Difference between revisions of "Category:Outpatient"
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Revision as of 09:26, 12 June 2019
|Welcome to the Outpatient Primary Care Resource Page. Please follow the links below to find information about caring for patients in our outpatient clinics.|
|GENERAL INFORMATION AND ORIENTATION
|GENERAL CLINIC INFORMATION|
|CLINICAL SERVICES, WORKFLOW, AND RESOURCES
|EMERGENCY/HOSPITAL SERVICES||PRIMARY CARE SERVICES||SPECIALTY CARE SERVICES||SUPPORT SERVICES|
|VILLAGE HEALTH||TELEHEALTH SERVICES||COMMON OUTPATIENT ENCOUNTERS|
Medication refills are part of your daily clinic responsibilities.
Request for refills will arrive in your Message Center in PowerChart/FirstNet. Our pharmacists have a medication refill protocol that will allow them to refill meds for 6 months if they meet certain criteria, as well as allow them to order labs in your name for your review. Please review the labs and if able, give 6-11 months of refills.
If a controlled medication is ordered, and the provider has access to the EPCS (Electronically Prescribed Controlled Substances), the process will be paper-less. Providers without access to EPCS (locums), will need to print the prescription, sign it, and deliver it to pharmacy.
Currently we are rotating C2 refills through outpatient providers with assistance from pharmacists checking PDMP. If someone is on vacation, you may be asked to refill medications for patients from their panel. Please review the patient's labs and refill them as needed. If they are on a chronic pain agreement, please refill them as well. Part of our obligation in doing a pain agreement with a patient, is that when that provider is out, someone will fulfill their agreement and refill their pain medications.
At times, when doing RMTs with the villages, you may need to order medication refills. Once you have verified that it is appropriate for them to get the refill, order it in PowerChart/FirstNet by right clicking over the medication.
In the villages, patients are taken care of mostly by Health Aides (HAs) who consult with their assigned outpatient providers when patient care falls outside of their standing orders or expertise. These communications are called RMT’s (Radio Medical Traffic).
RMT’s are sent in by Health Aides through PowerChart/FirstNet where they come into message centers under the Proxies Tab as panels (i.e., Chronic Peds, Emergency, Kusko or Yukon). These proxies are set up for providers by IT, usually as part of the initial onboarding process.
At any given time there are assigned providers (some internal at YKHC and some remote providers) for each panel who will review the cases submitted and either discuss the care plan with the Health Aide via telephone, or send back the form with assessment/instructions. They will read the encounter, review orders from the appropriate power plan, modify the orders as needed, submit an addendum to the encounter with their plan, and send it back to the Health Aides.
Emergency cases who need Medevac or immediate attention to Bethel, are called in to the on-call Ward Docs in North Wing and sent to the Emergency Proxy panel.
When Telemed (media files) are reviewed as part of the RMT, providers should add a charge by selecting the order "Telemed Consult Level 1" and insert "..rmtmediareview" autotext (sampled below).
- "Appreciate the photos of the _ that were sent to the Bethel provider so that the Health aide could get some help with the diagnosis and treatment plan.
- Diagnosis: _
- Plan: _
- Please give immunizations that are due."
For more details about the process of RMT, urgent RMT, emergency RMT, and different scenarios, click on the Radio Medical Traffic Link at the top of this section.
We have a very "at risk' population for suicide and substance abuse. There is a high rate of suicide in our patient population. We screen for depression on every visit. If the depression screen is positive during the screening for an outpatient visit in the SRCs, the Wellness Counselor or Behavioral Health clinician in the SRC should be called to see the patient. Click the title above to see a more comprehensive list of behavioral health resources available for our patients at YKHC.
YK has several on-campus (internal) consultants and a network of outside Bethel (external) consultants. Within the hospital, we have a pediatrician (in house) on call 24/7; high risk OB provider who is either an OB/gyn specialist or family medicine physician with extra OB training on call 24/7; emergency room physicians available 24/7; dentist on call 24/7; optometrist on call 24/7 and TB officers (providers who have received extra training in TB), lactation, HIV and wound care consultants. All other consultants are accessed through a network of providers, hospitals, and services outside YK.
ANMC is our Native referral hospital located in Anchorage, Alaska. They have multiple adult specialists and many pediatric specialists that can be accessed through their system. For non-beneficiary (or non-native) patients and any specialists not available through ANMC, we contact Providence. Occasionally, we are required to call specialists outside Alaska such as pediatric rheumatology or pediatric neurosurgery. These specialists can be reached at Seattle Children's Hospital or through a second opinion hotline (MEDCON).
For more detailed information, please click the above "Consults" category title to link to a list and description of the provided consulting services.
For patients who need a referral to a specialist, search orders for "Refer to ________" in PowerChart/FirstNet.
"Refer to ___ Internal" means you are referring a patient within the YKHC system. *This includes the Specialty Clinics (e.g., Refer to ENT Internal, Refer to Pediatric Neurology Internal, etc.). *ANMC (Anchorage Native Medical Center) sends some of their specialists out to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of having to travel to Anchorage. These referrals would be called INTERNAL since the patients are seen here. *We will periodically have providers in the Specialty Clinic for Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Pulmonology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with anmc (lower case).
"Refer to ____External" means the patient needs to be seen somewhere other than YKHC (e.g., ANMC, Providence, Anchorage, etc.) For all referrals, the provider documentation should:
- Always be signed
- Specify the reason for the referral
- Include as much past medical information as possible
- Include Beneficiary/Non-Beneficiary status
- If non-beneficiary, case management will also need the name of the provider they want to see
- If beneficiary and they want a non-ANMC second opinion (they must have Medicaid/Medicare coverage for this), inform the patient that they will be financially responsible for whatever Medicaid does not pay for.
- Indicate what if any Multimedia files are applicable for the referral
- Images and/or scanned documents should be scanned into Multimedia
- Dermatology always wants pictures
- Case management will need to know which Multimedia files should accompany an external referral
- Indicate STAT status if warranted and inform case management ASAP.
- Include current patient contact information. If a peds referral, also include escort name/DOB.
Try to be as complete as you can with the referral in giving as much past medical information as possible.
If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. Outside referrals can be made, but patients must make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.
Please, do not enter multiple referrals for the same patient, same problem. This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.
Case Management does not make ANMC appointments. ANMC will only attempt to contact the patient x3, then send a letter to the patient. A referral would need to be resent if still needed.
Please click here for more detailed information about individual referral types.
We have a web-based application (AFCHAN) that facilitates long distance consultation by allowing our providers to share media with specialists at ANMC, our referral center in Anchorage. The application allows you to send pictures of rashes, ears, eyes, etc., to a provider at ANMC. Access is given by IT to providers during the onboarding process.
The Health Aides are now able to upload media directly into patient's chart: PowerChart/FirstNet for RMT. If a provider views photos, or other media such as an EKG from a village, they can bill for a telemedicine consult in our EHR, but must document that pictures were reviewed.
Video Teleconferencing or VTC enables a provider in Bethel to do a clinic visit with a patient in a remote village. The VTC system we primarily use is Vidyo. This is also used by specialists at ANMC in Anchorage to do visits remotely with patients who are here in Bethel.
VTC/Vidyo is an extremely useful tool as travel is quite expensive and remote visits can save patients the substantial cost and inconvenience of traveling long distances.
The VTC/Vidyo system requires special software, hardware, and training on both the provider and patient's clinic ends. Once these are in place, providers can use the system to see and hear their patients remotely, usually in a village with the assistance of a Health Aide. We have electronic stethoscopes to transmit heart, lung, and abdominal sounds and cameras that can take/save/send pictures and function as otoscopes.
These visits will be scheduled for providers much the same way that regular visits are scheduled, except that the patients in the villages are advised that they will be seeing the provider remotely. Not all patients are appropriate for VTC visits, but they can be extremely useful for appropriately selected patients who cannot easily travel. Currently, exam rooms 3 & 4 in Yukon clinic are set up for this purpose, but these visits can be done in any private room with a laptop that has the appropriate software installed.