Smart Flow Sheet integration - billing and notes

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Development Project Status: Completed

Total cost estimate (ex-Tax): 
$4800
Due date for completion of this stage: 
12/07/2016
Release: 
2.0
Current Percentage Funded: 
100.00%
Project funding: 

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Project description: 

This project will enhance the existing Smart Flow Sheet integration to:

  • charge treatments given to a patient in Smart Flow Sheet
  • synchronise products and clinicians with Smart Flow Sheet
  • add notes entered in Smart Flow Sheet to the corresponding patient's history
  • add support to specify a department on Check-In
  • add support to associate a default department with a work list
  • add support to import anaesthetic sheets
  • automatically discharge patients from Smart Flow Sheet on Check-Out
  • automatically import documents on discharge

Billing

When a treatment is entered into Smart Flow Sheet, a corresponding Customer Pharmacy Order will be automatically created in OpenVPMS. If the order is complete, this will be charged automatically during the normal Check-In/Consult/Check-Out workflows.

If the order is incomplete (e.g the product doesn't correpond to one in OpenVPMS, the units are different, or the quantity is unset), an error will be displayed during invoicing, as is the case with the existing Pharmacy Order support.

Notes

When a note is entered into Smart Flow Sheet, these will be automatically added to the patient's history.

Product Synchronisation

Where a practice location is configured to use Smart Flow Sheet, a new Synchronise with Smart Flow Sheet button will be added to the Products - Information workspace.

This will add or update all medication, merchandise and service products that are available at the current practice location to Smart Flow Sheet.

If a product is no longer active, it will be deleted from Smart Flow Sheet.

Mapping

Medications in Smart Flow Sheet require concentration, concentration units and concentration volume. These will be source from the medication product's Concentration, Dispensing Units and the Weight Units of the first dose associated with the medication, if any.   

Clinician Synchronisation

Where a practice location is configured to use Smart Flow Sheet, a new Synchronise with Smart Flow Sheet button will be added to the Administration - Users workspace.

This will add or update all clinicians that are available at the current practice location to Smart Flow Sheet.

If a clinician is no longer active, it will be deleted from Smart Flow Sheet.

Departments

Smart Flow Sheet supports departments. This project will:

  • allow the user to select from a list of departments on check-in
  • default the department to one associated with the work list, if any

Event Mechanism

Smart Flow Sheet provides two mechanisms to send events, web hooks and Azure Service Bus. The former requires the practice to open up a port in the firewall, whereas the latter is polled. This project will use the Azure Service Bus option, as it is more secure and typically requires no additional network configuration.

Anaesthetic sheets

Support will be added to import anaesthetic sheets, along with the existing Flow Sheet, Medical Records, Notes and Billing documents.

Check-Out

At present, patients must be manually discharged from Smart Flow Sheet.

This will be changed so that at the start of check-out, the patient will automatically be be discharged from Smart Flow Sheet.

Document import at discharge

When a patient is discharged from Smart Flow Sheet, Flow Sheet, Medical Records, Notes, Anaesthic and Billing documents will be automatically imported to the patient history. This replaces the manual import currently performed as part of the Check-Out workflow.

If a document has been previously imported, it will be versioned.

Outstanding Issues

  • SFS doesn't support display names for units, so if the code is submitted (e.g. GRAMS) this is what will be displayed in the UI. The alternative is to submit the display name, and then map this back to the appropriate lookup when performing charging.
  • Need to determine if billing can be disabled in SFS if Cubex is connected

 

JIRA: OVPMS-1871

Comments

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Re: Smart Flow Sheet integration - billing and notes

Hi,

Thank you. Looks good.

Questions:

- Importing documents automatically on discharge. Is this discharge from SFS or check out from OVPMS? In practice what happens is patients are checked out from OVPMS. Currently this is when documents are imported. Then we discharge from SFS. Will this double up importing of documents? Can check out from OVPMS trigger a question? -> "Do you want to discharge from SFS" -> If yes then patient is discharged from SFS and documents imported?

- Billing - I am not clear how billing works. For items such as a PCV/TPP will an entry in a box in SFS equal a charge? What happens if we want to skip or delay an item? 

- Nice to specify a department as well from OVPMS. Also have a default department for each worklist.

- Nice to be able to download images and videos from SFS as well.

- Ditto for patient image.

- Will notes in SFS be created as separate notes in SFS?

Re: Smart Flow Sheet integration - billing and notes

Hi Adrian - taking your points in turn:

Importing documents on discharge

At present, OpenVPMS prompts to import the various documents at check-out. Instead, it could be changed so that:

  1. OpenVPMS tells SFS to discharge the patient as part of Check-Out
  2. SFS notifies OpenVPMS that it has discharged the patient
  3. OpenVPMS adds the various documents to the patient Visit

There may be several minutes delay between the request to discharge the patient, and the documents being available; this would be done in the background so Check-Out is not held up.

The advantage of this approach is that you can perform the entire Check-out process from within OpenVPMS, removing the ability for someone to performs billing operations in SFS after the invoice has been finalised.

You would still be able to manually request documents to be imported via the Import Flow Sheet Reports button. If the automatic import has taken place, then you would get duplicate documents.

Billing

When a treatment is executed in SFS, it generates an event. If the treatment corresponds to an OpenVPMS product, this would lead to an invoice item in OpenVPMS. An intermediate Customer Order would be used to store the treatment until it is invoiced, as part of consult/checkout, as is the case with Cubex initiated orders.

I suspect no events are generated (and therefore no charges) until you execute a treatment, but I will confirm with SFS.

Departments

I've updated the project to include department support.

Notes

Notes in SFS will be added as separate notes in the patient's visit in OpenVPMS.

Images

SFS doesn't provide an API to download images or videos.

Re: Smart Flow Sheet integration - billing and notes

Hi,

Importing documents - What you propose is great (except that would be ideal if duplicates could not be created - perhaps can documents be versioned if this button is pressed and existing documents already exist?).

Billing - yeah, I think this is dependent on SFS and something they need to sort. I.e. we have treatments where we want to note a treatment has NOT been given (e.g. we delayed a methadone injection because the animal didn't require it).

Departments - Would be awesome.

Thanks,

Adrian

Re: Smart Flow Sheet integration - billing and notes

Documents could be versioned, either during the automatic import on check-out or if the import button is pressed. 

I believe the only time a billing occurs is if you execute something and enter a comment with Billing set to On:

Re: Smart Flow Sheet integration - billing and notes

I dont believe Anaesthetic Sheet downloading has ever been integrated either 

I suspect most people would want this added to the spec.?

Regards
 
Ben 
OpenVPMS Installer and Helper 
Ph: +61423044823 
Email: benjicharlton[at]gmail[dot]com

Re: Smart Flow Sheet integration - billing and notes

Now added.

Re: Smart Flow Sheet integration - billing and notes

Hi,

We (Sam) will donate $3000 to this project. Let me know if I just need to go in through the add to cart, or if it's better for Sam to log in and do it.

Thanks,

Greta

Re: Smart Flow Sheet integration - billing and notes

Hi Greta,

Thanks very much for your ongoing support. I think it may be best for this to be done under
Sam's log in.

Peter

Re: Smart Flow Sheet integration - billing and notes

Hi,

I'm wondering if there was a way to automatically send smart flow sheets to the attached referring vet on check-out? Or when we send referral letters?

Can you automatically group documents? If you send a referral letter, it could also ask you if you want to send the PDF documents from the SFS.

Maybe too complicated, but thought I'd ask.

Greta

Re: Smart Flow Sheet integration - billing and notes

It could be done, but its not something I'm keen to add. If the referrals haven't been kept up to date, it could mean the previous referrer is sent an unsolicited email.

Once the above project is implemented, the steps would be:

1. On checkout, Smart Flow Sheets will be imported automatically into the patient history.

2. In the patient summary, select the referring vet, click on their contacts, and select their email address. This will launch an email Write window.

3. Click the Attach button, and select the Patient Documents tab

4. Select the Smart Flow Sheet.

    Documents are ordered on date, most recent first, so the SFS should be at or near the top

This could be streamlined e.g we could add a mail button next to the referring vet and/or practice. Clicking this would display a mail editor, with a prompt of the patient documents to attach. All of the documents for the most recent visit could be pre-selected.

There is some overlap with http://www.openvpms.org/project/multiple-email-attachments-delete-attach...

Re: Smart Flow Sheet integration - billing and notes

Hi Tim,

No worries. That makes sense.

I really like the mail button next to referring vet and/or practice!

I didn't remember the multiple-email-attachments project, but that would be great too.

Greta

Re: Smart Flow Sheet integration - billing and notes

A further commitment has been made to this project. Thanks very much Adrian.

Re: Smart Flow Sheet integration - billing and notes

Hi Peter,

Just wondering if this project has been fully funded and is in development yet?

Thanks,

Adrian

Re: Smart Flow Sheet integration - billing and notes

Hi Adrian,

It has now been fully funded. My apologies for not updating this information sooner.

Peter

Re: Smart Flow Sheet integration - billing and notes

Hi,

I've had a request to ask for secondary phone numbers to be pushed into Smart Flow Sheet from OpenVPMS. Is this possible?

Greta

Re: Smart Flow Sheet integration - billing and notes

This is supported in 1.9. If a phone contact has a Work classification, it will be sent to SFS along the customers default phone contact.

Re: Smart Flow Sheet integration - billing and notes

Hi,

Not sure if this can also be included but would generally be useful for us:

- Can the "Attending Clinician" in SFS be linked to the clinician on the Worklist Task. Then if this clinician on the worklist is updated then so would the clinician on SFS.... Why - We currently need to change both manually when a new clinician takes over the case. Seeing as this happens several times a day with multiple patients this can be an onourous task.

- Can an updated weight in OVPMS update patient weight in SFS?

- Any chance of a system where the notes from SFS create a new note in OVPMS to record vitals. I.e. each hour there is something done that hours notes is entered as a text note in OVPMS?

Thanks,

Adrian

Re: Smart Flow Sheet integration - billing and notes

Hi,

Just looking at this.

Items invoiced in SFS do not appear to retain the attending DVM name from SFS but come across as blank clinician, and then the clinician's name is added when the invoice order is processed (happens automatically, but can obviously be changed if needed within the invoice).   

Generally this should be fine, as the vet adding the items to the SFS is likely to also be reviewing the patient invoice at the time and possibly adding any non SFS billable items.  It would be better if the DVM vet in SFS was linked to the billed items in OpenVPMS

Similarly for notes - these don't come across with the vets / DVM details, but just as 'no clinician'.  The vet can go back into these and add their details if they wish to.

Not sure if this is able to be update or if SFS has this functionality?

 

Thanks

David

 

 

 

Re: Smart Flow Sheet integration - billing and notes

Clinicians are included in 2.0-SNAPSHOT (7487). At present, Smart Flow Sheet doesn't send the clinician accross in the notes, although it will apparently be supported in future.

Re: Smart Flow Sheet integration - billing and notes

Hi All,

I have been testing OVPMS-187.

The integration appears to be working well, but there is difficulty aligning the units; - from the implementation notes

  • product synchronisation requires all three of Concentration, Concentration Units (new field), and Dispensing Units to be set for medications, or they will be silently skipped 
  • Dispensing Units and Selling Units must be the same for medication products with a concentration, or they will be charged incorrectly in OpenVPMS

Could we / should we (?) have the ability to extend the synchronisation functionality to report any errors where a product is skipped because of a unit error. 

Could we standardised the units of measure (within the lookups) and then have these map to SFS?

Finally; - would anyone else find it useful if the product import/export function could be extended to include the  concentration, concentration units, dispensing or selling units.  With this, we could then have improved functionality to review / tidy up any unit "issues" within OpenVPMS.

Thanks

David

Re: Smart Flow Sheet integration - billing and notes

Hi Tim, Tony and Team,

Billing from OpenVPMS back into SFS is not working for me.  Just gone through the SFS details with Ben Nitschke (SFS integrator) and everything appears to be working at their end.

Products appears to be integrating all ok, and I can pull from OpenVPMS the patient notes / forms/ etc, but not the product items.   The 'notes' feature which is also pushed from SFS into OpenVPMS is not working either.

Not sure where to go from here?

Many thanks

David

 

 

Re: Smart Flow Sheet integration - billing and notes

Looking through the logs, the initial attempt to access the Azure Service Bus configuration from Smart Flow Sheet failed, so the event service never started up.

I forced it to restart by editing the practice location, and it now appears to be working.

Ideally, there would be a user interface that displays the current status of the SFS interface to track these problems down, and force a restart rather than practice location edit workaround.

 

 

Re: Smart Flow Sheet integration - billing and notes

Hi Tim

Brilliant.  seems to be working now.

Cheers

David

Re: Smart Flow Sheet integration - billing and notes

Hi All,

Just wondering where we are upto with a couple of discussion points between OpenVPMS and SFS.

When we create the new field in OpenVPMS of "Concentration units", it is coming across as an empty field.  Can we either:

  1. Create a default value (eg "each)" or
  2. Preferably a way to export a product list with this field (and the other two required fields of concentration and dispensing units) so that they can be bulk edited and then reimported to update the products.?

Similarly for the issue that we need the dispensing units and selling units to be the same.  If we had option 2 above then we could correct these in excel and then reupload the amended details.   Alternatively (less popular) would be to have a report that can provide us with a list of discrepancies.

It would also be good if the 'silently skipped' could be improved to generate a list that needs to be corrected.

In regards to the units what (if any) discussion has been had with SFS about haveing standardised iso units?   We do this already with ESCI interface for the wholesalers (package units) so hopefully we could do this as well here.

Many thanks

David

Re: Smart Flow Sheet integration - billing and notes

There is currently a bug in Smart Flow Sheet which is preventing concentration units being synchronized. It should accept OpenVPMS units without any modification (i.e. no mapping between OpenVPMS and SFS is required)(.

It is possible to write a report to list all medications that don't have all of the fields for Smart Flow Sheet, but a batch import would require a new project as there is a bit of work involved.

 

Re: Smart Flow Sheet integration - billing and notes

Hi Tim,

Thanks for the update.   Do you know if SFS is aware of this bug and are addressing it?

A batch import function would be good, but as a minimum a report to show the required fields would be great.   Are you able to provide a scope of costs to do both of these please.

Thanks

David

Re: Smart Flow Sheet integration - billing and notes

Hi Tim,

I met with David today and we discussed some items that I wanted to update you about.

Clinicians

When a hospitalization is sent across from Open to Smart Flow you can specify the medicID so that any treatments and notes that are sent back to Open will include the clinician. It looks like currently you are not sending a medic along with the hospitalization event. David and I tested and if the DVM field is updated within Smart Flow after the fact then the clinician information will update in Open.

Patient Weight

David is interested in having the patient weight update in Open when it is updated within Smart Flow. This is possible and currently being utilized by ezyVet. Excuse my lack of development knowledge but this is facilitated when a monitoring parameter called "Weight" is added to the patients flowsheet and then the values can be sent back to the EMR.

I will be following up with my development team about the concentration units and will be in touch via email.

Cheers,

Ben - Smart Flow

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