MA/Office Staff: Proposing Surgical Procedure Orders and PowerPlans (Order Sets)

Acute Surgical Procedure Orders and PowerPlans Affiliated MA/Office Staff: Proposing Surgical Procedure Orders and PowerPlans (Order Sets) This document walks you through: 1. Requesting a FIN (Financial Identification Number = encounter number) for your patient. 2. Opening the patient s chart; entering weight or allergy information if prompted. 3. Proposing procedure or surgery order; proposing phased orders (PowerPlans) if you have been instructed to do this by your physician. 4. Attaching a History and Physical document or Informed Consent document to your patient s icentra chart if your office s computers and EMR allow you the needed file access. 5. Viewing a provider s OR schedule. Requesting a Surgical Encounter FIN# 1. Office calls Intermountain Registration and requests a pre-registration FIN for their surgery patient. Intermountain Registration: 800-624-3972 (toll-free), option 1 OR 801-442-8818, option 1 Note: Registration will need the following information: Patient s name, date-of-birth, phone number, location for the procedure (for example: Utah Valley Main OR or MKD endoscopy), procedure, diagnosis or reason for procedure, insurance carrier, and ID number. 2. Intermountain Registration does a quick registration and the Registration staff will give the clinic the FIN#. The MA/Office staff must stay on the phone until the FIN# is given. 3. MA/Office staff relays the FIN# to the provider so orders can be placed or the MA/Office staff uses the FIN# to propose orders. Opening the Patient Chart and Entering Weight or Allergy information 1. From the home screen, in the upper right corner, click on the search field, noting whether the search parameter is set to MRN, Name, or FIN. 2. Modify the search parameter, if desired, by clicking on the small dropdown to the right of the search field; place the checkmark next to the desired search type. Enter the FIN# that was created for you in the step above OR type the patient s Lastname, Firstname into the field and press ENTER. 2018 Version 3.5 07/20/2018 Page: 1

If you entered the FIN directly into the search field, the patient s chart will open and you may proceed to Step 4. a. If you entered the patient s name, the Patient Search window will open. From the Patient Search window, verify that you have the correct patient highlighted in the top portion of the screen, and then highlight the recently created Pre-Reg or Pre-Admit FIN in the bottom of the screen. Remember to look for the appropriate location and service (e.g. surgery). b. With the correct FIN selected for the correct patient, click OK and the patient s chart will open. 3. If the patient does not have a current weight or allergies documented in icentra, you may see the Missing Weight/Allergies message/prompt. (If you do not see this message skip to the next section Entering a Surgical/Procedure Order, starting on page 3 of this document.) a. Click the Document button to document the necessary weight or allergies. If you do not have the information available, click Document, but then cancel charting in the next window to skip this step however, if there are medications with weight-based dosing in the PowerPlans entered for this patient, those medications will trigger an alert to reappear later for each medication. Best practice is to document the patient s weight and allergies at this point. b. If you clicked the Document button, the Height Weight Allergy Rule window appears (see image on the following page), where you can document the patient s height, weight, and allergies. 2018 Version 3.5 07/20/2018 Page: 2

c. Once the weight and/or allergies have been documented, click Sign (the green check mark that appears in the upper left corner of the window) to save your changes. Proposing a Procedure/Surgery Order and a PowerPlan (Order Set) 1. Click the Patient Summary menu item to view the Patient Summary screen, if it is not already displayed. 2. With the Summary tab displayed, navigate to the Procedure/Surgery Request component. Note: If the Procedure/Surgery Request component is not displayed on your screen, complete these steps: a. Click the Options icon on the far right side of the Patient Summary screen. b. Click the Components item in the dropdown menu. (Displayed components are indicated by the appearance of a checkmark next to the component item; components will remain displayed until you deselect them.) c. Click the Procedure/Surgery Request item to select and display the component. d. Move your mouse away from the menu to refresh your screen. 3. In the Procedure/Surgery Request component, click the Shared tab. 4. Below Shared is a search field showing Provider Last name, First name. Type in the name of the surgeon who is requesting the surgery. 2018 Version 3.5 07/20/2018 Page: 3

5. You should see at least one Common Procedure List folder and one My Plan Favorites folder. Select the Common Procedure List folder which correlates with the location where the surgery will be done. Note: This favorite folder must be set up in advance by the provider. 6. The folder will open to show you a list of the provider s Surgical Procedures done at that facility. These favorite procedures are linked to the unique Doctor Preference Cards used by this provider for that facility. (The Doctor Preference Cards are set up by the surgeon working together with the Surgical Services team at each OR location where the surgeon operates.) 7. Find the procedure that you need to order and click on the Order button to the right of it. 8. An initial Ordering Physician window will appear. a. Proposal is the default selection. b. Enter the ordering provider s name. c. Select a communication type of Signature Required (Route to LIP). d. Click OK. 9. The Orders for Signature box will turn green and show the count of orders you are proposing for the provider. You can add as many unique procedures as desired by the provider. 2018 Version 3.5 07/20/2018 Page: 4

10. Next, close the Common Procedure List by clicking on the blue word Favorites found just below the provider s name to return to the Favorites folders. 11. Select the folder My Plan Favorites. Select a PowerPlan (order set) to go with the procedure scheduling order by clicking on the Order button of the PowerPlan being requested. Note: This favorite folder is set up in advance by the provider when he/she saves favorite PowerPlans. 12. The green Orders for Signature box should now show 2 as the count of orders you are proposing for the provider. 13. Click the green Orders for Signature button. In the box that appears, click Modify to fill out the details which the OR scheduler will need to accept the procedure request. 2018 Version 3.5 07/20/2018 Page: 5

14. The Ordering Physician window appears. On the Ordering Physician window: a. Proposal is the default selection. b. Enter the ordering provider s name. c. Select a communication type of Signature Required (Route to LIP). d. Click OK. 15. On the next PowerPlan Routing for Signature window, confirm that the ordering physician is listed and click OK. 16. On the Orders screen, review the PowerPlan that has been proposed. Click Orders for Signature in the lower right corner to proceed to the next section. 2018 Version 3.5 07/20/2018 Page: 6

17. On the next screen, click on the name of the procedure order you ve just proposed OR click the Missing Required Details button in the lower left section of your screen. This will open up the order form. 18. If needed, click and drag the top of the order details form higher on your screen so you can see the full form. Fill in all the appropriate fields. Fields highlighted in yellow are required for placing the order. See the Order Details Field Explanations sheet on Page 9 for more information. **Please remember that the Additional Procedure Detail (Consent to Read) field needs to have the full name of the procedure(s), including laterality (i.e. right or left) with NO ABBREVIATIONS. 19. Next, click the Diagnoses tab and enter all applicable diagnoses. This can be done by description OR by code in the IMO search window. Note: The +Add button uses a different search engine and is not recommended for use by those in the MA/Scheduler or View Only roles. Use the IMO search window. 2018 Version 3.5 07/20/2018 Page: 7

20. Once you have completed entering the order details and diagnoses, click Sign in the lower right corner of your screen. (You may get an alert that the Check for Missing Details in a PowerPlan is incomplete. The signing provider will be reviewing the PowerPlan and entering any missing details, so you may simply click YES to continue signing.) 21. The proposed procedure order and PowerPlan are now routed to the provider s Message Center Inbox (proposed orders). Once the provider accepts the proposed orders, the signed procedure order is routed to the surgery scheduling request queue and the signed PowerPlan orders are ready for the lab, pre-admission nurses, pharmacy, and surgical nurse to initiate for the patient s care. The procedure scheduling process is now complete. 2018 Version 3.5 07/20/2018 Page: 8

Some Important Points to Remember: Surgical Procedure Orders and Power Plans Affiliated (cont.) The Procedure Order and the Power Plan may be proposed separately. (Some providers prefer to enter their own PowerPlans, rather than have them proposed by their office staff.) When proposing orders for a case with multiple procedures for one patient, choose the most complex procedure as the primary and choose its order from the Common Procedure List; add in all the codes for it and the other procedures you will be doing within the order details. For instance, if scheduling a Lap Appy, excision lesion, and a Chole, you would do one request, but put all three procedures in the Additional Procedure Detail field, and include the CPT codes for all procedures. o The exception to this would be if the procedures are in different anatomical areas or involve differing surgical approaches, which necessitates different equipment and setup in the OR. In these cases, you will choose procedure orders for each of the different anatomical areas/approaches. For example, EGD and Colonoscopy have separate approaches. If a surgeon is doing a combination case with another surgeon (such as an OB/GYN and an Urologist coordinating their surgeries for one patient), the more complex or longer case will be the primary case. This surgeon s office will call to obtain the pre-registration FIN, then communicate the pre-reg FIN to the other office. Both offices will use the same pre-registration FIN for their procedure orders. o The office with the primary case will send the PowerPlan. (There is no need for two PowerPlans, so the office with the secondary case need only send a procedure order and not a PowerPlan.) When a scheduled case (for which the orders have been signed and order status reads as Planned ) needs to be cancelled or rescheduled to another date, please call the OR scheduler to communicate this change. o If orders are still in a Proposed state and have not yet been signed off by the provider, they may be withdrawn (right-click on the order and choose Withdraw ) and re-proposed with any needed date or detail change. If a particular procedure is not found a the provider s Common Procedure List, an order for this procedure may be searched for and selected from the comprehensive order catalog (accessed from the Search New Order window in the Procedure/Surgery Request component. **Caution: be sure to NOT use any orders which have $$ at the beginning of the order name; these are billing orders for Intermountain-employed physicians. This process of looking in the Search New Order window for a procedure order should only be used in the RARE CASE in which your provider does not have a preference card for the procedure set up at the scheduling facility. If this procedure is to be performed more than once, the provider needs to meet with the OR Nurse Specialists to set up preferences (and thus have a Common Procedure List order created) for that procedure. Please contact the OR to convey the message that your provider needs to set up a preference card for this procedure. 2018 Version 3.5 07/20/2018 Page: 9

Primary Surgeon: Required Surgical Area: Facility for Procedure Primary Insurance: Name of Provider Authorization Number: If known, please fill in. Patient Type: Please provide this detail if known. It also drives inpatient only order 1. OP: Going home after surgery, won't be admitted 2. Same Day Admit: coming in day of surgery and will be admitted for 2 day stay 3. Extended Observation: admitted to the hospital and is typically known as 23 hr. stay or op in a bed. 4. In-Patient: Patient is admitted pre surgery Requested Start: Date you would like the case to be scheduled Primary Procedure: Choose Yes for the Primary Procedure. If additional Procedures are ordered, choose No for the additional procedures. Anticipated Anesthesia type: Required Additional Procedure Detail: Required, this should be the same description of the procedure used on the patient surgical consent, ex. Laparoscopic Appendectomy. Order Details Field Explanations Setup Duration: Not required Cleanup Duration: Not required Surgeon Assistant: Not needed if already included in the Special Instructions Field above. Surgical Resident: Not needed if already included in the Special Instructions Field above. First and Second Assistant: Not needed if already included in the Special Instructions Field above. Diabetic Patient: Yes or No Labs Done in Office and Results Sent? Yes or No Due to Device Recall? Yes or No Due to warranty issue? Yes or No AICD? If Yes, model #: If Yes, include Model number. Otherwise, No Pacemaker: Yes or No (This does not take the place of the form used within the OR) Post-Op Pain Management: If needed (ex. Place PCA Post-Op etc.) Insurance Contact Name/Phone: If this information is available please enter here. Special Instructions: Anything to be communicated to the scheduler or the OR regarding the case (ex. Rep name, Surgeon availability, etc.) Modifier 1-3: Not needed if already included in the Additional Procedure Detail Field above. Procedure Duration: Over time this will auto populate with the average time for this procedure. If not populated, please fill in with the number of minutes for the procedure. 2018 Version 3.5 07/20/2018 Page: 10

Attaching H&P or Informed Consent Documentation to the Patient s Chart 1. Select the correct patient FIN# to which you wish to attach the H&P or Consent Form. 2. Click on the +Add button to the right of the Notes menu option to begin adding the note. 3. Click the small Scan/Import icon in the Notes tool bar (when hovering with mouse it says, Scan/Import). 4. The Add Document window appears. a) In the Type field select the note type appropriate for your document. b) Do not change the Author field. Your name will populate in that field because you are generating the note to which the document is attached. c) In the Subject line, type the Date of Service for the History & Physical or Consent Form you are importing, then your provider s name; for example, 07/15/2018 John Smith, MD. (This is the appropriate location to note the author of the document you are importing.) 2018 Version 3.5 07/20/2018 Page: 11

5. Click the Import button in the lower right hand section of the window. 6. Select the location where your document is saved as a PDF or JPG file and select the file. This requires you to select the location on your Local Disk (C: ) that you are using. The first local disk C: is the icentra server disk and will not contain your files; select the lower Local Disk option. 7. Once the file is found and selected, click Open to attach it to the patient record. 8. Review the document to ensure you have attached the correct document. Once you have verified that it is the correct document, click Submit at the bottom of the window. 2018 Version 3.5 07/20/2018 Page: 12

Viewing a Provider s OR Schedule in icentra Surgical Procedure Orders and Power Plans Affiliated (cont.) 1. Log in to icentra PowerChart. Click on Ambulatory Organizer in the top tool bar. 2. Click on Patients for: No Resource Selected to search and select a provider s name. After checking the box next to a provider s name, click Apply to view the provider s scheduled cases. 2018 Version 3.5 07/20/2018 Page: 13