We are beginning the process of transitioning to visits. I’m a bit confused though on how to configure visit attribute types. Specifically, can we specify a list of allowable values? For example say we create a visit type “Outpatient”. We then create a visit attribute type “HIV Return Visit” within which we want to only allow “Adult”, “Pediatric” and “pMTCT”. Is this possible?
May be you should copy implementers too.
The question doesn’t seem clear to me, where Adult, Pedriatic and pMTCT are what? Are they encounter types? Do you mind giving more details please?
In Mirebalais and the Reference Application, we didn’t use Visit Type in any meaningful way (we just had a “Facility Visit”) because in the real-life workflow, the front desk clerk that was creating a visit couldn’t possible know at the beginning what type of clinical visit it would be.
One thing to note is that in Mirebalais they specifically insisted that if a patient shows up at outpatient clinic, and is then admitted as an inpatient, they wanted this to count as one visit. If AMPATH prefers to think of this as being two visits, then you’d want to have “Inpatient” and “Outpatient” visit types.
At the end of my time at PIH I was working on a new version of the visit dashboard, whose workflow was that at some point a clinician (e.g. triage nurse or consulting doctor) will say what type of visit this is. We would then store this as a Visit Attribute (whose type is “Visit Template”). This would control the layout of the visit dashboard (e.g. a pediatric primary care visit includes an immunization history widget, but an adult primary care visit does not) and presumably also be used for analytics.
I don’t think this particular feature is in production yet, but someone from PIH could comment.
Here’s the definition of the VisitAttributeType:
Darius, this makes sense to me. My concern now is that if we choose a certain flow at this point with specific labels (e.g. outpatient vs outpatient hiv follow-up, etc.) we’ll get stuck with a certain way of analyzing the data later on.
I think I like the idea of just having inpatient, outpatient, laboratory, pharmacy for now and using attributes to provide further description (when those details are known).
We don’t have the requirement of making an outpatient that turns into an inpatient visit count as a single visit. At this point, the registration desk should know what type of visit it will be.
Eventually, we should add Care Setting to Visit and the Care Setting Type would distinguish between outpatient & inpatient visits. For AMPATH, I would make a single inpatient visit type (since there’s one hospital) and then a visit type for each specialty clinic, so providers (and researchers) could look at a list of visits and see something like:
- 2015-Aug-07: Medicine Clinic Visit
- Nurse Triage
- Medicine Return Encounter
- 2015-Jun-11: Ophthalmology Visit
- Ophthalmology Initial Evaluation
- 2015-Apr-15: General Surgery Visit
- Surgery Return Follow Up
- Physical Therapy Note
Where the top level represent visits and the second level are encounters.
Regarding Care Systems
Although Care Setting has only been introduced with orders thus far, the plan is Care Setting (which should be added to Visit) would specify which care system (e.g., Clinic, Hospital A, Hospital B, etc.) and Care Setting Type will discriminate the basic type of care setting e.g., (outpatient, inpatient, ED, nursing home, …). Most implementations will serve a single care system, so may only have need for one or a few Care Settings. Implementations that serve multiple hospitals will appreciate the flexibility.
From a clinical standpoint, a “Care Setting” can be thought of as defining the scope within which a single “chart” (or “patient record”) is typically shared. For the list of active inpatient orders for Hospital A, outpatient orders for Hospital A, and inpatient orders for Hospital B would be managed separately.
I have a use case that exactly matches @burke suggestion on having visit type for specialty clinics. Any updates on development of the same and/pointers for progress?