S02 - Attachment 20 - One Consult Model Imaging Training.pdf

Office of Community Care

Single Booking/One Consult Model Imaging Training

November 2017

Authorized Use Only

Attachment 20

Objectives

• Overview for ONE CONSULT Model / Single Booking

• Participants will learn the process required for One Consult for all Imaging

Services requiring Community Care

• Checklist for all Imaging Services to standardize One Consult process

Definitions

• Single Booking:

• No longer make internal appointment when patient opts in to Community Care

• One Consult: 10N Memo September 2017

• All VA Must Comply to naming convention change from NON VA CARE to COMMUNITY

CARE (CC); and required CC Consult for all CC services by November 22, 2017.

• One Consult follows the care of the Veteran, regardless of where they obtain their care (VA or community)

• Can forward Internal VA Consult to community care

• Must have Provisional Diagnosis Code (Lexicon – ICD-10) for ALL CC and VA In-house

Consults

• Referring provider enters CC consult for access (Services not available / Wait Time) and

Geoburden

• Consult Toolbox: 10N Memo June 2017

• Macro-enabled tool in CPRS used in conjunction with CC Consult with standardized and trackable data from entry to completion

• Mandatory for tracking patient care throughout the process and for enterprise wide standardized metric reporting

A Brief History of VA Community Care

NVCC Phase 1: In 2011 Required NON VA CARE Consults for All Requests for NON VA CARE which included Radiology until Choice

Process implemented in 2014

Goals for Community Care & Operating Model

Easy to understand.

Easy to administer.

Meets Veterans’ needs.

Providing structure for

Office of

Community Care to function

Operating

Model with supporting tools and processes for the new CCN

18 sites early adopters

(including

VAPORHCS)

One Consult major tool for consistent hand-off to

Community Care

In order to support operations as outlined in the new RFP, sites will need to enable certain functions and processes which are included in the

Operating Model.

Overview of Community Care Operating Model

Tools and Technology to Support Transformation

Tool Benefit

One Consult Template Provides VA providers, VA clinic staff, and Community Care staff with a new Community Care consult template that standardizes and streamlines the internal and external consult processes.

Consult Toolbox New program for use by VA providers and Community Care staff that documents standardized and trackable statements on to a consult in order to screen/ triage and track the Veteran throughout the

Community Care experience.

PCCAS Enables staff to view patient and consult information, create, assign, and track care coordination tasks, and set reminders and alerts for each episode of care.

REFDOC New program that compiles medical information quickly to form a complete referral package for

Community Care staff to send to community providers.

FBCS Modified referral and authorization system such that a 10-0386 will no longer be required.

Virtru Pro Secure email system for VA providers and Community Care staff to communicate with community providers.

Community Viewer Program that sends referrals to community providers securely giving them access to Veteran records;

a new platform similar to the joint legacy viewer.

CUI The Community Care portal allows communication and exchange of health information among community providers, VA providers, Community Care staff, and potential scheduling and care coordination contractors.

PPMS Provider Profile Management System is a searchable database of community provider information.

Overview of Changes – KEY POINTS

• A Consult and Order is required for all Imaging episodes of care in the community

• All consults now require use of diagnosis lexicon (Provisional

Diagnosis) when entering a consult (internal and community care)

• VA providers must be actively involved in understanding their own

VAMC access challenges

– Providers conversation with Veteran is critical, “actively involves the

Veteran in decisions about community care”

• Imaging Services must make VA Clinic staff aware of access challenges

• All documentation related to episode of care will be on the “One Consult”

• Single Booking and One Consult are currently deploying

Overview of Changes

• Process change with Single Booking / One Consult:

– No VA appointment is made (Single Booking)

– No VCL entry required (consult replaces VCL entry) for Wait Time eligible

– No EWL entry required (consult replaces EWL entry)

– Consult becomes the consistent hand off to Community Care Office

– All documentation related to that episode of care will be on the “One

Consult”

Current Barriers with Entering a CC Admin

Imaging Consult

• Due to the required ICD-10 provisional diagnosis – unable to “pre-fill” with a generic Provisional Dx code for Imaging

– Cannot bypass the Lexicon Field an admin consult as there is no acceptable General Provisional Diagnosis Code for Imaging therefore, it must be completed by VA Ordering Provider

• Admin/MSAs cannot enter provisional diagnosis codes

Future Potential Process Improvements

• Community Care and OI&T are evaluating multiple process improvements for Imaging Orders

– Our GOAL is NO HANDOFFS BACK to VA Ordering Provider!

• Currently there is a potential IT Solution converting a Radiology Order to a

Community Care Consult in VistA

Reasons for Generating Community Care

Imaging-Specialty Name Consult

Reasons for Community Care

• Wait Time

• Service Not Offered

• Distance Eligible

– 40 miles

– Unusual or Excessive Burden (UEXB/Geoburden)

Wait Time (no appointment within 30 days of

CID)

Wait Time Scenarios:

• Imaging receives order from referring provider

• Imaging unable to schedule within timeliness standard

• Imaging Offers Community Care to Veteran

• If Veteran opts into Community Care:

– Imaging hands the order back to referring VA Provider to enter a required Community Care consult

• If the patients Opts OUT of Community Care:

MSA/Admin schedules the appointment and indicates in the VistA remarks

“#COO# - Choice Opt OUT”

Underlined- Imaging admin actions

Italics- VA Provider actions

Wait Time-How to Hand off to Ordering Provider

Imaging hands the order back to referring Provider to enter a required Community Care consult

1. Imaging Admin puts order on hold with “VA PROVIDER MUST ENTER CC IMAGING CONSULT”–as reason

» Sites will need to create this hold reason exactly as written in their LOCAL reason Edit file until a national hold reason is established

» This sends an alert to the referring provider to enter the required Community Care Imaging consult

» Mandatory alerts must to be enabled

» Imaging Admin will run “hold” list each business day to see if the consult has been entered

» Once the Community Care Consult is entered the official handoff has occurred

» Imaging Admin will update the hold reason to use the national hold reason file “COMMUNITY CARE APPT”. The title of the hold reason file is “75.2- RAD/NUC MED REASON”. This will communicate that the patient has been sent out to Community Care

Underlined- Imaging admin actions

Italics- VA Provider actions

Wait Time-How to Hand off to Ordering

Provider (continued)

2. Imaging Admin will enter CPRS templated note “Community Care

Request Note - Imaging” adding referring provider as additional signer.

This is a que to enter the Community Care Consult.

3. Referring Provider:

» Receives an alert of “Imaging Order Hold & Community Care

Request Note – Imaging”

» Must enter COMMUNITY CARE–IMAGING MODALITY Consult

• Reason - access

• Provisional diagnosis mandated

» Sign and release to Community Care

Order – “hold”

Screenshot of putting order on hold with reason “VA PROVIDER MUST ENTER

CC IMAGING CONSULT”

EXAMPLE

Provider Alert

Screenshot of provider alert with order hold to enter a consult

Community Care Request Note Template

Community Care request note template entered by Imaging Admin

How to track the “order on hold”

• Weekly the Imaging MSA will run a Hold Report and confirm that the Community Care consult has been placed

• Once the consult is entered, the hand off is complete

• Update the “Hold Reason” with the national reason: “COMMUNITY CARE APPT”

• Community Care is now responsible for tracking the appointment/care in the community

– Scheduling appointment

– Ensuring report is returned and uploaded into CPRS and consult completed with alert to ordering provider

– Collaboration with Imaging and referring provider is critical to ensure reports and images (if appropriate) are received

– Each site should develop local policy for tracking Community Care consults

• It is highly recommended Imaging is responsible for:

– Upload and index received images to VistA Imaging, PACS, and images tied to the Radiology

Package in order to complete the study

– Reconcile patients on “COMMUNITY CARE APPT” Hold status greater than 60 days with

Community Care staff

Service Not Offered/Geoburden

• Wait time:

– Imaging MSA alerts ordering provider to enter Community Care Consult

• Service not offered

– VA Provider enters Community Care Imaging Consult

– Provisional diagnosis mandated

• Unusual or Excessive Burden (UEXB/Geoburden)

– A Veteran who resides 40 miles or less from the closest VA medical facility is eligible for the

Veterans Choice Program if he/she faces an unusual or excessive burden in accessing such a facility based on one of the following four provisions:

• (aa) Geographical challenges

• (bb) Environmental factors

• (cc) Medical condition that impacts ability to travel

• (dd) Other factors (nature or simplicity, frequency, need for an attendant)

– VA Provider enters Community Care Imaging Consult

– Provisional diagnosis mandated

Underlined- Imaging admin actions

Italics- VA Provider actions

How to Enter a Community Care Imaging Consult

(Process for VA Providers)

Community Care–Imaging MRI Consult: Initiation

(1) Click on “Orders” tab

(2) Click on “Consults”

Community Care-Imaging MRI Consult –

Initiation

Select “Purchased Care”

Community Care–Imaging MRI Consult: Initiation

Select “Specialty Title”

Community Care-Imaging MRI Consult:

Selecting Ordering Provider

Enter Ordering Provider

Select “New

Visit” & enter

Community

Care-

Imaging for visit location

Community Care–Imaging MRI Consult

Choose justification

Clinical Reason

Same template as

NVCC

continued

Okay

Community Care–Imaging MRI Consult:

Complete Template

Local decision

Click “Accept Order”

Required “Provisional Dx code/Lexicon” field

The CID cannot be a date in the past. If CID is in the past select “today”. If this is the case it will not match the original

CID entered.

DENTAL

R93.8-Abnormal findings on diagnostic imaging of body structures

Community Care–Imaging MRI Consult: DONE

This is the screen that appears after you click

“OK”

Click “Done”

Community Care–Imaging MRI Consult: SIGN

Community Care Imaging Consult Naming

Conventions

• COMMUNITY CARE-IMAGING MRI

• COMMUNITY CARE-IMAGING CT

• COMMUNITY CARE-IMAGING ULTRASOUND

• COMMUNITY CARE-IMAGING IR

• COMMUNITY CARE-IMAGING MAMMOGRAPHY

• COMMUNITY CARE-IMAGING GENERAL

• COMMUNITY CARE-IMAGING NUCLEAR MEDICINE

• COMMUNITY CARE-IMAGING PET SCAN

• COMMUNITY CARE-IMAGING BONE DENSITY

• COMMUNITY CARE-IMAGING FLUOROSCOPY STUDY

Summary of Changes

• There must be a Community Care-Specialty Name consult for every

Veteran receiving community care

• Imaging services must take a proactive approach to communicate access issues with clinical services and the Local Office of Community Care

• Referring VA Provider MUST have active conversations with Veterans regarding possible use of community care

• Imaging Admin will hand off to referring VA provider when there is no access to schedule internally

• Referring VA Provider MUST enter Community Care Consult, which requires a provisional diagnosis using lexicon

• No longer add patients to VCL or EWL when Veterans Opt in for CC

• No longer make internal VA appointment when Veterans Opt in for CC

To-do list

• Complete the One Consult national service checklist

– Work with your CAC to create the standardized consults. See slide (33) titled

Community Care Imaging Consult Naming Conventions

– Create Community Care CPRS Note, see slide (19) titled Community Care

Request Note Template

• Complete One Consult Model training for Providers and Administrative staff

– Communicate Imaging’s handoff process for VA provider to enter a CC consult

• Sites must create a new reason in file 75.2-RAD/NUC MED REASON “VA PROVIDER

MUST ENTER CC IMAGING CONSULT”

• Attend the VHA CI Solutions Office Hours on November 22, 2017 at 2:00pm ET for any additional questions

– Adobe link: https://va-eerc-ees.adobeconnect.com/_a1089657440/choicefirst/

– Join by Phone (VANTS): 800-767-1750; Participant Code: 01973#

Questions

Additional Resources

• Consult Toolbox version 1.0.6051 User Guide, the One Consult

Model Fact Sheet/FAQ document, SOP, CAC Technical Guide, and

Process flow can be found here.

• The Consult Toolbox Reports are located here.

Note: To access this site, please go to the following link to request access to PHI/PII data in the data warehouse by clicking on the

"Request Access to PHI/PII Data" button on this page.

https://vaww.vha.vaco.portal.va.gov/DUSHCC/DC/DO/CI/S/default.aspx https://vaww.dev.fre.cdw.va.gov/sites/BISL_ConsultTB/Dashboards/Pending WorkList.rdl?Web=1 https://vaww.cdw.va.gov/sites/security/Pages/Home.aspx

Additional Resources (cont’d)

• UEXB documents can be found here

• Facilities report verification of implementing the One Consult Model on the VHA Community Care Station Dashboard SharePoint site

• Post-Training Q&A sessions announcement will be posted here

• One Consult Implementation Tools are found here

– Consult Service Development Checklist

– Master Timeline Planner https://vaww.vha.vaco.portal.va.gov/DUSHCC/DC/DO/CI/S/default.aspx https://vaww.vha.vaco.portal.va.gov/DUSHCC/DC/DO/CI/S/default.aspx https://vaww.vha.vaco.portal.va.gov/DUSHCC/Lists/SD/AllItems.aspx https://vaww.vha.vaco.portal.va.gov/DUSHCC/DC/DO/CI/S/default.aspx https://vaww.vha.vaco.portal.va.gov/DUSHCC/DC/DO/CI/S/default.aspx