Home Forums Discussions General Discussion How do you track patients with a medical problem?

I have a problem for which I have no clear fool-proof solution. Please help.
Being a Neurologist, my two patient groups with potential problems are M.S. and Epilepsy. (I am sure your specialties will have your own.) These patients need to be monitored for clinical changes, medication levels, routine blood monitoring CBC, CMP etc, MRIs and follow-up appointments.

1. How does your office keep track of these patients? People move residences, practices, etc.. If for example I had 50 M.S. patients and 50 Epilepsy patients in 2015, how do I know at the end of 2016 that they are still my patients? Patients do not schedule, change appointments, cancel, move to other practices, etc.. How do I know how many/which patients I am liable for. Yes, I can do a database search for the diagnoses and send them mailers, but how often? What are others doing?

2. Labs, MRIs etc: The newer MS drugs need labs done 3-6 months. Patients don't have the labs done or may do it but as a part of a panel with another provider which does not get sent to me. How do I have a fool-proof way of making sure that they are done/received?

3. Appointments: I make them an appointment when they leave for 6 months, for example. Invariably, they cancel, no show or reschedule. Then, they are lost to follow-up. Cannot not fill their seizure meds ...

These are my main questions, among many others. Thank you for listening.

I think it is commendable that you are concerned enough to take on this much responsibility. I am sure other specialists can give you more helpful information, but bottom line, patients are responsible for their own care. If you give lab slips, you can set a reminder so you can reconcile, but other than that, you can't hold their hand. If they cancel or reschedule, you know then what is going on. If they no show, you can simply try to mail them or call them.

We get letters all the time from a neurologist to a patient which is copied to us saying they have not been able to reach them. Now, it falls on the patient and us. Invariably, we call the same number and reach them the first time. But, we also may have an updated phone number. Many patients change their number, and the last person they think about is their neurologist where they have an appointment in four months. Then you can't reach them for a reminder call, and they no show. I guess one breakdown in communication would be PCPs forwarding new phone numbers and addresses to the consultants.

I am always surprised to read in the letter where it says, we have tried to notify you four times but have been unable to reach you. And, then to the provider, "Please reschedule them if they still need us." That is more than I would do.

As far as meds go, it would seem they would call you for those. Again, a reminder would help as would a refill request from the pharmacy.

Better communication all the way around would be helpful. We forwarded labs to a consultant for over a year before she told us she was getting them. But, it is still difficult when a Dilantin level of 40 comes back. Do we just assume the consultant sees it? I would hope not, and we would call.

But, again, I don't lose any sleep over patients who don't accept responsibility for their own care. Most of my patients don't pay for their care, so they could at least make note of appointments in their calendars.

Zak,

You can run a report on your patients using the REPORTS function. You can run a specific report for example to give you a list of patients with the diagnosis of Epilepsy that haven't been seen in 6 months. You can then use this list to start making calls. This is one option.

As for labs, you can make reminders that are sent to a staff member or yourself regarding when a patient is due for labs (or appts). Now obviously that doesn't guarantee that they will come in. You can at least document as an addendum that you called, spoke to or sent a letter to the patient.

As for liability, I can't answer that. In our office we attempt two phone calls. After two phone calls we send a letter. Each of these are documented as addendum. I'm with Bert, patients need to be responsible for themselves.

Here's what we would do:
Give every patient a follow up visit before they leave the office. If they do not want one, say you are very busy and need to at least put them on the schedule. They can reschedule it later if they need to. (In our practice, they will at LEAST need a wellness visit in the future.)

Give them a lab order for their seizure med levels to be drawn before their next appointment. Put a copy of the order in the Reconcile Book.

Make sure staff goes through the reconcile book regularly. We call patients twice asking if they are going to get the lab done. If we can't reach them, we send a letter. These attempts are documented on the original order sheet in the Rec book, and by the letter it is removed and put onto the chart. I'm hoping this will take care of any liability, showing good faith that we tried to contact them about their test. If it is something serious, like following up on a malignant pathology report, I may send it certified.

I don't see if you are liable for anything if you give a lab slip and an appointment time. It's up to them. Plus, you can reconcile the orders. My hats go off to you guys and girls. I don't worry about any of this staff. I guess I am a bad doctor. I have my next patient. I have to worry about them.

The last one walked out the door with a lab slip and a follow-up. They are smart enough to do it. If they don't, it's documented, and it sure isn't my fault.

**I need time to post in here.""

you can use the boomerang add on to email, if you are using email
need signed consent form from patient to use non secure email
then print the lab order to document printer ( like paperport) and attach to gmail email to patient which you can then schedule to arrive in 3 months 6 months 1 year etc.

so what we do is write the order and post date for the future in AC order module
then in 3 months Or whenever the order was written it goes out via boomerange automatically
then we reconcile orders ( now with fancy shmancy version 9.0 reconciling is so easy, it used to gobble up huge amounts of time but now can be done with receipt of labs - YAY) then we reconcile lab ordersa month after that to nudge people that have not done

that's how we do it, we had to to do if for NCQA PCMH

boo!

Lynn