eConsults for Alzheimer’s Patients

An eConsult is the primary referral method to the South Carolina Alzheimer's Network and the best way to ensure that your patient is evaluated quickly. Referring a patient to MUSC Health neurology will not automatically schedule them with a cognitive specialist. Patients should give verbal consent to the eConsult and understand there may be cost sharing. However, if it is determined that a patient should be evaluated in a South Carolina Alzheimer's Network Memory Treatment Center, no charge will be made. If 16 or more minutes is spent in preparation for the eConsult, the referring provider may be able to bill for their time.

Reasons to initiate an eConsult to the South Carolina Alzheimer's Network include:

• Diagnosis of signs/symptoms of cognitive impairment
• Evaluation for anti-amyloid medications for Alzheimer's disease
• Management of abnormal behaviors or medication management
• Patient education or resource recommendations
• Other

Potential outcomes of an eConsult to the South Carolina Alzheimer's Network include:

• A reply to the eConsult with recommendations for management
• A reply to the eConsult suggesting referral to an alternative specialist such as general neurology, psychiatry, or neuropsychology. The South Carolina Alzheimer's Network team will help with scheduling within MUSC if possible.
• The patient is scheduled in South Carolina Alzheimer's Network memory treatment clinic

For MUSC providers including those in the MUSC Regional Network, an order for an "eConsult to SCAN Panel" or "eConsult to SCAN" can be made in EPIC. Please complete all prerequisites as discussed below. The panel order will make it easy to order prerequisite studies (i.e., MRI brain).

For providers outside of MUSC, an eConsult can be placed using MUSC Health Carelink. Information on how to request a Carelink account can be found here.

Instructions on how to place an eConsult from within MUSC Health Carelink can be found in this tip sheet. The order to place is "eConsult to SCAN."

South Carolina Alzheimer's Network eConsult Prerequisites

When placing an eConsult to the South Carolina Alzheimer's Network we require multiple prerequisites. These allow us to have all the clinical information necessary to give an appropriate response. The most important prerequisite is the Patient Symptom Questionnaire (PSQ) (PDF). This can be filled out by the patient's provider or by the patient and their family. We do not recommend patients with cognitive impairment filling out the form on their own.

Additional prerequisites include:

• MRI brain without contrast (CT head without contrast if contraindications)
• Labs: CMP, CBC, Thyroid studies, Vitamin B12, Syphilis antibody
• A cognitive screening test is helpful but not required
  • For anti-amyloid medication evaluations, an MMSE will expedite the determination for treatment

Instructions for completing the eConsult can be found in the "scheduling instructions" box of the order. Typing F3 will enlarge the instructions. Example screen shots are below:

When to refer somewhere other than the South Carolina Alzheimer's Network

Neurology vs. eConsult to South Carolina Alzheimer's Network 

• eConsults to the South Carolina Alzheimer's Network should replace MUSC referrals to neurology when the primary problem is cognitive or behavioral complaint

Neuropsychology vs. eConsult to South Carolina Alzheimer's Network 

• Neuropsychology is appropriate for:
  • Known neurologic condition which is likely contributing to cognitive complaints (e.g., history of stroke, traumatic brain injury, Parkinson's disease, epilepsy, multiple sclerosis, history of neurosurgery)
  • Question if psychiatric disorder is driving symptoms
  • History of interventions with cognitive side effects (ex: chemotherapy, radiation therapy)
  • History of significant alcohol or other substance use

Geriatric Psychiatry vs. eConsult to South Carolina Alzheimer's Network 

• Geriatric psychiatry is appropriate for:
  • Patients with a major psychiatric diagnosis (e.g. bipolar disorder, psychotic disorder, moderate to severe depression, substance abuse) thought to be driving or significantly contributing to cognitive symptoms
  • Patient with known dementia diagnosis where behavioral/psychiatric symptoms are the main concern (these can also be sent to the South Carolina Alzheimer's Network)

Are You Not Sure?

• If in doubt, it is ok to place an eConsult to the South Carolina Alzheimer's Network, and we will help determine the right place for the patient