Electronic queries

Unknown
edited April 2016 in CDI Talk Archive
For those who do electronic queries, how does your system work? Does
anyone use this function with Meditech? We're upgrading to Meditech 5.6
and our hybrid medical record is going all electronic, so we need to
look at an electronic query process.

Stacey Forgensi, RN, BS, CCRN, CCDS
Clinical Documentation Specialist
Pager 642-1011

Comments

  • fishdl@shands.ufl.edufishdl@shands.ufl.edu
    edited April 2016
    Good point of discussion. We'll be converting from our hybrid record to EPIC in March 2011 and are considering our options regarding our electronic queries. The HITECH Act provides incentives for hospitals and clinicians to adopt and use EHRs. For those hospitals in the process of, or planning to convert to an electronic record, we could learn from those who have already made the conversion.
    Thanks.
    Donna Fisher, CCS, CCDS
    fishdl@shands.ufl.edu
  • stacy.vaughnstacy.vaughn
    edited April 2016

    we are converting to EPIC also and I would be interested in any procedures
    on electronic queries.

    Stacy Vaughn, RHIT, CCS
    Data Support Specialist/DRG Assurance
    Aurora Baycare Medical Center
    2845 Greenbrier Rd
    Green Bay, WI 54311
    Phone: (920) 288-8655
    Fax: (920) 288-3052

  • dsmith12h@aol.comdsmith12h@aol.com
    edited April 2016
    We converted to completely EMR in April of this year (EPIC). We use the "sticky note" feature to query our physicians and it seems to be working well thus far. There is a "smart phrase" option within the "sticky note" feature which can be populated with any query templates that you may already have. Happy to answer any question you may have.

    Debbie (UTSW)
  • stacy.vaughnstacy.vaughn
    edited April 2016


    thanks!!

    Stacy Vaughn, RHIT, CCS
    Data Support Specialist/DRG Assurance
    Aurora Baycare Medical Center
    2845 Greenbrier Rd
    Green Bay, WI 54311
    Phone: (920) 288-8655
    Fax: (920) 288-3052

  • dbutlerdbutler
    edited April 2016
    We are also with EPIC, however we do not use the "sticky note" function. We now use the staff message portion of the inbasket. Initially we did use one of the sticky notes (as I understand it, there are several-- interdisciplinary that ancillary / nursing / providers see, providers only & one that providers don't see). With the interdisciplinary, providers need to aware of it and essentially go 'find' it -- it isn't easily visible in most provider default views. This was largely a political decision. Hopefully you are using the provider sticky note.

    There are pros/cons between the sticky note and the inbasket. The inbasket by design is an area where there are a number of provider flow & activities that occur, so that area is / will be an area that providers become accustomed to and spend a lot of time in. These messages are seen whether or not the provider goes into the pt's chart and a 'hot link' of sorts can be set up with the query to drive to the pt record. However, the CDS chooses (like an email) the 'to' and 'cc' addressees who will see the inbasket message. I believe that one can also see whether the provider has read the message. Replies to the message are also delivered directly to the CDS, shortening the CDS response time to any questions or discussion. Of course, we want answers to the queries in the PN &/or DCS. Though the inbasket messages are not part of the record (usually?), they are retained in the system. This is separate from the inbasket post discharge coding query function.

    The sticky note is visible to anyone who is in the pt's record (and has the authorization to see the variety of sticky note) but is not visible if not in the record. The sticky note is also NOT a part of the medical record by design.

    Our experience with the sticky note's we were able to use was mixed -- cooperative providers found it, other's did not. The inbasket staff message has overall worked better.

    I encourage others to share (in some detail) their experiences with various query systems -- some of the issues are software specific but many are process related and are across software platforms.

    Don


    Donald A. Butler, RN, BSN
    Manager, Clinical Documentation
    PCMH, Greenville NC
    dbutler@pcmh.com

  • dsmith12h@aol.comdsmith12h@aol.com
    edited April 2016
    Our Sticky notes must be set up differently than yours'. We have only four disciplines (Pharmacy to MD, CM to MD, Nursing to MD and Therapies to MD). When documentation in put on a sticky note it appears a on the main screen in a big yellow box that pops-up and is visible immediately when the chart is accessed. We do not retain concurrent queries as part of the medical record--they are held in a seperate file. We are only 3 months into complete EMR and have found that not all physicians access the inbasket feature yet. Perhaps this will change as they become more familar with the systems capabilities. We were using both options initially but still had greater success with the sticky notes ( I was actually surprised by this). I suppose EPIC can design these features to meet the needs of individual facilities and for those that have EPIC or will have EPIC, check with your EPIC rep. to see what options are available to you.

    Debbie
  • dbutlerdbutler
    edited April 2016
    Are your sticky notes a pop-up window? or are they one of the series of fields seen on the pt chart 'home' screen? Ours are the later.

    One difference might also be what version we each are running -- I believe we are testing one version behind what is the latest & greatest, and thus our production is at least 2 versions behind. There are stronger features often in newer versions.

    Don

  • dsmith12h@aol.comdsmith12h@aol.com
    edited April 2016
    Not a pop-up window--it's a field:) When I populate the field with a query it tends to cover the screen making it virtually impossible to miss. I agree that the EPIC versions must explain the differences.

  • Unknown
    edited April 2016
    We have Meditech version 5.63 and about a month ago I began using an
    electronic note process for my queries. There is not a way to enter
    templates using this system so my queries have been written for each
    individual patient. I have only had this system for about a month but
    the physicians have been much happier with it then with written queries
    that were cumbersome to locate.

    When the physician pulls up his patient work list, there is an envelope
    that will show up just below the patient's room number on the left hand
    side of the screen. A dark colored envelope means the note has not been
    opened and a light colored envelope means it has been opened. They click
    on the envelope and it then shows a list of notes and from whom. They
    click on the note they want to read and the "view details" button and it
    opens up the query.

    One problem that I have encountered is when hospitalists change service
    from one day to the next. Some physicians will review the query and
    enter an addendum to their progress note the same day but some will
    ignore the query since they have already documented on the patient for
    that day. Since I don't always know who will be taking the patient the
    following day, I do have to resend the query the following day to the
    new physician if it had not been answered.

    The notes are not part of the medical record but there is a glich in
    this system that Meditech is still trying to fix.

    Hope this helps. Let me know if you come across any other helpful hints
    with the Meditech system.

    Lisa Taylor, RN
    CDIS
    Wooster Community Hospital
    ltaylor@wchosp.org
  • cstukenbergcstukenberg
    edited April 2016
    Lisa
    I have Meditech also but am confused on where you are putting in your notes. I will send you an e-mail.
    Thanks
    Colleen Stukenberg MSN, RN, CMSRN, CCDS
    815-599-6820
  • tkreilingtkreiling
    For those of you that use meditech for queries can you tell me what module you go into. I am interesting in seeing if this is something we may have available but just don't have set up.
    Thanks,
    Tara
  • Unknown
    edited April 2016
    I use the message system on the nursing module's status board.

    Lisa

  • tdavistdavis
    We currently are using 3M. We have mainly an electronic MR, except for inpt progress notes & OR room notes. We print a paper copy of our query and place it in the papaer chart and then send a nother copy to a scanning queue which put the document into our MR as a scanned document.
    Theresa
  • ssalinasssalinas
    edited April 2016
    I am interested in this as well. Please include me in this thread.

    Thanks,

    Sharon Salinas, CCS
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    ssalinas@barlow2000.org
  • cstukenbergcstukenberg
    edited April 2016
    We are just getting ready to upgrade to 5.66. Are your physicians doing p doc?

  • lsipos@monument.healthlsipos@monument.health
    edited April 2016
    We are currently using 5.65 Meditech and our CI people have built the e-queries into the system and we plan on using them starting in a few weeks! (we will undergo a trial with x3 doctors). CI took our "own" queries and just built them like they are into meditech for us. The CDI will be the author/signer and the doctor will be the co-signer. It will stay in "draft" status under "other reports" until it is signed! We are SO looking forward to it!


    Juli Bovard RN CCDS
    Certified Clinical Documentation Specialist
    Clinical Effectiveness/Clinical Quality
    Rapid City Regional Hospital
    719-4390 (work)
    786-2677 (cell)
    "No Limit to Better......"


    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens

  • laura.jansenlaura.jansen
    edited April 2016
    With this process then do your queries/clarifications remain part of the medical record? We also have Meditech & with our process the clarifications are not part of the medical record. We send messages via the physician desktop. It doesn't work the best & I am interested in how everyone else is using electronic clarifications with Meditech.
    Thanks,
    Laura


    Laura Jansen, RN, Clinical Documentation Improvement Specialist
    St. Joseph's Hospital Breese, Southern Illinois Division
    618-526-5638/618-526-5623
    laura.jansen@hshs.org
  • lsipos@monument.healthlsipos@monument.health
    edited April 2016
    Yes, they ARE a permanent part of the record. That didn't change for us though, as even our paper queries have been a perm part of the record for a few years now!

    Juli

  • cbarnescbarnes
    edited April 2016
    Hi- Our physicians are training. There are few that have completed the training but the chart is still a hybrid model of because it seems to be evolving ever so slowly.
    23
  • ssalinasssalinas
    edited April 2016
    They sure are. I would suggest that template parameters be established for pdoc. Our physicians were given free rein and they have gotten out of control!

    Sharon Salinas, CCS
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    ssalinas@barlow2000.org
    treet, Danvers MA 01923
  • cbarnescbarnes
    edited April 2016
    Hi Julie- Do the queries appear in EMR or PCS ? Thanks Charlene
  • lsipos@monument.healthlsipos@monument.health
    edited April 2016
    EMR!
  • cbarnescbarnes
    edited April 2016
    Thanks !!!! Charlene
    1923
  • cstukenbergcstukenberg
    edited April 2016
    What do you mean about setting template parameters for p doc?
  • lsipos@monument.healthlsipos@monument.health
    edited April 2016
    FOR US, it means that the CDI will be the only ones allowed to "amend" them. The providers can answer the queries in the ({ }) fields, and we also give an area for free text, but in the actual "response" fields, they cannot just change our response/choices. Does that make sense??

    Juli
  • afeighnerafeighner
    edited April 2016
    Can you tell me what module you used in setting up the queries in Meditech? Thank you, this would be wonderful to be able to generate electronic queries from Meditech.

    Amber L. Feighner RN MSN CDIS
    Clinical Documentation Improvement Specialist
    Blanchard Valley Hospital
    1900 South Main Street
    Findlay, Ohio 45840
    419-425-5787
  • shinesshines
    To those who use Meditech, what area are you using for your query? Could you send me a screenshot of what this looks like, how do you use pdoc?
    Does the query go to the physician que to be signed electronically and is this then able to be coded?
    Thanks, send replays to shines@bch.org
  • cbarnescbarnes
    edited April 2016
    We would love to see a screen shot, also !!


    Thanks Charlene Barnes RN, CDS
    Hardin Memorial Hospital
    Elizabethtown, KY 42701
  • angelisa.romanelloangelisa.romanello
    edited April 2016
    Hello Rhonda,
    We have been using electronic queries now for about a year. Our queries are loaded in McKesson and we fill them in and they are electronically sent to the physicians queue.

    Is there a way for you to scan your query forms into the record ?
    If you IT department can create a progress note, can they create a query form ?

    Good luck.
    Lisa


    Lisa Romanello, RN,BSN,FNS,CCDS
    Manager, Clinical Documentation Improvement
    Quality and Compliance
    CJW Medical Center
    804-228-6527
    Angelisa.Romanello@HCAHealthcare.com

  • tcoffeytcoffey
    edited April 2016
    Hi Rhonda,
    We also use Soarian.
    Our IT department just (last Friday!) loaded a query form into the CPOE area of Soarian.
    The query form will be filled out by the CDS and will appear on the MD's worklist.
    The revised Order with the physicians comments (when completed) will be emailed to me.
    Feel free to email me directly or call me if questions.
    Thanks,
    Theresa

    Theresa A. Coffey RN, BSN, CCM / CDI Specialist
    HealthAlliance Hospital – A Member of UMass Memorial Health Care
    60 Hospital Road, Leominster, MA 01453 | www.healthalliance.com
    phone: 978-466-2824
    fax: 978-466-4159
    email: tcoffey@healthalliance.com

  • rhondawest619@hotmail.comrhondawest619@hotmail.com
    Good Morning,

    No we can't scan any documents into Soarian. As of now we a brainstorming. IT demonstrated a note with a text field for my department to enter the information . However,in the permanent medical record I can't distinguish between the MD and CDI notes because it signs both of their names at the bottom of the message. I was concerned about compliance issues. Therefore, we have to create something that can clearly distinguish between what the clinicians and CDI documented.
    Did you create a query fro each diagnosis or do you have a standard template?

    Thanks,
    Rhonda
  • tcoffeytcoffey
    edited April 2016
    Hi Rhonda,
    We have just one template with a free text box for my question and a free text box for the MD response.
    Theresa

    Theresa A. Coffey RN, BSN, CCM / CDI Specialist
    HealthAlliance Hospital – A Member of UMass Memorial Health Care
    60 Hospital Road, Leominster, MA 01453 | www.healthalliance.com
    phone: 978-466-2824
    fax: 978-466-4159
    email: tcoffey@healthalliance.com
  • Unknown
    edited April 2016
    We use Meditech as well and have not been able to do electronic queries. May I also have your process??? Please and thank you !

    Elaine Sakala RN
    Clinical Documentation Specialist/UR
    Delta County Memorial Hospital
    esakala@deltahospital.org
    970-874-2287
  • tpeytontpeyton
    edited April 2016
    Thank you, I forwarded this to my manager.

    Tracy M Peyton RN, CCDS
    Bradford Regional Medical Center
    Upper Allegany Health Systems
    116 Interstate Parkway
    Bradford, PA 16701
  • dholowczakdholowczak
    edited April 2016
    Does your electronic query become a permanent part of the medical record??

    Deanna Holowczak
    Clinical Documentation Specialist
    SJRH
    (914) 964-4580

  • dholowczakdholowczak
    edited April 2016
    Do any of your physicians voice concerns over them being part of the permanent record?? And how do you handle it if they do not answer the query???

    Deanna Holowczak
    Clinical Documentation Specialist
    SJRH
    (914) 964-4580
  • lsipos@monument.healthlsipos@monument.health
    edited April 2016
    We also had to have our queries approved by Legal, CDI Champion, Quality, Forms committee, etc. So long as you have a complaint query, are not leading, and can substantiate it with clinical indicators,& treatment monitored or rendered relative to the clarification, there should never be an issue with them being a legal part of the medical record. :)

    We have had electronic queries in Meditech for 3 years now, and not one provider has ever voiced a concern about them being part of the legal record!

    Juli

    Juli Bovard RN CCDS
    Certified Clinical Documentation Specialist
    Clinical Effectiveness/Clinical Quality
    Rapid City Regional Hospital
    755-8426 (work)
    786-2677 (cell)
    "No Limit to Better......"
  • dholowczakdholowczak
    edited April 2016
    Do you have any examples of what your query looks like in meditech ? we have the ability to do this and will have to bring this to our CMO/compliance officer

    Thank you for your help


    Deanna Holowczak
    St. John's Riverside Hospital
    914-964-4580
    Dholowczak@riversidehealth.org

  • afloyd24afloyd24
    We just implemented EMR with an electronic query process on April 1st (yep, April Fools Day). We used the same process as Melissa does and have some tickets in for improvements to the process. It is my understanding that Meditech is making this best practice. There are two different ways to process a query in Meditech 6.1, through the ITS module and then through the ABS module. We by far preferred the ITS process and have not had any issues moving from paper to electronic. The physicians have not had a problem for the most part picking up the process. I would be glad to share my experiences if anyone has questions, please feel free to ask by email or phone. My advice...be persistent and heard or you will be left out!!!

    April Floyd, RN, CCDS
    afloyd@andersonregional.org
    601-553-6299
  • vanessa.falkoffvanessa.falkoff
    edited April 2016
    We had to narrow it down to our top 20 queries, and use the generic question/answer query for the rest.
    Good Luck!

    Vanessa Falkoff RN
    Clinical Documentation Improvement Coordinator
    University Medical Center of Southern Nevada
    1800 W Charleston Blvd
    Las Vegas, NV
    vanessa.falkoff@umcsn.com
    office 702-383-7322

    Compassion * Accountability * Respect * Integrity
  • angie.guiler@bergerhealth.comangie.guiler@bergerhealth.com
    edited April 2016
    Hi Lona:

    I use "physician messaging" in MediTech. The IT department had to provide access to myself and each MD using this function. I personally provided 1:1 training with each physician which took about 5-10 minutes per session then I followed up with each doc for a few weeks after going live to answer any questions.

    The messages go straight to the physicians "desktop" which is the first screen that appears when entering MediTech (no excuse that they did not see a message). I had to re-review how to delete the messages after a response in order to keep their desktop up to date.

    If you would like to talk off line fell free to contact me.
    Thank you and Good Luck!


    Angie Guiler RN
    Clinical Documentation Specialist
    angie.guiler@bergerhealth.com

    Berger Health System
    600 N. Pickaway Street, Circleville, OH 43113
    (740) 420-8177 Direct
    (740) 474-2126 Phone
    (740) 420-8644 Fax
    www.bergerhealth.com

    Care first. Community always.
    ________________________________
  • dholowczakdholowczak
    edited April 2016
    Hi

    We use Meditech as well, with the electronic queries, do they respond in the progress notes, or do the queries become part of the permanent record? We are trying to make electronic queries but haven't found a place for them yet. I would love to see the physician message area?



    Deanna Holowczak, RN, MSN, CCDS
    Clinical Documentation Specialist
    St. John's Riverside Hospital
    dholowczak@riversidehealth.org
    (914) 964-4580
    Cell (914)560-6673

  • angie.guiler@bergerhealth.comangie.guiler@bergerhealth.com
    edited April 2016
    Hi Deanna:
    The physicians respond in their progress notes. They have a choice to either clarify in next days progress note or add addendum to current/previous progress note. We just began "dragon" dictation so the physicians are signing off notes immediately after dictating which requires an addendum, unfortunately.

    How I access physician messaging:
    I access PWM (physician work list) - IT needs to give access to
    Select "physician desktop" ~ all my messages appear here
    To send a message I select "inpatient" ~ the MD's that have access to electronic message their patients will show up here
    Select a patient then click on "send new message"
    This is what appears:
    (Patient information does appear at top, I cut that out for HIPAA purposes:))
    Select MD that you intend to send message to, priority (defaults to routine), enter the subject/title.
    Then enter clarification request and send
    [cid:image002.jpg@01D1367E.2DA1C250]


    I also keep an excel spread sheet of all requests and responses,

    Hope this is helpful.


    Angie Guiler RN
    Clinical Documentation Specialist
    angie.guiler@bergerhealth.com

    Berger Health System
    600 N. Pickaway Street, Circleville, OH 43113
    (740) 420-8177 Direct
    (740) 474-2126 Phone
    (740) 420-8644 Fax
    www.bergerhealth.com

    Care first. Community always.
  • lsipos@monument.healthlsipos@monument.health
    edited April 2016
    WE use Meditech and place a query in the "other reports" section of the record. The CDI is the author and is required to I-sign once responded to by the provider for whom we place the query. The query is called a "physician clarification", and is A permanent part of the medical record.

    About the only issue we have is getting them to continue that diagnosis or clarification through to subsequent progress notes!

    Juli
    Juli Bovard RN CCDS
    Certified Clinical Documentation Specialist
    Clinical Effectiveness/Clinical Quality
    Rapid City Regional Hospital
    755-8426 (work)
    786-2677 (cell)
    "No Limit to Better......"
  • lmcnamara@cortlandregional.orglmcnamara@cortlandregional.org
    edited April 2016
    Thank you everyone! My IS dept. appreciates all the help! :)

  • ssalinasssalinas
    edited April 2016
    What version of MT do you have?

    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org

  • lmcnamara@cortlandregional.orglmcnamara@cortlandregional.org
    edited April 2016
    Meditech Magic 5.66

  • dholowczakdholowczak
    edited April 2016
    Hi Everyone,

    When the physician signs the query where does the query stay? Is it visible to everyone in the physician document section with your name on the query or does it sit somewhere else in Meditech? And what happens if the physician never responds. Is there a way to remove the query from the document section?


    Deanna Holowczak, RN, MSN, CCDS
    Clinical Documentation Specialist
    St. John's Riverside Hospital
    dholowczak@riversidehealth.org
    (914) 964-4580
    Cell (914)560-6673

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