This appendix presents examples from the e-transitions Web site used in training materials for Cornell-NYPH physicians and VNSNY nurses during the pilot testing phase of this project. Note: All patient information on these pages is fictitious.
From the e-transitions home page (Figure D.1), the physician or nurse is prompted to select the "Login"; button at the upper left hand corner and enter an assigned User Name and Password to access the user's personal page. A list of patients currently receiving home care from VNSNY acute care teams will appear on the physician's home page; similarly, a list of patients referred by participating physicians at the Cornell-NYPH will appear on the nurse's home page (Figure D.2).
When a patient is added to these lists or if there is new information or revisions to orders for a current patient, the user is alerted through e-mail. To view or revise orders for a patient, the user selects the patient's name and is directed to the plan of care page.
The patient's plan of care orders are listed in date order, with the most current working plan at the top (Figure D.3).
By selecting "CMS-485"; the user can access a complete and printable plan of care (Figure D.4).
Other options from the plan of care page include:
The physician can refer a patient and create a plan of care from his or her personal home page (Figure D.9) by selecting "Add a New Patient."
This directs the physician to a set of pages where the patient's demographic information, care plan, goals, and other data are input. Figure D.10 illustrates the final page of the set.