Some chart and document workflows require a sign-off step before the record is considered complete, for example a physician or reviewer approving a chart. Each sign-off request has a due time (the timeout). CoolFocus now actively watches that due time and follows up automatically instead of leaving the request to sit silently in the queue.
Default review windows:
24 hours for most sign-off requests.
48 hours for the DocAlert review template.
Your organization's workflow configuration may set different windows for specific templates. If your organization uses a custom approval chain for a chart type, each step has its own timeout and the reminders and escalation described below apply to each step in turn.
When staff send a chart for review, CoolFocus checks whether the reviewer it resolves to can actually be notified before completing the send. This check applies to every chart type, not just Ultrasound.
No reviewer can be resolved at all (for example, no physician or clinical reviewer position is configured or staffed, and no specific user was picked): the send is blocked, and staff see an error asking them to configure a reviewer before trying again. Nothing is left in an in-review state.
A reviewer resolves but has no email on file: the send still succeeds, but staff see a non-blocking warning explaining that the reviewer will not be alerted automatically and should be notified directly. The chart still moves to in-review and shows up in the reviewer's queue.
A reviewer resolves and has an email on file: the send succeeds with no warning.
This check looks at whoever the workflow would actually assign, in priority order: a reviewer picked directly on the visit or chart (for example, the physician selected on an Ultrasound chart), then a configured reviewer position, then any position flagged as the clinical reviewer, then any user marked as a physician. Once one of those tiers resolves someone, that is who the review goes to, whether or not a more reachable person exists further down the list, so the warning is telling you about the actual assignee, not a hypothetical fallback.
Reminder. When a pending sign-off reaches about 75% of its allowed review window, CoolFocus re-sends a notification to the assignee (the specific reviewer, or everyone currently holding the assigned position). This reminder is sent once per sign-off request.
Overdue escalation. Once the due time passes and no one has responded, CoolFocus notifies the person or team that started the workflow that the review is overdue. This escalation repeats at most once per day for as long as the sign-off remains unanswered.
A background check runs every 30 minutes to look for sign-offs that have crossed either threshold.
An overdue sign-off is never automatically approved, denied, or failed. Clinical and compliance reviews are meant to wait for a real decision, so CoolFocus keeps nagging the assignee and the initiator instead of closing the item out on its own. The related chart or document stays in its current status until a reviewer responds.
The assignee's own Physician Review Queue, which only shows items assigned to that person.
The Overdue Sign-Offs report, in the Reports module under the Compliance category. Unlike a personal queue, this report is org-wide, it shows every overdue approval across the organization, along with the on-time signing percentage AAAHC surveyors ask for. A companion Unsigned Encounters report lists everything currently awaiting physician sign-off, whether or not it is yet overdue, and a companion Chart Access Log report lists who has opened clinical charts and review sheets, and when. All three support date-range filters (Unsigned Encounters and Overdue Sign-Offs can also be filtered to a single center; the access log filters by user instead) and can be exported to CSV. See Reports by Area for details.
If your team relies on that report, an item appearing there means the reminder and escalation emails described above have already started going out for it.
Sending a chart for review, having it signed, denied, or returned for corrections each write a plain-language note to the related case or visit timeline (for example "Chart returned for corrections. Reason: ..."). These are separate from the reminder/escalation emails above and are visible only to staff, never in the client portal.
Reminders and escalations go to the same people who would normally be notified about the sign-off: the assigned user, every active holder of an assigned position, and the workflow's initiator.
If the workflow tied to a sign-off has already been cancelled or completed some other way, that sign-off is left alone and does not generate further escalation emails.
These notifications are sent automatically as part of the sign-off workflow itself, they are not controlled by your personal Notification Preferences settings.
Physician Review Queue (DocAlert Reviews)
Custom Approval Chains for Charts
