TIME V7.2 Service Pack 23 - Medical Billing Services : … · Progress Notes ... Hemodialysis...

TIME V7.2 Service Pack 23

Release Notes of 61 Last Saved: 1/5/2016


Contents

TIME V7.2 Service Pack 23 ....................................................................................................................................... 1 Enhancements – Clinical ........................................................................................................................................ 3

Crystal Reports – QAPI Dry Weight Pct Variance Report .................................................................................. 3 Dialysis Order Changes ...................................................................................................................................... 4 Progress Notes ................................................................................................................................................... 5 Remove Reference to Method ............................................................................................................................ 7 Extended Care Team .......................................................................................................................................... 8

Enhancements – General ....................................................................................................................................... 8 Technology Upgrade ........................................................................................................................................... 8

Enhancements - Interfaces ................................................................................................................................... 10 HL7 2.5.1 Inbound (to TIME) and Outbound (from TIME) ADT ........................................................................ 10

Custom ................................................................................................................................................................. 10 WO 3052 USRC Performance Tracking Purge ................................................................................................ 10

Custom – General ................................................................................................................................................ 10 Common ............................................................................................................................................................... 11

Patient Info Selections ...................................................................................................................................... 11 Clinical .................................................................................................................................................................. 12

Access Maintenance Module ............................................................................................................................ 12 Assessment/Care Plan Alerts and Notifications ............................................................................................... 13 Clinical Registration .......................................................................................................................................... 14 Crystal Reports – Admin Svc View ................................................................................................................... 15 Crystal Reports – Patient Status History Report............................................................................................... 15 Crystal Reports – Treatment Counts Report .................................................................................................... 16 Family History ................................................................................................................................................... 16 Hemodialysis Flowsheet – Machine Check Screen .......................................................................................... 17 Hemodialysis Flowsheets Rpt ........................................................................................................................... 17 Home Dialysis Service Charting ....................................................................................................................... 18 Infection Control Report .................................................................................................................................... 19 Medication Orders ............................................................................................................................................. 19 Patient Inquiry ................................................................................................................................................... 20 Service Charting ............................................................................................................................................... 20

Financial ............................................................................................................................................................... 21 Additional Codes – Occurrence Codes ............................................................................................................. 21 Crystal Reports – Payer Mix Census ................................................................................................................ 22 Deposit Summary report ................................................................................................................................... 22 Payment Transactions ...................................................................................................................................... 22 Reassign Diagnosis Codes ............................................................................................................................... 23 Reimbursement Schedule................................................................................................................................. 24 Send to Collections Utility ................................................................................................................................. 25

Interfaces .............................................................................................................................................................. 25 Charge Extractor ............................................................................................................................................... 25 Inbound (to TIME) ADT ..................................................................................................................................... 26

Clinical Appendices .............................................................................................................................................. 26



Appendix A – Dialysis Order Changes ............................................................................................................. 26 Appendix B – Progress Notes ........................................................................................................................... 37 Appendix C – Remove Reference to Method ................................................................................................... 51 Extended Care Team ........................................................................................................................................ 56



Enhancements – Clinical NOTICE: TIME V7.2 Service Pack 23 contains two significant technology changes. We upgraded the underlying

technology from Progress OpenEdge 10.2B to OpenEdge 11.4. In addition, we completely re-engineered the

technology used for Progress Note so that Progress Notes can run reliably in Windows 7/Windows 8.x/Windows

Server 2008/Windows Server 2012. Because of these significant changes, it is highly recommended you allocate

more time than usual during your In-Service testing to make sure these changes work as expected in your

environment. (no documentation required)

Crystal Reports – QAPI Dry Weight Pct Variance Report Compliance auditors at multiple sites requested that users provide information about the number of treatments

with a variance between the ordered dry weight and the post weight. In some cases, they wanted to know

when the post weight was a difference greater than x% of the dry weight. In other instances, the compliance

auditors wanted to know if the weight removed during the treatment was greater than x% of the dry weight. In

response to the auditors’ requests, the new QAPI Dry Weight Pct Variance Crystal Report was created.

The following parameters may be set when generating this report:

1. Facility – users may select all, one or several facilities to report.

2. Date Range – users may define the date range of the flowsheets whose dry weight variances meet the

report criteria.

3. Variation Percentage – users may define the percentage of variance to check the flowsheets when

sorting the records to report. The report will find all flowsheets with a percentage higher than the

entered value. Therefore, if you enter ‘5’, the report will display all flowsheets with a percent variance

greater than 5%.

4. Variance Type – There are two types of variance that may be selected:

a. Weight Loss: When Weight Loss is selected, the report will identify flowsheets where the

treatment’s weight loss divided by the patient’s ordered dry weight is greater than the entered

percentage.

b. Post Weight: When Post Weight is selected, the report will identify flowsheets where the

difference between the patient’s ordered dry weight and the treatment’s post weight, divided

by the patient’s ordered dry weight, is greater than the entered percentage.

No documentation required. Add to Key User Training Agenda – QAPI Reports section

A sample report is displayed below:



Dialysis Order Changes The purpose of this project is to enhance the ability to more specifically order a hemodialysis dialysate or

dialysates delivered during a hemodialysis patient’s treatment. In order to meet this objective, the following

changes have been made to the TIME system (NOTE: These changes apply only to hemodialysis orders):

1. A new table, the Bath Type table, has been added to the Medical Records Codes menu. A Bath Type

code includes the following information: Documentation needed to the Medical Record Codes

Document. Need to add to Code Table Training Agenda and Worksheet documents

a. Bath Type Code

b. Bath Type Description

c. Calculation Type (+, -, x, or / - that is, add, subtract, multiply or divide)

d. Calculation Number

2. A new field, the Total Delivered Buffer field, has been added to the hemodialysis dialysis order screen.

When a bath type, defined above, is ordered as a patient’s bath, the system will calculate this value

based on the following formula:

a. Base Bicarb (the new field introduced in SP22), Calculation Type, Calculation Number

b. For example, the Base Bicarb is entered as 25, the Calculation Type for the selected bath is +,

and the Calculation Number for the selected bath is 8, the system would calculate the Total

Delivered Buffer to be 33 (25+8=33). (Documenation will be needed if this functionality will be

displayed by default including screen new screen shots and field definitions. If it is hidden by

default we will need to update the optional sessing section. Need to include this as

preference decision in the Core Group Decisions Document)

3. An option has been added to allow users to hide or display this functionality.

4. The new dialysate information is available on the following applications:

a. The Treatment Rx and Connect screens of the Hemodialysis Flowsheet (documentation required

if on by default)

b. Flowsheet History screen (documentation required if on by default)



c. The Hemo Orders screen part of the Physicians Rounding App (No documentation required as

we do not get into this level of detail within this document)

d. The new dialysate information is available on the hemodialysis dialysis orders and flowsheet

history Progress Note Template Data Elements. No documentation required as we do not get

into this level of detail within this document)

e. The new dialysate information is displayed on the following clinical reports: No documentation

required as we do not get into this level of detail within this document)

i. Hemodialysis Flowsheet

ii. Physicians Rounding Report

iii. Patient Review Report

iv. Dialysis Orders Report

v. As You Like It Report

5. A new Infobutton has been added to the hemodialysis Dialysis Orders screen. When the Infobutton is

selected, you are taken to the Medline Plus website to provide additional clinical information.

(documentation required – update screen shot)

See Appendix A for more details.

Progress Notes The Progress Notes application has been overhauled to use newer technology so that progress notes may be

shared using many different user interfaces. Old progress notes may still be modified and copied, and existing

progress note templates have been converted to work with the new technology. In addition, a new application,

the Organize Progress Note Templates application, has been added to provide a more streamlined and efficient

means by which users may select a template. Stored progress note templates may now be marked as shared or

not shared with other users. If a template is shared, it may be further filtered by granting access by user,

security group or by facility. By targeting specifically with whom a template is to be shared, the overall list of

stored progress note templates for any given user is shortened and more easily managed..

The following changes have been made to the Progress Notes and Progress Note Templates applications:

1. The following changes have been made to the Progress Notes application:

a. The following changes have been made to the Edit menu of the Add/Edit Progress Notes screen:

i. The Undo and Redo menu options, selected from the Edit menu of the Add/Edit

Progress Notes screen, now support multiple undos and redos. (Documentation

required – Procedure section)

ii. The Delete option has been removed from the Edit menu of the Add/Edit Progress

Notes screen. (There does not appear to be a screen shot with the Edit Menu at this

time )

iii. The Search and Replace dialog boxes have been enhanced with additional options.

(There does not appear to be a screen shot with the Edit Menu at this time –

recommend created screen shots for this functionality and entering supporting bullets

in the procedure section)

b. Users may now select page ranges when printing multi-page documents. (Docuemntation

required – procedure section)



c. When the Text menu option is selected from the Insert menu, it can now load the latest version

of Microsoft Word documents (DOCX). . (No documentation required)

d. The following changes have been made to the Format menu of the Add/Edit Progress Notes

screen:

i. When the Character option is selected, the options displayed on the Font dialog box

have been re-arranged. (No documentation required)

ii. The Display Only option has been renamed “Restrict Editing”. If the cursor is located

inside a restricted editing area when the Format menu is selected, the option changes to

Allow Editing so that the restriction may be removed. . (No documentation required)

iii. The Set Changeable option has been removed from the right-click menu. Restrict

Editing fields are now displayed with a gray background when they are clicked. . (No

documentation required - need to address in Key/End user Training sessions )

e. When entering a progress note, the Tab key now indents text or increases a bullet list item level.

Using the Shift key + Tab will do the opposite. The Tab key also moves the cursor from cell to

cell in a table. . (No documentation required – need to address during Key/End User Training

sessions…NOTE clicking Shift + tab does not appear to do the opposite)

f. You may now add a table within a cell of another table. This is useful for formatting a page with

side by side tables. . (No documentation required)

g. When applying a template to a progress note, the As of Date dialog box is only displayed if the

date of the progress note is different than the current date, and the session setting for the As of

Date has not been set yet. (Documentation required screen shot and corresponding text box

changes needed)

h. The Sign button has been renamed as the Save button. (Documentation Required – multiple

screen shots)

2. The following changes have been made to the Progress Note Templates application:

a. A new Progress Note Templates security setting, the “Prior To” date field, has been added. The

Prior To setting is used in conjunction with the Prevent Copy checkbox. If the Prevent Copy

checkbox is selected, and the Prior To date field is blank, no notes that include the template can

be copied. This mirrors the functionality that existed prior to SP23. If, however, a date is

entered in the Prior To field, then only progress notes containing the template that were

created prior to the given date are restricted and unavailable to be copied. Progress Notes using

the template that are created after the date entered in the Prior To field may be copied.

(Documentation required, multiple screen shot changes, field definitions)

b. It is now possible to add multiple templates to a Progress Note. Each template is appended to

the bottom of the existing text. The settings of the templates are combined in the following

manner: (Documentation Required – procedure section)

i. Security: If any of the templates used is set to ‘Allow changes – all users and times’,

then the resulting progress note will follow this security setting. In addition, the ‘Allow

changes only by creator day of creation’ overrides the ‘Follow security of other notes’

setting.

ii. No Change Days: The lowest setting of the templates used in the progress note will be

used as the overriding setting.

iii. Template: The settings of all of the templates used in a given progress note are

combined for the most restrictive result.

iv. Elapsed days: The largest setting of all of the templates used in a given progress note is

used as the number of elapsed days.



v. Prevent Copy: If any of the templates added to the progress note is set to prevent

copying, then the resulting progress note is restricted as well.

vi. Prevent Copy Prior to Date: The latest date used for any of the templates used to create

the progress note is the date that is used for the overall progress note. A blank date

(prevent all) overrides all other dates.

c. The restriction on copying notes due to template changes has been relaxed. If a template has

been modified since a note has been created, then a warning is displayed but the user is allowed

to proceed with copying the note within the copy restrictions detailed above in the Prevent

Copy description (2.b.v.) (Documentation Required – procedure section)

d. The CVX Category constraint has been added to the Immunization History grid. (no

docuemtation required)

e. The Historical Med Order Grid has been enhanced by adding the Dose, Frequency and Route

columns. The doctor column was removed from the grid. In addition, the columns have been

rearranged to display in the following order: Medication, Place, Start Date, Stop date, Dose,

Frequency and Route. (no docuemtation required)

f. The Treatment Observation Grid data element has been added. The grid is constrained by date-

driven constraints, and includes the following columns: TX date, time, BP, pulse, BFR, VP, AP,

TMP and UFR. (docuemtation required – update list of data elements)

g. The Pt. Other Contact Info data element has been added so that additional patient information

that includes but is not limited to patient employer, financially responsible party, clinical .

(docuemtation required – update list of data elements)remarks, transportation, and primary

physician may be added to a progress note template.

h. A new option has been added to the File menu of the Progress Note Templates application. The

Organize Progress Note Templates option allows you to mark a template as shared with other

users or not shared. In addition, you may specify whether the template should be shared with

specific users, security groups or facilities. This new screen helps to reduce the number of

progress note templates that are displayed when a user searches for a template to apply to a

progress note, making it a more streamlined and efficient process. . (docuemtation required –

Note I do not see this under the File Menu)

3. When applying a progress note template to a progress note, the As of Date dialog box is only displayed if

the date of the progress note is different than the current date, and the session setting for the As of

Date has not been set yet. (see previous note/comment)

4. The Maestro Template and the Progress Note editor now use the same type of active spell checking that

is used with most word processors. (no documentation required – address during key/end user

training)

See Appendix B for more details.

Remove Reference to Method As a result of changes in reimbursement for home dialysis services, organizations may no longer choose

between Method I and Method II billing as this distinction has now become obsolete. All home dialysis services

are billed as Method I claims. In response to these changes, references to Method I and Method II billing, and

the options to select these methods of billing, were removed from the TIME system. The historical information

is still available to be viewed, although it may not be edited. The method designation is not displayed on any



current or future records. (documentation required – update Hemo and PD related dialysis orders screen

shots)

See Appendix C for more details.

Extended Care Team With Service Pack 23, you can now record and view information about other clinicians and family members who

are part of the patient’s overall care team (not just the team that treats the patient in your clinic). The following

changes have been made to support this

• Extended Care Team: This new screen allows you to document the extended care team for the patient.

It allows for you to document both personal team members (spouse, daughter, father, etc.) and clinical

team members (Cardiologist, Endocrinologist, etc.) For each team member you can provide address and

phone numbers, as well as an indication of whether or not the team member can make decisions on the

patient’s behalf or if they can receive patient health information. (Documentation Required)

• Clinical Registration: A new button, “Extended Care Team” has been added to the “Current Status” tab

of Clinical Registration. Pressing this button launches the new Extended Care Team screen

(Documentation required – update Current Status tab screen shots to show button, field definitions,

and procedures if this is the source of the screen)

• Physician Rounding App: A new screen part has been added – Extended Care Team. If this list is part of

a view, the patient’s Extended Care Team will be displayed, with fields for Name, Role/Specialty, Phone,

and Address. Performing a right-click on the screen part will display a context menu allowing you to

Add, View, and/or Edit Extended Care Team members via the new Extended Care Team screen

(Documentaton required, screen shots and field properties)

• Progress Note Template: A new data element – Extended Care Team – is now available under the Data

Element -> Pt. Other Contact Info menu on the screen. This will display the Name, Role / Specialty,

Phone, and Address of the patient’s extended care team members. (Documentation required – update

the list of data elements)

See Appendix D for more details.

Enhancements – General

Technology Upgrade

Overview

As part of TIME V7.2 SP 23, we have upgraded our underlying technology to a more current version. TIME is

based upon the Progress OpenEdge environment. With SP 23, we’ve upgraded OpenEdge from 10.2B to 11.4.

For existing TIME functionality, this upgrade has little impact (a couple screens needed minor tweaks to perform

correctly with the new technology). The primary reasons for the upgrade, from an Infian perspective, are:

• Staying on the most recent Progress OpenEdge environment

• Access to capabilities that allow us to more efficiently build mobile solutions

• Access to bug fixes from Progress that they will no longer perform in OpenEdge 10.2B



• Ability to run 32-bit or 64-bit versions of OpenEdge

Access to capabilities that allow us to more efficiently build mobile solutions

With TIME V7.2 SP 23, we are introducing the initial version of our TIME Mobile application. In SP 23, this

application will allow for viewing of Physician Rounding App views from a tablet like an iPad and an Android

Tablet. In later service packs of TIME V7.2, we will add the capability to fully document dialysis rounds with

TIME Mobile.

In order to provide this capability, we needed to upgrade to OpenEdge 11.4 so that we can easily exchange data

securely between the TIME environment and a tablet computer.

NOTE: TIME Mobile will be offered at an additional cost. Please contact your Regional Account

Executive for more information . (No docuemtation required)

Access to bug fixes from Progress that will no longer be performed in OpenEdge 10.2B

One of the reasons we chose Progress back in 2001 to be the foundation of TIME is its robustness. Very rarely

have we had an issue at our client sites that required a fix from Progress to resolve. But, we do periodically have

issues crop up during the development of new TIME features that may require a fix from Progress before we

deploy. Sometimes those issues are considered critical by Progress and they will fix them in OpenEdge 10.2B,

but sometimes they don’t consider our issue to be critical enough to fix in an older version and will only fix it in a

current version. . (No docuemtation required)

Ability to run 32-bit or 64-bit versions of OpenEdge while maintaining a single code base

Prior to SP 23, we could only run the 64-bit version of OpenEdge for the database engine – and only if the server

hosting the database engine was only running the database engine. With the upgrade to OpenEdge 11.4, we

can now run both the database engine and the application server logic on a 64-bit version of OpenEdge.

Running the database engine on a 64-bit version of OpenEdge allows us to access more memory for caching

patient information – thus users spend less time waiting for data to be retrieved from the database. Running

the application server logic via 64-bit OpenEdge will provide a slight performance increase in two ways. One,

modern Windows and AIX servers are 64-bit – running 64-bit software on 64-bit servers gains a slight

improvement in performance. Two, if the Application Server and Database server are both running on the same

Windows or AIX server, the time needed to move data between the two components is reduced, thus leading to

faster performance for users.

A couple notes

• The UI side of TIME still needs to run using the 32-bit version of OpenEdge. In order to take advantage

of the 64-bit capabilities of OpenEdge at the Application Server level, no changes to TIME were needed.

In order to take advantage of the 64-bit OpenEdge for the UI, we will need to make substantial changes

to TIME. As TIME is not doing a notable amount of logic at the UI level that can take advantage of 64-bit

processing, we have chosen to defer upgrading the UI to 64-bit to sometime in the future.

• In general, the main gain for going to 64-bit is at the database level. The Application Server layer does

not get a notable increase in performance by itself by using the 64-bit version of OpenEdge. The clients

who will get the best “bang-for-the-buck” are those that are not already running a standalone 64-bit

Database Server but have (or wish to have) a separate DB/AppServer server.

For more information on getting an assessment from Infian on whether or not upgrading the Database Server

and/or Application Server to 64-bit, please contact your Regional Account Executive (No docuemtation

required)



Enhancements - Interfaces

HL7 2.5.1 Inbound (to TIME) and Outbound (from TIME) ADT In this service pack we have created new versions of the inbound and outbound ADT interfaces to support HL7

2.5.1. This is not an update to the existing interface – instead it is a brand new interface. For existing clients,

your current ADT interface (based upon HL7 2.1 and 2.3) will continue to run as is. You would need to upgrade

to the 2.5.1 version of the interfaces only if required by the institution / vendor on the other side of your ADT.

This version of the interface will primarily be used for new TIME clients and new installations of the ADT

interface if the other institution / vendor supports HL7 2.5.1 (No docuemtation required – may need to update

the interface preferences document)

Another use case for the HL7 2.5.1 ADT interfaces is if you have two TIME environments where you wish to

register patients in one of the environments and have those patients automatically move to the other

environment. With the new HL7 2.5.1 ADT interfaces, we have built them to transfer all TIME registration

information between the two environments.

Custom

WO 3052 USRC Performance Tracking Purge

This project provides an automated ability to purge historical performance tracking information on a nightly

basis. It has an Infian-controlled configuration option to indicate the number of days of performance

information to retain.

Details

• The purge program will be run by the daily standalone process which runs every midnight

• Purge program will physically delete the performance tracking UI event records older than the Infian

configured purge days

• The purge process is disabled by default and the clients will need to contact Infian to enable the purge

process.

Limitation:

• Number of purge days is configurable by Infian only

• Interface can only be enabled / disabled by Infian personnel.

(No docuemtation required)

Custom – General The following modules were modified either as a result of a custom work order or due to a technology change.

The changes should have no impact to your utilization of TIME. (No docuemtation required)

• Progress OpenEdge 11.4 Upgrade

o The following modules needed slight technology changes in order to display correctly in

OpenEdge 11.4. No change to end-user functionality was made. Please perform some basic

tests in your environment to confirm these modules continue to work as expected



� Patient List Maintenance

� Encounter eSuperBill

� Notifications

� Physician Rounding App

� Home Dialysis Service Charting

� Web Resources

� Infection Control

� Security Settings

� Ticklers

� Progress Notes – Co-Morbidity Entry

� Assessment / Care Plan Alert Setup

� Flowsheet Alert setup

� Hepatitis B Alert setup

� Lab Panel Codes

� Medicare Eligibility Codes

� SQL Views: Policy_View & Curr_Ins_View

• HL7 2.5.1 Inbound (to TIME) Lab Results

o Added additional debug messages to help Infian Support work on support requests. No change

to HL7 Message processing functionality was made. Please perform some basic tests in your

environment to confirm results continue to be received as expected

o NOTE: This is the newer version of the interface. Most clients are running the HL7 2.1/2.3

version of the interface which was not changed as part of this project

• Inbound (to TIME) ADT

o As part of the new HL7 2.51 ADT (inbound and outbound from TIME), existing logic was changed

to allow for the initial claim # of the patient to start at a value other than 1. TIME will continue

to default to “1” as the starting claim number, so existing Inbound (to TIME) ADT interfaces

should not be affected. Review claim numbers associated with patients newly created by the

ADT to confirm.

Common

Patient Info Selections

Problem

In SP22, the Lab Panel – Pat Info Additional Code table was modified so that users could modify the Status field

to indicate whether the Patient Information Code should be sent in the OBX (status A) or the OBR (status B)

segment of the electronic file. The project did not, however, modify the Patient Info Selection application to

include the same functionality. This functionality was needed in the Patient Selection application as well. This

included system codes. The status of system codes should be available to be modified.



Resolution

The Patient Info Selection application has been modified so users can update the Status field of patient

information selection codes, including system codes. The description and status may be changed on user-

entered codes. The Status field is the only field that may be edited when a system code is selected.

(docuemtation required)

Test Plan

1. Launch the Patient Info Selections application (Main Menu=>Code Tables=>Transaction Codes=> Patient

Info Selections).

2. Select a user-entered code and select the Edit button.

3. Verify that both the description and the status may be changed. Save the change. Verify that the

changes are saved.

4. Select a system code. Verify that only the Status field is available and that it may be edited. Save the

change. Verify that the change is saved.

Clinical

Access Maintenance Module

Problem

When the TIME environmental is set to only require a general body location on the Access Maintenance module,

the Access Maintenance module is still validating for a specific vein side. This prevents be able to save an

updated or new access.

Resolution

Revised the Access Maintenance module to not validate for a specific vein side when the screen only requires a

general body location to be entered.

Test Plan

1. If not already set, contact INFIAN support to set the access module to only require "general body

location".

2. Select a hemodialysis patient.

3. Either add a new access or edit a current access. Fill in all the require fields and press save.



4. You should be able to save the change and the screen not display the error of "Vein side N/A is not

valid selection for Hemo".

Assessment/Care Plan Alerts and Notifications

Problem

The Action button in the Notification screen was not prompting users to update an existing, incomplete

assessment care plan progress note when the associated progress note template had been modified after the

assessment care plan progress note was created.

Resolution

Users are now able to update an incomplete assessment care plan progress note when an alert is generated and

the Action button is selected even when the associated progress note template has been modified.

(No docuemtation required – fix )

Test Plan

NOTE: The assessment care plan template needs to be updated as part of this testing. Making changes to an

existing care plan template will prevent you from creating a new assessment care plan progress note by

copying it from an existing assessment care plan document. To avoid this, it is strongly recommended that a

“test” assessment care plan template be used for this testing.

1. Launch the Assessment/Care Plan Alerts application (Main Menu=>Medical Records=>Clinical Utilities=>

Assessment/Care Plan Alerts). Select the Enable Test Mode and Run In Report Only Mode checkboxes

and run the process to identify a patient for whom the system will generate an assessment/care plan

alert.

2. Launch the Assessment/Care Plan Alerts maintenance screen (Main Menu=>Code Tables=>Medical

Records Codes=>Alert Codes=> Assessment / Care Plan Alert) to change the assessment/care plan

template configured to generate an alert to the test template. Save the change.

3. Launch the Progress Notes application (Main Menu=>Medical Records=>Patient Charts=> Progress

Notes). Create a progress note for the patient identified in Step 1 using the template entered in Step 2.

Save the progress note, but leave it with an “incomplete” status.

4. Run the Assessment/Care Plan Alerts process again (Main Menu=>Medical Records=>Clinical Utilities=>

Assessment/Care Plan Alerts) and generate alerts for the test patient.

5. Launch the Notifications application (Main Menu=>Medical Records=> Notifications). Search for the

Assessment/Care Plan Alert generated in Step 4.

6. Select the Action button. Verify that the system displays a message about the incomplete Assessment

Care Plan document and that it provides an option to update/copy from the existing notes.

7. Launch the Progress Note Templates application (Main Menu=>Code Tables=>Medical Records

Codes=>Progress Note Templates). Make a change to the template used to create the assessment care

plan document.

8. Click the action button again in the Notifications screen. Verify that the system displays a message

about the incomplete assessment care plan document and that it provides an option to update the

incomplete assessment care plan document. Verify that the copy option is no available because the

template has been modified.



Problem

The Assessment/Care Plan Alert does not include the option to postpone the alert; however, users were

permitted to opt to postpone the assessment/care plan alert. When users changed the alert date by opting to

postpone the alert, it was creating issues in the Assessment/Care Plan Alert process.

Resolution

The Postpone button has been disabled when an Assessment/Care Plan Alert is generated. This change was

applied to any alert that does not include the configuration option to allow an alert to be postponed. (No

docuemtation required- fix )

Test Plan

1. Launch the Notifications application (Main Menu=>Medical Records=> Notifications).

2. Search for the Assessment/Care Plan alerts using the Group filter field.

3. Select an Assessment/Care Plan alert from the browser and verify that the Postpone button is disabled.

Problem

The default setting for the ‘Date From’ filter field of the Notifications application defaults to display alerts

generated one day prior to TODAY. This was not taking into account users who logged in on Friday, and then did

not log in again until Monday. Critical lab alerts could be missed if the user did not remember to set the date

back to Friday.

Resolution

The default date displayed in the ‘Date From’ filter field was changed to three days prior to TODAY.

(docuemtation required)

Test Plan

1. Launch the Notifications application (Main Menu=>Medical Records=> Notifications).

2. Verify that the date displayed in the Date from filter field is three days prior to TODAY.

3. Change the Date From value and select the Reset button to verify that the Date From field is refreshed

back to three days prior to TODAY.

Clinical Registration

Problem

When the Print button was selected on the Clinical Registration screen, a Patient Inquiry report was generated.

The Transplant Status field of the report was not displaying the description of the patient’s transplant status.

Instead, it was displaying the transplant status code. The transplant status needed to be changed to display the

description instead.



Resolution

The Patient Inquire report generated when the Print button is selected on the Clinical Registration screen has

been modified so that the transplant status description is displayed in the Transplant Status field of the report.

The code is no longer displayed. (No docuemtation required)

Test Plan

1. Launch the Clinical Registration application (Main Menu=>Medical Records=>Clinical Operation Mgmt=>

Clinical Registration).

2. Select a test patient for whom a transplant status has been defined.

3. Select the Print button.

4. Generate the Patient Inquiry report. Verify that the transplant description is displayed on the report.

Crystal Reports – Admin Svc View

Problem

The Crystal view, ADMIN SVC VIEW, was not excluding logically deleted service remarks.

Resolution

The ADMIN SVC VIEW has been modified so that it excludes logically deleted service remarks. (No docuemtation

required – fix)

Test Plan

1. Launch the Hemodialysis Flowsheets application (Main Menu=>Medical Records=>Flowsheets=>

Hemodialysis Flowsheet).

2. Select a test patient with an incomplete flowsheet ( or create a new one if necessary).

3. Select the Service Charting option. Select the Administration Remark button. Enter a service remark.

4. Exit the flowsheet and launch the Progress Notes application (Main Menu=>Medical Records=>Patient

Charts=> Progress Notes). Logically delete the service remark you created in Step 3 above.

5. Create a Crystal report or select an existing Crystal report that uses the ADMIN SVC VIEW to display

service remarks.

6. Verify that the logically deleted service remark is not displayed on the report.

Crystal Reports – Patient Status History Report

Problem

The Patient Status History Crystal Report was not pulling historical facility information when the Patient Status

History Report was generated. It was selecting patients based on their current facility. When a patient had

expired or transferred out and was no longer assigned to a facility, the patient did not display on the report for

any facility regardless of the dates for which the report was generated.



Resolution

The Patient Status History Crystal Report has been modified so that if a patient is no longer associated with a

facility at the time the report is generated, his or her status history will be displayed under the facility heading of

‘Not Currently Associated with a Facility’. (No docuemtation required – fix)

Test Plan

1. Select a test patient. If the patient is currently active, launch the Clinical Registration application (Main

Menu=>Medical Records=>Clinical Operation Mgmt=> Clinical Registration), select the Current Status

tab and change the patient’s status to an inactive status with an effective date prior to today.

2. Launch the medical records Crystal Report application (Main Menu=>Medical Records=>Clinical

Reports=> Crystal Reports). Select the Patient Status History report.

3. Generate the report for all facilities with a last month and year to report prior to the current month.

4. Verify that your test patient is displayed under the ‘Not Currently Associated With a Facility’ heading.

Crystal Reports – Treatment Counts Report

Problem

The Treatment Counts Report was not working properly when all facilities and all services were selected. It was

only working properly when specific facilities and services were selected.

Resolution

The Treatment Counts Crystal report was modified so that it worked properly when all facilities and all services

were selected as constraints. (No docuemtation required – fix)

Test Plan

1. Launch the Crystal Reports application (Main Menu=>Medical Records=>Clinical Reports=> Crystal

Reports).

2. Select the Treatment Counts report.

3. Generate the report, selecting all facilities and all services as the constraints.

4. Verify that the report generates correctly and that it includes all applicable data.

Family History

Problem

The wildcard was not operating properly when users tried to use a wild card when searching for an ICD-9 code

by description.



Resolution

The Health Conditions tab of the Family History application has been modified so that the wildcard operates

properly when searching for an ICD-9 code by description. (No docuemtation required – fix)

Test Plan

1. Launch the Family History application (Main Menu=> Medical Records=> Patient Charts=> Family

History).

2. Select a test patient. Click on the Health Conditions tab.

3. Select the Add button. Click on the Add Health Condition binoculars.

4. Enter a partial description using the ‘*’ wildcard and select the Search button.

5. Verify that the ‘*’ wildcard is recognized properly and that it yields the correct search results.

6. Repeat the test by changing the position of the wildcard. Verify that the results are correct.

Hemodialysis Flowsheet – Machine Check Screen

Problem

The Dialyzer field on the Hemodialysis Flowsheet Machine Check screen was only displaying the dialyzer code

and not its description if the Treatment Rx screen had not yet been signed. The description should always be

displayed.

Resolution

The Machine Check screen has been modified so that the dialyzer code and description are both always

displayed regardless of whether or not any other screens have been signed. (docuemtation required – screen

shot)

Test Plan

1. Launch Hemodialysis Flowsheet (Menu Path: Main Menu=>Medical Records=>Flowsheets=>

Hemodialysis Flowsheet). Select a flowsheet for which the Treatment Rx screen has not yet been

signed. Select another flowsheet whose Treatment Rx screen has been signed.

2. Review the Machine Check screen of both flowsheets. Verify that the dialyzer description is displayed on

the Machine Check screen regardless of whether or not the Treatment Rx screen is signed.

Hemodialysis Flowsheets Rpt

Problem



The Exp Weight Loss field of the Pre-Treatment Vitals hemodialysis flowsheet screen may be customized to use a

user-defined label. The Hemodialysis Flowsheets Rpt, however, did not display the customized label. It

continued to display Exp Weight Loss.

Resolution

The Hemodialysis Flowsheets Rpt was modified so that it displays, when applicable, the customized label for the

Exp Weight Loss field, displayed in the Pre-Treatment Vitals section of the report. (No docuemtation required –

fix)

Test Plan

1. Launch the Hemodialysis Flowsheets application (Main Menu=>Medical Records=>Flowsheets=>

Hemodialysis Flowsheet).

2. Select the Pre-Treatment Vitals option.

3. Select the Help menu from the top tool bar. Then select Support. Select Field Properties from the

Support menu.

4. Locate the Weight Loss field. Double click the field to launch the Field Property Maintenance screen for

this field.

5. Select the Edit button. Change the field label, and save the change.

6. Launch the Hemodialysis Flowsheets Rpt. (Main Menu=>Medical Records=>Treatment Reports=>

Hemodialysis Flowsheets Rpt.).

7. Generate the report and verify that the field label is displayed correctly in the Pre-Treatment Vitals

section of the report.

Home Dialysis Service Charting

Problem

When a service was charted as not done on the Service Charting application, it was still displayed as charted on

the Home Service Charting application.

Resolution

The Home Service Charting application has been modified so that when a service is marked as undone on the

Service Charting application, it is marked as ‘N’ for undone on the Home Service Charting application. (No

docuemtation required – fix)

Test Plan

1. Select a test PD patient.

2. Launch the Service Charting application (Main Menu=>Medical Records=>Patient Charts=> Service

Charting).

3. Select a test service and mark it as undone by entering an undone reason.

4. Save the entry.



5. Launch the Home Dialysis Service Charting application (Main Menu=>Medical Records=>Clinical

Operation Mgmt=> Home Dialysis Service Chart).

6. Verify that the test service is displayed as ‘N’, for undone.

Infection Control Report

Problem

The first constraint tab of this report has a field called "Report Format". When a user started this screen, this

field was blank. If the user didn’t set this field, the report defaulted to the summary format. The summary

format does not include the medications that are linked to the infections. This field works differently than

similar report format fields on other reports.

Resolution

The Infection Control Report has been modified so that the report format defaults to the detailed format. The

detailed format includes medications that have been linked to infections. (docuemtation required – possible

field definition)

Test Plan

1. Launch the Infection Control Report (Menu Path: Main Menu=>Medical Records=>Clinical Reports=>

Infection Control Report),

2. Verify that the report format field defaults to ‘Detailed’.

Medication Orders

Problem

When medications were transferred from DrFirst using the eRx process, they are displayed on the Reconciled

Meds tab of the Medication Orders application. When users selected the Reconciled Meds tab, and then

selected the Med Check button, the employee code of the user who reconciled the medications was displayed,

but his or her name was not displayed.

Resolution

The Med Check browser has been modified so that it displays the employee code from eRx even when it is

longer than the employee code allowed in the TIME system. If the user has been registered in both eRx and the

TIME system, the employee’s name is now displayed on the Med Check browser screen. (No docuemtation

required – fix)

Test Plan

1. Select a test patient who has external medications.



2. Click the Med Check button on the Medication Screen. (Path: Main Menu=>Medical Records=>Patient

Charts=> Medication Orders)

3. Review the records on the Med Check Screen. Verify that the Emp Code field displays the full user ID if

the medication is from eRx, and the Emp Name field displays the user name if the user has been

registered in both eRx and the TIME system.

Patient Inquiry

Problem

The suffix to patient names was not printing on the Patient Inquiry report, and needed to be included for proper

patient identification.

Resolution

The Patient Inquiry report has been modified so that, when applicable, the patient suffix is printed properly on

the report. (No docuemtation required – fix)

Test Plan

1. Launch the Patient Inquiry application (Main Menu=>Medical Records=>Patient Charts=>Inquiry=>

Patient Inquiry).

2. Select a patient whose suffix field is not blank.

3. Generate the report.

4. Verify that the suffix is printed correctly on the report.

Service Charting

Problem

When a patient received an extra treatment, the TIME system required a diagnosis code to justify that

treatment. Most of the time, this diagnosis was fluid overload or something similar. The problem was that the

heparin associated with the extra treatment was automatically charted with the extra treatment diagnosis

rather than ESRD. Insurance carriers were rejecting the heparin because of this diagnosis error.

Resolution

The Service Charting application was modified so that the heparin associated with an extra treatment is

automatically charted with ESRD as the diagnosis code.

(No docuemtation required – fix)

Test Plan



1. Launch the Hemodialysis Flowsheets application (Main Menu=>Medical Records=>Patient

Charts=>Flowsheets=> Hemodialysis Flowsheet).

2. Select a test patient and create a flowsheet for an extra treatment for the test patient.

3. Sign off the Treatment Rx step, and then select the Service Charting option.

4. Verify that the heparin associated with the treatment is automatically charted with ESRD as the

diagnosis code.

Financial

Additional Codes – Occurrence Codes

Problem

Some payers require that Occurrence Code 72 (Date of First Dialysis) be reported on claims. Prior to SP23, this

occurrence code was not available to be added to claims. These occurrence codes are controlled by INFIAN and

could not be added by TIME system users.

Resolution

Occurrence Code 72 has been added to the list of occurrence codes that may be added to an insurance claim.


Test Plan

1. Launch the Additional Codes application (Main Menu=>Code Tables=>Transaction Codes=> Additional

Codes).

a. Select code type 73.

b. Verify that occurrence code 72 has been added to the list of available occurrence codes.

2. Launch the Claim Data and Service Trx application (Main Menu=>Patient Accounting=> Claim Data and

Service Trx).

a. Select a test patient and test claim.

b. Select the UB tab.

c. Select the Edit button. Select the binoculars to the right of an occurrence code field. (NOTE:

This is not the same as the Occurrence Span fields).

d. Verify that you can select occurrence code 72 from the list of available occurrence codes.

e. Verify that you can save the entry.

f. Launch the On Demand Insurance application (Main Menu=>Patient Accounting=>Billing=> On

Demand Insurance).

g. Generate a claim for your test patient and test claim selected in Step a above. Verify that the

new occurrence code is displayed on the insurance form.



Crystal Reports – Payer Mix Census

Problem

The Total Count for the All Patient Facility displayed on the last page of the report did not match the total count

for each modality. This report was using the service code to determine the total count instead of the service

units. This resulted in a discrepancy in the total count.

Resolution

The Payer Mix Census Crystal report was modified so that the total count is calculated based on service units.


Test Plan

1. Launch Payer Mix Census Crystal Report (Main menu/Patient Accounting/Financial Reports/Crystal

Reports/Payer Mix Census).

2. Select the month, year and facility for which to run the report.

3. Verify that the total count displayed last page of the All Patient Facility heading matches the summary

count for each modality.

Deposit Summary report

Problem

In Service Pack 21 we enhanced the Deposit Summary report to exclude payments identified as Insurance

payment types. Multiple clients have requested we add insurance payment types back into the report.

Resolution

Restored the report logic back to where it was prior to SP 21. Insurance type payments will now display.

(Need to check documentation – I think a change will be needed)

Test Plan

1. Find a batch that has insurance type payments and post it(Path: Main Menu=>Patient Accounting=> Post

Transactions)

2. Verify insurance payments displayed on the Deposit Summary report.

Payment Transactions

Problem

The following issues were reported regarding the check number associated with a payment:



1. The check number was being stored correctly when the payment was entered via electronic remittance,

or when it was entered manually on the Payment Transactions application as long as it was applied to

the entire claim. When the payment was not applied to the whole claim, or when it was auto applied

manually (that is, not via Electronic Remittance), the check number was not stored.

2. The check number was being copied from prior payment transactions within the same session. The

check number should not be copied when the Batch # or Trx Date (that is, payment date) was changed.

3. When an un-posted payment was edited and its check number was changed, the modified check

number was not being stored.


Resolution

The following changes have been made to the Payment Transactions application:

1. The check number is stored regardless of method of entry, or whether it was applied to the entire claim.

2. The check number is not copied from one payment to the next when the Batch # or transaction date is

changed.

3. When the check number of an un-posted payment is edited, the change is stored.

Test Plan

1. Launch the Payment Transactions application (Main Menu=>Patient Accounting=> Payment

Transactions).

2. Select a test patient and test claim. Auto apply a payment. Save the payment. Verify that the check

number was stored.

3. Select another test claim. Manually apply a payment to some but not all of the services associated with

the test claim. Save the payment, and verify that the check number was stored.

4. Change the Batch # on the Payment Transactions screen. Verify that the check number, entered in Step

3 above, is not copied for this payment. Enter a payment and save the transaction.

5. Change the payment transaction date. Verify that the check number entered in Step 4 above is not

copied for this payment.

6. Select any of your test payments above. Select the Edit button, and change the check number of the

selected payment. Save the change. Verify that the revised check number is saved.

Reassign Diagnosis Codes

Problem

The Reassign Diagnosis Codes application included a mandatory diagnosis code filter. This filter should not have

been mandatory.

Resolution

The Reassign Diagnosis Codes application has been modified so that the diagnosis code filter is not mandatory.

It is now only mandatory that at least one filter is selected.




Test Plan

1. Launch the Reassign Diagnosis Codes application (Main Menu=>Code Tables=>External Codes=>ICD10=>

Reassign Diagnosis Codes).

2. Leave all filters blank and select the Search button. Verify that you receive an error message that at

least one filter must be selected.

3. Select a filter, leaving the diagnosis code filter blank, and select the Search button. Verify that you do

not receive an error message, and that the records are selected based on your selected filter.

Reimbursement Schedule

Problem

The following issues were reported regarding editing and adding a reimbursement schedule:

1. When a saved reimbursement schedule’s description was edited, an error message was displayed

indicating that an end date was required. An end date already existed for the reimbursement schedule

and therefore the error itself was an error.

2. When a new reimbursement schedule was added, the Copy From fields were not automatically

available.

Resolution

The Reimbursement Schedule application has been modified to include the following changes:

1. When the description of a saved reimbursement schedule is edited, no error messages are displayed

regarding a missing end date.

2. When a new reimbursement schedule is added, the Copy From fields are automatically available.


Test Plan

1. Launch the Reimbursement Schedule application (Main Menu=>Code Tables=>Insurance Codes=>

Reimbursement Schedule).

2. Select a saved reimbursement schedule that is marked as ‘Standard Schedule’ in the Schedule Type field.

Select Edit. Verify that you are able to edit the description and save the change without receiving an

error message.

3. Select a saved reimbursement schedule that is marked as ‘Standard Schedule’ in the Schedule Type field.

Select Edit. Verify that you are able to edit the description and save the change without receiving an

error message.

4. Select a saved reimbursement schedule that is marked as ‘Auto Calculated Schedule’ in the Schedule

Type field. Select Edit. Verify that you are able to edit the description and save the change without

receiving an error message.

5. Verify that you are able to create a new Standard Schedule and a new Auto Calculated Schedule

reimbursement schedule.

6. Verify that when a Standard Schedule type reimbursement schedule is created, if the Copy From logic

field is set to any value other than ‘None of the above’, that the Copy From Start Date field is required.

Verify that an error message is received if the Copy From Start Date field is blank. This field must be

completed before proceeding.



7. Verify that when an Auto Calculated Schedule reimbursement schedule is added the Copy From fields

are not displayed.

8. Verify that when the Add button is selected, the Schedule Type field defaults to Standard Schedule.

Send to Collections Utility

Problem

When the Send to Collections Utility was run and the collections batch was automatically created by the system,

it marked the batch as completed, but it set the edit list flag to N. Staff were required to update the edit list flag,

changing it to Y, before they could post the batch

Resolution

The Send To Collections Utility has been modified so that the system generated batch is marked as complete,

and the edit list flag is marked as ‘Y’. Users are no longer required to generate an edit list for this type of batch.


Test Plan

1. Launch the Send to Collections Utility application (Main Menu=> Patient Accounting=> Financial

Utilities=> Collections Utility=> Send to Collections Utility).

2. Run the utility. Verify that the batch is marked as completed and that the Edit List is marked as ‘Y’.

Users should never be required to generate an edit list for this type of batch.

Interfaces

Charge Extractor

Problem

The charge extractor has a lot of filters which prevents charges from transferring. The log file gives just the

generic message ''EXCLUDE: FILTERS NOT PASSED''. This does not help the users or Support in analyzing the

exact reason for not transferring the charges. It should log a detailed message.

Resolution

When filtering services, the charge extractor now logs more specific message instead of 'Exclude: Filters Not

Passed'..


Test Plan



1. If your charge extractor is not configured to filter services, this change should not cause any changes to

your environment. Please run some basic tests to ensure services continue to transfer as expected to

your billing system

2. If your charge extractor is configured to filter services

a. Select a database that is setup to use code matching for service codes in Chxpay Transfer

Settings (One of the filters example).

b. Select a patient and enter service codes for which no matching is available.

c. Run the charge extractor.

d. Verify that the charges were not transferred.

e. Verify that the log file gives more specific message about the missing the Recode value for

service.

Inbound (to TIME) ADT

Problem

Currently ADT assumes the facility type ''Dialysis'' when loading patient data to the database. It does not work

for the Physician database. The Inbound ADT needs a new configuration to decide on the facility type.

Resolution

Created a new configuration setup in HL7 inbound ADT. The ADT now decides the facility type based on the

configuration setup. The default is 'Dialysis'.

(No docuemtation required)

Test Plan

1. Contact Infian to set the configuration, if required.

2. Set the configuration to 'Physician'.

3. Repeat the testing and verify that the patients’ facility gets updated with physician type facility.

4. Set the configuration to 'Dialysis' or do not set the configuration.

5. Repeat the testing and verify that the patients’ facility gets updated with dialysis type facility.

Clinical Appendices

Appendix A – Dialysis Order Changes

Project Overview

The purpose of this project is to enhance the ability to more specifically order a dialysate or dialysates delivered

during a hemodialysis patient’s treatment. In order to meet this objective, the following changes have been

made to the TIME system (NOTE: These changes apply only to hemodialysis orders):

1. A new table, the Bath Type table, has been added to the Medical Records Codes menu. A Bath Type

code includes the following information:



a. Bath Type Code

b. Bath Type Description

c. Calculation Type (+, -, x, or / - that is, add, subtract, multiply or divide)

d. Calculation Number

2. A new field, the Total Delivered Buffer field, has been added to the hemodialysis dialysis order screen.

When a bath type, defined above, is ordered as a patient’s bath, the system will calculate this value

based on the following formula:

a. Base Bicarb (the new field introduced in SP22), Calculation Type, Calculation Number

b. For example, the Base Bicarb is entered as 25, the Calculation Type for the selected bath is +,

and the Calculation Number for the selected bath is 8, the system would calculate the Total

Delivered Buffer to be 33 (25+8=33).

3. An option has been added to allow users to hide or display this functionality.

4. The new dialysate information is available on the following applications:

a. The Treatment Rx and Connect screens of the Hemodialysis Flowsheet

b. Flowsheet History screen

c. The Hemo Orders screen part of the Physicians Rounding App

5. The new dialysate information is available on the hemodialysis dialysis orders and flowsheet history

Progress Note Template Data Elements.

6. The new dialysate information is displayed on the following clinical reports:

a. Hemodialysis Flowsheet

b. Physicians Rounding Report

c. Patient Review Report

d. Dialysis Orders Report

e. As You Like It Report

6. A new Infobutton has been added to the hemodialysis Dialysis Orders screen. When the Infobutton is

selected, you are taken to the Medline Plus website to provide additional clinical information.

7.

8. SQL Views have been created for the new bath type table. The dialysis order and hemodialysis

flowsheet SQL views have been modified accordingly with these new fields.

Project Enhancements

The new Bath Type Codes maintenance screen, displayed below, has been added to the TIME system.



This maintenance screen allows users to create bath type codes that include the following information:

1. Bath Type Code

2. Bath Type Description

3. Calculation type (+, -. X. /)

4. Calculation Number

Modified Applications

The following applications have been modified in SP23 in order to provide enhanced bath information both at

the time the dialysis order is created and at the time treatment is provided:

1. Dialysis Orders – The Dialysis Orders application, displayed below, has been modified for hemodialysis

orders.



NOTE: The Total Delivered Buffer field is a calculated value. It is the Base Bicarb entered on this

screen, and the Calculation Type and Calculation Number values entered on the Bath Type Codes

screen. For example, if the GRAN bath type was set up with ‘+’ as the Calculation Type and 4 as the

Calculation Number, the TIME system calculates 30+4=34 and inserts this value in the Total Delivered

Buffer field

2. Hemodialysis Flowsheet – Treatment Rx – The Treatment Rx screen of the Hemodialysis Flowsheet

application, displayed below, has been modified to include the new Bath fields:



The Bath fields may be edited on this screen.

3. Hemodialysis Flowsheet – Connect Screen – The Connect Screen of the Hemodialysis Flowsheet

application, displayed below, has been modified to include the new Bath fields:



The Bath fields are display only on this screen.

4. Physician Rounding App – Hemo Orders Screen Part – The Hemo Orders screen part of the Physician

Rounding App has been modified to display the new Bath information. The modified screen part is

displayed below:

The bath information for both Bath 1 and Bath 2 are displayed in the Hemo Orders screen part.

5. Progress Note Data Elements – Two changes have been made to the progress notes data elements

options:

a. The Flowsheet History data elements menu has been modified to add the Bath Type and Total

Delivered Buffer options. The revised menu is displayed below:



b. The Hemo Dialysis Orders data elements menu has been modified to add the Bath Type and

Total Delivered Buffer options. The revised menu is displayed below:



6. Flowsheet History – The Flowsheet History application, displayed below, has been modified to include

the enhanced Bath information:



7. Hemodialysis Flowsheet Report – The Hemodialysis Flowsheets Rpt, displayed below, has been

modified to include the new bath fields.

8. Physicians Rounding Report – The Physicians Rounding Report, displayed below, has been modified to

include the new bath fields.



9. Patient Review Report – The Patient Review Report, displayed below, has been modified to include the

new enhanced bath fields:

10. Dialysis Orders Report – The Dialysis Orders Report, displayed below, has been modified to include the

new bath fields:



The Hemo Dialysis Orders report displays all bath information entered for both Bath 1 and Bath 2.

11. As You Like It Report – The following new bath fields have been added as available selection and

display fields:

a. Bath1 Type

b. Bath 2 Type

c. Total Delivered Buffer Bath 1

d. Total Delivered Buffer Bath 2

12. SQL Views – A new SQL view has been created for the new Bath Type table. In addition, both the

dialysis order and hemodialysis flowsheet SQL views have been updated with the new fields.

Test Plan

1. Launch the Bath Type Codes maintenance screen (Main Menu=>Code Tables=>Medical Records Codes=>

Bath Type Codes).

2. Create new bath type codes. Record the Calculation Type and Calculation Number values entered for

the new codes. You will need this information for Step 4 below. the Save the codes and exit the

application.



3. Launch the Dialysis Orders application (Main Menu=>Medical Records=>Patient Charts=> Dialysis

Orders). Select a test patient. Create a new hemodialysis order for your test patient. Complete all of

the Bath 1 and Bath 2 fields.

4. Verify that the Total Delivered Buffer is calculated based on the Base Bicarb entered on the Dialysis

Orders screen and the calculation type and number entered on the Bath Type Codes screen. For

example:

a. Base Bicarb = 30

b. Calculation Type = +

c. Calculation Number = 4

d. You should see 34 in the Total Delivered Buffer field (30+4=34)

5. Contact INFIAN. Verify that INFIAN support staff are able to set background setting to enable or disable

the new bath type functionality.

6. Add a new flowsheet for your test patient selected in Step 3 above. Verify that the new bath fields are

displayed on the Treatment Rx and Connect Screens for both Bath 1 and Bath 2, and that the

information displayed is correct.

7. Verify that the new bath fields may be edited on the Treatment Rx screen.

8. Verify that the new bath fields are available on the following applications:

a. Flowsheet History Screen

b. Progress Note Template Data Elements:

i. Hemo Dialysis Orders

ii. Flowsheet History

c. The Hemo Orders screen part of the Physician Rounding App.

9. Verify that the new bath fields and their related information are displayed on the following reports:

a. Hemodialysis Flowsheets Rpt.

b. Physicians Rounding Report

c. Patient Review Report

d. Dialysis Orders Report

e. As You Like It Report

Appendix B – Progress Notes

Project Overview

The Progress Notes application has been overhauled to use newer technology so that progress notes may be

shared using many different user interfaces. Old progress notes may still be modified and copied, and existing

progress note templates have been converted to work with the new technology. In addition, a new application,

the Organize Progress Note Templates application, has been added to provide a more streamlined and efficient

means by which users may select a template. Stored progress note templates may now be marked as shared or

not shared with other users. If a template is shared, it may be further filtered by granting access by user,

security group or by facility. By targeting specifically with whom a template is to be shared, the overall list of

stored progress note templates for any given user is shortened and more easily managed.

The following changes have been made to the Progress Notes and Progress Note Templates applications:

1. The following changes have been made to the Progress Notes application:

a. The following changes have been made to the Edit menu of the Add/Edit Progress Notes screen:



i. The Undo and Redo menu options, selected from the Edit menu of the Add/Edit

Progress Notes screen, now support multiple undos and redos.

ii. The Delete option has been removed from the Edit menu of the Add/Edit Progress

Notes screen.

iii. The Search and Replace dialog boxes have been enhanced with additional options.

b. Users may now select page ranges when printing multi-page documents.

c. When the Text menu option is selected from the Insert menu, it can now load the latest version

of Microsoft Word documents (DOCX).

d. The following changes have been made to the Format menu of the Add/Edit Progress Notes

screen:

i. When the Character option is selected, the options displayed on the Font dialog box

have been re-arranged.

ii. The Display Only option has been renamed “Restrict Editing”. If the cursor is located

inside a restricted editing area when the Format menu is selected, the option changes to

Allow Editing so that the restriction may be removed.

iii. The Set Changeable option has been removed from the right-click menu. Restrict

Editing fields are now displayed with a gray background when they are clicked.

e. When entering a progress note, the Tab key now indents text or increases a bullet list item level.

Using the Shift key + Tab will do the opposite. The Tab key also moves the cursor from cell to

cell in a table.

f. You may now add a table within a cell of another table. This is useful for formatting a page with

side by side tables.

g. When applying a template to a progress note, the As of Date dialog box is only displayed if the

date of the progress note is different than the current date, and the session setting for the As of

Date has not been set yet.

2. The following changes have been made to the Progress Note Templates application:

a. A new Progress Note Templates security setting, the “Of Notes Saved Prior To” date field, has

been added. The Of Notes Saved Prior To setting is used in conjunction with the Prevent Copy

checkbox and is available only when the Prevent Copy checkbox is selected. If the Prevent Copy

checkbox is selected, and the Of Notes Saved Prior To date field is blank, no notes that include

the template can be copied. This mirrors the functionality that existed prior to SP23. If,

however, a date is entered in the Of Notes Saved Prior To field, then only progress notes

containing the template that were created prior to the given date are restricted and unavailable

to be copied. Progress Notes using the template that are created after the date entered in the

Of Notes Saved Prior To field may be copied.

b. It is now possible to add multiple templates to a Progress Note. Each template is appended to

the bottom of the existing text. The settings of the templates are combined in the following

manner:

i. Security: If any of the templates used is set to ‘Allow changes – all users and times’,

then the resulting progress note will follow this security setting. In addition, the ‘Allow

changes only by creator day of creation’ overrides the ‘Follow security of other notes’

setting.

ii. No Change Days: The lowest setting of the templates used in the progress note will be

used as the overriding setting.

iii. Template: The settings of all of the templates used in a given progress note are




iv. Elapsed days: The largest setting of all of the templates used in a given progress note is

used as the number of elapsed days.

v. Prevent Copy : If any of the templates added to the progress note is set to prevent

copying, then the resulting progress note is restricted as well.

vi. Prevent Copy of Notes Prior to Date: The latest date used for any of the templates used

to create the progress note is the date that is used for the overall progress note. A

blank date (prevent all) overrides all other dates.

c. The restriction on copying notes due to template changes has been relaxed. If a template has

been modified since a note has been created, then a warning is displayed but the user is allowed

to proceed with copying the note within the copy restrictions detailed above in the Prevent

Copy description (2.b.v.)

d. The CVX Category constraint has been added to the Immunization History grid.

e. The Med Orders History Grid has been enhanced by adding the Dose, Frequency and Route

columns. The doctor column was removed from the grid. In addition, the columns have been

rearranged to display in the following order: Medication, Place, Start Date, Stop date, Dose,

Frequency and Route.

f. The Treatment Observation Grid data element has been added. The grid is constrained by date-

driven constraints, and includes the following columns: TX date, time, BP, pulse, BFR, VP, AP,

TMP and UFR.

g. Many new Pt. Other Contact Info data element has been added so that additional patient

information that includes but is not limited to patient employer, financially responsible party,

clinical remarks, transportation, and primary physician may be added to a progress note

template.

h. A new option has been added to the File menu of the Progress Note Templates application. The

Organize Progress Note Templates option allows you to mark a template as shared with other

users or not shared. In addition, you may specify whether the template should be shared with

specific users, security groups or facilities. This new screen helps to reduce the number of

progress note templates that are displayed when a user searches for a template to apply to a

progress note, making it a more streamlined and efficient process.

3. When applying a progress note template to a progress note, the As of Date dialog box is only displayed if

the date of the progress note is different than the current date, and the session setting for the As of

Date has not been set yet.

4. The Maestro Template and the Progress Note editor now use the same type of active spell checking that

is used with most word processors.

Project Enhancements

The following enhancements have been added to the Progress Notes and Progress Note Templates applications:

1. Treatment Observation Grid – A new data element, the Treatment Observation Grid, has been added to

the Progress Note Templates application. When the Treatment Observation Grid data element is

selected, it is displayed in the template as it is displayed below:



Once selected, the properties browser below is displayed:

2. Organize Progress Note Templates - The new Organize Progress Note Templates option (Main

Menu=>Code Tables=>Medical Records Codes=> Progress Note Templates=> File=> Organize Progress

Note Templates) has been added to the TIME system. This new screen helps to reduce the number of

progress note templates that are displayed when a user searches for a template to apply to a progress

note, making it a more streamlined and efficient process. There are four tabs included on this new

screen: Progress Note Template, Share with Employees, Share with Security Groups, Share with

Facilities. These tabs may be used to define whether a template should be shared, and if so, which

users, security groups or facilities should be granted access to the template. The new Organize Progress

Note Templates screen is displayed below:



When the Share with Employees tab is selected, the screen below is displayed:



When the Share with Security Groups tab is selected, the screen below is displayed:



When the Share with Facilities tab is selected, the screen below is displayed:




The Progress Notes and Progress Note template applications have been modified as detailed in the Project

Overview section above. The following outlines screen changes that are included with the re-engineered

applications:

1. Add/Edit Progress Notes – The following changes have been made to the Edit menu of the Add/Edit

Progress Notes screen:

a. Search – The Search dialog box, displayed below, has been enhanced with additional options so

that it closely resembles the Search function of a word processor:



b. Replace – The Replace dialog box, displayed below, has been enhanced with additional options

so that it closely resembles the Search function of a word processor:

c. Print – The Print dialog box, displayed below, has been modified so that you may select a page

range when printing a multi-page progress note:



d. Font – When Character is selected from the Format menu, the Font dialog box, below, is

displayed. The options on this screen have been re-arranged:

e. Restrict Editing/Allow Editing – The Display Only option of the Format menu, available on the

Add//Edit Progress Notes screen, has been changed to Restrict Editing/Allow Editing. Text may

be protected by selecting the Restrict Editing option so that users may not edit the selected text.



Once protected, the text may be selected and made available for editing by selecting the Allow

Editing option. The modified option is displayed below:

2. Progress Note Templates – The following changes have been made to the Progress Note Templates

application:

a. A new security setting has been added to the Progress Note Templates to control the date prior

to which a template may not be copied. The Of Notes Saved Prior To setting is used in

conjunction with the Prevent Copy checkbox and is available only when the Prevent Copy

checkbox is selected. If the Prevent Copy checkbox is selected, and the Of Notes Saved Prior To

date field is blank, no notes that include the template can be copied. This mirrors the

functionality that existed prior to SP23. If, however, a date is entered in the Of Notes Saved

Prior To field, then only progress notes containing the template that were created prior to the

given date are restricted and unavailable to be copied. Progress Notes using the template that

are created after the date entered in the Of Notes Saved Prior To field may be copied. The

modified screen is displayed below:



b. A new field, CVX Category, has been added to the Immunization History Grid data element. The

modified properties dialog box is displayed below:



c. The Med Orders History Grid (Data Elements=> Med Orders=> Med Orders History Grid),

displayed below, has been enhanced to include Dose, Frequency and Route columns.

d. Many new Pt. Other Contact Info data element have been added to the Progress Note

Templates application. When the Pt. Other Contact Info option is selected from the Data

Elements menu, the following options are displayed:

Test Plan



1. Launch the Progress Notes application (Main Menu=>Medical Records=>Patient Charts=> Progress

Notes).

a. Select a test patient, and select the Add button to add a new progress note.

b. Select the Insert menu, then select Text.

c. Verify that you are able to insert a .docx Microsoft Word document.

d. Highlight a portion of the text. Select the Format menu. Verify that the Restrict Editing option is

available.

i. Select the Restrict Editing option. Save the progress note.

ii. Select the progress note created in Step 1.a. above. Click the text that was selected to

restrict editing. Verify that it is highlighted in gray. Verify that you are unable to edit

this text.

iii. Select the Format menu again. Verify that the Restrict Editing option has been changed

to Allow Editing.

iv. Verify that you are able to edit the text.

e. Make a few changes to the progress note.

i. Select the Undo option from the Edit menu. Verify that you are able to undo multiple

changes.

ii. Select the Redo option Verify that you are able to add multiple changes back into the

progress note.

iii. Verify that the Delete option has been removed from the Edit menu.

f. Select the Search option from the Edit menu. Verify that this dialog box contains additional

options and that they are functioning correctly.

g. Select the Replace option from the Edit menu. Verify that this dialog box contains additional

options and that they are functioning correctly.

h. Select the Character option from the Format menu. Verify that the options have been

rearranged and that they are functioning correctly.

i. Highlight a portion of text in the progress note, and right click to launch the right click menu.

Verify that the Set Changeable option has been removed from the right click menu.

j. Verify that the Tab key indents text as well as increases a bullet list item level. Verify that Shift +

Tab performs the opposite function.

k. Verify that you are able to add multiple templates in one progress note, and that one is

appended to the end of the other.

i. Verify that the security settings of the templates are combined in the following manner:

1. Security: If any of the templates used is set to ‘Allow changes – all users and

times’, then the resulting progress note will follow this security setting. In

addition, the ‘Allow changes only by creator day of creation’ overrides the

‘Follow security of other notes’ setting.

2. No Change Days: The lowest setting of the templates used in the progress note

will be used as the overriding setting.

3. Template: The settings of all of the templates used in a given progress note are


4. Elapsed days: The largest setting of all of the templates used in a given progress

note is used as the number of elapsed days.

5. Prevent Copy : If any of the templates added to the progress note is set to

prevent copying, then the resulting progress note is restricted as well.



6. Prevent Copy of Notes Prior to Date: The latest date used for any of the

templates used to create the progress note is the date that is used for the

overall progress note. A blank date (prevent all) overrides all other dates.

l. Verify that the As of Date dialog box is only displayed if the date of the progress note is different

than the current system date, and the session setting for the As of Date has not been set yet.

m. Insert a table in your progress note by selecting the Table menu. Select a cell of the table, and

select the Table menu again. Verify that you are able to insert a table within a cell of another

table.

n. Misspell a word. Verify that the progress notes editor marks the misspelled word with a red

underline.

2. Launch the Progress Note Templates application (Main Menu=>Code Tables=>Medical Records Codes=>

Progress Note Templates).

a. Verify that the Of Notes Saved Prior To date field has been added to the Security section of the

Progress Note Templates screen.

i. Verify that the Of Notes Saved Prior to field is available only when the Prevent Copy

checkbox is selected.

ii. Verify that when the Prevent Copy checkbox is selected, but the Of Notes Saved Prior To

field is blank, that no notes that contain the progress note template may be copied.

iii. Verify that when a date is entered in the Of Notes Saved Prior To field, that no notes

created prior to that date may be copied, but notes on or after that date may be copied.

b. Select the Data Elements menu. Select the Immunization History grid and verify that the CVX

Category field has been added to the properties dialog box.

c. Select the Med Orders History Grid (Data Elements=> Med Orders=> Med Orders History Grid)

and insert the grid in a progress note. Verify that the Dose, Frequency and Route columns have

been added.

d. Select the Data Elements menu. Verify that the Treatment Observation Grid has been added,

and that it includes the TX date, time, BP, pulse, BFR, VP, AP, TMP and UFR.

e. Verify that the Pt Other Contact Info data elements have been added to the Data Elements

menu.

f. Misspell a word. Verify that the Maestro editor marks the misspelled word with a red underline.

g. Create and save a new test template.

h. Select the Organize Progress Note Templates option from the File menu.

i. Select the Progress Note Template tab.

ii. Mark the template as not shared.

iii. Exit the TIME system and log in as another user.

iv. Verify that the template is not available to another user.

v. Log back into the TIME system as the user who created the test template.

vi. Select the Organize Progress Note Templates option from the File menu again. Repeat

the test by defining access by user, security group and facility, verifying that each filter

works properly to restrict or allow access to your test template.

Appendix C – Remove Reference to Method

Project Overview



As a result of changes in reimbursement for home dialysis services, organizations may no longer choose

between Method I and Method II billing as this distinction has now become obsolete. All home dialysis services

are billed as Method I claims. In response to these changes, references to Method I and Method II billing, and

the options to select these methods of billing, were removed from the TIME system. The historical information

is still available to be viewed, although it may not be edited. The method designation is not displayed on any

current or future records.


The following applications were modified to remove the reference to method:

1. Dialysis Orders - The Dialysis Orders application for both hemodialysis and peritoneal dialysis orders,

has been modified to remove the Method section from the Patient Info tab. Historical data is displayed

in a display only field for previous dialysis orders for which a method was selected. The modified

Dialysis Orders screens for each modality are displayed below:

a. CAPD/CCPD Orders with Historical Data

b. New CAPD/CCPD Orders – (Notice that there is no reference to method on the screen):



c) Hemodialysis Orders with Historical Method Information – (Notice that there is no reference to

method on the screen):



d) New Hemodialysis Orders



2. Dialysis Orders Reports – The Dialysis Orders Reports for CAPD or CCPD orders has been modified

so that historical information about a patient’s billing method is printed on the report when the

method is Method I or Method II. Nothing is printed when the method is blank.

Test Plan

1. Launch the Dialysis Orders application (Main Menu=>Medical Records=>Patient Charts=> Dialysis

Orders).

a. Select a test hemodialysis patient.

i. Create a new hemodialysis order.

ii. Select the Patient Info tab.

iii. Verify that the Method section is not displayed, and that the Diabetic and Home

Training checkboxes have been repositioned on the screen.

b. Select a test CAPD or CCPD test patient.

i. Create a new peritoneal dialysis order


iii. Verify that the Method section is not displayed.

c. Select test hemodialysis patient for whom Method I or Method II billing was designated in the

past.

i. Edit or view the order.


iii. Verify that the method type is displayed properly.

iv. Verify that the method information may not be edited.

d. Select a test hemodialysis patient with a previous order on which the method of billing was not

indicated.

i. Edit or view the order.


iii. Verify that no reference to Method is displayed on the screen.

2. Launch the Dialysis Orders Reports (Main Menu=>Medical Records=>Treatment Reports=> Dialysis

Orders Reports).

a. Select a new hemodialysis or peritoneal dialysis order created above.

i. Generate the report.

ii. Verify that there is no reference to Method in the Patient Information section of the

report.

b. Select an existing hemodialysis/peritoneal dialysis order for which there is no method selected.


ii. Verify that there is no reference to Method in the Patient Information section of the

report.

c. Select an existing CAPD or CCPD dialysis order for which a method was selected.


ii. Verify that the Method information is printed in the Patient Information section of the

report.

3. Launch the Progress Note Templates application (Main Menu=>Code Tables=>Medical Records Codes=>

Progress Note Templates)

a. Verify that the Method Type data element is still available on the Dialysis Orders menu. This

data element is available for historical purposes only.



Extended Care Team With Service Pack 23, you can now record and view information about other clinicians and family members who

are part of the patient’s overall care team (not just the team that treats the patient in your clinic). The following

changes have been made to support this

• Extended Care Team: This new screen allows you to document the extended care team for the patient.

It allows for you to document both personal team members (spouse, daughter, father, etc.) and clinical

team members (Cardiologist, Endocrinologist, etc.) For each team member you can provide address and

phone numbers, as well as an indication of whether or not the team member can make decisions on the

patient’s behalf or if they can receive patient health information.

• Clinical Registration: A new button, “Extended Care Team” has been added to the “Current Status” tab

of Clinical Registration. Pressing this button launches the new Extended Care Team screen

• Physician Rounding App: A new screen part has been added – Extended Care Team. If this list is part of

a view, the patient’s Extended Care Team will be displayed, with fields for Name, Role/Specialty, Phone,

and Address. Performing a right-click on the screen part will display a context menu allowing you to

Add, View, and/or Edit Extended Care Team members via the new Extended Care Team screen

• Progress Note Template: A new data element – Extended Care Team – is now available under the Data

Element -> Pt. Other Contact Info menu on the screen. This will display the Name, Role / Specialty,

Phone, and Address of the patient’s extended care team members.


Extended Care Team (new)



This new screen allows for a user to add, edit, and view the members of the extended care team for the patient.

For each extended care team member, the user can provide the following information

• Medical or Personal: If the care team member is a medical professional, then select “Medical”.

Otherwise use “Personal”

• Contact Name: The name of the care team member

• Care Team Role:

o If the team member is personal, then use the Care Team Role field to identify how the team

member is related to the patient. This field uses the Relation to Insured table (Main Menu ->

Code Tables -> Insurance Codes -> Relationship to Insured) to supply the list of valid values

o If the team member is medical, then use the Care Team Role field to identify the clinicians

classification using Taxonomy codes

• Address, Home Phone, Work Phone, Cell Phone: Populate as little or as many of these fields as is

appropriate for the team member

• Authorized to make decisions on the patient’s behalf: Check this if the care team member can make

medical decisions for the patient

o NOTE: As of SP 23, this field is information only. TIME does not use the value of this field for

processing

• Authorized to receive patient health information: Check if this team member can received health

information about the patient

o NOTE: If you have not purchased our Secure Mail solution (using the Direct protocol), this field

is for informational reasons only. TIME does not use the value of this field for any processing

o NOTE: If you have purchased our Secure Mail solution, this field is used when sending a Secure

Mail message to determine if the contact can received clinical information

• Authorization Start / End: These fields are used with the Secure Mail solution to determine if the

contact has authorization to receive clinical information

• Details: A place for miscellaneous comments Clinical Registration



Clinical Registration has been modified to allow for the new Extended Care Team screen to be launched from

the Current Status tab. The Extended Care Team button is only enabled if you are in View mode on the screen.

The button is disabled if you are adding or editing the registration information for the patient. Clicking on the

button displays the Extended Care Team screen.

Physician Rounding App

There are two changes to the Physician Rounding App to support Extended Care Team



The Configure View screen now has an option for adding the Extended Care Team screen part to a view. The

Extended Care Team screen part has no configuration options – it always shows all of the active extended care

team members.



Right-clicking on a row in the screen part displays a context menu with the following options:

• Add – launches the Extended Care Team screen in add mode

• View – launches the Extended Care Team screen to display the extended care team member

• Edit – launches the Extended Care Team screen with the extended care team member’s record in edit

mode

• Refresh – updates the screen part with the currently available list of team members

The screen part itself displays the:

• Name: Team Member name

• Role / Specialty: The descriptive version of the Relationship code (if Personal) or Taxonomy code (if

Medical)



• Phone: Will show all three phone numbers if available with a suffix of “(H)” for home, “(W)” for work,

and “(C)” for Cell

• Address: Shows the address information concatenated into a single cell

Progress Notes Templates / Progress Notes

A new data element has been added to the Progress Notes Templates allowing for the display of the patient’s

care team members in a Progress Note. This new Data Element is available under the Data Elements -> Pt.

Other Contact Info -> Extended Care Team menu option on the Template editor screen

When the Extended Care Team data element is dropped onto a template, it displays the same four columns as

the Physician Rounding App screen part – Name, Role / Specialty, Phone, Address. Also like the Physician

Rounding App screen part, there are no parameters for this Data Element.

TIME V7.2 Service Pack 23 - Medical Billing Services : … · Progress Notes ... Hemodialysis...

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