Health information systems presentation

Kingdom of Saudi Arabia Ministry of National Guard Health Affairs King Abdulaziz Medical City – Riyadh Information Systems & Informatics Division Technical IT Program Management Office Document Change History Version # Edited by Date Changes 1.0 David Lee 7-10-2014 Initial Version 1.1 David Lee 15-11-2014 Minor Modification and Functions added Requestor [KASCH BESTCare 2.0A] User Manual [Administration-Reg/Adm/Sched/Billing] User Manual [Administration] HIS BESTCare Project 2.0A Contents CONTENTS …………………………………………………………………………………………………………………….1 1. INTRODUCTION ………………………………………………………………………………………………………………3 1.1. ABOUT THE SYSTEM ………………………………………………………………………………………………………….3 1.2. ABOUT THIS MANUAL ………………………………………………………………………………………………………..4 1.3. ELEMENTS OF ADMINISTRATION MODULE …………………………………………………………………………………4 1.3.1. TITLE BAR …………………………………………………………………………………………………………………………….. 4 1.3.2. MAIN MENU ICONS …………………………………………………………………………………………………………………. 5 1.3.3. WINDOW DISPLAY AREA …………………………………………………………………………………………………………… 6 1.4. BASIC MANIPULATION AND COMMON FEATURES …………………………………………………………………………7 1.4.1. HOW TO USE MOUSE IN BESTCARE 2.0A ………………………………………………………………………………………. 7 1.5. COMMON FEATURES USED IN BESTCARE 2.0A ……………………………………………………………………………8 1.6. LOG-IN AND MY PAGE ……………………………………………………………………………………………………….9 1.6.1. LOG-IN………………………………………………………………………………………………………………………………… 9 1.6.2. MY PAGE ……………………………………………………………………………………………………………………………. 10 2. KEY FEATURES: …………………………………………………………………………………………………………….. 11 2.1. COMMON SCREENS ………………………………………………………………………………………………………… 11 2.1.1. PATIENT MRN SEARCH…………………………………………………………………………………………………………… 11 2.1.2. CHECKLIST ………………………………………………………………………………………………………………………….. 13 2.1.3. SMS…………………………………………………………………………………………………………………………………. 16 2.1.4. SIDE SCREENS ………………………………………………………………………………………………………………………. 17 2.1.5. RIGHT PATIENT SYSTEM – PATIENT’S BIOMETRIC TEMPLATE (FINGERPRINTS) …………………………………………… 22 2.2. REGISTRATION ……………………………………………………………………………………………………………… 26 2.2.1. PATIENT REGISTRATION ………………………………………………………………………………………………………….. 26 2.2.2. PATIENT INFORMATION UPDATES/HISTORY ………………………………………………………………………………….. 34 2.2.3. REFERRAL/LETTER OF EXCEPTION ………………………………………………………………………………………………. 36 2.2.4. ER REGISTRATION …………………………………………………………………………………………………………………. 39 2.3. ADMISSION …………………………………………………………………………………………………………………. 43 2.3.1. WARD – BED – ROOM …………………………………………………………………………………………………………… 43 2.3.2. PATIENTS FOR ADMISSION……………………………………………………………………………………………………….. 45 2.3.3. BED ASSIGNMENT …………………………………………………………………………………………………………………. 51 2.3.4. ADMITTING PATIENTS …………………………………………………………………………………………………………….. 57 2.3.5. ADMISSION, DISCHARGE STATUS ……………………………………………………………………………………………….. 60 2.4. SCHEDULING ………………………………………………………………………………………………………………… 64 2.4.1. TEMPLATE AND SLOT MAINTENANCE ………………………………………………………………………………………….. 65 2.4.2. OUTPATIENT APPOINTMENTS …………………………………………………………………………………………………… 89 2.5. BILLING ……………………………………………………………………………………………………………………. 101 1 HIS BESTCare Project 2.0A User Manual [Administration] 2.5.1. ISSUED ORDER PAYMENT ………………………………………………………………………………………………………. 101 2 HIS BESTCare Project 2.0A User Manual [Administration] 1. Introduction 1.1. About the System BESTCare 2.0A is a hospital information system (HIS) that provides multiple functions including electronic medical record (EMR), computerized physician’s order entry (CPOE or OCS), nursing, radiology, special clinic examination, pharmacy, patient service, billing, inpatient services and social services. Each module provides its specific function applications, like patient’s care, order management, scheduling and various statistical data. Therefore, not only medical staffs but also hospital management staffs are able to use various functions at the same time. As a result, hospital provides better quality of care and proper responses. The Administration Module enables users from Patient Service, Medical Protocol Department, and Business Center to carry out tasks of Registration, Scheduling, Admission and Billing. The key features of Administration Modules are:  Create new patient Medical Record Number and update patient demographics  Eligibility and Coverage Management  Visit Management by Referral, Letter of Exception, and consultations  Ward – Room – Bed Management  Pre-admit patient by assigning beds and admitting patients  Create and apply patterns for Outpatient clinic appointments  Templates and slots maintenance  Add clinic cancellations and holidays  Schedule Outpatient appointments  Add and schedule patients from the Outpatient Waiting List  Review Physician’s orders and Medical Records for payments 3 User Manual [Administration] HIS BESTCare Project 2.0A 1.2. About this Manual This is a core manual for users who use the Administration module, which guides the users to register a patient to the hospital, update schedule appointments, admit patients, and receive payments if needed. This manual guides the users from 3 different departments to follow each and every steps using BESTCare 2.0A involved in their everyday tasks of Registration, Admission, Scheduling and Billing. This manual covers basic procedures such as using your mouse for this system, basic elements of the Administration module, and common feature that are applicable to most of the functions in BESTCare 2.0A. This manual will provide basic process oriented explanation and guide to the users for their use of BESTCare 2.0A. It will also provide help for advanced functions of this system. 1.3. Elements of Administration Module 1.3.1. Title bar Title bar is located at the top of the Administration module. Detailed explanation of title bar is as below: You can check the institution and user name and see when the user logged in. The current time is displayed at the top of the screen. You can change the font size of letters in the windows. You can expand or reduce the size of windows in main screen. You can initialized font size (9 pt) and window size (100%). You can check current module on the screen. The modules can be changed in this tab. You can maximize, minimize, restore, and close the main window. 4 HIS BESTCare Project 2.0A User Manual [Administration] 1.3.2. Main menu icons You can log out from the BESTCare 2.0A This button opens up the list of various windows. You can find and activate certain window that you are going to use from the list. You can also create group of your favorite windows from the list You can write down a memo and also save the memo. This button opens up the Personal Settings window (You can open the same window from Menu > Settings > Personal settings window). This button opens up the help messages for BESTCare 2.0A This button links directly to the NGHA Intranet for easy access. 5 HIS BESTCare Project 2.0A User Manual [Administration] 1.3.3. Window Display area Most of the functions offered by Administration module of BESTCare 2.0A will appear on the screen as a separate window format. One screen is in a full size at the back of the screen and you will be able to move around other pop up screens within the monitor. You can have multiple full size screens on the left side of the menu panel, and click on one to appear in the screen. Pop up screens will appear on the right side of the menu panel. More than one pop up screen can be displayed. Screens that are open but not shown in the menu panel can be viewed by clicking on placed on the right side of each menu panel. You can also find these windows by placing mouse at BESTCare 2.0A icon on the Microsoft Windows Task Bar. You can also find open screens by placing mouse at or clicking button. 6 HIS BESTCare Project 2.0A User Manual [Administration] You can initialize the Window Display area back to your default setting. 1.4. Basic Manipulation and Common Features 1.4.1. How to use mouse in BESTCare 2.0A  Point: By placing your mouse pointer – Icons, windows, or specific region will be highlighted. – Further explanation or information will appear.  Click: By clicking the mouse left button once – You can open up a window for specific task. – You can select a tab or activate any function related to the button.  Double click: By double clicking the mouse left button twice (select and execute) – You can open a different screen with the selected patient’s MRN inserted automatically. – You can view the details of the selected contents from the list. – You can choose options to restore the program from searching or continue searching when the screen is occupied by a heavy loaded search. 7 HIS BESTCare Project 2.0A  User Manual [Administration] Click and drag: By holding the mouse left button and drag –  You can select the region of interest or text contents for multiple selection or copy and paste. Right mouse click: By clicking the mouse right click button once – You can open up a list of available functions such as adding a line. – You can freeze a line or a row, or initialize the screen from freeze functions.  Click and drag, and drop: by holding the mouse left button, dragging, and dropping – You can move the window and change the window position. – You can change to location of icons in patient list category. – You can place certain window icons from menu tab to My Favorites area 1.5. Common Features used in BESTCare 2.0A Refresh or initialize button: You can change the settings to default or refresh the data. Calendar: You can open up a calendar and designate certain date or duration of your interest. Settings button: You can open up setup window or change the setting  Scroll bar: If there is data, note template, or window page that is not completely shown in the window, you will find a scroll bar. You can 1) click and drag scroll bar 2) click up/down button located on top of scroll bar or 3) use mouse scroll button, to move the scroll bar. 8 HIS BESTCare Project 2.0A User Manual [Administration] 1.6. Log-in and My Page 1.6.1. Log-in Double click this icon on your computer’s Desktop to start BESTCare 2.0A. If there are any updates, it will automatically download and install just before log-in screen appears. Enter your ID and password to log-in to BESTCare 2.0A. There is a checkbox that enables the system to remember your ID for next log-in. If you forgot you password, click ‘Forgot your password?’ to initialize your password. 9 HIS BESTCare Project 2.0A User Manual [Administration] 1.6.2. My page Once you logged in to BESTCare 2.0A, you will find ‘My Page’. ‘My page’ begins with the name of user and latest log-in information. It will also check Notice and announcements added from the Hospital Information System. If you click this icon, window showing detailed explanation will open on the right. You can select the module you are going to use, at the bottom of My Page. If you don’t find a module that you are looking for, click the left or right arrows to find the module. The module will be shown based on your role and authority to the modules. 10 HIS BESTCare Project 2.0A User Manual [Administration] 2. Key Features: 2.1. Common screens There are a number of screens and features widely used in the Administration module. To start with, nearly all of the screens require a patient MRN (Central Medical Record Number) which is linked to the Patient MRN Search. In most of the main screens, once you type in the patient MRN, the Checklist pops up if there are any notes added inform the users before proceeding with the tasks. SMS is not only sent as a fixed message when scheduling an appointment but also sent in free text to the patients or their relatives immediately or at any scheduled time by the users. Scanned documents and Medical Records are now uploaded or typed into the system through the viewer, convenient and highly accessible to related caregivers and employees. 2.1.1. Patient MRN Search BESTCare 2.0A is an all-in-one system of electronic medical record, order communication system, and other hospital information system. It’s workflow begins by selecting a patient to work on and retrieving all information of the patient. The patient’s MRN can be searched through many different values as follows.  Patient ID: The patient’s KSA ID(for Saudi Arabians), Iqama ID and Passport ID(for 11 HIS BESTCare Project 2.0A User Manual [Administration] foreigners)  Name & Sex & Age: The patient’s name is the only mandatory field and the others are to narrow down the search results. The name can be searched in a sequence such as the last name, first name, father’s name, grandfather’s name. For example, When searching for a Mr. ‘Ghaziri Ahmed Mohammed Abdullah’ (last, first, father’s, grandfather’s name), you have to search the name as ‘Ghaziri’, or ‘Ghaziri Ahmed’, or ‘Ghaziri Ahmed Mohammed’ or ‘Ghaziri Ahmed Mohammed Abdullah’. The patient won’t be searched if you search for ‘Ahmed Mohammed’ or ‘Mohammed Abdullah’. Since too many names pop up if not searched under this alignment, make sure you type in the last name first and then the first name, father’s name and the grandfather’s name when searching a patient. When using “~”, it enables the soundex function and searches for patients with similar names. When using “-”, it searches for names that includes letters in between. For example ‘Mohammed’ can be searched by ‘M-h-d’. The age can be searched by a certain range as well.  Telephone Number: Any added phone number, whether it is cellphone or office phone, can be searched through this condition.  Family ID: The Family ID is the head of family’s Patient ID. It can be the KSA ID (for Saudi Arabians), Iqama ID and Passport ID (for foreigners).  U & D: Unknown and Disaster patients. When they are generated, they can be searched under this condition. No value needs to be typed in to search them. Their names are saved as Unknown or Disaster and have a sequence number.  Badge Number: The hospital employee’s badge number is searched from the HR database. 12 HIS BESTCare Project 2.0A User Manual [Administration] 2.1.1.1. Search Results The Patient MRN, Full Name (last, first, father, grandfather’s name), Sex, Age, KSA ID, Iqama ID, Passport ID, Badge number, SANG ID number, patient’s address, telephone number, eligibility and coverage are displayed in the results. Patient Classification is the only column to be introduced.  Patient Classification: This indicates whether the patient is an Outpatient (shown as OP), currently in the Emergency department (shown as EP), currently admitted or pre-admitted as Inpatient (shown as IP) and a patient who just created a MRN and haven’t done anything yet (shown as New for new patients who just only registered). Double click the patient and the patient’s MRN will be retrieved to the main page where you clicked on the link to the Patient MRN Search. 2.1.2. Checklist A Checklist is a list of memorandums about the patient for the users. If there is any checklist added to a patient, it will automatically pop up when you type in the MRN into the main screens before you can carry out your task. You can check the details of an issue written by the users through the checklist. Once the issue or information about the patient is no longer needed, you can complete it and it won’t be active anymore. The Checklists of the patients can be searched by clicking on the green icon next to the patient MRN in most of the screens. 2.1.2.1. Checklist Registration In this screen, you will be able to add, modify, view, and complete checklists. As default, the search condition is set to Not Completed and the completed checklists are not shown. 13 HIS BESTCare Project 2.0A User Manual [Administration] The screen consists of patient’s basic information and uncollected/deposit payments at the top. The patient’s ID(KSA, Iqama, or Passport), Sex, Eligibility and coverage codes, Company code, the address and contact information are shown. The Business Center can check how much deposit or uncollected payments the patient currently has. Deposit is shown in blue, Uncollected (Negative) amount is shown in red. The first tab displays the list of checklists added to the patient searched by the search condition above.  Input Date: The day when the checklist was added.  Written by: The first employee who added the checklist.  Completed Date/Time: The day when the checklist was completed. Once completed it will no longer show by default. Double click the checklist to see the details in the second tab. 14 User Manual [Administration] HIS BESTCare Project 2.0A  To Add a Checklist – Type in or search the patient MRN. – Click – Select the Type of the checklist from the dropdown list. – Fill in the Title and Details. – Type in the Notification Date, the date you need to see this checklist again. It will appear in the side screens to notify the user in the selected date. – Click  and the screen will change to the second tab with blank fields. to add it into the list. To Modify a Checklist – Double click one of the checklists in the list. – Modify information in the given fields. – Click – The last user who modified the checklist will be shown on the bottom of the checklist with the date and time of modification made.  and to save the information. To Complete a Checklist – Once you have completed the task written in the checklist, or when the checklist is not needed anymore, you can complete it by clicking Process Complete. The completed checklists can be searched if you set up the search condition, then it would no longer pop up in the main screens to notify the user who first wrote the checklist . 15 User Manual [Administration] HIS BESTCare Project 2.0A 2.1.2.2. Checklist Notification Search You can search for the checklists in this screen and by setting up the search conditions; you can view it in various ways. The search conditions are not mandatory. If you type in the Patient MRN and nothing else, it will show all the checklists registered to that patient. If you only type in the employee’s Badge number, it will show the checklists the employee has written. You can add the Notification date and/or the Input date in periods to narrow down the search results. The Type is Total by default but you can select a specific Type to search for certain checklists. 2.1.3. SMS The SMS are sent to the patients when scheduling an appointment, or notifying the patient before the appointment and so on. Additionally, the system supports sending SMS in free text to the patient. They can also be audited from the SMS Sending History screen. 2.1.3.1. Send SMS In the Checklist Registration screen, you can spot the button. This is linked to the Send SMS screen. Or you can always search from the menu directly. The SMS button is also located in other main screens such as the OP Appointment Schedule screen or the Admission Appointment Screen. To Send a SMS 1) Type in or search the patient MRN. It will autom 16 HIS BESTCare Project 2.0A User Manual [Administration] atically retrieve the patient’s registered cellphone number from the Patient Demographic s contact to the Receiving Number. 2) Write the message to the patient in the field above. If you want to erase the message, cli ck and it will turn blank. 3) Type in the Sending Number. 4) Select Immediate Sending or Scheduled Sending – Immediate Sending: Sending the SMS to the patient right away. – Scheduled Sending: Sending the SMS on a selected date and time that you set up. 5) Click Send to send the SMS to the patient. 2.1.3.2. SMS Sending History The SMS sent to patients can be searched by typing in the patient MRN in this screen. The MRN is a mandatory field for the search. You can look up the list of SMS sent within a certain period to the patient or search by the Receiving number with the patient’s MRN. 2.1.4. Side screens The system is designed to show a screen full of information which is needed in order to complete the task in one screen. Therfore, in the main pages, the side of the screens display the patient’s basic information and other frequently used information to help the tasks of the users. The two side screens are as follows. 17 HIS BESTCare Project 2.0A  User Manual [Administration] OP Appointment Schedule screen has both side screens. 18 HIS BESTCare Project 2.0A  User Manual [Administration] Admission Activation screen has both side screens. 19 HIS BESTCare Project 2.0A  User Manual [Administration] Issued Order Payment screen has one side screen. 2.1.4.1. Patient Demographics (Side screen) The side screen on the left side is the Patient Demographics screen reduced into one third of the screen. The difference is, instead of the E-mail address at the bottom, the Valid Eligibility and Coverage are displayed so that the user can easily check the patient’s Eligibility without opening a different screen. The Primary Eligibility is highlighted in green. You can view the patient’s information but you cannot modify or delete them. For those tasks, you have to go to the Patient Demographics screen and make the changes. 20 HIS BESTCare Project 2.0A User Manual [Administration] 2.1.4.2. Patient Checklist (Side screen) Despite the patient’s Checklist popping up as a screen when typing in the patient MRN, there will be a screen to show the list of checklists on the screen so that the user doesn’t miss an important notice. Double click on the checklist to pop up the Checklist Registration screen. 2.1.4.3. User Checklist Notification (Side screen) Unlike the patient checklist, the User Checklist Notification displays the checklist which the user has set up a notification date as today. Therefore it displays the checklists registered in a number of different patients. You can select the notification date other than today if needed. Then click on the Refresh button to display it below. Double click on the checklist to pop up the Checklist Notification Search screen. 2.1.4.4. Family Information (Side screen) You can have a concise view of the patient’s family. When double clicking on the list, you can pop up the Family Relation screen for further details of the family members and relationship with the patient. 21 HIS BESTCare Project 2.0A User Manual [Administration] 2.1.4.5. SMS History You can view the recent SMS sent to the patient. When double clicking the list, it links to the SMS Sending History screen and can view all the messages sent to the patient. 2.1.5. Right Patient System – Patient’s Biometric template (fingerprints) The Right Patient System is to ensure that the person who came to receive treatment is the patient himself/herself. Since there are restrictions to verify the patient with photographs because women cannot be photographed, the patients will be verified with their biometric template which is the fingerprints. The patients over 13 years old should enroll their biometric template of the right hand middle finger. For the registration, scheduling and admission office, they will mostly be using the Identify function. The registration office will be also enrolling, updating, changing from one patient to another, and also deleting the biometric template to ensure the Right Patient System. 22 User Manual [Administration] HIS BESTCare Project 2.0A This function is to check if the patient has enrolled the biometric template or not. But you can also know by the fingerprint icon. It is red enrolled yet. when enrolled and white when not  Type in the patient MRN.  Click Enrollment check and the message will show whether the patient has enrolled or not. This function is to add and register a patient’s biometric data into the system. All patients over 13 years old are required to enroll their biometric data or the users should not be able to proceed with their tasks as hospital policy. The enrollment is only to be done by the Registration office.  Click the fingerprint icon from any screen. For new patient’s registration, it will automatically pop up after creating a new MRN in BESTCare.  Type in the patient MRN and click Enroll.  Scan the patient’s biometric template of the right hand middle finger.  Message will show that it is registered successfully or not. This function is to read the biometric data of the patient and search for the patient MRN. The patient must be registered prior to the identification. It can be used to identify the patient when the patient didn’t bring the hospital card or any identification cards.  Click the fingerprint icon from any screen that you want to retrieve the patient’s MRN by the scanning the fingerprint. 23 HIS BESTCare Project 2.0A User Manual [Administration]  Click Identify and and scan the patient’s biometric template.  It will retrieve the patient’s MRN if the fingerprint is properly scanned and matched with the biometric data enrolled in the system. To read the biometric data of the patient and see if it matches the biometric template that was already registered by patient. This is used in check-ins from the ward or exam rooms.  Click the orange fingerprint icon from the screen where you need to verify the patient. Or through the process it will automatically ask you to verify the patient. The icon should be orange which means the patient is already enrolled.  Click Verify and scan the patient’s biometric template of the right hand middle finger.  The message will show whether the patient is verified or that it doesn’t match the patient’s registered biometric template. This function is used to move a patient’s biometric data to a different patient. Used when registered the biometric data to a different patient. The change is only done by the Registration office.  Type in the patient MRN on the left and on the right. The biometric template of the patient MRN on the left will move to the patient MRN on the right.  Click Change MRN and the message will show whether the change was successful or not. 24 HIS BESTCare Project 2.0A User Manual [Administration] To re-register and update a patient’s biometric data who has already enrolled in the system. Updating is only done by the Registration office.  Type in the patient MRN.  Click Update and scan the patient’s biometric template of the right hand middle finger. It will update the existing biometric template by replacing it to the newly scanned biometric template into the system. This function is to delete the biometric data and information of a task above. Deleting is only done by the Registration office.  Type in the patient MRN.  Click Delete and the message will show whether it is successfully deleted or not. 25 HIS BESTCare Project 2.0A User Manual [Administration] 2.2. Registration 2.2.1. Patient Registration New patients to the NGHA hospitals are to be registered and receive their unique Medical Record Number generated by the system. Patients who have already registered are to update their personal information and eligibility for continuous treatment. Central Medical Record Number will be addressed and used as the Patient MRN in this system. 2.2.1.1. New Patient Registration This Screen is to register a new patient and create a unique Medical Record number. Patient’s personal information including patient’s name, DOB (Date of Birth), Patient ID and expiry date, contact information, address, eligibility and coverage, and additional information such as preferred language, religion, or occupation can be inserted and saved in the system. The mandatory fields are colored in light blue so that when you are in a hurry of creating a Patient MRN, you can leave the other fields to be updated after you generate an MRN for the patient. When you are done, the new MRN will be shown on the left upper side. Click on the card print button next to the MRN to print the patient’s hospital card with the primary eligibility. 26 HIS BESTCare Project 2.0A  User Manual [Administration] English & Arabic Name: The system will display the patient’s full name as shown in the first row in a single field. You can type in the patient’s last name, first name, father’s name, and grandfather’s name in the second row. Only the last name and first name are mandatory since foreigners do not have a father’s or grandfather’s name. The Arabic name is also not mandatory.  Sex: Patient should be either ‘male’ or ‘female’, however, there are emergency situations when the user cannot identify the patient’s gender but has to create a MRN. For these occasions, you can select ‘unknown’ for the time being and update the information afterwards.  Nationality: The patient’s nationality is set up as Saudi Arabia as default. You can change the nationality by either typing in the nationality code or by clicking on the magnifier to search for other countries.  KSA ID & Iqama ID: This ‘Patient ID’ field changes depending on the patient’s nationality. It will show ‘KSA ID’ for Saudi Arabians and ‘Iqama ID’ for foreigners. But for foreigners who do not have an Iqama ID will have their Passport ID to be inserted instead.  ID Expiry date: The expiry date for the ‘Patient ID’ above is in Hijiri calendar as it is in the Patient ID cards. It is not a mandatory field because family dependents under 18 years old does have their ID number listed in the Family ID card without expiry date.  Date of Birth (DOB): There are two calendars for the date of birth. Choose either one of them and it will automatically convert to the other. Once selecting the date of birth, the patient’s age will appear above. It will start from number of days (up to a month), months (up to 3 years of age) and then the patient age will show in years.  Calendars: The calendars have convenient features. Click on the year above to move from to monthly and yearly calendar. It will make it easy for you to look for a specific 27 HIS BESTCare Project 2.0A User Manual [Administration] date. If you have navigated in a wrong month or year, simply click on the date (for Hijiri) or the return arrow (for Gregorian) below and it will bring you back to today’s date. If you want to select today, click on the arrow with the round mark and it will retrieve today’s date and insert it into the field at once. To navigate, you can also use the two arrows on the upper side of the calendar. The inner arrow moves by months and the outer arrow moves by year in the Gregorian calendar and by month in the Hijiri calendar.  The Hijiri Calendar  The Gregorian Calendar 28 HIS BESTCare Project 2.0A  User Manual [Administration] Marital Status: There are number of selections to display the patient’s marital status: Single, Married, Divorced, Separated, Widowed, Legally separated and Unknown.  Privacy Protection & Fingerprint Icon: The privacy protection icon on the right upper side shows whether the patient is a privacy protected patient when in red color, and a normal patient when in grey color. Likewise, the fingerprint icon let’s you know whether the patient has registered the biometric data into the system or not by the colors as same as privacy protection icon. All patients over 13 years and older are required to register their biometric data in order to verify the patients before treatment, exams, and checking into the wards to get admitted. You can simply click on the fingerprint icon to Identify the patient’s biometric data in other screens. But for registering a new patient, the system will ask you to enroll the patient’s biometric template or else the patients won’t be able to proceed with other tasks.  Family ID: The head of family’s Saudi or Iqama ID is to be inserted. If the head of family is already registered in the system, they can be searched and the other information except the relationship will automatically be retrieved. Once the already registered head of family is selected, the information button will show detailed information such as the sex, date of birth, home phone, cell phone number and address of the head of family. If not a registered patient, you can insert their Patient ID and type in the head of family’s name on the right and fill in the rest of the fields manually. 29 User Manual [Administration] HIS BESTCare Project 2.0A The second row specifies whether the Patient ID is KSA, Iqama, or Passport ID. The relationship with the patient can be chosen in the next dropdown. The calendar on the bottom is for the head of family’s KSA or Iqama ID expiry date.  EPN and MRNs: The Enterprise number and regional medical record numbers (Central MRN, Eastern MRN, and Western MRN) are displayed.  Mother’s MRN: Mother’s MRN will be automatically added to newborns delivered within KAMC starting from KAMC Expansion. For the time being, you can search for the mother’s MRN by clicking the magnifier button and save it in the system. The mother’s name in English and Arabic will be automatically retrieved once the mother’s MRN is selected.  VIP Status & Type: VIP patients can be checked by VIP Status and it will enable the VIP type field on the right which can be selected as MPD-A or MPD-B. Only MPD employees can register and access VIP patients whereas other departments will be blocked. The VIP patients will be under privacy protection and only the caregivers who treat the patient will be able to see the Medical Records and their personal information.  Telephone No: The contact information of the NOK can be added with detailed information. First, select the relationship with the patient and then write the name of the NOK in free text. The contact classification can be cellphone, home phone, office phones, and emergency phone and so on. SMS to notify the patient will be sent to the cellphone number added in this field. The extension is available only to the office phones.  By clicking on , an additional line for contact information will appear. For deleting existing lines, click on to make it disappear. 30 User Manual [Administration] HIS BESTCare Project 2.0A  Address: The patient’s or NOK’s addresses can be added in this field. After selecting the relationship and typing in the name, select the City, District, and Province shown in the dropdown and fill in the rest of the address in the Details field. The details field is mandatory in order to maintain quality data.  E-mail: The e-mail address can also be saved to enable contacts when you cannot reach the patient or the NOK through the telephone numbers above. The full e-mail address can be typed in or you can select the domain that are listed in the system such as ngha.med.sa or Gmail, Hotmail, and yahoo.com  Eligibility & Coverage: The patient’s eligibility and coverage can be inserted by their codes or selected when clicking on the magnifier button on the right. Add a new eligibility by clicking on the button. Once you click on this button, the fields will be activated. If you want to cancel what you have typed in, click on the button. Once selecting the start and end date of the eligibility and coverage, you can select whether this is a primary eligibility by checking the box. When registering a new patient, only one Eligibility and coverage can be saved. If you need to add more eligibilities, add as much as needed in the Patient Demographics screen which is used to update. Only users with authority can cancel exisiting eligibility and coverage using the button. The list of eligibilities and coverages will be shown once they are saved and the primary eligibility will be colored in green to differentiate with other eligibilites. 31 HIS BESTCare Project 2.0A User Manual [Administration] For each eligibility, the eligibility fields will indicate different group of mandatory fields in orange. You cannot proceed if they are not filled with certain data. The green boxes indicate optional fields which you can utilize if needed.  Preferred Language: The patient’s preferred language can be either Arabic or English. The SMS sent to the patient will follow the preferred language registered in the patient’s information.  Religion: Patient’s religion is to identify the patient’s fasting in religious events such as Ramadan. You can select Muslim or non-Muslim and unknown in case you cannot identify it when registering the patient.  Employee Status: This is mostly used for hospital employees to know whether they work full-time or part-time.  Occupation: The patient’s occupation is in free text.  File Closed: Shows whether the patient’s file is closed or not.  File Closed Reason: You can choose the reason for closing the file once you choose to close the file. It can be closed by Merge, Uncollected Payments, or Deceased etc.  File Closed at: If you close the file, it will display the date and time of the event. 32 HIS BESTCare Project 2.0A  User Manual [Administration] File Closed by: The badge no. and name of the user who closed the file is displayed. 2.2.1.2. Enroll to Right Patient System: Biometric Template (Fingerprint) The last step of registering a patient to the hospital’s system is to register the patient’s biometric template into the system as well. All patients over 13 years old are required to enrol their biometric data or the users should not be able to proceed with their tasks as hospital policy. Once you fill in all the information above and click , it will show you the fingerprint screen so that you can scan the patient’s biometric template right away. Now use the patient’s MRN shown on the upper left side of the screen. Print the Patient’s Hospital Card by clicking at the bottom. 33 HIS BESTCare Project 2.0A User Manual [Administration] 2.2.2. Patient Information Updates/History Any field that has been updated in the Patient Demographics screen can be audited. The history remains to view all the differences made by whom, when, and what kind of updates has taken place. 2.2.2.1. Patient Demographics This screen is not so different from the New Patient Registration screen. Once the patient acquires a MRN, it is used to update the patient’s personal information, eligibility, and coverage. In some occasions, the patient can have more than one eligibility and coverage when creating a new MRN. Since the user can only add one eligibility in the New Patient Registration screen, they will have to add additional eligibilities in this screen. On the bottom of the screen, click on the patient. to issue a hospital ID card for the Additionally, you can click for the patient. to view the history of cards issued The last issued history is shown with the red box. 34 HIS BESTCare Project 2.0A User Manual [Administration] 2.2.2.2. Patient Information Modification History The information updates can be tracked in this screen. By searching the patient MRN it will show the modification history starting from the Patient/Mother’s full name in English and Arabic, other attributes including the DOB, Eligibility and Coverage, who registered or edited the information, and so on. 2.2.2.3. Elig. Cov. Change History For the Eligibility and Coverage, the user’s insert, update, or cancelled information is displayed in detail. The second tab gives an overview of the valid eligibility and coverage. There are two main columns, Before modification and After modification. When an eligibility is inserted, there will be no information in the Before modification column. When updated, both will show information and when deleted, After modification will be blank. You can compare each fields and see what kind of changes was made for them. The Application date is also one of the key fields to keep track because it affects the validity of the eligibility. 35 HIS BESTCare Project 2.0A  User Manual [Administration] Eligibility Coverage History: There are two main columns, Before modification and After modification. When an eligibility is inserted, there will be no information in the Before modification column. When updated, both will show information and when deleted, After modification will be blank. You can compare each field and see what kind of changes was made for them. The Application date is also one of the key fields to keep an eye on because it affects the validity of the eligibility.  Valid Eligibility Coverage: The valid eligibility and coverage will be colored and the primary eligibility will be displayed at the top in this tab in dark green. The expired eligibility and coverage will also show but they will not be colored at all. 2.2.3. Referral/Letter of Exception The hospital’s policy is that outpatient appointments are not to be allowed if the patient came without a Referral from the PHC or a Letter of Exception (LOE). Therefore, the schedulers won’t be able to schedule unless the patient has submitted their referral to the Registration Office and typed into the system. When the physician ends the treatment of what he/she was referred to, the nurse will complete the refer and it will automatically update the referred information as completed so that the patient has to submit a new referral if willing to receive treatment in this hospital for the completed treatments. Business Center patients do not need to register Referrals or LOE for their treatment. 36 HIS BESTCare Project 2.0A User Manual [Administration] 2.2.3.1. Referral/LOE Management Type the patient’s MRN and press the find button. If a new referral is submitted by the patient, click on the new button and type in the referral’s information into the system.  Classification: Referrals submitted by the patients should be added as Referral. The Letter of Exceptions should be added as LOE. When the physician requested consultation to a different physician, it will be added as Consultation.  Referral Type: The referral types are Urgent or Routine as written in the referral letter.  Application Period: Type in the start date that proves the validity of the referral, LOE, or consultation. The end date is set up to 31/12/9999 at first. For the LOE, the end date will be set up as the coverage end date. The moment the treatment becomes completed by the phsyician/nurse, the end date will be updated and fixed to the completed day. The completed box will be checked to show that it is completed.  Date Req.: The date when the referral letter was actually written.  Completed Reason: When the referral, LOE, or consulation is completed, it will state the reason why. It can either be completed by the physician, or by 3 no-shows, or by 37 HIS BESTCare Project 2.0A User Manual [Administration] the registration office.  Referring Physician: The name of the physician who referred the patient from the PHC or the who ordered consultation.  Department: Select the department which the referral, LOE, or consultation was addressing to. Only the selected department will be available for the patient to schedule an appointment. But for as for departments like Pediatrics, the higher level of department will be added since the patient can be screened from General Pediatrics and then scheduled to a clinic with specialty in Pediatrics Endocrinology. Fill in or select the rest of the fields: Referral/Visit Source, Primary Coverage, Referral Hospital Telephone number, and remarks are also available as freetext. There is a No-Show count field and the the treatment count field counting the number of No-shows and treatments received by the patient for the selected referral, LOE or consultation. In order to modify the existing data, click on the list and the modify the information that appears above. The information is saved when clicking on the button. For completing a valid referral, LOE, or consultation manually, click on the list and check the box and it will automatically change the end date into today. The Completed Reason becomes activated by the check. So fill in the reason and save the information. Now, the referral, LOE, or consultation is manually completed and remove from the valid list. The button is used for deleting what you have been typing in when adding a new one into the list. It will delete the currently input information which is not yet saved. To view completed ones, check and it will show you the list of completed referral, LOE, and consultations as well as valid ones. You can also sort by clicking the column that you need to organize with. 38 HIS BESTCare Project 2.0A User Manual [Administration] For Letter of Exception, and Consultation, there are different mandatory fields as below. Letter of Exception Consultation In order to view the appointments that are scheduled by selecting the referral can be displayed by clicking 2.2.4. ER Registration Patients who come for treatment in the Emergency department will first go to the reception desk. If they already have a MRN, you will activate the EP visit for them. If not, the ER registration office will add a new patient and this new MRN made by the ER Registration office will have an active EP visit at the same time. Patients who are in a serious condition will go straight to the Critical Care and the ER registration office will create a patient MRN as Unknown. If a number of patients arrive at the same time due to a disaster, the Disaster patient MRN which is prepared in advance will be used. 39 HIS BESTCare Project 2.0A User Manual [Administration] 2.2.4.1. ER Activation This screen is used to activate the ER visit. When the patient comes, they will go through triage first and then checked further with their eligibility in detail for future treatment plans. When the patient’s eligibility is valid, you can select it and activate the visit. But if not, you can instantly add an Emergency Eligibility by clicking . Depending on the patient’s nationality, it will add an eligibility as Emergency Department Patient for Saudi or Emergency Department Patient – Non-saudi for foreigners. Then you can proceed with activating the visit. The New patient, First Visit, Follow up will be inserted as follows. -New: Patient New to hospital. -First Visit: Default for patients with MRN. -Follow Up: When patient is referred or has an LOE that has a previous treatment, it will be set up as FU. To activate an EP visit, click on the button. The time of the arrival will be shown in the list. Inpatient’s MRN cannot be typed into this screen because they are not to be activated as EP. You can select how the patient was brought in to the ER and write down the valuables if the patient possessed any. 40 HIS BESTCare Project 2.0A User Manual [Administration] 2.2.4.2. Adding an Unknown Patient From the ER Activation screen, click on at the bottom left side and open the New Patient Registration screen. There, at the bottom right side of the New Patient Registration Screen, you can find the following buttons. In order to creat an Unknown patient MRN, first type in the gender and Date of Birth to set up for the patient. Then, click on the Unknown button. A new unknown patient will be created with no data except a new MRN and the full name typed in as UNKNOWN with a sequence number. When a patient MRN is generated, it will show you the patient MRN on the left upper side of the screen. The unknown patients can also be searched by any screen with a Patient MRN Search control. Search under the condition U&D and it will show all unknown patients that are yet updated with the patients information on the top. Later on, when the patient is identified, you will be able to merge the patient’s medical records and visits from the unknown MRN to the patient’s original MRN. 41 User Manual [Administration] HIS BESTCare Project 2.0A 2.2.4.3. Adding a Disaster Patient Disaster patients are similar to the Unknown patient, however, the difference is that it can be generated in numbers. Click on button at the bottom left side of the EP Activation screen and type in the number of disaster MRNs you want to generate in the following pop up. To prepare the Disaster patients in advance, there is no need to check the EP Activation box. But for generating disaster patient MRNs who need EP Activation, because they just came to the ER, check the box and press the button. The disaster patients can also be searched from the Patient MRN Search Control. The sequence numbers will follow what is already created. Once you change the disaster patient’s name to the patient’s name, the newly added disaster patient sequence number will take place of it. Same as the unknown patient, later on, when the patient is identified, you will be able to merge the patient’s medical records and visits from the unknown MRN to the patient’s original MRN. 42 HIS BESTCare Project 2.0A User Manual [Administration] 2.3. Admission Inpatients are patients who stay in the hospital for treatment and care. The patient type next to the name will become IP to indicate the inpatient status when pre-admitted. Once admission is activated, the patient will not be able to receive outpatient clinic appointments or treatments. The inpatient admission process includes:  Checking patients with admission orders.  Scheduling and fixing the date of admission when confirmed by the OR/Exam coordinator.  Assigning Bed.  Contacting/Sending SMS to the patient on the day of admission.  Admission Activation and receiving valuables. 2.3.1. Ward – Bed – Room Patient Service, Medical Protocol Department, and the Business Center have their own wards and beds used for their patient’s admission. Since there are not many occasions of adding or deleting wards, other than when opening the hospital or going through a major remodelling, you have to request to the System Management team for such changes. However, creating rooms and beds into existing wards are available through using the Room Registration/Modification screen. 2.3.1.1. Room Registration/Modification The system will show the patients and beds according to the user’s department and the box will be checked to indicate what wards 43 User Manual [Administration] HIS BESTCare Project 2.0A and rooms you are looking into. The button is for retrieving the data by updating the information and adjusting the ward list in a tree structure on the left side of the screen as below.  Adding a Room/Bed: This screen has functions to add rooms and beds in the selected wards. The button is activated when clicking on the Ward or the room on the list located on the left side of the screen. When clicking on the ward, you can type in a new room number and bed number at once. If you want to add another bed within the room, click on the room and type in a new bed number.  Modifying a Bed: Select a bed and click on the that the button. You will be able to see button is activated. Modify the room information and click on the button. The previous room information is saved under the application date which the end date will be fixed to the day it was modified. At the same time, another application date for the modified information will be appearing above the previous application date. By this way, you can keep track of the modifications made for the rooms.  Closing (Deleting) a Bed: Select a bed and click on Close Bed. The bed cannot be closed if a patient is currently admitted in the bed.  Primary Tx. Dept, Sub. Dept: The selected bed can be designated as the primary 44 HIS BESTCare Project 2.0A User Manual [Administration] treatment bed of a department. It is set as a referential value for the bed assigners.  Dept: Referential matters about setting the primary treatment bed are entered.  Rm Class: The class of rooms and the bed is set. The values can be single, semisingle, shared, small suite, large suite bassinet and so on.  Rm Type: The types of rooms including bed are classified, such as intensive care unit, isolation room, and general room, etc. are set.  Charge Code: The automatic charges will be applied under the charge codes set up for the room/bed through nightly batch.  Manage Dept Code: This defines which department’s patient will be using the selected Room/bed.  Sex: The room can be set up for male, female or regardless of the patient’s gender, so that males and females are prevented from staying in the same room.  Tel.No: The telephone number of the bed is entered. Up to 2 telephone numbers can be entered. 2.3.2. Patients for Admission Patient’s admission order is issued from the Emergency Department or the Outpatient Clinic and will appear in the admission appointment screen. Yet, the physician’s admission order is an expected admission and operation date. The dates are not fixed until the coordinator confirms the date of admission and operation and contacts the admission office to proceed with bed assignment. The Admission office finalizes the dates and it is considered as scheduled. 2.3.2.1. Inpatient-to-be Search 45 HIS BESTCare Project 2.0A User Manual [Administration] By providing the list of inpatient-to-be patients searched by expected/scheduled date or by requested date, and additional conditions such as by each departemnt or by MD who ordered the admission, it will be easy to find the patient list in need. Enter the search period to find the admission expected/scheduled patients.  By Expected/Scheduled Date: The patients who are expected or scheduled for admission will be searched under the condition.The ‘Y’ and ‘N’ in the Schedule column shows whether the admission is expected or scheduled.  By Admission Order Date: Sort By the date admission order was issued.  By Admission Expected or Scheduled patient: You can search only the admission expected patients by setting the radio button as NO, or only the scheduled button by setting the radio button as YES. If you need to view all the patients who are a potential inpatient, set it as ALL. 46 HIS BESTCare Project 2.0A  User Manual [Administration] By Department or By Admitting MD: Search by a specific department or by the admitting MD to narrow down the list of patients viewed in the list.  By Appt Type: Search by General Admission or Short-stay for your convenience. The patients under your selection will be viewed in the list below.  By Status: You can also search pre-admitted patients only, or by excluding the pre-admitted patients to search expected and scheduled patients, or both at the same time. Sort each column by clicking on it, for example by clicking on Sched you can separate the admission expected patients to the scheduled patients if you need to. Patient’s basic information, contact information, eligibility and coverage is displayed as well. – Valid Eligibility: If you click on the button next to the patient’s elgibility, you will be able to view all the valid eligibilities of the patient in a small box. The primary eligibility is shown in green. – Ward-Rm-Bed: The location of patients who are staying in the ER can be shown in this field. Furthermore, the patients who are pre-admitted will also show the beds that they are assigned for. – ER Stay: Whether the patient is currently in the Emergency room or not. The patient will be colored in brown to easily indicate them. – E/C (Eligibility Check): 47 HIS BESTCare Project 2.0A User Manual [Administration] From the Admission office, you can check the patient’s eligibility. The column will show ‘N’ for patients who are not checked, ‘E’ for those who are checked and verified as eligible, ‘I’ for those who are checked but were ineligible. Click on the patient and change the status once you have checked the patient’s eligibility. The patients can be searched by their checked eligibility status as well. Only the Eligible Emergency Patients will be shown to assign beds from the Inpatient-to-be Room Assignment Screen. Later in the Room Assignment screen, Eligible patient will be shown to the Patient Service. Once you mark the E/C, you will be able to right click on the patient and change EP to IP for patients who are currently staying in the ER. – Type: The type of the admission order is as follows:    OP – Outpatient EP – Emergency Department IP – Inpatient 2.3.2.2. Admission Appointment A patient’s Admission order from the list can be selected to schedule the admission appointment and fix the date of admission and operation as requested by the OR/Exam coordinator. The physician’s admission order and the details are shown in the screen. 48 User Manual [Administration] HIS BESTCare Project 2.0A  Adm. Order Date: The date when the admission order was issued.  Cancel. Date: If the admission appointment was cancelled by the user, it will display when the date of cancellation.  Cancelled by: It shows the badge number and name of the user who cancelled the admission appointment.  Expect/Sched Adm: The physician’s admission order specifies the expected admission date. Once it is confirmed by the OR/Exam coordinator and the admission office is contacted by the coordinators, the admission officer schedules it by fixing the date. Then it is called the scheduled admission date.  1st Adm. Date: The expected date that was set up by the physician from the admission order.  Expected LOS: The Length of Stay which the physician inputs when issuing an admission order.  Operation Date: The date of operation which the physician specifies with the expected admission date. Once OR/Exam coordinator contacts and gives the date to the admission officer, the officer has to change it just like the admission date. Same as Expected/Scheduled admission date, you know that it is finalized by knowing whether this patient is scheduled by admission office or not.  Appt Type: The physcian chooses whether the patient is short stay, short-term, or chemo pt. If he doesn’t choose any of the above, it will show as general admission. Short stay is marked in a different color.  Source: The admission order’s request type is displayed in this field. It can be issued by Outpatient clinic, Emergency Care Center, or a newborn automatically registered as an inpatient and so on.  Adm. Type: This shows the em. type of the admission order. Whether it is elective, urgent, emergency, immediate, or qualified elective can be shown in this field. For qualified elective, the remark will be filled by the physician.  NPO: If the patient needs fasting, this will be checked.  Rm. Class: The room class can be selected by the user to provide information when 49 User Manual [Administration] HIS BESTCare Project 2.0A assigning a bed. It does not affect or limit the bed assignment as it is only set up as a reference.  Rm. Type: The type of the room would be shown in this field. This is also selected by the user as a reference.  Isolation: If an isolation is needed for the patient, the physician will choose one of the selections when issuing the admission order. There are various types of isloation including Tuberculosis or Organ Transplant, which can also support freetext if needed.  Assign to Special Beds: The physician can also specify whether this patient needs a special type of room with suction equipment or ICUs, Stroke units and so on.  Weekend Adm.: The physician can choose to avoid weekend admissions if the services needed for the patient cannot be provided in weekends.  Scheduling an Admission Appointment – Select the Admission order from the list below. – The information of the admission order is retrieved to the fields above. Check the information. – Change the Expected Admission date and Operation Scheduled Date to the fixed date delivered by the coordinator. – Type the Preference Room Class as needed. – Remarks are available in freetext and the notifications to the patient printed in the admission slip can be typed in the Slip note field. – Finalize it by clicking the button. The Admission scheduler’s information, the date and time of the scheduling will be appearing on the top of the screen. – If modification is needed for the scheduled admission, make the changes and click on the – button. To cancel the scheduled admission, click on the list below and click the button. 50 HIS BESTCare Project 2.0A – To reschedule the admission, click on the information. – To cancel the admission order, click the button. Once cancelled, the cancelled user and date is displayed in the list below. – To reschedule a cancelled admission order, click on again. User Manual [Administration] button again after checking and the schedule it 2.3.3. Bed Assignment The patients have to be assigned to the beds according to the Admission order. The methods of searching for the right bed class, type, and gender for the patient’s admission will be introduced in the following screens. 2.3.3.1. Room Status Review This is a screen that displays all the beds operated in the hospital. It can also be searched under various conditions. The remarks for each bed can be typed in by the Nurses in the wards which can help in deciding the bed for assignment. 51 HIS BESTCare Project 2.0A User Manual [Administration] The search condition is set to total as default and the other conditions such as Department, Room Class, Ward, and Room info. are not mandatory. They can be utilized if needed to search for a specific bed.  Total: To show all beds including beds that are occupied and vacant.  Vacant: Unoccupied beds that are available for assignment to admission scheduled patients.  DSC: Beds that are scheduled for discharge today.  Vacant Beds + Discharge Sched. for today: Adding both of above to view the maximum number of beds that can be available under the circumstances. If there are any remarks to be left for a bed, type in the note and click on the button. 52 HIS BESTCare Project 2.0A User Manual [Administration] The remarks made by the Admission office can be viewed to the Nurses in the wards. The overview of the beds searched under the condition is shown on the lower left side of the screen.  Bed: Total number of beds under the selected condition.  InPt: Number of inpatients admitted to the beds.  No. of Vacant Beds: Number of beds that are available for assignment.  DSC Sched Pt: Number of patients scheduled for discharge which has a possibility to become a vacant bed The list of inpatients in the room are displayed at the bottom. It is especially useful to shared rooms, but also needed to single rooms to see the current inpatient. 2.3.3.2. Inpatient-to-be Room Assignment Registration This is the screen that assigns beds and pre-admits the patients. The beds can be assigned in the first tab ‘Inpatient-to-be Search By Sched Date’ and SMS notification to the patients can be sent in the second tab ‘SMS Sending for Assigned Pt’. 53 HIS BESTCare Project 2.0A User Manual [Administration] The Room Status Review screen is set up at the left side of the screen and the patients waiting for admission are displayed in the right side of the screen.  Room Status By clicking on the button, you can select a number of wards as a search condition. In order to release the set condition, click on the ward again to unselect it. Rooms with special attributes are colored as above to help the bed assigner look for, or avoid bed assignments. With the information given from the nursing as ‘Room entry Remarks’, you can – Add remarks in the ‘Adm. Remarks’ field. – If you want this remark to only last for 1 day, click on the 1-d check box and click on modify to save. The Adm. Remarks lasts only for today when the Rm Entry Time inserted by the Nursing disappears by nightly batch. – Set up the Allocation Restrictions if there is any, to display it with the bed information in the list above. 54 HIS BESTCare Project 2.0A  User Manual [Administration] Inpatient-to-be Status The list of patients who are scheduled for admission and to be assigned for a bed is shown under the selected conditions. 55 HIS BESTCare Project 2.0A User Manual [Administration] The patients can be viewed by their sex, by where the admission order was issued, or individually by their MRN, by the clinical departments, or even by their admitting MD, and last but not least, the scheduled date. Although the patient’s admission is not scheduled for today, if the patient wasn’t pre-admitted before and is still waiting, the system will automatically include these patients in the list regardless of their actual scheduled date. By selecting the radio button, you can search for patients with admission orders from the Outpatient Clinic, Emergency Room or all types. The ER column on the very right side of the screen indicates that the admission order was issued from the Emergency Room. Furthermore, the brown color indicates that the patient is still in the Emergency Room. Through these indications, you can identify combinations as the following: – ER / Brown : Admission ordered from ER and currently in the ER. – ER / not Brown: Admission ordered from ER but discharged and currently not in the ER. – Not ER / Brown: Admission ordered from Outpatient Clinic, but currently in ER due 56 User Manual [Administration] HIS BESTCare Project 2.0A to circumstances. – Not ER / Not Brown: Admission ordered from Outpatient Clinic and currently not in the ER (Normal Outpatients) Also, there are convenient features for frequently used screens. – When double-clicking the patient, the Admission Activation screen pops up. – click on the patient and the screen. button to open the Admission Appointment You can always add remarks to the selected patient below the patient list. Click on the modify button to save.  Assigning a bed to a patient – Set up the scheduled date for Inpatient-to-be Status as today and search patients by each department. – Select a patient and check the patient’s information and remarks. – In Room Status, search and select the ward, room, and bed according to the given information about the patient and select it. – Click on the – Once the patient is pre-admitted, icon will appear above the patient’s name to indicate that this patient is a pre-admitted patient  button to assign the selected bed to the selected patient. Cancelling Pre-Admission. – If you assigned the wrong bed, or found a better bed that would suit the patient, click on the button at the top to show pre-admitted patients in the patient list. – Select the patient and click on the – Assign a bed again. button for cancellation. 2.3.4. Admitting Patients 2.3.4.1. Admission Activation When the patient arrives to the admission office to be admitted, use this screen to activate the admission. Check the admission information, assigned bed, and save remarks if the 57 User Manual [Administration] HIS BESTCare Project 2.0A patient has valuables. Admission orders are located at the bottom. The most recent one will be selected and the following information will be shown above. A unique admission number will be generated and the information from the admission order and bed assignment is also shown. When clicking on the valuables as ‘Y’, the remarks field on the right side becomes activated. After checking, and filling in the fields, release the check from the check box and click on the button. Since you released the pre-admission and the patient is now officially an inpatient, the the patient’s name. icon will disappear from If there is any information to be modified, correct the field and click on the button. 58 HIS BESTCare Project 2.0A User Manual [Administration] 2.3.4.2. IP Currently Admitted Patient List All the inpatients who are currently admitted will be shown in this screen. Through the search condition, you can sort the patient list by name, department, ward, admission number, or admission date. You can also narrow down the patient list by selecting the gender and the ward. Most of the patient’s information such as patient’s MRN, name, age, and admitted department, ward-room-bed can be viewed. Most importantly, the eligibility and coverge with the remaining days until expiry are viewed in order to contact and inform the patient for renewal or to ask to leave under the circumstances. 59 User Manual [Administration] HIS BESTCare Project 2.0A 2.3.5. Admission, Discharge Status The statistics for beds rooms and wards are generated in real time or searched under a selected period. Important figures such as the number of patients admitted and discharged, Average Length of Stay (LOS), and Bed occupancy rate can be searched by the following screens. 2.3.5.1. Beds Status by Ward (Current Time) Status by Ward: Details of the bed occupancy rate calculated by number of beds, numbers of patients, and number of vacant beds per ward are shown on the left side. The average LOS, numbers of patients admitted and discharged are also shown. An overview of the total number of beds, inpatients (excluding the number of discharge scheduled patients) and the vacant beds can be searched. It is basically the summary of the details on the left side of the screen. 60 HIS BESTCare Project 2.0A User Manual [Administration] The number of today’s admitted and discharged patients can be searched to give you an idea how many vacant beds were out and filled today. The Average Length of Stay is viewed by shared rooms, other rooms excluding shared rooms, and the overall total. An overview of shared rooms is provided to see how many beds are occupied and available at the time. Patients are categorized by LOS 30 days and up to 90 days or more. Keep in mind that patients with 90 days of LOS are also included in the number of patients of 30, 45, and 60 days or more. 61 HIS BESTCare Project 2.0A  User Manual [Administration] Patient Status by Department: Number of inpatients and discharged scheduled patients can be searched by their department in detail.  Bed Occupancy Rate: A detailed overview of bed occupancy rate by each ward. It has different groups of occupancy rate to differentiate general beds’ occupancy rate which excludes ICUs and special beds, and total bed occupancy rate etc. 62 HIS BESTCare Project 2.0A User Manual [Administration] 2.3.5.2. IP Discharged Patient List This screen is to search for discharged patients under a selected period. They can be viewed by each ward if needed. The information includes the discharge date, patient MRN, date of birth, admission date, Length of Stay, department, MD and Resident, Ward, Room, and bed, eligibility and coverage, the number of admissions, and discharge results. 63 HIS BESTCare Project 2.0A User Manual [Administration] 2.4. Scheduling Scheduling is mainly divided into two categories. The template and time slot maintenance of the physicians and the patient appointments.   Slot Types: For scheduling, there are 5 types of slots. – Total: Clinics that receive any patients regardless of their slot types use the total slot. Therefore, it cannot be applied with the other slots at the same time. – First Visit (FV): First Visit slot includes new patients (New to hospital patients) and First Visit patients (New to department. When the previous refer ended, they will be considered as first visit when they come again with a new referral) – Follow Up (FU): Follow ups are treatments after the First Visit. – Walk In (WI): Patients who come to the hospital without any appointments and want to have consultation in the same day. – Emergency Patient (EP): Patients who came through the Emergency department and was asked to schedule an appointment in the ACC. – But as for statistics, you will still have to choose first visit or follow up when scheduling an appointment so that you know even though a patient is WI or EP, whether they are NP, FV, or FU.) Change Reasons: It is a field that is on the right side of each time slot. It includes all the unavailable reasons such as Vacation or Academic conference. But it is also used to block the slots on purpose so that the end users cannot schedule an appointment to that time slot. Some slots can be overridden by users with authority but some slots cannot be overridden at all. Instead, the users with authority will be able to delete the change reason, make an appointment and block it with the same change reason again. So for those change reasons, temporarily undoing the change reason will solve the problem. 64 HIS BESTCare Project 2.0A User Manual [Administration] 2.4.1. Template and Slot Maintenance The templates are the patterns for a physician’s clinic. If the physician has two different clinics, the physician will have different patterns set up for each clinic. Templates are created with one or a combination of weekly patterns and are applied into the calendar. These templates are to be made and managed by one person because if they are managed by each department, it is highly possible that the patterns from different departments might overlap. Once the patterns are created by the pattern creator, they are to be applied by each department. 2.4.1.1. MD Template Pattern Settings The following screen is where you first create the patterns for a physician to the selected clinic.  To create a pattern – The extension on the left side can be used to select the department – clinic – physician – templates. – Or simply click the magnifier the clinical treatment. – Type in the department code or the name of the physician to search for the clinic – physician and double click to retrieve it to the previous screen. to search for the physician who provides 65 User Manual [Administration] HIS BESTCare Project 2.0A – Click to add a new schedule code and type in the title. Save by clicking button. To modify the title of an existing pattern, select the pattern and click modify the title and save by clicking to . – Select morning session or afternoon session. Then select the time intervals shown in the dropdown list. Type in the starting and ending time for the pattern. You can select AM, PM, or both depending on the physician’s schedule. – Select either Regular or Clinic.  Regular: A normal clinical appointment  Clinic: The registered clinical code can be applied in cases when the physicia n chooses to see certain patients in certain weekdays although they are all wit hin the same pattern as a single clinic. For example, a Peds Neurology clinic by Dr. Abdulaziz may want to see Epile psy patients on Mondays and Neurodevelopmental delay patients on Thursda ys. Then to show it in the slots, you should add the clinical codes to Dr. Abudl aziz’s Peds Neurology clinic from the Clinic Code Management and then you will be able to select the clinical codes for each corresponding weekday.  – Type in the number of patients for each slot. Keep in mind that Total slots are for clinics that receive patients regardless of their type. Therefore, if you are entering a number in Total, you shouldn’t be entering numbers in other slots and vice versa. 66 HIS BESTCare Project 2.0A User Manual [Administration] – Check the boxes of the weekdays you wish to create for the pattern and click the Create button. – Then you will see the slots created according to what you have set up. – Change the time, the number of patients in each slot manually if needed. In order to copy slots, press Ctrl or Shift or Alt and drag from a slot to slot and color the boxes. Then Ctrl+C to copy the slots that you have colored. Undo the coloring of what you have copied and press Ctrl + click on the other slot you want to paste. Press Ctrl+V to paste. This will help you deal with setting up the pattern as you like. – Choose Clinic codes that are registered to this physician and clinic or Change Reasons for each slot if needed. – Click to save the pattern. Now the saved pattern will be shown to the MD Template Schedule Application so that you can apply it into the actaul schedule slots.  To add time slots to an existing pattern: – Same steps of selecting the clinic and physician as creating a pattern. – Select an existing pattern from the Sche. Code. 67 User Manual [Administration] HIS BESTCare Project 2.0A  – Change from the slots itself or click on the Individual Setting Extension on the top. – You can create new slots with the settings that only apply to the selected weekday. Click on to add slots on top of what you have created before or click to create patterns which is the same function as it is on the top of the screen. You can select Change Reasons or Clinics if you need to apply them to the patterns and slots. – Click to save the pattern. To Modify or Delete patterns Select the existing patterns as instructed above and click on the the pattern or button to modify button to delete the pattern. 68 User Manual [Administration] HIS BESTCare Project 2.0A 2.4.1.2. MD Template Schedule Application The following screen has 3 tabs. – Apply Patterns: It can apply the patterns to create the schedules for the select clinic and physician. – Clinic Cancellation: Add unavailable periods for the physicians (applies to all clinics of the physician) – Substitution: Add Substituting physician when the scheduled physician is not available.  Applying Patterns to Create Schedule – Click the magnifier treatment. – Type in the department code or the name of the physician to search for the clinic – physician and double click to retrieve it to the previous screen. The screen will now show the calendar. – Select the Schedule pattern in the dropdown list. You will find the patterns that you have created before. to search for the physician who provides the clinical 69 HIS BESTCare Project 2.0A User Manual [Administration] – Once selecting a pattern, Drag the days in the calendar to color it in orange and then click . You will see the days are circled with a different color. Those days are the ones that are to be created in the schedule. – Click on the circled day on the left side of the calendar to see the slot’s details on the bottom of the screen and check if it is the right slots that you want to create. – Youcan apply multiple patterns if needed. Select a different pattern and drag the days in the calendar again. Click on and you will be able to see circles with different colors at the same time. 70 User Manual [Administration] HIS BESTCare Project 2.0A – It is possible to drag the days to apply irregular schedules. Press Ctrl and drag for a certain week only and press . It will show you that the pattern consisting Wednesday & Thursday slots are applied to the weeks that I have chosen manually. – Or select option on the top and click select every other week for you. – Delete patterns from the days which you have dragged in the calendar by clicking . – Check the currently applied schedules by clicking at the bottom of the screen because the schedules that are newly applied will delet the exisitng slots that are already there. For example, the pattern changed from Tuesday, Wednesday to Sunday and Monday. When you apply the new pattern(Sun, Mon), it should delete the existing schedule(Tues,Wed) automatically. This is to maintain the schedules simple and clean because if existing schedules does not rub off, you will have to delete them manually prior to applying new patterns. Keep in mind that a patient’s scheduled appointment will never be deleted at any time. Only the slots without appointments will be deleted. – Click – You can check the applied slots right away by clicking on the monthly schedule calendar. so that the system can to apply the patterns and create the schedules. which pops up 71 HIS BESTCare Project 2.0A  User Manual [Administration] Clinic Cancellations When the physician plans for a leave, the clinic cancellation period and the reason for the leave can be added into the system to block the existing schedules so that no appointment will be scheduled. There are 3 processing sequences – Reg. Date: Searching by the date when the clinic cancellation was registered. – Clinic Cancel. Date: Searching all the cancelled clinics in the selected date. – MD: Search by the physician to add, modify, or delete clinic cancellation.  To add a Clinic Cancellation – Choose MD from the Processing Sequence and Click screen. – Search for the MD by department, clinic, badge number or name. double click on the clinic and the physician to retrieve the information to the previous screen. If the at the bottom of the physician has clinics in more than one department, click and it will add clinic cancellations to all departments. If not, you can release the check and add clinic cancellation for one department. 72 HIS BESTCare Project 2.0A User Manual [Administration] – Select the magnifier which is identical to the change reason. – Select the cancellation period by typing in the dates or selecting dates from the calendar. and select the cancellation reason 73 User Manual [Administration] HIS BESTCare Project 2.0A  – Select the Type to block: it is either OP, Admission, or both. – When selecting the OP, it will block the outpatient clinic schedules and if there were any exisiting slots, the change reason will turn to the one selected here. – When selecting Admission, it will let the user know that they are on leave when admitting a patient and the Attending MD is on leave. – It will create individual data lines for OP and Admission. Therfore, when selecting and adding clinic cancellation as OPD/ADm., two data lines will be created at once. – Type in the Remarks as needed. For example, state the period and purpose as 5/10~7/10 Overseas Academic Conference. – Click – When the official document is confirmed, you can double click on the empty field to make a circle appear and check the line and click to save. This will be useful at times when the physician has to add clinic cancellation in a hurry and contacted to person who adds clinic cancellation prior to the official document. to add clinic cancellation. To Modify or Delete Clinic Cancellations To modify, select the clinic cancellation line and apply the changes and click on the button to save. To delete, select the clinic cancellation line by checking the box on the left side and click . You can only delete it one by one in order to avoid deleting the something unexpectedly. If you select multiple data lines, it will only delete the last selected clinic cancellation.  Substitution This screen is used when a physician is on leave, and a substitute is to fill in his appointment schedules. The substitution is added in periods which means if the substitute is for 15th of October, it has to be added as 15/10/2014 00:00~ 16/10/2014 00:00 in order to substitute for the whole day of the 15th of October. The reason for substitution is same as the change reasons. 74 HIS BESTCare Project 2.0A  User Manual [Administration] To Add a Substitution – Search for the MD who is on leave by department, clinic, badge number or name. double click on the clinic and the physician to retrieve the information to the previous screen. – Select the Substitute MD. – The substitution is added in periods which means if the substitute is for 15th of October, it has to be added as 15/10/2014 00:00~ 16/10/2014 00:00 in order to substitute for the whole day of the 15th of October. – Select the reason for substitution. The codes are same as the change reasons. – Click and it will add it into the substitution list below. 75 User Manual [Administration] HIS BESTCare Project 2.0A  To Modify or Delete Subsitutions To modify, select the substitution line and apply the changes and click on the button to save. But you cannot change the start date of the substitution nor can the end date be today or the past. If you need to, you have to delete it and add a new one. To delete, select the subtitution line and click . 2.4.1.3. Schedule Modification Management There are two tabs in this screen that manages multiple slots.  – Modif./Del.: The outpatient schedule slot’s change reason, clinic codes ore remarks of a physician can be modified, deleted in this screen. The use of it is that they can be applied in multiple slots at the same time. Remarks can be left to be shown in the scheduling calendar for the schedulers or the user maintaining schedules. – Daily Creation: This tab has the functions to create a day’s schedule or to copy a day’s existing schedule to be pasted. To Modify and Delete Slots There are several search conditions to search for the slots at the top. The ones that you search will appear in the list below and they will be the ones that you can apply the changes for. 76 User Manual [Administration] HIS BESTCare Project 2.0A – Search for the MD and clinic with an existing schedule that you want to modify or delete certain slots. – Select the period and time of the slots that you are looking for. Time will be 00:01~23:59 by default. If you are looking into a specific time, set it up in detail. – If you are looking for specific slots such as slots with change reasons, select the change reason. If the field is null, it will search for all types of slots. If you are looking forward to not include slots with change reason, check on the box which will exclude the slots with change reasons. – If you are only trying to modify Mondays within a time period, check the weekday and it will only show the slots within the weekday. – Once you have set up the searching conditions, click below. – To all the slots that have appeared, you can apply change reasons or clinic codes at once. Choose the change reason/clinic and click on – and the list will appear button. If you want to empty out the change reasons or clinic codes, check the box and click on the button. 77 User Manual [Administration] HIS BESTCare Project 2.0A – To add remarks to all the slots at once, fill in the remarks in freetext and click button. Like all the functions above, it will save it to each slot. – To delete the slots, click at right away.  and it will delete all the slots that you were looking To Copy a Day’s Schedule – There are two MD fields this time. The one on the top is the one you will copy it from. Select the MD that you will copy from and choose the date you are willing to copy. If you want to go to the schedule calendar to see what kind of slots there are for each day, click on the magnifier Then click to have the scheule appear below. – The one below called MD to Create is the physician you want to paste it in. It can be a different physician but it can also be the same physician. Then choose the day to paste the schedules. – Click to copy and paste the schedules 78 HIS BESTCare Project 2.0A  User Manual [Administration] To Create Slots for a Day – There is no need to use the MD field on the top. Choose the MD to Create and the Day to Generate slots. – The method of creating slots for a day is the same with creating the patterns for templates. Choose AM or PM and the interval time, the start and end time, regular session or a clinic code, and the number of patient types for the slots. Once you have filled in the fields, click and it will show you the slots above. – Once you have checked the schedule generated, click schedule. to apply the 2.4.1.4. MD Slot Modification by day This screen has functions to modify a day’s slot by one slot at a time. For the slots, it shows the initial slots that were created at the time of applying the patterns. The currently allowed slots and scheduled slots are followed. 79 HIS BESTCare Project 2.0A  User Manual [Administration] To Create a Slot – In order to create a slot, after selecting the MD at the top and the visit date. – Click on the bottom of the screen and it will move your focus to the visit time. Enter the time that for your slot. – Fill in the number of patients in the type you want to create for the slot. – Select Change Reason or Clinic code if needed. – Click and create a slot. 80 User Manual [Administration] HIS BESTCare Project 2.0A   To Modify or Delete a Slot, Change Reason, or Clinic code – Select the MD and visit date as above. – Modify the number of patients or patient type in the slot. Add/modify/delete change reason and clinic code if needed. – Click for slots or information. – Past or today’s slots cannot be deleted in this screen to prevent mistakes. You can only delete future slots. If you really want to delete past or today’s slots, you can delete it from the Schedule Modification Management screen. for change reasons to save the Add Remarks The Remarks is set up for the day of the schedule, not to each slots. So When you leave a remark, save by click  . Then it will show the last modified person as below. Change Reason to All Slots (Aggregate Process) This screen is used to add or modify one slot at a time but it has a special function to apply change reasons into all the slots like the Schedule Modification Management screen. Select a change reason you want to apply to all the slots for the selected day and check the box on the right. Then click , which will ask you if you are going to continue with applying the change reasons to all the slots. Click Yes to apply. You can also change the search conidtions to By period which is mainly used to view slots within the selected period. You can apply the change reasons or clinic codes for all the slots in this condition but cannot make modification in the slots. Click on the on the bottom left which is linked to the schedule calendar. 81 HIS BESTCare Project 2.0A User Manual [Administration] 2.4.1.5. Holiday Management The holidays are to be added into the system to show it in the schedule calendars. The user can choose to block all the schedule slots that are created, or can allow treatment schedules as before.  Add a Holiday – Select the date of the holiday in the calendar and type in the Name of the holiday below. – Set Treatment as YES for your department, if you want to allow outpatient appointments when applying patterns in the MD Template Schedule Application, or NO if no slots should be applied from now on. However, added as holiday doesn’t mean totally blocking you from creating slots. Although selected as NO, you can still create a single day’s schedule and see patients if needed.The templates that are previously made before adding a holiday will still remain. So you need to block them in a different screen. You will be able to block a certain period’s certain time range for all the clinics that are manged by each department at once to block slots in holidays like Ramadan. – Click and the holiday will be added. 82 User Manual [Administration] HIS BESTCare Project 2.0A  – To add a period of holidays, drag the days from the calendar. Once you save it, the selected days will be added as holidays. – Click after adding all the holidays. XML Export Once you have added the holiday, you need to ask for build up to the System Management team in order to display holidays in red color in the calendar controls. By clicking on , you will see a message with the directory where a file is exported. Contact the System Management team for further assistance. In order to see it in the calendar in the current screen, close it and open it again.  Modify or Delete Holidays To modify, change the name and click will have to delete and add again. . The date cannot be modified. For that, you To delete, click on the boxes next to the holidays and click . 83 HIS BESTCare Project 2.0A User Manual [Administration] 2.4.1.6. Clinic Management The structure of the appointment is that you select the clinical department and you will see the clinics within the department. Each clinic can have one or more physicians providing services. This screen will enable you to add the clinics to the departments and add the physicians to the clinics. By setting up this structure, the clinic and physician will now appear in the schedules to create patterns, apply patterns and schedule appointments. There are two tabs for this screen. – Clinic Registration: To register a clinic within a selected department. – Clinic Registration by MD: To register the clinic made from the Clinic Registration tab to a physician.  Add a Clinic – Click and select the department you want to add a clinic to. – Type in the clinic’s name that you are going to use. This name will appear in the schedules. – Select ‘Y’ if you want to activate it or ‘N’ to just add a clinic but not activate it. – Select additional information of the clinic such as the charge code for treatment or 84 User Manual [Administration] HIS BESTCare Project 2.0A the period that the appointment scheduling is allowed for. –  Modify or Delete a Clinic – To modify, double click on the exisitng clinic and change the name. Then click to save. – To delete, double click on the existing code and click message.   Click and add it into the list. Now you have created a new clinic within the selected department. . Click YES in the pop up Clinic Registration by MD – Search for the physician who you are willing to add the clinic code for. – Click and the clinics added to this physician will appear below. If no codes were added before, it will be blank. – Click and the clinic will be active. Search for the clinic you have added previously. – Click to add the clinic to the physician. Modify or Delete a code registered to the MD If you added a wrong clinic to the physician, double click on the added code modify it to the right clinic code. Then click to save. If you want to delete the clinic, double click the existing code and click the pop up message. . Click YES in 2.4.1.7. Clinic Code Management A physician’s clinic can have clinic codes within the pattern or slot usually to display that the physician is only seeing certain patients in this weekday, and different patients in another, although they are included in a single clinic. First, you have to add a code and code name to a department. Then you will be able to add the code to a physician. Once this is done, the clinic codes will appear when creating templates and managing slots of the physician. There are two tabs for this screen. 85 HIS BESTCare Project 2.0A User Manual [Administration] – Code Registration: To register the code and the name for a department or two. – Code Registration by MD: To register the code made from the Code Registration tab to a physician.  Add a Clinic Code – Click – Type in the code after checking what code you are going to add. If there is a sequence, follow it. But it is up to you how you set up your codes. The codes are 2 digits and can be a combination of numbers and letters. – Type in the Code name which will appear next to the time slots and patterns. This is the name the schedulers will be finding the the schedules. – Type in or search the departments that are going to use this code. and look into the previously added codes below. 86 User Manual [Administration] HIS BESTCare Project 2.0A  and add it into the list. Modify or Delete a Clinic Code – To modify, double click on the exisitng code and change the fields. Then click to save. – To delete, double click on the existing code and click message.  . Click YES in the pop up Code Registration by MD – Search for the physician who you are willing to add the clinic code for. – Click and the clinic codes added to this physician will appear below. If no codes were added before, it will be blank. – Click and the added previously. – Click   Click will be active. Search for the clinic you have to add the clinic code to the physician. Modify or Delete a code registered to the MD – If you added a wrong clinic code, double click on the added code modify it to the right clinic code. Then click to save. – If you want to delete the code, double clic…

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