1. Consults

2. Learning Objectives Identify the purpose and use for Consults. Examine the procedure for setting up a new Consult. Learn how to manage Consults. Learn about Consult reports. Learn about Consult Notifications.

3. Purpose and Use “The Consult/Request Tracking package (Consults) was developed to improve the quality of patient care by providing an efficient mechanism for clinicians to order consults and requests using Computerized Patient Record System (CPRS) Order Entry, and to permit hospital services to track the progress of a consult order from the point of receipt through its final resolution.” - Vista CPRS Consult/Request Tracking Technical Manual June 2009

4. Purpose and Use (Cont.) The primary purpose and main use of Consults is to provide an order to an “in- house” individual or group to perform their duties legally or per policy. Consults are Orders like Orders for labs, x-ray, nursing and medications. Examples: –Nutrition; Diabetes Education; Anticoagulation; Public Health Nursing; Physical Therapy

5. Purpose and Use (Cont.) Another use of Consults is to track the acceptance into and disease management of patients while in “in-house” specialty clinics. Examples: –Optometry; Cardiology; OB/GYN

6. Purpose and Use (Cont.) Some sites also use Consults to administratively track “outside” referrals. –Users send a Consult to Contract Health Services to initiate the Referral process. –This is not the intended use of Consults. Consults differ from Referrals: Consults are for “in-house” and Referrals are for “outside” and utilize the RCIS package.

7. Setup Procedure Consults can be very simple to setup and manage, but have many options that could make them more complex than they need to be. Three steps to make a simple, working and effective Consult. –Create a Team –Create a Consult Service –Create a Consult Note Title

8. Setup Procedure (Cont.) Step 1: Create a Team Created in RPMS: –EHR > BEH > PAT > TEA > CRE Even if the Consult only goes to 1 person. Easier to maintain in the future. Choose any type if only used for Consults. –P PERSONAL PATIENT –TA TEAM PATIENT AUTOLINKED (Most Common) –TM TEAM PATIENT MANUAL –MRAL MANUAL REMOVAL/AUTOLINK ADDITION Auto-linked not needed if only used for Consults. –Enter team autolink: (may leave blank)

9. Setup Procedure (Cont.) Step 2: Create a Consult Service Created in RPMS: –EHR > BEH > CON > SS Service Team to Notify: –Assigning a Team here will send a New Consult Request Notification to all members of the Team. –Members of the Team listed here can use Consult Tracking actions to Result the Consult both Administratively and Clinically. Assign to “All Services” Grouper. –Consults have a hierarchy with “groupers” as parents. –The All Services Grouper is the parent of all the Consults and sub-groupers.

10. Setup Procedure (Cont.) Step 3: Create a Consult Note Title Created in RPMS –EHR > BEH > TIU > HIS > TMM > DDM > DDM3 Create in: – Progress Notes > Consults Only a Note Title under Consults will correctly finish a Consult when resulted with a note. Selecting the Note Title from the Notes tab will display a list of available Consults. –The number of days TIU will search back for active Consults is set by the parameter: GMRC CONSULT LIST DAYS –Found in: EHR > XX > EP

11. Setup Procedure (Cont.) Test to make sure your Consult works. Team members receive the notification of the Consult order? Team members able to update the Consult through Consult Tracking? Team members able to administratively complete the Consult? Team members able to clinically complete the Consult by resulting and writing a note? Ordering provider receives the correct notifications when the consult is updated and resulted?

12. Managing Consults (Cont.) Making Consults more specific for what the service needs. Setup a printer. –Assign printers under Consult setup or Team setup. –Will only print to ONE printer. Prints at the printer under Consult setup only if there is no other printer assigned elsewhere. Setup the provisional diagnosis prompt. –An optional or required field for the provider to enter a diagnosis as free text or a Lexicon code. Add prerequisites. –A pop-up that appears when the Consult Service is selected that displays information to the provider.

13. Managing Consults (Cont.) Making Consults more user friendly. Create a Consult Quick Order. –EHR > CPRS > PE > MM > QO –Use namespace GMRCZ Adding a Template for the Consult Request. –A template for the provider to use when ordering a Consult. Adding a Template to automatically display when the Note Title to complete the Consult is chosen. –Useful if the service uses only one template.

14. Managing Consults (Cont.) Using additional prompts for other options. Some change the functionality of users able to update and receive notifications. Example: –UPDATE USERS W/O NOTIFICATIONS: A list of individuals who can do update tracking, but who will not get a notification. IFC prompts used for VA Inter-Facility Consults only (not IHS)

15. Managing Consults (Cont.) Using Other Options on the Consults Menu. Some used for various troubleshooting issues. Prosthetics, Procedures and Pharmacy TPN refer to specialized VA Consults that store additional data in a separate package and require a more detailed setup and management, (not used by IHS)

16. Management (Cont.) Disabling a Consult When a Consult is not needed any longer, change the service usage to disabled. –SERVICE USAGE: DISABLED Will not permit the Consult Service to be selected for new Consults. Will still allow any pending Consult requests to be finished.

17. Reports Only available through RPMS roll & scroll. Used by the consult service, Medical Records and CACs. Used for tracking completion status, time statistics, and consult service quarterly reports. Can specify report for all or individual services. Can specify date range. Example: –PC Service Consults Pending Resolution Report used by the service to determine Consults still pending.

18. Notifications Setup in RPMS. –EHR > BEH > NOT > PRC New Service Consult/Request –Set to Mandatory –Users may lose track of their Consults: this notification does not stay in the users notifications after review because there is no follow-up action. Consult/Request Resolution –Set to Mandatory –Notifies Ordering provider upon consult completion. Consult/Request Cancel/Hold –Notification sent upon discontinue, cancel or hold actions. Consult/Request Updated –Notification sent to user when a comment is added via “Add Comment” or “Schedule” actions. –The Consult Service can send an alert to a user via a check box even if this notification is “off” for the user.

19. Questions and Discussion