1. 1 Consult Services Process

2. 2 What Happens When Consult is Ordered? Individuals may get alert Individuals may get alert Team of folks may get alert Team of folks may get alert Copy may print Copy may print

3. 3 Time Frames……….. Inpatient Inpatient  Emergency, STAT – need phone call  Routine – within 72 hours  Within 48 or 72 hrs. Outpatient Outpatient  STAT – need phone call  Today – need phone call  Next available, routine – next appt. within 30 days  Within 1 week, month, etc.

4. 4 OPT Process…………. Patient checks out, the orders are reviewed Patient checks out, the orders are reviewed  Appt. is made for the consult  Consult request updated to status of SCHEDULED  Patient reports for appt. If the appointment cannot immediately be made, than the consult should be RECEIVED which will change the status to ACTIVE If the appointment cannot immediately be made, than the consult should be RECEIVED which will change the status to ACTIVE

5. 5 NO SHOWS…. Appointment is rescheduled Appointment is rescheduled Patient notified Patient notified Clerk makes COMMENT to the request noting the new appointment Clerk makes COMMENT to the request noting the new appointment

6. 6 CANCELLATIONS…….. Clinic cancelled Clinic cancelled  COMMENT added noting new appt. Patient cancels Patient cancels  If does NOT wish to be re-scheduled, request is CANCELLED. This sends an Alert to ordering provider who may Edit and Resubmit if necessary

7. 7 CANCEL VS. DISCONTINUE CANCEL is used by the Receiving Service. This will send an Alert back to the ordering provider who may choose to Edit/Resubmit or leave it be. CANCEL is used by the Receiving Service. This will send an Alert back to the ordering provider who may choose to Edit/Resubmit or leave it be. DISCONTINUE is used by the ordering provider to stop the request.

8. 8 ADDENDUM VS. COMMENT ADDENDUM allows one or more people to add comments to the RESULTS of a consult ADDENDUM allows one or more people to add comments to the RESULTS of a consult COMMENTS add a note to the consult BEFORE it is resulted COMMENTS add a note to the consult BEFORE it is resulted

9. 9 Inpatient Receiving individual in service updates status to ACTIVE (by receiving the request) and makes a comment when physician notified Receiving individual in service updates status to ACTIVE (by receiving the request) and makes a comment when physician notified

10. 10 If INPT. Request not done before discharge & will be OPT instead Ward clerk will update status to SCHEDULED and note date/time patient to be seen Ward clerk will update status to SCHEDULED and note date/time patient to be seen

11. 11 Why services need to take actions Pending doesn’t say anything Pending doesn’t say anything  Who took action?  What action was taken?  Was anyone aware the request was made?  Did patient no show  Did patient die  Was clinic cancelled Many ???? With a pending status Many ???? With a pending status

12. 12 Clinician examines patient and/or reviews information  Direct enters result In EHR on Consults or Notes tabIn EHR on Consults or Notes tab  Dictates result Adds comment noting date/time patient/info was reviewed and dictated report to followAdds comment noting date/time patient/info was reviewed and dictated report to follow Adds Significant Findings noting date/time of review & dictated report to followAdds Significant Findings noting date/time of review & dictated report to follow

13. 13 Completing a Consult in EHR 2. Left mouse click on consult you wish to take action on, to highlight it. 1. Click on Consults Tab 3. Click on Action dropdown menu 4. Choose Consult Results 5. Complete/Update Results 6. You will be prompted to select the visit if you haven’t already defined that.

14. 14 Choose your title – It has to be a title with the word consult in it Following this you will be writing your note. You may just type and/or use a predefined template. Sign by clicking on the hand/pen icon. Once you have signed the note, the consult status will change to complete.

15. 15 You may also complete the consult on the Notes Tab… 1. Click on new note 2. Choose your consult title 3. Highlight the consult you wish to take action on in the bottom white box. 4. Click OK 5. Then you will be writing your note and signing as previously mentioned.

16. 16 1.Consult Tab 2.Action dropdown menu 3.Consult Tracking Consult Actions using the EHR

17. 17 Consult actions using RPMS To display pending consults… Select IHS Core Option: CST Consult Service Tracking for RDL SU Select IHS Core Option: CST Consult Service Tracking for RDL SU  CS Consult Service Tracking PC Service Consults Pending Resolution PC Service Consults Pending Resolution  Select Service/Specialty: RD RE 1 RD REFERRAL GROUPER GROUPER ONLY 1 RD REFERRAL GROUPER GROUPER ONLY 2 RD REFERRAL-INPT 2 RD REFERRAL-INPT 3 RD REFERRAL-OPT 3 RD REFERRAL-OPT  CHOOSE 1-3: 1 RD REFERRAL GROUPER GROUPER ONLY  List From Starting Date: ALL DATES//

18. 18 PC Service Consults Pending Resolution…

19. 19 RPMS option for consult actions… CST Select Consult Service Tracking for RDL SU Option: CST Select Consult Service Tracking for RDL SU Option:  CS Consult Service Tracking  CS Consult Service Tracking

20. 20 CS Consult Service Tracking

21. 21 Understanding Consult Hierarchy GROUPER ONLY – Allows a service to be used for grouping other services together for review purposes, and aids in defining the service hierarchy (e.g., ALL SERVICES, IN HOUSE SPECIALTY, CONTRACT HEALTH). GROUPER ONLY – Allows a service to be used for grouping other services together for review purposes, and aids in defining the service hierarchy (e.g., ALL SERVICES, IN HOUSE SPECIALTY, CONTRACT HEALTH).  Every Consult is tied to ALL SERVICES Service/Specialty: Service/Specialty:  Consult service users may choose the individual consult name.  Or, may choose a grouper name to get a report on all of the consult services defined under that grouper name. Example: If Contract Health wants to see what consults are ordered for CH-SURGERY they may choose that name at the SERVICE/SPECIALTY prompt. If they want to review all of their consults, they would enter CONTRACT HEALTH GROUPER at the SERVICE/SPECIALTY prompt. Example: If Contract Health wants to see what consults are ordered for CH-SURGERY they may choose that name at the SERVICE/SPECIALTY prompt. If they want to review all of their consults, they would enter CONTRACT HEALTH GROUPER at the SERVICE/SPECIALTY prompt.

22. 22 Consult Services without a service grouper AUDIOLOGY AUDIOLOGY COMMUNITY HEALTH COMMUNITY HEALTH DENTAL DENTAL FITNESS PROGRAM REFERRAL FITNESS PROGRAM REFERRAL PRENATAL EDUCATION PRENATAL EDUCATION PT/OT PT/OT

23. 23 Consult services with groupers CONTRACT HEALTH GROUPER (Grouper Only) CONTRACT HEALTH GROUPER (Grouper Only)  CH-CARDIAC REHAB  CH-CARDIOLOGY  CH-DERMATOLOGY  CH-ENT  CH-GYNECOLOGY  CH-HIGH RISK OBSTETRICS  CH-MISCELLANEOUS (SPECIFY)  CH-NEPHROLOGY  CH-NEUROLOGY  CH-OCCUPATIONAL THERAPY  CH-OPHTHALMOLOGY  CH-ORTHOPEDICS  CH-ORTHOTICS  CH-PHYSICAL THERAPY  CH-PODIATRY  CH-RHEUMATOLOGY  CH-SPEECH LANGUAGE PATHOLOGY  CH-SURGERY  CH-UROLOGY  CH-WOUND HEALING CLINIC This service also has this sub-grouper defined: CH-PROCEDURES GROUPER (Grouper Only) CARDIOVASCULAR PROCEDURES CT SCAN DEXA ECHOCARDIOGRAM EMG/NCV MAMMOGRAPHY MRI ULTRASOUND VASCULAR ULTRASOUND

24. 24 Service Groupers… DM GROUPER (Grouper Only) DM GROUPER (Grouper Only)  DM EDUCATION  DM WOUND/FOOT- INPT  DM WOUND/FOOT- OPT EYE GROUPER (Grouper Only) EYE GROUPER (Grouper Only)  OPHTHALMOLOGY  OPTOMETRY-INPT  OPTOMETRY-OPT MENTAL HEALTH GROUPER (Grouper Only) MENTAL HEALTH GROUPER (Grouper Only)  MENTAL HEALTH- INPT  MENTAL HEALTH- OPT RD REFERRAL GROUPER (Grouper Only) RD REFERRAL GROUPER (Grouper Only)  RD REFERRAL-INPT  RD REFERRAL-OPT

25. 25 Service Groupers… IN HOUSE SPECIALTY GROUPER (Grouper Only) IN HOUSE SPECIALTY GROUPER (Grouper Only)  IN-DERMATOLOGY  IN-GYNECOLOGY  IN-HIGH RISK OBSTETRICS  IN-NEPHROLOGY  IN-ORTHOPEDICS  IN-ORTHOTICS  IN-PODIATRY  IN-RHEUMATOLOGY  IN-SURGERY  IN-WOUND HEALING CLINIC

26. 26 REPORTS……….. CST Consult Service Tracking for RDL SU Option: CST Consult Service Tracking for RDL SU Option:  RPT Consult Reports  CC Service Consults Completed  CP Service Consults Completed or Pending Resolution  NU Service Consults with Consults Numbers  PC Service Consults Pending Resolution  SC Service Consults By Status  ST Completion Time Statistics Collects and display the mean number of days that consults/requests take to be filled, from the time that they are accepted by the service to the time that they are entered as Complete in the computer. Also lists the Standard Deviation and number of consults that were found for a date range.Collects and display the mean number of days that consults/requests take to be filled, from the time that they are accepted by the service to the time that they are entered as Complete in the computer. Also lists the Standard Deviation and number of consults that were found for a date range.