passthrough cost. For those customer interested in enabling within their instance, please be sure to request a demo with product@canvasmedical.com or connect with your customer support team member. 

Use Cases

To enhance a user’s experience in Canvas, integration of functionalities aims to provide a seamless experience across the application. With PDF annotations, users are able to interact directly with any uploaded document within Canvas.  Previously, users needed to download a document, make annotations, and re-upload to associate to a patient’s chart. Some example use cases include:

Enabling PDF Annotations

In order to enable the PDF annotation functionality, Administrators must contact Canvas support in order to configure this feature within any instances. Given that there is a passthrough cost associated with the utilization of the PDF annotation functionality, it is important for all customers to understand the cost and full capabilities of this feature. 

There are guardrails in place to ensure that when the functionality is enabled, users understand the cost implications of utilizing within any given document as the cost is calculated per utilization. 

As a user selects the Annotate button, prior to accessing the functionalities, there is a confirmation popup asking if the user is sure about utilizing. If a user cancels, they are brought back to the previous view, but if a user confirms a new version of the document is displayed with all functionalities. This cost warning popup can be disabled if desired.

Annotating in Data Integration

Once a document is available within Data Integration, and PDF annotation is enabled in an instance, a user will see an annotation button above the patient name field. This button will be included per each document faxed or uploaded. 

Users have the ability to determine whether they want to annotate a document or not. Users can either annotate a document before or after linking to a patient and choosing the document type value. This allows customers to determine the most appropriate workflow for their teams. 

When users want to annotate a document, they are able to click the Annotate document and after confirming the associated cost popup, a new version of the document with annotation capabilities will appear. 

Users are able to take the following actions within the annotations feature:

Many of the actions allow for flexibility of color used and can be undone if needed. 

Once a document has been annotated and is ready to be saved, users simply click the save button on the top right corner of the menu bar. Once the document is saved, a user is able to associate it with the corresponding patient. 

If users make annotations to a document and in the process of associating to a patient, forget to save their annotations, prior to the document being associated there will be a popup confirming the action a user was intending to take. 

Once an annotated document has been saved to a patient, a user is able to find it on the patient chart in the corresponding section of the document type. (Ex. Consents will be found on the consent link of a patient’s profile or within the documents section of the patient chart). Any annotated documents that have a review document type association can also be found within the review workflow. These document types include:

Annotating in Clinical Review Workflow

When selecting New Labs, New Imaging, New consult reports, or New uncategorized reports from the action center, users are able to annotate any document within these workflows.

When a user selects to annotate any of these clinical review documents, the same functionalities and user experiences from Data Integration are available:

The associated command information can also be inputted through this workflow for a seamless user experience. Once signed the command and annotated document will be added to the patient’s timeline as a Chart Review.

Annotating in Patient Chart

From the patient chart, users are able to annotate New Labs, New Imaging, New consult reports, or New uncategorized reports.

When a user selects to annotate any of these clinical review documents, the same functionalities and user experiences from Data Integration are available:

The associated command information can also be inputted through this workflow for a seamless user experience. Once signed the command and annotated document will be added to the patient’s timeline as a Chart Review if the curser is not placed on an open note. If the cursor is place on an open note, the command will be added within the note.

Annotation Functionalities

This feature has an extensive list of possible actions that can be taken on a document. Below is a quick summary of possibilities within this workflow.

History of Annotated Documents

For use cases in which Administrators need to review what team members made annotations to a document, what the annotations were, and when, this information is located within the Settings section of each instance. Under the Practice header, Administrators will see a Document Annotations page which will list all annotated documents, within each document the following is visible:

FAQs

Q: When enabled, can annotation be restricted by user or role? 

A: If a customer is utilizing the permissions functionality within their instance, the Data Integration and Clinical Read/Write restrictions will prevent certain users from utilizing the annotation functionality. If a customer is not utilizing the permissions functionality, annotations cannot be restricted by user roles. 

Q: Can my signature be stored for future use?

A: Yes, if your Staff Admin page has a stored signature, it will automatically be available for PDF Annotation Signing workflows. Users can utilize this stored signature image or enter a new signature if they desire.

Q: Can I remove or edit an annotation after it has been added? 

A: Yes, for most annotation actions and prior to associating the annotated document to a patient, a user is able to undo an action or erase part of inserted annotations. 

Q: What is the associated cost to enable the ability to annotate documents?

A: To learn more about the associated cost, please email product@canvasmedical.com

Q: How can a signed document be returned?

A: Once an annotated document has been associated with a patient’s profile, it can be printed, attached to a letter to be faxed, linked to tasks, or reviewed. 

Q: Does "Forward by Fax" within data integration include annotations?

A: Yes, users can annotate a document within Data Integration and forward the saved document with the Forward by Fax functionality.

Q: When annotation is selected for a document a new version of the document is created.  What happens to the original version of the document?

A: The original version of the document is stored and can be access via Settings within the Document Annotations page. Once a specific annotated document is selected the Integration task will link to the original version of the document (Settings > Document Annotations > selected document > Integration task > Document).

Q: How can I inform colleagues that a document requires PDF annotation for a signature?

A: Admins can enable the ENABLE_REQUIRES_SIGNATURE constance config, which will denote on clinical review documents if a signature is required. Once the document has been annotated and the associated command has been signed (lab, imaging, etc), the requires signature label is automatically removed.

Q: Are keyboard shortcuts supported?

A: Yes - within the Apryse modal all Apryse native keyboard shortcuts are supported. You can view a full list here.