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Initial Communication

Second Requirement in Transitional Care Management

Bill Ruby avatar
Written by Bill Ruby
Updated over a week ago

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Navigate to the Patient TCM Page:

First you will want to navigate to the Patient's View Page by entering the patient's first name, last name, or EHR ID in the search bar on your dashboard. 

Once the search results appear, select the patient's name, EHR ID, or the "View" button under the Actions column to open the patient view page. 

Once on the patient view page select the "Transitions" tab and click "View" under the actions column to bring up the patient's TCM Page.

Documenting Attempt to Contact:

Whenever a user makes an attempt to contact a patient in TCM, the call should be documented in the "Communication Overview" section.


Note: Make sure to document all calls made to the patient, even if they are unsuccessful. 

If a user is ready to document an attempted call, they would simply select the "+ Add new Attempt" button located under the Interactive contact section

Note: Notice the "Due Dates" listed within the "Communication Overview". These dates are provided to let the user know when the initial contact/call to the patient is due by and when the Face-to-Face Visit is to be completed by. If the date is highlighted in red this means that it is past due.

Once the "+ Add new Attempt" button is clicked, the "TCM Communication Attempt" pop-up will appear. Take a second to look over the pop-up along with the call information that will need recorded here.

Note: If there is a red banner at the top of the pop-up, it is infirming the user that the Date and Time that is recorded under the "Date and Time" field is outside the TCM initial interaction window.

First, begin by choosing the "Start" time and "End" time of the call made to the patient. Click within the provided date/time field to change the selected day and time.

Note: The current day and time will automatically be added to the "Start" box, and the "End" box will be automatically populated with the time 30 minutes after the current time, so this will most likely need changed whenever the user is documenting a previously made call.

Once the pop-up calendar appears, click to select the proper date that the attempted communication was completed. Also, make sure the recorded time is accurate.

Note: If the month/year/time needs changed simply use the provided drop down arrows at the top and bottom of the calendar pop-up to change the time, month, or year in which the attempt was made.

When the correct date and time is selected, click the blue "Apply" button, as shown in the below screenshot.

Note: If the user clicks out of the calendar pop-up without clicking the "Apply" button, the changes will not populate in the "Date and Time" field, so when changing the date or time make sure this is clicked before moving forward with logging an attempted communication.

Next, the user can click within the "Assigned" drop-down box to document care manager that made the communication attempt.

Note: This field will be automatically filled with the name of the care manager currently logged in.

Once the drop-down menu appears, type or scroll to find the care manager that made the communication attempt.

Now, one must record the "Type" of communication attempt made. Click within the "Type" drop-down field and select the proper type of communication.

Once the "Type" is selected, the user can then add the "Purpose" of the call using the "Purpose" dropdown. Click on the "Purpose" dropdown and select the appropriate purpose for the communication attempt.

Note: This field will automatically be filled with the TCM Initial Communication, but can be changed if needed.

User's can then add what programs were relevant to this communication attempt. Select the "Programs" dropdown and add any applicable programs.


Note: "TCM" will automatically be added to this field.

Lastly, user's can select the "Outcome" of the communication attempt. Click the "Outcome" dropdown and select the applicable outcome.

If a patient has had previous communication attempts made, and a user has made notes about them, they will appear in the "Previous Interaction Notes" section. These previous notes can also be edited using the blue button in the top right of the boxed off area below.

If a summary or note needs added to the Communication Attempt, a user may use the "Notes about this interaction" field that is provided. Simply click within the text field and begin typing to record any notes.

Whenever the user has completed the Communication Attempt form, they can click the "Save" button in the bottom right hand corner of the screen.

Note: If the user clicks outside the "TCM Communication Attempt" pop-up before saving the attempt, all recorded information will be lost.

The number of attempts made, along with the most recent call that was completed will be listed at the top of the screen in the "Communication Overview" section. Also, the newly added contact attempt will be displayed in the "Communication Overview"

Note: If the user wishes to add an additional call they simply need to click the "+ Add new Attempt" button again to begin documenting an additional communication.

Note: How a user can edit a preexisting communication attempt is explained in the Editing a Contact Attempt section.

Completing the Initial Communication Requirements:

Whenever the user has documented a successful initial communication event one may go right ahead and click the "To Do" button located in the Requirements column to the right of "Initial Communication" (shown in below screenshot).

The "Initial Communication" section will appear at the bottom of the screen. Scroll down to be able to view the entire section.

Recording Initial Communication Details:

The first half of TCM's "Initial Communication" section covers where the patient was discharged to, the caregivers name, the Care givers relationship to the patient, and any health home notes that should be documented.

To record where the patient was discharged to, select the bubble to the left of the proper place/home they went to once their hospital stay concluded.

Note: If the "Other" option is chosen, the user has the ability to enter an additional place/facility, that is not listed, in which the patient was discharged to.

If needed, add any additional "Note" within the "Notes about discharge location" text box.

Now, click within the "Caregiver name" box and begin typing to record who is caring for the patient.

Once the Caregiver's name is recorded, click within the "Caregiver Relationship" box and begin typing to describe the relationship the care giver has with the patient.

If there are any additional details relating to the patient's "Home health", they may be documented in the "Home health notes" area. Click within the provided text box to begin typing to add a new note.

The second side of the Initial Communication section includes the "Interactive contact" section which lists any logged contact attempts made to the patient. There is also, an additional text box that can be used to document any additional "Notes" that may need to be recorded.

Editing a Contact Attempt:

If you wish to edit one of the contact attempts simply click the "Edit" button located next to the interaction you wish to edit. By clicking the "Edit" button the user will reopen the "TCM Communication" pop-up discussed earlier in the article

If the user wishes to delete/remove a contact attempt, they can simply click the "Remove" button located below the target logged call in the "Interactive contact" section.

If a user attempts to remove a logged call, ThoroughCare will prompt the user if they are sure they would like to delete the call attempt, click the "Ok" button to continue with removing the logged call.

Adding an Additional Contact Attempt:

A user can also select the "Add new Attempt" button as shown below. This will open the "TCM Communication Attempt" pop-up for the user to document any additional attempts at contact.

If the user tries to document a communication attempt that is outside the TCM window the user will be notified with a red banner that will appear at the top of the "TCM Communication Attempt" pop-up as shown in the screenshot below.

Once all necessary contact attempts have been documented, the user has an option to add any additional notes to the "Notes" section located underneath the "Interactive Contact" area.

Completing the Initial Communication Section:

Once the entire "Initial Communication" page has been completed the user can then select the "Mark as reviewed and complete the section" button located in the bottom right hand corner of the screen.

Once marked as completed, underneath the "Requirements" section in the upper right hand corner of the patient's TCM screen, the blue "To Do" should change to a green "Completed" as shown below.

If you wish to begin the walk-through of the next section (Non Face-to-Face) click here.


To access other helpful ThoroughCare articles in the Knowledge Base or to get help from the ThoroughCare Support team members, click the ‘i’ icon in the top right corner of the software next to the username and use the appropriate link!

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