Here's how the consultant's staff triage referral requests.
Each Portal's New Request screen displays its own unique instructions for the composition of referral request letters. These requirements are customized by the consultant and are practice-specific. The referring HCP fills out all required fields, attaches a referral request letter and sends.
The consultant's secretary sees a new Booking Request displayed in red on her Manage Requests screen. (Red = for secretary's immediate attention). She opens it, reads the referral request post and the attached referral request letter. She then either creates and posts an appointment booking, declines the consult request, or refers it to the consultant for further disposition.
Part 1: Declining a Request
If the referral is unsuitable or cannot be accommodated, the secretary declines the request by selecting "Booking Declined" and adding her reply in the “Update this Request” field. She can select a response from the “canned response” dropdown menu and then modify or add to it. She then saves. The Request status changes to from “Booking Request” to “Booking Declined” and an email notification is automatically generated and sent to the referring HCP's office.
The referring HCP's office opens the notification and clicks through to the post. The referring HCP's staff has the opportunity to reply and try to renegotiate or accept the refusal. In the latter case, she would then copy the entire thread to the patient's EMR or print it for the paper record, click "Yes, I have printed the Request" and “Close the Request”.
The Request status changes from “Booking Declined” to "Copy and Close", which is displayed in red, on the consultant secretary's Manage Requests screen. She opens the Request, copies the entire thread to the patient's EMR or prints it for their paper medical record, clicks "Yes, I have printed the Request" and clicks "Delete this Request", which deletes the ticket from the Portal’s database. As a result, it will not longer appear on her Manage Requests screen.
Part 2: How the Secretary Refers a Request to the Consultant
If the consultant’s secretary is uncertain about a Booking Request and requires the consultant to review the referral request before proceeding, she simply updates with a "?", checks "Pre-Consult for Approval" and Saves.
The Consultant’s Manage Requests screen will now display this request in green (to indicate that it is for immediate action). The status has changed from “Booking Request” to "Pre-Consult for Approval". All “Pre-Consult for Approval requests are consolidated in the Pre-Consult for Approval tab, located at the bottom of the consultant’s screen. Clicking on this tab will display only the "Pre-Consult for Approval" requests that must be attended to by the consultant.
The consultant opens the request, reads it and reviews the attached referral letter. He /she will now either click "Booking Declined" and add a comment and Save, or click on "Specialist Approved" (below the “Update this Request” field) and save. In this scenario, he updates, selects "Specialist Approved" and Saves.
The request status changes to from “Pre-Consult for Approval” to “Specialist Approved”. It is automatically brought to the consultant secretary’s attention because it is displayed in red on the secretary's Manage Requests page.
It is also consolidated with all other requests of the same status in the secretary’s "Specialist Approved" tab. She opens the request, knowing by the status that it has been approved by the consultant and proceeds to book the appointment. She selects a response from the dropdown, schedules the date and time using the calendar, copies and pastes it into the Update field, and Saves. This generates an automatic email notification to the referring HCP’s office.
The request status changes to from “Specialist Approved” to “Pre-Consult Approved”, with the appointment time and date and clearly indicated.
The referring HCP's office opens the email notification named "Pre-Consult Approved" in their inbox and clicks through to the post. The date and time is displayed in the Consultation Session box at the top of the thread, as well as appearing in the most recent post made by the consultant’s staff.
Both the referring HCP and consultant's offices can now notify the patient of the appointment.
The consultant's secretary can do so by opening a "Booking Request", clicking "Booking Declined", updating the post and Saving. The secretary can alternatively refer the request to the consultant. The consultant opens the request, which will now have the status "Pre-Consult for Approval". Clicking the "Booking Declined" button, updating and Saving changes the status to "Booking Declined". This status change generates an email notification to the referring HCP.
The post that indicates that the consultant will not be able to see the patient contains the addendum that advises the referring HCP to respond by updating, if there are any questions or extenuating circumstances. Otherwise, the referring HCP is asked to copy the entire thread to the patient's EMR or print it to the paper file, then click the "Yes, I have printed" button and the "Close" button. This changes the Status to "Copy and Close" and the request now displays in red on the consultant secretary's Manage Requests screen. She opens it, clicks "Delete". This removes the Request and its entire thread and any attachments from the Portal's database. The Request no longer appears on the Manage Requests screen.
(i) Medical record systems (both electronic and paper) are required to maintain contents for a number of years. ConsultSTAT portals are not medical record systems. They are not intended to replace medical record systems. They are pure communication platforms. The contents of a Request represents all of the communications between referring HCP's office and consultant's office, displayed as consecutive posts, regarding consultation fulfillment for a patient. The Request also includes referral request letter and consult reporting letter attachments. These attachments are downloaded and added to the patient's medical record. The communication thread is converted into a PDF and added to the patient's medical record, primarily for medical-legal purposes.
(ii) If every communication thread were saved to the Portal's database, the database would become unmanagable in terms of size and access speed would dramatically decrease.
(i) Health care professionals are responsible for the behaviour of their staff. Having access to every communication between staff and patient as a reviewable PDF offers insulation from professional misconduct complaints. It also assists in staff communication training by providing actual case studies.
(ii) The PDFs can provide evidence to defend against wrongful dismissal claims made by former staff members.
(iii) The communication threads also contain dialogues between referring HCP and consultant and between consultant and consultant's staff. PDFs can provide evidence to defend against harrassment or negligence claims made by one of the parties.
(iv) Similarly, the .mp3 files that result following verbal (phone) eConfers are strong evidence in legal and regulatory actions.