RPMS Multi-Site Support
Creating Consults
DRAFT
I.
Purpose
For directing internal referrals and managing the documentation. (Not for
external referrals which are managed via the RCIS package).
This process uses one template for the Consult order and a special Consult Note
and (optional) template for the report/result that completes the consult.
If this is initial set up of the package, see last section in the Procedure section.
II.
Procedure
A. Determine the process.
1. Who handles the referral, one person or several? In any case, create a team
for the consult process because team composition is easily updated. The
consult notification can be set to be satisfied by one person’s response, or such
that each member of the team must acknowledge the notification.
2. What information needs to be included in the consult?
3. Who completes the consult? Administrative staff or the originating provider?
4. Who manages the process? Who updates team lists? Who checks for
incomplete consults?
B. Create the team to receive the consult. E.g. Consult Diabetes
1. On the EHR menu, under Patient Context Configuration, Team list
management, Create/Add team.
2. Name your team. The team name should begin with the word “Consult”.
3. Enter type : MRAL (manual removal/autolink addition)
4. Team autolink: <leave blank>
5. Enter team provider/user: <enter a provider, repeat until done>
6. Enter Subscription status: No (i.e. providers are assigned, they can’t take
themselves off the list)
7. Other functions on the team list management menu allow you to delete or edit
lists.
C. Set up the Service
1. From the EHR menus, Consult Tracking configuration, Setup consult services
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2. Select Service/Specialty: <enter the name of the new service. E.g. Diabetes
request>
3. Abbreviated print name: <optional, 1-7 characters if used>
4. Internal name: <optional, no spaces or special characters allowed, used for
fileman searches>
5. Synonym: <optional>
6. Service usage: <blank, means enabled>. (Set this to 9 when you disable a
service.)
7. Service printer: <optional> (You may want a hardcopy if the scheduler can’t
reach the patient the first time)
8. Notify service on DC: 0 (always notify service if request is discontinued)
9. <return through the next series of questions>
10. Provisional diagnosis prompt: <may be ‘R’ if required or blank if optional>
11. Provisional diagnosis input: <may be ‘Free Text’>
12. <return through the next series of questions>
13. Select Service team to notify: <enter the consult team name as defined
above.>
14. Select notification by pt location: <only use this field if the consult depends
on patient’s location>
15. <skip more questions>
16. Select Administrative update team: <optional>
17. <skip more questions>
18. Select Special update user: <choose someone for cleanup if necessary>
19. <skip more questions>
20. Select Sub-service/specialty: <blank>
21. Add/edit another service? : N
D. Add the new Service to the All Services grouper
1. Choose “Setup Consult Services” again.
2. Select Service/Specialty: All Services
3. <return past all prompts until…>
4. Select Sub-service/specialty: <enter new service name, e.g. Diabetes request>
5. Add/edit another service?: N
E. Create the Note title
1. Create a Note title for the Consult Report using TIU Configuration per your
normal process, DDM3 Create Document definition, under Clinical
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Documents (class), Progress Notes (class), Consults (documents class). (See
EHR for HIM class notes)
2. Consult notes MUST be in the CONSULTS document class.
3. Class owner should be Clinical Coordinator. Status: Active. Sequence: leave
blank.
4. Note: the number of days that TIU will search back for active Consults is set
by the parameter: GMRC CONSULT LIST DAYS (see Edit parameters).
5. An associated template is optional. If your workflow always requires that
you use the same template to answer a given consult, drag that template into
the “Document Titles” and add this new Note title in the Associated Title
field. Or you may have multiple templates and the consultant chooses at the
time the consult is completed.
F. Create Create the template for the request. Edit Shared. Add a new template in
the “Consults reasons for Request” folder. This template may be just input space,
or check boxes or it may pull data from the database or ask the provider for the
prerequisite information for the consult that you identified during planning. Be
sure to enter the service into “Associated Consult service”.
G. Create the Quick Order
1. From the EHR menus, Create a Quick Order.
2. Begin the QO name with GMRCZ.
3. Type of Quick Order: Consults
4. Display test: <this is what appears on your menu>
5. Verify order: Y
6. Consult to Service/Specialty: <service name>
7. Consult service pre-requisite: <optional text to display on order>
8. Consult type: <free text, optional>
9. Category: <leave blank. Or restrict to I for inpatient or O for outpatient only.
If blank, will use the actual visit type automatically.>
10. Place of consultation: <1 = Emergency room, 2= Consultant’s choice>
11. Autoaccept = N
H. Add the new Consults to the Consult orders menu (not applicable if GMRCOR
CONSULT is used)
1. BEH | ORD | MNU | MNU
2. The Consult Orders menu is normally named GMRCZM CONSULT
ORDERS. Submenus may be created and used.
I. Training talking points
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1. To order a consult, select Consults on the Orders tab (or from the Consults
tab). You must supply a “Reason for request”. Note requirement in the notes
window. Consults must be electronically signed.
2. Answer consult requests via your Notifications tab, which will take you to the
Consults tab. If you choose the ‘Action’ pull down, choose Tracking to add
comments or cancel the consult. Please note that adding a comment will clear
the Notification and you must use other mechanisms to remind yourself to
follow up the incomplete consult.
3. To complete a consult, create the associated note, selecting the appropriate
consult request date. (Or go to the Consults tab, identify the consult to be
completed and the Note title to be used.) The completed note will be visible
on the Consults tab as well as on the Notes tab.
4. Consults tracking reports can list pending consults and completed consults and
other statistics. You should check frequently for uncompleted consults.
J. Reports
1. Reports exist to review completion time, pending consults, completed
consults, counts and lists of consults by status.
2. On the EHR menu, under Consult Tracking Configuration, Consult tracking
reports, see the lists of reports.
K. Disable a Service
1. From the EHR menus, Consult Tracking configuration, Setup consult services
2. Select Service/Specialty: <enter the name of the new service. E.g. Diabetes
request>
3. Service usage: Disabled (change the service usage from either 2=tracking or
blank=enabled to 9=Disabled).
4. And on the All Services group, in the list of sub-services, specify the service
to be deleted, and when it echoes back, answer ‘@’ and yes to delete that
subservice.
L. Initial set up – do once only for the entire database for the Consult system
1. Define Notification rules – do this once for your Consult system
(1) From the EHR menus, Notification Configuration, Notification
Parameters, Set Deletion Parameters.
(2) Set this up at the System level (or by Division if your divisions have
different operations). Never set at the Package level (since a patch update
could overwrite your settings.)
(3) Select Notification: 27 New service consult/request.
(4) Value: <set this to ‘A’ if the first person to view the consult removes the
notification for all other team members, or to ‘I’ if each member of the
team sees the notification and removes it.>
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(5) Note: you may want to add a purge level for the Notification for a new
consult to be longer than the default of 30 days, especially if you use the
Deletion Parameter of All, so that you can see which team member took
responsibility to answer the consult and when.
(6) Repeat for : 23 Consult/Request Resolution, 63 consult/request updated,
66 consult/proc interpretation and 30 Consult/Request Cancel/Hold
2. Set the providers to receive notifications. For the New Consult, this is
probably the Consult team (= T). For the Consult resolution and the Consult
Cancel, this is probably the Ordering provider (= O). This list depends on
your site’s workflow.
3. Write Business Rules for the Consult Result Note – do this once for your
System and only if access rules are different from the parent class (which may
be “Progress Notes”).
(1) Consult result Notes must be in the Document Class “Consults”.
(2) See UCM4 “Manage business rules”.
(3) (add yourself for testing purposes!)
(4) Enter device: <blank>
4. Set value for ORWDX NEW CONSULT using General Parameters. This
defaults to GMRCOR CONSULT, which creates a drop down of consults and
a generic input screen. Or it may be a custom menu for your site, which you
should call GMRCZM CONSULT ORDERS, and which is created as above
for specific consult menus.
5. Hang your overall Consult menu (GMRCZM CONSULT ORDERS) on the
main menu system as well.
III.
Definitions
1. RCIS : Referred Care Information System
2. Business Rules : this is a feature supported by TIU to manage the security of
documents by class and user type.
3. TIU : Text Integration Utility, an RPMS module used also by EHR
IV.
References
A. EHR Basic CAC class materials
V.
Documentation requirements
VI.
Procedure history
Written:
10/12/10 K. Gosney, ANTHC CAC
Revised:
KG 11/1/10, 1/6/11, 3/30/12, 4/3/13, 5/30/13, 10/14/13
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