Eye Exam office workflow

(Al) #1

I am working on understanding how to use the OpenEMR Eye Exam form in an optometry office workflow. This test scenario is modeled upon the current office workflow with the current EMR software.

Testing scenario: Assume 3 roles:

  1. Front desk (intake, insurance, calendaring, payment duties)
  2. Clinician (duties include auto-refraction, non-contact tonometer, near & distance VA, Ishihara, confrontation fields, etc.)
  3. Optometrist (duties include Manifest refraction, slit-lamp exam, dilation, all state-law required exam items)

Workflow: (used with current EMR system that OpenEMR may replace)

  1. Front Desk inputs / updates calendar, demographics, insurance, POH, FH, ROS, SocHx, medications, eye surgeries, allergies, other surgery info, collects copays / fees.
  2. Clinician executes AR, NCT, near and distance VA, CF, etc. and inputs data into system
  3. Optometrist reviews patient data, examines patient, inputs exam data into system and codes ICD10 and CPT codes, prints prescriptions (Spec, CL and / or medicine)

Observations & Questions

  1. In default OpenEMR setup, the Front Desk default role cannot access encounters and therefore cannot initiate / open the Eye Exam form and therefore cannot input POH, FH, ROS, SocHx, etc. Is it accurate that the Front Desk cannot input the info from the intake paperwork into OpenEMR? How would other offices handle this? Modify the ACL? Make the front desk personnel use the Clinician role instead?

  2. Since the Front Desk couldn’t access the Eye Exam form, I used the Clinician role to open the Eye Exam form and input POH, FH, ROS, SocHx, AR info, etc. Subsequently the Eye Exam was listed (in the Encounter Summary) as “Eye Exam by Clini Clinician”, even though the Eye Exam was, in the end, e-signed by a physician role. How should this be handled so the “Eye Exam by Clinician” the permanent attribution for this eye exam?

  3. Can OpenEMR Eye Exam form accommodate 2 eye-exam-encounters for the same patient in the same day? After a physician-role-user completed the first eye exam for a patient and e-signed it, a second physician-role-user open a new encounter on the same day. When the Eye Exam menu item was selected, the previous eye exam from the encounter earlier in the day displayed in read-only mode. The Eye Exam Form displayed the 2nd provider as the Provider while displaying all the exam data from the eye exam earlier in the same day. Am I doing something incorrect? I am trying to simulate a situation where a patient came in early in the morning for a foreign body removal and then returned late in the evening complaining of severe pain and bleeding. On the second encounter of the day, a new, blank Eye Exam form should be displayed, correct?

  4. Is the proper way for the physician to complete the eye exam:

  5. Do coding

  6. Populate the fee sheet

  7. Close the tab containing the exam

  8. E-sign the eye exam and the encounter?

Thank you very much for your help.


(R Magauran) #2

My workflow inserts a technician for 2. All that really matters here is acl privileges so the staff can complete the task.

A.1. I believe you have to modify acl for your front desk people to allow them to view encounters.
A.2 Not sure if this matters - I believe this label lists who created the encounter. I am not sure if this happens with all the other forms too but for us it has not been an issue since billing attribution is given to the provider. Perhaps others can speak to this point.
A.3. It should show a new blank form. We can mark this as a bug and submit a fix.
A.4-8. Locking/e-signing can be at the form level or the encounter level. (Administration->Globals->e-sign). There were some issues with e-sign and 5.0.1 through 5.0.2 that I am looking into for 5.0.2, but in general, yes, this seems like a reasonable work-flow.
Please let us know if you encounter e-sign issues…


(Al) #3

Thank you for the answers. That helps me understand the correct path to follow for deploying this into production.