Home Forums Discussions General Discussion Colonoscopy recalls... or any other type

An effective system to remind patients that it is time for their follow-up colonoscopy is important to any GI practice. At its best, it represents a "win-win" where the patient gets appropriate surveillance exams and the doctor stays busy. Keeping our friendly malpractice lawyers at bay is another benefit. I would assume this comes up with other types of recalls for primary care providers and other specialists as well.

We may generate 20 or more of these a week. Follow-up intervals typically range from 1-3 years for significantly higher risk individuals to 5-10 years for positive family history or routine screening. Or 2 years for everyone if you are David (TOTALLY kidding there, David, just an inside joke referring to an old coding thread).

The system we are now implementing follows. It seems to work for us, though I have the nagging feeling that there may be ways to improve efficiency. When a patient has a colonoscopy and needs a recall, that is transmitted to the office staff. We have set up a provider "Dr. Recall" and the patient is scheduled for a follow-up with that doctor in 3,5,or 10 years. This is not a true appointment (the patient isn't even aware of it). We pick the first Saturday of the appropriate month to schedule all the month's patients to avoid confusion with regular appointments. When that month is reached, the staff person goes through the days appointments, using the letter writer to send a templated letter to each patient. As the patients respond, they are scheduled.
So please tell me, has anyone got a better way? Suggestions for improvements would be appreciated. As a bonus, suggestions on how best to document who responds to the letter and who doesn't (so we can decide who to pursue further) would also be welcomed.

I just put a reminder in AC to remind a staff member - if you are worried about staff turnover you can set it to send you the reminder on whatever date you choose and then forward it to the staff member when you get it. I use this for followup tests, colonoscopies, paps, etc.

I do as Steven does and put a reminder in after each person's colonoscopy. Of course, I'm only 1 year into AC so we'll see how it works in 5-10 years. The thing I don't like about reminders is that they are not very permanent and can be deleted/changed fairly easily. Ideally, a pop-up would happen in the health maintenance but I haven't even ventured into that thing.

I don't like reminders for another reason. They sit in your Messages outbox until the date that they are dispatched. If you only do one reminder daily for an annual call-back...well, do the math. Didn't Jon attribute an overstuffed Message box to some AC glitch?

Exactly John. That's what happens sometimes inadvertently. My M.A. will try to clear out the clutter and off disappears a reminder of two accidentally. Reminders should be for short term things I would think. Not things 5-10 years down the road. Isn't that the purpose of this Health Maintenance crap? I would like to just use Colonoscopy screening only out the Health Maintenance stuff but I get all these messages about diabetes, cholesterol, mammograms, chlamydia and whatever. Granted, I've spent a sum total of 2 minutes looking at it.

Agreed, the Health Maintenance section is overstuffed with irrelevant and often trivial CCHIT-conforming reminders, and therefore hard to use in a practical fashion. It takes longer to customize each patient's HM section than to complete their Encounter note.

Just part of the whole "Meaningful Abuse"..err, I mean "Use"...conundrum.

I like JBS' method. Kind of separates everything.

I think the overstuffed mailbox thing was just a placeholder until the real bug could be fixed.

I thought Practice Management softwere will do that, If you have one. I am waiting for AC PM, hopefully will take care of that.

Practice Management software does the billing, checking insurance eligibility, accounts receivable and all that jazz. Doesn't do anything for your actual "practice" of medicine except get you paid.

I was under the impression, that part of the PM softwere is scheduling and patient recall to keep track of patients and reports etc.,
I used medisoft few years ago for scheduling and it included all patient recall. I am not sure what is available now.
So if I don't use PM for billing , it won't do me any good!

Almost all billing software programs: Medisoft, Lytec, Medware, etc. have billing and a scheduler. We use the scheduler from Medware and not the one from AC.

I think this is a good thread, and it good that Jon is asking for ideas. I think his way of doing it is great.

Ultimately, it comes down to what works for everyone. I think that using a scheduler works best as the reminders just have too much potential for issues down the road. Just my opinion.

We use a dummy staff member to hold our recalls and they are set to the 25th of the month before it is due so staff has a week to send out reminders. They just sign in under the dummy and get the recalls. If patient doesn't show a second reminder goes out the 2nd month. If they don't show the second month a letter goes out that says we are not held responsible if something bad happens because they didn't do what the reminder was for. About 95% call to schedule several days after the letter goes out.

In another thread, Travis, I tried to find a way to set the health maintenance so colonoscopy reminders would come up at different intervals depending on the diagnosis... villous adenoma, multiple adenomas, etc. It could not be done.

Just a thought, but sometimes we may try to use one program to do everything. I know it makes sense to use the EMR to manage medical and scheduling issues. But, there may be some 3rd party software that would work much better.

Above discussion is to a great interest to me. I am relatively new to AC and using it since June 2009.
In the previous Version 4, I was placing a note in 'Addendum' section of the chart - for example 'Colonoscopy due 08-2015'. Then in the first week of the month, we run the Search Feature for the item '08-2015' and it will pull up all the patients with pharase '08-2015'. We print out the list and then send a templated letter to the patient for the reminder.
Sadly enough, with newer version 5, Search can not be performed in 'Addendum' section. This is severely compromising our ability to look for who is due now. I am also looking for help in this regard, how to retrieve that info.
Thanks

That is a problem, isn't it? However, we went with AC to consolidate several different programs that didn't talk to one another very well. At one point, we had the patient demographics entered in 3 separate programs, which tripled the odds of corrupt data. I still prefer the way two of those programs performed their individual functions to the way AC does them, but the whole point is to have things as unified as possible.

Yes, that is the whole point, but from the sounds of this discussion, it doesn't seem that unification is jumping out at everyone.

I don't even need to do this. I am just throwing out there that sometimes using 3rd party software may work better.

We'll see what the PM system with AC comes up with. You guys are right that my PM system has a scheduler and will call patient's the day before their appointment for reminders but I use AC's scheduler as it seems to make the office flow better. Ideally, if AC's PM system is worth a dang, we would become an all AC office. The scheduler with my PM system is much better than ACs but except that AC's is quicker because it's in house on my server versus over the web.

At this point in time, I have no good way to remind me that patient's are due a colonoscopy and send out mass mailings for everyone who is due for one each month. Definitely a work in progress.

Maybe I'll create a big old fashioned log book.

http://www.groupready.com/gr2.htm

This is a little pricey and probably overkill. Again, I don't have a dog in this fight. But, maybe a scheduler with good CRM attributes. This thing looks like it will do everything but pick up the patient for the appointment.

Of course, there's always Outlook, but it isn't always the easiest thing to back up.

I would love to have all-in-one also. I could with eMDs or eClinicalWorks, etc. We are probably way on the other side of the curve with these programs:

Medware: Billing and Schedule. It's just a far better scheduler
VIPER: Immunization program getting better but still not as accurate and easy to use as our vaccine program. And, still faster. I would say four shots entered in 10 seconds vs AC in 30. Better printout. Better inventory.
Amazing Labels: Freeware; works with AC and prints lab labels, chart labels and free text with DYMO printer. Decreased lab errors from 7% to < 1%
Sharepoint: Of course, this couldn't be included in an EMR, and there is no way to even explain how incredible it is. A year ago it crashed until I could restore it. Staff was practically in tears and threatened to not come to work until back up.

Not showing off just making a point that you can get used to it. I guess you don't know any differently. It's like Outlook. I don't really think why do I need a separate email program.

F.A.P., Amazing Labels and VIPER could all be incorporated into AC, but it will never happen. Plus, the immunization program within AC did take a giant leap forward with v5. Just needs to be streamlined a bit.

I give up... how are you finding Sharepoint so invaluable?

Why do you give up? I take it you use Sharepoint or are familiar with it?

To be honest, I would consider it one of the top five application (actually it's not really an application) I have ever used. Just my opinion. Used correctly, in a network environment and multiple employees, yes, I would call it invaluable. And, the name basically says it all.

After rereading this, I could see how this may be taken the wrong way. The statement "I guess you don't know any differently," was and is NOT intended to mean YOU as in others on here not knowing differently. That would be a bit arrogant. I meant you collectively, as in I guess those using separate programs don't know that it's harder that way. Hope that clears that up if anyone did misunderstand. Just poorly written.

No, Bert... what I meant was " I have no idea what Sharepoint does, can't tell from the web site, and have no idea how I could use it, so please elaborate."

However, it is kind of fun to watch you, if left alone for a little while, get all in a tizzy wondering if your really wonderful assistance might be misinterpreted ;-). Being not nearly so nice a person as you, I just wouldn't care.

I think I'll take that as a compliment. lol No, sometimes I do actually think, you know you don't always have to try to change someone's mind.

I don't really expect people to understand the benefits of SharePoint unless they have used it. I guess that is kind of circular. I remember back when I was working with another doctor and learning peer-to-peer with a server, I didn't know much about server OS. We had Windows Server 2000. At that time, Microsoft had Windows Back Office as kind of its SMB OS. So, when SBS 2003 came out which included Exchange Server and SharePoint and Remote Web Workplace, he was telling me you really need to get Small Business Server. I really didn't understand why it was so great, and since it would be the owner who would be purchasing it -- who changed No Known Allergies to NKDA in AC to save toner -- I didn't care much either.

He then told me about SharePoint. If you hear someone talk about it and what it does, you will pretty much say, so. What's so great about that? You have to use it. But, unless you have SBS or Windows Server 2003 (where it can be added on free), then it is probably not worth going in to.

Uhhhh.... ok Bert, you sold me on Sharepoint.

I can't tell if you guys are being sarcastic.

Another great thing about SharePoint. Say you do what I did. Just go to Windows Internal Database which is the shared database for SharePoint and Windows Server Update Services. Just look at it and think. This database is really important. Then delete it. There goes SharePoint and there goes WSUS.

Then, tell Microsoft what you did and watch them spend two days (they remoted in and worked on it from 2 pm Tuesday until midnight. Then they told me to go home and get some sleep. They worked on it overnight until 5 am. Picked up again at 4 pm next day. Fixed it by 8 pm. But, then wouldn't stop until they restored all my data. The next day, the rebuilt WSUS.

It was so funny, because the support technician was named Nisha. She was so nice. Not only did she seem like she really wanted to fix the server, but she kind of came across like it was the only thing to do over those three days. My whole staff got to know her. She would call and just ask if Bert was there, and they would get me out of a room. She would say, OK, let's get started. I would have to tell her I was with patients. But, she could do everything remotely, but I would have to go and reboot the server and reconnect.

Sorry for the sarcasm, but I have NO idea what this program/application/not-really-an-application does. Can you make a stab at a description and say a few words about how it might be useful to us?

OK, I will. Have to do it on the weekend.