Who does what — doctors, MAs, and the mapping list

This page is for clinic staff. It is not a technical runbook.

There are two different places people work. They do not automatically update each other.

Fax arrives in Elation inbox
        │
        ▼
  Our system reads it
  (Cloud Run — you do not wait here)
        │
        ├── Codes it is sure about  →  lab values on the patient chart
        │                              MA reviews them in Elation
        │
        └── Codes it is not sure about, or a mapped code someone flags as wrong
                                           →  LOINC review in the fax app
                                           →  a clinician's answer applies from the next fax
                                           →  Publish certifies it in the mapping list

Everyday lab review (medical assistant)

Where: Elation — the patient chart, Add Lab Values for Trending.

What you do: Check that the numbers (and units) are right. Save.

What this does not do: It does not teach the system a better test name → LOINC code. The next fax can make the same coding mistake.

If a code on the chart is wrong, open the fax app → LOINC review → New correction. Type the test name, unit, lab, and the wrong code. A clinician then picks the right LOINC and Publish. Do not try to “fix the mapper” from Elation.

Teaching the system new / wrong codes (clinician)

Where: the fax app in the browser → LOINC review (/loinc-review) after login. Step-by-step: LOINC review clinician guide.

What you do:

1. Open a case (an abstained row, a row that filed by inference, or a disputed mapped row).
2. After a parse, you can also click Wrong code on that lab card in Extraction. A small form asks why the code is wrong (not a browser alert).
3. Pick the correct LOINC code. The line under it says what your choice means before anything is saved: new, a confirmation, or a conflict with an earlier answer.
4. Approve. On a conflict, Keep the earlier answer or Replace it.
5. Publish when the batch of approvals is ready.

Each test is asked once. The same test from another fax, another run or another laboratory lands on the same card. A row that prints no unit or no panel takes the answer of the fuller one.

Ignore — the practice's choice. A test the practice does not want coded (the weekly review): Ignore on the card closes it and puts the printed test name on the ignore list, at every laboratory and unit. From the next fax, a row of that name that files nothing is named in the Elation note as left uncoded by the practice's choice, is not counted as unfiled (no "needs communication" and no hold because of it), and opens no card; a row of that name the mapper does code still files. Reopen takes the name off the list. On Quick review, Ignore the rest puts every open question on the list at once — the end of the weekly review; disputes, cases that need the full page and rows that filed are left where they are.

When an approval takes effect: from the next fax. What Publish does: certifies the approvals in the mapping list (registry), each on its own. One that cannot be published comes back to its reviewer with the reason; the others are published.

On a phone, Quick review shows the simple cases one at a time — tap the right code, read the line, approve, next — and sends anything that needs the search box to the full page. Filed by inference has Confirm all. MAs should not live in this screen. Abstained inbox rows already create cases. Disputed rows are the extra path for “the mapper was sure, but it was wrong.”

What never reaches the doctor: a result the mapper filed itself, also when the report printed no unit or no specimen. Those are counted for the operator under Ops queue.

Filing a document from the fax app

Where: Extraction → Document type dropdown (same labels as Elation) → File to Elation.

You can change the type even when automatic classify is off. The dropdown defaults to whatever the system guessed.

Above the results the filing verdict says how many lab results could not be filed to the grid. Needs communication (a yellow line): the fax files, the Elation note says NEEDS COMMUNICATION, and the fax explorer lists it under Needs communication so the practice can follow up. Held — not filed (a red line): too many results could not be filed; the button reads File anyway… and asks first — filing then is your decision and is recorded with your name.

An upload with more pages than the cap is refused before anything runs ("Settings → Max pages").

An Imaging Result files with the report's Indication, Findings and Impression copied word for word into the Elation note (page breaks marked), once the operator has switched the feature on. The medical assistant reviews that note in Elation. Once the practice has switched on the communication module, the care coordinator of the patient's doctor is paged in Spruce with the Findings and the Impression (Communication).

Who is told about a fax (fax owner, care coordinators)

Where: Communication in the fax app, and Pages in Spruce.

A fax that was filed with results left out, a fax that was held, and a filed imaging report each page a member of staff with an internal note in Spruce. A filed report is titled for the chart: "Lab Results" and the latest collection date, or for imaging the study, the report date and the Impression, Indication and Findings as far as they fit (the patient's name only on the staging chart). The fax owner gets the notes about faxes in a thread of their own; the care coordinator of the patient's doctor gets the imaging note inside the patient's thread, and the doctor is paged too when the finding is major. Resolve the page in Spruce when you are done. The app never messages a patient. Who is told, where, and in which mode is set on the Communication page (how it works).

Settings (operator or doctor)

Where: Settings in the fax app.

Thresholds and switches both the inbox and the harness read on the next fax: the page cap, the warn share and count, the hold share and minimum rows, whether the judge may file MEDIUM picks, whether an unknown patient gets a new chart, whether Gemini classifies document types, the fallback model, and what to do with a fax filed in part (keep: the item stays in the inbox and the fax owner is told which pages were not filed; retry: the lab pages that had nothing to file get one more run after the usual wait, the pages already filed are never posted again, and the owner is told only if the retry still cannot file them). An override beats the server's env until it is cleared; blank means "use env". Every save records who saved it and when; the status strip counts the overrides in force. No redeploy.

Held faxes (operator)

A fax whose every segment filed leaves the Elation inbox on its own when the practice turns that on (the runbook's INBOX_REMOVE_AFTER_FILE): the chart keeps the one report with the values and the pages, and nothing else is filed anywhere. A fax with a failed segment, one filed to the staging chart, or a part the app did not file stays in the inbox for the MA.

What the app files is a lab result, an imaging report, or any pages whose results it could code. Pages that read as a lab with no value to file, or as another kind of document (a referral, a consult note without a lab table, clinical notes), are not filed: the rest of the fax files, the item stays in the inbox, and the fax owner gets a note saying which pages and why. A fax that is only such a document is left whole in the inbox, no chart is made for it, and the owner is told. A fax over the page cap is left in the inbox before anything is downloaded, and the owner is told the page count and the cap.

A fax the inbox could not file after its retries, or one the verdict held, shows in the fax explorer under Held and stays in the Elation inbox for a person. Releasing it is an operator step for now (deploy runbook, "Settings page and held items"); the release button is the next pass. When Elation itself cannot be reached after a fax was read, the app keeps what it read and waits (no second read is paid for); only after a long outage is the fax held. A fax whose filing got no answer from Elation is held at once: the operator looks at the chart before releasing it, because the report may already be there.

Harness upload (testing / training)

Where: the same fax app → home page → upload a PDF → File.

Same mapping rules: only a mapped code is sent to Elation. Rows the mapper could not code go to LOINC review. Wrong mapped codes use Wrong code. Publishing happens on LOINC review → Publish or Quick review → Publish.

Find a fax (anyone with a login)

Open Fax explorer in the fax app. Search by the Elation report id (from the chart), the inbox id, the patient id, the job id, or a date range, and narrow by document type, patient match or outcome (filed, partly filed, parsed only, failed, skipped, held, older runs), or by Needs communication (the verdict flagged the fax or held it). Pick a row to see:

• Timeline — every stage the fax went through and how long each took.
• Funnel — how many rows were extracted, kept, coded and filed, and every row that was not kept with the reason.
• Filing — the filing verdict (numbers and thresholds; who overrode a hold), then each segment's document type, patient match, results on grids, the Elation report id (a link when the operator set ELATION_WEB_BASE_URL), the grid note, and Read back from Elation to compare what Elation holds now (for an imaging report only the note's length — the text stays in Elation).
• Rows — every extracted result with its value, unit, reference, LOINC and status; Wrong code opens a correction case for a filed row, even for an inbox fax that never touched the harness.
• Review cases — the cases the fax opened, each a link into LOINC review.
• Logs — a Logs Explorer link filtered on this fax (needs GCP_PROJECT_ID on the service).
• Retries — every attempt on the same inbox item (a retried item never overwrites the first run).

Patient names are never stored in the record or shown on the page; the Elation chart is the place for the name.

Short answers

Question	Answer
Where does the MA work?	Elation chart / trending (numbers). Wrong codes → fax app New correction
Where do new aliases get saved?	An approval in LOINC review or Quick review applies from the next fax; Publish certifies it
If MA corrects a code in Elation, is the next fax smarter?	No
Does the doctor need the harness for normal charting?	No — charting stays in Elation
Login on the fax app	Cookie login (password shared out of band). Does not replace Elation login.
Who tells me that a fax needs me?	An internal note in Spruce that pages you. Set on Communication in the fax app
Can the fax app message a patient?	No. It can post internal notes to staff only

No patient names, MRNs, or fax numbers belong in this documentation.

More detail (technical)

Registry publish rules and the clinician review contract live in the sibling mapper docs: Clinician-governed learning.