Interfacility Consults (IFCs) Anchorage [463]

The following describes Consults, specifically Interfacility Consults (IFC), for the most recent year of Anchorage VistA cut on 2021-01-06.

Local consults - those ordered and fulfilled within this VistA - represent fully 132,553 (98.8%) of the consults created in this VistA during the last full year for which data is available. Of the IFCs, there are more Placer consults (“placed” elsewhere) 1,483 (1.11%) than Filler consults (fulfilled by this VistA for another) 129 (0.1%). In terms of IFCs, this is a Placer VistA …

VistA Consults are ordered using consult types called services. Local consults use 362 (67.79%) of the services used in this system, less than their proportion of consults. In other words, more services are employed for ordering IFCs than their numbers would suggest. Notice also that some services used for local consults - 0 - are also used for IFC fulfillment. While services used for placement are exclusively for IFCs, the same is not true for fulfillment.

As seen below, most patients with consults only have local consults and the majority of the balance have both local consults and IFCs (“mixed”).

A small minority of patients have only fulfilled consults. With fulfilled consults, a patient’s home record is typically elsewhere so you would expect to see more such patients and less mixed patients. The lower number of such “remote-only patients” should be examined further.

As for users, a smaller proportion are only involved in local consults. While no users only fulfill consults submitted from elsewhere, a relatively large set only place consults elsewhere. This set of “placer only users” needs further examination.

Placer

There are 170 Placer Services - services that route/place consults to 76 other facilities. In VistA, a Placer Service identifies a specific remote (routing) facility which is always the main, default facility of a remote VistA. In this VistA, 92.0% of the IFC Consults are “Placed” and the vast majority go to other facilities in the same VISN, facilities highlighted in bold in the tables below. Placer consults can be broken into four broad classes …

6 of the Placer Services are for TeleReading to 3 facilities …

Service by Service …

80 of the Placer Services denote travel to remote facilities and represent 33.72% of placed consults. These prove to be the exception to the rule that a VistA places most IFCs within its own VISN.

By Facility …

10 are “Common” Placer Services sent between both filler and placer VistAs. They represent a range of typical administrative (“VIRS”, Lodging, Domiciliary) and care requests to remote facilities (Follow ups). In this VistA, such requests represent 4.25% of placed consults.

Note that equivalent services are filled by this VistA. Those are detailed in the Filler Section below.

By Facility …

The balance, 74, of the Placer Services to 7 facilities, are mainly for specialized clinical services and represent 41.6% of placed consults. Once again, the vast majority go to other facilities in the same VISN but the flow is mainly from smaller facilities to larger with the small placing with the large.

By Facility …

Filler

There are 2 Filler Services - services that accept/fill consults from other facilities. In VistA, a single Filler Service may be employed by more than one remote facility and may also be used for purely local consults. In this VistA, 8.0% of the IFC consults are “filled”, mostly from VistAs in the same VISN …