Consults

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 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

4. 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

5. 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.

6. 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

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 • 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. • 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 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.

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