visits in openmrs 1.9

Visits in 1.920-Jun-2012

djazayeri@pih.org

From the upcoming version of the OpenMRS Guide at http://booki.flossmanuals.net/openmrs-guide/_full/

A Visit in OpenMRS represents exactly what it sounds like: a time period when a patient is actively interacting with the healthcare system, typically at a location.

The metadata differentiating different types of visits is a Visit Type. Visit Types are displayed in the user interface, and can be searched against.

A visit contains Encounters, which store more granular data about treatments or services.

What are Visits?

Historical note: Encounters were supposed to be what Visits are, but we got them wrong…

Visit◦ Patient◦ Visit Type◦ Location (optional)◦ Start DateTime◦ End DateTime

i.e. a duration

◦ Contains Encounters

Encounter◦ Patient◦ Encounter Type◦ Location (optional)◦ DateTime

i.e. a single instant

◦ Providers◦ Contains Obs

Visits vs. Encounters

Think of an Encounter as a “data collection transaction” or a “clinical transaction”

A big improvement in our information model◦ Especially if you’re doing point-of-care work

If you already have workflows and forms built around encounters, shifting to visits may require significant work and reconfiguration.

Disabling visits lets you continue with the old model

Don’t want to migrate yet?

Visit Types

Assigning Encounters to Visits

Auto-closing Visits

Visit Attributes

Configuring Visits

To categorize Visits

Displayed in the UI

Make them granular enough for meaningful use: Outpatient Primary Care is better than just Outpatient

Just a Name and Description◦ In the future Visit Type may

drive which encounters are allowed/expected in a visit

Visit Types

Reporting and Reporting Compatibility don’t let you search on them◦ If you want this, create a ticket or vote for it!

HTML Form Entry and XForms don’t explicitly support visits◦ thus you need to configure automatic assignment

of encounters to visits

Many Modules do not support Visits (yet)

Choose one of the two “Assign …” options

As each encounter is created (assuming it doesn’t have a visit specified explicitly) it will be assigned to a visit with:◦ encounter location is visit.location or a sublocation◦ visit start <= encounter datetime <= visit end

“Create New” option also requires you to set “Encounter Type to Visit Type Mapping” GP

Assigning Encounters to Visits

This is all very new. Let us know how it works out. Tickets welcome!

HTML Form Entry works fine with Visits if you configure your forms right!

Bad:<encounterDate default=“today”/>

Good:<encounterDate default=“now”

showTime=“true”/>

A note about HTML Form Entry

The UI creates visits starting “now.”

An encounter at 00:00 today cannot be assigned to a visit started at 9:15.

???◦ I haven’t used XForms in OpenMRS 1.9.◦ I assume it works.◦ Can someone comment?

A note about XForms

Outpatient visits typically do not have an official check-out

Need to auto-close outpatient visits, or they will never get closed.

Inpatient visits typically have a real-life discharge workflow.

Ending Visits

If you’re building a custom UI, you probably want something like this:

Custom attributes, Recorded for each visit

Virtual “columns” in the visit table

Arbitrary use cases. I can’t think of any good examples. :-)

Visit Attribute Types

Data collected pre-1.9 doesn’t have visits We need to improve this UI a bit

◦ https://tickets.openmrs.org/browse/TRUNK-3299

Legacy Encounters w/o Visits

Start Visit defaults to “now”. Add Visit asks you to enter the date

Starting a New Visit

Billing code should be shown as required. We have some UI issues to work out.

Significant Bugs around AttributesAvoid these in production at the moment…

Encounters grouped by visit Active Visits highlighted

Visits on the Dashboard

Entering a form adds an encounter to the visit◦ With the correct setup

(note the ugly time widget)

Adding an Encounter to a Visit

Header shows encounters in active visit Visits tab shows encounters grouped by visit

Multiple Encounters in a Visit

Close a visit from the dashboard header◦ In 1.9.1 a popup will let you confirm the datetime

on “End Visit Now”◦ Otherwise, “Edit Visit”, set end datetime, and

save.

Closing a Visit

Allowed to have simultaneous visits (intentionally)

Overlapping Visits

Manually assigning encounters to visits is tedious (partly due to poor UI)◦ https://tickets.openmrs.org/browse/TRUNK-3460 ◦ Won’t actually let you do the obvious wrong thing

Manually Adding Encounters

Visits in 1.920-Jun-2012

djazayeri@pih.org

Any Questions?