Download Brief guide on managing tasks in clinic for patients in

Brief guide on managing tasks in clinic for patients in between Office Visits
EPIC Communication - Who Sends you Messages in EPIC?
The “NAC”
The 3701 Market practices use a phone system that allows patients to access a nurse if they have a
pressing question. This program, call the “Nurse Access Center” or “NAC” is the primary route for
urgent patient calls into the practice. The NAC nurses have access to several “urgent” slots on the
schedules of all providers in the practice (including faculty and NP’s). When you are CC’ed a note from a
nurse from the NAC line, it is often because he/she has scheduled you a NAC patient and you are getting
a heads up.
Of note, the NAC nurse (or any RN who routes you a message from the NAC line) is not responsible for
any further management of the patient’s issues. If you need a nurse to help you out with additional
tasks for the patient, do not route the message back to the RN who fielded the NAC call. Rather, route
the message to your nurse pool.
The Call Center
Non-urgent calls to the practice are typically handled by the call center. The call center is off site and will
field & route calls to the appropriate person in EPIC. If a patient wants information about results, or
wants to speak to a doctor about something non-urgent, you will often be routed the message from the
call center. The call center provides a one way flow of information. While they will route you messages,
they do not call our patients back or assist with task completion in any other way, and they will not
respond to any of your messages in EPIC. If you need assistance from someone else with reaching out to
a patient, route the message through the office pools.
Messages from within the office
Staff within the office will frequently send you messages regarding patients. If you aren’t sure whether a
particular person works within the office, check the staff facebook and feel free to route to the message
to the pools if you’re still unsure.
Staff pools which you may utilize in routing messages include:
P PCS RED NURSE
P PCS BLUE NURSE
P PCS RED PSR
P PCS BLUE PSR
P PCS PRESCRIPTION
P PCS MEDICAL RECORDS
P PCS SOCIAL WORK
Routing messages – Which pool do I route this to?
Getting things done for patients means routing the message to the right person or pool. Below are some
quick tips on where to route things.
 Completed letters  P PCS Red Nurse or P PCS Blue Nurse
 Need for assistance obtaining durable medical equipment (DME)  P PCS Red Nurse or P PCS
Blue Nurse
 Need for prior authorization for a medication  P PCS Red Nurse or P PCS Blue Nurse










Need help reaching a patient to communicate something clinical  P PCS Red Nurse or P PCS
Blue Nurse
Need help getting medical records for a patient  P PCS Medical Records
Need help getting a patient transportation to/from appointments  P PCS Social Work
Need help getting patient mental health provider appointment  P PCS Social Work
Patient refill questions  P PCS Prescription
Need assistance scheduling a radiology study or consultant appointment  P PCS Red PSR or P
PCS Blue PSR
Need for assistance with appointment in our office  P PCS Red PSR or P PCS Blue PSR
Would like a patient to have a visit with PharmD  P PCS Red PSR or P PCS Blue PSR
Have a question about a patient seen in clinic  Attending you saw the patient with
Have a general clinical question about a patient in your PCT  Continuity Attending (aka PCT
attending)
Other FAQ’s
What’s the best means to communicate with nursing or front desk (PSR) staff in the office
about a patient matter?
Create a telephone encounter and document/ask your question there. While it’s tempting to use “Staff
Messages” to correspond, this keeps no record of the correspondence in the chart and requires extra
steps to order testing, labs, medications in EPIC. “Telephone Encounters” are for MUCH MORE than just
calling a patient. They are the default means by which we communicate with one another and
accomplish tasks in EPIC between office visits.
Do I need to do anything in particular before renewing a prescription?
Before refilling a medication, is prudent to do a quick chart check and ensure that 1) the patient should
still be taking the medication (per last office visit), 2) the patient has had appropriate labwork to monitor
any toxicities (i.e. BMP in past year if refilling HCTZ), and 3) the patient has been seen within the past
year or has appropriate follow-up scheduled if not.
What do I do with CC’d charts or Letters that arrive in my EPIC inbox?
Specialists who see your patient will frequently CC you on the chart or a Letter documenting their
encounter. Typically there is not something specific that you need to do with the CC’d chart or Letter, but
it is sent to you for your review so you can remain aware of what’s going on with your patient. You
should review the specialist’s note to ensure there is nothing that needs to be done from a primary care
standpoint (i.e. sometimes they’ll request an immunization or assistance with blood pressure
medication). Once you have reviewed the chart or letter, you can “done” the encounter.
What do I do with a telephone encounter for a NAC call where it looks like the patient was
already given an appointment?
Review the call and ensure that you agree the patient should be seen in the office and the patient can
wait until their appointment time. In most cases, you’re being sent this telephone call because either 1)
you’re the PCP and it’s just an FYI, or 2) you’re actually going to be seeing the patient. Occasionally
nurses will send you the calls and ask a very specific question about management.
I keep calling this patient about an important result, but I can’t get a hold of them, and I think
their phone number might be out of service. What should I do?
Look under patient demographics in EPIC and make sure you’ve tried all listed phone numbers of the
patient. You may also try the emergency contact listed under the demographics tab to try to reach the
patient. If after multiple times you are unsuccessful at reaching the patient, you can draft a letter in EPIC
and ask the RN to sent it as a certified letter under the comments section.
How do I communicate an EPIC message to another resident in my PCT?
The best way to do this is to write a staff message to that resident. Staff messages can be left in
the resident’s inbox (unlike most other messages which should be handled and “doned”), and
the resident can review it when they get back onto ILM.
I sent a message to this person in EPIC who told me that a patient wanted a call back from the
doctor, but they never responded. What’s going on?
This was probably a call center staff member. The call center fields all calls that come into the practices,
triages the calls, and routes them to the appropriate person. This is a ONE-WAY line of communication.
While the call center accepts all calls to the practice, they do not know much about the inner workings of
our practice, and cannot assist you further with accomplishing any tasks. If you need someone to assist
you with a patient task – your best bet is to route the message to the pools (P PCS Red PSR, P PCS Blue
PSR, P PCS Red Nurse, P PCS Blue Nurse, etc.), rather than routing it back to the person who sent you the
message.
I sent a message to the NAC nurse asking her to call the patient back to ask another question,
but she never did. What’s going on?
Keep in mind – the NAC nurses field sick phone calls coming into the office and send them to providers,
but they are not responsible for further addressing the patient’s needs once they are off the phone. The
NAC nurses only field sick calls when they’re on the NAC line, and do not have time to reach out to
patients. If you need anything additional done for the patient by nursing or office staff, you must send
the message to your nurse pool (P PCS Red Nurse or P PCS Blue Nurse), NOT back to the NAC nurse.
What do I do with results from another resident on my patient care team?
Address them as though they are your own results. Look up the patient’s prior visit to see in what context
the labs were ordered and discuss with the precepting attending who saw the patient with the resident,
if you’re unsure of how to handle the result. Ultimately, once handled route your result note to the
attending who saw the patient with the resident.
What do I do with lab results?
New lab and imaging results will show up bolded in your EPIC inbox under “Results” tab. When a new
result comes back, decide what action you need to take (i.e. no action, change medication, order
additional labs, unsure, etc.) If you’re not sure what to do, send a staff message to the preceptor who
saw the patient with you and propose a plan. If no particular action is needed on a result, contact the
patient either by phone (find their # by clicking the telephone button on the horizontal toolbar at the
top), by creating a letter (click the letter button on the horizontal toolbar), or electronically on
MyPennMedicine (click the release result button). Important results or those which require new
medication or referral should typically be communicated by phone or MyPennMedicine. You should then
create a “result note” by clicking this button on the toolbar. In the note, document your interpretation of
the result, how you contacted the patient, and route the message to your preceptor. If you need to order
additional studies or medication, it is best to open a new telephone encounter (click on the top toolbar)
and you can document everything there. Make sure to still route to your preceptor. If you create a
telephone encounter to document, you should create a result note & say, “see telephone encounter from
___ (date)”.
What can I do to get my patients’ specific medications?
Some medications may require a prior authorization by the insurance company, meaning that the
medicine will be prohibitively expensive unless you submit a prior authorization which is approved. If you
find out a medicine requires prior authorization, create a new telephone encounter & send a message to
your nurse pool requesting assistance (P PCS Red Nurse or P PCS Blue Nurse). Include which alternative
medicines the patient has tried (as usually this is required). If a prior authorization is declined, you will
typically get a list of medications which the patient must try/fail first.
How do I get my patient oxygen/wheelchair/special shoes/a cane (durable medical
equipment or DME)?
DME requests should go through the nursing pool. Create a new telephone encounter, document what
equipment you are requesting & the diagnosis associated with this. Order the equipment in “order entry”
& route to the nurse pool (P PCS Red Nurse or P PCS Blue Nurse). Note that mechanical wheel chairs &
scooters have requirements above the norm for DME. If you receive a request for this, you should discuss
with your preceptor/attending for guidance.
How do I get a patient an appointment with a specialist?
Place a “Consult to ______ (specialty)” order under order entry. In the comments section give a 1-2
sentence summary of the patient’s history & reason for referral. Select consult priority within the order
(urgent = within 2 weeks or routine = highly variable). For a savvy patient you can give them the “consult
order” printout & upon checkout at the front desk, the patient will be given the phone number for the
specialty clinic. For some patients you way wish to request the front desk make the appointment for the
patient prior to leaving. You can indicate this by writing it directly on the consult order, verbally by letting
the front desk know (surest way), or by putting it in the “check out note” portion of the wrap up tab. If
you’re getting the patient an appointment after they’ve left the office (maybe in response to labs or
imaging), you should call & let the patient know you are referring them and create a new telephone
encounter to document & place the order. If you know the specialty office phone # you can give it to the
patient & ask them to call to make an appointment, or you can route your message to the Patient
Scheduling Representatives (PSRs, route to P PCS Red PSR or P PCS Blue PSR), and ask them to call the
patient to assist with making the appointment.
How do I get outside medical records?
You can route requests to our medical records staff. Route to P PCS Medical Records. Be as specific as
possible, including all information you can provide about the place you are requesting from (physician
name, phone #, fax #, etc) & exactly what information you need (labs, office notes, ekgs, or maybe just a
specific test which was done). Vague requests will typically generate poor results & create more work for
you in the end. You can also get records yourself if you’d like. To do this, just ask front desk for a record
release form, fill out with the patient, and fax yourself in our office mailroom (dial 9-1- + Fax #)
How do I request that a patient be scheduled with an appointment in my office?
If you decide a patient of yours needs to be seen, create a telephone encounter, document your request
in the note section, & route to PSR pool to request they call the patient to arrange an office visit. Be
specific about the time frame you want the patient seen in.
How do I refill medications for a patient?
Under the medication tab, right click & select reorder. If you need to make changes to an existing
medication you can also DC the existing medication & create a new order under the order entry tab.
Make sure to pay attention to quantity, refills, and the pharmacy you are sending it to.
How do I help my patient get an appointment with a mental health provider?
Mental health benefits are tightly regulated by insurance companies who often have very specific
providers that are in-network. Options include having the patient call the phone number on the back of
their insurance card in order to find out who is in-network and utilizing EPIC smart phrases which have a
list of common mental health providers who are covered that you can print out for the patient
(.GMMentalHealth). Finally, we have a wonderful social worker, Vonda Greene who is a great resource
for patients when you need help getting them plugged in to a mental health provider and particularly
when you’re looking for something specific (substance abuse rehab, eating disorder management,
specific types of support groups). Feel free to knock on Vonda’s door when you need help getting a
patient a mental health appointment. If she is not in the office you can also send her an EPIC message by
routing to P PCS Social Work or directly at Greene, Vonda, or you can call her cell at (215) 651-4955.
What do I do if I think my patient needs to be in the ED or hospital?
If your patient is being seen in the office, you need to decide the acuity of the issue and whether an
ambulance/9-1-1 needs to be called. If so, call 9-1-1, treat/stabilize the patient as you are able to until
they arrive. Find out where Fire/Rescue is taking the patient (HUP or PPMC) and once they leave, call the
ED (215) 662-8215, and let them know what’s going on. If you are speaking to a patient on the telephone
who you think needs to go to the hospital assess whether you think it is safe for them to drive themselves
or if 9-1-1 is required. If they drive themselves, find out what emergency department they are going to
and call ahead to let the emergency department what is going on with the patient.