ccLink

I'm not sure yet how the ccLink portion of the wiki will be configured (just like we all wonder how ccLink will be working for us). So the format of pages may be in flux.

ccLink Ambulatory Pediatrics SmartStuff (this shows the names of smartSets for peds and some tips autism, ADHD and obesity referrals) ccLink Newborn SmartStuff ccLink Public Health toc =General Tips on ordering labs=


 * When ordering labs on patients you are seeing in clinic, please order the labs within the open encounter, **to avoid a second registration being created**. If after you close an encounter, you decide to order labs, then as long as you are ordering the labs before midnight on the date the patient was seen, order the labs under an "Addendum" (i.e. double click on the patient on your schedule)
 * If you are ordering labs for a patient who is NOT/has NOT been seen that day, then do an "Orders Only" encounter (under "Epic" menu, select "Patient Care" and select "Orders Only")

=OB Visit Navigator=

Per Rajiv, here is how to access the OB Navigator from any visit type:. 1) When you are ready to create your encounter for the patient, double click on the patient on your schedule. 2) In the bottom left corner of the screen, click on the "More Activities" button. Additional options appear 3) Choose the "Initial Prenatal Visit" option

Tai's addendum: to look at prenatal labs, try the following: 1. When you are in the Schedule View (i.e.if you look on the top row, there is the "Epic" button, then "Home" then "Schedule". Click on "Schedule"), click at patient in your schedule (don't double click, that will open an encounter!) and look at that patient's SnapShot. 2. Just above Snapshot, there is a place in upper right where you can enter a different "Report" to view. One of the options is "OB Pregnancy Episode". You can use the Wrench icon to add this as one of your available default Snapshot views. This "OB Pregnancy Episode" snapshot lets you look at prenatal labs.

=Prior authorizations= Thanks to Courtney for this tip. If you need to do a prior authorization on a patient who is NOT present for an encounter: 1) Do "Orders only" (under "patient care", which is under the "Epic" menu) 2) Enter "**Perform Rx"** and the PA pops up

=Schedule colored dots=
 * Green : Patient is ready for provider
 * Blue : Patient is ready for medicines or treatments or discharge from MA/nurse
 * Yellow : Resident needs preceptor
 * Red : Patient is discharged, and provider can close encounter

=SnapShot=

Family Comments
This is a good place for entering information about family members or significant relationships of a patient in a more free text manner than is allowable under "Family History". However, it does not appear that previous versions are saved. So whatever is entered, someone else can erase or edit.

=Visit Navigator=

Medical History
Kim Haglund states (I haven't verified this yet) that comments you put in Medical History do not consistently migrate to the Problem List if you tell ccLink to add the item to the Problem List.

Family History
The default "Cancer" as an item in "Family History" is not useful. If you wish to add a specific kind of cancer, e.g. "colon cancer" or "breast cancer", enter in the little box above, and it will be added to the long list of available options in the grid.

If you want to enter comments for one of the checkboxes, *right* click.

Medicines
If a medicine is not in the ccLink database, then a workaround is to enter it as "Unable to find". In the "Instructions" area of that medicine, you can enter the medicine's name, and that will appear in the list of medicines.

Problem List
Per Jan Diamond and others, you need to enter diagnoses with 2 (?) digits after the decimal point, or else it will be rejected and you cannot close your encounter.

The "Patient Coordination Note" might seem like a good place for entering information about a patient's health that does not fit nicely into the "Problem List", since the Problem List forces one to use problems with ICD-9 codes. Unlike "Family Comments" (see above), it appears previous versions are saved. **However, the "Patient Coordination Note" appears in the AVS!! So use with caution.**

Remember that a Problem can be filed to the History by clicking on the "File to History" button (keyboard short cut "Alt H" -- though that keyboard short cut sometimes does not work).

In the Problem List, you have the option to change the "Display Name" for an item, i.e. what actually appears in the problem list. For instance, if a patient might have depression but you are not certain yet about the diagnosis, you could tell ccLink to display "Depression?".

If you cannot find the proper "Problem" in ccLink to match something going on in your patient, another option is to list the problem as "Unknown and unspecified cause of morbidity". At a later point, when you determine the proper diagnosis, you can remove that.

You can also use the following lists you help you find the most common Family Practice diagnoses: Short List: @http://www.aafp.org/fpm/icd9/icd9-short.pdf The Long List: @http://www.aafp.org/fpm/icd9/icd9-long.pdf

=External referral=
 * 1. Referring provider places an order for an external referral in the "Meds and Orders" section of the encounter.** If making a referral outside of a face to face encounter create an "order only encounter." Most referrals start with the words "amb ref" so if you type this into the order box you will see a list of all possible referrals. Make sure you mark the referral as "external."
 * 2. When the provider signs the referral, the request is sent to CCHP.** CCHP reviews the referral and either approves or denies the referral.
 * 3. CCHP mails the patient a notification of the approval or denial with the authorization number if approved.**
 * 4. CCHP sends a copy of the referral with the authorization notice to the contracted referral specialist.** This contains all the information about the referral, including which specialty, the time frame requested, and the clinical information regarding the reason for the referral.
 * 5. CCHP also sends a notification to the inbasket of the referring provider.**
 * 6. Two copies of the referral are automatically printed at the referring clinic site.** This again contains all the clinical information about the referral. One copy should be given to the patient to hand carry to the referral site. The other copy should be sent to the care coordinator so they can track the referral and send any additional relevant information such as pertinent medical records. The referring provider can print out specific parts of the chart or indicate with a note to the care coordinator what information to send along once the referral is approved and the specific referral site to send the information is identified.
 * 7. Non-CCHP referrals (i.e. straight Medicare or Medi-CAl) are handled the same way.** At the current time the request goes to CCHP which will approve the referral in ccLink to prevent confusion and the patient thinking the referral was denied, although CCHP will not be covering the referral. The patient can hand carry the printed out referral to the specialist they find who accepts their coverage, and/or the care coordinator or nursing staff of the referring site can fax the referral form if they are facilitating the referral appointment.

=Resident-specific tips= A *temporary* solution is the following. This will likely change and be optimized in the future.
 * Co-signatures on charts**

1) Resident goes to "Follow-up" portion of Visit Navigator and enters preceptor name as a recipient of the chart in the "Send Chart Upon Leaving Activity" section, which may be visible only if you click on the blue-text "Expand" 2) Preceptor receives in In Basket, in the "CC'd chart" folder, a message. The message is the AVS. 3) Preceptor can review that note. If the note is fine as is, preceptor is done (since everything we do in ccLink is recorded, then, in my opinion, that is essentially equivalent to "co-signing" the note). 4) If preceptor wants to add a note, he/she when looking at the message in the In Basket clicks on the "Enc" button. ccLink will ask whether to create an addendum. Click "yes" 5) Preceptor can write an additional note, order new meds and labs, etc., and then sign the addendum.

1) Prior to closing the encounter (or else the new medicine orders will NOT appear properly on the AVS), the resident verbally tells the preceptor that there are prescriptions to co-sign. 2) The preceptor looks on the resident's schedule (see the postscript if you want detail on how to add other providers' schedules to your schedule view) and clicks on the patient. 3) Preceptor clicks on "Order Entry" (or faster yet, types "Alt-O") 4) Preceptor clicks on "Sign/Nav" (or faster yet, types "Alt-G")
 * Co-signatures on meds** (for unlicensed residents)

=Very specific tips=

>> orderables.
 * For gastro procedures, do "ambulatory referral to gastro procedures" In the "reason for consult", indicate the procedure you want and the indication. You will be prompted with the sedation risk questions.
 * For flex sig, until the smart set is done, instead:
 * order "amb ref sig"
 * Put "Flex sig" instructions into "Patient Instructions"
 * order the mag citrate (2 10 oz bottles)/ bisacodyl (4 of the 5 mg tabs) prep
 * For an open MRI, order an MRI and indicate the reason why you want it open, e.g. claustrophobia
 * For public health nurse referrals, do NOT refer to " Public Health & General Preventive Medicine"
 * To view future appointments for a specific patient, choose "Epic" menu, select "Scheduling", select "Appts", and then open that patient's Chart. If you are already in a patient's chart, then go to "Chart Review", and under the "Encounters" tab, uncheck "Default filter" (so that future appointments show up).
 * For therapy referrals, to put instructions for patient on how to schedule appointment, use smartphrase .therapyref
 * Assign yourself as PCP: send message to "P Sched" with the request
 * To request a paper chart, send a "quick note" to your care coordinator.
 * Make sure the "internal" box is checked when you are doing a referral that you wish to go to our internal queue.
 * How to remind yourself about something (and get past the annoying fact that "Reminders" get sent to you immediately (thanks to Michel Sam for researching this):
 * Use "Remind Me", and when the message appears in "All Reminders", click on the message, choose "Properties", click on "Postpone", and choose the date when you really want to see the message.
 * Instead of "Remind Me", send yourself a message (Alt-M). Before sending it, choose "Options", and pick the future date.
 * If your screens look funky, with multiple mention of "Print Groups", to turn it off, go to "Epic" -> "Help" -> "Help Desk Reports". Then click on "Report & Print Group Assistant". That should turn it off. Please note, doing this could accidentally turn them on (it toggles)
 * To get records with "CareEverywhere", go to "More Activities" -> "Request Outside Records"
 * To find out patient's preferred pharmacy (when not in an Encounter), click on "Demographics" and click on the "Clinical Information" tab and find on the left "Pharmacy Preferences"
 * To order an epidural from Interventional Radiology, this was suggested by Kim Haglund on 7/19/12:
 * Type "Fluoroscopy guided spinal injection" in order box. Fill out order details.
 * DO NOT use amb referral to IR...it goes nowhere that IR department can see it.
 * DO NOT order Fluoroscopy Epidurogram (EPIDURAL). This also does not go to IR work queue.
 * If you need another IR procedure but are having trouble finding it, try typing "IR (space)" in the order box and hunting through their long list of

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