FertiSoft Work Flow

Patient's Chart creation and modification.

     In order to avoid confusion and duplication errors, it is suggested that the ability to create a chart be vested in very few staff. In the process that will be described in this manual, the insurance department creates the charts. The patient's ID number can be the same as the one generated by the billing system for easy linking of both systems. The users creating the chart will fill the information required on the first (Demographic) and second (Insurance) tabs. It's possible that, when they know it from the patient, they will fill a part of the third TAB (Medical Info), the Referring and Primary Doctors and the current Patient's Pharmacy.

     On the first TAB (Demographic), The OK checkboxes beside the phone numbers are to indicate if the patient gives permission to be called and messages left at either home, work or both, if they are unchecked, do not call at these numbers. At intake, the patient should be asked for permission to call and / or to leave messages at these numbers. A check indicates that the patient has given permission. No check means that the patient may NOT be contacted at that number. Under each phone number, there is a text box for special phone instructions.

     The Partner number is a link to another chart and you can switch to the partner's chart by clicking on one of the 2 buttons: <Switch to Partner…> or <Partner: > under the patient's name. There is a checkbox for Mailing, it is checked by default and you should ask a new patient if she wants to be removed from our mailing list. This checkbox is located in the change name window beside the Active and Reports checkbox. Be sure to use this checkbox if a patient calls you and wants to be removed from our mailing list, this is the law.

     When the chart is created in FertiSoft, the patient usually comes for an initial consult. During this consult, the Office nurse should enter the missing data in the third TAB (Medical Info), which could be the allergies, doctors, pharmacy and physical information, including the medical history. To modify data in an existing chart, you have to click on one of the buttons near what you want to change. These buttons have labels like: <Name…>, <Address…>, <Change…>, <Employer…>, or <Allergies…>. From the single clicking, it will opens a window with all the data you can change. If the button is gray, you do not have the permission to modify this data, ask your supervisor or the employee responsible for this section. The Office Nurse should also change the date in the next visit box when they know it, it is changed from the "Change name" window. 

     When you change some data from a window, you should exit the window with the <Save> button if you want to keep your changes, if not, exit with <Cancel>. The allergies window is a double list box, you choose an allergy in the list on your left and single click on the ADD-> button. If you want to remove an allergy, click on it in the list on your right and then single click on the REMOVE-> button. You want to remove all of the allergies in the right list, click on the <Remove ALL> button. Don't forget to save your changes when closing this window. When you need to change a physician, you have to choose in a Combo box. A combo box is a kind of list that shows up when you click on the little arrow to the right of the name. From this list, you can scroll to find the desired entry. If you type a letter, the list will scroll automatically to the first occurrence beginning with this letter. As soon as you choose an item in the list, the Combo box close leaving only the name you chose in the box.

Confidentiality

     Be aware that FertiSoft is deploying confidential patient information. You should not have screen placement where the information may be viewed by others. Nor should you walk away with information displayed on your screen. If you have to leave your computer, please logout. FertiSoft can be configured to automatically logout a user after a specified time of inactivity.

Patient before a cycle.

     Normally, when a patient is starting a treatment, a checklist should be created. If you have any concern about checklist, you should talk directly with the employee responsible for it. For the cycle checklist report to be completed, data must be filled in many part of the computer chart. Patient's date of birth, telephone numbers and partner info comes from the first TAB (demographic). The height, weight, allergies, rubella immune, smoker, blood type and previous pregnancy status all comes from the third TAB (Medical Info). The rest of the information on the check list comes from the TAB "Cycle Checklist". The responsible nurse for each section must enter all the results for the different tests. If the patient needs more tests, the responsible nurse should click on the traffic light button and choose the pending tests from the list on the left side (like the allergies window) and save this information. When the test is done, the nurse should go back and remove the pending test from the list on the right side. When the patient is ready, the primary nurse should click on the traffic light and check the "All tests are OK" box and her name will be shown in the approved by box. This will be shown on the Cycle checklist report. When there is no pending test, but the patient has not been approved, the traffic light is yellow. When there is a pending test, the traffic light will be red. When there is no pending test and the approved by checkbox is checked, the traffic light will be green, meaning everything is OK for this patient to start a cycle.

     Then the patient should be flagged as ACTIVE in the system. This will reduce the number of charts in the reports and listings to only the one you need to work on. Some of the employees, according to security rights, will see ONLY the active patients. If you do not flag a patient as <Active>, the chart will not be seen by some medical staff. Also, there is a flag for <Reports>, which means, "This patient is on the Monitoring Room Reports". When a patient is starting a cycle, the chart MUST be flagged <Reports>, so that the monitoring room has the patient included in their reports and also for the blood tests at the laboratory. This checkbox can be changed in the window "Change the name…" by clicking the <Name…> button under the patient's name. Without this check, the patient will not be able to have blood tests or results.

     There is all kind of note boxes in the chart, you can put any medical data which is related to the note box title. In the <Cycle Notes> TAB, there is a list box for the stimulation type the patient will have in the current or next cycle. There is also Biology test orders to list the tests required by the doctor. There is also 2 notes (Stimulation and medication) for miscellaneous notes regarding these subjects. To enter data, just click once on the <Change> button beside the boxes, type in your text and then press the <Save> button.

Patient starting  a cycle.

When the patient calls to start a cycle, the responsible nurse should flag the patient accordingly. There is a flag for <Reports>, which means, "This patient is on Blood Room Reports". When a patient is starting a cycle, she MUST be flagged <Reports>, so that the blood room has her included in their reports and also for the blood tests sent at the laboratory. This checkbox can be changed in the window "Change the name…" by clicking the <Name…> button under the patient's name. Without this check, the patient will not be able to have blood tests or results.

     The responsible medical staff should then create the cycle in the TAB "Cycle results". To do this, (he/she) must click on <New cycle>. After answering <Yes> to "Are you sure you want to create?" the first cycle day number and date will be filled and saved. The first thing to do is to choose the type of cycle in the Combo box in the top left corner of the cycle day window. Clicking on the little arrow of this Combo box will bring a list of possible cycle types. Choose one by clicking on it, it will close the list and leave only your choice in the box. You should type the cycle day and date in the appropriate fields. According to the type of cycle, the different boxes will rearrange to reflect the possible combination of data related to each type of cycle. If you have rights to change Medication orders, the boxes will be white, if not, they will be gray. Same thing for the Lab test results, if you have the rights to change that, the fields will be white, otherwise they will be gray. Some cycles have data twice a day AM and PM. Normally the Lab results will be automatically filled by the laboratory via a communication link between their computer and yours. If, for any reason, the Laboratory data is not transmitted, you can still fill it manually. Some other laboratory may not communicate with you for results, these will be entered manually. Be careful where you put the data, AM or PM and the good test type (LH, E2, P4 or BHCG). The Laboratory Number field is for the communication link between the laboratory and the chart, this number is like a street address for the result to find their way back to the good chart and cycle day.

     Patient Progress Notes and Doctor Medication Orders are the fields on the right side of the "Edit cycle day" window. Every time you need to add a note for a specific day, you should first enter your user ID in the user box. As soon as your user ID is approved, the Password box will become available, enter your signature password. As soon as your password is approved, the <New: > note box will become accessible for you to write the note that will be filed in the patient chart with your signature attached to it. If there are medication orders in this cycle day, you have to check the check box "Patient has been called" when you call the patient, failing to do so will leave the cycle day column header in red, meaning that their is still something to do on this chart. Notes are NOT editable. If you make a mistake writing a note, you will have to write a NEW note to identify the mistake. The law does not permit to change notes in a patient's chart.

     The Satellite Combo box is for specifying which location the patient will go for the blood retrieval. This will help to print the test tube labels for the specified location and to arrange a better delivery schedule.

     You have to create a cycle day each time there is medications or Lab test results. You should also create a cycle day for the procedure day and click the check box "This is a Procedure day" to identify this day and turn the corresponding column header to green. The days you create don't need to be contiguous in the numbering. You can also create a day # 20 and then create a day # 15, the order will adjust automatically. So you can really create an estimated day # for the procedure and continue filling the days during the normal cycle. If you create an estimated day #20 and realize that it should be 19, just reopen the cycle day and change the number and date, it will adjust.

     The ultrasound tech can also enter the results in each of the cycle day by clicking the <Ultrasound…> button. This will open a window to enter the side (L or R) and size (up to 5 char.) for each follicle. They have to click on the <Add> button to create a new result and from there they can enter the ENDO result. Note that the ENDO is the same in each edit window. Don't forget to click on <Save> to close the window, clicking on the <X> in the upper right corner will never save your changes, but will close the window like the "Cancel" button.

     Every time a patient needs a test, the medical staff can do a test order by clicking the <Order Tests…> button. This will open a window for the currently selected cycle day column to order tests for this cycle day. From this window, you choose one or many tests in the list to be performed on this cycle day. You will have to type the number of tubes needed for all the selected tests. Saving this order will add the patient to the list of patients that will have blood drown on this day. Specifying a satellite in the cycle will direct the test to the good location. This data will also serve to print all the labels to stick on the tubes. The labels will identify the patient with the laboratory ID number, our ID number, Patient's name and the tests to be performed.

     The grid on the Cycle results TAB will adjust according to the type of cycle displayed. If you want to see previous cycles, click the tab corresponding to the past cycle you want to see.

     All the orders and progress notes for your patient can be reviewed on the TAB "Doctor Notes" or "Nurse Notes". You can scroll the notes ordered by date. You CANNOT change the contents of a note, it is not permitted by the law. But you can add a new note to annotate a correction.

Security

     What is the electronic signature? It is a special password attached to your user name that identifies you as the person who creates a progress note (if you are a nurse) or medications order if you are a physician. This is NOT and should not be the same password as the one you use to login FertiSoft. First, you must be on file as an employee, and then you must enter a signature password via the <Options> menu item under the <System> pull-down menu. Only the user can change this signature password and you must do it when the user is logged under his/her name. This is a double protection. Your electronic signature password is as precious as your bank PIN. NEVER give your passwords to anybody. Protect yourself and your patient's rights to privacy.

     You should change your passwords every 3 months or less. Try to find good passwords that are hard guessing. In FertiSoft, you have to go in the <System> pull-down menu and then <New Password> to create a NEW password for your account.

Reporting

     FertiSoft is ready to give you all the reporting facilities you need. But, if you need more reporting features, our development team will be able to customize many of the reports or create new reports for your practice.

     You can do mailing list with the patients' database or the physicians' database. To do this, open the Reports pull-down menu and choose Mailing and from there select Patients or Physicians. You will have to define your query for filtering and ordering your output. There are 2 types of mailing; directly print the names and addresses on #10 envelopes or create a file on disk to send to your printing company or use with your favorite Word processor to do a mail merge in a document.

     There are also some reports for patients listing. Most of the reports can be displayed on the screen or printed on paper. In the patients' listing, you can create a specific query to your filtering and ordering needs.