Online Consultation Ordering

Shorter diagnosis time, better knowledge transfer, and improved adherence to compliance regulations were three key improvement areas identified by Montefiore Medical Center's administrative leadership.

The Weiler Division's former phone-based ordering system was becoming increasingly impractical for physicians with high patient volumes and busy work schedules, and reducing time between consult order placement and consult recommendations was critical. Rapid changes in technology and the increasing array of available tests were making it difficult for physicians to select the best evaluative methods. Furthermore, third-party payers require justification for the consult being ordered, and inadequate compliance results in poor reimbursement rates and even fines. Previously, nonexistent, inadequate, or inappropriate indications and illegible handwriting complicated reimbursement for consultations.

In response to these issues, an online consultation ordering system was implemented.

Results

Online consultations have improved efficiency in a number of areas:

• asynchronous ordering and fulfillment of consults using the computerized physician order entry system (CPOE)
• reduced delays in care due to order forms and delivery of paperwork to consultants
• knowledge transfer between specialist and physician at the time of order entry, reducing time spent reviewing simple order decisions and increasing time available to assist the ordering physician in diagnosing complex health issues
• fewer tests performed without compromise of patient care
• better note-taking, measurement of time from request to completion, and tracking of discrepancies between resident and faculty interpretations of diagnostic tests
• clearer, more comprehensive data and improved results reporting to third-party payers

Future Directions