EMR How-To

What are they?

When you sign in to EMR, you will see a section called "Alerts" with many different tabs.  These tabs are:

Cert Ending

These are patients that will need to be discharged or re-certified within the next few days.  

Often this can be resolved by confirming there is a discharge or re-certification plotted. 

Thirty Day Assessment

These are patients that need a 30 day re-assessment, which is required by both CMS and licensing boards.  

Often this can be resolved by plotting a Re-assessment visit. Some patients will be discharged on day 31-35 so in those cases, a Re-assessment may not be necessary.  

Out Of Frequency

These patients have not had their frequency followed.  Sometimes this is because there is an approval pending, which is outside of your control.  But other times it means either too many visits or too few visits are being completed in a week. 

Often these can be resolved by submitting a Therapy Order or adding/deleting visits to match the ordered frequency. 

Past Due Visit

These are visits that should have been either started or marked as missed.  Occasionally there are patients whose visits will be completed in the next couple of days -- you can ignore those or move them on the calendar to clear the alert. 

Saved Visit

This is a quick way to jump to visits that you have saved.  You can access these notes even if you have been re-assigned from a chart or the patient's record is now inactive.  You should keep this list cleared out as often as possible by opening the notes, adding information, and hitting Finalize.  

This is also where notes will go if they are returned.  

Save Other Form

Other Forms are notes like Communication Reports and Therapy Orders that you may have started but forgotten to remove.  Keeping this cleared out can help you to stay organized.  Either finish the notes or hit 'delete' to clear the alert.  

DC's pending

DC's pending are notes in which a DC attached to a progress note is in saved mode.  This happens if you complete the progress note for an in-person discharge but do not complete the Discharge Summary.  To clear this, simply Edit the Discharge Summary and hit Finalize.  

Lapse in Care

A Lapse in Care is any patient not seen for exactly 7 days.  Sometimes this is because you have a 1 time per week frequency or are awaiting authorization, but often it is instead because a patient has been forgotten or the chart was not properly documented.  You should aim to clear these out frequently.  

What are they?

Communication reports are great because they can be downloaded by agencies, sent to insurance providers or doctors, and attached to other EMR systems.  Unlike comments, communication reports are legal aspects of the record and are great for documenting things that happened outside of a visit or things you would like everyone on the case to be aware of. This can include:

• Difficulty reaching a patient

• Rescheduling Evaluations

• Reasons for back to back visits

• Potential plans such as vacations patients are telling you about

How to document

To document a communication report, click on the blue Other Forms button on EMR, located in the Schedule/Documentation portion of the patient record. Choose Communication Report from the listing and hit Confirm.

What are they?

Hospitalizations are defined as any time a patient is admitted to the hospital, or there for 24 hours or greater.  Sometimes patients visit the ER for considerable periods of time, say 12 hours, but this is not considered a hospitalization.

What to do

If a patient reports they have been hospitalized, it is important to obtain information for the Transfer OASIS, a note used to document the transfer of a patient outside of home health.  Important details to obtain are:

• Why the patient was hospitalized

• When the patient was hospitalized

• Where the patient was hospitalized

To document the hospitalization, you may either put in a missed visit or a communication report.  The QA team will ensure the agency is notified and will hospitalize the chart.  

You will then stop seeing the patient.  

If a patient returns home

If a patient returns home from the hospital with orders for home health to continue, the agency will either complete or request a Resumption of Care OASIS (ROC). This is a note completed to resume home health, similar to a Start of Care OASIS (SOC).  Each discipline following this will then be asked to complete a Post Hospital Evaluation.  

In short, if a patient returns home, Lifespan will offer this patient to you, so there is no need to wait around or do anything until we reach out. 

 Lifespan always offers patients to the same therapists who previously saw the patient so that they can have "first dibs" before offering to others if you would prefer to not take them back on. 

If a patient reaches out to you, kindly direct them to the agency and/or reach out to the agency (we'd be happy to help facilitate this!) so that the agency can ensure there are home health orders and an ROC is completed.  

Why a patient hasn't returned home

Patients who are hospitalized may end up in a Skilled Nursing Facility for rehabilitation, move to go live with family members, choose to go with a different home health agency, transfer to hospice, or may be in the hospital for a significant period of time.  For this reason, we do not recommend saving spots for hospitalized patients.  

To access a patient record, you can choose the patient from the dropdown on your homepage and select 'Retrieve.'  This is only valid for active patients to which you have been assigned.  If you are trying to access patients that have been reassigned or discharged, you will need to use the Search tool. 

What are they?

Certification periods are 60 day periods patients can be seen for.  A certification period starts when home health begins (at SOC) and ends 60 days later.  If a patient needs to be seen for more than 60 days, they must be recertified.  

How to change between certification periods

To change between certification periods, or episodes, you will simply select the episode from the dropdown in the top right corner of the patient record.  This dropdown will let you jump between certification periods. 

Active or Inactive

Whether the patient is active or inactive you can still access their chart. You will select "Patients" on the left side of your screen after clicking on Therapist. On the My Patients page you will be able to access your inactive patients by selecting the inactive patient status. 

We always suggest selecting "Both" to facilitate your search for all your patients. 

What are they?

Comments are notes meant to include updates or pieces of information that an agency or other involved parties have provided, so that information is not lost in Emails, phone calls, and app messages.  Examples include:

• Gate codes or directions

• Contact instructions (such as calling a specific family member after visits)

• Authorization updates (in addition to App messages)

• Updates from the Unable to Reach team

How to address assigned comments

Comments added to a patient's chart may be assigned to a specific discipline.  In this case, they will pop up on your homepage.  To keep this cleared out, you can simply select 'Clear' and the message will disappear from your homepage.  Don't worry, the comment will still be available when viewing the patient record. 

What are they?

Sticky notes are reminders added to individual visit notes.  These reminders appear as yellow talk bubbles on the notes, which pop up when you open a visit.  

Typically the team will add sticky notes to remind you to do something during a visit, such as:

1. Ask a patient a question

2. Collect paperwork

3. Incorporate something specific in your documentation

Sticky notes are not a great way to communicate with agencies or Lifespan staff, as they are only accessible when on a patient's chart.  Lifespan staff will also notify you of notes being added to stickies in an additional way, such as via a message on the Lifespan Therapy app. 

What are they?

Therapy orders are used to  make official changes to the record, which are then signed off on by physicians.  Examples of common orders include:

• Delay orders - used to request/explain a delay from the physician-ordered start of home health services.  

  • In accordance with regulatory expectations for the timely initiation of care, a delay order should be documented for any SOC that has been delayed by 48 hours and any Evaluation delayed for five days from the SOC.  

  • Lifespan recommends simply writing the date you have scheduled with the patient and any delays that may or may not have occurred on your end for all patients .  

• Frequency orders - not needed for an Evaluation or SOC (which themselves are orders) but required for any modifications or additions to the originally ordered frequency.

• Discharge orders - technically not needed as the physician signature line is present on the discharge summary,  but some agencies may request this.  A discharge order is just an order stating "patient has been discharged from (PT/OT/ST/MSW) services with (goals met/goals not met)" 

How to document

Document a Therapy Order of any kind by selecting the blue Other Forms button on the patient record and choosing Therapy Order from the dropdown.  

All Medicare patients can be treated "as medically necessary" meaning no authorization is required.  But if your patient is a private insurance patient, the insurance provider will need to authorize enough visits to complete your requested frequency.  If you do not have enough authorization, you will be met with a message stating "You are currently at the max number of visits authorized" when trying to plot the remainder of the frequency.

To request authorization, simply submit your frequency on your Evaluation as quickly as possible. The QA department will coordinate with the home health agency for any missing visits, track the request, and update the chart when visits are approved.  They will then send you a message on the Lifespan Therapy app.   

Sometimes you visit a patient's home, start the visit note at the door, and find out that they aren't home.  Or maybe you're clicking around on the chart and accidentally start a visit note.  If this is the case, you can delete the note by clicking on the saved visit, pressing the x, and answering yes to the prompt asking if you are sure.

Non visit discharge documentation may be needed for different circumstances. Some patients  may refuse all further visits, sometimes insurances changes occur, or no more visits were authorized for the patient etc.. Non visit discharges are not limited to just these circumstances  but if a team member informs you to document a NVDC it will be plotted for you and all you need to do is pull up the DC summary as shown.