Developed for GRHCC Charles Schmitt MD 3/11/2007 Taking Care of Business Managing Consults in RPMS-EHR For Receiving/ Completing Consults

Developed for GRHCC Charles Schmitt MD 3/11/2007 The Easy Part Providers that do the consults have the easy part. Primary Care providers have assessed the patients need and generated consults. Front Desk personnel have gotten the patient to show up at the right time. To ‘Result’ the consult – all you have to do is tweak the way you start a note.Result

Developed for GRHCC Charles Schmitt MD 3/11/2007 Realizing there’s a Consult 1 If you see a patient with a pending consults, and just write a regular note [which is how consults have been used to date] then 1- the consult stays pending in the system as if you never did it. 2- the provider who generated the consult doesn’t get a notification letting them know it was done.

Developed for GRHCC Charles Schmitt MD 3/11/2007 Realizing there’s a Consult 2 The best way to realize that there is a consult is to set your default note title to your Consult note title – that way, a list of pending consults for that patient will always show up before you start a note.set your default note title Some providers get into the habit of going directly to the Consults tab to read look for a read the consults – this is easily done if your clinic flags new consults for you.Consults tab

Developed for GRHCC Charles Schmitt MD 3/11/2007 Realizing there’s a Consult 3 ways you’ll know there’s a consult You get a notification [if your consult is set up that way. You clerk has flagged the visit as a consult on your PCC+ worksheet. You go to the Consults Tab and look for a pending consult.Consults Tab You go to start a New Note, and notice there’s a pending consult for your clinic.New Note

Developed for GRHCC Charles Schmitt MD 3/11/2007 Whattatheywant To read the consult – to see what is wanted- you need to go to the Consult tab, click on the consult in the upper left pane, and read the consult where it shows in the large Right pane. There will be the consult from the sending provider, but also some added information from your front desk.read the consult

Developed for GRHCC Charles Schmitt MD 3/11/2007 Whattatheywant While reading the consult – you may want to highlight and copy part of it – especially if there is a detailed history section – you can paste this into your note and edit it while you do the visit.

Developed for GRHCC Charles Schmitt MD 3/11/2007 The Consult Visit The consult visit is the same as every other visit except: 1.You want to realize this is a consult visit and read the consult very early on. 2.You will write a Consult Note attached to the Pending Consult.

Developed for GRHCC Charles Schmitt MD 3/11/2007 Starting Your Consult Note There are two places you can start a Consult Note: 1.On the Consults tab, with your pending consult highlighted, choose Action, then Consult Results, and then Complete/Update Results…You will then choose a note title.On the Consults tab 2.Or you can do it from the Notes Tab: click ‘New Note’, choose the pending consult from the list at the bottom of that dialog box.do it from the Notes Tab

Developed for GRHCC Charles Schmitt MD 3/11/2007 Which is the better way …to start a consult note. I don’t know – you should probably be on the Consults tab reading the consult- so that way might be easy. But if you’ve gotten off of the consults tab after reading it – then starting your note from the Notes tab might be easier because then your default note title, which will be your consult note title, will be automatically selected for you. default note title

Developed for GRHCC Charles Schmitt MD 3/11/2007 Answering a Consult By completing a consult – a notification will be sent to the person who sent the consult. If you wanted to ‘cc’ another person- then add them as an ‘Additional Signer’ after you’ve signed your note.add them as an ‘Additional Signer’

Developed for GRHCC Charles Schmitt MD 3/11/2007 Close but no cigar. Consults may also be Forwarded.Forwarded This may happen if the consult was sent to the wrong service. This may be part of your workflow. For example Diabetes Case Management, may forward consults to Psychology or Wellness if necessary. In this situation the Case Management folks would not complete the consult but would add ‘Significant Findings’ then forward it.add ‘Significant Findings

Developed for GRHCC Charles Schmitt MD 3/11/2007 Oops, I didn’t mean to do that. You may get consults that are not needed – like a Diabetic Eye exam a week after a normal one was done, or a Diabetes Education Consult on a patient already attending classes – in these cases – go to the Consult and ‘Cancel’ it. You can add a comment stating why it is you cancelled it.Cancel

Developed for GRHCC Charles Schmitt MD 3/11/2007 QI, QA, PDCA, Continuous Quality Improvement, etc. etc. etc. Used correctly – the data that comes from consults may be very useful. It will help you figure out how patients are getting into your clinic – how well and how quickly your are meeting the demand. The numbers may help you facilitate and justify needed changes in process and staffing. You may want to consider keeping the consult printouts for later review since they will NOT be part of the medical record.

Developed for GRHCC Charles Schmitt MD 3/11/2007 Tweaking As time goes by, your clinic may want to change how consults are set up. You may want to split your consults between multiple services i.e. routine vs urgent, or Diabetic vs Non-Diabetic. You may want to change where things print out, who gets notifications etc. Work with EHR team as you assess your clinic workflow – and they’ll keep tweaking the set up for you.

Developed for GRHCC Charles Schmitt MD 3/11/2007 If it’s broke don’t use it? If there is a problem your clinic has- or if there’s an area where this process is not working – please don’t come up with a paper-work around without first getting the EHR team to tackle your problem. There is a fair amount of flexibility in the set up that might meet your needs.

Developed for GRHCC Charles Schmitt MD 3/11/2007 Canceling, Scheduling, Discontinuing, Forwarding, Adding Significant Results, Receive All of these are done basically the same way as Scheduling a Consult, you just choose a different choice on the last menu [these are other choices on the same menu that the choice ‘Schedule’ appeared].Scheduling

Developed for GRHCC Charles Schmitt MD 3/11/2007 Additional Signer To add an additional signer to a note: Write the note and sign it yourself. Then go to the note and RIGHT click it, one of the choices, at the bottom of the pop-up menu is ‘Identify Additional Signers’. Choose that, and then select the names that you want to ‘cc’ the note to.

Developed for GRHCC Charles Schmitt MD 3/11/2007 Reading Consults

Developed for GRHCC Charles Schmitt MD 3/11/2007 Consult Note from Consults Tab

Developed for GRHCC Charles Schmitt MD 3/11/2007 Consult Note from Notes Tab

Developed for GRHCC Charles Schmitt MD 3/11/2007 Scheduling a consult.

Developed for GRHCC Charles Schmitt MD 3/11/2007 Setting Default Note Title to Consult Note Title