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ConsultServices Process

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What Happens When Consult is Ordered? Individuals Individuals maymay get alert get alert Team of folks Team of folks maymay get alert get alert Copy Copy maymay print print

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Time Frames……….. InpatientInpatient

Emergency, STAT – need phone callEmergency, STAT – need phone call Routine – within 72 hoursRoutine – within 72 hours Within 48 or 72 hrs.Within 48 or 72 hrs.

OutpatientOutpatient STAT – need phone callSTAT – need phone call Today – need phone callToday – need phone call Next available, routine – next appt. within 30 Next available, routine – next appt. within 30

days days Within 1 week, month, etc.Within 1 week, month, etc.

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OPT Process…………. Patient checks out, the orders are reviewedPatient checks out, the orders are reviewed

Appt. is made for the consultAppt. is made for the consult Consult request updated to status of Consult request updated to status of

SCHEDULEDSCHEDULED Patient reports for appt.Patient reports for appt.

If the appointment cannot immediately be If the appointment cannot immediately be made, than the consult should be made, than the consult should be RECEIVEDRECEIVED which will change the status to which will change the status to ACTIVEACTIVE

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NO SHOWS…. Appointment is rescheduledAppointment is rescheduled Patient notifiedPatient notified Clerk makes Clerk makes COMMENTCOMMENT to the request to the request

noting the new appointmentnoting the new appointment

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CANCELLATIONS……..

Clinic cancelledClinic cancelled COMMENTCOMMENT added noting new appt. added noting new appt.

Patient cancelsPatient cancels If does If does NOTNOT wish to be re-scheduled, wish to be re-scheduled,

request is request is CANCELLEDCANCELLED. This sends an . This sends an Alert to ordering provider who may Edit Alert to ordering provider who may Edit and Resubmit if necessaryand Resubmit if necessary

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CANCEL VS. DISCONTINUE

CANCELCANCEL is used by is used by the Receiving Service. the Receiving Service. This will send an This will send an Alert back to the Alert back to the ordering provider who ordering provider who may choose to may choose to Edit/Resubmit or leave Edit/Resubmit or leave it be.it be.

DISCONTINUEDISCONTINUE is is used by the ordering used by the ordering provider to stop the provider to stop the request.request.

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ADDENDUM VS. COMMENT

ADDENDUMADDENDUM allows allows one or more people to one or more people to add comments to the add comments to the RESULTSRESULTS of a consult of a consult

COMMENTSCOMMENTS add a add a note to the consult note to the consult BEFOREBEFORE it is resulted it is resulted

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Inpatient

Receiving individual in service Receiving individual in service updates status to updates status to ACTIVE (by ACTIVE (by receiving the request)receiving the request) and makes and makes a comment when physician a comment when physician notifiednotified

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If INPT. Request not done before discharge & will be OPT insteadWard clerk will update status Ward clerk will update status

to to SCHEDULEDSCHEDULED and note and note date/time patient to be seendate/time patient to be seen

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Why services need to take actions Pending doesn’t say anythingPending doesn’t say anything

Who took action?Who took action? What action was taken?What action was taken? Was anyone aware the Was anyone aware the

request was made?request was made? Did patient no showDid patient no show Did patient dieDid patient die Was clinic cancelledWas clinic cancelled

Many ???? With a pending Many ???? With a pending statusstatus

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Clinician examines patient and/or reviews information

Direct enters result Direct enters result • In EHR on Consults or Notes tabIn EHR on Consults or Notes tab

Dictates resultDictates result• Adds comment noting date/time Adds comment noting date/time

patient/info was reviewed and patient/info was reviewed and dictated dictated report to followreport to follow

• Adds Significant Findings noting Adds Significant Findings noting date/time of review & date/time of review & dictated report to dictated report to followfollow

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Completing a Consult in EHR

2. Left mouse click on consult you wish to take action on, to highlight it.

1. Click on Consults Tab

3. Click on Action dropdown menu4. Choose Consult Results5. Complete/Update Results6. You will be prompted to

select the visit if you haven’t already defined that.

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Choose your title –It has to be a title with the word consult in it

•Following this you will be writing your note. •You may just type and/or use a predefined template.•Sign by clicking on the hand/pen icon.•Once you have signed the note, the consult status will change to complete.

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You may also complete the consult on the Notes Tab…

1. Click on new

note

2. Choose your consult title3. Highlight the consult you wish to take

action on in the bottom white box.4. Click OK5. Then you will be writing your note and

signing as previously mentioned.

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1. Consult Tab2. Action dropdown menu

3. Consult Tracking

Consult Actions using the EHR

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Consult actions using RPMSTo display pending consults… Select IHS Core Option: CST Consult Service Tracking for RDL SUSelect IHS Core Option: CST Consult Service Tracking for RDL SU

CS Consult Service TrackingCS Consult Service Tracking

PC Service Consults Pending ResolutionPC Service Consults Pending Resolution Select Service/Specialty: RD RESelect Service/Specialty: RD RE 1 RD REFERRAL GROUPER GROUPER ONLY1 RD REFERRAL GROUPER GROUPER ONLY 2 RD REFERRAL-INPT2 RD REFERRAL-INPT 3 RD REFERRAL-OPT3 RD REFERRAL-OPT CHOOSE 1-3: 1 RD REFERRAL GROUPER GROUPER CHOOSE 1-3: 1 RD REFERRAL GROUPER GROUPER

ONLYONLY List From Starting Date: ALL DATES//List From Starting Date: ALL DATES//

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PC Service Consults Pending Resolution…

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RPMS option for consult actions…

CST Select Consult Service Tracking for CST Select Consult Service Tracking for RDL SU Option: RDL SU Option: CS Consult Service TrackingCS Consult Service Tracking

CS Consult Service TrackingCS Consult Service Tracking

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CS Consult Service Tracking

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Understanding Consult Hierarchy

GROUPER ONLY – Allows a service to be used for grouping other GROUPER ONLY – Allows a service to be used for grouping other services together for review purposes, and aids in defining the service services together for review purposes, and aids in defining the service hierarchy (e.g., ALL SERVICES, IN HOUSE SPECIALTY, hierarchy (e.g., ALL SERVICES, IN HOUSE SPECIALTY, CONTRACT HEALTH).CONTRACT HEALTH). Every Consult is tied to ALL SERVICESEvery Consult is tied to ALL SERVICES

Service/Specialty:Service/Specialty: Consult service users may choose the individual consult name.Consult service users may choose the individual consult name. Or, may choose a grouper name to get a report on all of the consult Or, may choose a grouper name to get a report on all of the consult

services defined under that grouper name.services defined under that grouper name.

Example: If Contract Health wants to see what consults are ordered for Example: If Contract Health wants to see what consults are ordered for CH-SURGERY they may choose that name at the CH-SURGERY they may choose that name at the SERVICE/SPECIALTY prompt. If they want to review all of their SERVICE/SPECIALTY prompt. If they want to review all of their consults, they would enter CONTRACT HEALTH GROUPER at the consults, they would enter CONTRACT HEALTH GROUPER at the SERVICE/SPECIALTY prompt.SERVICE/SPECIALTY prompt.

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Consult Services without a service grouper AUDIOLOGYAUDIOLOGY COMMUNITY HEALTHCOMMUNITY HEALTH DENTALDENTAL FITNESS PROGRAM REFERRALFITNESS PROGRAM REFERRAL PRENATAL EDUCATIONPRENATAL EDUCATION PT/OTPT/OT

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Consult services with groupers CONTRACT HEALTH GROUPER (Grouper Only)CONTRACT HEALTH GROUPER (Grouper Only)

CH-CARDIAC REHABCH-CARDIAC REHAB CH-CARDIOLOGYCH-CARDIOLOGY CH-DERMATOLOGYCH-DERMATOLOGY CH-ENTCH-ENT CH-GYNECOLOGYCH-GYNECOLOGY CH-HIGH RISK OBSTETRICSCH-HIGH RISK OBSTETRICS CH-MISCELLANEOUS (SPECIFY)CH-MISCELLANEOUS (SPECIFY) CH-NEPHROLOGYCH-NEPHROLOGY CH-NEUROLOGYCH-NEUROLOGY CH-OCCUPATIONAL THERAPYCH-OCCUPATIONAL THERAPY CH-OPHTHALMOLOGYCH-OPHTHALMOLOGY CH-ORTHOPEDICSCH-ORTHOPEDICS CH-ORTHOTICSCH-ORTHOTICS CH-PHYSICAL THERAPYCH-PHYSICAL THERAPY CH-PODIATRYCH-PODIATRY CH-RHEUMATOLOGYCH-RHEUMATOLOGY CH-SPEECH LANGUAGE PATHOLOGYCH-SPEECH LANGUAGE PATHOLOGY CH-SURGERYCH-SURGERY CH-UROLOGYCH-UROLOGY CH-WOUND HEALING CLINIC CH-WOUND HEALING CLINIC

This service also has this sub-grouper defined:

• CH-PROCEDURES GROUPER (Grouper Only)• CARDIOVASCULAR PROCEDURES• CT SCAN• DEXA• ECHOCARDIOGRAM• EMG/NCV• MAMMOGRAPHY• MRI• ULTRASOUND• VASCULAR ULTRASOUND

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Service Groupers… DM GROUPER (Grouper DM GROUPER (Grouper

Only)Only) DM EDUCATIONDM EDUCATION DM WOUND/FOOT-DM WOUND/FOOT-

INPTINPT DM WOUND/FOOT-DM WOUND/FOOT-

OPTOPT EYE GROUPER EYE GROUPER

(Grouper Only)(Grouper Only) OPHTHALMOLOGYOPHTHALMOLOGY OPTOMETRY-INPTOPTOMETRY-INPT OPTOMETRY-OPTOPTOMETRY-OPT

MENTAL HEALTH MENTAL HEALTH GROUPER (Grouper Only)GROUPER (Grouper Only) MENTAL HEALTH-MENTAL HEALTH-

INPTINPT MENTAL HEALTH-MENTAL HEALTH-

OPTOPT RD REFERRAL RD REFERRAL

GROUPER (Grouper Only)GROUPER (Grouper Only) RD REFERRAL-INPTRD REFERRAL-INPT RD REFERRAL-OPTRD REFERRAL-OPT

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Service Groupers… IN HOUSE SPECIALTY GROUPER (Grouper Only)IN HOUSE SPECIALTY GROUPER (Grouper Only)

IN-DERMATOLOGYIN-DERMATOLOGY IN-GYNECOLOGYIN-GYNECOLOGY IN-HIGH RISK OBSTETRICSIN-HIGH RISK OBSTETRICS IN-NEPHROLOGYIN-NEPHROLOGY IN-ORTHOPEDICSIN-ORTHOPEDICS IN-ORTHOTICSIN-ORTHOTICS IN-PODIATRYIN-PODIATRY IN-RHEUMATOLOGYIN-RHEUMATOLOGY IN-SURGERYIN-SURGERY IN-WOUND HEALING CLINICIN-WOUND HEALING CLINIC

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REPORTS……….. CST Consult Service Tracking for RDL SU Option: CST Consult Service Tracking for RDL SU Option:

RPT Consult ReportsRPT Consult Reports

CC Service Consults CompletedCC Service Consults Completed CP Service Consults Completed or Pending ResolutionCP Service Consults Completed or Pending Resolution NU Service Consults with Consults NumbersNU Service Consults with Consults Numbers PC Service Consults Pending ResolutionPC Service Consults Pending Resolution SC Service Consults By StatusSC Service Consults By Status ST Completion Time StatisticsST Completion Time Statistics

• Collects and display the mean number of days that consults/requests take to Collects and display the mean number of days that consults/requests take to be filled, from the time that they are accepted by the service to the time that be filled, from the time that they are accepted by the service to the time that they are entered as Complete in the computer. Also lists the Standard they are entered as Complete in the computer. Also lists the Standard Deviation and number of consults that were found for a date range.Deviation and number of consults that were found for a date range.