Practice Management Part 2 - Appointment Types, Services, Work

What is the context?

Meddbase is a complex, multi-layered EMR system, capable of accommodating a wide variety of workflows and business models ranging from small practices, straightforward setup and only a couple of people using the application, through to global enterprises with thousands of users and nuanced workflows and business requirements.

Meddbase provides a high number of configuration options allowing the application to adapt to complex business scenarios, as well as a host of default settings that it can fall back on when complexity is minimal.

Meddbase can be and is used in Primary Care, Secondary Care as well as in Occupational Health.

What is the purpose of the article?

This article is the 2nd in a series of articles providing overview and details of setup and configuration steps required for Practice Management, which focuses on the application of the Meddbase system in Primary and Secondary Care.

Click here for Part 1.

Click here for Part 3.1.

Click here for Part 3.2.

Click here for Part 4.

Click here for Part 5.

This article will walk you through the following steps:

1. Setting up Appointment types via Appointment Admin
2. Setting up Service Types via Service Management

3. Additional configuration options relevant to specific Service Types

Setting up Appointment types via Appointment Admin

A very important task in the process of configuring Meddbase is to create appointment types. Appointment Types will be the 'blocks' booked on clinicians' schedules.

To configure an appointment type, the following process applies:

1. From the Start Page, navigate to Admin > Appointment Admin
2. To create a new appointment type, hit New, to edit an existing appointment type, select it from the dropdown and hit Edit.

The Appointment Configuration dialog window allows many aspects* to be determined for an appointment type:

*There are many OH-specific configuration aspects for an appointment type. Click here for more details. These aspects will be omitted in this article.

Details section

1. Name - relevant name for the appointment type. This name will be visible¹ in Meddbase when interacting this appointment type as well as on the Patient Portal² for patient self-booking.
2. Default duration - the length of time (size of the booking 'block' on a clinician's session) the appointment is expected to take. This duration can be overridden during the booking process.
3. Follow up - when ticked/set to true, this checkbox allows this appointment type to be booked as follow-up from a previous appointment. When booking this appointment type via schedule, a list of previous appointments is presented and the user can select which one this booking is a follow up from. The list only shows previous appointments linked to an ongoing referral.
4. Clinical form - select the Clinical form³ from the dropdown to be used in Consultation for this appointment type by default⁴. Click here for more details on Clinical Forms.
5. Charged by the hour - when ticked/set to true, this checkbox will cause the price of this appointment type to be calculated based on the price set in billing rules and the default/actual length of the booking and will be charged using a formula⁵.
6. Service code - an alphanumeric code can be entered here. This code can be reported on. Furthermore it will be used when this appointment type is consumed and charged for, as an additional description of the Billing item on an invoice. Billing Items are reportable and the code can be used to filter the results.
7. Cancelled code - an alphanumeric code can be entered here. This code will be used when this appointment type is booked and subsequently cancelled, as an additional description of the 'Cancellation' billing item on an invoice raised by the cancelling the appointment⁶. Billing Items are reportable and the code can be used to filter the results.
8. Did Not Arrive code - an alphanumeric code can be entered here. This code will be used when this appointment type is booked and subsequently cancelled, as an additional description of the 'Did Not Arrive' billing item on an invoice raised by the marking the appointment as DNA⁶. Billing Items are reportable and the code can be used to filter the results.
9. Reschedule code - an alphanumeric code can be entered here. This code will be used when this appointment type is booked and subsequently rescheduled, as an additional description of the 'Rescheduling' billing item on an invoice raised by rescheduling the appointment⁶. Billing Items are reportable and the code can be used to filter the results.
10. VAT Exempt - this checkbox defines (ticked = 'True' or 'Yes') whether VAT charges are applied to the price of this appointment type set in your Billing Rules on relevant Charge Band(s).
11. Can book services on portal - this checkbox when ticked, allows services, e.g. Test or Vaccine, to be added to this appointment type when it is booked via the Patient Portal. 

¹ When this appointment type is consumed and charged for it appears as a Billing Item on an invoice. It can appear under a different name (Safe Name) on invoices by using the Safe Name Rule.

² The Patient Portal is a chargeable feature. Click here for more details.

³ Meddbase has a default Clinical form. Additional Clinical forms can be built by MMS and uploaded to your chamber. Please contact the Client Account Management Team on accountmanagement@meddbase.com to discuss your requirements and associated costs.

⁴ Multiple Clinical forms can be used simultaneously in Consultation in parallel episodes.

⁵ Price set in Billing Rules  x  Appointment Length, e.g. Price set in Billing Rules = £100; Appointment Length (booked) = 15 mins; Price charged: £100 x 0.25 (15 mins = 0.25h) = £2

⁶ Automating charges to the patient/patient's payer for cancelling, not arriving for and/or rescheduling an appointment require the use of the Cancellation Charges Rule(s) in your systems' Billing Rules. The system informs the user performing the action that it triggers a charge, but the user has the option to complete the action without charging the patient/patient's preferred payer

Accountancy section

1. Nominal code - nominal codes can be defined in Admin > Configuration > Accountancy and subsequently assigned to appointment types to sort them into groups. Nominal Codes provide additional reporting options for accountants (on utilisation of this service). Nominal codes are also used in the integration with Xero* and mapped to the chart of accounts.
2. Department code - department codes can be defined in Admin > Configuration > Accountancy and subsequently assigned to appointment types to sort them into groups. Department codes can be reported on as well as used in the integration with Reviso.

*Click here for more details on integrating with Xero.

Questionnaires section

Add a questionnaire by clicking the + button. Questionnaires* selected here will be sent to the Patient Portal for patients to fill out prior to arriving for the appointment.

*Questionnaires are built, based on client requirements, by Meddbase Solution Engineers and uploaded to the relevant chamber where they can be selected. If you require questionnaire(s), please reach out to the Client Account Management Team on accountmanagement@meddbase.com

Patient confirmation Tab

1. Confirmation letter template - this dropdown allows selecting the template¹ to be used to          generate an Appointment Confirmation Letter for a booked appointment. The letter can be generated on the Appointment Home Page using the Confirmation letter action button.
2. Prevent confirmation email - this checkbox when ticked prevents any appointment                      confirmation emails² from being sent for this appointment type.
3. Prevent confirmation SMS - this checkbox when ticked prevents any appointment                        confirmation SMSs² from being sent for this appointment type.
4. Prevent reminder email - this checkbox when ticked prevents any appointment reminder              emails² from being sent for this appointment type.
5. Prevent reminder SMS - this checkbox when ticked prevents any appointment reminder                SMSs² from being sent for this appointment type.
6. Confirmation SMS message - this field allows defining a custom appointment confirmation SMS using a combination of free text and template code. This message will be sent when this appointment type is booked, instead of the message defined in Admin > Configuration > Task Checker
7. Confirmation email message - this field allows defining a custom appointment confirmation SMS using a combination of free text and template code³. This message will be sent when this appointment type is booked, instead of the message defined in Admin > Configuration > Task Checker .

¹ The template to be used here must be created first in the Templates section of the Start Page. Click here for more details.

² Appointment Confirmation and Reminder email and SMS messages can be enabled Admin > Configuration > Task Checker by ticking the relevant email/SMS checkbox. Generic email and SMS messages can be defined there as well using a combination of free text and template code.

³ Template Code enables you to insert placeholders into templates and/or automated email/SMS messages, that can be used to produce an output (document or sent message) which incorporates values from a record, e.g. Patient and appointment details, clinical data and much more

Notes for admin Tab

This section allows adding a message that will be displayed as an on-screen pop-up to the Meddbase user booking this appointment type. The user must accept the message before continuing.

The message:

The output:

Notes for patient Tab

This section allows adding a message that will be displayed on the Patient Portal* under this appointment type name when it's selected for booking by the patient.

*The Patient Portal is a chargeable feature and requires additional setup. Click here for more details.

The message:

The output:

Telemedicine Tab

This section allows enabling this appointment type for Telemedicine*:

*Telemedicine is a chargeable feature and requires additional setup in Meddbase. Click here for more details.

1. Telemedicine type - this dropdown provides a selection of options for enabling Telemedicine:

• • • Disabled - when this option is selected, Telemedicine is disabled for this appointment type
    • Enabled by default - when this option is selected, Telemedicine is enabled for this appointment type and can be disabled during the booking process

• • • Can be enabled at booking time - when this option is selected, Telemedicine is disabled for this appointment type and can be enabled during the booking process

• • • Mandatory - when this option is selected, Telemedicine is enabled for this appointment type and can not be disabled during the booking process

2. Telemedicine confirmation SMS - this field allows defining a custom Telemedicine appointment confirmation SMS* for this appointment type using a combination of free text and template code.

3. Telemedicine confirmation email message - this field allows defining a custom Telemedicine appointment confirmation email* for this appointment type using a combination of free text and template code. 

*Appointment Confirmation must be enabled for the chamber in Admin > Configuration > Task Checker. Furthermore, the message configured here will be sent for Telemedicine appointments instead of the message configured in Admin > Configuration > Telemedicine > Telemedicine patient appointment confirmation override

Medical Policy

Meddbase provides the ability to split patient medical record (e.g. OH vs GP) by means of assigning separate Medical Certificates to different Appointment Types, thus protecting the clinical notes, documents etc. captured/created during the respective appointment type. If Medical Certificate(s) are in use, a Meddbase user will have access to the part of the patient's medical record according to their permissions on the respective certificate(s).

Click here for more details on Medical Certificates

Click here for a detailed article on Split Medical Record.

Click here for a detailed article on deleting a Medical Certificate.

Setting up Service Types via Service Management

Another aspect of configuration is governed by Service Management, where Modules, PACS services, Procedures, Products, Tests and Vaccinations you wish to offer can be defined.

Meddbase can accommodate various workflows and since different providers have different ways of providing services and different workflows apply to them, there is no right or wrong way to configure appointment types and services. Some providers only configure appointment types and no services, others configure a handful of core appointment types and configure all other services in Service Management, e.g. as Modules.

How to create a new service type?

When anew service is created, there are common values that can be applied for all service types. There are additional settings that are relevant. To begin to configure a new service type, from the Start Page, navigate to Admin > Service Management, hit New and select the service type you'd like to create.

There are common configuration options for all service types. For each service type you can:

1. Assign a Name
2. Assign a Safe Name- this will appear on an invoice instead of the 'Name' when this service is consumed
3. Assign a Code - for reporting purposes e.g. service utilization
4. Make service VAT Exempt or not
5. Assign a length of Time- when this service is added to a booking, the time will be added to the overall booking length
6. Define a Recall for the service - recall reason, recurrence and recall automation (a recall Task created automatically)
7. Assign Nominal and Department codes to the service - for accountancy integration and reporting purposes
8. Add Notes for Admin - this field allows adding a message that will be displayed as an on-screen pop-up to the Meddbase user booking this service. The user must accept the message before continuing.

From here you can:

1. Continue to add in further configuration settings relevant to the service type (described in different sections below).
2. Save the service.

Additional configuration options relevant to specific Service Types

The below sections describe configuration options that are not common and are available for specific Service Types:

Modules:

1. Associated to Appointment Type - when booking via the Slot Finder, this module will only be available with the associated appointment type
2. Public notes for Patient Portal - these will be displayed under the module name when booking via the Patient Portal
3. Billing Type - allows billing for the module as a single service or procedure, or billing for individual services which make up the module
4. Service which make up the module - multiple services can be selected as parts of the module
5. Module attendees - multiple professionals can be required to conduct the module. They can be specified by their Specialism or Role Group they belong to.
6. The point in time (Start Offset) when an attendee is required and the length of time (Length) they are required for during the module can be configured, so that module attendees only get the required duration at the right time booked on their respective schedules.

PACS:

1. Receiving Application - this is an optional field only used in some PACS integrations for mapping purposes
2. Receiving facility - the piece of equipment that will produce the image.
3. Modality - selecting the modality the PACS service belongs to; the option to create multipart PACS services is also available here.

Products and Vaccinations:

1. Stock Control - selection of the the type of stock control the product or vaccine will be governed by. Stock Control allows tracking quantities, Batch Control allows tracking quantities, expiry dates, batch numbers and trade names
2. Unit - what is a single unit of the product or vaccine e.g. 5ml ampoule, pack of 10 etc.
3. Decimal Quantity - allows dispensing decimal quantity when the unit is larger than the amount dispensed

Tests:

1. Expected turn-around (in days) - the value entered here can trigger a task and/or email after the stated length of time had elapsed¹
2. Provider - the laboratory providing the test and examining the specimen written in capital letters²
3. Print Code - TDL laboratories require a print code for all tests they process. The codes are provided by the laboratory from their catalogue.

¹ The above requires 'service reminder' to be enabled under Admin>Configuration>Task Checker

²  Meddbase supports electronic pathology request and/or response with TDL and HCA laboratories in the UK. Non-UK laboratories are not supported for electronic request/result and a manual process would apply.

How to Edit a service type 

This process is very similar to creating a new service (as described above). To do this:- 

1. 1. From the Start Page, navigate to Admin > Service Management
   2. Navigate through the list of existing services
   3. Select the item to be edited
   4. Make changes (using the ‘How to create a service’ as an option)
   5. Save the update

The Service Type characteristic is then updated.

Work

Another configuration aspect is adding and configuring Work Types in your chamber.

• Appointment Reminders - default Work Type
• Incoming Referrals - default Work Type
• Outbound Referral - default Work Type
• Outstanding Debt
• PACS Inbox - default Work Type 
• Pathology Results
• Recall Reminder - default Work Type
• Result Reminder - default Work Type
• Tasks - default Work Type

Incoming Referrals - default Work Type

When an internal referral is made within your Meddbase chamber, or another chamber linked to yours in a Referral Network sends you a referral, a new work item is generated and can be viewed by clicking the relevant section from the Start Page.

Click here for more details on setting up a Referral Network.

Click here for more details on configuring this Work Type.

Outbound Referral - default Work Type

When an Outbound Referral is made either electronically, internally within your Meddbase chamber, externally to another chamber linked to yours in a Referral Network or to an external provider via email/print route, a new work item is generated and can be viewed by clicking the relevant section from the Start Page.

Click here for more details on setting up a Referral Network.

Outstanding Debt

When an invoice with an outstanding balance is generated via an appointment or directly via a Company or Patient Record page(s), new work item is generated and can be viewed by clicking the relevant section from the Start Page.

Click here for more details on Working with Outstanding Debt.

PACS Inbox - default Work Type .

The PACS service sends HL7 requests to imaging providers and receives HL7 images/reports from them. These images/reports can be viewed as work items by clicking the relevant section from the Start Page.

Click here for more details on configuring this Work Type.

Click here for more details on setting up Multipart PACS Services.

Pathology Results

Meddbase currently interfaces with The Doctor’s Laboratory (TDL) and HCA Laboratories. When a pathology result is returned to Meddbase electronically, a new work item is created and can be viewed by clicking on the relevant section from the Start Page.

Click here for more details on configuring this Work Type.

Click here for more details on Requesting Pathology Results.

Recall Reminder - default Work Type

Meddbase allows setting up recall reminder email message to be sent to patients a set number of days prior to the recall due date, at a specified time of the day.

These messages are set up in Admin > Configuration > Task Checker.

At the same time an email can be sent to your Admin team and an Recall Reminder work item can be generated and can be viewed by clicking the relevant section from the Start Page. 

Click here for more details on the Task Checker.

Result Reminder - default Work Type

When a test result is not returned within the expected turn-around time (in days) from starting the test, and can be viewed by clicking on the relevant section from the Start Page.

Click here for more details on Service Management (configuring an expected turn-around timeframe for Tests)

Tasks - default Work Type

Tasks are used when you want to create an item of work, and either assign it to another user, group or simply add it to your own list.

You can view tasks by clicking on the relevant section from the Start Page.

Click here for more details on Tasks.

*Users meant to be involved in the above workflows and responsible for specific work need to be members of a relevant Role Group. Click here for more details on Role Groups and associated workflows/work.

Review date

This article was last updated on 12th of Jan 2023 in the context of Meddbase version 1.264.1.14998