I’ve seen some notes on the list about referrals and closing the loop - but has anybody cracked the nut efficiently.
It seems like the issue is…
Doc sends Referral from Progress Note to a P2P Specialist
[in my case, we are trying to solve the flow within the same hospital system with primary care and specialists on the same system]
Specialist gets the Referral and sees patient and completes their note.
The conundrum seems to be…
How does the Specialist notify the Primary Care doc that the evaluation is done and the PC doc can review the note.
And does the PC doc need to document that they reviewed the Consult.
It seems like the options are….
Fax - old school, but works - however, is redundant if we are all on the same eCW. PC Doc gets fax of the record that is already in the EMR, but now they know that the consult is done. Can attach to the chart (redundant) or print out to notify doc or delete, but send other message to PC doc that consult is ready to review.
Messaging - M-jelly bean—works, but not directly attached to the patient, so if the referring doctor wants to go look at the note, s/he has to remember the name in the message and look them up—extra steps.
P2P Messaging - M-jelly bean - works, but same problem as above. I guess it’s a more secure way to message provider 2 provider - or perhaps it just allows you to message someone that is on the P2P Network that isn’t part of your office eCW
P2P Patient Records—can be sent for T-jelly bean and from Common Send window .
Advantage is that the message includes the patient and can include labs, xrays, etc.
Accessing from T-jelly bean - a bit of a hassle - you have to search out the patient you want to attach to the message and add in the labs, xrays, etc—BUT, you can add a free-text message that the other person can see.
Accessing from Common Send window in the Progress Note - this is nice because it’s part of the flow and the patient is automatically attached and the subject line of the message is the name of the progress note and the progress note is automatically attached - I’m not sure, but I wonder if any labs, xrays performed in the note are automatically attached, too - I haven’t checked that out to confirm. The downside is that it doesn’t allow free text.
Telephone Note - Specialist sends a Telecon back to Primary Care that they saw the patient and maybe gives a very brief summary. PC doc can then sign it off and review note. Patient is automatically attached to the Telecon, so PC doc is right in the chart and can review labs, xrays, etc. Disadvantage is that it “clutters” up the chart with documentation of notifications, etc. Advantage is that it documents that PC Doc saw consult. The PC Doc can order further studies within the Telecon, etc. In theory, could even send back to the specialist to clarify the consult if needed.
Action - Specialist sends an Action to the PC doc. Similar to the Telecon, but more behind the scenes. Possibly allows the PC doc to document that they are aware of the consult being done. Specialist can attach patient note and labs, etc to the Action, so they are easily seen.
Phone Call - specialist calls PC doc office to let them know consult is done. Seems silly since they are on the same system.
P2P Referral—The original Referral that was sent—either from the R-jelly bean or usually from inside the Progress Note - and sent electronically to the Specialist. Is there a way for that to be changed in status by the Specialist, so that the PC doc office knows the consult is done? If the Specialist signs it off as complete, then I guess it disappears. We have someone in the office tracking Referrals to sign them off as complete. Could the Referral be changed from Open to Pending and then our office during their review would look for Referrals with that status and know the Consult was complete?
Doesn’t seem ideal, but it is the piece of info that starts the process at the beginning and ultimately needs to be closed.
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In our situation, we are working with Orthopedic docs for our referrals. They have Med Techs and schedulers and PA’s that do much of the grunt work of tracking this stuff. So, they may not use it in the way it was maybe intended.
I think we are leaning toward using the P2P Patient Records from the common send in the progress note.
So….
PC doc sends referral to Specialist.
Specialist handles the Referral however they want on their side, but when done with the note, clicks send and selects the referring doc to send a P2P Patient Record.
Referring/PC doc gets the P2P Patient Record and reviews the automatically attached consult note. Then either goes to the full chart and documents an addendum that they have seen the consult or does a telecon documenting, etc.
Then forwards the P2P Pt Record from the specialist to the PC Doc clinic person who monitors Referrals to let them know that the consult is done - whereupon, they will close out the Referral that was originally sent.
Thoughts?
How are other people closing the documentation and referral pending loop?
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