In this patient disposition, a referral to a specialist is required following the office visit. In this case, it’s an urgent visit.
It’s time for the office visit. The HCP opens Ann's Request just prior to entering the examining room and reads the problem description on the “Manage Request” screen. At the end of the appointment, the HCP makes a separate note to Ann’s EMR or paper file. He then returns to the “Manage Request” screen and enters instructions to the secretary.
He updates, instructing that she make an urgent referral to a specialist. He checks "Consult Pending Tests" and Saves.
On her “Manage Requests” screen, the secretary's uncompleted tasks are pink banded. She can click the "For Secretary’s Attention” tab to display all the pink-banded tasks on one screen.
Ann has just left the examining room. The secretary opens her newly pink-banded Request, and sees that an urgent consult with a specialist is required. However, in order to make this referral, she first needs a referral request letter from the HCP. He has to dictate it and have it transcribed.
While awaiting the referral request letter, the secretary clicks back to “Manage Requests” and works on other pink-banded Requests until the letter is ready.
Once she has the referral request letter, she will request the referral by logging in to the specialist's "ConsultSTAT-Refer" portal. If that specialist does not yet have a ConsultSTAT-Refer Portal, the secretary must transmit the request by fax. Now she can reopen Ann’s Request and update that she has made the referral. After updating, she unchecks the "For Secretary's Attention" box, checks the "Refer to Specialist" box and Saves. This changes the status to “Referral Pending Approval”.
When the sec receives a booking confirmation from the specialist's office, she reopens Ann’s Request. She enter the consultation appointment info into the Update Request field, checks "Referral Approved" and Saves.
This sends Ann an email notification regarding her booking to see the specialist. In Ann’s Gmail inbox, we see her previous "Consult Today" email, as well as a most recent email, the "ReferralApproved"notification.
When Anne clicks through to the post in the thread, she can see the details of her referral appointment.
Ann checks the box indicating that she has made note of her appointment info and clicks “Close”.
On her “Manage Requests” screen, the secretary sees the red Copy and Close status on Ann’s Request. She opens it, creates a PDF of the entire thread, either saves it to the patient’s EMR or prints it to the patient's paper record. She confirms that she has printed the information. She then clicks “Delete” to remove Ann’s Request completely from database. Ann’s Request, which was ID number 67, can no longer be found on anyone’s “Manage Requests” screen.
(i) If the consultant does not yet have a ConsultSTAT-Refer Portal, the referring HCP's staff must revert to old-fashioned, slow faxing of the referral request letter. This means it can take days for the appointment to be scheduled and the details received by the referring HCPs office.
(ii) If the consultant has a ConsultSTAT-Refer Portal, the referring HCP's staff log into it as a member, create a New Request, enter the patient's information and upload a referral request letter. The referring HCP's office should receive a response on the thread containing the appointment details, within minutes.
In either case, once the appointment information is received, the referring HCP's staff then open's the patient's Request that is on her own Portal's screen (which still has the status "Referral Pending Approval"). She updates with the consult appointment information, checks "Referral Approved" and Saves. In this way, the patient will receive an email notification and upon opening the thread, will see the consult appointment information, with name of specialist, address, time and date. If the consultant's office has sent special instructions to the HCP's office, this document will also be uploaded to the patient's thread and will be downloaded and read by the patient.
You'd be in real trouble with the Provincial and Federal Privacy Commissioners and subject to six figure fines (which also attracts College of Physicians and Surgeons sanctions), if an email communication containing personal health information got into the wrong hands or went astray. Public email (examples include Gmail, Yahoo email, Bell or Rogers email) has two huge problems: (i) it is non-secure and unencrypted. Anyone intercepting it can read the contents...and it is easy to intercept. Public emails are hacked all the time. (ii) All public email (whether originating in Canada or the US) is routed through the US before reaching its destination and is therefore subject to viewing by the National Security Agency, which is an obvious privacy breach for personal health information. This is a key reason why both the Privacy Commissioners and the provincial Colleges have ruled that personal health information may not cross international borders. It must stay inside Canada.
It has none of the problems of public email. The Portal is a secure membership site. This means that communications posted to the portal or read on the portal are encrypted: they can only be read by legitimate Portal members. Additionally, documents uploaded to and downloaded from the Portal are similarly protected. Picture an email akin to physical mail: a packet of information is sent over wires (instead of over roads), which can be intercepted anywhere along the way. Picture a Portal akin to a safety deposit box inside a bank, to which only the member patient and the HCP have the key. A patient adds a letter to the box and locks it. The HCP's staff unlocks the box, reads the letter, leaves it in the box and adds a letter in reply.