1. Developed for GRHCC Charles Schmitt MD 3/11/2007 Taking Care of Business Scheduling/Managing Consults in RPMS-EHR For Front Desk Personnel

2. Developed for GRHCC Charles Schmitt MD 3/11/2007 Bridging the Gap Many patients are deficient on services they should get – especially in the are of diabetes. The EHR helps to flag these deficiencies for providers, and generate consults. The EHR also helps these services to be documented in a reliable way. However – it’s the front desk personnel that do the important work- making sure that a Consult turns into a real visit.

3. Developed for GRHCC Charles Schmitt MD 3/11/2007 Receiving the Consult. The consult will print out on your printer. It’s possible that the provider will call or the patient will show up before the EHR consult is done. In this case you will need to ask the sending provider to sign an EHR consult order. When the consult order is signed – it will print out in your clinic. And, if desired, a notification will come up on your EHR screen [this may make it easier to find the patient].

4. Developed for GRHCC Charles Schmitt MD 3/11/2007 Scheduling the Consult Urgent issues should be brought to the attention of one of the providers immediately. Non-urgent consults can be scheduled when the clinic calls, when the patient shows up, or through the mail. When a specific appt date/time is given – go to the EHR and ‘Schedule’ the consult. You should do this in addition to whatever scheduling process you have now.‘Schedule’

5. Developed for GRHCC Charles Schmitt MD 3/11/2007 Falling Through the Cracks You may get consults, but no call from the clinic and no patient that presents. If your clinic mails out an appt – then do so and ‘schedule’ the consult. If you have called the patient and did not reach them – you should add this to the consult as a comment. This way multiple attempts to reach the patient and set up the appointment can be documented.

6. 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

7. Developed for GRHCC Charles Schmitt MD 3/11/2007 Close but no cigar. Consults may also be 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.

8. Developed for GRHCC Charles Schmitt MD 3/11/2007 Throwing in the Towel. Ideally – every consult generated would be needed, and the patient would show up to be seen. But- there are cases where the consult should be ‘Discontinued’Discontinued Examples would be after multiple attempts to reach the patient, or multiple No-Shows. By discontinuing these consults- you keep your ‘Pending Consults’ list valid and full or real consults. Also- this action will send a notification to the sending provider letting them know that the patient did not follow through.

9. Developed for GRHCC Charles Schmitt MD 3/11/2007 Keeping it Real The RPMS will tally up a lot of data for you concerning consults - # done, time to complete, # cancelled or discontinued, #pending etc. But, it’s necessary to make sure that consults are being handled properly for these numbers to be valid. The two most important things are 1) discontinue invalid consults and 2) do everything possible to make sure that a patient with a Consult Pending with your Clinic gets it completed when they show up.

10. Developed for GRHCC Charles Schmitt MD 3/11/2007 Helping to Complete Consults Consults are Completed by being Cancelled, Discontinued or Resulted. Providers ‘Result’ the consult by writing a consult note attached to that consult. Clinics should track appt’s that are new consults and flag these visits for providers to help ensure that they catch and result the consult that visit instead of writing a regular note –leaving the consult pending.

11. 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.

12. 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.

13. 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.

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

15. Developed for GRHCC Charles Schmitt MD 3/11/2007 Canceling Scheduling Discontinuing All of these are done basically the same what as Scheduling a Consult, you just choose a different choice on the last menu.Scheduling