University of Washington Medical Center
DEPARTMENT: Ambulatory Care Division
DOCUMENT TYPE: Policy
DATE OF ORIGIN: 04/2009
LAST REVIEW DATE: 05/2021
APPROVED BY: Assistant Administrator, Ambulatory Care Division; Associate Medical Directors, Ambulatory Care Division

(Click here to view this document & content as a PDF) 

 UW Medical Center Guidelines for Prioritization of UW Medicine Referrals and Patients

STATEMENT OF PURPOSE:
UWMC provides levels of care that range from primary to highly specialized. Access to highly specialized care is limited by its nature. These guidelines have been created to ensure UW Medicine patients are given priority access to UW Medicine Center outpatient care and ancillary services.

POLICY:  The following outlines how UWMC manages appointment access to its outpatient clinical and ancillary resources:

1. UWMC appointment availability access policies are set at the individual unit/clinic level based on unique or highly specialized clinical services that are only offered by that particular practice.
a. Units/clinics will prioritize UW Medicine referrals by developing a clearly defined process that is mutually agreed upon by UWMC Administration and unit/clinic leadership.
i. The process may include but is not limited to setting aside a portion of the appointments for UW Medicine patients/referrals; prioritizing the processing and appointing of internal UW Medicine referrals before external referrals; and/or limiting or eliminating clinical review of internal UW Medicine referrals.
b. The established process will be reviewed quarterly to ensure that all parties agree it is supporting the prioritization of internal UW Medicine referrals.
c. Any unused UW Medicine appointment slots will be released no later than 48 hours in advance for scheduling of any other patients.

2. New patient access to care is prioritized based on the following criteria, in priority order:
a. Referral Source: UW Medicine – Internal Referral
i. These patients will be appointed and given priority over Non-UW Medicine referrals.
b. Clinical Criteria
i. In the event a patient is being referred for a unique clinical specialty only available at the UW Medical Center, the patient will be given priority access to a specialty appointment regardless of the referral source.
ii. Medical review will occur in a timely manner to ensure the UW Medicine Referrals Standards are met. (All patients are contacted within one business day, if there are no financial barriers to scheduling, medical review should be done after the appointment is made, and medical review is completed within seven (7) calendar days of the referral date.)

3. UWMC reserves the right to prioritize access for established UW Medicine patients:
a. Established UW Medicine patients are given priority appointments over Non-UW Medicine referrals.
b. Non-UW Medicine patients are provided access to care based first on clinical criteria and are appointed in slots not designated for UW Medicine patients.

4. Emergency Room Access
a. Patients seen in the UWMC Emergency Department for care who have an assigned PCP for managed care plans will be referred back to their PCP if a referral for specialty care is needed.
b. Patients seen in the UWMC Emergency Department who are referred to a UWMC outpatient clinic for follow up care are prioritized for access as an established UW Medicine patient. The patient is considered an internal referral./’

REVIEW/REVISION DATES:  04/2009, 08/2012, 12/2013, 06/2019, 05/2021
REVIEWED BY:  Richelle Bagdasarian; Assistant Administrator, Ambulatory Care Division, reesh@uw.edu
Thomas Hei, MD, FAAFP; Associate Medical Director, Ambulatory Care Division; thei@uw.edu
Justin Rothmier, MD, FAAFP; Associate Medical Director, Ambulatory Care Division; rothmier@uw.edu
APPROVED BY:  JoAnne McDaniels, Hospital-Associate Administrator, UWMC, jmcd1@uw.edu

From NSI Manager-Leadership Meeting Minutes 3.2.22, with Nick Postiglione, UWM Patient Access Sr. Consultant

Definitions:
FastPass – allows a pt. that wants a sooner appointment to be pulled forward if an opening arises.

Appointment Request – AKA “Ticket scheduling”.  – involves clinic sending patients a “ticket” to schedule with a specific provider at a specific date and location.  The ticket is returned by the patient, reducing the amount of calls, phone tag and allows flexibility for patient to return their ticket at  their convenience. (Must use MyChart).

Direct Scheduling – refers to return patients initiating their own appointment which is supported by a decision tree to route the patient to the correct provider, etc.  Direct scheduling can support telemedicine as an option*. 

“Open Scheduling” is an additional tool you may hear of but is not appropriate for Neurology or Neurosurgery.

NOTE: All of the scheduling tools rely on patients registering and engaging in MyChart. 

Utilization:
FastPass – is more commonly used particularly in some clinics. Nick demonstrated tracking and noted that in the past 3 days, Epilepsy had offered appointments to 72 returning patients.  Memory Brain Wellness clinic is another high user of this tool. HMC Neurology, UWMC Neurology & Neurosurgery clinics are also using this tool extensively.

Notes for FastPass:

• Check your waiting list – patients must be linked to MyChart to be on the waitlist.
• Check your settings – for example, “visit types enabled”.
• Reach out to your business operations analyst to review your settings and your FastPass waitlist reports.

Appointment Request – AKA “Ticket scheduling” is not commonly being used, though the Neurology Clinic utilizes it somewhat.  It might prove beneficial since it takes less than a minute to generate and send a ticket to a patient’s MyChart account. The patient is immediately alerted of the appointment request.

Notes for Ticket Scheduling: Clinics will NOT receive a ping notifying lack of patient response  – clinics will need to routinely review sent tickets to be sure a patient has followed up with requests, therefore, this method would be most appropriate for pts that are more responsive.

Advice on using the tool: For the Epilepsy clinic, requests are frequently driven by medication refills (though basic calendar reminders are an assist). 
 Another use is that patients are notified that they should anticipate a ticket as they leave from their appointments. It’s  particularly helpful for pts who are not ready to schedule in the moment, but are able to follow up at a later date.

Direct scheduling -High utilizers of this tool included UWMC Neurology and HMC Memory & Brain Wellness – over 50 patients in March!  UWMC Neurosurgery and NW Neurology are also frequent users. HMC Eplipsy are using it to a degree – but it may be helpful for telemedicine.

Notes for Direct Scheduling:
 – In some cases, departments are turned on for direct scheduling, but providers are turned off. (click here for list of providers that are NOT turned on for direct scheduling as of April 2022). Tricia can help facilitate conversations with providers as necessary to adopt this tool.

–  *Direct Scheduling CAN support telemedicine – a ‘visit type’ on the decision tree asks pts if they want a return visit or a telemedicine visit.

*Reach out to Nick via email to have the telemedicine option added so pts can have that option available to them when using Direct scheduling – nickpost@uw.edu

MY Chart Manager Dashboard

Data and clinic scheduling metrics as well as parameters that define patient access are available through the MyChart Management Dashboard.

• MyChart Activation Trends – provides helpful data to regarding clinics and pts.

Same Day/Seven-day Activation Rate shows who is signing up for MyChart.***

(HMC Stroke Clinic is doing a great job of signing up patients for MyChart).

• MyChart Appointment Utilization – key metric noting the % of appointments being scheduled online.
• MyChart Scheduling Breakdown – shows different ways pts are scheduling appts. online.
• Same-day activation – shows who signed up for MyChart

Upcoming technology –

Mychart reschedules is rolling out. If you are enabled for Direct Scheduling those visit types will enable for rescheduling within mychart for patients so they can do this all online.

See also – “MyChart Reschedule (3)

Simply put, Encryption is the use of computing technology to make electronic data unreadable by anyone that does not have a password key.  Any confidential electronic data, including PHI (personal health information) and PII (personally identifiable information) must be encrypted when being transmitted.

Sending confidential information:

In general, individual files being shared with our any of our partners on the Approved Email Domain List does not require any extra encryption.  The UW email system is setup to automatically encrypt all email messages to these email domains. You do not need to do anything else.   (Click here for the current list of Accepted Email Domains).

If you are sending an email to a domain that is not listed below you can easily encrypt an email using Outlook on the web:

Navigate to Outlook by typing this URL in your browser: https://outlook.office.com
When you open a new message, at the top, there is a button that looks like this:

Simply click on that button and that message will be encrypted when you send it to the recipient.

For file encryption, look for this option when saving the document:

Be sure to fully encrypt the document.  save as using a modern file format e.g. – “.docx. “.  Be sure to send password for the document in a separate email or via phone.
Adobe PDF Encryption – > Once a document is saved as a PDF, you can use Adobe Acrobat or Reader to encrypt a file. You can find this option under Tools > Protect > Encrypt with Password.

Zip Files – if you are sending a large amount confidential data, typically over 10MB, zip files can be used for transmitting, though there are inherent risks, and some email servers are configured to deny zip attachments.  (For instructions on how to send zip files, click here).                                                                  E

Receiving confidential information:

If you are frequently receiving PHI from an outside facility that is not on the list of here are three possible options to help ensure they meet encryption standards:

• Contact and request they be added to the approved domain email list
• Have users send zip files with extra levels of encryption
• Send through OneDrive (the user will need to be set up with a sponsored NetID – contact I.T. for assistance).

Sharing with OneDrive: https://support.office.com/en-us/article/share-onedrive-files-and-folders-9fcc2f7d-de0c-4cec-93b0-a82024800c07#OS_Type=OneDrive_-_Business

Did you know? In Epic, the Communications section can be used to send letters to patients, providers and other clinicians, including work excuse/school excuse letters for patients. Letters can be generated with an Encounter, or outside of a scheduled visit. 

A variety of letter templates exist – or – you can create your own letter template!  Once you have composed and sent a letter, you can view it in Chart Review under the Letter tab. 

For a guide to creating and sending letters through Epic click here: AMB_Clinician Sending a Letter in Communications.