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
