TSWF Clinical Support Staff Training May May-Aug 2020 Medically - - PowerPoint PPT Presentation

tswf clinical support staff training may may aug 2020
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TSWF Clinical Support Staff Training May May-Aug 2020 Medically - - PowerPoint PPT Presentation

TSWF Clinical Support Staff Training May May-Aug 2020 Medically Ready ForceReady Medical Force 1 Dis isclaimer Content shown is from an AHLTA Training System (ATS) and does not contain actual patient data. Medically Ready


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TSWF Clinical Support Staff Training May May-Aug 2020

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Dis isclaimer

Content shown is from an AHLTA Training System (ATS) and does not contain actual patient data.

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Agenda

  • Review benefits of using the TSWF process and AIM

forms

  • Review clinical support staff workflow
  • Discuss use of TSWF worksheets
  • Demonstrate processes performed by support staff
  • Discuss specific form-related tasks to be completed by

support staff

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Benefits of f TSWF AIM IM Forms

  • Improve continuity of care and healthcare outcomes
  • Support staff engagement in care
  • Provide links to references for patient education and

clinical recommendations

  • Standardize documentation
  • Streamline workflows
  • Provide clinical cues

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Contents of f This Slide Deck

  • Intro, Workflow, Worksheets

slides 6-7

  • Open Not Checked In

slides 8-15

  • Overview of Copy Forward

slides 16-17

  • Obsolete Terms

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  • Encounter Summary Properties

slides 19-22

  • Creating Encounters for Support Staff Services

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  • Adding Forms to Favorites

slides 24-27

  • Lists/Adding to/Prioritizing

slides 28-32

  • Documenting in the HPI & Screening Tabs

slides 33-50

  • Overview of the Navigator AIM form

slides 51-54

  • TSWF Resources/Feedback

slides 55-56

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Workflow

Load appropriate TSWF AIM form and remove

  • bsolete terms

Perform copy forward (Open-not-checked-in process recommended if applicable) Copy forward PMH fields: Medications, Medical Conditions, Surgeries/Procedures, Family History, Social History, Preventive Services, and Comprehensive Care Plans

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TSWF Worksheets

(a (avail ilable le at t ts tswf-mhs.com)

  • TSWF Worksheets are intended to be

completed by the patient. Each worksheet mirrors the fields in the HPI and ROS tabs. They are available with and without the PE portion on side 2. The forms may be modified locally.

  • Use of these forms is determined locally.
  • Worksheets are most useful for new

patients with no prior documentation on a CORE form.

  • Use face-to-face intake instead of

worksheets if that meets local needs better.

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Open Not Checked In In

The “Open Not Checked In” function allows the user to prepare patient encounters ahead of time. This can be done at the end of the day or during down times throughout the day so that periods of high-patient flow are more efficiently used.

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Open Not Checked In In

  • TSWF recommends using the “Open Not Checked In”

function (must be used by 11:59 pm of day prior to appointment, or patient will be listed as checked in)

  • Follow your MTF’s policy on placing orders (labs &

consults) for overdue Clinical Preventive Services (CPS) when using the “Open Not Checked In” function

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Open Not Checked In In

Things that can be done in Open Not Checked In

  • Copy forward (CF) the Past Medical History (PMH)
  • Review CF & enter information pertinent to the

upcoming encounter

  • Enter labs/radiology results
  • Remove Obsolete Terms

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Open Not Checked In In

Click on “Change Selections” in the Appointments module

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Open Not Checked In In

When the Appointment Search Selections pop-up box appears, select the date range to include date of the future visits you will work on.

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Open Not Checked In In

Open patient appointment. Patient status will be listed as Open Not Checked In.

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Open Not Checked In In

When the Military Clinical Desktop pop-up appears, click OK to allow orders and documentation on this future appointment.

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Open Not Checked In In

“Disposition” and “Sign” are disabled but information can be entered into all other modules Status is listed as Open Not Checked In

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Copy Forw rward

TSWF recommends following the Copy Forward process:

  • Copy Forward is the process of moving Past Medical History

(PMH) elements from a patient’s Previous Encounter to the Current Encounter. PMH terms are indicated in TSWF forms by yellow highlighted boxes or any field with a .

  • Elements of a previous encounter must be validated with

the patient during each and every visit. Ensure you follow the steps correctly or the encounter may corrupt, which will require you to re-enter all information in the Copy Forward fields.

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Copy Forw rward

When selecting a Previous Encounter, be sure to check the “Include Cancelled and LWOBS” box. This will ensure a complete list of previous encounters, including encounters that may have been prepped but were cancelled or the patient left without being seen.

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Copy Forw rward

This is a quick summary. For detailed instructions see the 2 minute video at http://www.tswf-mhs.com/support/cf/

  • Select Previous Encounters
  • Click on a Previous Encounter
  • Click Copy Forward
  • Select S/O tab
  • Select PMH
  • Select AutoEnter
  • Select the desired TSWF form from your favorites list
  • Go to Obsolete Terms (see next slide)

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Obsolete Terms

Review the Obsolete Terms tab for elements that copy forward from previous

  • encounters. This function is very important when performing Copy Forward!

If obsolete terms are not deselected, you will see past medical history terms in an encounter note that the provider is not aware of when he/she signs the note.

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Access this setting by opening any clinical encounter or tel-con. Click on the OPTIONS tab.

Options Tab in in AHLTA

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Setting User-Specifi fic Options (E (Encounter Summary ry Properties)

Line 1-will default to your name Line 2-as directed by your MTF-in the LIVE system, AHLTA’s default is a PHYSICIAN Line 3-as directed by your MTF (usually rank or position) Co-signer-as directed by your MTF AUTO CITES-recommend Allergies and Questionnaires

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VITALS/LABS/RADS-this will automatically place ANY vitals/results in your note for the time period you selected-ie for the last 7 days. WARNING-THIS FUNCTION WILL AUTOMATICALLY PLACE INFORMATION IN YOUR NOTE REGARDLESS OF WHO ORDERS THE LABS, POTENTIALLY PLACING ABNORMAL/CRITICAL VALUES A/P Active Order Default-checking these boxes will show active orders in the A/P module

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Setting User-Specifi fic Options

S/O Default Automatically convert positive ROS findings to HPI Checking this box will move any ROS documented in the TSWF form of MEDCIN to the HPI. This selection needs to be consistent with the team Merge DX Prompt/Prompt with Default Template Recommend not setting a DEFAULT TEMPLATE Disposition Follow Up Discussed with Patient Defaults to Patient; for Pediatrics recommend changing to Parent. There is an option to override for exceptions in the DISPOSITION tab.

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Setting User-Specifi fic Options

E&M Calculator For support staff, you have the option to change the service type to “Other Unlisted E&M.” This will automatically place a 99499 in your E&M. Auto-Print Do NOT check AUTO PRINT or SENSITIVE Include ICD9 CM/CPT4/HCPCS Check this box. This will place the codes on the signed encounter. No action required by user. Warn me if no procedure documented For primary care, no need to check this box Auto Save-follow MTF guidance

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Creating an Encounter for Support Staff-Provided Services

All encounters documented solely by support staff in primary care should be created as NON-COUNT (still counts for DoD workload, but isn’t billable). You can either: 1) create the appointment/tel-con as non count or 2) change the workload in the DISPOSITION tab. **Workload should always be set to ‘NO.’

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Adding Forms to Favorites Folder

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  • Click on Tools
  • Click on Template Management
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Adding Forms to Favorites Folder

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  • Select Expanded Search
  • Type “TSWF” in Template Name field
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Adding Forms to Favorites Folder

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  • Click on drop-down arrow and change

Owner Type from “Personal” to “Enterprise”

  • Click Search
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Adding Forms to Favorites Folder

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  • Select the TSWF form you’d like to use
  • Right click and select Add Favorite
  • Do not use “Save As”
  • The form will now appear in your

favorites drop-down list in S/O module

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Favorites Li List How-Tos

Within the Folder List, Tools, List Management, users have the ability to add commonly used diagnoses and procedures for easy access in the A/P module. A clinic Favorites List is also available-recommend input from local coder for creation of clinic favorites list based on past reporting.

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How to Add to Your Li Lists

  • 1. From List

Management, click on My Diagnoses or My Procedures

  • 2. Click on Add

in the top left

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How to Add to Your Li Lists

  • 3. Enter the code or

diagnosis name in the Medcin Search box

  • 4. Click Search

5.Double click your selection or select and click OK.

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How to Prioritize Li Lists

Prioritize your lists of diagnoses and procedures in List Management. Simply click on the diagnosis or procedure to highlight, click on the MOVE UP or MOVE DOWN tile until your code is in the desired location.

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How to Prioritize Li Lists

After clicking MOVE UP several times, the diagnosis now appears at the top of the Favorite Diagnoses list.

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Documenting in in HPI/PFSH and Screening Tabs

HPI: Location, signs/symptoms, duration, modifiable factors PFSH: Past medical, family, surgical, and social history elements *Medication Reconciliation is found on the HPI/PFSH tab. Clinical support staff can document that the medication list was updated at the beginning of the visit. The lower red section should be completed by the provider

  • nly.

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Undo Button

If you click the X at the top left of most text-entry boxes, it will reset the box, erasing all text you’ve entered. By clicking the UNDO button at the top of the screen, you will return to your previous

  • step. Clicking it more than
  • nce will undo multiple steps

so be careful.

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HPI/PFSH Tab

Form version, links to MilSuite, TSWF Navigator, TSWF Website, and Change Log are listed at the top of the form

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Attending physician field is intended for training programs only.

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HPI/PFSH Tab

Include all medical conditions/problems Note: check box if meds not currently taken Document all current meds/OTCs/herbals, etc. Recommend documenting dosage, route, and frequency.

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HPI/PFSH Tab

Medication Reconcil ilia iation

Support staff updates medication list (and checks box verifying completion) Provider completes “provider use only” section Text field to input name

  • f patients Primary

Opioid Provider, if any.

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HPI/PFSH Tab

Open the ribbon to show more details

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Infectious Disease Travel Screen is here with clinical clues for reference

Screening Tab

Travel Sc Screening/Infectious Dis Disease

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Links out to DHA COVID-19 form and CDC site

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Patients who drink alcohol should complete an AUDIT-C annually at a minimum, or when clinically indicated. Place the date and score of completion in the ‘AUDIT-C’ field.

Screening Tab

Alc lcohol l an and Tob

  • bacco

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Screening Tab

Verbal/ l/Physical Abuse

If the patient answers “yes,” the ribbon will expand prompting you to ask two additional questions. A link to the Domestic Violence Questionnaire is included here for use as needed. If the patient declines to answer, NOTIFY PROVIDER.

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“Medically Ready Force…Ready Medical Force” These questions need to be completed annually. If more than 12 months have elapsed since last updated, uncheck the red “X” to reset the questions to current requirements. The Single Item Literacy Screener (SILS) for assessing health literacy is in the Annual Questions field. If patient’s response is either “often” or “always,” conduct a more thorough assessment (see next slide).

Screening Tab

Annual l Questions/Health Lit Literacy

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If the SILS response is either “often” or “always,” further assessment

  • f the patient’s health literacy is documented here along with an

action plan if indicated. While a link to REALM-SF is provided here, any appropriate assessment can be used.

Screening Tab

Healt lth Lit Literacy/Mil ilit itary-Specific

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BH/Other Screening Tab

This tab is used to screen for depression, suicidality, PTSD, anxiety, TBI, and sleepiness. Follow Service or local guidance.

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PHQ-2/PHQ-9

A PHQ-2 should be documented on every visit. Complete a PHQ-9 on each visit IF:

  • The PHQ2 is positive
  • The patient is on an antidepressant
  • The patient has a diagnosis of depression

Ensure documentation of the scores in the appropriate boxes. ALWAYS NOTIFY the provider if a PHQ2 is positive, or follow local protocols.

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PHQ-2

Screener enters PHQ-2 score here. If positive, continue assessment and notify provider. Use this specific verbiage to ask the

  • questions. Questions must be asked in a

standardized way to maintain validity of the screening tool.

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PHQ-9

1 2

  • 1. If PHQ-2 is marked positive…
  • 2. … PHQ-9 opens automatically.

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PHQ-9

Check boxes are available to mark responses, the score is auto-calculated. Note the blue cue: if “All Normal” was selected, the user must enter a score of “0”. (AHLTA quirk)

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BH/Other Screening Tab

C-SS SSRS

Cues give instructions on how to ask the questions.

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BH/Other Screening Tab

PTSD Sc Screenin ing

Place the date the screener was completed in the copy forward field

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Note the DoD policy summary

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TSWF Navigator Form

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The top section of the form contains links to all current AIM forms. Select the form you’d like to use.

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The link to the TSWF website is in the bottom left section

TSWF Navigator Form

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The bottom portion of the form contains links to relevant resource materials

TSWF Navigator Form

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TSWF Resource Material: www.tswf-mhs.com

The TSWF repository for training/educational materials and updates: www.tswf-mhs.com/

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Pri rimary Care Clinical Community Content Working Group

▪ DHA - Maj Matthew J Royall ▪ ARMY - Dr. Robert Marshall ▪ AIR FORCE – Dr. Matthew Barnes

TSWF Feedback https://www.milsuite.mil/book/groups/tswf TSWF Website http://www.tswf-mhs.com/