There are circumstances where Medical Records (notes, attachments and other entries) should not be shared with customers or external parties (referring clinicians etc) via printed or mailed Medical Records or API calls.

Many practices would like to provide Wellness Plans which offer Customers a regular payment plan that provides benefits in the form of  discounted or free consultations, vaccinations and other services for a specified period.

We need a mechanism that allows various plans to be defined including what product types are included, percentage discount on these products and , in some cases, the no of times the discount can be applied during the plan duration. i.e 4 free consultations per year,  2 50% discounts on Vaccinations etc

Wellness Plan creation for a specific Patient should be simple including management of full or scheduled payments through a suitable payment gateway.  i.e 12 monthly payments.

Wellness Plans for a specified Patient should be visible in the Patient Summary and Patient Infotrmation and viewing a plan should show full plan details as well as no of discounts applied vs allowed by product type.

Wellness Plan renewals can be managed though the standard reminder system. When a Wellness Plan is created a specific reminder will be automatically added for the plan expiry date.

Wellness Plans can be Cancelled.

Practices that use the record locking facility sometimes find that a record has been incorrectly attached to the wrong patient, after the record is locked.

Locking prevents it from being deleted. A subsequent note or annotation needs to be added to indicate that the record should be ignored.

Provide a facility for administrators to hide these records so that they aren't shown by default.

Hiding Records

To hide finalised records, users with Administrator or Practice Manger role would click the Delete button, which would display a message:

This record is finalised and cannot be deleted.

Do you want to hide the record?

Yes/No
 

If the user clicks Yes, it would display another prompt:

Enter a reason for hiding this record:

Once a reason is entered, the record would be suppressed from view.

Showing Hidden Records

Hidden records will not be displayed by default, but can be shown by ticking a 'Show Hidden' box.

Records that are hidden will be displayed with a strikethrough.

The reason for why they are hidden can be displayed by viewing the record.

Unhiding records

If a record is hidden, users with Administrator or Practice Manager role can select it and click an Unhide button. This marks the record finalised, and removes the reason for hiding it.
 

Record types

The following record types can be hidden:

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

The following record types cannot be hidden:

• Invoice Item
• Visit
• Problem

Auditing

When a record is hidden/unhidden, an audit message will be generated, containing the patient name, the record type, and time, the user that performed the action and the reason the record was hidden.

E.g.,

• Note dated 2022-02-01 10:30 for Fido (12345) was hidden by admin with reason: attached to the wrong patient
• Form dated 2022-02-22 17:53 for Spot (1123) was unhidden by jsmith. Previously hidden with reason: incorrect form

Outstanding Issues

• For insurance claims, are hidden records suppressed or included with annotation that they are hidden?

Public holidays are currently handled within OpenVPMS schedules by using calendar blocks.
This requires users to add public holidays per schedule. To avoid repetition, provide a way to:

• create a calendar to record public holidays
• indicate how holidays affect schedules i.e. do they prevent scheduling or are they informational
• allow holidays to be restricted to particular locations, to support regional holidays
• display public holidays within a schedule

Calendar configuration

A single holiday calendar may created in Administration - Organisation.

This will support defining repeating holidays in a similar manner to how calendar blocks or repeating appointments are defined.

Location-specific behaviour

Different practice locations may have different requirements for particular holidays e.g.

• one location may be open between 10am and 2pm and another closed
• the holiday may be local rather than state-wide

This will be supported by allowing each holiday to:

• list the practice locations it applies to
• for each location, indicate:
  • if the location is closed; or
  • the open and close times

Multiple holidays on a given day will initially not be supported.

Schedule Display

• If a holiday prevents scheduling, the schedule for that day is greyed out.
• If a holiday indicates open and close times, the region outside the times are greyed out. This overrides the Start Time and End Time for the schedule.
• If a holiday is informational, it displays like a calendar block that can be scheduled over

Online Booking

• The location associated with a schedule will be used to determine what holidays apply to that schedule.
• If a holiday prevents scheduling no free slots will be returned for the day
• If a holiday indicates open and close times, free slots returned will be limited by those times.
  If the schedule has Online Booking Times, these will further limit the times
  e.g.
  • if a holiday has times 10am - 2pm, and the Online Booking Times for the day are 9am - 5pm,
    the holiday times take precedence.
  • if a holiday has times 9am - 4pm, and the Online Booking Times for the day are 10am - 5pm,
    the free slots returned will be between 10am and 4pm
• If a holiday is informational, calendar blocks determine the free slots

Rostering

TO DO

Service Ratios

There is currently no requirement to integrate holiday calendars with service ratios.

Overview

Time-based product templates will allow different products to be charged based on time-of day.

This can be used to improve charging accuracy. E.g. an Admission template might have two service products:

• Night Admission -  17:30 -  7:30
• Day Admission   - 7:30 - 17:30

If charged at:

• 9am, the Day Admission charge would be added to the invoice.
• 6pm, the Night Admission charge would be added.

Configuration

A Time Range will be added to the Product Template Includes to determine when a product is included.

E.g:

• Time Range: 9:00 - 17:00  - applies between 9am and 5pm
• Time Range: 17:00 - 9:00 - applies between 5pm and 9am

If the Time Range is unset, the product is always included (subject to any patient weight criteria).

Estimates

If a time-based template is expanded on an Estimate, it will reflect the time that the template was expanded. When the estimate is subsequently invoiced, the expanded items will be charged. So if a template X includes:

• Product A - 9:00 - 17:00
• Product B - 17:00 - 9:00

Expanded template X on an estimate at 10am will generate a line item containing Product A.

If this estimate is subsequently invoiced at 6pm, Product A will be invoiced, not Product B.

Exclusions

This project will not support date range or calendar inclusion.

When a customer or patient is deactivated, or a patient dies, any pending appointments for them remain, and need to be manually cancelled.

This should be automated. To avoid cancellation of appointments after accidental deactivation, schedule the cancellation to occur 24 hours after the customer or patient was deactivated.

Overview

This project will provide a Lost & Found, a central facility to view documents and results where the patient or investigation is not known, and attach them to the appropriate patient.

It will:

• provide a workspace to list documents and/or results that cannot be linked to a patient
• update the Document Loader store documents that cannot be loaded, so they can be managed by the workspace
• provide a plugin API to enable laboratory services to record documents and results that cannot be associated with patients

Background

At present, documents are loaded into OpenVPMS using the Document Loader.

This is a scheduled job that periodically load files from a directory and attaches them to documents or investigations.

Files are associated with documents or investigations by parsing their identifier from the file name.

If a document or investigation cannot be found, the file is moved to an error directory. Users must remember to check this periodically, and then manually attach the file to the patient history.

In OpenVPMS 2.2, there will be better laboratory integration, however results from these can still fail to be associated with a patient if the original investigation has been deleted, for example.

Lost & Found Workspace

The Lost & Found Workspace will be located under Workflow.

It will provide a table that displays all documents and results that cannot be matched to a patient, with the following columns:

• Date - the document date
• Patient Name - the patient name, if known
• Patient Id - the patient id, if known
• File Name - the file name
• Message - the reason the result cannot be attached
• InvestigationType - the investigation type, if known
• Document - link to view the document content
• Results - link to view any results

The following buttons will be provided:

• Recover - displays a dialog that links the document or result to the correct patient.
• Delete - deletes the document permanently

The Recover button displays a dialog that prompts for the:

• Patient
  • will be preselected, if known
• Type
  • one of Investigation, Attachment, Letter?
  • defaults to:
    • Investigation, if results are known to be for an investigation
    • Attachment, for other documents
• Investigation Type
  • the investigation type, if the Type is Investigation
• Patient Visit
  This will be preselected, based on the patient and document date.
  A History browser may be shown to select a different Visit, or create a new one.

When the relevant details are populated, clicking OK will add the appropriate record to the patient's history, and remove it from the list of 'lost' documents.

Document Loader

The Document Loader will be updated so that any document that cannot be loaded will be moved to Lost & Found.

Plugin API

A plugin API will be provided to allow plugins to log documents and results to Lost & Found.

Overview

At present, Smart Flow Sheet can be used to bill Medication, Service, and Merchandise products.

This project will enable Smart Flow Sheet to bill Template products. This will streamline charge capture in sites where Smart Flow Sheet is used predominantly used for patient visit management.

This will support:

1. template expansion, when invoiced
2. removal of invoice items, if the the corresponding treatment is removed in Smart Flow Sheet
3. removal of invoice items, and re-invoicing, if the corresponding treatment quantity is changed in Smart Flow Sheet

Template Expansion

If a Template is billed in Smart Flow Sheet, this will be expanded on customer invoice. If product doses or weight based charges this will use the patient's current weight.

To support subsequent amendments, meta-data will be associated with expanded items.

Treatment Removal

If a treatment is removed in Smart Flow Sheet that previously resulted in a template expansion, each item in that expansion will be:

• removed, if the corresponding invoice is not finalised
• credited, if the corresponding is finalised

Treatment Amendment

If the quantity for a treatment is changed in Smart Flow Sheet that previously resulted in a template expansion, each item in that expansion will be removed or credited, as per Treatment Removal above. The template will then be expanded again, using the new quantity.

Overview

This project will add a Charge Note field to Merchandise and Service products.
This will be displayed in a popup when the products are added to an Estimate, Invoice, or Counter Sale.

This could be used in the following scenarios:

1. Estimating a service: Fancy blood test
   Charge Note: "Unlike other tests, DO NOT ask owner to fast their pet. Make sure they get the special Fancy Blood Test form before they leave your consulting room so they can bring it with them on test day"
    
2. Selling over complicated Merch: Dog lead  
   Charge Note: "This lead comes with the free collar stored behind the front desk."
    
3. Billing a service with special considerations: Lab test on Lump
   Charge Note: "This fee only covers one lump. If you are sending multiple lumps use, MULTI LUMP HISTOPATHOLGY"

Display

When a product is charged that has a Charge Note, a popup will be displayed, with the name of the product, the current quantity and the Charge Note.
This is purely informational; the product and quantity cannot be changed.

An OK button is used to close the window.

Overview

Time-Based Charging will allow patients to be invoiced:

• for the amount of time they spend on a Work List
  This can be used to improve charge capture as it removes the need to manually calculate a charge based on patient visit times.
   
• a 'flag-fall' product, when they a transferred to a Work List
  This can be used to charge an admission fee for example.

A Work List may have multiple charging configurations, to reflect the complexity of the case. E.g, there might be configurations for:

• Surgery - Simple
• Surgery - Moderate
• Surgery - Complex

Charging will be triggered:

• when a Task is transferred to a Work List
  The user will be prompted to select from the available configurations.
  If the configuration has a 'flag-fall' product, this will be invoiced.

  The selected configuration will determine which time-based charge to apply.
   

• when Check-out is performed from a Task

  A prompt will be displayed e.g.

          The following charge will be invoiced: Hospitalisation Fee - 12

• when a Task is transferred to a different Work List
  A prompt will be displayed e.g.

          The following charge will be invoiced: Hospitalisation Fee - 12

  If the new Work List is also configured for charging, the user will be prompted also.

  Pressing OK performs the transfer and invoices the charge. This will display the Visit Editor if the charge displays pop-ups.

  Pressing Cancel cancels the transfer.
   

• Periodically
  Charging can be configured so that a new charge is added periodically, when the configured interval expires. This can be used to better inform customers of their current bill, rather than waiting for Check-Out

The following rules apply:

• Charging will only occur if the Task is In Progress
• The time that a patient spends on the Work List determines the quantity charged. This time resets:
  • when they are transferred to a different Work List
  • each time they are charged, if period charging is configured

Check-Out

At Check-Out, a prompt wil be displayed if a Task exists for the patient that is on a Work List that attracts a charge, and is not the one being checked-out from. For example if the patient is on a hospital Work List that attracts a periodic charge, but Check-Out is performed from the appointment, this gives the user the option to bill and complete the Task.

Configuration

Charging will be configured by attaching one or more Work List Charges to a Work List. If multiple Work List Charges are available, the user will be prompted to select the appropriate one.

A Work List Charge will contain:

• Flag Fall product
  A product that is charged whenever a patient is added to the Work List.
  E.g, an Admission Fee, or IV Catheter
• Recurring product
  This product is charged based on how long the patient spends on the work list.
• Interval
  Determines how often the the Recurring product is charged e.g. every:
  • 15 minutes
  • 1 hours
  • 12 hours
• Periodic Charging
  A flag to indicate if charging should be done periodically, or in bulk.
  When charging perodically, a separate charge will be added each time the interval expires. This will be limited to intervals of not less than 1 hour.
  Any remaining time will be charged on transfer or check-out.
  When charging in bulk, a single charge will be added for the total time that the patient is on the Work List.

   

A Template product may be used for both the Flag Fall and Recurring products.

Specifying a Template:

• enables multiple products to be charged
• supports Location-based pricing via the Practice Use Location Products option
• supports weight-based product inclusion
• supports patient doses

If the Time Based Product Templates project is implemented, it will also allow different products to be charged based on when the patient is transferred to the Work List.

Quantity Calculation

The quantity charged is calculated based on the elapsed time that the patient spent on the Work List, rounded to 1 decimal place.

E.g., given a patient spending 95 minutes on a Hospitalisation work list, the following would be charged for the intervals:

When periodic charging is configured, a charge of quantity 1 is added each time the interval expires. The interval remaining at transfer or check-out will be charged as above.

Charging Mechanism

Charging will be done via Customer Orders, to avoid multiple threads/users updating an invoice concurrently. A new Customer Order type will be required, in order to support product templates.

Changing Charges

A Change Work List Charges button will be available in Workflow - Work Lists to change charging for the selected task.

This can be used if a patient needs to have their recurring charges changed (e.g. level of hospitalisation needs to be upgraded).

This:

• prompts the user to select the new Work List Charges
• prompts the if they want to bill any unbilled charges at the old rate, or the new rate

Note that any:

• periodic charge that has already been applied will not be updated to reflect the new Work List Charge
• Flag Fall charges applied previously need to be manually removed if they are no longer applicable.

Stopping Charging

A Stop Work List Charges button will be available in Workflow - Work Lists to stop charging for the selected task. It will not stop any charges that have already been generated.

This will prompt the user if they want to bill any outstanding charges.