8.3 Care Management Template Workflow Overview. Presented by Corporate Training

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1 8.3 Care Management Template Workflow Overview Presented by Corporate Training

2 Overview of KBM workflow Care Management Workflow Case and Consent Workflow

3 Agenda What is Care Management Who will use Care Management and why What do the Care Management Templates offer to the clients Overview of KBM workflow Care Management Home Template Case and Consent Case and Consent Documentation Tools Tracking Care Transitions Comp Assessment Functional Status Plan / Intervention

4 Care Management With the Release of the 8.3 users will be able to import the new Care Management template package. In this package, users will be able to access two new templates that allow them to provide better care for their patients.

5 What is Care Management? The new Care Management templates will primarily be utilized by clients that have a specialized need to coordinate and track in a single location all of the treatment and intervention efforts made for a patient by all providers involved in the patient s care.

6 Who will use Care Management and why? This will be essentially used by multispecialty clients that have a specialized need to have multiple healthcare professionals access patient data in one centralized location. The templates will allow each individual healthcare professional the opportunity to review and add data associated with a patient that may not fit the normal scope of health issues. Many times the patient may be dealing with chronic conditions or may be challenged by multiple illnesses. In these cases healthcare professionals need to collaborate in order to deliver properly coordinated and accurate care to effectively increase the overall health of the patient.

7 What will the Care Management templates offer to the client? Improve the quality of care as well as patient safety thus avoiding hospitalizations and re-admittance Increase staff efficiency by reducing the time required to develop a plan of care. Greater focus on patient goals, expected outcomes and establishes a clear and organized set of specific interventions that function together to improve patient care. Improve patient compliance to their prescribed care plans through enhanced communications while at the same time delivering greater insight into the current status of the patient population Faster times to critical intervention

8 Care Management Home Template

9 Care Management Home Page Care Management Home medical records template and associated popups are used as a central repository for patient care information available to all members of the patient care team. Using these templates and popups, users can define the team, enter and review referral information, define barriers to care, review the current care plan and track care plan progress and review all patient-related communications.

10 Care Management Home Template Currently users will navigate to the Care Management Home from the templates module on the history toolbar OR By selecting the *Intake Template Then selecting the Specialty Care Management and Visit type Care Management.

11 Care Management Home Template The Care Management Home Page consists of five sections Care Management Team Referral History Barriers to Care Care Plan History Communication Users should add a visit type and specialty when populating the template.

12 Care Management Home Template Care Management Team In this section users will be able add to define the team members that will be providing healthcare services to the patient.

13 Care Management Home Template Care Coordination Team This template consist of two sections Agencies Interdisciplinary Team

14 Care Management Home Template Care Management Team Both the Agencies and the Interdisciplinary Team sections of the Care Management Team use the same popup

15 Care Management Home Template Care Management Team (Agency Information) In this section users will be able define the agencies/ practice providing care to the Patient Agency type- Meaningful description of the type of services that the agency/practice provides, such as Pain Management, Dialysis and Physical Therapy Agency name- The name of the agency/practice Agency phone and Fax- phone and fax numbers used to contact the agency/practice NOTE: End-users can utilize the Common Phrases to populate fields. If the patient has any previous plan data, the data will be available for selection in the corresponding section under Previous Problems/Goals/Outcomes

16 Care Management Home Template Care Management Team (Interdisciplinary Team Information) In this section users will be able define the team members providing care to the Patient Name- this is the name of the team member or the provider caring for the patient Interdisciplinary team role- select the member role from the picklist Address-add the providers address Phone- phone number used to contact the team member or provider NOTE: In most cases each team member will have an entry on both sections. However, it is not uncommon to have agencies defined without having a specific provider identified or a provider who is not associated with a specific agency.

17 Care Management Home Template Care Management Team (Completed example) In this section users can see the agency and interdisciplinary team populated in the process of defining the team members providing care to the patient NOTE: user will add and define multiple team members.

18 Care Management Home Template Care Management Team (Completed example) Once the values are added to the popup they will populate the data grids below NOTE: user can edit the values by highlighting the desired value and selecting the edit button.

19 Care Management Home Template Referral History Users can review a list of all the referrals that have been issued for the selected patient. If necessary, users could add a new referral or updated an existing referral from this section.

20 Care Management Home Template Referral History By selecting the add button the users will launch the Referrals Order popup, users will follow the same process as the typical EHR workflow to create a new referral order.

21 Care Management Home Template Barriers to Care This section will allow the clinical personnel to document any issues that could impede the provision of care. For example, a patient could have a physical limitation such as a missing limb or social issues such as lack of transportation that may interfere with compliance to the care plan.

22 Care Management Home Template Barriers to Care By selecting the add button the Barriers To Care popup launches. Onset Date- Date that the patients physical discrepancy began Barriers to care- what the patient is suffering from that could deter successful care Resolve date- Date that the patients ailments diminished Status- current standing of the patients ailments Comments- Any clinical notes that would clarify the patients discrepancies

23 Care Management Home Template Barriers to Care Once values have been added users can filter them based on the status that was applied to the Barriers to Care popup

24 Care Management Home Template Care Plan History This section is typically completed on the Care Plan Homepage. If needed users can add or edit the care plan from this section. Users also have the capability to generate the Care Plan History document if needed.

25 Care Management Home Template Communication The Communication section allows users to view phone, and other contacts with the patient

26 Care Management Home Template Communication In order to add a communication value the user will have to select the type via the communication tool section on the left. Once the value is selected they can then select the add button to launch the associated popup.

27 Care Management Home Template Communication The users will then fill out the data according to the communication that takes place between the patient and the clinician. This is the same workflow used in EHR.

28 Care Management Home Template Communication Users can filter calls based on the status of the communication. Users will also find a numeric value to the right of the value in the communication section, indicating the number of communications per history topic.

29 Additional Workflows / Templates

30 Care Management Additional Templates Additional Care Management templates and associated popups are used as a central repository for patient care information available to all members of the patient care team. Using these templates and popups, users can document additional information such as: Care Transitions Comprehensive Assessments Functional Status Plans and Interventions

31 Care Management Care Transition Template Care Management Teams can document General Information Discharge Diagnosis s

32 Problem List after Discharge By selecting the appropriate check box ADL s Equipment / Supplies Home Care services Home Safety Medication Management Nutrition Pain Management Then free texting in the provide box

33 As well review or add problems to the patients chart.

34 Care Management Comprehensive Assessment Template General Recent ERH Visits Recent Hospitalizations Problems List Active and Managed Problems Care Plan History Medications Social Review of Symptoms Patient / Caregiver Concerns

35 CM Functional Status 8.3 Care Management Overview By clicking the add button additional features can be added by selecting the appropriate check boxes in each section.

36 CM Plan and Intervention Template Users can Review, add or edit Care Coordination Team Plan Interventions Problems or Goals Active and Managed Problems Care Plan History Care Coordination Education / or Recommendations Action Items Goals Documents

37

38 Case and Consent

39 Case and Consent Overview Additional Templates are available in which Coordinators can document Case and Consent data by utilizing the popups and menu items in the following Templates: Case and Consent Documentation Tools Tracking

40 Case and Consent Overview Case and Consent templates can be accessed by changing the Visit type to Case & Consent from the drop down menu or from the History Toolbar by selecting the Template Module directly.

41 Case and Consent Template Case and Consent Overview Consent Patient Consent can be documented on the Consent tab by adding in the appropriate data. Case History By Selecting the Add/Update button, additional data can be added to the Case History utilizing a Popup Menu. The data is then stored and will display in the grid below for review.

42 C & C Documentation Template Case and Consent Overview Additional information can be added on the Documentation template. Items such as Provider Interactions Telephone Call Interactions Face to Face Interactions Care Coordinator Interactions Documentation Generation of Care Plan Summary, Transition of Care, Comp Assessments and return visits

43 C & C Tools Template Screen Tools Case and Consent Overview

44 C & C Tracking Template Case and Consent Overview Allows the addition and review of Action Items by Care Team Members.

45 Questions?

46 Thank you

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