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Mychart Messages

  • 1.  Mychart Messages

    Posted 01-16-2023 21:12
    Hello!

    I would be interested in to know if anyone is using RNs or LPNs to respond to PCPs patient advice requests in Mychart.

    Our PCPs are overwhelmed with patient messages. We are developing a team to follow up on these requests from patients. Mostly using RNs to triage.

    We currently have an RN team who intakes emergent calls sent from our non-clinical agents. We are expanding this team to help with triaging messages that are sent through Mychart. 

    Any ideas or recommendations would be appreciated!

    Andrea Green, MSN, RN

    Manager of Clinical Services

    OhioHealth Physician Group

    Andrea.Green@OhioHealth.com

    740-243-2442 (Mobile)

     



    ------------------------------
    Andrea Green MSN RN
    Manager Clinical Support Services
    OhioHealth
    Columbus OH
    (740)243-2442
    ------------------------------


  • 2.  RE: Mychart Messages

    Posted 01-17-2023 00:37
    The majority of our patient messages are answered by nurses using chart review or discussing plan of care with clinician.

    Amy

    Sent from my iPhone




  • 3.  RE: Mychart Messages

    Posted 01-17-2023 09:09
    Hi Andrea,

    All of the messages are routed to the unit specific nursing pool, Each morning the Head Nurse/Charge nurse from the unit routes the message to the assigned Nurse.Our ratio is (1RN/2MD) and this nurse will address this closed loop communication.

    Sandhya Daniel,
    Assistant Director for Nursing Professional Development
    NYC Health and Hospitals

    ------------------------------
    Sandhya Daniel
    Assist Dir of Nursing Education
    Harlem Hospital
    New York NY
    (347)455-1716
    ------------------------------



  • 4.  RE: Mychart Messages

    Posted 01-17-2023 09:25
    Hi Sandhya,

    I am interested in your care model. 1 RN to 2 MDs. What is the RNs role aside from managing providers' in-basket? Do providers have unlicensed personnel to room patients? 

    Respectfully,

    ------------------------------
    Roxanne Flores MSN RN
    Population Health & Clinical Quality Nurse Manager
    Austin Regional Clinic
    Austin TX
    (512)483-9512 (35512)
    ------------------------------



  • 5.  RE: Mychart Messages

    Posted 01-17-2023 10:11
    Thank you, Roxanne,

    PCA- Patient Care Associates room patients, take vitals, schedule follow up appointments and draw labs.
    RN's complete intake and assessments, discharges and vaccine administration.

    ------------------------------
    Sandhya Daniel
    Assist Dir of Nursing Education
    Harlem Hospital
    New York NY
    (347)455-1716
    ------------------------------



  • 6.  RE: Mychart Messages

    Posted 01-17-2023 10:16

    We just began this process in December.  We have a "trigger word" workflow where the MA may automatically escalate this message to a in-basket pool.  There is also a mechanism in place to have MAs outreach for unclear (no trigger word), clarify and if in conversation the patient mentions the trigger work to warm hand off to the RN Triage and Advice. As these are messages, we do not have the ability to turn them around with the efficiency of a telephone call.  For now, we have a 3-hour turnaround from time the message get into RN pool to time of connecting with patient and using decision support tool.  We only attempt one call when these messages come through MyChart.  Often patients are not home.  Our MyChart states that MyChart messaging is not intended for use of urgent and emergent communication (this may not be the exact verbiage).  RNs are a limited resource and as such we can't work every MyChart message, so we created a clinical escalation process. 

     

     

     

    Description: Description: colorbar

     

    Judith Puzon, RN, MSN

    Director of Outpatient Nursing Services|Clinic Network Administration

    17910 Talbot Rd S|Renton, WA 98055| (o) 425-690-3373

    M/S:  PRC-8316

    UW Medicine | Valley Medical Center

    Judith_Puzon@valleymed.org | Lita_Gill@Valleymed.org">www.valleymed.org

     

    Non-urgent emails received after 4pm, will be responded to the next business day.

     

     

    IMPORTANT: This communication contains information that may be confidential or privileged, and is intended solely for the entity(s) or individual(s) to whom it is addressed.  If you are not the intended recipient, you should delete this message, and are hereby notified that any disclosure is strictly prohibited.  If you received this communication in error, please notify the sender and delete the message.

     






  • 7.  RE: Mychart Messages

    Posted 01-20-2023 12:37

    Hi Julie,

    Are the MAs scanning the messages for the trigger words, or the EMR has this built in function to flag them?

    I am also curious what your decision support tool looks like. 

    When RNs are doing triage and advice, are they working off of a decision support tool as well?

    Thank you,
    Sarah



    ------------------------------
    Sarah Vakili
    Clinical Nurse III
    Santa Clara Valley Medical Center
    San Jose CA
    ------------------------------



  • 8.  RE: Mychart Messages

    Posted 01-23-2023 12:13

    No, they do not scan and not there is not a built in function.  Our Hotlist exists in a SharePoint site.   Using SharePoint allows the team to use function F3 or Ctrl F3 to search for words.  Per protocol this is how the search is conducted if after they have used F3 the wish to scan they may, but the bottom line is there are too many words to scan and F3 will bring up the words corresponding to that which you have placed in the search box.  Please let me know if this is unclear.  Sorry for the delay.  Have a great day. 

     

     

     

    Description: Description: colorbar

     

    Judith Puzon, RN, MSN

    Director of Outpatient Nursing Services|Clinic Network Administration

    17910 Talbot Rd S|Renton, WA 98055| (o) 425-690-3373

    M/S:  PRC-8316

    UW Medicine | Valley Medical Center

    Judith_Puzon@valleymed.org | Lita_Gill@Valleymed.org">www.valleymed.org

     

    Non-urgent emails received after 4pm, will be responded to the next business day.

     

     

    IMPORTANT: This communication contains information that may be confidential or privileged, and is intended solely for the entity(s) or individual(s) to whom it is addressed.  If you are not the intended recipient, you should delete this message, and are hereby notified that any disclosure is strictly prohibited.  If you received this communication in error, please notify the sender and delete the message.

     






  • 9.  RE: Mychart Messages

    Posted 01-17-2023 13:56
    Yes we use RNs to answer my chart messages. Our RNs answer clinical questions and our MAs handle prescriptions. They answer certain questions for the provider and then send the provider a message for which the provider orders the medications





  • 10.  RE: Mychart Messages

    Posted 01-17-2023 14:09
    Hi Andrea,
       I'm actually a triage nurse and we answer all the MyChart messages for our providers.   We have 3 triage nurses that work with 6 providers (MD/NP/PA).  All of the portal messages go to the nurse first, the providers cannot even see them unless we forward the message on.   We triage the message and will pass them on to the providers nurse if its a questions/issue that the nurse working with that provider is aware of, but otherwise we try to answer most of the questions. We only send to the provider if there is some question that we cannot answer.  Hope this helps!

    ------------------------------
    Nicole Muller
    RN
    Sauk Prairie Healthcare
    Prairie du Sac WI
    (608)778-7300
    ------------------------------



  • 11.  RE: Mychart Messages

    Posted 01-23-2023 20:44
    Hi Nicole,

    What type of office do you work in?

    ------------------------------
    Andrea Green MSN RN
    Manager Clinical Support Services
    OhioHealth
    Columbus OH
    (740)243-2442
    ------------------------------



  • 12.  RE: Mychart Messages

    Posted 01-24-2023 09:46

    Outpatient Nursing Services, Primary and Specialty Care.  We are a hospital owned system.

     

     

     

    Description: Description: colorbar

     

    Judith Puzon, RN, MSN

    Director of Outpatient Nursing Services|Clinic Network Administration

    17910 Talbot Rd S|Renton, WA 98055| (o) 425-690-3373

    M/S:  PRC-8316

    UW Medicine | Valley Medical Center

    Judith_Puzon@valleymed.org | Lita_Gill@Valleymed.org">www.valleymed.org

     

    Non-urgent emails received after 4pm, will be responded to the next business day.

     

     

    IMPORTANT: This communication contains information that may be confidential or privileged, and is intended solely for the entity(s) or individual(s) to whom it is addressed.  If you are not the intended recipient, you should delete this message, and are hereby notified that any disclosure is strictly prohibited.  If you received this communication in error, please notify the sender and delete the message.

     






  • 13.  RE: Mychart Messages

    Posted 01-17-2023 18:24
    Hi Andrea,

    We have a large ambulatory practice and when MyChart messages are being worked on in the inbasket, if they are symptomatic messages, they are routed to the team nurse (RN) to handle, if they are other non-symptomatic messages, typically the MA or LPNs handle. Ob/Gyn is the only specialty that has dedicated triage RNs that are a warm transfer call. All other specialties/Primary Care those are messages that either come from our phone schedulers or through MyChart. RNs have Nurse Initiated Protocols (NIPS) they can work off of for many symptomatic issues. These are for RNs only, LPNs/MAs will route the message either to the team nurse or provider depending on staffing for the clinic. I live in NM so MAs do not have a scope of practice and our LPN one does not allow them to assess (this includes telephone triage). We also have a variety of protocols that both MAs and LPNs can work from depending on the message (normal vs. abnormal lab results...)

    ------------------------------
    Jessica Jones
    Director of Nursing Specialty Care CDS
    Presbyterian Medical Group
    Albuquerque NM
    ------------------------------



  • 14.  RE: Mychart Messages

    Posted 01-18-2023 08:54
    Good morning, 
    We have a robust process utilizing RNs to triage incoming MyChart Advice requests. Much like others have mentioned. The pt initiated messages are based within each specialty group. The RN then connects with the provider for any follow up orders. All triages, regardless of disposition are sent to the provider for review and information. 
    Karla

    ------------------------------
    Karla Schroeder, DNP, RN, ANP-BC, MHA, NE-BC
    ACNO
    Emory Health Care
    Atlanta, GA
    karla.schroeder@emoryhealthcare.org
    ------------------------------



  • 15.  RE: Mychart Messages

    Posted 01-20-2023 12:41
    Hi Karla,

    Are there any instances where the messages are not sent to the provider (for review/and information)?  I like the idea of sending to the provider as "fyi" regardless; but also seems it does not address the issue of providers being inundated with In Basket messages.

    What protocols and training are offered to the RNs for triage? Are there any tools they utilize? (i.e. Schmitt-Thompson)

    Thanks,
    Sarah

    ------------------------------
    Sarah Vakili
    Clinical Nurse III
    Santa Clara Valley Medical Center
    San Jose CA
    ------------------------------



  • 16.  RE: Mychart Messages

    Posted 01-23-2023 12:09

    Forgive me if I have stated this but, in our organization, we do not send and FYI message for all messages managed by triage.  This does inundate the provider.  There are times when we need the provider to complete an action and if they are overwhelmed by FYI's, it will delay the response to time sensitive action item related to triage.  So, we only send a message to the provider if there is action needed.  Otherwise, all messages are available in the chart.  This has worked for our system for two years.  Prior to that we sent FYIs on all triage messages. Our current process is more efficient and prevent unintentional delays in care. 

     

     

     

    Description: Description: colorbar

     

    Judith Puzon, RN, MSN

    Director of Outpatient Nursing Services|Clinic Network Administration

    17910 Talbot Rd S|Renton, WA 98055| (o) 425-690-3373

    M/S:  PRC-8316

    UW Medicine | Valley Medical Center

    Judith_Puzon@valleymed.org | Lita_Gill@Valleymed.org">www.valleymed.org

     

    Non-urgent emails received after 4pm, will be responded to the next business day.

     

     

    IMPORTANT: This communication contains information that may be confidential or privileged, and is intended solely for the entity(s) or individual(s) to whom it is addressed.  If you are not the intended recipient, you should delete this message, and are hereby notified that any disclosure is strictly prohibited.  If you received this communication in error, please notify the sender and delete the message.

     






  • 17.  RE: Mychart Messages

    Posted 02-24-2023 08:39

    Hi Sarah,

    I work as a triage nurse in primary care, and we have Epic with an integrated Triage Protocol using the Schmitt-Thompson protocols. We aren't able to use the protocols within My Chart messages, so the nurses will sort the My Charts and route them to the appropriate "pools". If it is a medication refill, then we forward to the MA staff. If it has any symptoms that need triage, we will convert it to a telephone call and call the patient and then we use the triage protocols. If using the protocols, we get a straightforward disposition and can schedule an appointment, then we can close the encounter and don't have to route it to a provider. We are trying to use the protocols to give the nurses autonomy. Forwarding everything definitely clogs the in baskets. If the My Chart is to book an appointment that doesn't require triage, then that can be forwarded to our admin staff. 

    All of the My Charts come into the nurses' pool unfortunately and we are the ones that usually sort the My Charts and answer the ones that the nurses need to do. When nursing staff is really short-staffed, sometimes we will have a clinical M.A. sort the My Charts and pull the refills, etc. and just leave the triage ones for the nurses to handle. 

    Prior to having the triage protocols built into Epic, we used the same protocols in book form. 

    Thank you,

    Katie Denslow, RN, AMB-BC



    ------------------------------
    Kathleen Denslow RN
    Maine Medical Partners
    Windham ME
    (207)714-0175
    ------------------------------



  • 18.  RE: Mychart Messages

    Posted 01-20-2023 10:56
    Hi Jessica,

    Can you share a list of your NIPS? My group is expanding the use of RNs in Primary Care and I would love to see how you are using the NIPS to allow the RN to function to scope.

    Thank you in advance!

    ------------------------------
    Cindy Drapal, DNP, RN, SCRN, NEA-BC
    Interim Chief Nurse Executive Ambulatory Services
    System Director Neuroscience Service Line
    Office: 239-343-6573
    Cell: 239-989-9413
    Email: cindy.drapal@leehealth.org

    Fort Myers, Florida 33908
    www.LeeHealth.org
    ------------------------------



  • 19.  RE: Mychart Messages

    Posted 01-23-2023 20:48
    My team uses Schmidt-Thompson protocols which have been built in Epic for my team. We used the hard copy books before we have the triage tool built in Epic.

    ------------------------------
    Andrea Green MSN RN
    Manager Clinical Support Services
    OhioHealth
    Columbus OH
    (740)243-2442
    ------------------------------



  • 20.  RE: Mychart Messages

    Posted 01-19-2023 07:17
    Hi Andrea, 

    I work for a multispecialty practice with about 25 physicians and our messages are answered by mostly RNs.  The physicians do not see these messages unless we send it to them; however, as a nurse, I can respond directly to the patient, answer their questions and provide directions/instructions based on chart review.  Calling patients is ideal as a lot of these messages are not clear and need further information.  While our physicians have specific nurses RN/LPN and even MAs mix, some of the messages can be addressed by the nurses, and communication and collaboration with those nurses ensure they are aware of the message and can follow up with patients appropriately. For Messages sent to physician, the primary nurse is copied so they are aware and can followup. Triage requires a good understanding of the practices covered as well as the physician's preferences.  For example, our pediatric physicians prefer to know any and all concerns with their patients, so some messages are sent as FYI for issues/concerns so they are aware and the nurses are aware.  Our triage sends messages to MD to clarify/verify changes in poc and MD can choose to add new orders, see patient sooner than scheduled or provide a referral to another provider etc.. SBAR is preferred for communication.


    ------------------------------
    Lynette Ogwang BSN, MHA, RN AMB-CC CRN
    TIRR Memorial Hermann
    Houston TX
    (832)935-9190
    ------------------------------



  • 21.  RE: Mychart Messages

    Posted 02-03-2023 19:44
    Edited by Janette Morgan 02-03-2023 19:47





  • 22.  RE: Mychart Messages

    Posted 02-03-2023 19:53
    While it’s not required, due to the fact that 80% of adverse reactions occur in the first 15 minutes, we have always stated that the patient should remain in an area where they can be observed for 15 minutes after any vaccine for which it is the first time receiving it and all teenage vaccines.

    It’s really about preventing injury to patients and being available when those concerns arise. They don’t have to stay in an exam room, or prevent workflow, but should be close by in the eye line of a staff person.

    Best,

    Sent from my iPhone




  • 23.  RE: Mychart Messages

    Posted 02-03-2023 20:43
    Edited by Janette Morgan 02-04-2023 12:59

    ------------------------------



  • 24.  RE: Mychart Messages

    Posted 02-03-2023 20:31
    Edited by Janette Morgan 02-04-2023 12:53

    ------------------------------



  • 25.  RE: Mychart Messages

    Posted 02-03-2023 21:03
    Getting back to the original question, we have LVNs who sort through the messages, answer what they can under their scope of practice, and forward remaining questions to the Providers.  They confirm that the patient actually needs refills, pull together basic information about refills (last primary care appointment, etc.) and forward refill requests to a team of remote LIPs who will either refill or send to the primary if they aren't sure about the plan. 

    We are looking into splitting some requests off that can be answered better by the Referrals team, by appointment techs, etc. so that everyone works to the top of their scope.

    All questions to the Portal are displayed in the patient's chart as messages, in case we need to see it, but they are not all sent to the inboxes of the PCPs.

    ------------------------------
    Lisa Duncan, DNP, MBA, RN, AMB-BC, CIC, NEA-BC
    VP, Regulatory and Compliance
    Family Health Centers of San Diego
    ------------------------------



  • 26.  RE: Mychart Messages

    Posted 02-23-2023 08:51

    I saw one ratio listed of 1RN/2 MD - does anyone else who utilizes RNs for triage in this capacity have ratios established as well?



    ------------------------------
    Joelle Toal BSN, RN
    AVP of Clinical Operations
    Evergreen Health
    Buffalo NY
    (716)860-1781
    ------------------------------



  • 27.  RE: Mychart Messages

    Posted 02-23-2023 15:20
    Answering triage is one of our many jobs and we are staffed at .33 per provider.  For Example we have 8.75 FTE providers and have 3 RNs to do triage, nurse visits and wound care.