Home Forums Discussions General Discussion DNKA Methods

This topic has been covered in past years, however, I am curious as to whether V4 users have come up with any better solution. With the software the office used prior to AC implementation, our Office Manager could view a complete list of a patient's visit history and their appointment status. If the patient missed an appointment, an "M" was entered, into the "Status" column, kept appointment is "K" and so on. As many know, right clicking on a patients' appointment and selecting the "Did Not Keep Appointment" feature, brings up the screen to "document" the missed appointment by sending a message to the selected provider. The provider, can then save an "Addendum" to the patient's chart, in order to add that visit to the Patient's past encounters list.

Because sending the message to the provider, alone, does not record an entry into past encounters, our Office Manager is selecting "Add Chart Addendum" and choosing "Did Not Keep Appointment" from the menu herself (and adjusting the date if neccessary). This prevents the provider from having to perform this task his/her self. However it is also important, for a multitude of reasons, that the doctor is made aware via "Messages" of a missed appointment.

Without compromising security/administrative preferences significantly, can anyone describe a way for the Office Manager alone to achieve both sending a message notification to the Doctor of a missed appointment, and having that missed appointment show up in "Past Encounters?"

I can see an overly complicated solution of selecting the "DNKA" option, sending the notification to the provider that way, and then going back to save an addendum to the patient's chart, but this presents a few problems, as I see it: for one the message and the addendum need to be linked in some way (if a doctor receives a message about a missed appointment and an addendum has already been saved by the Office Manager, this can prevent overlapping problems if the provider takes any action beyond the message e.g. adding an addendum his/her self when an addendum has already been made.

short story long: Does this method present any issues that I am not seeing? If so does anyone have any recommendations for an alternative method?

Thanks alot!

When the provider reads the DNKA message, they can save it to the patients chart just by clicking the button.

I can see that option, but unfortunately that means the office manager is performing the task, and so is the provider, effectively making two people perform one task (to get DNKA to show up in past encounters).

That how we handle it, and the doctor generates the letter to the patient. From a template but still a PITA. Once in a while comes the payoff, a failed appointment that REALLY, REALLY matters, so you call the patient on the phone right then, OR it is the final DNKA and you forward the termination order to the office manager. It is double work, but I feel we should be doing it.

I agree - I think the doctor needs to address the DNKA and make decision about it. I often call, write or decide based on that DNKA in the chart.

Our receptionist sends the DNKA notice to the office manager. The notice is processed through the scheduler. I can't imagine burdening the doctors with extra emails about scheduling issues. Especially with cumbersome AC email! As an owner and business manager, I make certain policy is set and procedure implemented accordingly.

In terms of communication, we use Outlook to notify the team and the MA's are required to keep the doctors additionally informed of any discrepancies in their schedules. Our docs need to focus on their patient's and the medical care not be burdened with front desk duties or administrative policies.

I actually would do this, but there are some patients who I feel need different treatment outside of a policy - I usually set a certain number of DNKA and then terminate, some due to psychiatric issues, emotional issues, etc I treat different, some I feel a registered letter due to medical issues is needed, some I call and find out what is going on so I can do this. Would love if policies could be set in stone - not always possible. I also do not think AC e-mail is cumbersome - use it and attach to chart easily, fill scrips easily, etc.

As of now, we have decided to create three new appointment types: "DNKA," "Resched," and "Cancelled." At the end of the day, the office manager "edits" the necessary appointments, changing the appointment type to one of the above. This keeps the appointment in the schedule for later viewing by the physician (selecting the 'Do Not Keep Appointment' feature removes the appointment from the schedule) and allows the office manager to select the appointment search feature to see whether a particular patient has been scheduling and missing a lot of appointments. This leaves out the message notifying the physician, but as I said, in our case, the Dr. doesn't need a message for each missed appointment. Thanks for the responses.