UCSF System:  Would like an APEX IT fix for documents (labs/scans/progress notes) scanned into APEX: the overall move is to have them imported through eFax to avoid paper printing.  However, there is not a mechanism to comment or sign off on the documents in Media Manager (i.e. labs were reviewed, within normal limits, or labs reviewed, potassium high-plan recheck in 1 week, etc).  Thus, either, there is no documentation that the scanned documents were actually reviewed/acted upon (safety issue) OR the scanned document has to be printed out on paper to be signed and then rescanned into APEX (inefficent use of staff time and waste of paper).  This is both a safety and efficiency problem that affects patients receiving standard-of-care treatment and those who are on research studies.  A mechanism to addend/acknowledge the review of these documents would be huge and solve many workflow problems we currently have in our clinics.