iPATH Best Practices:
Managing the Discharge Process
iPATH Best Practice Education: Managing the
Discharge Process
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Purpose
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Objectives
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Optimal management of the discharge process involves use of EHR tools to provide a standardized,
well-coordinated and communicated discharge. This course will highlight these tools and overall
management of the process.
Manage the discharge process to provide safe and efficient communication at transfer of care.
Manage the problem and diagnosis list.
Define the role of the attending and consultant in the discharge process.
Faculty and Disclosures:
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The following faculty report that they have no relevant financial relationships to disclose in the
context of this activity
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Commercial Support
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NA – no commercial support
Accreditation and Credit Designation Statements
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Peter Springsteen, MD, Medical Director, Information Systems, Munson Medical Center
Stacey Sands, BSN, RN, Clinical Electronic Health Record Educator, Munson Medical Center
Munson Medical Center is accredited by the Michigan State Medical Society Committee on CME
Accreditation to provide continuing medical education for physicians.
Munson Medical Center designates this enduring material activity for a maximum of 0.5 "AMA PRA
Category 1 Credits ™". Physicians should claim only the credit commensurate with the extent of
their participation in the activity.
Medium use and release dates
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This MS PowerPoint/HealthStream course was originally released 09/2014.
iPATH Best Practice Education: Managing the
Discharge Process
• To complete this program:
▫ View each slide in the program.
▫ Utilize the hyperlinks to access additional information on
specific areas of the discharge process as needed.
▫ Print the post-test. Return the completed post-test to the
Clinical EHR Department at Munson Medical Center.
▫ Your completion will be recorded in HealthStream. The CME
office will give appropriate credit based on post test
completion.
▫ Please email ssands@mhc.net if you desire a Certificate of
Completion.
Required steps for Attending Providers
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It is important that medication history is updated before Admission Medication Reconciliation
occurs. Completing Admission Med Rec before the medication history is updated may result
in meds that the patient is no longer taking being ordered inappropriately. The green
checkmark indicates completion.
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The following items must be completed before the Hospital Summary is Final/Distributed:
• The Problem and Diagnosis list (Consolidated Problems)
• Follow up
• Discharge Medication Reconciliation
• Discharge PowerPlan
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Utilize the “Home Meds Stopped” form to indicate medications stopped during this admission.
Click here for a 2
minute demo of
the DC MPage.
Required steps for Attending Providers
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The Hospital Course must be completed as a part of the Hospital Summary utilizing
contents of defined templates. Click here to view the templates.
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If any change is made to Problems and Diagnoses, Follow up, Discharge Medication
Reconciliation, or Discharge PowerPlan after the Hospital Summary has been
Final/Distributed, the Hospital Summary must be Final/Distributed again to update the
content.
 Clicking Final/Distribute updates the document to reflect the most current
information for distribution and the medical record.
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For discharges to Skilled Nursing Facilities, the Hospital Summary must be completed and
signed prior to the patient leaving the hospital.
Click for a 2
minute demo on
the Depart
window.
Hospital Course Content
The Hospital Course narrative should contain the following elements at a minimum:
Simple Med/Surg patient
• Date of Discharge
• Attending/Discharging provider
• Non-physician provider
completing summary (if
applicable)
• Description of hospital course
and condition at discharge
• Core Measure requirements
Complex Med/Surg patient
• Date of Discharge
• Attending/Discharging provider
• Non-physician provider
completing summary (if
applicable)
• Description of hospital course
and condition at discharge
• Pertinent procedures/diagnostic
testing
• Core Measure requirements
• Discharge disposition
Click here for a pocket sized printable version of the templates.
Click here for printable instructions on creating Auto Text.
Click here to return to Requirements for Attending Providers
Required steps for Attending Providers
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The Discharge(specify) order must not be entered until all of the above items are
completed.
 Nursing looks for the Discharge Order as the indicator that your work for discharge
is complete and the patient may depart.
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This process applies only to patients who are discharged from an inpatient unit.
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Ultimate responsibility for and completion of medication reconciliation and the
medication list sent home with the patient belongs to the attending provider.
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Consulting providers are responsible to reconcile those medications related to the
consultation.
Required steps for Consulting Providers
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The following items must be completed before the Hospital Summary is Final/Distributed
by the attending provider:
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The Problems and Diagnosis related to the consultation
Follow up appointments related to the consultation
Discharge medication recommendations or prescriptions
Discharge Instructions entered via the Discharge PowerPlan (or specific consultant
orderable, i.e. Infectious Disease)
If any change is made to any element listed above after the Hospital Summary has been
signed, the Hospital Summary must be Final/Distributed again to update. Therefore,
Consultant work must be completed prior to the Attending Final/Distributing the Hospital
Summary. Communication must occur between consulting and attending providers.
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This process applies only to patients who are discharged from an inpatient unit.
Efficiency Tips
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Completion of required elements is most efficiently accomplished through the use of the
Discharge MPage. Work your way down the yellow section.
Click for a 2
minute demo on
Problems and
Diagnoses.
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Problems and Diagnoses. Use the MPage component called Consolidated Problems to
search for specific terms, drag and drop to prioritize, and multi select to cancel.
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Utilize
navigating away from the MPage.
to access documents without
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Utilize Dragon templates or auto text templates for required Hospital Course elements for
simple and complex patients.
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The myPatient Views PMP Med Reconciliation is a printable tool which will be helpful when
completing both admission and discharge medication reconciliation.
Click for a 2
minute demo on
the PMP Med
Reconciliation
tool.
Efficiency Tips
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Utilize the Estimated Discharge Date form to communicate the estimated discharge date
for the patient. This gives other disciplines, such as case management, HealthLink, and
Pharmacy information to help them complete their work in a timely manner.
Complete Estimated Discharge Date
information then sign by clicking the
green checkmark.
Click for a 1
minute demo on
Estimated
Discharge Date.
Utilizing HealthLink scheduling
Munson HealthLink can be utilized to schedule post-discharge follow up appointments for
inpatients.
Both primary care offices and MMC are incentivized to ensure medical-inpatients are seen by
their primary care provider within 7 days of their discharge. Many offices are enthusiastically
collaborating with Munson HealthLink to deliver on this objective – while additionally,
decreasing avoidable readmissions through ensuring a smooth transition of care.
Utilizing HealthLink scheduling
HealthLink can schedule primary care and specialist follow up appointments when you
request. Appointments able to be scheduled include:
• Primary Care appointments – establishing a new patient who didn’t previously have an
established PCP
• Primary Care appointments - already established relationship between PCP and
patient
• Specialist appointments, most-feasible (yet not limited to) already-established
relationships or when specialist consulted with in-patient
Due to tests/labs needing to be ordered prior to specific specialist appointments, should
HealthLink be unable to schedule a specific specialist appointment, they will update the
MPage to read appropriately for the printing of the patient’s DC instructions.
Click for a 1
minute demo on
Estimated
Discharge Date.
Utilizing HealthLink scheduling
1. Complete Estimated Discharge Date form. This
information allows HealthLink to schedule the
appointment in a timely manner.
2. Enter provider info; name, timeframe, address.
3. Double click to select “HealthLink to Schedule” in
comments.
4. HealthLink will schedule and update appointment info.
The orderable to “Schedule Primary Care Follow up”
will be removed from the system on October 14,
2014.
Double click “HealthLink to Schedule” on the Follow Up tab
within the MPage and provide an Estimated Discharge Date
as early in the patients stay as possible.
Click for a 1
minute demo on
Estimated
Discharge Date.
Future Enhancements
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Effective October 14, 2014 PowerChart will allow partial Admission and Discharge
Medication Reconciliation. This will allow attending and consulting providers to work
together to complete medication reconciliation.
• Utilize the PMP Med Reconciliation as a source of truth so see what home
medications may have been discontinued by either the consultant or the attending
provider.
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At discharge, active inpatient meds default to Do Not Continue. Home medications
must each be addressed.
Click for a 2
minute demo on
partial
Medication
Reconciliation.
• Inpatient medications default
to discontinue.
• Home medications have no
default and must each be
addressed.
Future Enhancements
To improve the value of the Hospital Summary information to ambulatory and follow-up
providers, effective October 14, 2014, changes will be made to the Hospital Summary.
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Medications to Stop Taking will be moved above the medication list on both Hospital
Summary and Patient Instructions.
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The discharge medication list for the Hospital Summary will no longer display in grid
format. However, Patient Instructions will continue to display in the more patient friendly
grid format.
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Prescription routing and quantity dispensed will be listed on both Hospital Summary and
Patient Instructions.
Core Measures and Quality
Measures
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At this time, completion of core measures requirements remains unchanged from preiPATH. Continue to include in the Hospital Course (clinical narrative).
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Core Measure templates are available in Dragon. Core Measure templates can also be
built into autotext for the Clinical Course.
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Munson reports on 3 Quality Measures at this time:
• ED Throughput
• VTE
• Stroke
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VTE and Stroke Quality Measures documentation is located on the Discharge MPage and
require a provider signature prior to patient discharge.
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Munson Clinical Quality nurses complete the form when indicated. The provider must cosign the form prior to patient discharge.
Click for a 2
minute demo on
Quality
Measures.
Two minute demonstrations
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Please view the 2 minute demonstrations below for areas you want more information
about. When you are done, please continue through this program.
Click here for a 2
minute demo of
the DC MPage.
Click for a 2
minute demo on
the PMP Med
Reconciliation
tool.
Click for a 2
minute demo on
the Depart
window.
Click for a 2
minute demo on
entering Follow
Up.
Click for a 2
minute demo on
Problems and
Diagnoses.
Click for a 2
minute demo on
the Discharge
PowerPlan.
Click for a 2
minute demo on
Partial
Medication
Reconciliation.
Click for a 2
minute demo on
Quality
Measures.
Click for a 1
minute demo on
Estimated
Discharge Date.
Thank you.
To receive credit for completion of this program, please complete the post-test and return it
to the Clinical EHR Education department at Munson Medical Center.
Click to access the
post-test.