LibreHealth EHR Encounters
LibreHealth EHR Encounters
The purpose of this document is to create a generic encounter within the LibreHealth electronic health records system and showcase the basic workflow.
We will create a very simple scenario that uses default access permissions for the different staff roles.
In this document, encounters may be called visits or referred to as patient visits.
We will see how the Front Desk and Nurse’s Station operates. We will also follow the doctor in creating notes and orders, and see how they are followed through.
We will then look at the final Report to see how the LibreHealth EHR system tracks each step within the patient’s visit.
Note: Patient and staff names or any data you may see are completely fictional.
Toni Shortsleeve, LibreHealth Documentation Intern, July 22, 2018
The Encounter Workflow
Doctor offices differ widely in the tasks that occur and who is allowed to do which tasks.
By default in LibreHealth EHR, a clinician such as an LPN will not be allowed to edit medication orders or to see any other staffs encounter notes. As in this case, those with Administrative access privilege can give the LPN permission to access these areas.
The high-level flow of this encounter is as follows:
- The Front Desk checks in the patient and assigns an exam room
- The Clinician takes the Vital Signs
- The Provider performs a Review of Systems, documents the visit with a SOAP note, and records the services on the fee sheet
- The Provider orders medications
- A medication-certified staff member - or LPN - administers the medication and documents the activity
- The Front Desk takes a payment and checks the patient out of the appointment
- The Facility Manager or Administrator reviews the Flow Board Report
LibreHealth’s Accountability and Auditing functions associated activities with the user who is logged in on the computer where the activity occurs. It is most convenient for each participant in the workflow to have their own computer logged in to the EHR system where they each do their work.
However, if staff members are sharing a computer they must absolutely learn to log into LibreHealth, do their work and then log out. This leaves the computer for the next person to log in, do their work and log out.
We’ll begin with the patient’s arrival.
Tina Chan is the Front Office staff member at the South West Practice.
Tina has the Calendar and Flow Board opened for today’s events. Hovering over the patient name in the calendar shows that the 9:00 am appointment is a new patient. Knowing this allows Tina to have the initial paperwork prepared.
Sarah Johnson arrives fifteen minutes early so that she can fill out new patient paperwork. After Tina has given the patient the paperwork, she will click on the Status (- None) for the patient in the Flow Board. This will pop open a new screen.
By choosing None in the Status column, a Change Status menu will popup. Tina selects @Arrived to show that the patient has arrived.
Tina can now choose an available Exam Room. She has chosen Room Number 2.
The Flow Board has updated to reflect the current status as arrived, in Room 2.
Each Provider can only see their own appointments. However, the Front Office staff sees all the provider’s information on the Flow Board.
Dana must click on the patient’s name from the Patient Finder. This will open the Patient’s Record.
Notice there are three patients with the last name of Johnson. Jenny and her twin daughters, Jessica and Sarah, are patients at the South West Practice.
Dana has opened the patient’s record. Each appointment gets its own New Encounter. The list of past encounters is there in case you need to look at them.
From the Encounter menu, Dana will click on Clinical. From the Clinical drop-down menu, Dana will then click on Vitals.
If Dana does anything else, such as taking a patient’s statement, then Dana could also create a SOAP Note.
Once the chart entries are complete, Dana should digitally sign them. This locks them to prevent modification.
Dana returns to the Flow Board and changes the status to < In exam room. This lets the Provider know that the patient is ready to be seen.
Then Dana escorts the patient down the hall to Exam Room 2.
The Patient Exam
Review of Systems
Dr. Apgar will conduct a Review of Systems.
On the Encounter Summary menu, she will choose the Clinical menu group.
This will bring up a new screen that will evaluate various aspects of the current patient situation.
During the exam the patient complained of lower back pain.
Dr. Apgar will create a SOAP Note by clicking on Clinical from the Encounter menu.
Then she will click on SOAP from the Clinical drop-down list.
Subjective is what the patient says.
Objective is the practitioner’s observations during the visit.
Assessment is the provider’s statement of what the problem is.
Plan is what the provider wants to do for this situation - mention any medication to be ordered or any actions to be followed.
Always remember to click the Save Form button.
Dr. Apgar will document the visit for billing purposes.
From the Encounter menu, she will click on Administrative.
Notice the Type Code automatically entered the CPT4 code associated with a new patient.
Dr. Apgar will enter the price for the visit. Then she will choose to search the ICD10 Diagnosis code for low back pain.
Dr. Apgar will choose the Search Results dropdown of the IDC10 code of M54.5 for Low back pain.
Inside the CPT4 code is the Justify drop-down list.
Dr. Apgar will choose the ICD10 code of M54.5 from that drop-down.
Now that Dr. Apgar has completed the visit, she needs to let the Flow Board know that there is still one thing to do before the patient can leave.
She will change the current status of the Flow Board from In Exam Room to | Requires Action.
This is a customized Status Type preferred by this facility for communicating that something must occur by another staff member, such as administering medication, before the patient can be Checked Out.
At the Patient Encounter screen, Dana confirmed that no prescription has been filled yet.
First Dana must enter the name of the medicine and click to search.
The trade name will be shown in the search box.
Choose Select on the drug’s trade name, and that medicine will be ordered.
Check Yes to add to the Medicine List.
We do not want to substitute this medication.
Choose to dispense this 1 unit as described above.
Enter the cost of this prescription.
Choose Save and Dispense.
A new screen with show that the prescription has been prepared.
Sarah Johnson now has a prescription order for Robaxin in her health record.
Add to Fee Sheet
Dana opens the current Fee Sheet.
The Fee Sheet has updated with the HCPCS code.
The price is included based on the information already in the system. If the cost is not in the system, it will need to be added manually.
Notice the NDC code is not needed for Cash Only patients. It is used for insurance billing purposes only.
The Fee Sheet now has all of the information needed, and each code is justified for this particular ICD10 coded procedure.
Remember to Save.
Dana will give Sarah the requested medication. Now it must be documented that this has occurred.
Returning to the Patient’s Summary Screen, Dana will expand the Prescription tab and click on the prescription name.
Clicking on Edit will re-open the Prescription screen.
Dana will unclick the Currently Active checkbox.
Dana will change the End Date to the date of the medication administration.
Dana will add the Comments: given by Dana Evans.
Then Dana will change the Outcome to Resolved.
Tina will click on Fees from the main menu for today’s Encounter.
Both Fees have carried over to the Checkout screen.
The Payment Method of Cash is the preferred method of payment for many cash-based clinics.
The Receipt can also show the details of the charges to include the Injection.
Now Tina can use the Flow Board to change the Status to Checked out.
Tina can also use the Calendar to change the Status. However in this practice, the Flow Board is preferred for Status changes.
Flow Board Report
The Flow Board is a great help for staff to communicate on where the patient is within the appointment. The Flow Board also generates a report on the data it collects to assist in monitoring Practice performance and other uses.
This report can be run daily, weekly or monthly depending on the practice needs. Usually this is run by the practice manager or administrator.
For the purpose of this document, the Facility Manager will run the report on this patient near the end of the day.
From the top Menu, the Facility Manager will click on Reports.
From the Reports drop-down, she will choose the Visits sub-menu.
From the Visits drop-down, she will choose Patient Flow Board. This will open a new screen.
She will choose the South West Practice as the Facility and Dr. Apgar as the provider.
The From date should be the date of encounter. The To date can be the following day to assure all the information is viewed.
Clicking on Submit will drop down a list of patients who fit the chosen parameters.
Check on Show Details and click Submit to see the entire flow of the visit.
Now we have the detailed Flow Board report for the visit.
We can see the time each Status Change occurred and how much time was spent at each segment of the patient’s visit.
We have met the staff members of the South West Practice.
We have followed a patient from the arrival to the checkout, and seen how the doctor, nurse and front desk work with the patient.
And we have seen how the LibreHealth EHR Flow Board tracks and reports the entire encounter.
We hope this guide has been helpful in preparing for your future encounters.