this template is designed to provide guidance and examples for€¦ · 4 reminders about...

Care Recommendations Template

This template is designed to provide guidance and examples for:

Adding a Patient Care Provider

Adding Patient Background Information

Adding a Care Recommendation

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Background: Oregon EDIE/PreManage Implementation

The rate of adoption of EDIE/PreManage in Oregon is quickly expanding, and in addition to

hospitals, health plans and primary care, includes new use cases such as behavioral health

and long term care. With this rapid expansion there is an opportunity to align and coordinate

efforts to maximize the benefits of the tools.

The Care Recommendations Toolkit developed by CMT has provided a useful resource for

new users, however there has been requests for more specific guidance on the use of the

care providers section, patient background section and developing care recommendations.

This template was developed with input from EDIE/PreManage users throughout Oregon,

including the OHLC Care Recommendations Workgroup, the CareOregon Care

Recommendations Workgroup, and key stakeholders from hospitals, health plans, primary

care and Behavioral Health practices.

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Key Recommendations Reflected in the Template

Use the Care Provider section to document members of the patient’s care provider team

including care managers, social workers, etc.

Use the Patient Background section as a place to collaboratively record objective

information that will be helpful to ED providers.

Have one Care Recommendation for each patient, ideally developed by primary care

whenever possible, rather than multiple and possibly conflicting guidelines being developed.

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Reminders about Information Sharing

Include Only Necessary Information

In connection with the Health Insurance Portability and Accountability Act, only provide the minimum necessary information needed for the patient’s care for the Emergency Department.

– NOTE: EDIE/PreManage enable the exchange of information among health care organizations that have entered into data sharing agreements with CMT. ED providers and other users access the system through their own organization’s secure portals for EDIE/PreManage.

Carefully Follow Rules for Including Sensitive Information in Care Recommendations or Patient Background

Some state and federal laws provide special protections for certain categories of patient information. In EDIE and PreManage, these categories of information are called “Sensitive Information” and their use and disclosure is governed by the CMT Sensitive Information Policy. Here is a list of Sensitive Information categories for which you must consult the CMT Sensitive Information Policy1 before including any Sensitive Information into either the Care Recommendation or Patient Background sections:

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- Psychotherapy Notes (i.e., notes from a mental health professional documenting contents of conversations during therapy sessions) o NOTE: may not be uploaded into PreManage

- Mental Health Information o NOTE: may be shared for health care or care coordination purposes, per the Policy

- Information from Providers that hold themselves out as Alcohol & Drug Treatment Programs o NOTE: may not be uploaded into PreManage unless in case of emergency, per the Policy

- Sexually Transmitted Disease Information o NOTE: may be shared for health care purposes, per the Policy

1 The CMT Sensitive Information Policy can be found at http://collectivemedicaltech.com/about-us/cmt-policies/.

Information Security

PreManage users are reminded that use of PreManage is guided by CMT’s Security Policy

and Terms of Use, which includes details about password protections and other security

issues related to Protected Health Information. 2

2 The CMT Security Policy can be found at http://collectivemedicaltech.com/about-us/cmt-policies/.

http://collectivemedicaltech.com/about-us/cmt-policies/

http://collectivemedicaltech.com/about-us/cmt-policies/

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Limit Use of Acronyms

Because PreManage is used by a wide range of providers and others involved in patient care,

users should limit their use of acronyms throughout PreManage— “when in doubt, spell it

out.”

Sharing Information Across Organizations

PreManage is a powerful tool for coordinating patient care across ED settings and among a

patient’s entire care team. The remainder of this template explains how to use three key

features to maximize care coordination:

Adding a Patient Care Provider



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Adding Patient Care Provider

On the Patient Record, click the “Add Provider” button as shown in the below screenshot.

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The following dialog box will display once you click “Add Provider”. Follow the steps as indicated below to add a provider.

1. You can search for an existing Provider here.

2. If you can’t find them in the existing database, you

can create a provider. Make sure to add as much of

this info as possible.

If a provider’s availability is limited, enter the

hours available in the Provider Name field , e.g.,

Jane Doe (M-F 0800-1730).

3. There is a dropdown under the “Care Provider’s

Role” to select the type of provider added.

Adding the service dates will also provide helpful

information to the ED especially if the provider

assignment is short-term.

4. Adding the facility information is also very helpful

and valuable for the ED to see (e.g., Facility Name:

CareOregon)

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Here is an example of what this dialog box will look like if filled in completely.

A few things to note:

NOTE: Organizations may want to determine a

standard practice for entering in providers such as

Case or Care Managers, e.g., enter those determined to

be most connected with the patient in consultation with

the patient’s care team.

The fax number is especially important as many ED’s

in Oregon use this information to fax notifications

to the Patient’s PCP.

The ‘Provider Type’ drop-down provides many different

identifiers:

Other: Hospital Narcotics Prescriber Pharmacy Primary Care Provider Specialist Mental Health Provider Case or Care Manager Social Worker Dentist

If the ending service date is left open, it will display as

“current” on the patient record.

If the ending service date is filled in, it will display in the

record and continue to display after end date. NOTE:

provider records are not removed after the end date has

passed. Users will need to remove outdated providers

manually.

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Finally, this is what the Care Provider section will display now that you’ve added the

new provider.

There is no particular order in which the providers will display in this section with the current configuration. For example,

even though we just created Dr. Johnson, he is the last provider to display.

For reference, the below screenshot is how the ED will see this information. The Care Providers section on the EDIE alert will

only display CURRENT providers. In this example, there are only two providers on the EDIE alert in the ED (since the other

provider has an end date of 04/19/2016) as opposed to the three on the patient record itself (shown in the above screenshot).

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The Patient Background Section is for objective information related to the patient’s history.

When information is included in Patient Background, it will AUTOMATICALLY be sent to

the ED once the patient presents.

Any EDIE/PreManage user with access to a patient record can add information in this section

and can contribute to a shared understanding of the patient’s background.

There are 6 different subsections or ‘tabs’ that allow you to organize the type of information

you’d like to include:

– MEDICAL/SURGICAL

– INFECTION/CHRONIC

– SUBSTANCE ABUSE/OVERDOSE

– BEHAVIORAL

– SOCIAL

– RADIATION

On the following pages, each of these tabs is explained and example entries are provided.

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The first section is MEDICAL/SURGICAL

Limit this section to objective information about:

1. Medical diagnoses

2. Previous surgeries that are relevant for the ED to know

3. Any Rx Allergies or other Alerts

You can take advantage of the ability to bold/italicize/underline very important info

See the screenshot below for an example of what this might look like for a patient:

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The second section is INFECTION/CHRONIC


1. Diagnoses related to Infections/Chronic illness

2. Hospital-acquired infections


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The third section is SUBSTANCE ABUSE/OVERDOSE


1. Diagnoses related to substance abuse or overdose risks

2. Current drug use based on tox screenings, previous overdose info, etc.

3. Overdose risks associated with current or previous prescriptions

4. NOTE: If you are at, or have access to medical records from, a clinic or program that holds itself out to the public

as providing drug/alcohol treatment services, DO NOT include information relating to drug/alcohol services for the

patient.


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The fourth section is BEHAVIORAL


1. Diagnoses related to patient’s behavioral health

2. The patient’s baseline presentation

Use bold/italics/underline to emphasize information

3. Advisories or alerts that might be critical for ED to know

4. Behavioral contracts (which you can attach in the attachments section)


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The fifth section is SOCIAL


1. Social/Community services available to the patient

Make sure to include relevant contact information

2. Patient’s living conditions

3. Patient’s primary care givers

4. Any cultural/linguistic background that might be helpful

5. NOTE: For care managers/case workers who have sensitive information to share (e.g., history of

domestic violence), please include your contact information so that ED providers can call you to

discuss. This is to ensure patient safety while complying with all related state and federal rules,

regulations and guidelines.


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The sixth and final section is RADIATION


1. Patient’s radiation history

Number of X-Rays in a given timeframe

Number of CT scans in a given timeframe

Any additional radiation exposure that would be helpful for the ED to be aware of.

2. Any objective findings that have come from these scans


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Patient Background – Summary Level

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Patient Background – Voting/Flagging Info

In the patient background section, you have the ability to vote or flag information. This

allows you to quickly collaborate with other EDIE/PreManage users. To do this, simply

click the icon if you agree with the information presented or the icon if you

disagree with the information. If you click the flag, it will immediately send the

individual who input this information a note inviting them to update this information.

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The Care Recommendation Section is a powerful part of PreManage. When information is included in this

section, it will AUTOMATICALLY be sent to the ED once the patient presents.

NOTE: While the Patient Background Section can be jointly developed and viewed by many PreManage users working with a

patient, a Care Recommendation can only be developed and maintained by a single Facility—and if more than one are

created, only the most current Care Recommendation will be sent to the ED when the patient registers (or, in some cases, the

Recommendation developed by the hospital’s system will be sent). For these reasons, it is important and ideal if one Facility

takes the lead for a patient’s Care Recommendation rather than multiple and possibly conflicting recommendations being

developed.

There are 5 different subsections that allow you to organize the type of information you’d like to include:

1. Care Recommendation: (A recommendation for how a condition should be treated or has been

successfully treated in the past)

2. Care Coordination: (An explanation of the coordinated efforts in regard to this patient's care)

3. Pain Management: (A recommendation for how the patient's pain should be managed, including pain

contracts, etc.)

4. Helpful ED-Based Interventions to Try: (A list of helpful interventions that have been successful in

prior ED visits.)

5. Other Information: (Any additional information relevant for the ED). a. NOTE: This section should be used with caution as the most relevant patient information can likely fit into one of

the above Patient Background Tabs or other Care Recommendations sections.

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NOTE: Even if only one of the five subsections is completed, this will trigger the delivery of the Care

Recommendation to the ED. Therefore, you don’t need to complete all sections for the information to be

sent.

NOTE: Care Recommendation authors are encouraged to keep the recommendations up to date (e.g., review

and update guidelines every 3-6 months) in collaboration with a patient’s care team. Care Recommendations

remain viewable in a patient record for 18 months without updates. After that time, they are no longer sent

to the ED but remain attached to the patient’s record.

To add a Care Recommendation, click the button that says “Add ED Care Guidelines”

This is what it will look like once you click the button:

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Care Recommendations Section

This is a place to create a recommendation for how a condition should be treated or has been

successfully treated in the past. Or in other words, “Based on the above objective Patient

Background information, this is the recommended care for the patient…”

Simply click where it says “Care Recommendation” to create one.

What should be included in this section?

Patient goals for care

Team recommendations for how the ED should treat a patient when they present

Details about care the patient is currently receiving in an outpatient setting to help redirect them to the outpatient care

plan

Educational materials the patient has been given

Post-visit planning instructions

See example below for additional details

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Care Coordination Section

Use this section to provide an explanation of the coordinated efforts around a patient’s care.

NOTE: Members of a patient’s care team along with contact information should be listed in the Care Provider box

(explained above). The Care Coordination section here is intended to provide additional information about a

provider’s relationship with the patient. A good rule of thumb is you need to add context about a provider’s

relationship with a patient for entries in this section.


Details about the patient’s care team, i.e., who is considered the primary contact

Additional context about the relationship as appropriate, e.g., previous efforts to coordinate care for the patient

After hours contact details that aren’t included in the Care Provider box


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Pain Management Section

This is a place to provide a recommendation for how the patient’s pain should be managed,

including pain contracts, etc.


If the patient has an active pain contract with their PCP, this is a great place to reference the contract

If available, you can attach this pain contract to the patient record in the Attachments section

Mention appropriate pain medications and dosing in this section


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Helpful ED Interventions to Try

Use this section to provide a list of helpful interventions that have been successful in prior ED

visits.


Any helpful information you may have about previous ED interventions that have worked

Specific tips/strategies for interacting with the patient

See example below for additional details.

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Complete Patient Record

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Contact Information

For technical questions about using this Care Recommendations Template, please contact:

Dylan Barker

Client Relations Manager

Collective Medical Technologies, Inc.

http://www.collectivemedicaltech.com

Office: 385.351.3906

http://www.collectivemedicaltech.com/

tel:385.351.3906

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