Health Care Home Messaging Procedures

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1 Health Care Home Messaging Procedures Purpose/Scope: This document outlines how the clinic could document the use of the EMR's messaging (in-basket) capabilities. These functions may differ from one system to another, but there should be some consistency in the functionality versus the naming conventions.. Policy/Procedure: The clinic should use the EMR In Basket as a communication tool. Pools (or groups of individuals) have been set up to receive Results, Orders, Referrals, Discharge notification etc; and then can act on the information that they receive. Using the In-basket provides the clinic with a comprehensive method of communication and documentation within the HealthCare Home clients health record. In-Basket Basics: There are two basic types of messages that you get in your In Basket. 1. User generated the sender decides who the recipients are. Examples Staff Message and cc Results. 2. System generated These are messages created and sent by the EMR based on how it is configured. Example Results, My Open Charts Folders appear within In Basket only if they contain a message. New messages are in parentheses. My Out Basket Folder contains all of your sent messages. Patient-specific folders. When you open a patient workspace, a temporary Opened Patients folder appears which contains all messages specific to that patient. L My In Basket a; Opened Patients QMy Out Basket Views of the In Basket (Selected view has a black background) Folders within the In Basket only appear if they contain a message. In those folders, the number of new (unread) messages appears in parentheses. Page 1 of 15

2 In Basket jnewmsci Sec Pt Msg IA Results (1) n Canceled Ord ) i - ±H- Patient Calls Tips and Tricks (1) In Basket, Folder list Reading your In Basket Messages: When you click a folder in the left pane, a legend for that folder appears on the bottom right pane. t High Priority Olg Work Assigned To You 4 Low Priority #4 Work Taken By You II Critical Work Assigned To Your Pool I Abnormal Q. Work Taken By Others Previous Abnormal trj Carbon Copy Overdue messages are red and italicized. In Basket legend In a folder, you can view individual messages or groups of messages. When you click on a folder, the top pane displays a row of information for each message. To read a message, click on its row. In Basket New tvlsg Results (1) Sec Pt rvlsg n Refresh FA Edit Pools %Settings JD Search EaAttach ET Patient Calls 0 unread, 1 total Patient Calls Tips and Tricks (1) X Done HI Complete 4g,Take a Letter Review D Q R Status Patient Reason for Call Refill Read Pocan, Harold Back Pain Click In Basket, Rx Request folder Page 2 of 15

3 In Basket Tasks: How to... When navigating the In Basket, use your mouse or keyboard hotkeys. This section of the chapter helps you get comfortable with the panes, folders, and buttons you see in the In Basket. To see a list of In Basket hotkeys, click the question mark at the top right.? i Close X No matter what folder you are working with, you'll see a New Msg button on the In Basket toolbar. When you click the New Msg button, the In Basket Message workspace opens. To send messages other than "Staff Messages," instead of clicking New Msg, click the arrow next to it and choose a type of message from the menu. The basic steps to send a message are: 1. Use the To and Cc fields to select recipients. (The following sections of this chapter describe how to send to individuals versus groups.) 2. If patient-related, use the Patient field to specify to link to the patient. dvance EResize See the following section about the Patient field to learn more. 3. Compose the message using the Notes pane (SmartTool-enabled). 4. If needed, select a flag such as "Personal reminder." Page 3 of 15 In Basket MICA, PAT In Basket Message keff I Enter Staff Message Message 'Options To Cc II F5 Open seesch rnnclow X IMICAPAT[216261:OUARTERU(25265];SEEGERMAR - N[99063] Subject MINI vaccination clinic planning meeting this Friday Patient Phone Notes:. 0 4 ti^ ^- 4 " SP 05 C. Our planned stock is lower than anticipated. Let's make a Plan B. Priority 6 " P -. 1c7r r Ro ut ine e Lo w Patient Lookup I F3 Current patiei r Call Me Flags, n Call patent n I Call with results Patient reminclo n Schedule follow n Write loner PI Personal reminc Due date: 11/10/2009 Due lime

4 Recipients see the flag information as part of the message details and in a column called Action. 5. Set options if needed. On the Options tab of the Enter Staff Message form, you can specify when a message should be sent and when it should be retracted from the recipients' In Baskets if they haven't read it by a certain date. 6. Send the message. To send a message, click Accept. Send to Individuals Completion match on the recipient's name (last name, first name) and press ENTER. (Recipients are other end users of the EMR at your organization.) For additional recipients, add a semi-colon separator and then look up the next recipient. Send to a Pool Pools are groups of users, like classes. However, there are a couple important differences between classes and pools: Only send task-based messages to pools when you want one person in the pool to deal with a task, but you don't care who does it. For example, you want to ask your nursing staff to call a patient. Only one of the nurses will actually perform the task, but you want to inform them all about it, since your goal is to have the first available nurse perform the task. Page 4 of 15

5 To... P EMC ENT NURSES [12200] Cc... F5: Open search window Subject:IPatient experiencing ear pain Patient: SCHULER,KRISTI [923001] Phone:! Patient Lookup r Call Me Kristi Schuler went home after surgery two days ago, and called just now complaining of sharp pain in left ear. Wants advice. Please call] Enter Pt Call Back form with a pool listed in the To field An action taken by one pool member affects the message in all the pool members' In Baskets. When EpicCare generates a pool message, it only creates a single message that is viewed by all members of that pool. This helps to prevent multiple members of the pool from acting on the message. If Nurse Nancy is the first to view the message, the status changes to Read in his In Basket as well as in ALL the pool members' In Baskets (when In Basket next refreshes). Nurse Nancy is busy, so doesn't act on it. Half an hour later, Nurse Julie calls the patient and then marks the message as Done in her In Basket. When a pool member marks a message as Done, the message is removed from ALL the pool members' In Baskets (when In Basket next refreshes) because they were all sharing the view of one message. To send a pool message, in the To or Cc fields: If you know the pool name, type a "p" followed by a space, and then completion match on the name of the pool (for example: "p np clerical" for sending a pool message to the NP Clerical Pool). If you don't know the name of the pool, type p? (notice the space between the p and the question mark). Press ENTER. A list of all the pools appears. You can scroll through the list or completion match in the Search field. "Registry" is another name for "pool." Only the EMR Team can make pools. Clinic POOLS Page 5 of 15

6 Use pools for Does each person get their own copy of the message? If a recipient marks his message as Done, what happens to the other recipients' message? When should you mark a pool message as done Sending task-based messages (anyone in the group, do this!) No, one copy is shared by all It is removed at next refresh When the task is completed. P Nurse Pool P RX Pool P HIM Pool P Clerical Pool P Referral Pool P OB Care Coordination Pool P Scheduling Pool Some Abnormal Labs routed here Used to communicate with Team Leads, Triage Used by providers when responding to a RX Request Used by providers, support staff to request a chart from HIM. Used by providers to route letters to HUC for printing/sending. All referrals made by NP are routed to the Referral pool for distribution Used to communicate with the OB Team. Used by schedulers to review internal referral appointments. Specifying a Patient With many types of messages, you can specify a particular patient's record. This helps the message recipient because when they take an action on the message such as opening a telephone encounter, the system knows for which patient the action is intended. Page 6 of 15

7 0. Schuler,KrIstl [ In Basket Message inter Patient Call Back P EMC FM NURSE... Message I Qptions I To... I P EMC FM NURSES [21000] C c F5 Open search window Call dote:111/9/2009 ilcoll time: 12:10 PM Qotient:IS - CHUTIFLKRTS - T1(923001] - Patient Lookup Who colled:i Home: DOB:3/14/1982 Notes: atii 0 fav Prtfx41',Ir.ITer,1 E> There are different ways to populate the Patient field Priority r High R o u t i n e r Low 101 F3: Current patient Patient calls complaining of back pain for the past 2 hours. Thinks it might be a kidney stone. Wants to talk to you before going to ER.I Can you call? There are three ways to link a patient to a message: If you currently have the patient's workspace open, press F3. (If more than one patient workspace is open, a window appears from which you can choose the correct patient.) Completion match on the patient's name (last name, first name) in the Patient field. Click the Patient Lookup button to use the lookup window. Changing the Status of the Message you Receive: When a message arrives in your In Basket, its status is New. As soon as you click on the message to view it, the status automatically changes to Read. Finally, when you are finished with the message, you can mark it as Done. When you mark a message as Done, the message is removed from the folder the next time the In Basket refreshes. Mark a message as... Do this: Done Press the Delete key. Done or Pend Any status Click the Done button on the folder toolbar Right-click and select Done on the menu. Press SPACEBAR. Pressing this key more than once toggles between the statuses Done and Pend. Click the Mark As button on the In Basket toolbar. On the menu, select a status. Page 7 of 15

8 ?, Close X Depending on the type of folder, the Done button might be inactive. That is because the message you are viewing has responsibility enabled, so you Patient Calls 0 unread, 1 tota Done If Complete 40,Take P R Status Read Patient Pocan, Harold must click Reviewed or Complete instead of Done. Working with Message Responsibility: Your system can be configured so that certain In Basket folders use responsibility. Using message responsibility prevents tasks from falling through the cracks because someone thought that another person would deal with the task at hand. You can recognize that a folder uses message responsibility because there will be an R column with green balls of responsibility icons. Automatic Responsibility System-generated messages, such as Result messages, can automatically assign responsibility. The message appears with 8 g. When finished, depending on the folder, click Complete or Reviewed on the folder toolbar. Taking Responsibility If responsibility is assigned to a pool, then a pool member can take responsibility by clicking Take on the folder toolbar. The symbol for this member changes from to 4 0). At the next refresh other pool members see (-.= so they know that they are not responsible. Page 8 of 15

9 Patient Calls 1 unread, 1 total _ D u n e if Complet Status I Patient New Pocan, Harold In Basket, Result Notes folder with message responsibility Passing the Responsibility Ball to Someone Else D r. J o n e s w a n t s t o g e t D r. J o h n s o n ' s o p i n i o n a b o u t a r e s u l t, b u t d o e s n o t w a n t t o m a k e D r. J o h n s o n r e s p o n s i b l e f o r t h e R e s u l t m e s s a g e. O r, p e r h a p s, D r. J o n e s d o e s w a n t t o p a s s t h e I r e s p o n s i b i l i t y b a l l t o D r. J o h n s o n T o f o r w a r d r e s p o n s i b i l i t y, o n t h e I n B a s k e t f o l d e r t o o l b a r, c l i c k F o r w a r d. O n t h e m e s s a g e f o r m, c h o o s e w h e t h e r t o r e a s s i g n r e s p o n s i b i l i t y. C l i c k Accept to send the message. en Properties C >Forward tylatas -? C l o s e Enter Results Message 'Options I To... COAL PAT [21608] Cc... F5: Open search window Cr64 Reassign responsibility Informational only In Basket (Forwarding a Result message) For pool messages, there are times when a pool member took responsibility but is not be able to complete the task. In that case, responsibility should be "put back" so another pool member can take it. To do so, click the arrow next to Take and choose Put Back from the menu. At the next refresh, all the pool members see 1. 4 next to the message. Another way to pass responsibility is via Result Note messages. A Provider might want to pass responsibility for a Result message to her nurse pool, so they can follow up with the patient Page 9 of 15

10 Check Into and Out of Pools: Users with appropriate security can check themselves into and out of pools. This is especially useful for Nurses who float in different departments. In that situation, the Nurse would only want to get pool messages for the department she is working in today. On the In Basket toolbar, click Edit Pools. To check in, select a check box. To check out, clear a check box. Pr l Edit Pools ren i Sign Into Pools and Covering Groups Pools: EMC FM Nurses El EMH Deterred "Verbal Cosign Orders CI Help Desk Select All Select None Accept Cancel Use Searches: Using the search functionality of In Basket, you can search for messages regarding any combination of the following: message types, statuses, priorities, recipients, date, and patient. Access Private and Public Searches When you open In Basket, or when you select the My In Basket view, you see a Folder Summary page that includes information about your saved private searches (user-created) and saved public searches (created by administrators for you). Page 10 of 15

11 12 Folder Summary Favorite Searches Private Doned Patient Call Messages from past week Public Add/Remove Consolidated In Baskets NW I Keep or Remove 11 High Priority Messages My Messages Marked "Done Ilaut Keep or Remove My In Basket flopened Patients ijsearch Results &a My Out Basket To view a search, simply click its name. Messages fitting that search appear in the Search Results view. In Basket, Views list Set Up and Save Searches When a new search is available, use the Keep or Remove hyperlinks. Searches that you keep remain in the list. Public Consolidated In Baskets NEW! Keen or Remove - High Priority Messages My Messages Marked "Done" In Basket, Folder and Search Summary Also, you can create an ad hoc search and can also save your searches. For an ad hoc search, click Search on the In Basket toolbar. The Message Search Report Settings window opens on which you specify your criteria. Then click Search on the window. To save frequently a private search, follow the same process Page 11 of 15 as an ad hoc search, and:

12 On the General tab, name the search. Click Save.

13 To remove a saved search, click Add/Remove. 15) Folder Summary Resize Patient Reminder Messages: CddiRemovp Attached In Baskets Patient reminder messages appear not only in the In Basket's Patient Reminder folder, but also in the SnapShot report viewable in the Schedule activity and in the SnapShot activity in the patient workspace. Having Patient Reminders available in SnapShot is useful because a Provider might not check In Basket before seeing a patient, but likely will glance at SnapShot at the beginning of the visit. S naps hot SnapShot Demographics - Richard Snapdragon 55 year old male Problem List Mixed Hyperlipidemia Diabetes Mellitus Essential Hypertension, Benign la Health Maintenance 1979 Milky Way VERONA WI United States of America lj INFLUENZA VACCINE Reminders and Results Sent c, Denver, Terry, RN From lb, Chronic IleLate ØDue C) Soon Hold Type Pt Reminder D o n e Done OE. Allergies SULFA DRUGS (1 7,) Medications atorvastatin (LI Immunizatio None g Significant H Tobacco: Quit(0 Alcohol: 5.2 oz 3 open orders Specialty Co No comments r In the SnapShot report, to view the message, click on it. When a message recipient is done, select the Done check box (or mark it as Done in the In Basket). Page 12 of 15

14 To... MICA, PAT [21626]; DENVER TERRY [12147) F5: Open search window Priority _ High r: Routine Low Subject Share sympathies about Richard's wife's passing Catient. SNAPDRAGON,RICHARD [ Patient Lookup I F3: Current patient Phone: r Call Me Notes: P ab 4 l ED, 141.4g+Itinc.* B Flags: Susan passed away from a heart attack on 11/2109 Call with results Pi IPatient reminder) Schedule follow-up app 17 Write letter El Personal reminder Click New Msg button on the In Basket toolbar. 2. Select recipients. Only the recipients of the Patient Reminder message will see the information in the SnapShot report. If you want to see this message, list yourself as a recipient. 3. Select the patient in the Patient field. 4. Select the Patient Reminder check box in the flags pane. 5. Click Accept to send. In-Basket Folders: RESULTS Review at the clinic Folder Name You will find Who Owns? What do you do? Results Results from If sent to individual provider: You could: tests You have responsibility. 1. Call patient and document call Messages The responsibility ball will in result note. pertaining to appear in the R column with 2. Send letter to patient. procedures an exclamation point on it. 3. Mark as reviewed. ordered by you It has been assigned to you or the and only you! RESULT NOTE: physician you are working Your note is filed with the original result. Page 13 of 15

15 ith If sent to a nurse because you are part of a pool: The responsibility ball will have a question mark on it. You don't have responsibility until you "take" it. If you "Take" you let everyone know that you are working on the task and the ball will change to a plus sign. For others in the pool, at the next refresh, their ball will have a minus sign to show that they do not have responsibility. What Results go to Nurse Pool 1. Positive Chlamydia/GC 2. Pap Smears 3. Positive Urine Cultures. 4. Abnormal Leads 5. Abnormal Mammograms. You can route your result note to another. This note will come to their Result Note folder. You will see documentation of the Result Note in Chart Review within the order report. Once you are finished with the task, you must get rid of the message: If you are responsible, you must mark the result as reviewed. When the folder refreshes, it will be gone. NOTE: Normally, to remove message from your In Basket, mark them as Done. In the Results message folder, you must mark all messages as Reviewed. Other things you can do from Results Folder: 1. Go to Chart Review. 2. Place additional Orders, Select Reflex. 3. Forward; Reassign responsibility 4. Informational only, keep responsibility. 5. Telephone Encounter 6. Letter Page 14 of 15

16 Result Note Three reasons to write a result note are: 1. Write a note about a result. 2. Send task message to others. 3. Document that you called patient. As a provider, if you want to add a Result Note to a result for future review: If as a provider you want to send a message to the nurse pool: 1. Click on Result Note for the Result folder. 2. Write your note. 3. Click Accept and close window. 4. If no further action is required, click the Reviewed button. 1. Click on Result note 2. Use the Recipients field to select the pool or individual. 3. Click Accept to send the message., Note: You have now passed the responsibility "ball" to the recipients unless you remove the green ball that appears next to the recipients list. Click on it to remove.

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