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Tracking and managing referrals Advanced training
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Revised October 2015, version 5.3.108
PS Suite EMR® software and related products and services are owned by TELUS. PS Suite EMR® and TELUS Health™ are trademarks of TELUS.
The patients, physicians and circumstances depicted within this manual are fictitious. Any resemblance of any sample data or screenshots to any actual person, whether living or dead, is purely coincidental and unintentional.
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Table of Contents
What is referral tracking? ............................................................................. 4
Referral process – physician steps ............................................................... 5
Starting a pending consult ..................................................................................................... 5
Completing and sending the referral letter .............................................................................. 7
Update the referral to indicate that the letter has been sent .................................................... 9
Referral process - referral staff steps .......................................................... 11
Setting up your dashboard for referral tracking (one-time step) ............................................. 11
Tracking tasks for new referrals ............................................................................................ 12
Updating referrals ................................................................................................................ 12
Completing/finishing a referral .............................................................................................. 15
Auto-completing a referral ........................................................................................ 15
Manually completing a referral .................................................................................. 17
Viewing completed referrals ................................................................................................. 17
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What is referral tracking?
In many medical offices, ensuring that patients attend specialist appointments is an integral office process.
In the paper charting world this often involves complicated manual tracking solutions.
Using the Referral Tracking widget and pending consults makes tracking referrals easier than ever!
Referral tracking allows you to effectively track all outgoing patient referrals to specialists, consultants, or programs in one easy to manage place.
Patients appear in the referral tracking widget when a pending consult has been started in their record. As actions toward a referral are completed and the associated pending consult is updated, patients automatically move from one list to the next in the widget.
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Referral process – physician steps
With most clinic workflows, a physician will initiate the referral in a patient’s record. This is because:
a) Referrals typically require that a letter from the physician be created before any other actions can occur. In starting a pending consult the physician will be able to start a letter and send a message to the referral staff, all in one window.
b) The physician will be able to immediately update the pending consult on the status of the referral letter.
Starting a pending consult
1. Navigate to the patient’s chart and click Data > Pending Test or Consult (Ctrl {Cmd} + K).
2. Click on the Consultations tab and click to select the appropriate specialty on the left side of the window.
3. Specify the specialist for whom the referral is for by typing the consultant’s name or specialty into the Consultant’s Name field and press Tab
■ If you do not know the name of the consultant (i.e. your staff usually determines this based on availability) then leave this field blank
If the name you define in the Consultant’s Name field does not produce any matching results but you know that the consultant is in your Address Book, then type only the first few letters of the consultant’s name or type the consultant’s specialty. Pressing Tab will then present more search results from the Address Book.
4. If you have not yet started the letter for the referral, select Create Letter to start one automatically
Sending messages
To notify staff who are involved in the referral process that a referral has been initiated, select an individual or messaging group in the drop-down beside the Add with Message To button.
■ This message can be the trigger for staff that the referral letter is complete and ready to be sent. If you will be sending the letter yourself, and there is no immediate action required by staff, then there may be no need to send a message.
■ You may even consider sending yourself a message (acting as a reminder) if you have additional tasks that need to be completed before the referral can be sent.
■ The message subject is always defaulted to Make Referral
You can send a message to multiple users by typing their initials individually, separating each with a comma.
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If you do not need to send a message, click Add.
Editing the body of the message: the text area in the center of the Pending Tests and Consults window contains the default text for the body of the message. You will notice that the space automatically contains the consultant’s contact information; however you can delete, add, or modify text in this field to create your own message. E.g. “this is an URGENT request”, or “Please attach ultrasound from paper chart before faxing”.
1. Click Add with Message To to send the message.
2. The Pending Tests and Consults window will remain open so that additional tests or consults can
be ordered if desired.
3. Click Done.
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Do not “green-bar” the letter itself as this will result in two copies being faxed or printed.
Completing and sending the referral letter
Within the patient record you will now see a pending consult entry (appears in green text), the beginning of a letter, and “Make Referral” message(s) (if you chose to send any).
Click within the started letter and complete it as usual.
onsider making and using a referral letter stamp to save you time.
Printing or faxing the referral letter
Select any notes/documents to be sent with the referral letter by clicking the checkbox to the left of the note date. This will produce a green bar beside the selected attachments.
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If you are attaching scans (paperclip icons) ensure that you select the option to Include Printable Attachment of Notes.
Printing:
1. Click anywhere within the letter
2. Go to File > Print (Ctrl {Cmd} + P)
3. A print dialog window appears providing other attachment options to include with the letter.
4. You have the option to either Print (immediately) or Print Later.
■ Print Later will allow a staff member to print the referral with the attachments you indicated with green-bars.
■ Later, when you are ready to print, click within the letter and go to File > Print. You will then have the option to print with the previously saved attachments
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Faxing:
1. Click anywhere within the letter
2. Go to File > Fax (Ctrl {Cmd} + Shift + F)
3. Similar to printing, a fax dialog provides other attachment options
4. As with printing, you also have the option to either Fax (immediately) or to Fax Later.
■ When Fax Later is selected all selected attachments are saved.
■ Later, when you are ready to send a fax, click within the letter and go to File > Fax. You will then have the option to fax with the saved attachments.
■ Use case: this is common in the case were you may not know which specialist the letter will be going to (e.g., you don’t know which specialists can accept new referrals). You therefore complete the letter, select the necessary attachments and send a message to the staff to define the addressee, and fax.
Update the referral to indicate that the letter has been sent
1. Double-click on the pending referral entry (appears in green text) to open the Change Status window for the pending consult
2. Click to select Referral Letter Completed and Referral Letter Sent (if you sent it).
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Notice how notes are automatically added to the Test History section of the Change Status window with date/time stamps indicating when you completed each action.
3. Click Change This Test/Consult to save changes
This patient will now only appear in the Referrals to Book list within the Referral Tracking widget
Practise: physician steps – starting referrals Start a pending consult
1. Open a test patient record and go to Data > Pending Test or Consult (Ctrl {Cmd} + K)
2. Click the Consultations tab.
3. In the Consultant’s Name field start typing a specialist’s name or a specialty and press Tab to pick from a list of matches from your Address Book.
4. Click Create Letter.
5. Type your initials in the field beside Add with Message To.
6. Click the Add with Message To button to complete the pending consult.
7. Click the Done button to close the window.
Complete and print letter
1. Click within the started letter and complete the body of the letter.
2. Select one or two notes and/or forms to print with the letter by clicking the box beside the note date
3. Press Ctrl {Cmd} + P to print
4. Click Print Later.
Update the pending consult
1. Double-click the pending consult in the patient record (appears in green text).
2. Click Referral Letter Completed.
3. Click Change This Test/Consult.
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Referral process – referral staff steps
After a physician starts a referral you will be notified in two ways:
1. A “Make Referral” message will appear in your inbox (if the physician chooses to send you a message with any immediate tasks to complete. E.g. “Letter ready to be faxed”)
2. The Referral Tracking widget on your dashboard will update with the new referral being added to a list depending on the status of the letter.
Setting up your dashboard for referral tracking (one-time step)
The Referral Tracking widget of the dashboard is the best way to view all outstanding pending consults. You can also set up your Message Subject Summary dashboard widget to list all outstanding “Make Referral” messages. In having both widgets displayed, you will be able to easily track all referrals as well as any immediate tasks that need to be completed for them.
Setting up the Referral Tracking widget
1. From the main toolbar, click Dashboard
2. If you have never used your dashboard before a + button will appear. Click it to view options for widgets you can add.
3. Click Referral Tracking to activate it as a widget.
4. Click the blue ‘i’ button in the top left corner of the widget to view its’ configuration options.
5. Click Uncheck all Items then click to select all physicians whose referrals you will be managing and other referral staff you work with.
6. Set Ignore referrals acted on in past … days to “0”. This will ensure that your dashboard will update soon after any changes are made to referrals within your group.
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Set up dashboard to view “Make Referral” messages
1. Click Message Subject Summary to activate the widget in your dashboard.
2. Click the blue ‘i’ button in the top left corner of the widget to view configuration options.
3. A drop-down menu allows you to choose which message subject to display in the widget. Select Make Referral.
Tracking tasks for new referrals
Each message in the Make Referral widget represents a referral that requires some sort of action from you.
Double-click on a message to go directly to the patient’s record. Make note of any special instructions the physician may have put in the message for you.
If the referral letter displays “Faxed on” or “Printed on”, the letter has likely already been sent.
Printing or faxing letters (if required): see the section on “Printing or faxing the referral letter”.
If you or your physician(s) send a fax, you can monitor the status of that fax through the Fax Control Panel (from main toolbar go to File > Utilities >Fax Control Panel).
If you need to complete more tasks for the referral then append the “Make Referral” message to note what needs to be done. This will help you to track your work.
As soon as you have completed your tasks for the referral you can now archive the message to remove it from your “to-do” list
■ Either click Archive (if you would like to add a final note before closing) or Quick Archive to archive it immediately.
Updating referrals
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Notice that notes are automatically added to the Test History section of the Pending Consult Change Status window with date/time stamps indicating when you completed each action.
Indicating that letter has been sent
Once the letter has been successfully sent, double-click on the pending consult entry in the patient’s chart (appears in green text) and select Referral Letter Sent. This option may already be selected if the physician sent the letter themselves.
Each status listed in the Referral Tracking widget of the dashboard coincides with the checkboxes in the Pending Test window.
The patient will now no longer appear on the Letters to be Sent list of the Referral Tracking widget.
Tips for quickly finding pending consults in a patient’s record
Often, weeks or months down the line after a pending consult has been created it becomes challenging to find the consult in a patient’s record to make updates. With consults simply appearing as small chunks of green text, they can easily get lost amongst numerous lab results, custom forms, progress notes, letters, etc.
■ To filter a patient’s record to only display pending tests/consults, press Ctrl{Cmd}+3 and type “pending” in the box that appears
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■ If you have numerous pending tests/consults in a patient’s record and even after filtering the list you find it difficult to find the desired consult, then open the Table of Contents (Ctrl{Cmd}+Shift+T) and click the desired consult. This will take you to that consult in the chart.
Recording and notifying patients of consult booking times
When you receive the date back from the consultant, you can either search for that patient’s record directly, or select them from the Referrals to Book list in the Referral Tracking widget.
1. Find the appropriate pending test in the record and double-click it to open the Change Status of Pending Test window.
2. Click to select Test/Consultation Booked.
3. Right-click on the date field to select the booking date from a simple calendar.
4. Enter the time of the consultation.
5. If you have notified the patient of the appointment, then click to select Patient Notified. Otherwise, leave this unchecked and the patient will appear on the Patients to Notify list in the Referral Tracking widget.
The booking date and time now appears in the pending consult notes within the patient record for easy reference (e.g. when a patient calls back for a reminder on when their appointment is).
To find all patients who have not been notified, double-click Patients to Notify in the Referral Tracking widget. Double-clicking on the patient’s name in the search results will take you directly to that patient’s record.
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Continuing to track and manage further information and tasks for the referral (as needed)
You can rely on the Referral Tracking widget to track the progress of all referrals. Simply double-click any of the statuses listed and you can view the list of corresponding patients.
■ Each list can be sorted by clicking a specific column header to sort by that column.
■ To aid in categorizing your referrals, consider modifying the consult details of the pending referral. If your list becomes long and finding specific types of referrals becomes hard, then clicking to organize the list by Consult Details will help if consistent information is added.
You can use the Action buttons in the Change Status of Pending Test window to easily record details in the Test History of that pending test. E.g. to indicate that a message was left for patient, that more information was requested from the clinic etc.
Tracking significantly outstanding referrals
Referrals that have been outstanding for an extended period of time can be managed by double-clicking a status within the Referral Tracking widget and then clicking the column header for Days Overdue to sort by that column.
Completing/finishing a referral
Auto-completing a referral
PS Suite EMR has been designed to auto-complete referrals if specific conditions are matched.
When you receive the consultation report back from the consultant (either via paper which is then scanned, or via fax) you will process it using the Manage Received Documents interface (File > Manage Received Documents).
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For the pending consult to complete automatically, the report category specified must match the consult specialty specified in the consult. It is important that staff are trained to know what categories need to be specified for specific consult reports.
As part of this process you will categorize the report. When the software detects that a report has been entered with a date on or after the consult booked date and categorized with the same category as a pending referral, it will automatically mark the entry as complete. When the pending consult is complete, the text turns from green to black and the note will be collapsed going forward.
The diagram below demonstrates the links between the modules of the software:
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Manually completing a referral
In cases where you do not expect to receive a report back, referrals have to be mark completed (or closed) manually. In some clinic workflows a referral is considered “complete” as soon as the referral letter is sent.
1. To manually complete a referral, double-click the pending consult to open the Change Status of Pending Consult window.
2. Click either Completed or Cancelled (depending on the circumstance).
Viewing completed referrals
As soon as a referral has been completed, it is automatically collapsed in the patient record and the text colour changes to black. If you want to review the details, from the patient’s record go to View > Show Completed Pending Tests.
You will notice that all of the patient’s completed pending tests/consults automatically expand. These consults are still displayed in black and display the word Completed on them so as not to be mistaken for open pending consults.
Double-clicking this expanded text will open the Change Status of Pending Test window where you can see the details. You even have the ability to reactivate the pending consult by clicking Active in the Change Status window.
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Practise: referral staff steps - managing referrals Indicate that letter has been sent
1. From the Referral Tracking widget of the dashboard, double-click on Letters to Send
2. Double-click your patient’s name on the list to open their record.
3. Find the pending test and consult: press Ctrl {Cmd} + 3 and type “pending” or double-click on the pending test from the Table of Contents.
4. Double-clinic the green text to open the pending consult.
5. Click to select Referral Letter Completed and Referral Letter Sent.
6. Click Change This Test/Consult.
Note booked appointment details and record actions to contact patient
1. From the Referral Tracking widget double-click on Referrals to Book.
2. Double-click your patient’s name on the list to open their record.
3. In the patient’s record find the pending consult and double-click the green text to open it.
4. Click Test/Consultation Booked checkbox.
5. In the Scheduled Date field right-click to select date from a calendar.
6. In the Actions area, click the Record Note button.
7. In the Notes field that appears, type “Left message”.
8. Click the Post button.
9. Click Change This Test/Consult to save.
Notifying a patient
1. From the Referral Tracking widget double-click on Patients to Notify.
2. Double-click your patient’s name on the list to open their record.
3. Find the pending consult in the patient’s record and double-click the green text to open it.
4. Open the demographics section of the record to access the patient’s contact information - press Ctrl {Cmd} + D or single click on the patient’s name.
5. Click on the Patient Notified checkbox and Record Note if you need to add additional information.
6. Click Change This Test/Consult to save.
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Please take the time to complete the following questions.
1. A patient calls in asking when their cardiology appointment is. What is the quickest way to find this information?
2. Once a consult has been marked as completed you can no longer see all the Action notes that were created for that consult T/F
3. What is the keyboard shortcut to start a new consult?
Viewing Referral Tracking lists – organize by column
1. From the Referral Tracking widget, double-click on Referrals to Book.
2. Click the header for Days Overdue; notice how the list is now organized by number of days overdue.
Manually complete a referral
1. From the Referral Tracking widget, double-click on Results Overdue.
2. Double-click your patient’s name on the list to open their record.
3. Verify that a consult letter has been received from the specialist.
4. Find the pending consult in the patient’s record and double-click the green text to open it.
5. In the Pending Test/Consultation Activity section, select the Completed radio button.
6. Click Change This Test/Consult to save.
