Accounting

OpenVPMS includes only enough financial processing as is necessary.  Whilst it keeps track of invoices, payments etc for the veterinary side of the business, it does not keep full track of your bank accounts. Hence you will almost certainly need to run a separate accounting system.

However, since it does handle all the customer and supplier invoicing and payments, there is no need to export the detailed invoice and payment information to your accounting system.  Your accountant should be quite content with the data from the Bank Deposit Report. (This shows the total of the cash and all the detail of the EFT, credit card, and cheque payments.)

On the supplier side, since you need to make payments to the suppliers, you will need to enter the individual supplier invoices into your accounting system so that they can be paid and it can track the payments. However, you can omit the line item detail because OpenVPMS will handle this as it tracks the orders and deliveries.

The Accounting Cycle
Typically this proceeds as follows:

• at the end of each day the till is balanced using the Reporting|Till Balancing screen and the appropriate amount of cash and all the cheques, credit card slips etc removed from the till - note that you do not actually have to stop the business - you can do a till balance and still continue operating
• when appropriate (maybe immediately after the till is balanced, maybe every couple of days) use the Reporting|Bank Deposits screen to generate the Deposit Report, and then take this and all the money to the bank and deposit it
• when desired use the Reporting|Work In Progress screen to check that things are moving along and that no invoices have been stalled for some reason
• when desired use the Reporting|Debtors screen to check on overdue customer accounts
• at the end of the month (or whatever your accounting period is), use the Reporting|Debtors screen to do the Period End processing and then generate and print or email statements

Note that the system does not support multiple accounting periods.  That is, you cannot have a group of customers with monthly accounts and another with quarterly accounts.

Period End Processing & Statement Generation
These two facilities (invoked using the Reporting|Debtors screen) look at all or selected customer accounts and do as follows:

• period end: process all accounts. For any account with an overdue balance (see  Administration|Customer Account Type), check whether accounting fees should be applied, and if so generate the required Debit Adjustment transaction. For any account with transactions since the previous Opening Balance transaction (if any), generate both a Closing Balance and an Opening Balance transaction for the current account balance.
• statement generation: process the selected accounts. Statements will be generated for accounts:
  • which match the selection conditions (which allow selection by customer account type, name and overdue status)
  • with transactions in the period between the statement date and the previous Opening Balance transaction (if any),
  • if there is an outstanding balance
  • if the statement has not been already printed - however a 'Reprint Statements' option allows this to be overridden. This can be used for example to first print the statements of accounts overdue for more than 60 days so that you can include in the envelope a note suggesting that the account should be settled - and then printing the statements for all customers with no selection conditions.  The 60 day overdue customer statements will not be printed again on the second run.
     

Payments and Invoices
Since the system allows you to receive payment for an invoice after it is finalised, there is a tendency to think that the system marks indivual invoices as being paid.  This is not the case: payments are applied to all outstanding invoices, starting with the oldest and allocating the payment to each one until all of the payment amount has been allocated. This follows standard accounting practice.

Thus consider a customer with an invoice for $100 and an account balance of $100. If we now create a new invoice for $150 and the customer pays $150, then when the $150 invoice is printed, it will show the Amount Paid as $50 (because $100 got used to pay the older $100 invoice) and the account balance will now be $100 (ie $100+$150-$150).

Error Correction
The system has a concept of 'finalising' transactions so that they cannot be altered.  To correct a finalised transaction (for example to change the payment type on a payment), you have to Reverse the erroneous transaction (which creates a reversing transaction match the reversed one) and then enter a new one containing the correct data. This reversal facility is only available to users who are categorised as Administrators.

Hidden Transactions
In many cases the above correction procedure can be safely hidden from the customer.  That is rather than the statement showing the original erroneous transaction, its reversal and the new correct transaction, the system allows the first two to be hidden so that the statement shows only the correct transaction.

This hiding of the erroneous transaction and its reversal is only possible when correcting a transaction in the current accounting period (ie since the last Opening Balance transaction). If you reverse an earlier transaction then the hide flag will not be set for either of the reversed and reversing transactions.

For administrators, the Customers|Account screen has a Hide and Unhide button so that, if necessary one can adjust the hide flag for individual transactions.  This needs to be used with care so the statement appear correct in the sum of all the amount shown matches the outstanding balance, ie that all the hidden transactions balance one another out.

Transaction Dates
When a transaction is created, it is timestamped with the current date (and time). When it is finalised, the timestamp is updated. This ensures that the account's finalised transactions are in the proper order for statements and balance calculations. Note that transactions that have line items (such as invoices) then the line item timestamps are not updated at finalisation time and will retain their initial value.

Active/Deactivated

We need to keep old items (customers, patients, products etc) in the system, but we want to be able to ignore these most of the time.

For example, if a given product is no longer used, we can't just delete it, because there will be other references to this product recording its use. In fact, a good working rule is 'NEVER DELETE ANYTHING'. Essentially the only time you should be deleting things is immediately after you created them and you made an error creating them. [A good example is creating a new product with the wrong type, ie you set it as merchandise rather than medication. You can't change the type, so you have to delete and re-create the product.]

To suppress unwanted items you deactivate them by un-ticking their 'Active' checkbox.

If you need to find deactivated items, just set the 'Active' pull-down to 'No' or 'Both' on the search screen.

Addresses

The system is designed to handle location addresses in a structured manner, ie one or more address lines, a suburb, a postcode, and a state. Note however that you do not explicitly set the country - although this is implicit in the state (since each is associated with a country).

If you have to hold addresses in different countries, there are two possible approaches:

1. put the whole address in the address lines, and leave the suburb, postcode, and state fields empty
2. create the states and suburbs for each 'foreign' country

The second approach will potentially result in a long list of states (since it will include those from all countries). Hence the best approach is probably the first.

Alerts

You can set 'Alerts' for both customers and patients.  You can set them for individual customers and patients, and when this is done, you can add a reason, an end date (after which the alert is not shown in the left panel), and notes.

You can also make an alert show for all customers of a given Account Type.

Customer alerts display in the left panel when the customer is displayed, and similarly for the patient alerts. On the Workflow|Scheduling and Worklist screens, if you select an appointment or task the customer & patient's summary information is shown in the left panel and this shows the alerts as in the snippet shown on the left. Common usages of alerts are to flag important customers, bad debtors, aggressive patients, and patient allergies. The administrator creates the available alerts with different ones for customers and patients. (Hence if you want an Aggressive alert that can be shown for both patients and customers, then the administrator needs to create one for customers and and one for patients.) See Administration|Lookups|Customer Alert and Administration|Lookups|Patient Alert.

Barcodes

The system supports the use of barcodes so that you can use a barcode scanner to quickly and accurately enter product identification.

That is, instead of entering 'Advantix X Large Dog 3 Pack (25Kg+)' (probably by keying 'adv' then pressing Enter and then selecting from the long list of Advantix products), you can use the scanner to enter its barcode, and this will be used to find the product.

To get this to work, you need to enter the barcodes as product identities for each of the products that you want to be able to scan, and the scanner will be really useful when you enter this data as it saves keying the 12 digit number.

What is actually happening is as follows: if you enter a product (say on an invoice) as a number, then the system does an identity search of the products for that number, and if it finds only one, then it uses that product, otherwise it displays the select screen.

Note that there is no reason why you should not 'barcode' your own products and services. There are free programs available that will generate the required graphics, and you could print up a page listing these and keep it near the work station so that scanning calls up 'Consultation (9pm-Midnight)'.

A final warning: if you do use your own barcodes, make them long. As explained in identities, the IDs are also searched, so a barcode of 123 will find any IDs starting 123.

Categories and Classifications

OpenVPMS allows you to categorise and classify products, customers and suppliers. You don't have to use these, and the system does not require them to be set up. They are simply to enable you to report on breakdowns of categories and classifications.

For each, the available values are set via the Administration|Lookups facility. The following table gives the name of the lookup for each classification and category.

Classification/Category	Lookup
Product Classification	Product Group Product Income Type
Customer Category	Customer Type
Supplier - Organisation Category	Supplier Type Supplier Account Type
Supplier - Person Category	Supplier Type
Supplier - Veterinary Practice Category	Practice Type
Supplier - Veterinarian Category	Veterinary Specialty
User Category	User Type

 

 

 

 

 

 

 

 

Contacts

Customers, Suppliers, Users, Practice Locations, and the Practice itself all can all have 'Contacts' defined.

The screen shots below are taken from the Customer Edit screen (and hence the other tabs).

There are three types: Email, Location, and Phone. See also Fax Contacts. The entity can have zero, one or more of each type of contact. Each contact can be set as the default contact for each type, and each can be given 'purposes'.

The available purposes are set via Administration|Lookups|Contact Purpose. Each contact can have zero, one or more purposes. In general these are just for information purposes. However, in two cases they are very important. As discussed in Reporting|Reminders, the system looks for a contact with the purpose 'Reminder' in order to decide how to send out reminders. Similarly, as discussed in Reporting|Debtors, the system looks for an email contact with the purpose 'Billing', and if found emails the customer's statement rather than printing it.
To set the purpose(s) use the arrows to move the selected item from the Available list to the Selected list and vice versa.

 

For Email contacts:

The fields are as follows:
Name - this is the 'name' of the contact - by default it is set as per the following table. However, you can set it to anything useful - for example 'Eastside Vets (Accounts Dept)'. Note that email addresses created in versions prior to 1.8 will have 'Email Address' as the default name - but when the email address is used 'Email Address' will be replaced by the default shown in the table below.

Entity	Default Email Contact Name
Customer	Company Name if set; else firstName lastName if both set (eg Joe Bloggs); else lastName
Supplier (Organisation)	Company Name
Supplier (Person)	firstName lastName  (eg Joe Bloggs)
Veterinarian	firstName lastName  (eg Joe Bloggs)
Veterinary Practice	Practice Name
User	user’s Full Name
Practice	Practice Name
Practice Location	Location Name

Email Address - the email address - note that this is checked to have a valid format, but not to see if it exists - if it does not exist then you won't know until an email that you send to the address results in a failure message to the sender
Preferred - check this box if this is the preferred email address. See also below.

 

For Location contacts:

The fields are as follows:
Name - this is the 'name' of the contact - by default it is set to 'Location' but you can modify it to anything more useful
Address - as discussed in Concepts|Addresses this can either be the address lines (not including the suburb etc) or a complete address including the country
Suburb - choose the suburb from the pull-down list - those available are set via Administration|Lookups|Suburb. For international addresses, use 'None'.
Postcode - enter the postcode/zip code
State - choose the state from the pull-down list - those available are set via Administration|Lookups|State. For international addresses, use 'None'.
Preferred - check this box if this is the preferred location. See also below.

 

For Phone contacts:

The fields are as follows:
Name - this is the 'name' of the contact - by default it is set to 'Phone Number' but you can modify it to anything more useful
Area Code - the area code part of the phone number
Telephone Number - the phone number
Preferred - check this box if this is the preferred phone number. See also below.
Allow SMS - check this box if SMS is possible via this number. Note that if you flag multiple numbers as SMS capable, then when you send a SMS, there will be a pull-down list to select the required number.

 

For Fax contacts:
Note that the system cannot send faxes - this information is just for documentation purposes.
As from release 1.8, fax contacts are held as Phone Contacts with purpose Fax.

Note also that there are service providers who allow you to send them an email which will be sent on to a fax number.  Typically you send the email to 98765432[at]efaxes[dot]com and they send a fax to the number 98765432.  If you will be using a service like this, you will need to set the 'fax contact' as an Email Contact.
 

Preferred Contacts
The first contact of given type that is created will be set as Preferred.  When you add another contact of the same type, then by default its Preferred box will not be ticked. However, if you do set this as the new Preferred contact of this type, then the previous contact that was the preferred one will become un-preferred - ie there can only ever be one preferred contact of each type.

Deposit Accounts

The Deposit Accounts represent the actual bank accounts that you deposit money into. Each location can have its own account(s) or the accounts can be shared between locations.

Note that these Deposit Accounts are not like the bank accounts in your accounting system - ie they do not hold all the account transactions and you don't reconcile them.  The Deposit Account record simply holds sufficient information to print deposit slips.

The only time you need the deposit account is when you use the Reporting|Deposit screen after having cleared the till.

The deposit accounts are set up by your administrator using Administration|Organisation|Deposit Account

Discounts

There is an extensive discount system.  Discounts can be provided at the customer, patient, and product level. You can also give a discount at payment time, and disable discounts entirely.

Discount Types
The Administrator defines the various Discount Types using Administration|Types|Discount. For each (eg Staff Discount, Valued Customer, ...) they define  the type (percentage or fixed or at-cost), the rate, and whether the discount applies to the fixed component of the product price as well as the unit component.

One or more discount types can be included in a Discount Type Group (see Administration|Types|Discount Group) in which a start & end date can be specified for each Discount Type. 

Customers and Patients
For each customer and each patient you can define what discount types and/or discount type groups they have, and their start/end dates.

Products
For each product you can define what discount types apply to the product and their start/end dates.  However, since you can specify discounts for each product type (see Administration|Types|Product Type), it is normal to set the discounts at the type level rather than for each individual product.  If there are discounts on both the product and type, then they will be merged. If a discount appears on both a product and its type, it will only be applied once.

Calculation
When the charge is calculated, the only discounts that apply are those that are common to both product and customer/patient.

Hence if the customer has a staff discount, but the product they are buying has no staff discount, then they don't get the discount.

If the same discount has been set for both the customer and the patient, then the discount is only applied once.

However, if there are different discounts set (eg Valued Client for the customer, and Blood Donor for the patient) then both apply (provided that the product has both set).

If there are multiple At-cost discounts, then the one with the lowest rate is selected, as that gives the greatest discount. If there are other discounts as well, these will also be applied.

If the discount resulting from all the applicable discounts exceeds the maximum discount set for the product, then the maximum discount is used. If you want to use At-cost discounts for your staff (say 5%), you must be careful to set the product's maximum discount to allow this. The formula
     D = (M-R)/(100+M)
gives the discount percentage D where M is the Markup percentage and R the At-Cost discount percentage.  Hence for M=100 and R=5, then D=47.5.

Hence setting the product's maximum discount to less than this, say 30% will result in the staff paying more than cost+5%. For them to pay cost+5%, you need to set the maximum discount to 47.5% or more.

If the calculated discount is such as to reduce the price below the cost price, then unless:
a) there is both a fixed and unit price, and both have a 100% maximum discount
or b) there is only a fixed or unit price, and it has a 100% maximum discount
the following warning will be displayed:

Clicking Yes will set the discount amount to 0.

Note that all the above logic simply calculates and displays the applicable discount.  The user creating the invoice/charge can override the calculated discount.

Quantity Breaks
These are not currently supported by the system. There is a proposed design for them, but it's not a currently funded project.

Payment Discounts
You can give a discount at payment time. When the payment is being entered, select a payment type of 'Discount' and enter the discount amount. Thus if the customer is paying $1234, this can be 'paid' by a $1000 cheque and a $234 discount.  The Till Balance report will show these discount payments and their total.
 

Disabling Discounts

Discounts can be disabled by selecting the Disable Discounts flag on the Practice Location.

 

Documents

See Reports, Forms, Letters and Documents for background. See Reference|Reports and Documents if you need to build reports and documents.

The system has the ability to store documents for patients, customers and suppliers.

Products and emails can also have documents attached - see here and here respectively.

First a word on 'document templates' - as described here, these control things like what the document contains, and how and where to print it. Each template has a 'type' and this defines how information is provided when the document itself is generated using the template.  Thus a 'Patient Form' is provided with information about the current patient, a 'Customer Form' is provided with information about the current customer, etc.

For patients, customers and suppliers, there are three types of documents as follows:

Attachments - these can be uploaded from any file that you have access to. They can be pdf files, word processing documents or spreadsheets, or plain text document - anything. They can also be image files - so you can keep a photo of each of your customers etc if you want. Note however, that for patients, there is a specific image facility to add images.

Forms - these are things that are based on document templates of type Patient Form, Customer Form, or Supplier Form depending on whether you are attaching the form to a patient, customer or supplier. As part of the process of creating the attached form, the template will be used to generate the form with the appropriate patient/customer/supplier details inserted, and this is stored. 

Letters - these are things that are normally based on document templates of type Patient Letter, Customer Letter, or Supplier Letter depending on whether you are attaching the letter to a patient, customer or supplier. As part of the process of creating the attached letter, the template will be used to generate the letter with the appropriate patient/customer/supplier details inserted, and this is stored. However, the template used is also stored. For both the generated letter and template, the system stores the actual word processing document and a pdf that can be used to print it.  Hence for letters, you can either print another copy of the letter, or download the word processing document and edit this to make changes to the letter.
However, you can also bypass the use of the document template, and upload any file just as you can with an attachment. The downside is that you are bypassing the template's ability to insert the customer's/patient's/supplier's details into the document. The upside is that anything you upload is classed as a letter - even if it is the scanned image of something that you typed up and signed, or even hand wrote.

Note that for all three types:

• the document is stored in the database, ie the actual document is stored, not the name of the file in which the document may be found
• except for forms, you can have multiple versions of the document  - these could be real 'versions' of the document, ie revisions 1, 2 and 3, or they could be say multiple x-rays taken at the same session which you wish to group together
• since it the document is being stored, rather than a link to it, there is no problem in uploading what are in fact different documents from files of the same name - ie it does not matter if your scanned images are always scanned into a file scan001.jpg
• each document record has the following fields:
  • the date and description
  • a printed flag indicating whether or not it has been printed
  • the status which can be In Progress, Completed, or Finalised.  In Progress implies that you are still working on it; Completed implies that you have finished - but the entry can still be edited; and Finalised means that it is really complete and can no longer be changed.
  • for patient documents, the clinician - note however, that there is no facility for 'signing' the document.

Patient documents also include Images and Investigations. Images work in exactly the same way as Attachments (and in fact you can happily add a text or pdf file as an 'image'). Images are simply there to allow you to logically separate them from other sorts of attachments.

Investigations are also like Attachments in the sense that any sort of file can be attached as the Investigation 'Report'. However, as discussed in Concepts|Investigations, there is built-in support for tracking the status of the investigation and automatically attaching the report files to the Investigation record.

 

Products
You can attach documents to a product. Here you are not attaching an attachment, form or letter, but instead a document template. When you use the product (ie call it up in an invoice) then the required document will be generated from the template and can be printed etc.  The obvious use is to attach a vaccination certificate to a vaccination product. Note that because what you have attached is the template (and not the actual certificate) the generated certificate can include the patient and product details.

 

Emails
You can attach two sorts of things to emails: files and documents. Files are any files that you can access on your workstation, documents are customer, patient and supplier documents stored for the current customer/patient/supplier.
 

ESCI

ESCI stands for e-Supply Chain Interface - it is a facility for automating the orders/deliveries/invoices dialog between the practice and its suppliers.

You don't have to use it, and it requires setting up at both the OpenVPMS and supplier ends. Both Lyppards and Provet in Australia have implemented their parts.

To quote from the documentation:

The OpenVPMS ESCI (e-Supply Chain Interface) is a standards-based API to enable OpenVPMS to electronically place orders on suppliers and to receive order responses and invoices from suppliers . It is based on the exchange of Universal Business Language (UBL) 2.0 documents via web services.

ESCI defines a number of web services which are implemented by the supplier, namely:

• Order – enables clients to submit orders to the supplier
• Inbox – enables clients to receive documents posted by the supplier
• Registry - provides a simple lookup mechanism to resolve the other supplier web services

It works as follows:

• OpenVPMS creates UBL Order documents and submits these to the supplier via the supplier’s Order web service.
• Orders are processed asynchronously by the supplier.
• A UBL OrderResponseSimple document is placed in practice’s Inbox, indicating success or failure.
• When an order has been shipped, the supplier invoices the practice by placing an UBL Invoice document in its Inbox.
• OpenVPMS checks the Inbox web service regularly to process any incoming Order Response and/or Invoice documents.

 

If you are going to set up ESCI, then this link provides useful information.

Error Handling

If you make an error entering data you will get an error screen like the one below. (Here we have omitted to enter the product - a mandatory entry.)  You will see at times, that you could have suggested a better message like 'Please select the product - you must have one'. The messages are generated automatically and are not all individually created.  However, you will always be able to understand what the problem is. Simply click OK and try again.

If an internal error occurs you will get screen like the one below. Note the extra 'Report Error' button. This indicates that the problem should not have occurred and perhaps should be reported to OpenVPMS. If you do not want to report it, simply click OK.

If you click the Report Error button, then the screen below will appear.

The email address defaults to that for the Practice. If desired you can change this - say to that of a technical staff person. You are encourgaged to provide an email address, but if you really want to send in an anonymous report, then you can untick the 'Include my email' checkbox.

Press  the Send Error Report button to send the report, otherwise use Don't Send. If you click the blue 'click here' link a screen like the one below will appear. If you are not a programmer, it's gobbledygook, if you are it's useful.

Note:

• the error sender uses the email setup for the current location. If this is not set up (ie you cannot send email to customers) then the error report will not be sent (and you won't be informed that it could not be sent).
• there is no site specific information (such as your practice name, etc) included apart from the version and revision information you can see below

Estimates

An 'estimate' is a quotation for work to be done and/or goods to be provided. You create and manage estimates using the Customer|Estimates screen. You can also access the estimates for the current patient on the Estimates Tab of the Visit Editor.

On the estimate you can provide, for each line item, an estimate of the fixed price and low and high limits for the unit prices and quantities.

The estimate can be printed and given to the customer. It can also be used to create the invoice for the services and goods quoted for.

HL7

Health Level Seven (HL7) is a set of standards for Healthcare Data Interchange and Interoperability.

OpenVPMS can send and receive HL7 2.5 messages for select events as follows, using the MLLP protocol.

Patient Administration Messages

Patient admission, discharge and update messages are can be sent to registered Patient Event Services and Pharmacies.

See HL7 Patient Administration Messages  for a list of messages sent and the events that trigger them.

Pharmacy Orders and Dispenses

Pharmacy orders can be be placed with external pharmacies during invoicing, using the HL7 RDE O11 message type.

Orders are placed for products or product types that specify a Pharmacy or Pharmacy Group.

Pharmacy dispense messages (i.e. HL7 RDS O13 messages) can be received from external pharmacies. These are used to create Pharmacy Orders or Pharmacy Returns, which may be automatically invoiced during charging, or via Workflow - Customer Orders.

See HL7 Pharmacy Messages for the supported messages, and the events that trigger them.

For instructions on configuring OpenVPMS to interface with a pharmacy, see How To - HL7 Pharmacies

Laboratory Orders and Cancellations

Laboratory orders can be be placed with external laboratories during invoicing, using the HL7 ORM O01 message type.

Orders are placed for investigations with Investigation Types that specify a Universal Service Identifier and a Laboratory or Laboratory Group

Order cancellation messages (i.e. HL7 ORM O01 messages with CA for ORC-1 - Order Control) can be received from external laboratories. These are used to create Laboratory Returns, which may be automatically invoiced during charging, or via Workflow - Customer Orders.

See HL7 Laboratory Messages for the supported messages, and the events that trigger them.

For instructions on configuring OpenVPMS to interface with a laboratory, see How To - HL7 Laboratories

IDs

Almost everything in OpenVPMS has an 'ID'.  This is simply a number and it is unique - ie if there is a customer with ID 1234, then there cannot be a patient with ID 1234. Most of the time you don't need the ID. However, it can be useful in identifying the exact patient, customer etc, and hence it is normally printed on things like invoices.  Thus if there are two Mr Smith's each with a dog called Rover, the ID will identify which Mr Smith and which Rover.

An Identity search includes a search of IDs.  Thus, when you search for say a customer with an Identity 1234, those found will include those with ID's starting 1234.

Although almost everything has an ID, the ID is normally not displayed unless there is a mechanism to search for it.  Thus it is displayed on the on the customer, patient and supplier information screens, but not on the Workflow|Scheduling screen - although each appointment does have an ID.

Identities

A number of things such as customers, patients and products can be given 'identities'.  There are a number of different types of identities such as Alias, Microchip, Barcode, etc.  These are essentially just different ways of identifying the item.

The select screens, where applicable, allow you to search by identity.  Note that when doing so you are not able to search a specific type of identity, the search is done across all identities as well as the IDs.

Hence searching patients for the identity '123' will return any that have microchips, pet tags, aliases, or IDs starting 123.

Insurance

Support for insurance is currently very limited.  All that is supported is a field on the customer information screen showing the Insurance Plan.  However, most insurance policies are against the patient rather than the customer.

Providing better support is a current project that is under discussion.

Some practices have implemented a system of using a Patient Alert to indicate that the patient is insured.

The Patient Discount tab was originally designed to hold this type of information as it also provides start and end dates which are important.  You do not necessarily need to apply any specific discount (i.e no need to setup discounts attached to the discount group) so it can be used for insurance purposes.  What is missing is for this information to be clearly visible to the user when a customer/patient is selected and the ability to use this information to identity and process insurance claims.

Investigations

Investigations are any internal or external clinical test or procedure. The facilities to support these are as follows:

• as many different types of investigations as you want each with its own request form and supplier (ie the lab or organisation that does the test or procedure)
• the request forms are defined by document templates which enable the generation and printing of customisable forms including the automatically merged customer/patient/clinician details
• investigations can be initiated either manually or automatically when a product is added to an invoice
• the investigations and any attached results are displayed in the Patient's Medical record as part of the visit details
• the request forms can be reprinted
• investigations are assigned a unique Request Id
• the Document Loader Job can be used to automatically attach result files (ie reports and images) to the appropriate investigation - this is done via the request id
• you can have multiple revisions of results files
• the result files can be of any type (eg .jpg, .png, .doc, .odt, .csv, .xls, .txt, .xyz, .abc, .anything)
• the ability to list all investigations by status and/or date range.  This displays date, patient, supplier, investigation type, request Id, status and any attached results.  This is ideal for monitoring both internal and external investigation requests.

The tools to set up and use investigations are:

• Administration|Types|Investigation Types to setup and maintain each Investigation Type
• Administration|Templates to define the Document Templates used by each investigation type to define the content of the investigation request form
• Products|Information to attach investigations to the products so that when the product is invoiced, an investigation is created
• Patients|Medical Records to display and perhaps add an investigation for a patient
• Workflow|Investigations to display in-progress (or other status) investigations

 

Each investigation has a Status - one of:

• In Progress - the initial status
• Cancelled - the investigation has been cancelled. This is set automatically when the invoice item that created the investigation is deleted
• Finalised - the investigation has been finalised and may no longer be edited. This is set automatically when Medical Record Locking is enabled.

Each investigation has an Order Status - one of:

• Pending - the order is yet to be sent. This is the default.
• Sent - the order has been set. This is automatically set for HL7 Laboratory orders.
• Received - results have been received. This is set by the document loader when it imports results.
• Reviewed - results have been reviewed

All of these can be set manually.

Local Procedures

The information presented here is generally applicable but does not include conventions and procedures used in your own local practice. 

If your practice does have specific ways of doing things, your administrator may have created local documentation that can be accessed via a bookmark or other mechanism such as the Help item in the top menu of the OpenVPMS screen. (See here for how to set this up.)

Macros

Macros are similar to the "auto correct" facility in Microsoft Word where a small string of text can be expanded into a sentence or even paragraphs of text. The macros can also be set up to use the prefixed number, eg so that 5@w expands to 'for 5 weeks'. They can also be set up to include relevant data like the customer's name so that @dear expands to 'Dear Joanna' (assuming that the current customer's first name is Joanna). Finally it is possible to call a report to generate text for things like a referral email that includes the patient's medical history.

Macros can be used in any text field.  Note however that certain macros will be context dependent. For example, the @bid macro is designed for use when creating a Dispensing Label and uses information from the product record. If you use @bid when there is no current product, then the macro simply will not expand and the '3@bid' that you typed will be left unaltered.

You don't need to remember the macros, pressing Alt-M will display a Macro Select screen like that shown below. You can simply click on the macro you want to invoke it.

Note that the search facility searches both the code of the macros and their names. Hence entering say 'dg' will find all macros with code starting 'dg' and all macros whose name starts 'dg'.

The macros are set up by your administrator using the Administration|Lookups|Macro and Administration|Lookups|Report Macro facilities.

Medical Record Locking

Patient medical records are automatically locked to prevent them being edited, after a period of time. 

Once locked, a record may not be not edited nor deleted except in specific circumstances - see Exceptions below.

The following records support locking:

• Note
• Addendum
• Weight
• Medication
• Attachment
• Form
• Image
• Letter
• Investigation

Medical record locking is enabled by the practice level configuration option Record Lock Period. This defaults to 24 hours. If set to zero, locking is disabled.
 

Medical records are locked by setting their status to Finalised. This is done automatically by a background task that runs periodically to set the status on all In Progress or Completed  medical records with:

Start Time < now - period

where:

• Start Time = the date/time when the record was created
• now = the current date/time
• period = the Record Lock Period

Exceptions

There are a number of exceptions to the locking rule:

• Medication, investigation and document records linked to an invoice may be edited or removed via the invoice, until the invoice is finalised
• Investigation, Attachment, Image and Letter records can be updated via the Document Loader
• Medication, Investigation,  and document records can be unlinked from the patient history if the invoice is reversed.
• Investigation records can have:
  • results attached
  • their Order Status changed

Addendum Record

To support changes to Notes and Medication records that have been locked, an Addendum record can be added. This is displayed after the record in the history that it annotates

A record can have multiple Addendum records. They are displayed in increasing chronological order e.g.

20/10/2015 - Consultation - J Smith [Completed] (8 years)
  20/10/2015 Note      J Smith    S: P presents for a 5-6 day history of rear limb weakness and crying out in pain in the mornings. 
                                  O: PE unremarkable.  
                                  A: Differentials: IVDD, vascular event, etc
                                  P:  Treat symptomatically for now with prednisone and methocarbamol.
  23/10/2015 Addendum   A Bern    Above note was saved incomplete: O has tramadol at home and told o to continue to give tramadol 
                                  for the next 5-7 days.  Recheck in 7-10 days if does not resolve.
  24/10/2015 Addendum   A Bern    Another addendum to the note
  20/10/2015 Medication J Smith   Amoxil Tablets 200mg Qty: 1

An Addendum may only be created if the selected record is a Note or Medication. Adding an Addendum to another Addendum is not supported as it may make the chronology unclear.

Auditing

The ability to enable or disable locking is available to administrators. A new Audit Message will be logged to Workflow - Messaging when locking is changed. e.g.

1/10/2015 10:00 - Medical Record Locking Interval set to 1 week by admin

or:

1/10/2015 10:32 - Medical Record Locking was disabled by admin

This message may be read, but not deleted.

Post Locking updates

Investigations need to support some updates after they have been locked:

• Reports need to be able to be added. Adding a report creates a new version, if a report has already been attached.
• The Order Status is editable

All other fields are read-only.

Editing Records

Prior to editing an In Progress medical record, a check is performed to ensure that it may still be edited based on the locking criteria. This is required as the background task may not have got round to change its status to Finalised.

 

Messages

The system includes a simple messaging system that enables messages to be sent to other users and user-groups. You can reply to and forward messages. When initially received, the message is flagged as pending. After it's read by the addressee it is flagged as read.  When a message is finished with, you can either delete it completely or flag it as complete.

There are two types of messages, user and system. System messages are those used by scheduled processes to notify of status updates or errors. (Currently only the ESCI system generates system messages.)

Note that the messaging system is very simple. Specifically:

• messages have only To addressees and no CC and BCC addressees
• a message to a user group generates copies to each individual user
• a user looking at a message sent to a group cannot see that it was in fact sent to the group rather than him/herself (unless of course the sender puts in the text "To all Reception staff" or similar)
• messages are not private, that is a message to one user can be read (and responded to or deleted) by another
• there is no 'sent tray', ie you cannot see the list of messages that you have sent, only those that you have received.  But since you can look at the messages sent to anyone, you see those that you sent.
• the message status only changes from pending to read when it is read by the addressee. The status stays as pending if it read by anyone else.
• quick 'subject only' messages with no next are allowed

 

Global ToDo list: Because messages are not private, you can set up a global todo list.  The administrator creates a user called ToDo (with a password known only to the administrator so that nobody can login as ToDo). Messages sent to ToDo can be seen by everyone, and individuals can respond to and delete these messages. Thus we have a public todo notice board. You could also create a Work List for this 'todo' function but there is the benefit of being able to easily reply to or forward the messages.

 

Administrators note: since Message Delete is a specific 'authority' it is possible to block the deletion of message by specific users if you want them to only be able to set complete status when a message is finished with, rather than deleting it.

Names

Almost everthing (ie customers, patients, products, reports, etc) has a name. The names do not have to be unique - this is obvious for things like patients (where there are likely to be many Rovers, Busters and Scruffys) but less obvious with things like reports.

Everything has an ID and this is unique. Hence the system can quite happily handle two products named 'Best Dog Biscuits', or two reports named 'Stock Listing', but users will get confused.

Hence it is best to use unique names where appropriate.

OTC - Over The Counter

Over The Counter (OTC) transactions are used to perform sales where no customer and no patient is to be recorded. There is an OTC button on both the Workflow|Scheduling and Workflow|Work Lists screens.  This allows reception staff to quickly make OTC sales.

There is normally one OTC account per Practice Location - though it is possible for multiple locations to share the same OTC account. They are set up using the Administration|Organisation|OTC facility.

The OTC account is effectively a special customer account where the customer is anonymous.

Note that there is also a concept of a 'Counter Sale' to a given customer (accessed via Customer|Charges|New|Counter Sale) where the customer is recorded but there is no patient recorded. If you need the patient recorded, then you use Customer|Charges|New|Invoice.

As indicated above, the OTC account is a special customer account. If you call up the Customers|Charges or Customers|Account screen and then press the Select button, you will find that there is a Type pull-down - see below. Choosing OTC will allow you to access the account.

The Customer|Account screen - see below - is the most useful. Most of the time, the only OTC transaction you need is the sale - accessed using the OTC button of the Scheduling and Work List screens. However, if you need to reverse the transaction or print the payment receipt again, this is where you come.  It works in exactly the same way as the Customers|Account screen for a normal customer.

Payment Types

The system allows for customer payments by the following methods:

• cash - with support for rounding (ie cases where the amount is $12.33 and the smallest coin is 5 cents) and change calculation
• credit card
• EFT - with support for 'cash out'
• cheque

You can also include a discount at payment time. ie the amount payable is $100 and this is paid by $80 credit card payment plus a $20 discount.

One payment can also consist of multiple types, ie $100.75 can be paid by a $100 cheque and 0.75 cents cash.

The system also supports a payment type of 'Other', and Administration|Lookups|Custom Payment Type is used to define these.

The system also support payments by BPAY (an Australian payment portal) in that a facility is provided to generate the required Customer Reference Number to be shown on the invoice.

Practice and Locations

OpenVPMS structures the business as consisting of a single 'practice' with one or more 'practice locations'.  These locations may represent branches at different addresses, or another component of the business (eg the after hours clinic) that operates at the same address.

It is normal (but not mandatory) to have different tills, bank and OTC accounts, and stock locations for each practice location.

The currently selected Practice Location (shown at the top right of the screen) is used as follows:

• it determines which worklist and schedule views are available (as well as the till, bank, OTC account and stock location)
• it sets the default for the customer’s Practice Location (see below)
• it can select the document templates to be used (so that locations A and B use different invoice etc templates)
• it sets the Practice Location recorded for the various customer transactions when they are created - and this allows reporting of things like sales by location
• for the charge transactions (invoices, credits and counter sales) the recorded location determines any special pricing that has been set via the service ratio and/or pricing group facilities

There is no concept of customers (and their patients) 'belonging' to a practice location.  That is, a patient can 'visit' any practice location. However, it is possible to set a preferred Practice Location for each customer. This is used as follows:

• in various reports to select a set of customers
• to select those customers for whom statements and reminders  are processed
• potentially to change the content in documents as a function of the customer's preferred practice location (this requires tailoring of the various document templates)

By default all products are available at all locations. However, it is possible to limit what products are available at each location - see here.

Prescriptions

OpenVPMS provides support for managing and using prescriptions. The features are as follows:

• the prescription information includes the:
  • medication to dispense
  • quantity to be dispensed
  • number of repeats
  • expiry date of the prescription
  • label text; and
  • clinician who created the prescription
• the system tracks the times dispensed and will not allow dispensing if:
  • it has been fully dispensed; or
  • the prescription expiry date has passed
• a default prescription expiry interval is set for the Practice
• prescriptions are managed via:
  • the Prescriptions tab on the Patients|Medical Records screen
  • the Prescriptions tab on the Visit Editor screen, used in the Check In and Consult workflows 
• prescriptions can be printed
• prescriptions that have been dispensed cannot be deleted - this prevents the loss of the information about when and by whom the prescription was originally created
• when invoice line items are being added, the system checks to see whether there is a valid current prescription for the selected product - if so the user is prompted  to see if they want to dispense using the selected prescription or not.  If not the standard medication dispensing process is used.

As indicated above, you do need to set the Prescription Expiry interval for the practice using Administration|Organisation|Practice.

Pricing

OpenVPMS has a powerful and flexible product pricing system.

Price makeup

Products have two components to their price:

Fixed - this is the fixed component - it is effectively the 'flag fall'
Unit - this is the 'per item' component

Hence if something has a fixed price of $10 and a unit price of $1, then the total price for 4 is $14.

In general things that have no overhead such as cans of food will have no fixed price, and only a unit price. Things that have an overhead - such as tablets where you want to charge a dispensing fee as well as the per-tablet price, will have a fixed price representing the dispensing fee and a unit price for the tablet. You can also use this approach for services, where you might want to set a fixed price for some surgery, and a unit price that represents the per-hour charge for the theatre time. [Note that an alterative to this appoach is to have mutiple fixed prices - see below - so that you have different prices for different length operations.]

Tax

Fixed and unit prices may be entered both exclusive and inclusive of tax.
The exclusive tax price is stored, whilst the inclusive tax price is calculated from the tax-exclusive price and the tax rates associated with the product, product type or practice.

The practice Show Prices Tax Inclusive option determines if fixed and unit prices in Products - Information and during product selection should be displayed inclusive or exclusive of tax.

Price Entry

When setting the price, you can provide:

• a tax-exclusive Cost price and a Markup percentage, and the system will calculate the:
  • tax-exclusive Price using:
    Cost * (1 + Markup / 100)
  • the Tax-inclusive Price using:
    Price * (1 + tax / 100)
• a tax-exclusive Price. The Tax-inclusive Price and Markup will be calculated.
• a Tax-inclusive Price. The tax-exclusive Price and Markup will be calculated.

 

The Cost and tax-exclusive Price can be expressed to 3 decimal places; the tax-inclusive price is rounded according to Price Rounding below.

 

Dates

Prices also have from/to applicability dates.  This allows you to keep previous prices for reference purposes. It also allows you to set future prices, ie one that will take effect on some future date.

Templates

A product can have its price set from a 'price template'.  This allows the Fixed price component of a number of products to be set from a standard value.

Multiple Prices

It is possible to set multiple fixed prices for a product, each with its own name. When the product is called up when generating an invoice, the fixed price field will have a pull-down which can be used to show the available prices (with their names) as follows. Note that here the 150/medium price has been set as the default and so is initially displayed.

Service Ratios

Service ratios can be used to apply a multiplier to prices for products of a given product type at a given Practice Location. The multiplier is used when generating charges or estimates. This facility is designed to enable different Locations (such as those used for over-night emergency or house-call operations) to charge more for products of certain types.

Pricing Groups

Prices can be assigned Pricing Groups to enable different pricing for a product at different Practice Locations. If a Practice Location is assigned a Pricing Group, it only sees the Prices that have:

• the same Pricing Group
• no Pricing Group

To use Pricing Groups:

• create a Pricing Group for each demographic that needs to be represented.
• configure Practice Locations to use those Pricing Groups. One Pricing Group may be shared by multiple locations.
• assign Pricing Groups to Prices.

Pricing Groups are similar to Service Ratios in that they both support different prices for a product at different Practice Locations. Whilst Service Ratios are simpler to set up, Pricing Groups enable:

• different pricing of individual products, rather than just types of products
• the ability to enter a rounded price
• product price history
• prices to be exported and imported, per Practice Location

Price Rounding

Tax-inclusive prices are rounded to the default number of decimal places for the currency.

This can be changed by specifying a Minimum Price on the practice Currency.

The practice currency can be selected in Adminstration>Organisation>Practice.

The currency is a lookup, the rounding can be changed by editing the lookup in Administration>Lookups

E.g., to round prices to the nearest 5 cents, specify 0.05 for the Minimum Price.

Tax-inclusive prices will be rounded to the Minimum Price:

• when editing a product, and the Cost, Markup, or Price is changed
• after a Service Ratio is applied during charges or estimates
• a delivery is finalised that triggers an update to a unit price

Note that the Markup and Max Discount may be recalculated after the price is rounded.

Tax-inclusive prices will not be rounded to the Minimum Price:

• if the price is manually entered during charging or estimating
• if they are imported

Negative Prices

You can set as price as a negative amount - although this is not really kosher. Negative prices are used with a product that is in fact a discount. This enables you to have a discount line item on the invoice. For the standard way to apply discounts, see Concepts|Discounts.

 

Pricing Updates

Prices in OpenVPMS can be updated:

• by editing products individually
• automatically when the supplier's price changes if the Auto Price Update option is set for the product/supplier
• via Export Prices and Import Prices

To update a large set of prices, the latter is the preferred approach. The process is as follows:

1. on the Products|Information screen, press the Export button to display the Export Prices screen
2. fill in the parameters to select the products to export and press the Export button
3. this will export the data in CSV format in a file named 'products-yyyy-mm-dd.csv' (where yyyy-mm-dd gives the current date)
4. use a spreadsheet program to make the required changes and save the new data in CSV format.
5. on the Products|Information screen, press the Import button to display the Upload window and upload the new data file
6. the Import Prices screen will then be displayed showing the products be updated and any errors.  If there are no errors, press the OK button to apply the updates. If there are any errors, these must be corrected in the spreadsheet before re-importing it.

Note that the format of the CSV file being imported must match that exported. You cannot have extra columns (such as 'Old Fixed Price') and the column headers must match.

A relatively simple way to achieve this is to copy all the data to a second sheet (called say Sheet1). On the top sheet you can then replace the original data by formulas where you want to do updates.  Thus inserting the formula:

=IF(Sheet1!E2>0,ROUND(Sheet1!E2*1.2,2),"")

in cell E2 of the top sheet and then copying this to all cells below it in the E column will:

• increase all fixed prices by 20%; and
• round them to 2 decimal places

where there is an existing fixed price.

You then save the top sheet in CSV format and import that.

This technique can be used to both create and update prices. To maintain a price history, it is recommended to create new prices.

Creating new Fixed Prices

To create new fixed prices:

1. Clear the Fixed Price Id column contents

Clear the D column, starting in cell D2. This ensures that new fixed prices are created rather than updating existing fixed prices.

2. Change the Fixed Price column

E.g. to increase fixed prices by 50%, add the following to the E2 cell, and copy to the remaining E column cells:

 =IF(Sheet1!E2>0,ROUND(Sheet1!E2*1.5,2),"")

3. Change the Fixed Price Start Date column

The prices should be given a new start date, so that they don't overlap existing fixed prices. The existing fixed prices will have their To Date set to the Fixed Start Date with time 00:00:00. Thus if the new start date is 2/May/17, the old price will apply until midnight on 1/May/17, and the new price will apply from 00:00:00 on 2/May/17.

E.g. to date the prices 30 days from the existing prices. add the following to the H2 cell, and copy to the remaining H column cells.

 =IF(Sheet1!H2>0,Sheet1!H2+30,"") 

The Default Fixed Price column can be used to specify if a fixed price is the default price. This only applies if multiple fixed prices are active for a product at a given time. Valid values are false and true.

Updating Fixed Prices

To update fixed prices, retain the Fixed Price Id column contents, and change the Fixed Price, Fixed Cost, Fixed Price Start Date, Fixed Price End Date and Default Fixed Price columns as required.

Creating new Unit Prices

To create new unit prices:

1. Clear the Unit Price Id column contents

Clear the L column, starting in cell L2. This ensures that new unit prices are created rather than updating existing unit prices.

2. Change the Unit Price column

E.g. to increase unit prices by 50%, add the following to the M2 cell, and copy to the remaining M column cells:

=IF(Sheet1!M2>0,ROUND(Sheet1!M2*1.2,2),"")

3. Change the Unit Price Start Date column

The prices should be given a new start date, so that they don't overlap existing fixed prices. The existing unit prices will have their To Date set to the Fixed Start Date with time 00:00:00. Thus if the new start date is 2/May/17, the old price will apply until midnight on 1/May/17, and the new price will apply from 00:00:00 on 2/May/17.

E.g. to date the prices 30 days from the existing prices. add the following to the P2 cell, and copy to the remaining P column cells.

=IF(Sheet1!P2>0,Sheet1!P2+30,"")

Updating Unit Prices

To update unit prices, retain the Unit Price Id column contents, and change the Unit Price, Unit Cost, Unit Price Start Date, and Unit Price End Date columns as required.

Updating Product Printed Names

To change the Printed Name of a product, enter a value in the appropriate Product Printed Name cell.

Product Price Templates

Exported fixed prices can include prices linked from Product Price Templates if the "Include Linked Prices" option is selected when exporting prices.

Where this occurs, a warning will be displayed in the Notes column. E.g.:

Warning: fixed price is linked from Basic Surgery Fee (1047)

Linked prices cannot be updated via the product that links them; the Product Price Template must be updated instead.

 

Price Groups

If you are changing the price group or adding new prices with a price group, remember that the Price Group is specified by its code, not its actual name.  For example, if its name is say 'Price Group 3' then its code will be PRICE_GROUP_3, and if you edit the price group to change its name to say 'Group 3', its code will remain unchanged.  For this reason it is best to use the Export facility to export some prices with the relevant prices groups so that you can ascertain what the actual codes are.

 

Printing

The system is quite flexible when it comes to printing.  The standard print request window enables you to print to any available printer, but also to email and preview the document. If you request a preview, the pdf file will be downloaded to your browser from where you can save it or print it.

For many documents, ie invoices, receipts, etc, the system maintains a 'Printed' flag. If set it means that someone has printed the item. However, note that previewing or emailing it does not count as printing.

The administrator can set a default printer for each practice location using Administration|Organisation|Practice Location.

It is also possible to set a default printer for each type of document.  More correctly, you can specify the default printer for each document template - see Administration|Templates. You can also set the document to print to a specific printer without displaying the print request window. This is useful with dispensing labels where you always want these printed on the label printer rather than on a standard printer.

These templates also allow flexible control of when documents are printed - see the above link.

Note that these printers are the printers that are available to the server running the database and application. Unless you are running everything on your own machine, the server's printers may be different from your own.  If the server has no printers then you can still print - a pdf will be generated and downloaded just as though you pressed the Preview button.

 

If you have a situation in which your office is split over two floors and you want different default label and standard printers for each floor, then you can accomplish this as follows:

• Clone the primary practice location (say Main) to define a second location, Main-Upstairs.  This is a clone of Main (ie same Shedule & Worklist Views, same Stock Location etc) but with a different default printer set.
• For any templates for which you want to specify the printer to be used, edit the template to set the printer for each location.  Normally this will only necessary for the Drug Label template.
• If you wish, change the name of the Main location to say Main-Downstairs.
• If there is a standard printer for Upstairs, set this as the default for the Main-Upstairs location.
• For users who work upstairs, set their default location set to Main-Upstairs.

Note that if you are using reports that report stuff by practice location, you will need to combine the the information for Main-Upstairs and Main-Downstairs in order to get the totals for the Main location.

Problems

The system provides the clinician with the ability to create a "Problem" in a patient's medical records, and then enter notes and medication against that problem.

The Problem can have a lifetime that spans multiple visits and provides a way of looking at the notes and medication related to the problem. When looking at the the Medical Records summary, the items belong to the problem will be spread throughout the medical history, however, by using the Problems tab, one can see all the items associated with the one problem gathered together.

Note however, that caution should be exercised if medication entries are made against the problem because these will not be charged for, ie no invoice line item will be created for the medication.

The problem has a status which is set to either Un-Resolved or Resolved.

Product Batches

Products that have limited lifetimes or warrant explicit usage tracking typically have batch identification and expiry dates.

Product batches can be tracked during charging and dispensing.

This can be used to:

• auto-fill the expiration date of medication, based on the batch of a product at the current stock location
• record rabies vaccination details given to a patient
• determine who has been sold a particular product batch being recalled
• report on stock about to expire

Batches are created via the Product|Batches screen, or by finalising a delivery that contains batch information.

Products

OpenVPMS has a number of ways of grouping or classifying products as follows:

Type of Product
There are five types of product as follows:

Service	These just have a name (and other optional attributes like prices, discounts, taxes etc etc).  They are not stocked items and you cannot run out of them.  Example: Consultation
Merchandise	Things that are sold and hence also have a Selling Unit (eg Box, Vial, Unit etc) and associated supplier details.  Example: Dog Collar
Medication	In addition to the details held for Merchandise items, these can have drug labels, dispensing notes, a drug schedule and list of active ingredients.  Example: Baytril Otic
Product Price Template	These just have a name and a price and are used to set common pricing for a number of products (by linking the fixed price of the product to this template rather than setting its own).  Example: Dispensing Fee - Standard
Template	These are used to group a number of products together.  They are commonly used for procedures. When you use the template product when creating an invoice, it will be expanded into its component items. The template can include a note to be put on the invoice, and a note to be added to the patient's medical record. Hence, sometimes it is useful to have a template that includes only one product - because of this ability to automatically generate these notes. Product Templates: can include other templates included products can have an applicable weight range specified - so for example a cremation template could include a number of cremation services, each for a different weight range, and the system would automatically include only the one appropriate to the patient's weight included products can be flagged as 'zero priced' so that they are not charged for but are counted as used for stock control purposes Example: Cat Spay

Note that some things that are logically services - eg cremations (and in fact any services that you offer which are in fact drawn from an outside supplier) need to be set as Merchandise so that you can record the supplier of that service.

   
Product Type
(Note that ‘Product Type’ is not the same as ‘Type of Product’.)

Each Service, Merchandise and Medication product can be set to be one of a number of Product Types. Examples might be: Administration, Anaesthesia, Consultation, Consumables, Desexing, Dental, etc. As well as enabling reporting by the sort of product, discounts can be set by product type. Also one can determine the appearance of invoices by the order in which items are shown and whether or not items of the same type are combined into one line item.

 

Product Classification
This is another method for grouping or selecting products for reporting purposes. Your administrator can set up Product Groups and Product Income Types, and you can set a product to belong to one or more of the classifications.

Reminders

OpenVPMS has a powerful and flexible system for sending out reminders to clients that their animals are due for a vaccination, dental check, annual check, etc. Its features include:

• as many different types of reminders as you want, each with its own settings and formats of reminder notifications
• automatic generation of a reminder when a product is used or service provided (ie recording that a vaccination was done can generate the reminder for the repeat due in 12 months time)
• support for sending out reminders by post, email, SMS, or generating a list of customers to contact, or a set of address labels. The data can also be exported to CSV format for processing by a 3rd party.
• a group flag that enables optional grouping of reminders so that a customer having multiple animals each with multiple reminders receives only one reminder document listing all the individual reminders
• the ability to define when a given reminder is due, eg 12 months for this product/service, 3 years for another, together with the facility to override this
• flexible definition of when reminders become overdue and what to send out on the first, second, third etc reminders
• automatic cancellation of old reminders
• automatic completion of one reminder by another by making them members of the same Reminder Group. For example you may set a puppy vaccination and an annual canine vaccination as two different reminder types, but belonging to the same reminder group (eg Vaccination), so that when generating a subsequent invoice for a canine annual vaccination, the Canine Annual reminder will automatically "complete" any previous Canine Puppy or Annual reminder.
• highlighting of reminder status on the Patient screens
• colour coding of whether the reminder is not yet due, currently due, or overdue (as green, yellow and red respectively) with the ability to set the length of the 'currently due' window

Note that if you are interested in Appointment Reminders rather than Patient Reminders, see How To: Appointment Reminders

The tools to set up and use reminders are:

• Administration|Types|Reminder Types to setup and maintain each Reminder Type
• Administration|Lookups|ReminderGroups to define the Reminder Groups used to group different reminder types together
• Administration|Templates|Document Templates to define the Document Templates used by each reminder type to define the content of the reminder notifications
• Products|Information to attach reminders to the products so that when the product is invoiced, a reminder is created
• Customers|Information to display and edit the contact information to check and update how reminders are to be notified (ie which contact has the purpose 'Reminder')
• Patients|Medical Records to display and perhaps add a reminder for a patient
• Reporting|Reminders to display and generate the reminder notifications
• Administration|Organisation|Practice to configure the file format when exporting reminders

To send reminders via SMS:

• The Practice must have SMS support configured
• All document templates used for reminders must have SMS text. This includes the Grouped Reminders template.

In addition, Reminder Types can be configured to override a customer's default reminder method by selecting the SMS check box.

 

A reminder can be in one of 3 states as follows:

• In Progress - is active, ie neither completed nor cancelled
• Completed - what should have happened has (eg the next vaccination)
• Cancelled - the reminder either became too old and was automatically cancelled or it was manually cancelled

Only In Progress reminders are processed by Reporting|Reminders. The possible actions depend on the age of the reminder, whether the reminder type has a template, the 'reminder count' (how many reminders have been sent previously) and associated template, and the customer's contact details. The actions are as follows:

• Post - the reminder will be printed and will have to be posted to the customer
• Email - the reminder will be emailed to the customer
• SMS - the reminder will be sent via SMS
• List - the details will be listed on the Patient Reminders Report (the standard version of this lists the customers names with their pet's name and the reminder type, but it is possible to modify the report to generate address labels)
• Export - the details will be exported to file. See Reminder Export format for a description of the file
• Cancel - the reminder will be cancelled because it is too old and has reached its cancellation date
• Skip - no processing will be done either because there is no template at all specified for the reminder type, or because there is no template with the current reminder count

For a full discussion of how reminders are processed, see Reporting|Reminders

Reports, Forms, Letters and Documents

There are various sorts of things that the system can generate for printing. They are as follows:

Reports - these are invoked for the Reporting|Reports screen. Typically a report has some input parameters (eg the from and to dates, the product type, etc). As well as printing the report, you can also generate a PDF file (which can bve previewed and sved, or emailed), or export the data for use in a spreadsheet. Reports can be give a 'level', and only users with a 'level' equal to above that will be able to run the report.  A number of standard reports are included with the system distribution, more are available from the community resource. If you want/need to modify or create reports, this is possible but needs technical skills - see here.

Forms - these are what they sound like - forms that the system can generate that can include merged-in information about the current patient, customer or supplier. You can modify or create these with a standard word processor. See here for further information.

Letters - these are not quite what they sound like - in fact, they are just forms with input parameters. They are thus used where it is necessary to show information that is not available from the system.  For example, if we have a 'Health Check for Purchase' form, then although the system can automatically fill in the patient details, comments on items like Eyes, Ears, Teeth & Mouth, Chest Auscultation, etc need to be provided by the vet.  Rather than printing the form and then filling these in, the system can prompt for this information and enter it on the form. Since you can use macros when entering the prompted-for data, you can quickly enter standard information.

System Documents & Reports - these are the things like invoices, receipts, orders, statements etc that the system generates. The system distribution includes these, and in general you should not need to modify them because the Letterhead & Document Control facility should enable you to customise these documents for your practice.  However, if you do need further customising then see here.

 

See also Documents and Printing.

SMS

The system supports sending SMS messages. The SMS messages are sent using the 'email to SMS' facility provided by various companies.

SMS messages can be sent to any customer or supplier who has a Phone Number Contact with "Allow SMS" ticked.

SMS messages can be sent by clicking the SMS button:

• in the Customer Summary panel on the left of the screen
• in the Customer's Phone Number contact display (on the Customers|Information screen)
• in the Supplier's Phone Number contact display (on the Suppliers|Information screen)

SMS can also be used for both Appointment Reminders and Patient Reminders.

The message length is limited to the standard SMS limit of 160 characters - ie the linking of multiple SMS messages to send longer message is not supported.

Two companies are supported via tailored configuration screens, SMSGlobal and Clickatell. Other companies can be accomodated via a general configuration screen.

See also Reference|Setup|SMS, Customers|SMS and HowTo|Appointment Reminders.

Schedules, Work Lists and Workflow

Schedules, Work Lists and Workflow - these are the things that make OpenVPMS easy to use. Reception staff and clinicians can almost carry out all their work starting from the Scheduling and Work List screens. The system has a concept called 'workflow' which automates many of the necessary steps to get from an appointment being made to having the visit and invoicing all completed and the patient happily checked out.

Note that you do not have to used either schedules or work lists - you can check a patient in from their Patients|Information screen.  But it really does make life easier - the schedule(s) allow you set up an orderly system to enable customers to be serviced with minimum delay, and the work lists allow you to see the queue of things to be done and monitor what is happening.

This page contains the following headings: Schedules, Work Lists, Workflow, Check-In, Consult, Check-Out, Transfer, Follow-Up, Appointment status, Task status, Status Updates, Multi-Day Resource Bookings, Staff Availability, and Tools.

Schedules
A schedule is a simply a diary of appointments. The following features are provided:

• as many schedules as you need - you will probably want one per clinician (or perhaps per on-duty clinician) and one for 'any clinician'
• you can define 'schedule views' to allows groups of schedules to be displayed at the same time
• schedules can belong to more than one view
• schedules can also represent resources, ie consulting rooms and surgeries
• each schedule can have its own minimum time slot size (eg 5 minutes, 15 minutes)
• schedules with different minimum time slot sizes can be combined on the same schedule view
• you can tailor the check-in process for each schedule by defining the available worklists, documents, and whether or not there will be a weigh-in step
• schedule views can be assigned to one or more practice locations and configured to be the default when the location is changed
• schedules can have multiple appointment types (with a default) and each appointment type can be assigned a default appointment duration
• appointment types can be colour coded
• scheduling dates can navigated by day, week, calendar selection and also by entering abbreviations eg 6w to jump 6 weeks ahead
• a clinician can be assigned to an appointment
• schedules can highlight appointments by appointment type, clinician or appointment status colour
• appointments can be easily moved between dates and schedules
• schedule views can be filtered to show specific times (Morning, Afternoon, Evening, AM, PM) as well as filtered by clinician
• when the appointment is created any relevant customer and patient alerts are displayed
• when an appointment is selected, the customer and patient details are shown in the left panel
• the appointment details include a 255 character notes area, and a set of user defined list of reasons
• the way the appointment is displayed in the schedule is customisable, and the presence of notes is indicated by a bubble icon display to save space

Work Lists
A work list is at its simplest, a queue or list of things to be done. However, it can also be used to manage hospital occupancy, boarding kennels and other resources. While schedules contain appointments, work lists contain 'tasks'. The following features are provided:

• as many work lists as you need - you will probably want one per reception area/waiting room, one per resource (eg hospital, boarding kennels), and perhaps a general 'to do' list
• you can define 'work list views' to allows groups of work lists to be displayed at the same time
• work lists can belong to more than one view
• for resource work lists, you can set the number of slots in the list to corresponds with the number of kennels etc that the resource has.  For queues and lists, the number of slots is set high - normally 100.
• work lists can be combined on the same work list view
• work lists views can be assigned to one or more practice locations and configured to be the default when the location is changed
• work lists can have multiple task types (with a default) and each task type can be colour coded
• each worklist can be tailored to control the list of documents presented for use at check-in time and also whether or no a weigh-in screen is presented
• for a given date, only those tasks whose start & end dates span the selected date are shown - thus it is possible to 'book' a resource for some future period of time, and it is also possible to look at an earlier date to see what was happening on that date
• the dates can navigated by day, week, calendar selection and also by entering abbreviations eg 6w to jump 6 weeks ahead
• a clinician can be assigned to a task
• work lists can highlight tasks by type, clinician or task status colour
• tasks can be easily transferred between work lists
• work lists views can be filtered display tasks by status (incomplete or complete) and to highlight tasks for a selected clinician
• when a task is selected, the customer and patient details are shown in the left panel
• the task details include a 255 character notes area
• the way the task is displayed in the work list is customisable

 

Workflow
Buttons on the Scheduling and Work Lists screens enable you to proceed through the steps necessary to process a job from start to finish. These buttons are:

• New - create a new appointment or task
• Check-In - checks in the patient
• Consult - displays the Visit Editor (which enables you to enter all the visit details , ie medical records, invoice items, reminders & alerts, and documents from one screen)
• Check-Out - checks out the patient

The normal division of labour is that the Reception staff create the appointments and check the patient in. The vet(s) then use the Consult button to enter all the visit related data using the Visit Editor, and then press it's Completed button when they are done. Reception then takes over and does the Check-out.

Check-In
The Check-In button is available on Scheduling and Patient Information screens.  Pressing it does the following things:

• presents a work list select screen to allow the appropriate work list to be selected (you can skip choosing one but it is sensible not to)
• optionally presents a weigh-in screen to record the patient's weight - you can skip entering the weight if you want
• optionally presents a tailored list of patient letters and forms to be selected for printing (for example admission forms). If any letters are selected and these have fill-ins, then these will be prompted for. Depending on the document template setup, the forms may be printed immediately or held until check-out time.
• a task is created in the selected work list. The task type is set to the default for the work list, the notes field is set to the appointment reason with any appointment notes concatenated to it so it comes out like 'Checkup - owner worried about weight gain'. The task status is set to Pending.
• creates a Visit entry in the patient's medical record with reason set to the appointment reason, and the status 'In Progress'. Note that in some cases an existing visit is re-used - see Concepts/Visits.
• if no open invoice exists, a new one is created
• presents the Visit Editor screen. The appropriate visit information could be entered immediately, but normally (since the Reception staff are probably doing the check-ins and not the clinicians) this is exited using the OK button without entering further information.
• updates visit status to In Progress, the appointment status to Checked-In, and the task status to In Progress

Consult
The consult activity is much simpler. Pressing the Consult button (on either the Scheduling or Work List screens) brings up the Visit Editor screen. This is used to:

• add to and edit the medical record
• add items to the invoice
• manage reminders and alerts
• add any required documents to the medical record

The Visit Editor can be exited using one of the following buttons:

• Cancel - discards any pending updates (ie those for which the Apply button has button not been used)
• OK - applies any pending updates but does not update any status
• In Progress - applies any pending updates, and if the invoice status was previously Completed, sets it back to In Progress
• Completed - applies any pending updates and sets the invoice status to Completed, and the activity and task status to Billed

Note that the In Progress and Completed buttons are only available on the Invoice tab of the Visit Editor.

Check-Out
Pressing the Check-Out button (on either the Scheduling or Work List screens) does the following:

• presents a Select Boarding Appointments screen, if a boarding appointment is being checked out. This allows other boarding appointments for the customer to be checked out at the same time.
• presents the Invoice Edit screen to:
  • automatically charge boarding fees
  • allow any last minute changes to the invoice
• presents the Finalise Invoice? window so that you can finalise the invoice. If you say Yes, then its status will be set to Finalised.
• if the invoice is now finalised then the Pay Account? window is displayed. If you say Yes, then the New Payment window is displayed so that the payment can be made.
• if there are documents to be printed (eg the invoice and any patient documents), then the Print window will be displayed allowing you to print either all or selected documents
• the activity and task status are set to Completed

Transfer
The Transfer Transfer button on the Scheduling screens is designed for use after a consultation in which it decided to admit the patient to hospital or for surgery. It does the following:

• presents a work list select screen to allow the appropriate work list to be selected
• displays a Print window if the target work list has templates or Use All Templates is ticked, listing the available templates to print
• adds a new work list task for the selected work list, for the appointment patient. The task will be given the same status as appointment if they have a status in common. If not, it will be set to In Progress.
• updates the appointment status to Admitted, provided it is not Billed or Completed

Pressing the Transfer button on the Work List screens simply allows you to transfer the selected entry from one worklist to another.

Follow-Up
The Follow-Up Task facility allows you to quickly add a task to a worklist that has been defined as usable for follow-up tasks. These can be any worklist, but it is normal to create specific worklists such as 'Reception to follow up' and 'Dr Bloggs To Do'. You can create a follow-up task either from the Patients workspace by clicking the icon next to the patient's ID in the left panel, or if the 'Follow Up At Check Out' option is set for the Practice, then the New Follow-Up Task window will be automatically displayed at checkout time.

You can define one or more follow-up worklists (in order of preference) for each user and each practice location. When the New Follow-Up Task window is displayed, the default worlist is set from those set the current clinician, or if they have none, then the current user, and if they have none, the current location.

Appointment status
The appointment status can be as follows:

• Pending - the initial status when the appointment is created
• Checked-In - has been checked-in
• In-Progress - activity is in progress
• Billed - the associated invoice is complete
• Admitted - can be set manually
• Cancelled - appointment cancelled - set manually by editing the appointment
• Complete - has been checked-out

Task status
The task status can be as follows:

• Pending - the initial status when the appointment is created
• In-Progress - activity is in progress
• Billed - the associated invoice is complete
• Cancelled - task cancelled - set manually by editing the task
• Complete - has been checked-out

 

Status Updates

The following table shows the change in status of the appointment (in the schedule), the task (in the work list), and the invoice as things progress from a new appointment to all being completed. The actions are the buttons that are pressed on the various screens. Where the same action is shown for both the Schedule and the Work List, this simply means that the button is shown on both screens and you can use either one.

Schedule		Work List		Invoice		Visit
Button	Status	Button	Status	Button	Status	Status
New	Pending		-		-	-
Check-In	Checked In		Pending		-	In Progress
Consult	In Progress	Consult	In Progress		In Progress	(unaltered)
				OK	(unaltered)	(unaltered)
				In Progress	In Progress	(unaltered)
	Billed		Billed	Complete	Completed	Completed
Check-Out	Completed	Check-Out	Completed	Finalise=Y Finalise=N	Finalised Completed	Completed

You can of course manually alter the status, but in general you should not need to do, the workflow will take care of setting the appropriate status resulting from each action. The exceptions are: placing an invoice on hold, and cancelling an appointment or task  - you need to do these manually - but you won't need to do this often.

Note also that because the appointment and task are linked, changing the status of one will generally change the status of the other. Thus if you have an appointment checked in (and thus the task has been created and has status Pending), then the customer walks out, then you can simply change the status of either the task or the appointment to Cancelled and this will also update the other one automatically.

 

Multi-day Resource Bookings
This section discusses how to handle multi-day resource bookings. 

The scheduler can handle appointments that span the midnight boundary, so you can make an appointment for a 7-day stay in a boarding kennel. However, this does not give you the optimum resource control. The trick is to use work lists (rather than the appointment schedule) and do things is as follows:

• set up a work list that represents the kennels (or hospital), and set the number of slots to match the number of runs/kennels/cages
• when you get a booking for the boarding kennel, create a task in the kennels work list, with the start and completed date/times set for the expected stay - the status will be Pending
• when the patient arrives use the Consult button to move the status to In Progress and if necessary open an invoice and add notes etc to the visit record
• when the patient leaves, use the Check-Out button to do the discharge processing

Because we have limited the number of slots in the work list, the system will tell you if you are trying to book boarding between dates where the number of cages/runs available on any day between those dates exceeds the maximum.

 

Staff Availability
It is useful to be able to show on the schedule periods when staff are not available. This can be accomplished as follows:

1. create a dummy customer with the Name "--Do Not Use--", First Name "Dummy 'No Customer' customer", and Company Name "-" - this provides us with a customer to be used where there is none [necessary since when creating an appointment, one must specify the customer]
2. create an Appointment Type "Block Out", and Appointment Reasons such as "~Off Duty~", "~Meeting~", and "~Lunch~" - the use of the tilde ~ groups these reasons together at the bottom of the reasons list

You can now create 'appointments' which indicate staff unavailability for various reasons.

 

Tools
The tools to set up the above facilities are:

• Administration|Types|Appointment Type and Task Type to setup and maintain the required appointment and task types
• Administration|Lookups|Visit Reason to setup and maintain the the required visit reasons
• Administration|Organisation|Schedule and Schedule View to setup and maintain the required schedules and schedule views
• Administration|Organisation|Work List and Work List View to setup and maintain the required work lists and work list views
• Administration|Organisation|Practice Location to link the schedule views and work list views to the practice location, and to set the follow-up worklists
• Administration|Users to set the follow-up tasks for the clinicians and possibly users
• Administration|Organisation|Practice to link the schedule views and work list views to the practice location

Stock Control

OpenVPMS has a very capable stock control system. Its facilities include:

• stock control can be enabled or disabled for each Practice Location
• stock can be held in multiple locations - these are called Stock Locations and represent storerooms, warehouses, etc
• a Stock Location can be shared between Practice Locations, but a Practice Location cannot use multiple Stock Locations
• by default all products are available at all locations. However, it is possible to limit what products are available at each location - see here.
• when a customer invoice (or credit note) is processed, the associated stock updates are automatic
• each product can have stock levels (ideal and critical) set for each Stock Location together with always order and never order options
• each product can have one or more suppliers defined - one of which can be set as the preferred supplier, and for each supplier you can set the ordering information for that supplier
• orders can be generated either manually, or automatically
• the automatic order generation process allows the generation of orders for either a specific supplier and stock location, all suppliers and a specific stock location, or all suppliers and all stock locations. You can also specify whether to order only items at or below their critical stock level, or all those below their ideal stock level.
• to assist with the manual creation of orders, there is a Stock Reorder report
• the ESCI facility provides automation of the processing of orders, deliveries and invoices for suppliers who have implemented the required interface
• the manual handling of deliveries is well streamlined - you select what is being delivered from a list of outstanding orders and their line items, check these off, and after the deliveries are finalised, the supplier invoice can be automatically created. A given order can have multiple deliveries - ie if you place an order for 20, the system can handle this being delivered in say 5 and then another 15 some time later. Supplier invoices can be created for each delivery or you can manually create them.
• when receiving items stock levels are updated automatically, and it is also possible to have the product's cost price updated
• the stock adjustment transaction allows the update of the stock levels of one of more products
• the stock transfer transaction allows the transfer of products between stock locations
• the stocktaking process is facilitated by the ability to export and import stock quantity information for specified stock locations and product sets
• one can have a stock location not attached to a practice location. This can be used as a mechanism to keep a record of written-off stock, ie create a stock location called Write-offs unlinked to any practice location, and transfer written-off stock to it.  Similarly, to support conversion of one product into another, you could create a Conversion-out and a Conversion-in location, and transfer 10 cartons of pet food to Conversion-out and then transfer 10x12=120 cans of pet-food in from Conversion-in.
• reports available include Stock Take by stock location, Stock Value by stock location, Stock purchases, and Stock sales

To track the progress of orders and deliveries, both these have a status, and the order also has a delivery status.

The order status can be one of the following:

Order Status	Meaning
In Progress	the initial status when the order is created
Finalised	has been finalised, no more changes can be made
Accepted	order has been accepted by the supplier
Rejected	order has been rejected by the supplier
Completed	order is complete - no more items to be delivered
Cancelled	Order has been cancelled

The order's delivery status can be one of the following:

Delivery Status	Meaning
Pending	no items have deen delivered yet
Part	some items have been delivered
Delivered	all items have been delivered

The status of the actual delivery can be one of the following:

Status	Meaning
In Progress	items are being delivered
Posted	delivery is finalised, either because all items  have been delivered (in which case the Delivery Status or the order will be 'Delivered') or they have not (in which case the Delivery Status or the order will be 'Part')
Cancelled	the delivery is cancelled

Suppliers

In OpenVPMS the term 'supplier' includes all the entities that supply things:

• Supplier Organisations - ie companies that you purchase from
• Supplier Personnel - ie the representatives & sales staff within the above companies
• Veterinary Practices - ie the other practices that you use to refer patients to or purchase services from
• Veterinarians - ie the vet staff within the above practices
• Manufacturers - the manufacturer recorded against Product Batches

Note that the use of this split into organisations and staff is not mandatory, and you could just use Supplier Personnel and Veterinarians.  However, since staff change, it is probably best to set up the Supplier Organisations and Practices, and then add the appropriate staff entries.

On the accounting side, the supplier transaction set is not nearly as rich as the customer transaction set. Specifically there are no initial balance or adjustment transactions, nor a Check Balance facility.  As indicated elsewhere, OpenVPMS does not attempt to provide a complete accounting system for the business. Hence on the supplier side, it provides just enough to handle orders and deliveries.

If you are setting up the system and do want to bring in the current balances for your existing supplier accounts, then the work around would be to create a product say zz-prior-supplies with Printed Name say 'Prior Supplies' and create supplier invoices or credits using this product. Then deactive the product so that it will not be available for normal use.

Taxes

OpenVPMS provides support for item level tax systems where each invoice item is individually taxed, ie the GST used in Australia, the VAT system used in the UK, and the State taxes used in the USA. 

Also it can be configured (via Administration|Organisation|Practice ) to display amounts as either 'tax-included' or a 'without tax' or 'ex-tax' basis. The standard invoice etc document templates are sensitive to the current locale (ie country) and inc/ex tax setting and are formatted appropriately. Hence in Australia with inc-tax we have:

and in the US with ex-tax we have:

Where relevant, the standard reports provided with the system have options to show either inc-tax or ex-tax amounts.

Tax Settings
Taxes can be set at the product, product type, and practice levels.  One can also define multiple taxes.

In a simple 'same for everything' situation, it is only necessary to set the tax for the practice.

If different types of products are taxed differently, then the taxes can be set at the type level. Note also that the tax percentage can be set to zero. Thus in a situation where everything is taxed at 10% but one type of product is not taxed, then the simplest way to handle this is to set a 10% tax for the practice, and a 0% tax for the tax free product type. Similarly, if one type of product attracts an extra tax, the standard tax can be set for the practice, and the 'extra tax' product type set as having both the standard and the extra tax.

If there are only a few products with different tax rates, then it may be easier to set the taxes for the individual products.

Customers with special tax status can be accomodated since it is possible to set excluded taxes for any customer.

The system does not support location dependent taxes.  That is, it is not possible to have different practice locations with different taxes.

Product Pricing
Product prices can be entered as either inc- or ex-tax amounts. They are displayed on the product screens as either inc- or ex-tax depending on the setting for the Practice.

For each product, a cost price and a markup can be entered, and the system will calculate the tax-included price as follows:

      price = (cost * (1 + markup/100) ) * (1 + tax/100)

The tax rate to use is selected as follows:

• if taxes are set for the product, use these
• if the product has a product type, and if that type has taxes set, use these
• else use the taxes set for the practice

Alternatively, if desired, the tax included price can be entered directly without any cost or markup.

Customer Transactions
When a product is entered on an invoice (or credit-note etc) the system first uses the logic above to decide the applicable taxes.  It then checks if the customer has any tax exclusions, and if so removes these.

The amounts displayed on the invoice (or credit-note etc) screen are always inc-tax irrespective of the Practice inc-/ex-tax setting.

The tax included amount and the tax amount are calculated and stored for each line item. The invoice (or credit-note etc) record holds the total tax-included amount and the total tax amount.

Note that the line-item record also holds the cost and tax-inc amounts of the fixed component of the price, and the quantity and the cost and tax-inc amounts of the unit component. (See also Concepts|Pricing) Hence it possible to construct reports on the achieved sales margins by product, product type, customer, patient breed and so on.

Tills

The tills represent the actual tills that the practice uses to hold money. They track not only the cash payments that you receive, but all the other types of payment types (such as cheques, credit cards, EFT, etc) and also any refunds. There will normally be one till for each location but there can be more, and multiple locations can share a till.

At suitable intervals, normally at the end of the day, you will want to check what's in the till, and take out what should be deposited in the bank. This is done using the Reporting|Till Balancing screen. Using this you can print a report of what the system thinks is in the till; you can adjust the cash amount if there have been counting errors; and you can 'clear' the till to remove everything that should go to the bank. It is normal to leave a small cash 'float' in the till so that you have money on hand for change (and cash refunds) at the start of the next day.

Note that the system allows you to balance the till without stopping/pausing the business. Hence practices that operate around the clock are supported.

So the process is print, check and if necessary adjust, then clear.

After you have cleared the till, the money can only be deposited in the bank - it is not available for any refunds.  The deposit operation is done using the Reporting|Deposit screen.

The tills are setup by your administrator using Administration|Organisation|Tills.

Users

Each user is assigned a category, a role, and a level - these determine what the user can do.  Each user also has a login name and password and various other settings discussed below. Users are set up and maintained via Administration|Users.

User Groups can also be created via Administration|Groups. These are used only to allow messages to be sent to multiple users and cannot be used to set categories and rolls for groups of users.

Categories
The system comes with four, administrator, clinician, nurse and reception - but more can be added using Administration|Lookups|User Types. A user can belong to more that one category - ie it is quite logical for someone to be both a clinician and an administrator.

Administrators get an extra 'Administration' entry in the top menu line which allows access to the various administration functions. In addition, the following other functions are made available to Administrators (and are not available to non-administrators):

• Customers|Accounts Check
• Customers|Information Merge
• Patients|Information Merge
• Products|Information Edit, Delete, Copy, Export, Import

Only users set as clinicians are displayed in the 'Clinician' pull-down list shown on various screens. Note that as well as setting all vets as clinicians, it may be appropriate to set some some nursing staff as clinicians.

Roles
The role defines what the user can do. The system comes with only one, administrator, who can do everything, and the facility to add a Base Role (which should be given to all users) and a Stock Control role (which should be given to users who have logistics responsibilities). You can also add more using Administration|Roles.  A user can have one or more roles.

Each role can have zero or more 'authorities'.  A complete set comes with the system, but if necessary these can be maintained using Administration|Authorities. The authorities are split into areas with a create, save (ie modify), and delete for each area.

For example for Customer there are:

 Customer All Acts Authorities  (which includes all the following)
                 Customer Adjustment Authorities
                 Customer Alert Authorities
                 Customer Balance Authorities
                 Customer Charges Authorities
                 Customer Charges Items Authorities
                 Customer Document Authorities
                 Customer Estimation Authorities
                 Customer Note Authorities
                 Customer Party Authorities
                 Customer Payment Authorities
                 Customer Refund Authorities

Thus, potentially one can have very fine grain control.

It is also possible to create a role that can create and save everything, but delete nothing. You may want to use this to prevent anyone except the administrators from deleting things.

At an absolute minimum a user must have a role that includes the following authorities: Entity Links Create, Entity Links Save,  Preferences Entity Create, and Preferences Entity Save.  A user with a role containing just these authorities will be able to log on and look at things but will be unable to add or update any data.

Levels
Each user has a 'level' from 0 to 9. Reports also have a level. A user cannot run a report with a level higher than their own.

Login
All users have a Login Name and a Password. Note that:

1. A normal user (ie not an administrator) cannot change their own password - this must be done for them by an administrator.
2. There is no block in the system against multiple people logging on to the system at the same time with the same Login Name - that is if you choose to operate with logins that reflect functions (such as reception, pharmacy, and nurse) rather than names, then there will be no problem with multiple people logging on as 'reception' at the same time. However, in this environment there will be less tracking of who did what since a number of different individuals will be using the same login name.

Names and Descriptions
All users have a name and a description. The name can be anything, eg GB, George Brown, or Dr George Brown.  However, there is benefit in using short names (like GB), particularly for clinicians, because it makes it easier to quickly enter the clinician. This is particularly easy if each clinician's name starts with a different letter. If you are using short names, then the user's description should be set to the full name, eg Dr George Brown or even Dr George Brown BSc(Vetbiol), BVMS(Hons). This can then be displayed on forms and certificates.

Colours
All users have a 'colour' which determines how their names are highlighted on certain screens - notably the Scheduling and Work List screens. By default it is black on white. Different colours are really only necessary for clinicians since it is only clinician names that are highlighted.

Visits

A 'visit' is what it sounds like - a meeting between the vet and the patient. The visit entry in the medical records acts as a heading to group together all the items associated with the visit.  Thus under a visit one can have notes, documents, problems, medication and charged items.

The Medical Records Summary is displayed in visit order with the latest visit at the top. Within the visit itself, the items can be displayed in either ascending or descending date/time order.

There is no concept of 'finalising' a visit so that it cannot have entries added to it, or the existing entries deleted or edited. However, you cannot delete or add charges to a past visit.

The visit is normally created when you check-in the patient - but see also below. You then use the visit editor to add items to the visit. See also Schedules, Work Lists and Workflow.

The 'visit' will normally be a real vet-to-pet meeting, but could also be a phone call to the owner (and thus on the Medical Records screen there is an 'Add Visit & Note' button to allow this call to be easily recorded).

Visit Creation

Visits are created in the patient's medical record:

• as part of the appointment Check-In process
• if you create a task on the Work Flow|Work Lists screen, and then use the Consult button to open the Visit Editor
• if you use Customers|Payments to create or edit an invoice and the line item specifies the patient (and if the invoice involves multiple patients, then a visit will be generated for each one)
• if you use the 'Add Visit & Note' button on the medical records screen
• if you use the New button on the medical records screen to add a new visit

In the first three cases, and existing visit may be added to rather than creating a new one.  This occurs in the following circumstances (note that 'event date' means the appointment or task date or the date of the invoice line item):

• if an IN_PROGRESS visit exists and it is less than a week old, it will be added to
• If a COMPLETED visit exists starting on the same date as the event, it will be added to
• If a COMPLETED visit exists with both the start and and end dates set, and the event date is between visit start and end dates, it will be added to
• If a COMPLETED visit exists starting on a prior day but has no end date set, then it won't be used and a new visit will be created

Notes:

1. If the visit is being created as a result of checking-in an appointment, then the visit reason will be set to the appointment reason, otherwise the reason will not be set and the medical records will show 'No Reason'.
2. When a visit is completed as a result of the check-out process, the end date of the visit is not set automatically. The end date will be set if you edit the visit record manually and either change the visit status from In-Progress to Completed or set the Completed Date.

Workspaces

As indicated in Introduction|Screen Layout, the system provides a number of different (Customers, Patients, Suppliers, ...) 'workspaces'.

These are so called because the system preserves their contents as you switch between them.  Thus if you call up a customer in the Customer workspace, then go to say the Workflow workspace (by clicking on Workflow in the top menu line, or typing Alt-W), and then go back to Customers, your customer display will be unaltered.

Similar 'remember what was displayed' behaviour occurs within a workspace. For example, in the Workflow workspace there are four topics: Scheduling, Work Lists, Messaging, and Investigations. The displays for each of these is remembered separately so that you can switch between the screens without losing anything.

There is one problem with this 'remember what was displayed' behaviour - what happens if something has changed - ie another user entered a new appointment.  When you return to the Workflow|Scheduling screen, it will be as you left it.  In order to get an up-to-date view, you need to click the Find button or press the Alt-F key.