Notifications
Clear all
Topic starter
Regarding: Test results, phone notes and other interoffice communications…..
Does your doctor append to the actual test results (MRI or Lab)? If so do they sign it and then route it to a nurse to contact patient or do they leave on hold and route to nurse?
If they don’t append to the results, how do they document it? Create a phone note?
Phone notes- do those phone notes stay on hold or sign and then follow with an append from the nurse on a second action item? (i.e.: Patient calls c/o pain, nurse creates phone note, puts on hold to doctor, doc responds with recommendations, sends back to nurse to call in Rx—does this phone note stay on hold during the passes back and forth or does it get signed and then routed to next person and have appends on document.
We have a workflow taught to providers on the roll out of the EMR way back when that only things ‘on hold’ or ‘unsigned’ on their desktops need action…… so this is presenting quite the issue because they keep the same process on their interoffice communications (i.e.: append a lab result, keep it on hold and route to nurse. Because clinical list changes aren’t signed on the append, the append gets deleted by accident and there is no way for us to get it back)
Something so simple feels so complicated!
Thanks in advance!
Posted : October 17, 2018 3:46 am
Amy,
I recently had a discussion with our head nurse about this challenge and we came to the conclusion that the "best practice" for communicating instructions related to patient test results was to append to the original document and sign the append before routing to the next individual (the nurse typically routes the document to herself as well so that they can ensure the provider is following through on any additional actions). We also recommended clicking the "Change..." button before routing the message to another user and use the "Reason" and "Comments" fields to specify what is needed (action, signature or review) and any pertinent details. This would create a discrepancy in how you currently handle documents, but we communicate to our providers that if you have something on your chart desktop, then there is some kind of action or acknowledgement needed from you (they can always click on the reason column heading to get documents requiring a signature grouped together). If you want to continue putting these documents "On Hold", you might have the individual that is routing the document route it to themselves as well. I think if an unsigned append is on multiple desktops, it cannot be deleted.
Phone notes are a struggle because there is often a lot of back and forth routing required but the default phone note template doesn't capture anything that would be considered a clinical list change, so like you have seen with appends, someone can accidentally delete the document. I have an idea for a much better phone note design to replace the current version. My plans are to have the phone note display a history of the transactions that occurred with the communication (i.e. each user that updated it, when they updated it, and the textual note) as it bounces around to different users within the office and once the communication has been completely dealt with, the last user signs off on it. This running history would be captured to an OBS term, so signing clinical list changes when putting the note on hold would prevent the phone note from accidental deletion.
I believe that accommodating interoffice communication within Centricity is a common issue for everyone so you are not alone. Part of the problem is that the "event" that initiates the communication may come from different sources (e.g. a phone call from the patient, receipt of an external lab or test result, a patient portal message, verbal requests shouted from exam rooms, hand-written instructions on a superbill or faxed medical record, etc.). My experience has been that the manner in which providers use the system to communicate instructions to other staff members is dependent upon the situation. And sadly, the methods used are often chosen out of personal convenience rather than what is in the best interest of the patient. Our struggles have more to do with getting providers to adopt a consistent workflow once we have come up with a so-called "best practice."
Posted : October 17, 2018 7:23 am
Topic starter
"This running history would be captured to an OBS term, so signing clinical list changes when putting the note on hold would prevent the phone note from accidental deletion." Great idea- only problem is because of EPCS, the only people who sign clinical lists now are the providers. I guess that would prevent the providers responses from deleting but not everyone else. Thanks for the input!
Posted : October 19, 2018 1:25 am
Topic starter
OK- so I tried this and even the docs info can still be deleted by a nurse when document is on hold even with a signed clinical list and an obsterm in there. I had always thought that once an obsterm was in there and clinical lists were signed, that the note could not be deleted but I am apparently wrong. Did this change during some version I don't know about or has it always been this way? If I add a med, problem or order, it can't be deleted but it doesn't seem to matter if it was just an obsterm that was signed by a clinical list.
Posted : October 19, 2018 1:38 am
