TrakCare Solution Guide

Section 1: TrakCare Care Settings

TrakCare’s unparalleled flexibility makes it the ideal choice across care settings. While TrakCare is well-proven in the demanding acute care environment, InterSystems has made use of the core functionality and expanded the product to serve the specific needs of multiple care settings.

TrakCare offers configurations and advanced functionality specific to care settings such as community care, emergency departments, and multi-disciplinary polyclinic practices (including general practitioners). TrakCare Foundation CIS and Foundation PAS modules are configured to the unique requirements of the care setting and are accompanied by a module providing additional functionality specific to the care setting. Whether implementing TrakCare within one care setting or across multiple care settings, the system provides a fully unified solution that readily connects to other systems.

TrakCare Care Settings

1.1 TrakCare Acute Care

TrakCare is proven in even the largest, most complex multi-campus acute care settings. TrakCare’s Foundation CIS, Foundation PAS, and Departmental and Add-On modules provide rich functionality across the acute care setting. The unified modules are built on the Electronic Patient Record. Refer to sections 2.2, 2.3, and 2.4 for more detailed information.

1.2 TrakCare Community Health Management

Clients treated in the community are entitled to the same professional quality of care they would receive if admitted to a hospital. The TrakCare Community Health Management configuration ensures this by providing mobile healthcare professionals with access to all information normally available to them from within their own offices. TrakCare’s small footprint, ease-of-use, and low maintenance make it an attractive choice for community facilities that often have minimal IT support.

A client’s medical history, alerts, referral information, and assessments may be viewed, appointments can be booked, and new care plans can be created from the client’s home instead of the hospital.

The Community Health Management configuration assists in the continuum of care by providing tools to coordinate and manage daily planning and activity for staff and resources. Administrative and clinical details for the client can be recorded.

The Community Health configuration includes a Community Health Management module that is built on the EPR and allows the capture, display, and analysis of client-centric information, facilitating better client care. It is fully unified with all TrakCare modules and supports all parties involved with managing and providing services to the client beyond the confines of inpatient care.

Community Health Management functions include:

• Registration allows users to create a new client record or search for an existing client previously registered in TrakCare.
• Client Alerts allow healthcare professionals to add newly identified alerts and allergies and view those previously recorded. The nature and severity of allergic reactions is provided, notifying the user of potential risk to the client. The severity of the reaction can be color-coded to provide a visual indication of allergic sensitivities.

The Client Alerts facility records details such as:

• Administrative alerts (e.g., financial risk)
• Medical alerts (e.g., diabetic or epileptic)
• Other alerts (e.g., “Beware: client has large dog.”)

User access to alert details can be restricted by security controls.

• Assessments utilize TrakCare’s Questionnaire (user-defined form) tool, allowing the healthcare professional to define the content of the assessment and create standard templates. Assessments can be measurement-based using an algorithm that calculates a score. Electronic sharing of assessment information is provided under security controls and a full history of all changes is maintained.
• Referral Management records episode and client demographic details critical to effective community health management. TrakCare supports the creation and management of client referrals (including electronic referrals from external sources) ensuring that all are fully documented and actioned.

Referral management includes:

• Registration of referrals
• Referral assessments
• Referral outcomes
• Referral (caseload) transfers

• Appointment Management allows healthcare professionals to schedule appointments for clients into clinics or at home. The system can be used to book multiple resources (e.g., staff or equipment) for a service. Appointment Management supports an unlimited number of departments or service locations.

Appointment Management includes the ability to:

• Book individual and multiple appointments
• Create group and family bookings
• Attach individual and multiple interventions to an appointment
• Record an arrival
• Schedule a follow-up visit
• Reschedule an appointment
• Change appointment details
• Cancel an appointment
• Print letters to the client or referrer

• Multi-Disciplinary Care Team (MDT) caters for clinics staffed by a multi-disciplinary care teams where clients may need to see more than one care provider during the course of the appointment. An MDT can be assigned to a whole clinic session or to individual appointments and the teams can be defined in advance or on the fly at the time of booking the appointment.
• Family/Carer Linking allows a client’s family members to be registered or added to the community database. This functionality assists with, among other things, managing communication and family group appointments.
• Group Bookings allows patients to be registered as part of a family or carer group, simplifying and streamlining administrative processes when appointments for a group of related, but not necessarily next of kin, clients is required.
• Healthcare Professionals Diary provides users with a list of client appointments for any given day. New and internal referrals can be managed from the personal diary. It provides a list of all clients assigned with open episodes and ensures that active clients are regularly reviewed.
• Client Diary provides a client-centric view of appointments and activities, allowing healthcare professionals to schedule activities from the client’s perspective.

Example: Client Diary

Example: Client Care Plan – Diabetic Assessment and Care

Example: Review of Orders Placed as a Result of Care Plan Selection

• Community Diary View Worklist helps care providers manage the daily workload in a location or clinic, by quickly enabling the scheduling of pending orders directly into an available appointment slot. A daily, weekly, or monthly diary view is available.
• Assessments are created and documented utilizing TrakCare Questionnaires. Healthcare professionals can define the content of the assessment and standard templates can be created. A full history is maintained of all changes made to an assessment and sharing of information is provided under security control.
• Care Planning supports the planning of care tailored to an individual. A care plan can be assigned to a client on the basis of an assessment. Interventions derived as a result of care planning are matched and scheduled into the clinician’s diary. Any appointment conflicts generated in this process are highlighted, and functionality to resolve these is provided. Standard Care Planning templates can be created.
• Brokered Care Plans (or Brokerage) provides the ability to use designated funds to purchase services or goods to attend to individual client needs. Typically a community agency will broker for the services on behalf of the client. The required services may be sourced from external suppliers and they may be combined with services available from the healthcare agency to allow the formation of an overall plan of services that will be delivered to the client. The brokered plan includes the service, service provider, schedule and duration, and charges in conjunction with the overall budget that has been allocated for that service. An example would be daily meal services, monthly lawn mowing, and twice-weekly home visits by a community nurse for a patient where the meal and lawn mowing service is sourced from external suppliers.
• Client Contacts Module supports the recording of all encounters by a client, whether formal or informal, with a community-based healthcare facility. Client contact details, clinical notes, and other specific information can be recorded. Contact entries can be anonymous if required. An icon displays when a client has made frequent contacts to help alert users that a client may be in need of further assistance.
• Client Record Tracking provides a facility for locating and managing client records, including medical records, dental charts, and psychiatric records, significantly reducing the time it takes to perform such clerical tasks. Any record that can be linked to the client can then be tracked. The system maintains a history of all movements for later analysis.
• Client Discharge produces a discharge summary when a client’s care is completed and the client is discharged.
• Inquiry Contact allows healthcare professionals to record, forward, and monitor the status of casual inquiries made by a client or other person. Details, including inquirer’s name and contact details and client related to the inquiry, can be recorded and forwarded to relevant clinicians for further action.
• Event Creation and Management allows users to create events and manage them from the healthcare professional’s diary. It can, for example, be used to manage healthcare promotion seminars, group meetings, and functions. Users invite individuals to participate in an event, and RSVPs can be tracked. Events can be created for clients or clinicians. The system can alert clinicians of upcoming events at which they are responsible for presenting to a group.
• Complaints and Plaudits allow the recording and reporting of feedback, both positive and negative, in a formal and structured manner. This can be utilized to review service agreements with contracted agencies.
• Notification to General Practitioners automatically notifies general practitioners of a client’s involvement with an agency, if desired. This notification can be faxed, emailed, or printed.
• Labels and Forms produce a variety of printed documentation, including client labels and registration forms.
• Mobile Devices (Point-of-Care Access) address the challenges of recording information at the point of care. It applies the latest technology to bring fast, affordable, accurate, and computerized charting to the client’s home or bedside. Mobile Devices eliminate the ‘record on paper and transcribe later’ process.

1.3 TrakCare Polyclinic

Whether a patient has a minor condition like a common cold or suffers from a chronic condition like diabetes, a polyclinic is a one-stop provider of healthcare services. A diverse range of healthcare providers and ancillary clinics is usually found within a polyclinic, with services provided by general practitioners, nurses, and allied healthcare practitioners such as physiotherapists and podiatrists. Unlike traditional outpatient clinics that are located with tertiary care facilities, polyclinics tend to be autonomous and provide a broad range of services. These services range from management of acute and chronic medical conditions to health education, childhood immunization, health screening, vaccinations, X-ray and laboratory services, and minor surgical procedures.

The TrakCare Polyclinic configuration facilitates efficient scheduling of healthcare professionals and clinic locations. The coordination and management of daily planning and activity can be based on a centralized or decentralized booking environment. TrakCare’s small footprint, ease-of-use, and low maintenance make it an attractive choice for polyclinic facilities that often have minimal IT support.

Polyclinic functionality is fully unified with all TrakCare modules. This unification means information related to pre-assessment, clinic attendances, emergency attendances, past admissions, and services provided as part of these events can be viewed in the patient’s EPR. For any clinic attendance, the patient’s demographic details are linked with his clinical and billing processes, which allows for the real-time clinical and financial management of patient cases.

Polyclinic functions are derived from the TrakCare Outpatient Management module and are enhanced by providing additional functionality specific to the care setting.

Polyclinic functions include:

• TrakCare Outpatient Management: Please refer to section 2.3.2 for details.
• Recall Management combines appointment scheduling and recall lists to facilitate the planning of patient care and assessments over a prolonged time frame, to manage things like childhood vaccinations, preventative care, and annual assessments. The user can define appointment schedules (including required orders) at regular or irregular intervals with the flexibility to either generate the next patient appointment or place the patient on the defined recall list. Appointments are made only when required and upon confirmation by the patient, thus minimizing the amount of ‘no shows’ for appointments and ensuring maximum utilization of clinic resources.
• Consultation delivers clinicians a highly flexible and comfortable means of recording the details, clinical notes, tasks or actions required to complete a patient consultation including diagnosis and planning. This can be done from a single screen while minimizing the amount of navigation required. Information captured during the consultation will contribute to the overall EPR as well as being stored against the individual consultation meaning that every time a care provider completes a consultation the care provider is also contributing to the building of the longitudinal EPR. TrakCare Clinical Consultation functionality provides clinicians with the ability to:

• Review previous consultations
• Edit a previous consultation
• Create a new consultation manually or from an appointment
• Amend, add, or remove text from a consultation
• Review a patient’s EPR during a consultation

During a consultation, a care provider can complete the following:

• Add consultation notes as free text in a SOAP structured format (subjective, objective, assessment, planning) including use of canned text library or pre-configured text templates
• Add Actions to the consultation, where an action represents steps or tasks the care provider may typically choose as part of patient management (e.g., perform a physical examination, record allergies, complete an assessment questionnaire, write a prescription)
• View the consultation log.

• Clinician Priority Workbench helps care providers manage workload from a single screen, by providing summary views of all pending commitments, outstanding tasks, and new and important information for patients directly under their care.

The workbench includes:

• A monthly calendar providing information about booked appointments
• A daily diary view providing lists of appointments, operating theater sessions, events to attend, task lists, and multi-disciplinary team bookings
• A Quick Links section informs the clinician, at a glance, about key data to attend to. For example, outstanding orders can be identified, unread results can be signed off, pending discharges can be completed, or lists of active patients can be reviewed.

• Walk-Ins allow care providers to manage patients who arrive in the polyclinic without an appointment.

It allows the user to:

• Triage the patient
• Attend the patient without the need to schedule an appointment if the patient does not need to proceed to a general practitioner or clinic
• Allocate the patient to a clinic appointment for that day or a future date
• Automatically allocate a patient to an appointment with a care provider/clinic that is available to see walk-in patients

• Patient Tracking and Queue Management provides receptionists and care providers with an overview of where polyclinic patients are located with respect to their visit.

They are able to determine whether:

• The patient has arrived and is in the waiting room
• The patient is with the care provider
• The patient has departed the polyclinic
• The patient is with another care provider
• The patient has a long wait in the queue

• Worklist displays the daily or weekly clinics and appointments for any polyclinic care provider. Many of the functions required for day-to-day management of clinics and appointments are available from the worklist, including updating an appointment status, changing the available appointment slots for a clinic session, or updating patient appointment and episode details. Users can also define their clinic preferences. Clinic preferences allow users to define a list of regularly accessed clinics that they need to manage.
• Family/Carer Linking allows a client’s family members to be registered or added to the polyclinic database. This functionality assists with, among other things, managing communication and family group appointments.
• Assessments utilize TrakCare’s Questionnaire (user-defined form) tool, allowing the healthcare professional to define the content of the assessment and create standard templates. Assessments can be measurement-based using an algorithm that calculates a score. Electronic sharing of assessment information is provided under security controls and a full history of all changes is maintained.
• Care Planning supports the planning of care tailored to an individual. A care plan can be assigned to a client on the basis of an assessment. Interventions derived as a result of care planning are matched and scheduled into the clinician’s diary. Any appointment conflicts generated in this process are highlighted, and functionality to resolve these is provided. Standard Care Planning templates can be created.

1.4 TrakCare Emergency

The TrakCare Emergency configuration facilitates the triaging and treatment of patients and is designed to perform the registration, movement, and capture of care interventions during emergency attendances. In the emergency environment, readily accessible information is critical, but it has to be clearly visible and uncluttered. More importantly, information must be dynamically updated as events occur, allowing clinicians to make fast and accurate assessments. TrakCare supports a busy environment with skillful use of color and icons to alert without distracting. All users have access to data in real time so that coordination and efficient management of patient progress, emergency rooms, resources, and staff is possible for both clinical and non-clinical teams.

The Emergency functionality is fully unified with all TrakCare modules so that information related to pre-assessments, clinic attendances, and past admissions is available for viewing in the patient’s EPR. The configuration includes an Emergency module with functionality specific to the care setting.

Emergency Management functions include:

• Registration allows the user to create a new patient record or search for an existing patient previously registered in TrakCare.
• Incident Management provides the Emergency department with the ability to prepare for and accept a pre-defined number of unidentified patients from major incidents, such as multiple motor vehicle accidents or natural disasters.
• Triage allows healthcare professionals to distinguish critically urgent patients from less urgent cases to ensure care is delivered in the most effective and efficient manner, and in accordance with authorized protocol. The Triage feature allows the user to enter a patient’s triage details, including the triage date, time, and category; this data will subsequently determine each emergency patient’s priority. A specific color is assigned to each patient based on the triage category.
• Next Most Urgent Patient Flag is an icon in the floor plan that indicates which patient is the next most urgent case to see. The calculation for the flag is based on triage category and waiting time for a patient who has not yet been seen by a care provider.
• Emergency Frequent Attendees ensures that patients with excessive emergency attendances are highlighted to Emergency Department staff as a potential person at risk. Frequent attendee alerts, a warning message and an icon, can be configured based on a range of conditions being met including patient age range, number of visits, and the timeframe for those visits. Multiple alerts may be configured to be active at the same time, allowing different types of risk to be identified and tracked. A frequent attendees inquiry function allows users to search for and identify frequent attendees and actions can be recorded against those identified to help manage the risk accordingly.
• Clinician is used to create a record of all healthcare professionals who actively participated in the delivery of care for a patient. A history of healthcare professional activity is maintained.
• Floor Plans graphically display waiting rooms, cubicles, and procedure rooms available within the Emergency department. At a glance, a user can see where patients are located, together with selected patient information. Moving a patient from one location (bed or cubicle) to another (including waiting areas) within the Emergency department is done using drag-and-drop functionality.
• Multiview is used to search for emergency admissions within a given date range for a location or location type.
• Move records a patient’s movement away from the Emergency department to a temporary location, such as the Radiology department. The use of color on Floor Plans and Worklists provides a visual cue that the patient is temporarily absent from the assigned bed or cubicle.
• Bed Requests is used if an emergency patient requires admission as an inpatient to a ward. The request is recorded and transmitted to the bed manager.

Allocation of a ward and bed by the bed manager will:

• Notify the Emergency department that it may prepare to discharge the patient.
• Alert the ward staff of a pending emergency patient transfer/admission.
• Retain available patient data to eliminate the need to re-key information.
• Make available to the inpatient care provider all orders and results created under the Emergency Department episode

• Chart Requests facilitate the requisition and tracking of patient hard-copy charts. These documents can include the patient’s medical records, dental charts, psychiatric records, and radiology films. Requests for records can be triggered automatically or manually.
• Operating Theater Request is used if an emergency patient requires a surgical procedure. The request is recorded into the TrakCare Operating Theater module directly from the Emergency department.

The EPR provides a visual display of all information that has been collected and may include orders and results from laboratory and radiology departments, medication prescriptions, or a discharge summary for a specific episode or linked episodes.

• Discharge allows discharge details to be recorded against a patient. Assigning a discharge date and time will automatically remove the patient from the Emergency Floor Plan and Patient List.
• Letters is a facility for the production of patient correspondence. The form of the letters is defined by the organization, although InterSystems can provide an initial set of templates. A history of correspondence is available, documenting creation date and time, and any reprints made. Documents that have been sent may be viewed.
• Document Scanning allows users to associate a scanned document with a patient record. For example, a picture of an injury sustained from an accident can be scanned and assigned to a specific emergency episode.
• Labels and Forms produce a variety of printed documentation, including patient labels and registration forms.
• Electronic Patient Record captures the continuum of clinical and administrative information about the patient. It contains patient demographics, medical history, previous admissions, previous surgeries, and obstetric history information. The medical history contains allergy, disease, family, and social history. The EPR provides a visual display of all information that has been collected and may include orders and results from laboratory and radiology departments, medication prescriptions, or a discharge summary for a specific episode or linked episodes. For details about the latter, refer to section 2.2 (TrakCare Foundation CIS).

 

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