The 3 C's

Workflow refers to all of the functionality within the workflow section of OpenVPMS. You'll find however, that because workflow is so entangled with the rest of the system (that's the point), that you'll see elements of it throughout the system. Those parts that you'll see most frequently, and the three most important elements of workflow are these.

Furthermore, as you have seen from all the other sections, there is a number of steps that you need to take to make sure that all the data are updated in the right places throughout the system. Workflow automates that process.

Check-In

Check-in refers to anytime a patient enters the practice in such a way that we want to monitor its status. (Almost all of the time.) The idea here is very similar if you were to go to the hospital yourself. The check-in process gears up the practice to accept a patient into the facility. Here is a list of all the things that occur during a check-in:

• Patient forms are printed
• Work-list task is created (and linked to appointment if checked-in from appointment)
• A visit is created in the medical records
• Medical records can be edited
• Weight entry occurs (optional)
• Appointment status is updated (to waiting)

Tip: If you don't use the workflow, you'll be stuck doing all this manually!

The check-in button is most prominently found in the patient information, and on the appointment schedule.

Consult

The consult activity is much simpler than the others. This generally allows one to:

• Edit the medical records
• Edit the invoice

Often, a doctor will be using this functionality. When they're complete, they can click "Complete". This will have the effect of updating the associated task or appointment to the "Billed" status -- meaning read to check-out.

Check-out

Check-out represents the departure of a patient. The Check-out workflow does the following (not in this order):

• Completes the worklist task.
• Completes the appointment.
• Prints all associated documents (including ones added through consultation).
• Allows for editing and finalization of the invoice (for last minute items).
• Payments can be made

Statuses

There are several status in the system that should be used as cues to move patients from one step to the next. We're only considering the status as shown on the schedule for now. There is an associated set of statuses for task lists that may be added in a later version of this document. Here's a brief list of them, and how to bring them about:

Appointment Status

• Pending - Default status when appointment created.
• Waiting - Check-in from the schedule.
• In-Progress - Consult activity from schedule (or Worklist)
• Billed - Consult activity with pressing "Complete" at end of consult workflow.
• Admitted - Set manually in the schedule.
• Cancelled - Set manually in the schedule.
• Complete - Check-out activity from schedule (or Worklist).

Notice how the more important statuses are a direct result of a workflow activity.

Scheduling

The scheduler is the mechanism in the system to plan out appointments, surgeries, boarding, or any other type of time slots that are planned in your practice. Here's that it looks like.

Elements

In the screenshot shown above, the practice has three separate schedules that they choose to show all on one screen. Your practice might have a very different setup, but the basics set out in this chapter will be the same for usage of the scheduling facility.

The top portion of the screen has various controls for showing different days, different time areas, and even entirely different schedules (technically views, please refer to administration documentation). Here's a brief overview of what each element does.

• View: Allows you to select different schedules or sets of schedules.
• Date: Allows you to choose which date is shown, advance or rewind by day or by week, and snap to today (the square button).
• Schedule: When there are multiple schedules shown at the same time, this will allow you to show just one of them. Note that some formatting and extra information will be lost when you do this.
• Highlight: There are several different ways to highlight the data. If you have many doctors in at once, you may want to highlight based on clinician. The highlight shown above is based on status -- meaning that Completed, In Progress, and Pending (for example) will all be different colors.
• Clinician: This allows you to sort for a specific doctor's appointments.
• Time: Often, the whole schedule won't fit on the screen. This allows you to narrow the time period of interest down to AM, PM, evening, etc.

Tip: Many of the features of OpenVPMS are configurable. Your screen may not look like this at all. Work with your administrator to setup what calendars and timeslots you'd like to see.

The remaining elements are the core part of the schedule. The time of the appointment is shown to the left and right, and the name of the schedules are listed across the top.

Creating an Appointment

In order to create an appointment, click the "New" button. You'll see this dialog come up.

Creating the appointment can be done by filling out all these fields. Note that the system will automacally populate some fields if they have already been selected in the system.

Here is a brief description of each field:

• Customer: The customer whose appointment it is.
• Patient: The patient whose appointment it is.
• Appointment Type: The system can allow for default scheduling based on appointment type. You can have 15 minute, 30 minute, or any other length of appointment associated with this field. You can also override the times using Start and End Time.
• Start Time, End Time: Self explanatory, the start and end times of the appointment.
• Reason: This useful field is shown on the schedule to indicate the basic reason for the appointment.
• Notes: This is for further details that might not be covered by the Reason field. These notes will appear in a baloon window when the mouse hovers over the appointment.
• Clinician: Who the patient is coming to see.
• Status: The current status of the appointment.

Tip: Multiple appointments can occupy the same time period on the schedule. Have your administrator turn this feature on. You'll notice that the schedule will create an extra column to accomodate.

In order to complete the appointment, ensure each of these fields is correct, and click "Ok".

"Ok" and "Apply" both save the work. The only difference is that "Ok" will close the window after it saves the work.

Editing an Appointment

To edit an appointment, you'll be dealing with exactly the same screen as when you add an appointment. The only difference is that you first need to click on the appointment.

You can tell when an appointment is selected by one of two ways:

• It will be highlighted (this works only in the multiple schedules view, not the single schedule view)
• You can also see which appointment is selected by confirming the customer and patient information on the side of the screen. When an appointment is selected, the current customer information area changes to the information for that appointment.

Next, to bring up the edit window, click on "Edit". You can now change the fields you'd like to change in the same way as when adding an appointment.

Other Functions

You'll notice there are several other functions available on this screen. Some of these (Consult and Checkout) are discussed extensively elsewhere (Workflow). Here's a brief description of each:

• Delete: Deletes the currently selected appointment.
• Print: For printing an appointment (appointments?).
• Consult: Workflow function for medical notes and invoicing.
• Checkout: Workflow function for invoicing and payment.
• OTC: Over the counter.

The only one worth discussing further here is OTC. The OTC functionality allows for reception to quickly make sales that have nothing to do with appointments. A good general policy is to tie as many sales to patients as possible, as a matter of record keeping. However, there are always those times that someone who may not even have any patients would like to purchase something. This button is a shortcut to a screen that permits this type of sale. It's place here so that you don't need to leave the schedule at the reception area.

Work Lists

Work lists are basically lists of tasks that are queued up for completion within the practice. To get to the this section, click "Workflow" then "Work Lists". You'll see the following when you get there.

This header section of the worklists area shows that worklist tasks can be filtered and highlighted in numerous ways, similar to the schedule view. Here's a brief list of how you can configure your view.

• View: The system will have been configured with 1 or more views into the worklists. Some have multiple worklists showing at once, and some show only one, or a subset of all worklists.
• Date: This works identically to how the schedule date controller works.
• Work List: Which worklist to view. This can filter the current view.
• Clinician: Show only tasks for a particular clinician.
• Highlight: Change the view highlighting to be based on Status, Event Type, or Clinician.
• Status: Show all tasks, just incomplete tasks, or just complete tasks.

Tasks in the worklists can be used for almost any type of task in OpenVPMS. There is however, one type of task that is automatically part of the system, and part of the overall workflow -- the Consultation.

Consultations

A consultation is the primary activity as related to an appointment. That is, a consultation gets linked to an appointment. When checking-in a patient from the schedule, this task gets automatically created.

The benefit here is that doctor's, theoretically, have no need to look at the schedule. They can merrily go from consultation to consultation, or surgery to surgery without worrying about scheduling and reception. Of course, many doctor's do care to look at the appointment schedule as well. And so, the "Consult" workflow action has been placed in both of these places.

Tip: Any changes to a patient appointment or task, affected through the workflow or otherwise, will result in changes to the task and the appointment.

It's important to realize that the task is completely separate (although linked) from the appointment. As such, it's important to manage both.

Roll Call

One of the most important uses of tasks is that they hold the information of when a patient was in the practice. This is valuable information, and should be preserved as well as possible. Many pratices, therefore, have setup separate task lists just to track hospitalization. This work list can therefore become a list of all hospitalized patients -- very useful at a glance.

Other uses can include medical observation (or boarding), general appointment scheduling, phone callback scheduling, etc. We won't dictate here what the optimal configuration for your practice is.

You can also transfer patients from worklist to worklist. Say for instance you had a worklist called "Consultation List" and had another worklist called "Hospitalized List". It's often the case that during a consultation, it's decided to hospitalize a patient. In this situation, you would "Transfer" the patient from the Consultation List to the Hosptilazed List.

Tip: When you do the "Check-in" workflow action, you can select what task list to create a task on.

Tasks in the Workflow

The tasks that make up the worklist are an integral part of the workflow. When you click on a task, you'll notice that the associated (3 C's) buttons appear at the bottom of the screen. You can interact with the task or the appointment to achieve the same result.

Messaging

This section can be used for intraoffice communication. You can get to this section by clicking "Workflow" then "Messaging".

When you first get to the messaging area, you will see a list of messages to you, and their status.

To create a new message click "New" at the bottom of the screen. You will then see the screen to the right appear to create a new message. Fill out all the fields and then click "Ok".

The advantage of creating messages in this way is that the message can be directly linked back to the customer or patient within the system. It also reduces clutter throughout the practice. (Remember stick notes?)

Tip: A good habit is to check the messages section every day to see what new messages have been left for you!

Note that this mechanism is not recommended for things like patient callbacks. Messages are directed at a single individual. If work is to be shared amoung many individuals, it may make more sense to use the task list.

Investigations

Can someone else fill this in?... we're not using this fucntionality right now.