HOSPICE CTI Upon completion of the new referral, the workflow task Create/Edit Hospice CTI Order for Medical Director and Create/Edit Hospice CTI Order for Primary Physician are generated. For new admissions, both tasks will generate as a signature is required from both. If the MD is also acting as the Attending Physician, this will be indicated in the patient s referral during intake and will only generate a task for the MD. Note:These workflow tasks should not be processed until the SOC visit has been completed and synced back as that is when the verbal order information will become available. During the SOC visit, it is imperitive that the clinician completes the two coordination notes of Hospice Verbal Certification Medical Director and Hospice Verbal Certification Primary Physician before completing the visit. If the patient s Medical Director and Primary Physician are the same, the clinician will just complete the coordination note for the Medical Director. Each note includes a template that prompts the clinician to gather the required information (MD giving verbal certification and date verbal certification received):
PROCESSING HOSPICE CTI WORKFLOW NEW ADMISSIONS CREATE/ EDIT HOSPICE CTI ORDER 1. Double click on task of Create/Edit Hospice CTI Order for Medical Director or Create/ Edit Hospice CTI Order for Primary Physician to open it. Before processing this task, you must confirm that the attending physician listed on the order is the same attending physician that the patient has indicated in their signature form. Note: It is recommended that these tasks be processed by the clinical manager of that patient. Note: These tasks will be processed the same way. 2. Your only option is to Obtain Hospice CTI Order. By selecting this, you are agreeing to creating a CTI order in HCHB that will be tracked from this point moving forward, therefore, these workflow tasks should not be end- staged regardless if a signature is required or not. You will be prompted with the below message. Click Yes to proceed: 3. The next step is to edit the Order Description to include the Verbal Order that was obtained by the clinician. To do this, click on the Review Coordination Notes button at the bottom left corner of the order window.
4. This will allow you to access all coordination notes for the patient. Select the coordination note that was created by the clinician during their SOC visit to view the details. Click the Copy Note Details and Date/ Time to CTI Order button to copy the contents of the note and date/ time the note was taken to the CTI order. Select OK to the message that follows, then close. 5. You will now be able to see the contents of the coordination note copied into the Order Description of the CTI Order. The date and time at the top of the order window will also be updated to reflect the actual time the verbal order was received:
6. There have been asterisks placed in the verbal order text that will need attention: If the verbal order is for the Medical Director, you will need to remove the text in between the asterisks as this applies to the attending physician only. If the verbal order is for the Primary Physician, you will need to remove the asterisks only and leave the physician agreement statement
7. Since this order was received verbally by the nurse, you will need to indicate that it was read back to the Physician / Agent of Physician. This is in the top right corner of the orrder window. Use the drop down menu to change the N to a Y. 8. If the Narrative note is going to be completed by the Attending Physicain, rather than the Medical Director, you may check the box labeled Require Primary Physician s Narrative on this Order? It will add a narrative box on the order similar to the order of the Medical Director 9. Save your changes and then complete the task. The next task, Review/Edit/Approve CTI Order will automatically generate in the workflow console
REVIEW/ EDIT/ APPROVE HOSPICE CTI ORDER 1. Double click on task of Review/Edit/ Approve Hospice CTI Order to open the task 2. At this time you will review the order, make any edits if needed, then approve it. Any time edits are made, you will be required to review the order one more time before you can approve it. By reviewing the order, you will see the exact order that the MD or Attending Physician will be signing. Check for the appropriate date and time, name of MD or Attending Physician and order content. Compare the SOC date to the date on the order. Remember: The verbal order needs to be obtained 15 days prior or 2 days after the SOC for new admissions. Below the oder description is where the physician will write his narrative note. If the order is being process via website or IDG, this narrative note along with the signature will be obtained electronicly. If the order is processed on paper, the narrative note and signature will be obtained on paper. 3. If any edits are needed, close the report and select Edit Order. Make the appropriate edits and save your changes. Don t forget to review the order one more time before approving it. 4. Once the order is ready for approval, select Approve Order on the workflow task. The task to process the order to the physician will generate for the medical records responsible position.
PROCESSING HOSPICE CTI WORKFLOW RECERTIFICATIONS CREATE/ EDIT HOSPICE CTI ORDER FOR MEDICAL DIRECTOR Only one CTI order is required for patients that are being recertified for hospice care, therefore, only one task will genereate to obtain the CTI for the Medical Director. This task will generate simultaneously with the Review/Edit/Approve Hospice Recert Order task (13 days before the end of the benefit period). 1. Double click on task of Create/Edit Hospice CTI Order for Medical Director to open it. Note: It is recommended that these tasks be processed by the clinical director of that patient. 2. Your only option is to Obtain Hospice CTI Order. By selecting this, you are agreeing to creating a CTI order in HCHB that will be tracked from this point moving forward. You will be prompted with the below message. Click Yes to proceed: 3. The next step is to edit the Order Description to include the Verbal Order that was obtained by the clinician. To do this, click on the Review Coordination Notes button at the bottom left corner of the order window.
4. This will allow you to access all coordination notes for the patient. Select the coordination note that was created by the clinician during their Recert visit to view the details. Click the Copy Note Details and Date/ Time to CTI Order button to copy the contents of the note and date/ time the note was taken to the CTI order. Select OK to the message that follows, then close. 5. You will now be able to see the contents of the coordination note copied into the Order Description of the CTI Order. The date and time at the top of the order window will also be updated to reflect the actual time the verbal order was received:
6. Since this order was received verbally by the nurse, you will need to indicate that it was read back to the Physician / Agent of Physician. This is in the top right corner of the orerder window. Use the drop down menu to change the N to a Y. 7. There have been asterisks placed in the verbal order text that will need attention: a. If the verbal order is for the Medical Director, you will need to remove the text in between the asterisks as this applies to the attending physician only. b. If the verbal order is for the Primary Physician, you will need to remove the asterisks only and leave the physician agreement statement
8. Save your changes and then complete the task. The next task, Review/Edit/Approve CTI Order will automatically generate in the workflow console.
REVIEW/ EDIT/ APPROVE CTI ORDER 1. Double click on task of Review/Edit/ Approve Hospice CTI Order to open the task 2. At this time you will review the order, make any edits if needed, then approve it. Any time edits are made, you will be required to review the order one more time before you can approve it. By reviewing the order, you will see the exact order that the MD will be signing. Check for the appropriate date and time, name of MD and order content. Compare the certification period (found on the order) to the verbal order date on the order. Remember: The verbal order needs to be obtained 15 days prior to the first day of the new benefit period for recert patients. Below the oder description is where the physician will write his narrative note. If the order is being processed via website or IDG, this narrative note along with the signature will be obtained electronically. If the order is processed on paper, the narrative note and signature will be obtained on paper. 3. If any edits are needed, close the report and select Edit Order. Make the appropriate edits and save your changes. Don t forget to review the order one more time before approving it. 4. Once the order is ready for approval, select Approve Order on the workflow task. The task to process the order to the physician will automatically generate for the medical records responsible position.
PROCESSING CTI ORDERS Once the CTI order has been created and approved by the Clinical Manager, the Medical Records Specialist will be responsible for processing the order out to the physician for signature Process New Hospice Order to Physician. There are several different ways that the order can be processed to the physician. The task will let you know how the physician prefers their orders delivered to them, although, the user can change the method of communication if needed. Note: It is recommended that the selected method be Interface which is equal to Hospice IDG to ensure all orders available during the IDG meeting for the physician to sign. This will also allow the physician to create one narrative for both the CTI and IDG note, creating effiency and saving time. These options include: Fax Deliver Mail Website (Provider Link) Interface (Hospice IDG) Note: It is recommended that these tasks be processed by the medical records specialist Note: If your agency is set up to use auto fax, and the physician office is set to receive new order notification via Fax, the task to Process New Hospice Order to Medical Director/ Primary Physician will not generate and the order will automatically be faxed to the physician office Note: If the physician is a Provider Link user, and their office is set up to receive new order notificiations via Website, the task to Process New Hospice Order to Medical Director/ Primary Physician will not generate and the order will automatically be sent to Provider Link for signature
EDITING PREFERRED ME THOD OF COMMUNICATION To edit the physician s preferred method of communication, you will need to access the physician table throught the Orb in HCHB. Only certain people at the branch level will be able to access this table. 1. From the Orb, select Clinical Manager then Maintain Physicians. You will be required to either enter in the physician s name in the table, or you can select the magnifying glass by the search bar to pull the entire list of physicians to the column on the left. 2. Highlight the physician you would like to edit, then select Edit at the bottom of the widow. 3. You will now be able to make edit s the physician s profile in HCHB. Find the field labeled Notify New Orders Via and use the drop down to select the new preferred method of communication. Interface=Hospice IDG.
4. Once you have edited it at the physician level, you will need to make edits to each of the offices as well. Using the plus sign next to the physicians name, you can maximize the information to find the branches tied to this physician. Highlight the branch and update the Notify Orders Via using the drop down menu list. Interface=Hospice IDG.
SIGNING CTI ORDERS IN IDG The Medical Director may write narratives for the CTI and sign the CTI through the IDG console if that s how the order was processed. In the IDG console, you will see patients listed that have Open or In Progress meeting status. You can sort any column by clicking on the column header, or you can search by using the filters on the left. 1. Have the medical director sign into HCHB using their login credentials. Once inside the IDG console, they will need to find the correct patient and highlight their name by clicking once. Using the menu options at the bottom of the IDG console, the medical director can select Review/ Approve Unsigned Orders. If the button is grayed out, that means there are no orders that are ready to sign. 2. In this window, you will be able to see all unsigned orders for the Medical Director. Any unsigned CTIs will show here, as well. Before signing the CTI, the Medical Director should add the physician narrative to the order. To do this, highlight the CTI order in the grid above. You will see the Order Description populate in the Order Description box. Using the menu options at the bottom of the window, select Add Physician Narrative.
3. You will now see a text box where the physician will enter in the narrative note for the CTI: 4. After the narrative note is complete, select Save at the bottom of the window 5. The order is now ready to sign. Using the menu options at the bottom of the window, select Sign Order Note: The physician will not be able to sign the CTI order if there is an outstanding F2F in HCHB
PROCESSING SIGNED ORDERS INTO HCHB ELECTRONICALLY SIGNED ORDERS All orders that are signed electronically through the IDG console or the physician website will automatically be updated as signed in HCHB. 1. Below is an example of a CTI order that was signed electronically. Notice how the narrative note is included directly on the order. Also notice how the signature includes a notation of (electronically signed). It is not required for the medical records specialist to process this order back into HCHB.
ORDERS SIGNED ON PAPER Any orders that are not electronically signed through the IDG console or the physician website will need to be processed back in as signed manually. 1. To process an order back into HCHB, you will need to access the order through the Order Console. In the Order Consle, find the patient and the particular order that you are processing and highlight it by clicking it once. Using the menu options at the bottom of the Order console, the medical records specialist can select Process. 2. Using the drop down menu options, select how the order was sent (ex: Deliver or Mail) 3. Using the drop down calendar, you can select the date the order was signed by the physicin 4. For CTI orders, you should check the box labeled Physician Narrative on Paper indicating that the physician completed their narrative note on paper 5. Once the order has been processed back into HCHB as signed, scan and attach the order to the patient s medical record Note: It is recommended that these tasks be processed by the medical records specialist
CTI WORKFLOW