Beta software review and feedback
Chris Dare
Thanks for your time and attention. We are currently making software customizations that will make Serenity useful for medical operations in primary care, emergency and in-patient operations.
Please share your thoughts on the app: https://staging.nyaho.provider.serenity.health/
Rejoice Hormeku
Feedback from Admission demo with Doctors, Finance and Support - 28th September
Doctor's Notes:
- Doctors should be able to cancel labs or medications
*Feedback: This is not within admission scope. We'd need to reflect on the best way to allow this action without impacting work in the labs or pharmacy
Notes from Ward Biller/Finance
- Biller should be able to remove labs
- Biller cannot request labs or delete prescriptions
- Biller computes the daily fees for GP doctors and nurses
- Biller can also select Specialist visits and compute the fees for them
- Tests on the ward like Sugar test should be included in the list of billable tests
Notes from Specialists
- Specialists are paid by encounters they engage in. In the HIS, they have to input this information themselves in order to raise the bills/fees
Notes from Support
- Include filtering patients based on the advance payments, 3 groups: those who have deposited above the limit, below the limit and zero deposit
- Users should be able to filter admitted patients based on the attending physician
Chris Dare
Feedback from patient history demo with doctors (Oct 4th):
- Assigned MO should be conspicuous
- Extremely important to search and filter by date, practitioner, specialty/ward
- Very necessary to view notes as a timeline. Should just scroll through very easily. less clicks
- Billing for specialist encounters: This may be best described as workday for medical encounters. Patients are billed daily for specialists they have encounters with. Charges for the same may differ because there can be a different charge for the first encounter/day vs subsequent days/encounters
- Ability to cancel diagnostic tests (available). Ability to ensure that the diagnostics team can process service requests without the intervention of cashiers
- Drug availability for prescriptions
- Important to assess product fit for ER
- Important to show notes from service and medication requests
- Medication charting: Ability to manage medication administration (status, track filling of prescriptions) as well as medication statements, and comments from these encounters
- Need filters for fluid intake/output: date and time
- There may be digital forms for urgent care that are yet to be scoped
Other comments:
Do we see the bed availability on the ward?
Also for OPD and ER to know where to admit to?
Speaking of beds and admissions, how do we manage patients who come for day surgical cases?
The entries of a day should follow chronologically so that it’s not difficult to follow
Chris Dare
Product team notes notes from Fri Sep 22 ward set up demo:
- Capacity of wards are elastic for emergency purposes and exceptions. We should review the relevance Review setting of maximum capacity let's have another look at the max capacity so it's not a blocker
- Review "Type of Ward" (Type of service) use cases and valueset
- New service section for hospitalization service: Surgical
- Perhaps we should consider the creation of wards (and other services) without prices. It makes it easier for administrators to set it up especially since many stakeholders are required to provide the necessary info
- New scope items: In addition to wards and procedures, there are also other subscriptions that need to be billed for. So we'll need to design and implement that as well. Will engage with finance team to find out more in next feedback session.
- Increase configurations for subscriptions. Current policy dictates that patients are billed at 12am UTC and from the start of the billing period. We should consider making these configurations editable to users.
Chris Dare
Oct 5th Feedback session with Elikem on Ward set up:
- Area of change: Important to have a SOP for naming/creating services wards to ensure that they are created with the right categories/specialties/valuesets etc. To be approved by medical director and implemented by the Tech admin
- Type of ward is the major category, speciality is the micro-category.
- Default billing frequency should be daily so the likelihood of error is 0
- Concerning dynamic pricing. Pricing tiers vs room fee. Pricing for wards based on rooms. There may be custom pricing based on patient groups (eg. local vs foreign).
Also, necessary to consider service exclusions for ward. E.g private rooms may be excluded. Patient groups determine discounts. Highest fee is the true fee. For e.g. Foreigners pay the full amount, locals get a discount. Credit payments also attract additional fees (premium for interest)
- Have sensible defaults for ward availability
- Room and bed creation should be embedded in ward set up
Chris Dare
Oct 5th Feedback session with Elikem on admissions:
- Important to check-in patients before they are admitted. This happens at reception and is done to verify the information required to provide care based on the patient's profile and payment method. Also used to allocate resources like beds to patient.
Use case: If a patient comes in for elective surgery, the journey would start from OPD consultation to anesthetic review from where they are booked for a surgery.
There are pre-requisite actions for admissions and this can include medications, deposits etc.
Admitting patients from a list of patients requesting admission reduces the likelihood of patient identification errors.
- Normally, a patient is admitted under a consultant. This could be the consultant linked to the ward or the on-call consultant. This is the practitioner who's ultimately accountable for the patient's care. Many doctors will be responsible for providing care but they make sure that those doctors have done the right things.
May need to implement a doctor's rotor to help create a dynamic valueset of assigned doctors for a patient's admission. Reference: Admissions SOP.
- Need to add a risk assessment form normally recorded by the nurse for pressure ulcer, DVT. Should flag when risk assessments not done or there are no admission notes within a given period of time. Need to display these on the patient admissions list
- ER use cases:
Note: Patients may be charged by hourly billing period. e.g every 6 hours
- Unidentified patient (John Doe) needs to be registered and admitted. Has a credit limit
- Patient requires extremely urgent care before documentation of actions taken on EMR. Treatment may occur before the patient is actually registered
- Normal: Patient arrives, is able to provide details and is registered before providing care
Chris Dare
Feedback from Samuel: Will the system alert you when the bed is occupied or it only shows available beds
Chris Dare
Feedback from Dr. Nathan and Samuel: Display of key critical demographics and biometrics of patients is important. (Payment Method, Age etc.)
Chris Dare
Feedback from Robert (on project): I requested for the detailed schedule so we can all follow through and plan adequately so nothing is left to chance. I have not seen the detailed schedule besides the Milestone list that was shared in the previous presentation. Would you please share if you have it
Chris Dare
Feedback from Samuel: Key thing to note is that we would like to know the count of the number of times a patient is admitted.
If you can get a report like that we will be fine
Chris Dare
Feedback from Dr. Nathan: Useful to view observation history (vitals) by time periods. E.g. last 48 hours etc
Chris Dare
Feedback from Dr. Nathan: Need a VTE score digitized
Chris Dare
Question from Samuel: Will the system alert you when the bed is occupied or it only shows available beds
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