TrakCare Solution Guide

2.3 TrakCare Foundation PAS
(Patient Administration System)

TrakCare Foundation PAS automates the workflows associated with inpatient, outpatient, and emergency patient populations to ensure that the administrative needs of institutional and community-based healthcare organizations are met. Used extensively in countries where thousands of patients are managed and billed on a daily basis, Foundation PAS is built to cope equally well with large or small patient loads.

Foundation PAS includes inpatient and outpatient modules along with extensive capabilities for waiting list, recall, medical records management, and coding. Each module assists in meeting the unique requirements of registering and managing specific patient populations. Foundation PAS also includes functionality specific to the patient administration needs of maternity wards and operating theaters.

Administrative personnel are provided with the tools to capture data, and coordinate and manage patient encounters across the continuum of care in an intelligent, efficient, and automated way.

TrakCare Foundation PAS can be implemented as a stand-alone product integrated with existing systems or in parallel with one or more TrakCare modules. When installed with other TrakCare modules, Foundation PAS is fully unified. This unification means information related to pre-assessment, clinic attendances, emergency attendances, past admissions, and the services provided as part of these events is available for viewing in the patient’s EPR.

TrakCare Foundation PAS

Foundation PAS Functionality

All TrakCare patient administration functionality starts with the TrakCare Foundation PAS and includes:

• EPR and MPI (refer to sections 2.1.1 and 2.1.2, respectively, for details)
  
• Inpatient Management
  
• Outpatient Management
  
• Medical Records Management:
• Records Request and Tracking
  
• Coding and Grouping
  
• Waiting List and Recall Management

2.3.1 Inpatient Management

Envision a facility where a patient’s complete medical history is instantly available, up to date, and on-screen from the time a patient’s unique identifier is presented. How much easier would inpatient management become?

The TrakCare Inpatient Management (IPM) module is a comprehensive tool that functions in any environment, from a single organization to large and complex multi-site enterprises. It provides the functionality necessary to manage inpatient populations and events.

IPM, when installed with other TrakCare modules, is fully unified, so information related to pre-assessment, clinic attendances, emergency attendances, past admissions, and the services provided as part of these events is available for viewing in the patient’s EPR. Additionally, patient medical records can be automatically or manually requested and tracked in accordance with patient movements. Where applicable, the IPM module also provides an automatic billing process for patients who have received billable services.

IPM functions include:

• Registration allows the user to create a new patient record or search for an existing patient previously registered in TrakCare.
• Bookings/Pre-Admission allows the booking details of a patient previously registered in TrakCare to be entered directly or selected from a waiting list.
• Admission notes the method of admission (i.e., direct, from a waiting list, statistical, and transfer).
• Patient Inquiry
• Leave includes temporary and contract patient leave.
• Movement records patient movement throughout the healthcare organization.
• Condition includes patient condition, progress, and visitor status.
• Nursing Handover provides a flexible way of supporting the consistent and accurate sharing of important patient information between care providers during transition of care between shifts. The handover includes assigning care providers (nurse and/or doctor) and displaying pertinent information in patient-specific handover screens and multiple patient lists.
• Discharge
• Clinical and Discharge Summaries
• Letters include a history of correspondence.
• Ward Lists highlight current patients, pending admissions, patients in temporary locations, inliers, and outliers.
• Patient Labels/Registration Forms can be produced to suit a variety of printed documentation needs.
• Floor Plans provide a graphical representation of the layout of the ward, including a true view of the bed activity of the area. Inpatient activity is provided using colors and icons as descriptors of the current status.

Example: Floor Plan

• Bed Search
• Bed Request

• Bed Management provides bed managers with a complete view of all beds, their current status, and prospective activity to assist with planning (including current inpatients and those expected to arrive for admission). Ward lists, status, occupancy, floor plans, bed requests, bed searches, and reports provide the bed manager with a total view to plan and allocate beds.

Example: Bed Managers Start Page – Ward Summary List

The Bed Management module is a tool to help individual organizations optimize bed availability and resources at all times by providing a comprehensive and global view of bed status.

It addresses communication issues specific to bed management and bed allocation by providing online, real-time access to constantly changing indicators.

The Bed Management module manages:

• Available and unavailable beds
• Current bed occupancy
• Bed and patient bookings and waiting list entries
• Time of bed availability (projected and actual) and unavailability
• Location of available beds for emergency admissions, including specific services such as pediatrics, cardiology, and intensive care
• Proposed transfer of patients from one specialty to another
• The display of the bed status and other bed details on ward Floor Plans
• Transfer of patient from one bed to another using simple drag and drop
• Allocation of patient and bed status discharge times
• Closing and reopening cubicles, beds, rooms, or even wards
• Flagging/reserving a bed as pending for an individual patient
• Monitoring of patient movements to temporary locations (e.g., X-ray)
• Monitoring of patients on leave and their return date
• Inliers, outliers, and booked patient numbers for each ward

The system makes managing beds simple. Authorized staff can display all available, occupied, or booked beds for a single ward, single department (specialty), or the entire organization.

A ward list displays color-coded columns corresponding to various time frames to indicate estimated discharge dates. The number of patients per time frame appears in each column. Inliers, outliers, and booked patient numbers for each ward are also displayed.

From the Bed Management screen, staff can manage all functions, including opening and closing wards/rooms and beds, searching for available beds, and reviewing bookings and waiting list entries.

The Bed Management module also facilitates the movement of patients from the Emergency department to available beds in wards.

In the event of disaster management, the system will immediately identify bed vacancies in wards in relation to the Emergency department’s demand, allowing the department maximum access to beds.

This module can also act as a management tool in matching open and available beds to reflect nursing staff levels per ward.

• Icons
• Mental Health allows for the entry of patient details specific to and necessary for the completion of mental health data records.
• Mobile Devices (Point-of-Care Access) address the challenge of recording information at the point of care.
  

2.3.2 Outpatient Management

Imagine having to provide care for more than 1,000 patients per day in a single outpatient clinic. Or, imagine having to provide care in an environment in which 80% of patients present to the clinic without an appointment. Knowing that users face such extreme demands, TrakCare Outpatient Management (OPM) is designed to efficiently handle large patient loads while still providing flexible workflows.

OPM, like all other TrakCare modules, is built with the Electronic Patient Record (EPR) at its center, allowing the capture, display, and analysis of patient centric information to facilitate better patient care.

The OPM module can be used in any environment, from traditional outpatient units associated with public or private hospitals to very large, multi-site enterprises. OPM ensures efficient coordination, scheduling, and management of healthcare professionals and outpatient locations. Daily planning and activity is supported for centralized or decentralized booking environments.

TrakCare OPM, when installed with other TrakCare modules, is fully unified so information related to pre-assessment, clinic attendances, emergency attendances, past admissions, and the services provided as part of these events is available for viewing in the patient’s EPR. For any clinic attendance, patient demographics and admission, clinical, and billing processes are linked, facilitating real-time management of the patient’s care.

OPM functions include:

• Registration allows the user to create a new patient record or search for an existing patient previously registered in TrakCare. The registration workflow enables users to quickly create an episode on the fly if one does not already exist in the system..
• Referrals enable users to create and view referral details for the patient. Both eReferrals and paperbased referrals from external and internal sources are supported. A referral workbench is used to triage (e.g., accept/prioritize/reject) and process the requests into TrakCare where waiting list entries can be made or appointments booked. All patient appointments and services generated as a result of an accepted referral are intrinsically linked to it using a unique referral pathway identifier. Appointments can also be attached to inpatient and emergency episodes.
• Multi-Referral allows the user to search for outpatient episodes/referrals within a given date range, or by clinic, doctor, hospital, or admission status. Appointments can then easily be booked for those on the returned list.
• Preferences allow users to tailor the display of regularly accessed clinics.
• Worklist for outpatient management displays the daily or weekly clinics and appointments for any care provider using defined preferences. Many of the functions required for day-to-day management of clinics and appointments are available from the worklist, for example, updating an appointment status, changing the available appointment slots for a clinic session, or updating patient, appointment, and episode details. The worklist always displays the Next Available Time for each Location/ Resource so that booking clerks can immediately determine availability across any number of clinic sessions on a given day.

• Appointment Management facilitates the scheduling of patient appointments.

The user is able to:

• Book single, multiple, group, or follow-up appointments for a single patient
• Book group and family appointments for multiple patients
• View appointment details
• Record and update appointment status (e.g., arrived or failed to attend)
• Record and update appointment outcomes (e.g., rebooked or transferred to another hospital)
• Reschedule appointments
• Cancel appointments
• Notify relevant service providers of the need for transport or interpreter services
• Record the patient’s confirmation of attendance

• eBookings provides a facility where by TrakCare can expose designated appointment slots as available for direct booking by external or third party- based appointment booking systems.
• Over Bookings allow clinics to accommodate additional planned or unplanned attendances. Users can be assigned permission to overbook as required.
• Walk-In Worklist and Outpatient Attendee Workbench facilitate the management of outpatient walk-in patients, that is, patients with no appointment previously booked. An option to simply record the attendance or to perform an outpatient triage to assess the urgency and priority of the visit and the subsequent need to be seen by a care provider is provided. Both the Worklist and Workbench help speed the registration of large numbers of patients and ensure quick booking of outpatient appointments so large flows of patient traffic can
• Multi-Disciplinary Care Team (MDT) caters to clinics staffed by a multidisciplinary team where clients need to see more than one care provider during the course of the appointment (e.g., a doctor, nurse, and a dietician).
• Outpatient Whiteboard helps outpatient departments manage daily activities. A list displays all appointments for a day, at a specified location, and provides interactive tracking of each patient’s progress through appointments and related activities in other locations. For example, a visit to the outpatient clinic may include appointments with a consultant, a nurse for blood tests, and radiology for diagnostic procedures. The whiteboard allows clinic managers to quickly record information about the patient’s whereabouts, and interactive icons are used to track various aspects of the patient’s encounter, including arrival, ready to be seen, departure, or attending other appointments.
• Bulk Transfer allows the user to select a number of appointments for a schedule, and then cycle through these appointments by transferring them to another clinic or clinic session. Alternatively, a number of appointments for a given schedule may be selected and automatically transferred to the next available appointments in a single action.
• Schedule Management provides a framework for creating and managing clinic schedules. Schedule variables include length of appointment time slots, load levels, appointment overrides, not-available periods, services offered, and irregular sessions.
• Schedule Calendar displays a calendar view for a selected care provider/clinic showing the workload for a given month. The calendar may be configured to display summary information or details.
• Flexible Session Management enables outpatient clinic details, such as appointment slot availability, services offered, or load levels to be controlled at both a session and a day level, allowing maximum flexibility.
• Schedule Transfer and Copy allows “schedule templates” to be copied from one care provider or resource to another to reduce setup time. The schedule template and all future appointments attached to the schedule can easily be transferred from one care provider or resource to another.
Bulk Transfer allows the user to select a number of appointments for a given schedule, and then cycle through these appointments by transferring them to another clinic or clinic session.
• Variance records the reason for change against planned start and end times of a clinic.
• Clinical Summaries can be generated and automatically sent to nominated care providers.
• Medical Records Management allows medical records to be automatically requested in preparation for the patient’s attendance at a particular clinic.
• Letters produces patient correspondence directed toward the patient or general practitioner, including appointment letters, notification of rescheduled appointments, cancellation letters, and waiting list notification letters. A history of correspondence is available, documenting creation date and time, and any reprints made. Documents that have been sent may be viewed.
• Labels and Forms produce a variety of printed documentation, including patient labels and registration forms.

2.3.3 Medical Records Management

TrakCare Medical Records Management (MRM) includes the Requests and Tracking, and the Coding and Grouping modules to meet the particular requirements of managing medical records and allocating clinical classifications to episodes of care. The module functions across the full spectrum of healthcare environments, from single stand-alone facilities to multi-site enterprises.

When installed with other TrakCare modules, MRM is fully unified. This unification means information related to pre-assessment, clinic attendances, emergency attendances, past admissions, and the services provided as part of these events are available for viewing in the EPR to assist those involved with tracking medical records and clinical classifications.

MRM significantly reduces the time it takes to perform important clerical tasks. Each record is defined by both a document type and a volume number. There is no limit to the number of records that can be linked to a patient. Episodes can also be allocated to specific document types or volumes.

The system will track records both within the medical records department and at external locations. It maintains a history of all movements for later analysis.

Medical Records Requests and Tracking functions include:

• Medical Record Types allow different medical record types to be created, including main medical records, community health records, X-ray records, dental records, and microfilm records, to name a few.
• Batch Case Note Creation is a specific function for those facilities that are required to create new case note types and dispatch in one process.
• Outstanding Medical Record Requests display all outstanding medical record requests for an organization or multi-site campus. This function allows the medical record user to acknowledge receipt, move, and cancel medical record requests. Visual indicators such as color help prioritize the actioning of requests according to their level of importance.
• Bulk Request facilitates the request of any number of medical records and volumes in a single action. Bulk request details can be entered manually or with a scanning device.
• Automatic Record Request allows medical records to be auto-requested for inpatient, outpatient, and emergency patient attendances.
• Single Medical Record Tracking allows the user to create, update, and move medical records for a single patient. The ability to track records to temporary locations and make a record inactive is provided.
• Bulk Movement facilitates the movement of multiple medical records and volumes for many patients in a single action. Movement details can be entered manually or with a scanning device.
• Record Deficiency allows the patient paper medical record to be assembled and updated at discharge to address deficiency. The functionality includes a deficiency status history and the ability to identify overdue discharge records.
• Record Retention supports recording of medical record retention information to prevent culling or destruction including maintaining an earliest destruction date and the date when a record or volume is archived or destroyed.

The Coding System provides a facility for capturing the diagnosis and procedure codes assigned for each inpatient episode. The system can accommodate the range of versions of the WHO International Classification of Diseases and Procedures (ICD). With an interface to third-party grouping software, TrakCare can also record the Diagnosis Related Group (DRG) for that episode.

Coding System functions include:

• Coding
  
• Coding Search
  
• Auto-Coding
  
• Copy Coding
  
• Coding Edits
  
• Cancer Registration

Additional Features:

• Bar coding/Scanning is a tool for moving or requesting medical records within the system. It allows for timely processing of medical record requests and movements within a busy medical records department.
• Microfilm Entry (Single and Bulk) allows the organization to record the roll number and position of information pertaining to a patient’s microfilm entry. This can be recorded individually for a patient or in bulk.
• Batch Grouping can be performed to automatically assign a DRG to an episode or a number of episodes according to a defined date range.

Note: These options assume availability of third-party applications and/or hardware devices.

2.3.4 Waiting List and Recall Management

Among the biggest challenges for healthcare providers in many parts of the world is the task of managing the waiting list for pending inpatient admissions and/or outpatient appointments, identifying those requiring multiple follow-up or recall appointments at pre-defined intervals. Managing attendances for both inpatients and outpatients to maximize throughput and minimize cancellations is a further challenge. TrakCare Waiting List and Recall Management dynamically captures both administrative and some clinical data prior to the patient appointment, placing control of waiting and recall lists back into the hands of the care provider.

The term ‘waiting list’ is generally associated with public facilities for those patients requiring an inpatient surgical attendance or outpatient appointment, while ‘recall’ is associated with outpatient attendance (e.g., an annual screening event or general follow-up appointment that is booked more than six weeks in advance).

The Waiting List module is fully unified with both the TrakCare Inpatient and Outpatient modules.

Waiting List and Recall Management functions include:

• Registration allows the user to create a new patient record or search for an existing patient previously registered in TrakCare.
• Referral Management enables users to create and view referral details for the patient. Both eReferrals and paper-based referrals from external and internal sources are supported. A referral workbench is used to triage (e.g., accept/prioritize/reject) and process the requests into TrakCare where waiting list entries can be made or appointments booked. A patient’s waiting list, recall entry, and any appointments or services generated from the referral are linked to it using a unique referral pathway identifier.
• Bookings/Pre-Admission provides the ability to record a patient’s prospective admission details, including expected date of admission and admission location, while creating a direct link to the waiting list entry. This tool interacts with waiting list calculations and facilitates the speedy processing of the patient on the actual day of admission. Alternatively, a user with the appropriate authorization can cancel a pre-admission.
• Pre-Assessment Bookings provide the ability to make an appointment for a pre-surgical work-up or an assessment clinic visit prior to the inpatient admission. This booking is linked to the waiting list entry.
• Waiting List and Recall Management enables the user to:
• Place a patient on a single or multiple waiting lists
• Record the clinical priority of the request
• Make pre-assessment clinic appointments
• View appointment details
• Record and update waiting list status (i.e., initiated, booked, admitted, or cancelled)
• Record and update waiting list outcomes
• Transfer from one waiting list to another
• Link waiting lists
• Cancel waiting lists
• Record confirmation of attendance
• Waiting List Service Guarantees provides the ability to set defined target levels and monitor compliance. The service guarantees are based on the time elapsed between creating a waiting list entry and offering an appointment to the patient for the referred service. The configuration provided allows sites to determine if the action of patients such as non acceptance of a number of reasonable appointment offers, canceling of bookings, transferring or not attending accepted bookings should impact the calculated number of days waiting.
• Referral Time to Treatment Service Guarantees provides the ability to set defined target levels and monitor compliance. The service guarantees are based on the time elapsed between receiving the referral and commencement of appropriate treatment by the patient. The functionality includes the ability to determine if a waiting list entry is subject to the referral guarantees and, if so, to define a pathway (a series of stages) of activities and events that must occur before a patient’s treatment can commence (e.g., an outpatient appointment and a diagnostic procedure). Each stage of the pathway is proactively managed to identify compliance issues, correct them and ensure that the outcomes are recorded and reportable.

Note: This functionality specifically provides support for the Scottish 18 weeks referral to treatment standard.

• Inquiry allows the user to query a waiting list or recall list for any patient that meets specific criteria, such as total days waiting, priority, and waiting list status. The resultant list of matches allows the user to appropriately manage the entries. For example, bulk correspondence can be sent to all patients (and their general practitioners) to advise of a pending pre-admission.

• Transfers allow the user to transfer single or multiple waiting list entries to a different care provider, specialty, or organization.
• Suspend is used when a procedure or admission is postponed for a period of time for a medical or other reason. A suspension can be linked to waiting list calculation times.
• Remove/Reinstate allows users to remove or reinstate a waiting list depending on its status.
• Variance records details of any variance for a waiting list and reasons for the variance, including suspension, cancellation, reinstatement, transfer, or priority.
• Waiting List History provides a consolidated view of changes to the associated waiting list, including status, creation and deletion of reviews, transfers, cancellations, and completions.
• Days on List indicates how long a patient has been on a list waiting for a specific service. The “days on list” is a calculated value that can be customized to meet legal and site-specific requirements.
• 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.

 

TrakCare Solution Guide

Previous Page Section 2.2

Table of Contents

Next Page Section 2.4