TIME V7.2 Service Pack 24

Transcription

1 Contents... 1 Enhancements - Clinical... 3 Clinical Dashboards... 3 CMS Bundled Comorbidities Progress Notes Using ICD-10 Codes... 3 CROWNWeb Transmission... 4 Dialysis Orders Reports Display Units of Measure for Heparin... 4 Facility Security for User Password... 4 Flowsheets Respiratory Rate Default Value... 5 Home Dialysis Service Charting... 5 Immunization History VIS Date Display... 6 Non-ESRD Enhancement... 6 Physician Rounding App... 6 Service Charting NDC Vendor... 7 Treatment Observations Comments... 7 Enhancements Financial... 7 Batch Insurance Allow to Submit Future Dates... 7 TIME Crystal Non zero Balance Claim Summary (new report)... 7 Financial Dashboards... 8 Enhancements General... 9 TIME Crystal Patient Ethnicity SQL View... 9 TIME Crystal QAPI Fluid Management (new report)... 9 Custom WO 3064 USRC Purge HIPAA Audit Data WO 3134 USRC Label Printing via Zebra label printer Custom General Common Internal Doctor Codes Nightly Security Event Processing Clinical Access Crystal Reports Dry Weight Variation Report TIME Crystal Immunization History Dialysis Orders ESRD PPS Reports Hemodialysis Flowsheets/Notifications Medication Orders Notifications Physician Rounding App Physician Rounding App Reconciled Meds screen part Physician Rounding App User Preferences Physician Rounding App Hospitalization History screen part Progress Note Template Progress Notes Progress Notes Release Notes Page 1 of 90 Last Saved: 1/12/2016

2 Service Charting Web Resources Financial Auto Apply Batch Insurance Pre-Submission Report Claim Data and Service Trx Insurance Policy Maintenance Clinical Appendices Appendix A - Clinical Dashboards Appendix B - CMS Bundled Comorbidities Progress Notes Using ICD-10 Codes Appendix C - Dialysis Orders Reports Display Units of Measure for Heparin Appendix D - Flowsheets Respiratory Rate Default Value Appendix E - Home Dialysis Service Charting Appendix F - Immunization History VIS Date Display Appendix G - Non-ESRD Enhancement Appendix H _ Physician Rounding App Appendix I - Service Charting NDC Vendor Appendix J - Treatment Observations Comments Financial Appendices Appendix K Batch Insurance Allow to Submit Future Dates Appendix L Financial Dashboards Release Notes Page 2 of 90 Last Saved: 1/12/2016

3 Enhancements - Clinical Clinical Dashboards A new application, Dashboards, is now available for purchase. Once it has been purchased, it will be added to the TIME system Main Menu. The dashboards bring together disparate data and present it in a meaningful graphical manner so that quick answers to high level questions are available at your fingertips. These dashboards are available when an organization uses TIME s clinical software, and is specifically designed for dialysis-based clinical databases. There are four clinical dashboards: 1. Monthly Hosp/Mortality This dashboard displays a yearly snapshot of the total deaths, hospitalizations and number of hospital admissions for a selected facility, or for all facilities to which a user has access. 2. Dialysis Monthly Treatment The Dialysis Monthly Treatment dashboard displays treatment data for a selected facility, or for all facilities to which a user has access. This dashboard includes graph to report the following information: a. Noted Absence b. Hemo Treatment Count c. PD Treatment Count d. Missed Treatments with No Reason e. Rescheduled Treatments f. Scheduled Treatments g. Unscheduled Treatments h. Vacations 3. Access Report with Status This dashboard displays access data for a selected facility, or for all facilities to which a user has access. 4. Lab Test The Lab Test dashboard includes dashboards for the following types of labs: a. Anemia b. Adequacy c. Bone Density See Appendix A for more details. CMS Bundled Comorbidities Progress Notes Using ICD-10 Codes The Progress Notes CMS comorbidities screen has been revised in SP24 to display the ICD-10 codes and descriptions when a database has been configured to use ICD-10 Codes. If a database is configured to use ICD-9 codes, they will continue to be used and displayed on this screen. The CMS Comorbidities screen is displayed when a template using the promptable DX Group - Grid data element (Main Menu=> Code Tables=> Medical Records Codes=> Progress Notes Templates=> Add/Edit Template=> Data Elements=> Promptable=> DX Group - Grid) is added to the Progress Notes application. See Appendix B for more details. Release Notes Page 3 of 90 Last Saved: 1/12/2016

4 CROWNWeb Transmission Prior to SP 24, the CROWNWeb Transmission screen only allowed for the transmission of all patients for a facility. This worked well when sending the initial set of data for a given month, but there are times when data for individual patients needs to be fixed and re-transmitted. In order to make the re-transmission process easier, the CROWNWeb Transmission screen has been modified to allow for one or more specific patients to be identified. If one or more patients are selected, then the process will generate transmission files just for those patients. The CROWNWeb Transmission screen has a new tab Select Patients. After choosing a facility and a Clinical Month/Year, you can access the Select Patients tab to identify one or more patients you d like to specifically report on. The list of patients is restricted to the list of patients qualifying for the facility you chose on the Options tab. Dialysis Orders Reports Display Units of Measure for Heparin In order to satisfy the requirement of the Joint Commission (JCAHO) that the Heparin units administered to patients be clearly documented, the Dialysis Orders Reports has been enhanced to display the unit of measurement for the following Heparin related fields: 1. Bolus 2. Mnt 3. Total Amt 4. Total Maint The unit of measurement for all of the above fields is units. This information has been added to the Dialysis Orders Reports for these fields. See Appendix C for more details. Facility Security for User Password The TIME system has two variants for identifying the user signing clinical records: 1. The most secure variant is to require that the user enter both his/her login and password. This option, however, adds additional keystrokes, so the second variant, described below, was created in an effort to reduce the keystrokes required to save a clinical record. 2. The second variant, the optional password only variant, requires only that users enter their passwords to save records. A third option, the Validate Password variant, is now available with the release of SP24. When an organization has enabled Facility Security and has elected to use the password only feature described above, an additional optional setting is now available. The new validate password option compares the employee password used to sign a clinical record with that user s facility security authorization. If the patient whose record is being signed belongs to a facility to which the user does not have access, the record is not saved and an invalid password message is displayed. All three variants, detailed above, apply to all TIME system screens that require an employee signature to save a record. Release Notes Page 4 of 90 Last Saved: 1/12/2016

5 Test Plan 1. NOTE: This enhancement applies only to databases for which the facility security option is turned on, and the option to not require a login and instead only require a password to sign a record is turned on. 2. Contact INFIAN to turn on the password validation option. 3. Select two test patients from different facilities. 4. Select two test employees who have access to the test patients facilities. Identify the employees passwords. The test employees should not share authorizations for the facilities assigned to the test patients selected for this test. 5. Log into the TIME system as one of your test employees. 6. Find any application in TIME that requires a password to sign a patient record. Nearly all of the applications on the Patient Charts menu require a password to save the record. 7. Create a record for the test patient for whom the employee in Step 5 is authorized to access. Save the record using the other employee s password. This employee should not have access to the selected test patient s facility. Verify that you are prevented from saving the record and that you receive an invalid password error message. 8. Log out of the TIME system and repeat the steps above using your other test employee and other test patient. Select a different application for this test. Flowsheets Respiratory Rate Default Value Prior to the release of SP24, the Respiratory Rate on the Hemodialysis Flowsheet Pre and Post Treatment Vitals screens and the Peritoneal Flowsheet Treatment Vitals screen defaulted to zero (0). In an effort to avoid erroneous and misleading documentation of the respiratory rate, these fields now default to blank. Unless a user has entered valid values in these fields, they are now displayed as blank on both the entry screens and on the reports. See Appendix D for details. Home Dialysis Service Charting Two new optional settings have been added to the Home Dialysis Service Charting application in an effort to avoid user entry errors and to improve communication with the billing office: 1. Services and treatments have always defaulted to Y as done. An optional setting is now available that sets this to blank, and requires that users manually select each patient and service, and mark it as done. 2. The Save Currently Open button allows users to save administrations for multiple patients at one time. A new option has been added to disable this button, requiring that users save each patient, one at a time. See Appendix E for details. Release Notes Page 5 of 90 Last Saved: 1/12/2016

6 Immunization History VIS Date Display The Immunization History application has been enhanced to provide an immunization s VIS (Vaccine Information Sheet) publication date when viewing or entering an immunization. When an immunization is administered in a TIME facility, the VIS publication date is copied from the TIME immunization service code (when available), and is displayed as display only information. In addition, immunizations that do not originate from the TIME system may be updated to add the VIS publication date in the new VIS Date field. See Appendix F for details. Non-ESRD Enhancement Because most medication and lab orders are now included as part of the ESRD Bundled Payments, it has become more important that the Non-ESRD field be completed correctly to minimize lost revenue. Prior to SP24, the Non-ESRD field was a checkbox and was not handled as a required field. In an effort to capture as many billable services as possible, a new option has been released in the SP24 release of the TIME system. This option allows users to require that the Non-ESRD field be completed in order to save the record. When this new option is turned on, the checkbox is changed to a Yes/No combo box. In addition, the Administered Services Crystal report is added an option to list only Non-ESRD services. See Appendix G for more details. Physician Rounding App The Physician Rounding App has been enhanced in SP24 to provide better information needed by clinicians to make decisions, without requiring them to view detail screens. The following Physician Rounding App screen parts have been enhanced: 1. Hemo Flowsheet Grid The grid has been modified to display the Pre-Temp and Post-Temp. 2. Labs and Admin Meds Grid High and low lab results are now color coded to provide quick identification of labs that are out of the tolerance range. Pink is used for high lab values, and yellow is used for low lab values. 3. Medication Orders Grid The grid has been modified to include the following fields: a. Stop Reason b. Disp Order c. Dx Code d. Dx Code2 e. Disp Amount f. Doctor Name g. Employee Name h. Stop Dr i. Stop Employee In addition, new screen parts have been added to support the new capabilities with TIME Mobile to document Chief Complaint and Impressions. If you have purchased licenses for TIME Mobile, the Chief Complaint and Impression information clinicians document via TIME Mobile can be displayed (view-only) in the Physician Rounding App. Release Notes Page 6 of 90 Last Saved: 1/12/2016

7 See Appendix H for more details Service Charting NDC Vendor In an effort to increase the usability of the service charting screens, and to reduce errors, the NDC section of the Service Charting screen has been enhanced to display the vendor name corresponding to the NDC code of a selected medication. The vendor name is display only. See Appendix I for more details. Treatment Observations Comments The Treatment Observations screen of the Hemodialysis Flowsheet application has been enhanced to include a comments section. Entry on this screen has been streamlined so that it requires fewer clicks. Users are no longer required to click the Comments button to enter a comment on the observation screen. Observations and comments may be viewed, added and entered on the screen. One signature signs both the observation and the comment. Once a comment is entered and saved on the Treatment Observations screen, it is added to the Progress Notes application. See Appendix J for more details. Enhancements Financial Batch Insurance Allow to Submit Future Dates In order to assist you in testing ICD-10 diagnosis codes, INFIAN has revised the TIME system to allow future dated financial claims and transactions in your in-service database. This will allow you to enter a future date before and after the CMS ICD-10 implementation date of 10/01/2015. Claims and transactions on or after 10/01/2015 will use ICD-10 codes; claims and transactions prior to 10/01/2015 will use ICD-9 codes. Prior to using this feature, you must first import and assign ICD-10 codes to the diagnosis codes. When this has been completed, simply contact INFIAN support to enable the ability to use future dates on claims and transactions in the in-service database. See Appendix K for more details. TIME Crystal Non zero Balance Claim Summary (new report) Enhancement This report will only include non-zero balance claims and may be run for a selected claim date range. The balance and transactions included will be based upon the current date when the report is generated and only includes posted transactions. Release Notes Page 7 of 90 Last Saved: 1/12/2016

8 The information displayed on the report includes the Chart ID, Patient Name, Claim #. Claim From and Thru Dates, Total Charges and Adjustments, Payments and Claim Balance. The Payment information is divided into the following columns INS1, INS2, INS3, Other Insurance (OI) and Patient Payments and includes the insurance code for each of the insurer columns. The user will be prompted for the date range, patients and insurance codes for primary and secondary claims to include. This report can be exported into an excel spreadsheet for additional sorting and analysis as needed by your organization. Test Plan 1. Main Menu/Patient Accounting/Financial Reports/Crystal Reports 2. Launch the new report named Non Zero Balance Claim Summary 3. Enter valid constraints. 4. Verify the report shows the expected information Financial Dashboards A new optional application, Dashboards, is now available for purchase. Once it has been purchased, it will be added to the Financial Reports menu. The dashboards bring together disparate data and present it in a meaningful graphical manner so that quick answers to high level questions are available at your fingertips. The data presented in the dashboards is generated and preloaded into the dashboards overnight so that users may view the dashboards without the need to wait for data to generate. There are four dashboards: 1. Drug Utilization An organization s drug utilization over a six month time frame may be viewed on the Drug Utilization dashboard. Only drugs whose administration can be tied to a treatment are selected and added to the tally. Each drug utilization graph offers a single click drill down that presents the transactional data that supports the selected graph. 2. Accounts Receivable The Accounts Receivable dashboard provides an organization different views of its existing/outstanding accounts receivable balance. This includes all claims that have a balance. Claims are aged using the claim aging by calendar month process. The accounts receivable balances are broken down by pay class. In addition, a single click drill down is available on the graphs to present transactional claim data represented in the graphs. 3. Net Revenue The Net Revenue dashboard provides an organization different views of their net revenue over a four year period, including the current day of the current month. The net revenue is calculated as the total charges less the total adjustments. A single click drill down is available on the graphs to present transactional data represented in the graphs. 4. Payer Mix The Payer Mix dashboard allows an organization to easily view how its patient population is represented across the different pay classes, in other words, the total number of patients covered by each pay class. The Payer Mix dashboard defines payer mix as a list of all active patients whose policy records for a specific context date represent payers who belong to a specific pay class. For example, if the dashboard is displayed for Today, and John Doe s current payer is Medicare, he is added to the Medicare pay class total. The Payer Mix may be constrained by a specific context date, facility, and, when applicable, by degree of coverage and/or modality. The data presented is based on only those Release Notes Page 8 of 90 Last Saved: 1/12/2016

9 patients who were active within the selected date context. Once selected for inclusion, the patients insurance policies are based on the insurer s pay class and the degree of coverage (for example, primary, secondary, etc.). This information is maintained based on the patient s insurance policy set records. A single click drill down is available on the graphs to represent the policy data represented in the graphs. See Appendix L for more details. Enhancements General TIME Crystal Patient Ethnicity SQL View TIME allows for documentation of the patient s ethnicity ( Hispanic/Latino or Not Hispanic/Latino. This enhancement provides a SQL View, pat_ethnicity_view, allowing for this information to be retrieved using Crystal Reports (or any other third-party SQL-based reporting tool) Fields Usage GUID the unique identifier of the record generally you will not need to use this field Chart_ID the patient s chart number Patient_no the patient number associated with the Chart_ID unless you are setup for multiple patients from one FRP, this value will always be zero (0). Ethnicity three possible values for this o NULL means that the patient does not have an assigned Ethnicity in TIME o Not Hispanic or Latino o Hispanic or Latino Del_Flag three possible values o NULL means the patient does not have an assigned Ethnicity in TIME o N patient has an actively assigned Ethnicity o Y patient previously had an Ethnicity assigned in TIME but it is no longer assigned Generally, this view will be joined to the patient_view with patient_view.chart_id joined to pat_ethnicity_view.chart_id and patient_view.patient_no joined to pat_ethnicity_view.patient_no. If you are querying for specific values in pat_ethnicity_view, be aware of the NULL values in the Ethnicity and Del_flag fields. You ll need to look specifically for null or not null as part of your query. o Example: If you wanted a list of patients that did not have ethnicity assigned, you might include logic like and (isnull(pat_ethnicity_view.del_flag) or pat_ethnicity_view.del_flag = Y ) TIME Crystal QAPI Fluid Management (new report) Problem As part of routine surveys, clients are having to produce a list of patients whose average weight loss over the prior 3 month period is greater than 5% of the patient s estimated dry weight Release Notes Page 9 of 90 Last Saved: 1/12/2016

10 Resolution A new TIME Crystal report, QAPI Fluid Management.rpt, has been created to display the percentage of patients who have a 3 month average weight loss percentage less than or equal to 5% as well as listing the patients whose average weight loss percentage is greater than 5%. The report prompts for date range, variance percentage, and facilities. It excludes treatments where the duration is greater than 4 hours as well as excluding treatments where the pre weight, post weight, and/or target weight is 0. It groups/summarizes by facility. For each facility, it will show a list of patients with an average weight loss percentage greater than the entered variance percentage. It will also show facility totals for the number of patients treated, the number of patients meeting the entered variance percentage, and the percentage of patients meeting the entered variance percentage. Test Plan 1. Launch Crystal Reports under Main Menu -> Medical Records -> Clinical Reports 2. Select QAPI Fluid Management and process the report 3. Enter the following parameters a. Date Range b. Variance Percentage: the surveys are looking for 5%, but you can run any percentage you like c. Facility: select one or more facilities to report, or select all facilities Custom WO 3064 USRC Purge HIPAA Audit Data Enhancement As part of our 2011/2014 certification efforts, we added the ability to track security events (such as login / logout, etc). If a client enables all of the security events, a significant amount of data is collected (upwards of 5 MB / day). A purge utility is created to provide the capability to HIPAA audit data. Once it s set up, it can automatically purge the audit data in both the Audit Subsystem and in TIME production database. The utility allows for the purge settings to be configurable. It allows user to indicate how many days to keep the audit data in the system, the file directory to hold purge related files. WO 3134 USRC Label Printing via Zebra label printer Enhancement Currently, when TIME prints labels, it can waste labels as it needs a full sheet of labels for printing, even if a given page only has one label to print. This project provides a new open when printing med and heparin labels to allow for the labels to be printed to a dedicated label printer from Zebra which will print a single label at a time. Using this type of printer reduces the overall waste of printing labels. Release Notes Page 10 of 90 Last Saved: 1/12/2016

11 Modifications In-Center Medications Report o New Report Format option of Labels For Zebra Labels Printer (3.125 X ) o Allows the report to be sent out to a Zebra label printer Heparin Label Report o New Report Format option of Labels For Zebra Labels Printer (3.125 X ) o Allows the report to be sent out to a Zebra label printer Custom General The following modules were changed as a result of custom work orders or to resolve technical issues that were not directly impacting the user experience. For these modules, please perform some basic testing in your environment to ensure they continue to work as you expect. Clinical o Flowsheet Report resolved a memory leak issue o In-center Medication Report a custom work order added the ability to print to a dedicated label printer o Heparin Label Report a custom work order added the ability to print to a dedicated label printer Common Internal Doctor Codes Problem When a new internal doctor code is created, users are required to select an existing employee code to add to the Internal Doctor Codes table. Prior to SP24, when an employee code was selected, the employee s name was not displayed on the Internal Doctor Codes screen. Displaying the employee s name was requested in an effort to reduce errors caused by selecting an incorrect employee code. Resolution The Internal Doctor Codes application has been modified so that the employee name is displayed to the right of the right of the doctor code. Test Plan 1. Launch the Internal Doctor Codes application (Main Menu=>Code Tables=>Staff Codes=> Internal Doctor Codes). 2. Click the Add button. Release Notes Page 11 of 90 Last Saved: 1/12/2016

12 3. Either enter an employee code in the Doctor Code field, or click the lookup button to select a code to be entered in the Doctor Code field. 4. Verify that the name of the selected employee is displayed next to the doctor code field. 5. Complete the required information and save the new doctor code. 6. Browse through the doctor codes and verify that the name of the employee is displayed for each doctor code. Nightly Security Event Processing Problem The nightly process that unpacks the audit events for reporting purposes can take a very long time to complete. Under certain circumstances, when one database is no longer tracking audit events, the unpack progress marker stops advancing so events are processed over and over. Resolution There is now a progress marker for each database so the unpacking of events from one database does not confuse the unpacking for another. There is also an upper run time limit of 23 hours to prevent multiple processes from running at the same time. Test Plan 1. Run the System Audit Report for yesterday's data. Make sure data is displayed for the events that are enabled Clinical Access Problem When a database was setup to only require a general body location for an access, the Access application was still attempting to validate the specific vein location. As a result, new records could not be saved, and existing records could not be updated. Resolution The Access maintenance module has been modified to not validate for a specific vein side when the database is set up to only require a general body location. Test Plan Release Notes Page 12 of 90 Last Saved: 1/12/2016

13 1. If not already set, contact INFIAN support to set the Access application to only require a general body location. 2. Select a test hemodialysis patient. 3. Launch the Access application (Main Menu=>Medical Records=>Patient Charts=> Access). 4. Either add a new access, or edit a current access. Complete the required fields and select the Save button. 5. Verify that you are able to save the record and that you do not receive an error that a Vein Side of N/A is not a valid selection. Problem Users who were only granted permission to view access records were not prevented from adding status, complication or assessment records. Only users with add/edit permissions should be able to save these types of records. Resolution The security for the Access application was modified so that the status, complication and assessment records follow the security privileges for the Access application. Users with view only privileges are now only able to view complication and assessment records. Test Plan 1. Select a test user who has view only security privileges for the Access application. 2. Login as the test user. 3. Launch the Access application (Main Menu=>Medical Records=>Patient Charts=> Access). 4. Verify that the Add, Edit and Delete buttons are disabled. Verify also that the New Status, and New Complications/Interventions buttons are also disabled. 5. Verify that the user can only view the existing records. 6. Select another test user who has add, edit and delete privileges for the Access application. 7. Log in as this test user. 8. Launch the Access application (Main Menu=>Medical Records=>Patient Charts=> Access). 9. Verify that the Add, Edit, Delete, New Status, New Complications/Interventions, and New Assessment buttons are enabled for this user. Crystal Reports Dry Weight Variation Report Problem The Interdialytic Weight Gain field of the Dry Weight Variation Report was mislabeled as Intradialytic weight gain. Resolution The field label has been changed to Interdialytic Wt. Gain. Release Notes Page 13 of 90 Last Saved: 1/12/2016

14 Test Plan 1. Launch the clinical Crystal Reports application (Main Menu=>Medical Records=>Clinical Reports=> Crystal Reports). 2. Generate the Dry Weight Variation Report. 3. Verify that the field is labeled correctly. TIME Crystal Immunization History Problem It would be nice to have a view option for DONE, NOT DONE or BOTH. This is a configuration option that needs to be added to the current Crystal Immunization History report please. Resolution A new report constraint, or prompt, has been added to this report. This new constraint will allow the user to choose whether they would like to report on only those Immunizations that have been documented as Done, Not Done or All, where All would report upon both Immunizations Done and Not Done. This new constraint will default to All. Test Plan 1. Ensure this report runs as configured for your organization. 2. If ALL is chosen for this new constraint, all Immunizations will be reported whether considered Done or Not Done. 3. If Done is chosen for this new constraint, only those Immunizations that do not have a Reason Not Done value documented will be reported. 4. If Not Done is chosen for this new constraint, only those Immunizations that have a Reason Not Done value documented will be reported. Dialysis Orders Problem A number of fields on the Dialysis Orders screen did not contain the units of measure. For example, the Heparin Bolus field did not indicate the units of measure. This was due to a lack of space on the screen. Regardless of the screen space, units of measure was an important piece of information needed by users. Resolution The Dialysis Orders screens have been modified so that the units of measure for a field are now displayed in the FYI help line at the bottom of the screen. Release Notes Page 14 of 90 Last Saved: 1/12/2016

15 Test Plan 1. Launch the Dialysis Orders application (Main Menu=>Medical Records=>Patient Charts=> Dialysis Orders). 2. Select an existing hemodialysis dialysis order, or create a new order for any test patient. 3. Click on the following Heparin fields; a. Bolus b. Maint c. Total Heparin d. Total Maintenance Heparin 4. Verify that the help line for each of the above fields displays that the unit of measure is Units. ESRD PPS Reports Problem When the ESRD PPS Report was run by Exception (Format/Mod tab) for missing height or weight, the report looked at a patient s last flowsheet of the month to determine if he or she should be included as an exception due to missing height or weight information. The report was not, however looking at the flowsheet status. If a patient s last flowsheet of the month was an incomplete flowsheet, the patient was included in the height/weight exception format of the report. Resolution The ESRD PPS Reports, Missing Height or Weight format, has been modified so that the patient s last closed flowsheet of the month is used to determine if the patient s weight information has been entered correctly. Test Plan 1. Find a test patient whose last flowsheet for a given month is an open or incomplete flowsheet. The closed flowsheet preceding the open or incomplete flowsheet must include weight information. 2. Launch the ESRD PPS Reports application (Main Menu=>Medical Records=>Clinical Operation Mgmt=> ESRD PPS Reports). 3. Select a start and end date that includes the month during which the test patient selected in Step 1 above had an incomplete or open flowsheet as his or her last flowsheet of the month. 4. Select the Format/Mod tab. Select the Format drop down list, and select Exception. 5. Select Missing height or weight from the Exception box. 6. Generate the report. Verify that the patient was not reported in the list of height/weight exceptions. 7. Close the flowsheet, keeping the Post Weight as zero on the Post Treatment Vitals screen. 8. Run the ESRD PPS Reports again using the same constraints. 9. Verify that the patient was reported in the list of height/weight exceptions. 10. Modify the closed flowsheet, adding a post weight on the Post Treatment Vitals screen. 11. Save the changes and exit the flowsheet. 12. Run the ESRD PPS Reports again, using the same constraints. 13. Verify that the patient is no longer included in the list of height/weight exceptions. Release Notes Page 15 of 90 Last Saved: 1/12/2016

16 Hemodialysis Flowsheets/Notifications Problem When a medication order change alert was created prior to a hospitalization or absence record that lasted more than 7 days, users were prevented from closing the flowsheet because the alert was not displayed on the flowsheet application. Users were required to launch the main Notifications application, search for the alert and take action on the alert outside the flowsheet before the flowsheet could be closed. The Notification on the flowsheet should display the new/changed order alerts (which appear in red) regardless of the date range, because those alerts must be addressed in order to close the flowsheet. Resolution The Notification screen of the flowsheet has been modified so that it displays all pending New/Changed Order alerts, as well as the Patient Present Alerts, regardless of their dates. All other alerts are displayed only if they are within the date range that is set for displaying alerts and ticklers. Test Plan 1. Select a patient who has a pending alert for a new or changed order. Usually this alert appears in red. Remember the alert date. 2. Launch the Absence History application (Main Menu=>Medical Records=>Patient Charts=> Absence History). Create an absence record for that patient that lasts a duration of 7 or more days, with the start date equal to the date identified in Step 1 above. 3. Create a flowsheet for the day after the absence end date. 4. Verify that the non-tickler alert for the new/changed medication order appears on the Notification screen of the flowsheet. Medication Orders Problem When a database was set up to display ICD-10 codes, the codes and label displayed on the Medication Orders screen was not operating correctly. The label displayed ICD-10 but the codes displayed ICD-9 codes. The reverse was occurring as well. Resolution The Medication Orders entry/editing screen has been revised so that it first obtains the ICD version to be used in a database. The current system date or the medication order start date (whichever is older) is then compared to the ICD implementation date. Whichever ICD version is in effect for the given current system date/medication order start date determines which ICD label and ICD code is selected and displayed. Test Plan Release Notes Page 16 of 90 Last Saved: 1/12/2016

17 1. Verify your database settings and the implementation date for the ICD version currently in use. 2. Launch the Medication Orders application (Main Menu=> Medical Records=> Patient Charts=> Medication Orders). 3. Select a medication order and click the Edit button. 4. Verify that the ICD label matches the version of the ICD code, and that it is the version that was in effect for the order date of the selected medication order. 5. Add a new medication order. 6. Enter the current system date as the medication start date. 7. Verify that the ICD label matches the current version of the ICD code. 8. Exit the Medication Orders application. Notifications Problem The Lab Results Alert did not notify users when a lab result that had already triggered a warning was later updated with a value that was still outside the normal range. The system checked to see if there was an existing lab alert for the same lab on the same date for the same patient. If it found this to be true, it did not create a new alert. In the interest of patient safety, an alert should be generated when these conditions are true. Resolution The Lab Results Alert has been modified so that when an existing lab result is updated, it will generate a new alert if the updated lab result is eligible for an alert. Test Plan 1. Launch the Lab Results Alert application (Main Menu=> Code Tables=> Medical Records Codes=> Alert Codes=> Lab Results Alerts). Select a couple of lab test for which alerts have been configured. 2. Select a test patient. Launch the Lab Results application (Main Menu=>Medical Records=>Patient Charts=> Lab Results). Enter lab results for the labs identified above, entering a result outside the normal range so that an alert is generated. 3. Launch the Notifications application (Main Menu=>Medical Records=> Notifications). 4. Verify that an alert was created for your test patient for the lab results entered in Step 2 above. 5. Launch the Lab Results application again. Update the lab results with a value that is still outside the normal range. 6. Launch the Notifications application. Verify that another alert has been created and is available on the Notifications screen. Problem Users were unable to postpone ticklers on the Notifications screen. The Postpone button was always disabled. Resolution Release Notes Page 17 of 90 Last Saved: 1/12/2016

18 The Notifications application was modified so that ticklers can now be postponed. Test Plan 1. Launch the Notifications application (Main Menu=>Medical Records=> Notifications). 2. Select a test patient for whom a tickler alert has been generated. 3. Verify that when the tickler alert is highlighted, the Postpone button is enabled. 4. Verify that you can postpone the alert. Physician Rounding App Problem When there were no templates assigned to the PD Review and Lab Review buttons on the Physician Rounding App screen, users were receiving a blank error message (Error: AMI:2 ) if they selected the buttons. A blank progress note should have been displayed when a template was not assigned to the buttons. Resolution The Physician Rounding App has been modified to open a blank progress note when a template is not assigned to the PD Review or Lab Review buttons when those buttons are selected. Test Plan 1. Log into the TIME system as a physician who has not configured the PD Review or Lab Review buttons. 2. Launch the Physician Rounding App (Main Menu=> Physician Rounding App). 3. Select a test PD patient. 4. Click the PD Rev button. 5. Verify that a blank progress note is opened. 6. Click the Lab Rev button. 7. Verify that a blank progress note is opened. 8. Repeat the test logging into the TIME system as a physician who has configured the PD Rev and Lab Rev buttons, assigning templates to them. 9. Verify that the assigned template is displayed when the button is selected. Physician Rounding App Reconciled Meds screen part Problem The Reconciled Med List tab under the Medication orders application provides the Last Fill Date of the Reconciled Medications. However, this information is not available on the Reconciled Meds screen part in the Physician Rounding App ro the Encounter Home Page. Add this column between Sig/Disp Order and Dose columns. Release Notes Page 18 of 90 Last Saved: 1/12/2016

19 Resolution Added the column Refill Date to the Reconciled Med screen part, between the Sig/Disp order and the Dose columns. Test Plan 1. Select a test patient having Reconciled medication (refer to the Reconciled Med List tab under the Medication orders application). 2. Launch the Encounter Home Page application (Path: Main Menu=> Encounter Home Page) 3. Select a view that displays the Reconciled Meds screen part. 4. Select the test patient. 5. Verify that the Reconciled Meds view has the column labelled Fill Date and it is populated with the Fill Date. Physician Rounding App User Preferences Problem The Template lookups on the User Preference tab of the Physician Rounding application were not limiting the records displayed using the SP 23 Template "share" settings. The template lookups were showing all templates. Resolution Modified the lookups to only display the templates the user has access to Test Plan 1. After setting up the template sharing configuration, make sure the template lookups in the Physician Rounding application only show the records shared with the user. Remember to restart your session after each template sharing change. Physician Rounding App Hospitalization History screen part Problem Hospitalization History screen part is ignoring the record selection configuration property "Records from last nnnn Days/Weeks/Months/Years" and missing some records. This happens when "Active Only" property is unchecked. Resolution System now pays attention to the Records from last nnnn Days/Weeks/Years configuration setting. Test Plan Release Notes Page 19 of 90 Last Saved: 1/12/2016

20 1. Launch Main Menu=> Physician Rounding App 2. Select a View with Hospitalization History screen part 3. Select File > Configure view screen part 4. Double-Click on Hospitalization History screen part to view the properties 5. Uncheck Active Only option 6. Change the "Display All Records from last" option to 180 Days and save changes. a. Note: You will not be able save changes to "SHARED" viewed. 7. Right Mouse-Click on Hospitalization History screen part and "Add" few Hospitalization records with a start date within last 180 days and few records prior to last 180 days. 8. Close Patient Absence History screen to refresh Hospitalization History screen part. a. Note: You will need to manually refresh the screen part if Patient Absence History app was launched separately from main menu. Progress Note Template Problem If the Progress Note Templates maintenance screen is minimized using the menu Minimize All button, when it is display again, the buttons at the bottom of the screen are no longer visible. Resolution Modified screen to handle this situation more appropriately Test Plan 1. Minimize the screen and then activate it again. Make sure the buttons at the bottom of the screen are visible. Progress Notes Problem For non-grid Maestro elements under the Dialysis, Hemo Dialysis, and PD Dialysis element menus, the data displayed should not be from orders that are inactive on the As Of date. Resolution The dialysis orders are now constrained by the Inactive Date field so only data elements from active orders are displayed. Test Plan 1. For templates with data elements from dialysis orders, make sure no data is displayed from inactive orders. Release Notes Page 20 of 90 Last Saved: 1/12/2016

21 Progress Notes Problem When Adding / Editing a Progress Note, the -> symbol that indicates a window is in add/edit mode is not displayed in the Open Windows section of the main menu Resolution Modified the system to display the -> symbol when a Progress Note is being added or edited. Test Plan 1. When adding a new progress note or making changes to an existing one, make sure the arrow appears next to the Progress Note screen label in the Open Windows area of the main menu. Service Charting Problem When a medication required that the wastage amount be documented, the Waste Amount field was required. When users charted this service, however, they were able to save the medication on the Service Charting screen without entering a waste amount. Resolution The Service Charting application, available as either a standalone application, or as a menu option within the flowsheet applications, has been modified so that medications that require that a waste amount be entered may not be saved until a waste amount has been entered. Test Plan 1. Select a test hemodialysis patient and a test medication that requires that the waste amount be documented. 2. Create a hemodialysis flowsheet for the test patient. 3. Select the Service Charting option. 4. Add the test medication (Step 1 above). Verify that the Waste Amount field is displayed, and that it is displayed as a mandatory field. 5. Complete all of the required fields except the Waste Amount field. 6. Click the Save button. Verify that you receive an error that the Waste Amount field is required. Verify that you are prevented from saving the record. 7. Complete the Waste Amount field. 8. Click the Save button. Verify that you are able to save the record and no longer receive any messages. Verify that the amount entered in the Waste Amount field is saved. Release Notes Page 21 of 90 Last Saved: 1/12/2016

22 Web Resources Problem If the Web Resources window is open and the user closes the Patient Master Header window, then an error will be display: "Invalid Handle..." Resolution Made changes to prevent this issue from occurring Test Plan 1. When closing the Patient Master Header window with the Web Resources window open, make sure the Web Resources window closes also with no errors. Financial Auto Apply Problem When payments were auto applied for a PD claim, the Network Fee Reduction was not calculated correctly for itemized claims. The reduction was calculated correctly for summarized claims, where the service unit is greater than 1. When the claim was itemized, however, the calculated reduction varied by $0.01 or $0.02. The Network Fee Reduction should always be $0.20/treatment. Resolution The Network Fee Reduction calculations have been modified so that regardless of whether a claim is itemized or summarized, the reduction is calculated as $0.20/treatment. Test Plan 1. Select a test PD patient who has primary Medicare coverage. 2. Select a test claim that has treatment services and a non-zero balance. 3. Launch the Payment Transactions application (Main Menu=>Patient Accounting=> Payment Transactions). 4. Enter a test payment and select Auto Apply. 5. Verify that the Network Fee Reduction is calculated at $0.20/treatment. Release Notes Page 22 of 90 Last Saved: 1/12/2016

23 Batch Insurance Pre-Submission Report Problem The insurance validations performed when the Batch Insurance Report was generated did not properly handle checking whether specific Medicaid insurers suppressed or included value code D5, V5, V6 or V7 on the claim (these value codes are used to report Kt/V information). When these codes are suppressed, the validations are not required. Resolution The Pre-Submission Report has been modified so that it checks the background Insurance Setup application to verify whether a patient s Medicaid insurer requires Kt/V information to be reported on a claim. Test Plan 1. Select a test patient whose primary insurer is Medicaid. 2. Contact INFIAN to request that your database be set up to not require the Kt/V information for your test patient s Medicaid carrier. 3. Select test treatment services, verifying that they do not include a CPT modifier of V5, V6 or V7. 4. Enter the test service and post the transactions. 5. Run Batch Insurance. Verify that the claim prints correctly and that you do not receive any messages regarding V5, V6 or V7 CPT modifiers. Claim Data and Service Trx Problem Invalid modalities could be saved on the Claim Tab of the Claim Data and Service Trx application if an invalid modality was entered and the Save button was clicked immediately. When the Save button was selected immediately, the modality was not validated. As a result, the services associated with the claim all referenced an invalid modality. Resolution The Claim Data and Service Trx application has been modified so that the modality is validated regardless of when the Save button is selected. If an invalid modality is entered, an error message is displayed and the record may not be saved until a valid modality is entered. Test Plan 1. Launch the Claim Data and Service Trx application (Main Menu=>Patient Accounting=> Claim Data and Service Trx). 2. Create a new claim for a test patient. Select the Claim tab. Release Notes Page 23 of 90 Last Saved: 1/12/2016

24 3. Enter an invalid modality in the Modality field. Do not press TAB or advance to another field. Instead, click the Save button. 4. Verify that you receive an error message that the modality is invalid. 5. Enter a valid modality in the Modality field, and select the Save button. 6. Verify that that system accepts the modality and the record is saved. 7. Delete the entry in the Modality field, leaving it blank. 8. Save the record. Verify that you do not receive an error message and that the tab is saved. Insurance Policy Maintenance Problem Users were able to enter a lower case entry in the Accept Assignment field on the Insurance Policy Maint screen. When claims are generated, however, the lower case entry caused claims processing to fail. This field should only allow upper case entries in the field. Resolution The Insurance Policy Maint application was modified so that only upper case entries can be entered in the Accept Assignment field. Test Plan 1. Launch the Insurance Policy Maint application (Main Menu=>Patient Accounting=> Insurance Policy Maint). 2. Select a test patient. 3. Add a new policy record for the test patient. Verify that the system does not accept a lower case value in the Accept Assignment field. 4. Launch the Claim Data and Service Trx application (Main Menu=>Patient Accounting=> Claim Data and Service Trx). 5. Select a test patient. Add a new claim for the test patient. Verify that the system does not accept a lower case value in the Accept Assignment field. Clinical Appendices Appendix A - Clinical Dashboards Project Overview A new application, Dashboards, is now available for purchase. Once it has been purchased, it will be added to the TIME system Main Menu. The dashboards bring together disparate data and present it in a meaningful graphical manner so that quick answers to high level questions are available at your fingertips. These Release Notes Page 24 of 90 Last Saved: 1/12/2016

25 dashboards are available when an organization uses TIME s clinical software, and is specifically designed for dialysis-based clinical databases. There are four clinical dashboards: 1. Monthly Hosp/Mortality This dashboard displays a yearly snapshot of the total deaths, hospitalizations and number of hospital admissions for a selected facility, or for all facilities to which a user has access. 2. Dialysis Monthly Treatment The Dialysis Monthly Treatment dashboard displays treatment data for a selected facility, or for all facilities to which a user has access. This dashboard includes graphs to report the following information: a. Noted Absence b. Hemo Treatment Count c. PD Treatment Count d. Missed Treatments with No Reason e. Rescheduled Treatments f. Scheduled Treatments g. Unscheduled Treatments h. Vacations 3. Access Report with Status This dashboard displays patient access data for a selected facility, or for all facilities to which a user has access. The access information is provided by access type, and by facility. 4. Lab Test The Lab Test dashboard includes dashboards for the following types of labs: a. Anemia The Anemia Lab Test dashboard displays graphs of HGB, Ferritin and FE/SAT lab test results. The percentage of results that are above the normal range, below the normal range and within the normal range are displayed by facility. b. Adequacy - The Adequacy Lab Test dashboard displays graphs of KT/V, URR and PDKT/V lab test results. The percentage of results that are above the normal range, below the normal range and within the normal range are displayed by facility. c. Bone Metabolism The Bone Metabolism Lab Test dashboard displays graphs of Calcium, PTH and Potassium lab test results. The percentage of results that are above the normal range, below the normal range and within the normal range are displayed by facility. Project Enhancements Some common features are included in all of the clinical dashboards: 1. Dashboards are generated to display data for the past six months. The Monthly Hosp/Mortality Dashboard is the exception. It reports the past year s data. 2. All Dashboards display the consolidated data to which the user has access, and is based upon the facility selected while logging into the TIME system. If a working facility is not selected, all data to which a user has access is displayed. 3. When a graph is right clicked, the following menu is displayed: Release Notes Page 25 of 90 Last Saved: 1/12/2016

26 You may use this menu to print the graph, or to save it in a format that may be used for other purposes. In addition, you may change the Adobe Flash Player settings associated with the dashboard graphs. 2. When a drill down table or a pivot table includes the symbol to the right of a column heading, you may select a specific item (for example, date, facility name, modality, etc.) to display only the item you selected. Or you may select one of the following: a. All b. Custom c. Blanks d. NonBlanks When Custom is selected, the Custom Filter screen below is displayed. Once the Custom Filter screen is saved, the data displayed in a table or a pivot table is selected based on your custom filter. 4. When a pivot table is right clicked, the following menu is displayed: Release Notes Page 26 of 90 Last Saved: 1/12/2016

27 This menu allows you to group, summarize, reorganize, print and export the table. 5. Clicking on an item on a graph s legend toggles between displaying or hiding the selected variable. When the graph is a pie chart, the piece of the pie will appear to be physically removed from the pie, as is displayed below: When the graph is a bar graph and an item is clicked to remove it from the legend, a graph like the one below is displayed: When Dashboards is selected from the TIME system main menu, the screen below is displayed: Release Notes Page 27 of 90 Last Saved: 1/12/2016

28 The Dashboard application provides the following four dashboards: 1. Monthly Hosp/Mortality The Monthly Hosp/Mortality dashboard includes three tabs: a. Monthly Hosp Mortality Dashboard The Monthly Hosp Mortality Dashboard may be filtered to show an individual facility or all facilities by using the Facility Code drop down filter box. Once selected, three graphs are displayed: i. Total Deaths The Total Deaths graph displays the number of patient deaths reported during the six month period displayed on the dashboard. ii. Total Hospitalization Days The total number of days patients were absent due to hospitalization during the six month period represented by the graph are displayed. iii. # Admissions The total number of patients that were admitted to the hospital during the six month period represented by the graph are displayed. The Monthly Hosp Mortality Dashboard tab is displayed below: Release Notes Page 28 of 90 Last Saved: 1/12/2016

29 b. Data Grid The Data Grid tab, displayed below, provides the following information by month by facility: i. Total Patients ii. Total Deaths iii. Total Hospitalization iv. Total Hospitalization Days v. Death Rate vi. Rate of Hosp. vii. Rate of Hospitalization The Data Grid tab is displayed below: Release Notes Page 29 of 90 Last Saved: 1/12/2016

30 c. Monthly Hosp. Mortality Facility The Monthly Hosp. Mortality Facility tab displays the data presented in the first tab of this dashboard by facility. The graphs may be filtered to display data for a selected facility or for all facility by using the Facility Code filter. The tab is displayed below: Release Notes Page 30 of 90 Last Saved: 1/12/2016

31 2. Dialysis Monthly Treatment The Dialysis Monthly Treatment dashboard is provided on one tab that includes the following: a. Noted Absences - An organization s total of absences by facility recorded over the past six months is displayed on this graph. b. Home Treatment Count The total number of home treatments provided by facility during the past six months is displayed on this graph. c. PD Treatment Count The total number of PD treatments by facility over the past six months is displayed on this graph. d. Missed with No Reason The total count by facility for treatments that were missed by patients but for which a reason for their absence was not recorded over the past six months is displayed on this graph. e. Rescheduled Treatments The total number of rescheduled treatments by facility over the past six months is displayed on this graph. f. Scheduled Treatments The total number of scheduled treatments by facility over the past six months is displayed on this graph. g. Unscheduled Treatments The total number of unscheduled treatments by facility over the past six months is displayed on this graph. h. Vacations The total number of patient vacation days by facility over the past six months is displayed on this graph. Release Notes Page 31 of 90 Last Saved: 1/12/2016

32 The Dialysis Monthly Treatment Dashboard screen is displayed below: When a point on a graph is clicked, a table, like the one displayed below, is displayed automatically to drill down to the patient-specific details associated with the graph: Release Notes Page 32 of 90 Last Saved: 1/12/2016

33 3. Access Report with Status The Access Results with Status dashboard includes three tabs: a. Access Report with Status The Access Report with Status Dashboard may be filtered to show an individual facility or all facilities by using the Facility Code drop down filter box. Once selected, two graphs are displayed: i. Access Results with Status The percentage of an organization s patients with a fistula, catheter or graph over the past six months is displayed on this graph. You may click on a variable (fistula, catheter, graph) from the legend to remove it from the graph, or you may click on that section of the graph to display an additional graph that displays facility-specific results for the selected variable. ii. Access Results This bar graph displays, by facility, the breakdown of accesses by type over the past six months. You may click on a variable (fistula, catheter, graph) from the legend to remove it from the graph, or you may click on that section of the graph to display patient-specific information. The Access Report with Status tab is displayed below: Release Notes Page 33 of 90 Last Saved: 1/12/2016

34 When a section of the Access Results with Status pie chart is clicked, the screen below is displayed: Release Notes Page 34 of 90 Last Saved: 1/12/2016

35 When a section of the Access Results bar graph is clicked, the screen below is displayed so that you may zero in on specific patient data: b. Facility Dashboard - The Facility Dashboard may be filtered to show an individual facility or all facilities by using the Facility Code drop down filter box. Once selected, two graphs are displayed: i. Access Results (pie chart) The Access Results pie chart displays the percentage of patients using each type of access for all facilities or the facility for which the graphs are filtered using the Facility Code filter. You may click a section of the pie chart to remove that variable from the graph. Release Notes Page 35 of 90 Last Saved: 1/12/2016

36 ii. Access Results (line graph) The Access Results line graph displays by month, for the selected facility or all facilities, the percentage of patients using each type of access. You may click on a variable in the legend to toggle between displaying and hiding it on the graph. The Facility Dashboard tab is displayed below: c. Data Grid The Data Grid tab provides patient-specific information about the graphs displayed on the Access Report with Status and Facility Dashboard tabs. The data grid may be filtered to display one facility or all facilities, and by one month or the entire six month period by using the drop down filters. In addition, when the Patient Selection and Physician Rounding App applications are open, you may launch a patient s Physician Rounding App screen by clicking on a patient. Once a patient is selected, you will notice that the patient displayed in the Open Windows section of the TIME system menu is changed to the selected patient. To view the patient s information on the Physician Rounding App screen, simply select Physician Rounding App from the Open Windows section of the menu. Release Notes Page 36 of 90 Last Saved: 1/12/2016

37 The Data Grid tab is displayed below: 4. Lab Tests The Lab Tests dashboard provides dashboards for three lab categories: a. Anemia The Anemia lab category reports HGB, Ferritin and FE/SAT lab test results. b. Adequacy The Adequacy lab category reports KT/V, URR and KDKT/V lab test results. c. Bone Metabolism The Bone Metabolism lab category reports Calcium, PTH and Potassium lab test restults. The main Lab Tests dashboard screen is displayed below: Release Notes Page 37 of 90 Last Saved: 1/12/2016

38 Once a lab category is selected, the labs associated with the lab category are displayed on three graphs, and information is provided on the following tabs: 1. Lab Results Lab Category The label of this tab is determined by the lab category selected from the Lab Category drop down list. For example, if Anemia is selected, the tab is labeled Lab Results Anemia. This tab provides three bar graphs to display a lab category s associated lab tests, outlined above. The data displayed represents an organization s lab test results for all facilities over the past six months. The percentage of lab results that are below the normal range are displayed in yellow. The percentage of lab results that are within the normal range are displayed in green. And the percentage of lab results that are above the normal range are displayed in red. The Lab Results Lab Category screen is displayed below: Release Notes Page 38 of 90 Last Saved: 1/12/2016

39 The primary lab associated with a lab category is displayed in the upper left hand portion of the dashboard. When you click on a portion of the graph, the screen below is displayed: Release Notes Page 39 of 90 Last Saved: 1/12/2016

40 You may zero in on patient-specific data by clicking on a portion of one of the above bar graphs. When a section of the graph is clicked, the pivot table below is displayed: The graphs that display the two additional supporting labs (displayed on the upper right hand side of the dashboard screen and the bottom of the screen) provide two pivot tables users may use to drill down to additional information. When a portion of the graph is clicked, the first pivot table is displayed: Release Notes Page 40 of 90 Last Saved: 1/12/2016

41 This pivot table displays facility-specific information. To drill down to patient-specific details, simply click on a facility. When the facility is selected, the patient-specific pivot table below is displayed: 2. Data Grid The Data Grid tab provides patient-specific results for your selected lab category. The data grid may be filtered to display one facility or all facilities, and by one month or the entire six month period by using the drop down filters. In addition, when the Patient Selection and Physician Rounding App applications are open, you may launch a patient s Physician Rounding App screen by clicking on a patient. Once a patient is selected, you will notice that the patient displayed in the Open Windows section of the TIME system menu is changed to the Release Notes Page 41 of 90 Last Saved: 1/12/2016

42 selected patient. To view the patient s information on the Physician Rounding App screen, simply select Physician Rounding App from the Open Windows section of the menu. The Data Grid tab is displayed below: Test Plan 1. Launch the Patient Selection application (Main Menu=> Patient Selection). 2. Launch the Physician Rounding App application (Main Menu=> Physician Rounding App). 3. Launch the Dashboards application (Main Menu=> Dashboards). 4. Select the Monthly Hosp/Mortality Dashboard: a. Verify that the Monthly Hosp/Mortality Dashboard includes three tabs: Monthly Hosp-Mortality Dashboard, Data Grid and Monthly Hosp-Mortality Facility. b. Verify that the first tab includes the three graphs. c. Verify that they are displayed properly, the data is correct, and that they behave as detailed above. d. Verify that the third tab includes three graphs. Release Notes Page 42 of 90 Last Saved: 1/12/2016

43 e. Verify that they are displayed properly, the data is correct, and that they behave as detailed above. f. Verify that all three tabs may be filtered by facility. 5. Select the Dialysis Monthly Treatment Dashboard: a. Verify that this dashboard includes one tab. b. Verify that there are seven graphs and one pivot table. c. Verify that they are displayed properly, the data is correct,, and that they behave as detailed above. d. Verify that selecting a portion of any of the graphs drills down to patient-specific information. 6. Select the Access Report with Status Dashboard: a. Verify that this dashboard includes three tabs. i. Verify the first tab includes two graphs. 1. Verify that the first graph is a pie chart. Verify that it is displayed properly and that the data is correct. 2. Verify that clicking a section of the graph drills downs to facility-specific information about the selected access type. 3. Verify that clicking on a section of a facility s graph drills down to patientspecific information. 4. Verify that clicking on a variable displayed in the legend toggles between displaying and hiding that variable. 5. Verify that this tab of the dashboard may be filtered to display one facility or all facilities. ii. Verify that the second tab includes two graphs. 1. Verify that clicking on a section of the pie chart removes that variable from the chart. 2. Verify that this tab may be filtered to display one facility or all facilities. 3. Verify that clicking on a variable displayed in the legend for the line graph toggles between displaying and hiding that variable. iii. Verify that the third tab is a data grid. 1. Verify that the data grid may be filtered to show one facility or all facilities, and that it may be filtered to show one month or the entire six month period. 2. Verify that clicking on a patient displayed in the data grid changes the patient selected in the Patient Selection screen, and that the selected patient s data populates the Physician Rounding App screen. 7. Select the Lab Test Dashboard: a. Verify that three lab categories are available: Anemia, Adequacy and Bone Metabolism. b. Verify that once a lab category is selected that lab s dashboard is displayed. c. Verify that the dashboard includes two tabs: i. Verify that the first tab includes three graphs. 1. Verify that when a section of the graph displayed in the upper left portion of the screen (the primary lab) is clicked that it drills down to a graph that displays facility-specific information. a. Verify that clicking on a section of this graph drills down to patientspecific information. 2. Verify that when a section of the other two graphs are clicked, that they drill down to patient-specific information. Release Notes Page 43 of 90 Last Saved: 1/12/2016

44 3. Verify that selecting a patient for any of the dashboard s graphs changes the patient displayed on the Patient Selection screen and populates the Physician Rounding App screen with the selected patient s information. ii. Verify that the second tab is a data grid. 1. Verify that the data grid may be filtered to show one facility or all facilities, and that it may be filtered to show one month or the entire six month periods. 2. Verify that clicking on a patient displayed in the data grid changes the patient selected in the Patient Selection screen, and that the selected patient s data populates the Physician Rounding App screen. d. Verify that each of the three available lab categories generate dashboards, that their dashboards are displayed and behave correctly, and that the data is correct. 8. Verify that right clicking any graph displays a menu that allows you to save the graph in another format or to change the Adobe Flash Player settings. 9. Verify that any pivot table or data grid that includes the icon allows you to select Custom to create a custom filter. Verify that the custom filter displays the correct data. Appendix B - CMS Bundled Comorbidities Progress Notes Using ICD-10 Codes Project Overview The Progress Notes CMS comorbidities screen has been revised in SP24 to display the ICD-10 codes and descriptions when a database has been configured to use ICD-10 Codes. If a database is configured to use ICD-9 codes, they will continue to be used and displayed on this screen. The CMS Comorbidities screen is displayed when a template using the promptable DX Group - Grid data element (Main Menu=> Code Tables=> Medical Records Codes=> Progress Notes Templates=> Add/Edit Template=> Data Elements=> Promptable=> DX Group - Grid) is added to the Progress Notes application. Modified Applications The CMS Comorbidities screen has been modified so that when a database is configured to use ICD-10 codes, the ICD-10 codes and descriptions are displayed on the screen. There are two tabs: Acute and Chronic. The Acute tab is displayed below: Release Notes Page 44 of 90 Last Saved: 1/12/2016

45 The Chronic tab is displayed below: Release Notes Page 45 of 90 Last Saved: 1/12/2016

46 Test Plan 1. Contact INFIAN to verify that your in-service database is configured to use ICD-10 codes. 2. Launch the Progress Note Templates application (Main Menu=>Code Tables=>Medical Records Codes=> Progress Note Templates). 3. Create a progress note template that includes the CMS Comorbidity Grid (Main Menu=> Code Tables=> Medical Records Codes=> Progress Notes Templates=> Add/Edit Template=> Data Elements=> Promptable=> DX Group - Grid) data element. 4. Launch the Progress Notes application (Main Menu=>Medical Records=>Patient Charts=> Progress Notes). 5. Add a new progress note for a test patient using the template created in Step 3 above. 6. Verify that the CMS Comorbidity screen is displayed. Also verify the following: a. There are no duplicate ICD-10 codes displayed b. You are able to choose multiple comorbidities c. You can view a good portion of the ICD-10 descriptions d. You can see the active comorbidities in the top browser. e. Select the Done button. 7. Once the Done button has been selected, verify that the grid is populated correctly in the progress note with the diagnoses you selected on the CMS Comorbidities screen(s). 8. Save the progress note. Verify that it is saved correctly. Release Notes Page 46 of 90 Last Saved: 1/12/2016

47 Appendix C - Dialysis Orders Reports Display Units of Measure for Heparin Project Overview In order to satisfy the requirement of the Joint Commission (JCAHO) that the Heparin units administered to patients be clearly documented, the Dialysis Orders Reports has been enhanced to display the unit of measurement for the following Heparin related fields: 1. Bolus 2. Mnt 3. Total Amt 4. Total Maint The unit of measurement for all of the above fields is units. This information has been added to the Dialysis Orders Reports for these fields. Modified Applications The Dialysis Orders Report has been modified to print the unit of measurement (Units) for the Herparin Ordered fields. The position of the Bolus, Maintenance Heparin, Total Maintenance Heparin and Total Heparin have been adjusted to accommodate the unit of measure for each of these fields. The modified Dialysis Orders Report is displayed below: Release Notes Page 47 of 90 Last Saved: 1/12/2016

48 Test Plan 1. Select a test patient who has a dialysis order that includes heparin values. 2. Take note of the heparin values to compare them to the values printed on the Dialysis Orders Reports. 3. Launch the Dialysis Orders Reports application (Main Menu=>Medical Records=>Treatment Reports=> Dialysis Orders Reports). 4. Generate the report in detailed format for your test patient. 5. Verify that the Heparin values are correct. 6. Verify that the unit of measure, Units, is displayed adjacent to the Bolus, Maintenance, Total Heparin and Total Maintenance Heparin values. Appendix D - Flowsheets Respiratory Rate Default Value Project Overview Prior to the release of SP24, the Respiratory Rate on the Hemodialysis Flowsheet Pre and Post Treatment Vitals screens and the Peritoneal Flowsheet Treatment Vitals screen defaulted to zero (0). In an effort to avoid erroneous and misleading documentation of the respiratory rate, these fields now default to blank. Unless a Release Notes Page 48 of 90 Last Saved: 1/12/2016

49 user has entered valid values in these fields, they are now displayed as blank on both the entry screens and on the reports. Modified Applications The following applications were modified to default the Respiratory Rate to blank: 1. Hemodialysis Flowsheet Two of the hemodialysis flowsheet screens have been modified so that the respiratory rate fields default to blank: a. Pre-Treatment Vitals The Pre-Treatment Vitals screen, displayed below, now defaults the Resp Rate field to blank: b. Post-Treatment Vitals - The Post-Treatment Vitals screen, displayed below, now defaults the Post Resp Rate field to blank: Release Notes Page 49 of 90 Last Saved: 1/12/2016

50 2. Hemodialysis Flowsheets Rpt The Hemodialysis Flowsheets Rpt, displayed below, has been modified to print a blank in the Resp Rate portion of the report when an entry has not been made on the flowsheet treatment vitals screens. Release Notes Page 50 of 90 Last Saved: 1/12/2016

51 3. Peritoneal Flowsheet The Treatment Vitals screen of the Peritoneal Flowsheet, displayed below, has been modified so that the Resp Rate field defaults to blank. 4. Peritoneal Flowsheets Report - The Peritoneal Flowsheets Report, displayed below, has been modified to print a blank in the Resp Rate portion of the report when an entry has not been made on the flowsheet treatment vitals screen. Release Notes Page 51 of 90 Last Saved: 1/12/2016

52 Test Plan 1. To test the changes to the Hemodialysis Flowsheet: a. Select a test patient with an existing prior flowsheet. b. Launch the Hemodialysis Flowsheet application (Main Menu=>Medical Records=>Flowsheets=> Hemodialysis Flowsheet). Create a new flowsheet a date after the flowsheet identified in Step 1.a. above. c. Complete the Machine/Dlyzr Checks screen. Select the Pre-Treatment Vitals screen. Verify that the Resp Rate field defaults to blank. d. Verify that the Pre and Post Resp Rate values displayed from the prior flowsheet are either a valid value or are blank. Verify that zero is not displayed. e. Save the Pre-Treatment Vitals screen. f. Complete all screens up to the Post Treatment Vitals screen. g. On the Post Treatment Vitals screen, verify that: i. The Post Resp Rate defaults to blank. ii. The Post Resp Rate from the previous flowsheet is either a valid value or it is blank. h. Select the Pre Treatment Vitals screen again. Enter a valid value in the Resp Rate field and save the entry. i. Select the Post Treatment Vitals screen and verify that the Pre Resp Rate has been updated correctly. 2. To test the changes to the Hemodialysis Flowsheets Rpt.: a. Select a test patient who has a flowsheet on which the Pre and Post Resp Rate fields are blank. b. Launch the Hemodialysis Flowsheets Rpt. application (Main Menu=>Medical Records=>Treatment Reports=> Hemodialysis Flowsheets Rpt.). c. Generate the report for the patient identified in Step 2.a. above.. d. Verify that the report displays blanks in these fields. 3. To test the changes to the Peritoneal Flowsheet and Peritoneal Flowsheets Report applications: Release Notes Page 52 of 90 Last Saved: 1/12/2016

53 a. Launch the Peritoneal Flowsheet application (Main Menu=>Medical Records=>Flowsheets=> Peritoneal Flowsheet). b. Select a test patient and create a new flowsheet. i. Select the Treatment Vitals screen. ii. Verify that the Resp Rate field defaults to blank. iii. Leave the Resp Rate field blank and complete all of the flowsheet screens. Save the flowsheet. c. Launch the Peritoneal Flowsheets Report application (Main Menu=>Medical Records=>Treatment Reports=> Peritoneal Flowsheets Report). d. Generate a report for the flowsheet created in step 3.b. above. e. Select the Peritoneal Flowsheet application again to identify a patient for whom the Resp Rate was not entered. Run the Peritoneal Flowsheets Report for this patient and flowsheet. Verify that the Resp Rate is displayed as blank. Appendix E - Home Dialysis Service Charting Project Overview Two new optional settings have been added to the Home Dialysis Service Charting application in an effort to avoid user entry errors and to improve communication with the billing office: 1. Services and treatments have always defaulted to Y as done. An optional setting is now available that sets this to blank, and requires that users manually select each patient and service, and mark it as done. 2. The Save Currently Open button allows users to save administrations for multiple patients at one time. A new option has been added to disable this button, requiring that users save each patient, one at a time. Modified Applications The Home Dialysis Service Chart application with the two new optional settings is displayed below: Release Notes Page 53 of 90 Last Saved: 1/12/2016

54 Test Plan 1. Launch the Home Dialysis Service Chart application (Main Menu=>Medical Records=>Clinical Operation Mgmt=> Home Dialysis Service Chart). 2. Verify the application works as it always has. 3. Contact INFIAN support and request that the two new optional settings be enabled. 4. On the Home Dialysis Service chart screen, verify that: a. All patients load into the application as expected for the date range selected. b. All calendar days where an administration is expected is highlighted in red, but the entry is blank. c. The Save Currently Open button is always disabled. d. Administration of treatments, medications and labs are correctly documented as administered once a Y is entered and the Save This Patient button is selected. e. All previous validations upon saving the records are still performed. 5. Verify all services marked as administered transfer correctly when the Svc Transfer from Clinical process is run. Release Notes Page 54 of 90 Last Saved: 1/12/2016

55 Appendix F - Immunization History VIS Date Display Project Overview The Immunization History application has been enhanced to provide an immunization s VIS (Vaccine Information Sheet) publication date when viewing or entering an immunization. When an immunization is administered in a TIME facility, the VIS publication date is copied from the TIME immunization service code (when available), and is displayed as display only information. In addition, immunizations that do not originate from the TIME system may be updated to add the VIS publication date in the new VIS Date field. Modified Application The Immunization History screen, displayed below, has been modified to add the VIS Date field. This enhancement includes the following: 1. When a vaccination is given and charted using the TIME system, the VIS Date field is updated with the VIS Date entered in either the Service Codes or the Medication Codes table. 2. When a vaccination does not originate from within the TIME system, the VIS Date field is available so that a date may be entered. This field is not a required field. Release Notes Page 55 of 90 Last Saved: 1/12/2016

56 3. The VIS Date and VIS To Pt (patient) has also been added to the browser portion of this screen for easier reference. Test Plan 1. Launch the Medication Codes table (Main Menu=>Code Tables=>Medical Records Codes=> Medication Codes). 2. Select a test vaccination code. Enter a VIS Date if one is not already entered for your test code. 3. Select a test patient. 4. Launch the Service Charting application (Main Menu=>Medical Records=>Patient Charts=> Service Charting). 5. Enter the vaccination selected in Step 2 above for your test patient. 6. Launch the Immunization History Application (Main Menu=>Medical Records=>Patient Charts=> Immunization History). a. Verify that the VIS Date is displayed. b. Verify that the VIS Date field may not be modified. c. Select a patient who has vaccination information that was not entered directly in the TIME system. d. Verify that you are able to select and modify the VIS Date field. Appendix G - Non-ESRD Enhancement Project Overview Because most medication and lab orders are now included as part of the ESRD Bundled Payments, it has become more important that the Non-ESRD field be completed correctly to minimize lost revenue. Prior to SP24, the Non-ESRD field was a checkbox and was not handled as a required field. In an effort to capture as many billable services as possible, a new option has been released in the SP24 release of the TIME system. This option allows users to require that the Non-ESRD field be completed in order to save the record. When this new option is turned on, the checkbox is changed to a Yes/No combo box. In addition, the Administered Services Crystal report is added an option to list only Non-ESRD services. Modified Applications The following applications have been modified to include the new Non-ESRD combo box when the option is turned on: 1. Medication Orders: The modified Medication Orders screen is displayed below: Release Notes Page 56 of 90 Last Saved: 1/12/2016

57 The Non-ESRD field is visible when one of two conditions are met: a. The medication is defined as a bundled service. b. There is no HCPC code defined for the medication and the option to automatically default a Non-ESRD value is turned on. When the Non-ESRD field is visible: 1. If the medication is a Home medication, the Non-ESRD field is disabled and the field is automatically set to N. 2. If the medication is an in-center medication, the field is completed as follows: a. When the medication is administered, the Non-ESRD field is disabled. Otherwise, the Non- ESRD field is enabled. b. When the medication is defined by CMS as non-payable, the Non-ESRD field is automatically defaulted to N. 2. Alternate Lab Orders: The modified Alternate Lab Orders screen is displayed below: Release Notes Page 57 of 90 Last Saved: 1/12/2016

58 The Non-ESRD field is visible when one of two conditions are met: a. The lab test is defined as a bundled service. b. There is no HCPC code defined for the lab test and the option to automatically default a Non- ESRD value is turned on. When one of the two conditions above are met, and the Non-ESRD field is visible, if a lab test is defined by CMS as non-payable, the Non-ESRD field automatically defaults to N. 3. Standard Lab Order: The modified Standard Lab Order screen is displayed below: Release Notes Page 58 of 90 Last Saved: 1/12/2016

59 The Non-ESRD field is visible when one of two conditions are met: a. The lab test is defined as a bundled service. b. There is no HCPC code defined for the lab test and the option to automatically default a Non- ESRD value is turned on. When one of the two conditions above are met, and the Non-ESRD field is visible, if a lab test is defined by CMS as non-payable, the Non-ESRD field automatically defaults to N. 4. Service Charting: The modified Service Charting screen is displayed below: Release Notes Page 59 of 90 Last Saved: 1/12/2016

60 The Non-ESRD field is hidden when the service is a treatment service. Otherwise, the Non-ESRD field is visible. When the Non-ESRD field is visible: a. When a service originates from orders: i. The Non-ESRD field is set to the same value as it was set in the order. ii. When the Non-ESRD field was not set in the originating order and the service is defined by CMS as non-payable, the Non-ESRD field defaults to No. b. When a service does not originate from orders and is added within the Service Charting application: i. When the service is defined by CMS as non-payable, the Non-ESRD field defaults to No. ii. Otherwise, the Non-ESRD field defaults to blank. 5. Crystal Reports: The Administered Services Clinical Crystal Report has been modified to add a new prompt that allows users the option of selecting only Non-ESRD services. The new prompt, displayed below, is available regardless of whether the new Non-ESRD combo box option is enabled. Release Notes Page 60 of 90 Last Saved: 1/12/2016

61 Test Plan 1. Test the Crystal Reports application: a. Launch the clinical Crystal Reports application (Main Menu=>Medical Records=>Clinical Reports=> Crystal Reports). i. Select the Admin Services Clinical report. ii. Verify that the Show only services given for non-esrd purposes (Non-ESRD) selection criteria is available. iii. Set the option to Y. iv. Verify that the generated report lists only the non-esrd services. 2. Contact INFIAN and request that the Non-ESRD combo-box option be turned on. 3. Test the Medication Orders application: a. Launch the Service Codes maintenance screen (Main Menu=>Code Tables=>Transaction Codes=> Service Codes). i. Identify three test medication service codes: 1. An ESRD bundled service and is not payable by CMS 2. An ESRD bundled service and is payable by CMS 3. A non-esrd service b. Launch the Medication Orders application (Main Menu=>Medical Records=>Patient Charts=> Medication Orders). i. Test a bundled service that is not payable by CMS: 1. Select the medication service that is defined as an ESRD bundled service and is not payable by CMS. 2. Create a medication order using the above test service. Release Notes Page 61 of 90 Last Saved: 1/12/2016

62 3. Verify that the Non-ESRD field is visible and that it defaults to No. ii. Test a bundled service that is payable by CMS: 1. Select the medication service that is defined as an ESRD bundled service and is not payable by CMS. 2. Create a medication order using the above test service. 3. Verify that the Non-ESRD field is visible and that it defaults to blank. 4. Save the record without completing the Non-ESRD field. 5. Verify that you are prevented from saving the order until the Non-ESRD field is completed. iii. Test a non-esrd service: 1. Select the medication service that is defined as a non-esrd service. 2. Create a medication order using the above test service. 3. Verify that the Non-ERD field is hidden. 4. Test the Lab Orders application: a. Launch the Service Codes maintenance screen (Main Menu=>Code Tables=>Transaction Codes=> Service Codes). i. Identify two test lab service codes: 1. An ESRD bundled service and is payable by CMS 2. A non-esrd service b. Launch the Lab Orders application (Main Menu=>Medical Records=>Patient Charts=> Lab Orders). i. Test the ESRD bundled lab service that is payable by CMS: 1. Select the lab service that is defined as an ESRD bundled service that is payable by CMS. 2. Create a lab order using the above test service. 3. Verify that the Non-ESRD field is visible and that it defaults to blank. 4. Save the record without completing the Non-ESRD field. 5. Verify that you are prevented from saving the order until the Non-ESRD field is completed. ii. Test the non-esrd lab service: 1. Select the lab service that is defined as a Non-ESRD service. 2. Create a lab order using the above test service. 3. Verify that the Non-ESRD field is hidden. 5. Test the Service Charting application: a. To test the Service Charting application, you will use the orders created in the tests above. b. Launch the Hemodialysis Flowsheet application (Main Menu=>Medical Records=>Patient Charts=>Flowsheets=> Hemodialysis Flowsheet). i. Select the patient for whom orders were created above. ii. Select the Service Charting menu option. iii. View the orders created in the steps above. iv. Verify that the Non-ESRD field is completed on the Service Charting option the same way it was on the originating order. 1. Verify that the Non-ESRD field is visible and editable on the ESRD services. 2. Verify that the non-esrd field is hidden for the non-esrd service. c. Launch the Service Charting application (Main Menu=>Medical Records=>Patient Charts=> Service Charting). Release Notes Page 62 of 90 Last Saved: 1/12/2016

63 i. Verify that the Non-ESRD field operates correctly as documented, both in services for which there is an originating order, and for services that are created within the application. Appendix H _ Physician Rounding App Project Overview The Physician Rounding App has been enhanced in SP24 to provide better information needed by clinicians to make decisions, without requiring them to view detail screens. The following Physician Rounding App screen parts have been enhanced: 1. Hemo Flowsheet Grid The grid has been modified to display the Pre-Temp and Post-Temp. 2. Labs and Admin Meds Grid High and low lab results are now color coded to provide quick identification of labs that are out of the tolerance range. Pink is used for high lab values, and yellow is used for low lab values. 3. Medication Orders Grid The grid has been modified to include the following fields: a. Stop Reason b. Disp Order c. Dx Code d. Dx Code2 e. Disp Amount f. Doctor Name g. Employee Name h. Stop Dr i. Stop Employee In addition, new screen parts have been added to support the new capabilities with TIME Mobile to document Chief Complaint and Impressions. If you have purchased licenses for TIME Mobile, the Chief Complaint and Impression information clinicians document via TIME Mobile can be displayed (view-only) in the Physician Rounding App. NOTE: Details about the new TIME Mobile capabilities as they relate to the Physician Rounding App will be available in the TIME Mobile documentation that will be published in 1Q2016. Modified Applications The following screen parts have been modified in SP24: 1. Hemo Flowsheet Grid The Hemo Flowsheet History Grid, displayed below, has been modified to display Pre-Temp and Post-Temp. Release Notes Page 63 of 90 Last Saved: 1/12/2016

64 2. Labs and Admin Meds - The Labs and Admin Meds screen part has been enhanced to highlight lab results that are above or below the normal range. Labs that are above the normal range are highlighted in pink; labs that are below the normal range are highlighted in yellow. The revised screen part is displayed below: 3. Medication Orders Grid The Medication Orders Grid has been enhanced to include the following fields: a. Stop Reason b. Disp Order c. Dx Code d. Dx Code 2 e. Disp Amount f. Doctor Name g. Employee Name h. Stop Dr i. Stop Employee The revised screen is displayed in the two screen shots below: Release Notes Page 64 of 90 Last Saved: 1/12/2016

65 Test Plan 1. Launch the Physician Rounding App (Main Menu=> Physician Rounding App). 2. Create a physician rounding view that contains the Hemo Flowsheet Grid, Labs and Admin Meds Grid and the Medication Orders Grid. 3. Verify that the enhancements listed above are displayed and perform as described above. Appendix I - Service Charting NDC Vendor Project Overview Release Notes Page 65 of 90 Last Saved: 1/12/2016

66 In an effort to increase the usability of the service charting screens, and to reduce errors, the NDC section of the Service Charting screen has been enhanced to display the vendor name corresponding to the NDC code of a selected medication. The vendor name is display only. Modified Applications The following applications have been modified to provide the additional NDC information: 1. Service Charting - The Service Charting application has been enhanced as follows: a. The Vendor Name has been added to the NDC box at the bottom of the screen. This field is display only. b. The NDC box has been enlarged horizontally and vertically to accommodate the new NDC Vendor information. The modified Service Charting screen is displayed below: 2. Service Codes Export Import Utility The Service Codes Export Import Utility (Main Menu=> Code Tables=> Transaction Codes=> Service Codes=> File=> Mass Update=> Service Codes Export Import Utility) has been modified to include the vendor name, so that you are now able to update the vendor name on the NDC records on all applicable services. The new field option is displayed below: Release Notes Page 66 of 90 Last Saved: 1/12/2016

67 Test Plan 1. Select a test medication code that is set up with an NDC number and NDC vendor. 2. Select a test patient. Make sure the patient s facility is set up in the Facility Codes table with the Enable Clinical NDC checkbox selected. 3. Launch the Service Charting application (Main Menu=>Medical Records=>Patient Charts=> Service Charting). 4. Select your test patient. Add the test medication code. 5. Verify that the NDC Vendor name is displayed in the NDC box, and that the vendor name is a display only field and may not be modified. 6. Verify that the NDC box has been enlarged both horizontally and vertically. 7. Exit the Service Charting application. 8. Launch the Service Export Import Utility (Main Menu=> Code Tables=> Transaction Codes=> Service Codes=> File=> Mass Update=> Service Codes Export Import Utility). 9. Enter your test service code and click Search. 10. Verify that the NDC Vendor field is available in the Select Fields to Download multi-select box. Appendix J - Treatment Observations Comments Project Overview The Treatment Observations screen of the Hemodialysis Flowsheet application has been enhanced to include a comments section. Entry on this screen has been streamlined so that it requires fewer clicks. Users are no Release Notes Page 67 of 90 Last Saved: 1/12/2016

68 longer required to click the Comments button to enter a comment on the observation screen. Observations and comments may be viewed, added and entered on the screen. One signature signs both the observation and the comment. Once a comment is entered and saved on the Treatment Observations screen, it is added to the Progress Notes application. Modified Applications The modified hemodialysis flowsheet Treatment Observations screen is displayed below: The following changes are included in SP24: 1. If an organization s hemodialysis flowsheet Treatment Observations screen is not configured to be template-driven, the Comments button is hidden. Users may enter comments directly on the Treatment Observations screen above. 2. If an organization s hemodialysis flowsheet Treatment Observations screen is configured to be templatedriven, the comments section is not displayed on the observations screen. The screen remains as it was prior to the release of SP One signature signs both the treatment observations and the comments entered on this screen. Test Plan 1. Select a test hemodialysis patient. 2. Verify that your organization is not configured to use template-driven comments on the Treatment Observations screen. 3. Launch the Hemodialysis Flowsheet application (Main Menu=>Medical Records=>Flowsheets=> Hemodialysis Flowsheet). Release Notes Page 68 of 90 Last Saved: 1/12/2016

69 4. Select the Treatment Observations screen. 5. Verify that the Comments section has been added to the screen. a. Verify that the comments box is displayed. b. Verify that the Category drop down combo box is displayed. c. Verify that the Sub-Category drop down combo box is displayed. d. Verify that the Phz button is displayed to the right of the comments box. e. Select the Phz button. Verify that you are able to select a standard phrase and add it to your comment. 6. Save the Treatment Observations screen. Verify that you are only required to sign the observations and comments record once. Financial Appendices Appendix K Batch Insurance Allow to Submit Future Dates Project Overview In order to assist you in testing ICD-10 diagnosis codes, INFIAN has revised the TIME system to allow future dated financial claims and transactions in your in-service database. This will allow you to enter a future date before and after the CMS ICD-10 implementation date of 10/01/2015. Claims and transactions on or after 10/01/2015 will use ICD-10 codes; claims and transactions prior to 10/01/2015 will use ICD-9 codes. Prior to using this feature, you must first import and assign ICD-10 codes to the diagnosis codes. When this has been completed, simply contact INFIAN support to enable the ability to use future dates on claims and transactions in the in-service database. Modified Applications The following applications have been modified in the In-Service database to allow ICD-10 code testing when the future date option has been implemented: 1. Claim Data and Service Trx The Claim Data and Service Trx application has been modified to accept future claim and transaction dates. There were no changes made to the screens. 2. Payment Transactions The Payment Transactions application has been modified to accept future payment dates. There were no changes made to the screen. 3. Adjustment Transactions The Adjustment Transactions application has been modified to accept future adjustment dates. There were no changes made to the screen. 4. Batch Insurance The Batch Insurance application has been modified to allow the submission of future dated claims and services. There were no changes made to the screen. 5. On Demand Insurance The On Demand Insurance application has been modified to allow the submission of future dated claims and services. There were no changes made to the screen. Test Plan 1. Log into your in-service database. Release Notes Page 69 of 90 Last Saved: 1/12/2016

70 2. Import and assign the ICD-10 codes to the TIME system diagnosis codes. Refer to the ICD-10 Roadmap document for instructions. C:\Users\bmccracken\ICD-10 Roadmap.pdf 3. Once you have mapped and assigned the ICD-10 codes, contact INFIAN support and request that the option to allow future dates for the financial records, detailed above, be enabled. 4. Select a test patient who has current primary and secondary insurance policies. 5. Launch the Claim Data and Service Trx application (Main Menu=>Patient Accounting=> Claim Data and Service Trx). 6. Enter a claim with dates that are less than the CMS ICD-10 implementation date. a. Enter service and adjustment transactions on the claim. 7. Enter a claim with dates that are greater than or equal to the CMS ICD-10 implementation date (10/01/2015). a. Enter service and adjustment transactions on the claim. 8. Launch the Post Transactions application (Main Menu=>Patient Accounting=> Post Transactions). Post the service and adjustment transactions. 9. Launch the Batch Insurance application (Main Menu=>Patient Accounting=>Billing=> Batch Insurance). 10. Create a test insurance batch that includes your test claims created in Steps 6 and 7 above. 11. Print paper claims, and verify the following: a. The future dated claim on or after 10/01/2015 uses the ICD-10 code. b. The future dated claim prior to 10/01/2015 uses the ICD-9 codes. 12. Create an electronic claim batch for your test claims. Contact INFIAN support to review your electronic file to verify that the correct ICD code is used on the claim. 13. Launch the Payment Transactions application (Main Menu=>Patient Accounting=> Payment Transactions). Apply payments with future dates to both test claims. 14. Post the payment transactions. 15. Launch the On Demand Insurance application (Main Menu=>Patient Accounting=>Billing=> On Demand Insurance). 16. Generate claims for your test claims. Verify that they are correct and use the appropriate ICD codes. Appendix L Financial Dashboards Project Overview A new optional application, Dashboards, is now available for purchase. Once it has been purchased, it will be added to the Financial Reports menu. The financial dashboards bring together disparate data and present it in a meaningful graphical manner so that quick answers to high level questions are available at your fingertips. The data presented in the financial dashboards is generated and preloaded into the dashboards overnight so that users may view the dashboards without the need to wait for data to generate. There are four dashboards: 1. Drug Utilization An organization s drug utilization over a six month time frame may be viewed on the Drug Utilization dashboard. Only drugs whose administration can be tied to a treatment are selected and added to the tally. Each drug utilization graph offers a single click drill down that presents the transactional data that supports the selected graph. 2. Accounts Receivable The Accounts Receivable dashboard provides an organization different views of its existing/outstanding accounts receivable balance. This includes all claims that have a balance. Claims are aged using the claim aging by calendar month process. The accounts receivable balances are broken down by pay class. In addition, a single click drill down is available on the graphs to present transactional claim data represented in the graphs. Release Notes Page 70 of 90 Last Saved: 1/12/2016

71 3. Net Revenue The Net Revenue dashboard provides an organization different views of their net revenue over a four year period, including the current day of the current month. The net revenue is calculated as the total charges less the total adjustments. A single click drill down is available on the graphs to present transactional data represented in the graphs. 4. Payer Mix The Payer Mix dashboard allows an organization to easily view how its patient population is represented across the different pay classes, in other words, the total number of patients covered by each pay class. The Payer Mix dashboard defines payer mix as a list of all active patients whose policy records for a specific context date represent payers who belong to a specific pay class. For example, if the dashboard is displayed for Today, and John Doe s current payer is Medicare, he is added to the Medicare pay class total. The Payer Mix may be constrained by a specific context date, facility, and, when applicable, by degree of coverage and/or modality. The date context is defined as follows: a. Today today refers to the last date on which the nightly process to generate the data was run successfully. b. December 31 of the previous year c. December 31 of two years prior to today The data presented is based on only those patients who were active within the selected date context. Once selected for inclusion, the patients insurance policies are based on the insurer s pay class and the degree of coverage (for example, primary, secondary, etc.). This information is maintained based on the patient s insurance policy set records. A single click drill down is available on the graphs to represent the policy data represented in the graphs. Project Enhancements Some common features are included in all of the financial dashboards: 1. The graphs displayed on any of the dashboard tabs offer a single click drill down capability. When a point on a graph is clicked, a table, like the one displayed below, is displayed automatically to drill down to the transactional details associated with the graph. Release Notes Page 71 of 90 Last Saved: 1/12/2016

72 2. When a drill down table or a pivot table includes the symbol to the right of a column heading, you may select a specific item (for example, date, facility name, modality, etc.) to display only the item you selected. Or you may select one of the following: a. All b. Custom c. Blanks d. NonBlanks When Custom is selected, the Custom Filter screen below is displayed. Release Notes Page 72 of 90 Last Saved: 1/12/2016

73 Once the Custom Filter screen is saved, the data displayed in a table or a pivot table is selected based on your custom filter. 3. When a pivot table is right clicked, the following menu is displayed: This menu allows you to group, summarize, reorganize, print and export the table. 4. Clicking on an item on a graph s legend toggles between displaying or hiding the selected variable. When the graph is a pie chart, the piece of the pie will appear to be physically removed from the pie, as is displayed below: Release Notes Page 73 of 90 Last Saved: 1/12/2016

74 5. When a graph is right clicked, the following menu is displayed: You may use this menu to print the graph, or to save it in a format that may be used for other purposes. In addition, you may change the Adobe Flash Player settings associated with the dashboard graphs. 6. Many of the dashboard tabs provide constraints so that you may define which facility, modality, pay class, payer degree and date context is displayed on the dashboard. Some tabs include constraints in two places: in the box above the graph, or displayed to the left of the graphs. Whenever a constraint is changed, the graphs are automatically recalculated and redisplayed. When the Dashboards application is selected from the Financial Reports menu, the screen below is displayed: Release Notes Page 74 of 90 Last Saved: 1/12/2016

75 The Financial Dashboard project provides the following four dashboards: 1. Drug Utilization The Drug Utilization dashboard includes three tabs: a. Drug Utilization The Drug Utilization tab offers three graphs: i. Drug Utilization For Organization: This is the main graph on the Drug Utilization tab. The graph is created by selecting a specific drug as well as a modality from the primary filter fields. The primary filter fields are located in the box above the graphs. The resulting graph displays, by calendar month, the drug dose average per treatment for each of the facilities selected from the secondary filters, which are displayed to the left of the graphs. In addition, the graph may be further defined by the payers pay class by selecting the pay class checkboxes from the secondary filters. The legend of colors used to display a facility s information is displayed in the Drug Utilization By Facility graph (displayed to the right of the Drug Utilization For Organization graph). ii. Drug Utilization By Facility: This graph is a pie chart that displays, by facility, the average dosage of the drug, selected in the Drugs filter, that is administered per treatment by each facility. A facility is displayed only when there are records for the time context for the selected drug that was administered during a treatment. When the drug, modality or pay class filter is changed, the graph is automatically recalculated and displayed. Changing the facility filter does not affect the graph. Release Notes Page 75 of 90 Last Saved: 1/12/2016

76 iii. The Top 5 Drug Utilization Facilities: This graph displays the organization s top five facilities that administer the selected drug during treatment sessions. When the modality, drug, facility or pay class filter is changed, the graph is automatically recalculated and displayed. Changing the facility filter does not affect the graph. The first tab of the Drug Utilization dashboard is displayed below: b. Drug Utilization Facility Details This tab zeroes in on one selected facility s drug utilization for one drug type at a time. By selecting a facility and a drug on the left hand filter, the graph is automatically populated with that facility s drug usage by pay class. In addition, the graph is filtered to display only one modality at a time. Clicking on the graph automatically displays a table that lists the specific constraints for the portion of the graph selected. For example, if you select the first bar of the graph, a table displaying the constraints represented in that bar is displayed automatically in a table. The Drug Utilization Facility Details tab is displayed below: Release Notes Page 76 of 90 Last Saved: 1/12/2016

77 c. Drug Utilization Pivot Table The Drug Utilization Pivot Table, displayed below, provides the data and a summary of the data that has been presented within the other dashboard tabs. Release Notes Page 77 of 90 Last Saved: 1/12/2016

78 Each of the three tabs detailed above are governed by the following rules: 1. The most recent six months of data is selected for the graphs and pivot table. 2. The drugs for which the graphs and table are available are based upon the organization s medication classes. 3. Drug utilization is calculated by adding the dosages of all administered drugs within a specific medication class for a month s time frame, for a given facility, modality and pay class. 4. The treatments are calculated by adding the treatment counts for a month s time frame, for a given facility, modality and pay class. 5. The pay class is determined based on the patient s primary insurer. 6. A patient s modality is determined as follows: a. If an organization uses the TIME system for both its clinical and financial applications, and the financial applications are used for the purpose of dialysis claims, the modality if retrieved from the patient s modality history. If the patient does not have a modality history record that applies to the time frame used by the dashboard, the modality is determined by the treatment code used to identify the patient s treatment. For example, if the patient s treatment code is a hemodialysis treatment code, the patient will be identified as a HEMO patient. b. If an organization only uses the TIME system for its financial applications, the modality is determined based on the treatment associated with the patient s drug administrations. 7. The average drug utilization is calculated by dividing the total dosage amount (item 3 above) by the number of treatments (item 4 above), where like breaks are summed. For example, Release Notes Page 78 of 90 Last Saved: 1/12/2016

79 the average drug utilization of EPOGEN for Facility A hemodialysis patients whose primary insurer is a Medicare pay class. 8. Because only drugs that can be tied to a treatment may be billed to payers, the dashboard limits the selection of the drugs displayed on the graphs and tables to those drugs. 2. Accounts Receivable The Accounts Receivable dashboard includes four tabs: a. A/R General: The A/R General tab provides six graphs: i. Account Receivables Balances this graph displays debit and credit balances by facility. The debit balances are highlighted in blue; the credit balances are displayed to the right of the debit balances and are not highlighted. ii. Account Receivable Days this graph displays each facility s average number of days in accounts receivable. This total is calculated by dividing the facility s total accounts receivable by the average daily net revenue. The average daily net revenue is calculated by dividing the last full month s net revenue by the number of day in that month. iii. Current Accounts Receivable by Pay Class The organization s total accounts receivable is displayed in a pie chart that reports each pay class accounts receivable. For example, the total accounts receivable for which Medicare is responsible. iv. Average Daily Net Revenue This pie chart displays by facility the net revenue for the last full calendar month divided by the number of days in that month. v. Claims Aged Greater than 90 Days by Pay Class This pie chart displays the number of claims by pay class that are in the greater than 90 days aging bucket. vi. Pay Class Percentage of A/R Greater than 90 Days This pie chart is calculated by dividing each pay class claim count of the number of claims greater than 90 days old, by the organization s total claims that are greater than 90 days old. The A/R General tab is displayed below: Release Notes Page 79 of 90 Last Saved: 1/12/2016

80 b. A/R Aging: The A/R Aging tab provides three different representations of an organization s A/R Aging: i. A pivot table displays, by facility, totals for each aging bucket as well as grand totals for each facility and for the organization as a whole. Cells within the table may be clicked to drill down to an additional table that displays transactional details that comprise the totals. ii. A/R Totals for Organization This pie chart displays the organization s A/R totals by facility. iii. Aging Amounts This bar graph displays the organization s A/R totals for each aging bucket by facility. The aging buckets are color coded and defined in the legend. When a total is small and the graph is scaled, the colors are not always visible on the graph. Placing the mouse by the bottom axis will display the associated bucket. Using this method, users may also click to drill down to a table that provides transactional details. The A/R Aging tab is displayed below: Release Notes Page 80 of 90 Last Saved: 1/12/2016

81 c. A/R Percentages The A/R Percentages tab provides a bar graph that displays, by facility, the total A/R. The aging buckets are color coded within each bar. By allowing the cursor to hover over an area of the bar graph, the aging bucket to which the cursor is pointing is displayed as well as the percentage of the facility s total A/R that is represented by the selected aging bucket. A pivot table with the facility specific aging information is displayed above the bar graph. The Aging Percentages tab is displayed below: Release Notes Page 81 of 90 Last Saved: 1/12/2016

82 d. Claim Aging Details This tab is a pivot table that displays the transactional details related to the organization s aging buckets. The data is first sorted by facility, and then alphabetically by patient within each facility. The patient s information is broken down by individual claim. Each claim details the claim balance, the responsible party and which degree of coverage and pay class is responsible for the balance, as well as into which aging bucket the balance falls. A total for each claim as well as an organizational grand total for each column is displayed. The Claim Aging Details tab is displayed below: Release Notes Page 82 of 90 Last Saved: 1/12/2016

83 Each of the four tabs detailed above are governed by the following rules: I. The Accounts Receivable Dashboard includes all claims that have a balance, regardless of whether the balance is a debit balance or a credit balance. II. III. All data processed and included in the dashboard are pulled at the claim level. Accounts Receivable Days is calculated as Total Facility A/R divided by the Average Daily Net Revenue for that facility. The Average Daily Net Revenue is calculated by dividing the net revenue for the last full month by the number of calendar days in that month. IV. The net revenue is calculated at the claim level and represents the total services minus adjustments. V. Claims are aged using the standard claim aging by calendr month process. I. The claim s current responsible party is determined at the time the last aging process was run. II. If a patient is identified as being responsible for payment towards the claim, the age of that self pay amount is calculated by subtracting the claim s end date from the process calculation date (TODAY). VI. III. If an insurer is currently responsible for the claim, the age is determined by subtracting the last calendar day of the month to which the claim s end date belongs from the process calculation date. This can sometimes be the same date. Current aging greater than 90 days presents A/R by current pay class where claims have aged beyond 90 days. The current responsible party is shown as of the data generation date supporting the dashboards. Release Notes Page 83 of 90 Last Saved: 1/12/2016

84 3. Net Revenue The Net Revenue dashboard includes three tabs: a. Net Revenue: The Net Revenue tab provides three graphs: I. Net Revenue by Modality: This graph displays an organization s net revenue by modality for the facility/facilities selected in the Net Revenue Constraints box, displayed on the left side of the screen. As facilities are selected or de-selected, or modalities are selected or de-selected from the legend below the graph, the graph is recalculated and redrawn. Four years of data is included on this graph. II. Net Revenue: The Net Revenue bar graph displays an organization s net revenue by year. Facilities may be selected or de-selected in the Net Revenue Constraints box to include or exclude facilities in an organization s totals. Four years of data is included on this graph. III. Net Revenue by Primary Pay Class: This graph displays four years data about an organization s net revenue broken down by pay class. As facilities are selected or de-selected from the Net Revenue Constraints box, or primary pay classes are selected or de-selected from the legend, the graph is recalculated and redrawn. The Net Revenue tab is displayed below: b. Net Revenue by Treatment: The Net Revenue by Treatment tab is very similar to the Net Revenue tab, but it calculates and displays the net revenue per treatment averages. Net Revenue is calculated by dividing the net revenue by the total number of treatments. This tab includes three graphs: I. Net Revenue Per Treatment by Modality: This graph displays the average revenue per treatment by modality. A facility may be selected or de-selected from the Net Revenue Per Treatment Constraints box. When a facility/facilities has been added Release Notes Page 84 of 90 Last Saved: 1/12/2016

85 or removed, the graph is recalculated and redisplayed. Four years of data is provided on this graph. II. Net Revenue Per Treatment: This bar graph displays four years of net revenue per treatment for the facility/facilities selected from the Net Revenue Per Treatment Constraints box. III. Net Revenue Per Treatment by Pay Class: This graph displays an organization s net revenue per treatment by pay class. Facilities may be selected or de-selected from the Net Revenue Per Treatment Constraints box, and pay classes may be selected and de-selected from the legend. Changes made in either will cause the graph to recalculate and redisplay the graph. The Net Revenue By Treatment tab is displayed below: c. Facility Details The Facility Details tab provides a more detailed view of a specific facility s net revenue. The graphs provided on this tab may be viewed for: I. One facility and one year at a time. II. All modalities or only for a selected modality. III. All primary pay classes or only for a selected pay class. IV. All secondary pay classes or only for a selected pay class. V. All tertiary pay classes or only for a selected pay class. Each of the above criteria are used in the graph. You may not eliminate any of the criteria completely. The Facility Details tab provide two graphs: I. Net Revenue With Payment: This graph displays not only the monthly net revenue, but also the net payments applied to claims for the displayed month as Release Notes Page 85 of 90 Last Saved: 1/12/2016

86 well. The payment types (for example, primary payment) displayed in the legend may be selected or de-selected to recalculate and redisplay the graph. Each time the constraint criteria listed above is changed, the graph is recalculated and redisplayed. II. Net Revenue and Payment Per Treatment: This graph operates the same as the Net Revenue With Payments graph, except that it displays the per treatment net revenue. The Facility Details tab is displayed below: Each of the three tabs detailed above are governed by the following rules: 1. Net revenue is calculated as the total charges minus the total adjustments. 2. All data involved in this dashboard is processed at the claim level. That being said, the following are calculated: a. Modality is calculated for each claim as it was in the Drug Utilization dashboard. b. Treatments are summed at the claim level. c. Facility involved d. Year involved e. Pay class, where primary, secondary and tertiary are pulled f. Payments are pulled by the degree s pay class, as well as patient and uncategorized payments. 3. Net revenue is always presented at the claim level and is not broken down by pay class. When using the Net Revenue By Pay Class constraints, only those claims Release Notes Page 86 of 90 Last Saved: 1/12/2016

87 whose primary pay class is selected are presented. Net revenue in this case is still presented at the claim level, as the TIME system does not aggregate services and adjustments by pay class and degree. 4. Single click drill downs are offered on the graphs to display transactional claim data being visualized in the graphs. 4. Payer Mix The Payer Mix dashboard includes three tabs: a. Payer Mix The Payer Mix tab includes three graphs: i. Payer Mix by Pay Class (Regardless of Degree): This pie chart displays how many patients policies for the selected date context belong to each pay class. If a patient has both primary and secondary coverage and those policies belong to different pay classes, he or she is counted in both pay classes. ii. Payer Mix By Degree (Based on Chosen Date Context): This bar graph displays by degree by pay class the number of patients belonging to each pay class for the selected date context. iii. Payer Mix By Pay Class By Year (Regardless of Degree): This line graph displays a separate line for each year that indicates the number of patients for each pay class. The Payer Mix tab is displayed below: b. Payer Mix Details The Payer Mix Details tab provides a bar graph the may be constrained by facility, modality, pay class and degree. It may be constrained to show a specific constraint, or to show all. Each constraint is independently set. The Payer Mix Details tab is displayed below: Release Notes Page 87 of 90 Last Saved: 1/12/2016

88 c. Payer Mix Pivot The Payer Mix Pivot tab displays the payer mix by each date context: 1. Payer Mix Pivot The Payer Mix Pivot tab displays the payer mix for each of the following date contexts: 1. Today Today refers to the date on which the data supporting this dashboard was generated. The process runs daily overnight. 2. December 31 of the previous year 3. December 31 two years prior to Today The Payer Mix Pivot tab is displayed below: Release Notes Page 88 of 90 Last Saved: 1/12/2016

89 Each of the three tabs detailed above are governed by the following rules: 1. The data presented in this dashboard is uses three context dates: a. Today b. December 31 of the previous year c. December 31 two years prior to today 2. Only patients who were active during the date contexts listed above are included in the graphs and tables of this dashboard. 3. Single click drill downs are offered on the graphs to display transactional claim data being visualized in the graphs. Test Plan 1. Launch the Financial Dashboards application (Main Menu=> Patient Accounting=> Financial Reports=> Dashboards). 2. Select the Drug Utilization dashboard from the Dashboard drop down menu. a. Verify that the Drug Utilization dashboard includes three (3) tabs. b. Selecting each tab, verify that: i. Each tab includes the graphs detailed above. ii. The graphs are displayed properly and that the data is correct. iii. Changing the constraints changes the data presented in the graphs displayed on the tab. iv. Selecting a point on a graph automatically displays drill down table to view the transactional details. v. Right clicking any graph displays a menu that allows you to save the graph in another format or to change the Adobe Flash Player settings. Release Notes Page 89 of 90 Last Saved: 1/12/2016