Anyone Using Multiple Encounters per Visit?

Implementing
1

Hello there community members, the team at AMPATH, Kenya has decided to use multiple encounters per visit in a bid to streamline the PoC workflow where every point of care is an encounter, a collection of which forms a visit based on a visit date. This is a new venture for us and we would like to here from those who have already gone down this road.

Some of the question to help start the conversation are:-

  1. Did you convert all existing encounters and attach them to visits (i.e. creating new visits for existing encounters)
  2. What visit types do you have?
  3. What criteria are used to determine a visit if other than date?
  4. Are there any challenges related to reporting? Were there any major changes in your reporting tools.

Any general advice will be highly appreciated.

Thanks.

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@willa, @vsingh (Bahmni) and @mogoodrich ( PIH) are using the emrapi module to group encounters into visits prospectively and could help answer questions or find someone to answer any technical questions about grouping encounters into visits prospectively via REST.

Regarding retrospective grouping of encounters into visits…

I think Bahmni always used visits. I’m not sure if KenyaEMR (@wanyee) started with visits or converted to them. I’m certain that PIH had to make the transition to visits a few years back. @mogoodrich or someone else at PIH might be able to dig up some insitutional memory (notes from converting or people who had to do the work & might remember).

My attempt to answer your questions…

Did you convert all existing encounters and attach them to visits (i.e. creating new visits for existing encounters)?

I’d assume yes, since visits are the primary means for grouping data in 1.9+.

What visit types do you have?

These will be close to your form names and/or encounter types, since those were the only means to identify “visits” pre-1.9; however, with the ability to group data into meaningful visits, I would expect far few visit types (several forms may be used within a single visit type).

To get started, I would assume that you’ll want a visit type for each service (e.g., “HIV Visit”, “Oncology Visit”, “Neurology Visit”, etc.).

A single visit type can probably cover all inpatient visits (e.g., “Hospital Visit”), but it’s possible that an implementation may want to make exceptions for a few types of hospitalizations (e.g., “Emergency Department Observation” or “Surgery Visit”).

What criteria are used to determine a visit if other than date?

When performing retrospective grouping, encounter date is probably the most reasonable discriminator. If you create a list of visit types by service and define which encounter forms belong in which visit types, you may find that the encounter form and/or encounter type can be used as well (e.g., you may want to consider a patient with “HIV Return” and “Oncology Return” encounters on the same day to have two visits on the same day).

Are there any challenges related to reporting? Were there any major changes in your reporting tools.

I’d think @mseaton would have a good answer for this one.

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