Visits Overview

Summary

In the simplest of terms, a visit in the application is what happens anytime a patient walks through your door. The visit record contains all information from that visit, including the time, date, provider, activities performed, and charting notes.

Visit Record vs Appointment Record

Appointments are recorded in a completely different file from visits. An appointment is a record of something that might or might not happen in the future. It tells you who the patient is, which provider will be seen at what time, and the purpose of the visits. Appointments are entered for the purpose of managing your clinic resources.

A visit only occurs when the patient arrives in the clinic. It is inevitable that you will have appointments for which patients never show. To enter a visit record in lieu of an appointment would seriously misrepresent the activity in the clinic.

Record Every Visit

As stated above, a visit is what happens every time a patient walks through your door. And every visit should be recorded. You may wonder if you need to record a visit for something as simple as a TB skin test reading. That is not a billable activity and takes very little time, so why bother? One reason is that the program should accurately reflect what has occurred, and what occurred is that a patient came into the clinic. A second reason is so that you can fully document clinic activity. When explaining the need for more staff, for instance, you need to clearly demonstrate how much work you are doing. If you have failed to record a large number of visits, even very short visits, you will not be able to prove how active the clinic is.

Visit Record vs Incident Record

A central distinction in the application is the one between incidents and visits. A visit occurs in the clinic when you provide services to the patient. The incident is an injury, illness, or exposure which gave the patient reason to come to the clinic. Since the visit and the incident are logically different things, the software carries separate but related records for each. When you register a patient for a new injury, illness, or exposure visit, the software will automatically create an Incident record. All follow-up visits for this injury, illness, or exposure will be linked to the same incident which was created for the initial visit. So, a single incident can have multiple visits attached to it. Furthermore, information recorded about the incident on the first visit will automatically be associated with all follow-up visits.

The incident record carries all information related to the injury, illness, or exposure itself. You only need to enter what is of use to you in your clinic. This includes clinical and safety information, as well as tracking work restrictions, referrals, follow-up visits, lost or modified duty time, case costs, etc.

For Occupational Medicine visits, the incident record includes billing information. This is especially important since the carrier at the time of a Workers' Comp visit is obligated for all follow-up visits for that injury, even if the employer changes carrier.

Visit Categories

Visit categories are one of the key elements of the application. The list of visit categories is essentially your list of services. There should be visit categories for each of the physicals you provide, Workers' Comp visits (new injury and follow-up), Urgent care visits, PT/OT and others. They serve a range of purposes. They indicate the purpose for each visit, and through a link to a visit category protocol, they tell the clinic staff what needs to be done for each visit. They provide a classification scheme which can be used for tracking clinic utilization. The visit category drives billing by determining who will pay for the visit. The selection of the visit category when a patient is registered determines functionality available on subsequent screens.

A number of reports can be based on visit categories. To mention just one, the Visits Analysis Report is probably the work-horse of reporting both for clinic management and for reporting to Occupational Medicine employers.

Basic Visit Flow

The actual flow of a visit, who enters what information at what point, varies from clinic to clinic. Here is the basic version:

Check-In or Registration

A visit record is created when you check in or register, a patient. At that time, you record the visit category, the patient's chief complain for initial injury visits, time and provider, select the activities for the visit, if they are known in advance, and print an Encounter Form. The visit category will determine the payer and associate the visit with a visit category protocol which will contain all the instructions necessary for handling the visit. This is especially important for Occupational Medicine visits. For private practice injury visits, insurance information must be collected or confirmed. It might also be necessary to collect a payment or co-payment.

The purpose of checking a patient in is to produce a complete, accurate Encounter Form A flowsheet printed for a visit that lists all the activities to be performed, including special instructions. The Encounter Form carries complete instructions on everything that is to be done while the patient is in the clinic, and as follow-up to the visit. For physicals, the Encounter Form will show all standard activities, optional activities and instructions on when to do the optional activities. For all visits the Encounter Form will carry information on how to report back to the employer about the results of the visit. Once the Encounter Form is printed, no one should have to look up anything else about this visit in the computer, a notebook, or a file.

Check-Out

Check-out can be divided into two sets of activities: clinical discharge and administrative check-out. Clinical Discharge includes:

• Entering clinical result codes where needed. For most activities, all you need to know is that they were done and marking them complete is all it takes. For some activities, additional information is needed. Two examples are TB skin test and HBV. With both of these you need to indicate the step taken on this visit so that the program can calculate the date for the next step. The final result, positive or negative, needs to be entered for titers. To learn more about entering clinical results, please read Clinical Results Overview.

• Printing scripts and dispensing meds.

• Printing patient instructions.

• Entering diagnosis and work status information.

• Entering work restrictions.

• Creating a referral note.

• Managing other visit orders.

Administrative check-out includes:

• Scheduling a follow-up appointment when needed.

• Entering or verifying the activities that have been performed. This can include verifying that protocol activities have been performed and that additional charges have been entered. Or, if an activity was scheduled but not performed, indicating that it was canceled or refused. Once this step is completed, then the activities that were performed will be available for billing. You don't usually need to tell the software who the payer is or what the fee is. It will determine those based on setup information entered for the company.

• Printing the Encounter Summary or Work Status Summary.

• Following any additional instructions such as special reporting instructions.

Work Flow Variations

Having said all this about the basic flow of a visit, we must then add the major qualifier "Maybe". This program was developed to support four general types of organizations:

• Hospitals, for use in their Employee Health Departments

• Hospital-based or independent provider clinics, specializing in Occupational Medicine and Workers' Comp services to outside employers

• Urgent Care centers which provide episodic-based ambulatory care to patients, and often also market Occupational Medicine services to local employers

• Family Practice providers, especially those which also may choose to provide Urgent Care and/or Occupational Medicine services.

Each of these types of organizations tend to have different procedures and work flows, and even within types, there are great variations. To accommodate this broad range of users, a great deal of flexibility has been designed into software. For instance, many steps in documenting patient visits can be done from more than one location, many items only need to be entered when appropriate, and activities within a visit can be documented in any order. Here are some examples of how work flows vary:

• A number of steps which would be part of checking the patient out in a setting which does not use Provider Charting are, when Provider Charting is use, performed automatically from within the charting process. Entering a diagnosis code and entering work restrictions are two examples.

• Some clinics effectively combine clinical discharge and administrative check-out into a single process.

• Clinical results are often not received for a day or two and thus entered long after the patient has left. In fact, in some clinics lab results are returned via an electronic interface and need to be reviewed, but are not manually entered at all.

• Clinics using Hospital Employee Health, typically do not check patients in when they arrive and check them out when they leave but instead document the entire visit after the patient has departed. Visits might even be entered from within the Patient Chart instead of the scheduling calendar of the Home Nav Bar.

There are many other possible variations. This degree of flexibility has increased the challenge in writing these help screens since it is simply not possible to explain the overall flow of documenting a visit with a fixed "step 1, step 2, step 3, etc" format that will work for everyone. And lamentably, it adds some interpretive burden to those readers whose work flows diverge more widely from the "standard" work flow which the help screens reflect.

Considerable effort has gone into easing this burden. While the How-To screens are designed around the basic visit flow, there are abundant hyperlinks to let you hop from the current topic to the next one you need. Multiple methods are provided certain activities, for instance, there are separate "how-to" topics for logging a scheduled visit, a physical or drug screen visit, a Workers’ Comp visit, and an Urgent Care visit. Some topics have notes like this…

…which point out differences between using the application in your clinic.

It is our sincere hope that these efforts will support you in learning how to do what you need to do in the way in which you do it. We do welcome comments on any aspect of the How-To screens via email to Net Health Support. While it is certainly more fun for us to read about what you like, it is equally more useful to learn about what you don’t. Thus, we do welcome all comments and will see that your feedback is put to good use in this ever evolving documentation.