Download EHR Consults

Consults
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.
Purpose and Use
• The primary purpose and main use of
Consults is to provide an order to an “inhouse” 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
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
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.
RCIS Component
• BMC 4.0 Patch 7 delivered the ability for
providers to enter an outside referral and
contract services using the EHR GUI.
• Requirement- Site needs to implement the RCIS
package in RPMS
• Some Tribal sites may not be using the RCIS
package because contract health dollars are left
with IHS
• In these cases, the site needs to evaluate the
best possible method for managing outside
referrals
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
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
TA
TM
MRAL
PERSONAL PATIENT
TEAM PATIENT AUTOLINKED
TEAM PATIENT MANUAL
MANUAL REMOVAL/AUTOLINK ADDITION
• Auto-linked not needed if only used for Consults.
– Enter team autolink: (may leave blank)
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.
• 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.
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
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?
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.
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.
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)
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)
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.
Reports
• Only available through RPMS roll & scroll.
• Used by the consult service, Medical Records
and CACs.
• Used for tracking completion status and time
statistics.
• 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.
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.
Questions and Discussion