Need Clarity on the flow

Day-to-Day Users
#1

Dear Team,
Its been a month since I have started using openemr. But not yet comfortable with the flow. Please guide me with a scenario described below.

Consider a scenario where there is one Receptionist, a Nurse and a Physician.

  1. The receptionist creates an appointment with status. Arrived status creates an encounter
  2. Nurse Open the encounter and adds vitals
  3. The Nurse guides the Patient to the Provider who is a Urologist (In real world, no one addresses a person Physician or Provider. We all call him a Doctor). I was indeed ridiculed by a doctor during a demo.
  4. The provider then logs an observation note or a Clinical Note.
  5. Provider wants to suggest an Xray and a Urine Routine. Usually he will have two options. First, leave a note to the Nurse asking her to give a summary report suggesting a lab test. On receving the note the nurse creates a procedure order for Urine routing/xray. Two, the doctorhimself creates a procedure order for the lab tests. I am a Little consfused here. Do we have a different efficient path or flow here?. I see the doctor scrambling to find options to order the procedure.
  6. Consider these Lab tests were done and the results were entered by the Nurse in to the Procedure-Pending Review Screen. We dont see any indication a lab test has been suggested or reports received. Am I missing the flow of enabling any alert which will let the nurse know that a procedure has been suggested for this Patient or a result is available for this patient?
  7. Once the Doctor enters a few Clinical notes and other items in the encounter, He is just totally lost as to which date, where what was suggested from the encounter. It has a very different sort order. Usually it has to be in the chronological order. Am I missing something here too?
  8. I have to pass through multiple tabs and auto refreshes to prescribe a medicine and the output does not please the mind. I have done some customization here thats agreeable.

Can someone who has used the system for a considerable amount of time give a good direction on how to be a bit more efficient with the System.

1 Like
#2

Here are few pointers without either justifying or criticizing the current software.

  • If you are bothered by any labels, use translation feature to display doctor instead of provider. Same for other cases like clinician as nurse etc. If some places the translation of a word does not work, translate that specific phrase.

  • Encourage office to use messages unless you have a workflow system monitoring the changes in EMR.

  • Create a layout for the provider to choose commonly used planned actions - checkboxes work better than dropdowns.

  • If you have development skills, implement your own workflow otherwise nurse/clerk can act on doctor’s directions.

  • For labs, try to use HL7 interface with workflow to generate message to provider that results for a specific lab order are now available.

  • Clinic should experiment with referral vs orders to see what works best for radiology since the results contain opinion of another specialist.

  • This software has not implemented the concept of encounter history. So they will either need a small addition or manual process to follow the lifecycle of issue as seen from providers’ perspective.

Best.

#3

Hi
I’ve been customizing it for a medical attendance. But I’ve tried to make it extremely simple.
So I’ve modified some layout to include encounter’s entire info into that visit record

That’s because my friend require just give prescriptions, indications, analysis orders.

Check it in this video (spanish voice, but english subtitle available)

Entire encounter cycle with OpenEMR (Simple)

BUT

After that set up, he required use Peruvian Health Ministry’s rules to prescribe medicine , so WHO’s ATC tables were includes as prescripcion reference

Check that on this video

WHO’s ATC tables for meds prescription

That’s how I’ve set a workflow for that attendance

Bye
FER

#4

Hello @levijustus
In regards to your concerns about the Procedures module, the first thing to clarify would be if you have looked at the wiki docs on the subject?
The wiki has 2 pages showing different approaches to the workflow.
https://www.open-emr.org/wiki/index.php/Procedures_Module_Configuration_for_Manual_Result_Entry#Single_Study
and
https://www.open-emr.org/wiki/index.php/Sample_Create_and_Use_Procedure_Orders_4.1-4.2#Create_the_Single_Test_-_Two_Tier_Procedure

Both cases show fairly complex examples to illustrate the procedures workflow. However, in your use case, you would only create the ‘Single study’ (or ‘two tier’) procedure for the single Urine lab test, or for the X-ray.
Then, when the results return from the Lab, or the X-ray clinic, the Receptionist or Nurse can enter them into the Procedures module, and the Dr can come later, study them and sign them as reviewed.

To address some of your other points.

  • To let the nurse know the Dr has left an order for these procedures, many practices use the ‘Messages’ functionality in the patient’s dashboard.
    Screenshot at 2023-07-11 12-43-21

  • Your item #6:’ We dont see any indication a lab test has been suggested or reports received’
    Sounds like the module is not configured properly. When the Nurse (or Dr) enters the order in your step #5, it will leave the order in the Procedures module so that when it is opened again the order will appear, waiting for results to be entered.

  • #7 Is the Dr trying to find what procedures were written for a patient? Try the report here: ‘Report/ Procedures/ Pending Res’
    image

Best- Harley

2 Likes
#5

Hi @Fernando_Guerra, where did you get the ATC table in Spanish? Is it updated? Thank you
Hola @Fernando_Guerra , ¿donde has conseguido tabla de ATC en español? ¿Es acualizada?. Gracias

#6

Hi!
Yes, I’ve got it from an university page, but have to make some operations to get it included in mysql

This is that link : Bioportal

and got it translate it by google

then import it to my local mysql to manage some arragments because need a better description to be displayed in findings

finally imported to my exercise website

check it at my online demo : Terminux

user : doctor
pass : ibuprofeno

that’s where I recorded my videos from.

message me if need more details or send you the files

Hugs

FER

1 Like
#7

Thanks Harley. Yes we are currently proceding with your suggestions of using the messages function to alert about Procedure orders between Doctors and Nurses. Sorry for not acknowledging earlier

#8

That’s great, glad you found the info useful!
Come on back if you have any questions- Harley