Add Visit and Note - suggested change
The 'Add Visit & Note' button appears in two places: the Medical Records screen, and the Visit Editor.
We would like two changes in this facility:
1) when invoked from the Medical Records screen, allow the Visit Reason to be entered so that it is not always set to "No Reason"
2) on the Visit Editor screen, change the button name to just 'Add Note', and create the note in the current visit and do NOT add a new visit. ie make the button simply a shortcut to the New|Note facility. [If you are editing a visit, why add a new one.]
Note that the alternative would be to simply remove the 'Add Visit & Note' button from the Visit Editor, and thus force the use of the New|Note facility. However, I suspect that adding a note to a visit is a common activity and hence the 'Add Note' button shortcut should be left in place.
As you can see the above two changes are aimed at reducing the prevalence of 'No Reason' visits.
Comments/feedback appreciated so that I can proceed to ask Tim A to cost this so we can get it done.
Regards, Tim G
Re: Add Visit and Note - suggested change
The Practice Manager pointed out that I partially missed the point. She wants the Visit information to be editable with the note.
This is driven by two things:
Hence the requirement is that the 'Add Visit & Note' button present a screen that allows both the visit and note data to be set; and that when the Note is created or edited, the visit information is also presented for editing.
Functionally, this means that the Note Editor is adjusted to become a Visit and Note Editor.
Regards, Tim G
Re: Add Visit and Note - suggested change
Hi Tim G,
I think this makes a lot of sense. Currently I have to go back to the Visit editor to modify the Reason of visit a lot. Having a combined Visit and Note Editor will save the number of clicks and time.
Kind regards,
Anthony (ActiVet)
Kind regards,
Anthony (ActiVet)
Re: Add Visit and Note - suggested change
Yes - I too would like to be able to add the notes and edit the Visit reason on the one screen
as it is frustrating to go back and adjust the Visit reason.
Thanks Anna
Re: Add Visit and Note - suggested change
Hi,
In addition to these good ideas, is there any benefit in allowing administrators to merge visits? We still have issues with people creating new visits for inpatients. While the proposals will lessen the prevalence of these it would still be nice when they happen to be able to consolidate these so the medical history is more coherent.
Thanks,
Adrian
Re: Add Visit and Note - suggested change
Tim A - can you comment on Adrian's 'administrators should be able to merge visits' suggestion. It seems to me that:
Regards, Tim G
Re: Add Visit and Note - suggested change
This should be a separate project.
Visits have links to visit items (notes, medication, problems etc), and charges. When merging visits, charges would need to be updated, so business rules would need to be supressed to avoid triggering rules for finalised charges.
In 1.8, a problem can also be linked to multiple visits, so there would need to be a facility to remove duplicate links.
When performing Check-In/Consult/Check-Out, the appointment or task date is used to select the appropriate visit. If the Visits being merged have different dates then a subsequent Consult could select the wrong visit.
Merging visits with different dates should therefore display a warning e.g. 'The visits you are merging have different dates. This may result in an incorrect visit being selected when performing a subsequent consult or check-out. Are you sure you want to continue?'
Re: Add Visit and Note - suggested change
Hi,
Thinking about it, the perhaps the best option it so start by making it harder to create an extra visit. Thus perhaps we start with Tim's suggestion 2 and see if that improves the situation?
Re: Add Visit and Note - suggested change
Hi all,
I would agree to make it 'harder' to create a new visit too if there is an active one present already as Tim G suggested in point 2 above. I'm not as worried about the number of visits of inpatients as long as charges are logged under the one same invoice.
Kind regards,
Anthony (ActiVet)
Kind regards,
Anthony (ActiVet)
Re: Add Visit and Note - suggested change
OK - can we proceed as follows:
1) put the 'merge visits' matter aside for the time being
2) ask Tim A to create and cost a Visit/Note improvement to do as follows:
a) adjust the Note editor so that it also displays the Visit Reason as an editable field
b) when the 'Add Visit & Note' button is pressed (in either the visit editor or the medical records screen), check for the presence of a visit with 'In progress' status. If there is one display a message box with Yes, No and Cancel buttons which says:
There is currently an 'In Progress' visit dated dd/mm/yyyy. Do you want to create a new visit?
Press Yes if so; press No to add a Note to the In Progress visit; press Cancel to abort.
Note that the Yes option gives the current behaviour - ie the 'Add Visit & Note' button generates a new note. The No option is equivalent to selecting the In Progress visit and then pressing New and the OK to generate a Note.
Regards, Tim G
Re: Add Visit and Note - suggested change
I think its OK for Add Visit & Note to allow editing the Visit Reason, as they are both new records.
However, I don't it should be supported when creating or editing notes for existing Visits, as its misleading - the Reason is for the entire Visit, not individual notes.
Re: Add Visit and Note - suggested change
Tim - there is a very real question about what the Visit Reason represents - is it what the owners and receptionist thought was the problem, is it a summary of what the vet ascertained the problem to be.
In the normal workflow where the Visit has been created as part of the check-in, it will get its reason set from the appointment reason. If one uses a large set of appointment reasons (as we do) [rather than the very simple set like the None/Checkup/Vaccination/Other used in the demo system] then it is quite possible for Reception to set the reason as say 'Scratching'. When the Vet sees the patient, the actual problem is say 'Lice infestation' - hence it makes sense that in the medical record the Visit Reason should show, not what the owner and receptionist said the appointment reason was, but rather what was actually wrong with the animal.
While it is possible for the vet when writing up the consult, to edit the visit to change the reason, does it not make sense for the visit reason to be easily modified when the note is being entered.
I think we need some feedback from real vets - should it always be easy to update the Visit Reason when entering a note - or as you suggest, only be possible to set the reason when entering the note when creating a new visit via 'Add Visit & Note'.
Regards, Tim G
Re: Add Visit and Note - suggested change
The visit reason is intended to reflect the reason for the appointment, rather than the diagnosis.
In 1.8, Problems have been extended to have codified presenting complaint and diagnosis fields, so it would be better to create a Problem in the above case.
Re: Add Visit and Note - suggested change
From our perpective almost every visit we have has "No Reason" listed. This is partially what .
I think TimG's suggestion is a good one in that for us the "Reason" would be the overarching diagnosis for most cases (E.g. GDV) rather than "Sick" which is the owners reason for bringing their animal in and what would otherwise be recorded and is not very useful.
Re: Add Visit and Note - suggested change
Hi all,
Thank you all for your feedback on this. I understand TimA's point about the visit reason being different from the reason for the note. However, in practice, as other's have pointed out, changing either the visit reason or the 'problem' requires closing the visit note, and opening another window. Most of my staff don't bother to do it, which means that the visit reason is either left as 'no reason' or it is something that isn't particularly relevant.
I think the underlying issue is being able to change either the visit reason or the problem in the same window as the note so that you don't have to click in and out of different windows.
When reviewing a patient's medical record, the part that stands out to the viewer is the visit reason (because it is in bold text at the top of the notes). If this is solely the reason that the client made at the point of booking but doesn't reflect the diagnosis, it shouldn't be in bold and the 'Problem' should be.
What if we changed the wording and called it 'visit summary'. Would that make it clearer that it was designed to reflect the reason for the visit rather than the reason for the note?
I just want to make it clearer for viewers of the patient medical records to what the medical problem was.
Trilby
Re: Add Visit and Note - suggested change
The visit reason is exactly what it says, that doesnt mean thats what people are universally using it for.
It can show a range of things.
I would be against changing the wording for a number of reasons...
During the consult process - the visit REASON is transfered from the appointment reason....last I checked receptionists wont be making many diagnoses over the phone or prior to seeing pets.
The reason represents the concern the owner has - and the vet needs this information -
I think that the visit reason should become a derived field value - possibly transferring any original appointment reason to a note. Deriving the value means the visit reason becomes a dynamic field.
Initially it will take the appointment reason - and display that possible it would concat any info from the appointment notes field as well - (our receptionists often expand on the reason in notes.)
If a problem with a subsequent diagnosis is added to a Visit - the visit title will then derive the diagnosis. or if no diagnosis is made but a defined Presenting complaint is assigned that that will be the visit title.
The above fields will be added into 1.8 and comes with an extensive list of coded complaints and diagnosises.
I do believe the add visit and note button if it to continue - needs the ability to edit the reason on the fly.
Re: Add Visit and Note - suggested change
Hi all,
That's an interesting idea Ben - to make the Visit Reason a dynamic field! This would be good because it saves time and makes the medical record more readable to others by tidying up the visit title automatically if a Problem is entered.
Currently, from an end user view point, 'Checkup' is our default reason when a new appointment is entered into the work scheduler. Most of our nurses do not change the reason despite we have an expanded set but rather enter more details in the appointment note field, because often there are more than one reason for the appointment anyway, eg: vaccination + check lump + itchy skin + nail clip, so before the vet click on the Consult button, we make a habit of expanding on the note icon to read the appointment notes, so we know what is expected from us in consult.
When a new visit entry is made by pressing the New Visit and Note button, 'No Reason' is the default reason.
So after finishing with the visit note, whether it was followed throught the consult flow or created manually, I still had to go back to the visit title to edit the Reason field so the medical record would make more sense when read by others.
While Tim A's concern is very logical, I would still prefer both point a) and b) suggested by Tim G above on 18/6.
Kind regards,
Anthony (ActiVet)
Kind regards,
Anthony (ActiVet)
Re: Add Visit and Note - suggested change
I now understand a lot more about visit creation (see the revised http://www.openvpms.org/documentation/csh/1.7/concepts/visits ), and I have also been playing with a very early pre-release version of 1.8 (which includes a change to 'problem's - so that instead of being as documented here they are become simply an entry in the medical record that documents the diagnosis (and optionally the presenting complaint) in a structured manner [ie these are not free text but drawn from a set of lookups]. Thus we have:
and the system comes with standard Venom codes and you can add your own - so for example
Given this change in 1.8, I fully agree with Tim A's point that the Visit Reason should not be used as a place to put the diagnosis.
If you look at the revised Concepts - Visits you will see that a visit can be created in many ways other that from the check-in of an appointment, however it is only in this case that we get the reason set automatically.
I think that what annoys most of us is the very obvious "No Reason" - it looks as though we have not been doing things correctly, whereas it simply reflects that the visit was not created as a result of an appointment check-in with the reason specified. If we altered things so that nothing (or perhaps just "-") showed instead, then we would not be so worried.
While it makes sense to have 'Add Visit & Note' to allow to you put something in the visit reason (eg 'Phoned Owner'), it is not practical to pop up a window to enable you to set the visit reason whenever a visit is created as a result of other than an appointment check-in or using New|Visit - eg as a result of an invoice line item with the patient specified.
Given all the above, my suggestion is that we do the following:
Regards, Tim G
Re: Add Visit and Note - suggested change
Hi,
Just revisiting this thread. We are still having issues with people adding new visits when they should just be continuing a current visit. I think some of the time people may be pressing "Add Visit and Note" button when they should just be adding a new note...
So...
Q. Is there any way to disable the "Add Visit and Note" button? There is no situation I can think of where it is useful in our practice.
Q. If not, where are we at with Tim G's very sensible suggestions that I feel would solve at least some of our issues....
Thanks,
Adrian
Re: Add Visit and Note - suggested change
Sorry - this dropped off my radar.
I've raised OVPMS-1619 to remove the Add Visit and Note button from the Visit editor.
For the other points, this needs a new project. Tim G - do you want to do, this?
Thanks,
-Tim A
Re: Add Visit and Note - suggested change
Project created - see http://www.openvpms.org/project/reduce-incidence-no-reason-visits
Regards, Tim G