Enterprise Guide for Optometrists

Transcript of Video:

This video we will be looking at Clinical Records, both sight test and contact lens, ordering trial contact lenses and GOS1s

To access clinical records click exams in the bottom bar.

This takes us to the exam summary screen; this is an overview of previous clinical records, we can see all previous clinical records and prescriptions, these can be opened to view via right clicking and pressing open exam.

Below is the actions bar that allows you to open new clinical records.

Before looking at the contents of a clinical record let us first discuss navigation of clinical records during an exam.

Here at i-clarity we have come up with what we believe to be the most seamless way of navigating through patients clinical records which we will discuss now however you may find a method that works better for your work flow.

First it is important to note that you can have two of any type of clinical records open at one time, this being 2 Sight test clinical records, 2 CL clinical records and 2 supplementary clinical records. So in theory you could have 6 clinical records for a patient open at any one time provided you have two of each type open.

First open the old clinical records you wish to view alongside your new clinical record. We do so by right clicking the record and pressing open exam.

Now within the clinical record you will see the “go” button in the bottom right hand corner, close and go buttons are throughout i-clarity modules and allow you to build in your own workflows as the go button will take you straight to another module of your choosing. For what we want we will select “create a new clinical record”

We now have the new clinical record that’s cascaded a top the previous clinical record and the exams summary screen. There a multiple different ways of viewing these two clinical records in conjunction with one another, which works best will depend on number of screens, screen size and user preference.

Option 1: Cascaded clinical records

As we have the records now we can take advantage of windows in built functionality to view the previous clinical records.

So we have our new clinical record that we are working on selected, to view our previous clinical record we need merely hover over the i-clarity icon in the windows taskbar at the bottom of our screen and then hover over the previous clinical record tab, this then presents us with the previous clinical record to easily view potential differences from the new clinical record to the last, simply by moving our cursor between the two windows. To return to the new clinical record, As we haven’t clicked on either of these new windows, we are merely hovering over it to preview, we can then simply move our cursor off of the window and back to i-clarity and it has now switched back to being the clinical record we were last editing, that being our new clinical record we are working on.

Should you need to copy any of the information on this old record, simply click the window in the taskbar, copy the information, then click the new record in the taskbar and paste into the desired location. However you do have the option to “copy from previous” for some information that we will be talking about in a moment.

Another way in which you can switch between these records, is using the go button in the bottom right, click this and the options at the top of this list allows us to quickly switch between the other records that are open.

Option 2: Tiled clinical records

The next option for viewing multiple clinical records is to tile them, depending on your monitor size will depend on how viable this option is.

To tile our clinical records we click on the button with four boxes at the top, this tells us “The records we currently have open” and then “how we can organise them” We have the option to tile the records vertically, like so. Or tile them horizontally, like so. What works and looks best will again depending on your screen size. If at any point you wish to go back to cascaded clinical records you can do so by pressing Cascade records and then opening them to your desired size.

Option 3: Across multiple Screens

Should you have the benefit of having two screens you can move either clinical record to your second screen and have both records visible. Simply click and drag the window to you second screen.

Now lets look at the layout of the clinical record itself.

All information that needs to be inputted is on one screen, meaning you don’t have to click over to different tabs, combining this with the ability to view multiple clinical records at the same time means its easy to compare information.

To the left we have boxes for data input, that may want to be inputted on initial contact before beginning the examination. Consisting of “Reason for visit”, “Patient notes”, “General Health”, “medication”, “family history” and “ocular history”.

Moving down You then have space to enter your unaided and presenting Vas and also a space to make a note about specs they may have presented to you.

Below this you have a list of previous sight test prescriptions, contact lens prescriptions and prescriptions from any specs that have been inputted. You can filter to see any of these categories specifically with the buttons on the right.

Below this you have the pressures input, this lists previous pressures and you can add new pressures with the plus button.

On the right hand side at the top you have your left and right notes for information pertaining to each eye and then clinical notes below this. We will discuss the ways in which this info can be filled in momentarily.

Moving down we have the objective, subjective and final rx. These can be filled in in a number of ways, first you can free type into the boxes, you also have the ability to right click and select the prescription should this be easier. When filling out the prism, again you can freetype, right click or double click to bring up a separate window to select the prism depending on the method you find most natural.

If you wish to copy any of the prescriptions in the previous prescriptions box to your objective or subjective, merely right click any of these and you can then  copy to the prescription box you want.

You can then also use the buttons at the right hand side these prescription boxes to copy the information down, from objective to subjective and then subjective to final rx. This final rx will be the one printed on the patients prescription and used in dispensing.

You then have a space for exam outcome notes and dispensing notes, these dispensing notes will be seen by the dispenser when opening the dispense module.

Now lets discuss entering information into these boxes, All information can be free typed into the boxes within the clinical record but there are two additional ways to enter text to provide a quicker seamless way of filling in the patients clinical record, should the user wish to use them.

The first is “Tag text”

You will have noticed text in some of the boxes within chevrons, this is known as “tag text”.

Tag Text, allows the user to click on the word and select a pre-defined answer, these answers can be tailored to the practice and the user individually.

There are two methods of inputting information via tag text, left click and right click. A left click gives a quick drop down list of the answers available and the user then selects an option which replaces the original tag text. This is a quick way of selecting an answer if you know that you’re only going to be needing one option from the list.

Should you need multiple, right click the tag text which pops up an additional window, select the answers you wish to replace the tag text and press “use answers”.  If you have an answer that isn’t in the list but would like it to appear in future, free type a new answer in the box and press “add this answer” this then uses that answer and is selectable in future when using this tag text.

Entering information in this way works well in scenarios that rely on a list of options and are short answers to questions posed to all patients, or information about all patients. For example right and left notes will likely not need more expanded upon other than the answers created in tag text.

Should you wish to add a generic tag text back into the box simply right click and you will be given the option to “add tag:” this tag is the generic one found when opening a new clinical record.

Should you wish to add a new template to fill information in against, you can select the button from the top of the box “select template” and a list of templates can be selected. Again these can be tailored to the individual or to the practice as a generic template. This option is available throughout the text boxes on the clinical record.

The second way of inputting information into these boxes is with predictive statements, predictive statements are used throughout i-clarity in any text box that is a “smart text box” these smart text boxes can be identified by the buttons at the top of the box which allow for additional features such as voice to text (which in of itself is another method of information input), inputting templates as previously discussed and translation. The main feature of these textboxes though is predictive statements, predictive statements can be added by highlighting a piece of text that is frequently used in a text box, for example within the exam outcomes box you may frequently write similar outcomes for patients such as “Eyes healthy, rx change, update specs” highlight this, right click the text and you will see the option “Add Selected Text to Predictive Statements”. Now when we begin typing in this box in future this predictive statement will pop up as an option. Predictive statements are individual to the user (meaning your statements will not appear for anyone else) and individual to the box they are left in. Meaning that this predictive statement we have assigned to exam outcome will not appear in any of the other boxes so as not to appear when they are not relevant so the user can have tailored databases within each smart text box. This exam outcomes box has an unlimited character limit so notes can be as extensive as you wish.

Should you wish to copy the right, left and clinical notes from a previous clinical record should there be one, you can click the “copy notes from previous clinical record” button which is in the smart text box of the right notes field. This then places the notes from the previous clinical record into your current exam.

You also have the ability to copy the right notes to the left notes with the arrow in the right smart text box

It is important to note the patients drop down menu is still accessible whilst in our clinical record, where we can add an action, print a prescription, view documents or access other modules.

If you’ve finished the clinical record and wish to remove tags that you may not have needed to fill in, you can press the “remove tags” button, this will remove all tags not used within the record, this is an important habit to get into as it keeps clinical records tidy and prevents these tags from being repeated when copying over notes from this clinical record in future exams.

Once you have finished your clinical record you can save and then close it, once closed it will prompt you to “confirm” the clinical record, this completes the exam.

Here we can state the type of examination and recommendation for reporting purposes,

The recall you wish to place the patient on, this then automatically adjusts the “next due date” however this date can be adjusted separately should you need a due date separate from when the patient is being recalled. Below you can select an early recall code that will be attached to the patients GOS1 form when we move over to it.

Here we can also assign which fees will be used as a result of this exam, whether that be an NHS GOS claim, a private exam fee, or a corporate fee. Simply click the fee you would like to add this places it in the bottom box which means it’ll be added to the patient sale, should it be a fee the patient needs to pay for it’ll show as an  outstanding balance, if it is a payment paid for by an organization on behalf of the patient such as the NHS or a corporate scheme it’ll be paid off and moved to a payment in “deferred payments”.

If you have added a fee in error click the fee in the bottom box to remove it before confirming the clinical record.

Then below this you have the option to go back to the clinical record, confirm details and load claims which we will be doing momentarily, confirm details and close, or Close and don’t confirm should you wish to come back and finish anything at a later date.

Lets now discuss completion of a GOS1 claim, if a GOS1 claim has been started prior to you beginning your clinical record, perhaps by the front of house team then you will have the option on confirming your clinical records to load the GOS1 claim, this takes you directly to that claim and associates the clinical record you have completed with the claim form you are about to sign and submit. We can see that as we have loaded the GOS form directly from the clinical record it has linked both the exam we have done, this then fills in the optom details and also links the claim with the relevant payment. Should going straight from the clinical record to the GOS 1 claim not work with your workflow you can link the exam and payment via the link buttons in the top right, to add your signature simply click “get the optom signature” from within the claim or within the signature bar at the bottom, this is a list of all signatures that need to be garnered before submission to PCSE online.

Should you also be a registered contractor for the practice you can sign the contractor signature. You can then save the claim with the actions bar at the bottom and also submit to PCSE online. Once submitted you can then check the status of the claim on PCSE via the “Get latest status” button.

Now lets look at a Contact Lens clinical record. Navigating back to our exams summary we can create a new Contact Lens clinical record via the relevant button in the actions bar. Again it is worth mentioning you can open a previous Contact lens record as well as the new or a sight test record open at the same time.

Similar to that of our sight test clinical record we have Visit Notes and Right and Left notes boxes which are both smart text boxes so information can be entered in the same way.

Below we have the previous prescriptions box that like the clinical record with a right click can be copied either in to the primary prescription or a new trial lens, if an over refraction is placed into the over refraction prescription box it can then be copied over incorporating this if you so wish. There is also a box in which you can place the subjective prescription.

Multiple Contact lenses and trials can be associated with a single Contact Lens clinical record.

Initially we can input the prescription for the primary contact lens, we begin by entering the Brand of Contact lens from your practices selected list, this will then place validation on the following parameters. Should you wish to ignore this validation you can deselect the “enforce validation” button. After entering the prescription you then have fields to enter left and right parameters and comments, these comments are seen by the front house team when dispensing contact lenses.

Moving down you then have a space to see previous K readings and pressures that you can toggle between with the icons and enter new with the plus button.

Next to this is your Clinical notes/exam outcome summary box, again this is a smart text box so data entry is up to the user how they would prefer.

To enter new trial lenses we can do this one of 3 ways.

The first is copying from the previous prescriptions box, right click and you can copy to create a new trial that either incorporates or negates the over-refraction. This copies the prescription and the contact lens brand should you be copying from a contact lens rx or if it is a spectacle exam or a spectacle history it copies just the prescription.

The second is copying from the primary prescription. Clicking “options” on the primary contact lens prescription you are giving a list of options one of these is “Duplicate this to a new CL prescription (Trial)” This duplicates your primary prescription to a trial lens keeping both the prescription and the brand that you can then adjust either depending on whether you are trialing the same brand but a different prescription or vice versa.

Finally the “Add additional CL RX’s” at the bottom of the screen will add in another CL prescription but the Brand and Rx will be blank for you to fill in.

To mark any of these trial contact lenses as an additional CL prescription simply untick the Trial check box.

Or to make these trial lenses now the primary prescription click “options” then “copy to primary prescription”

To navigate these prescriptions its best to think of each defined line as its own C/L prescription and then the information below is relevant to that C/L prescription. You can expand and shrink these to view information that is relevant to you at whatever time allowing you to potentially stack up multiple trial prescriptions within a single clinical record.

To order lenses, including trials we need to access the C/L dispensing module, from the patient record that can be accessed through the C/L dispensing button in the bottom bar. From within the CL clinical record it can either be accessed by clicking Logistics and then “CL Dispense” or “Go” and then “Close and Go to CL dispense”

This then opens up the CL dispensing module, from here you have your list of potentially dispensable lenses. Whether that be the primary CL prescription, any additional CL prescriptions or trial lenses which can be identified via the icon on the far left of the contact lens. You can dispense a right or left by clicking the R or L arrows or both via the tick.

This then places the chosen contact lenses to the bottom of the page from here you can adjust the pack size, the quantity, and the price. Note this price will change depending on the pack size and quantity but should you need to adjust the price further you can do so.

You can then select whether you are ordering the lenses or supplying from stock, clicking “order from supplier” will create a sale for the patient on the till and an order in the orders module, supplying from stock will merely create a sale on the till as no order needs to be processed.

Once you are happy with your selection we can then confirm and close or confirm and go to a specific module.

If an order has been created you can then navigate to the orders module on the patient record within the bottom bar, or via the Confirm and go button and go straight to the orders module.

In this screen all orders both our Contact lenses and specs will be displayed for the patient. We can see our dispensed pair of contact lenses and also that this patient has some specs the practice is waiting delivery of.

When you look at a patients orders you are looking at all “active” patient orders, this means anything that the practice should have for the patient, anything the patient has collected becomes a previous order which can be viewed by selecting the relevant tick box at the top.

These tick boxes help us narrow down what information we want to see if the patient has a lot of orders at one time. A job that is “to be ordered”, once it is marked as ordered it becomes to be delivered, one its has been marked as delivered and checked it then becomes to be collected and finally once it has been collected it becomes a previous order. The process between each of these stages is the same so as to aid a seamless orders process.

The different order stages are colour coded to help quick identification, to be ordered is blue, to be delivered is pink and to be collected is green. We will see these colours change as we move our contact lens order through the system.

With our order we are essentially moving it through the different stages on this screen from left to right as its status changes in practice.

To mark the lenses as ordered tick the right and left lens, doing this you will notice the buttons in the bottom bar change as we can action these selected products in different ways. To order we press “order selected” this brings up the order that you can then print out if wanted, then we can press “ordered”. Now when we navigate back to the orders summary these are now marked as “awaiting delivery” and fall under the category of “to be delivered”.

This process of picking the selection and then moving the contact lens on via the bottom bar is repeated for each stage of an orders journey throughout the practice.

This concludes our tour of optometrist guide for i-clarity. Thank you for listening.