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Access Data Model > Scheduling > Flashcards

Scheduling Flashcards

1
Q

\What is scheduling?

A

Scheduling a patient is the process of matching a patient with a time, department, and provider.63

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2
Q

What are the 3 aspects of scheduling that affect a patients perception of their access to care?

A

Accessibility,
Availability,
Utilization 63

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3
Q

What is availability?

A

Availability is provider centered. A provider may want to know how much of their time is open or available on any given day.63

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4
Q

What is utilization?

A

Utilization is the opposite of availability. It represents how much of a provider’s time is used. Utilization is a measure of how effectively an organization uses the time of its providers.

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5
Q

What is accessibility?

A

Accessibility is a patient-centered concept, (access to care) it can be stated as “How long do I have to wait to see my provider?” Is the provider booked solid for the next 2 weeks? For the next 3 months? When I am curious on average how long someone has to wait for an opening we are reporting on accessibility.63 &65

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6
Q

We could measure accessibility by attempting to schedule an appointment and determining how many days we need to look ahead to find an opening for a particular provider, department, or hospital. There is a problem with this approach. If we look only for the first available opening, our numbers might be skewed by cancelations. What does epic do to tackle this problem?

A

The industry standard is to report on the third next available appointment (abbreviated 3NA). By skipping the first two openings, cancelations are less likely to skew our results. 61

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7
Q

How would you schedule an Appointment?

A
  1. log in to hyperspace ass the access administrator.
  2. Launch the appts activity for your patient
  3. Book a new office visit, by hitting the book it button
  4. Put in the notes.
  5. Put in Visit type.
  6. Put in the provider.
  7. Document that McKinley had no recent travel or concerning exposures.
  8. For any prompts, confirm the default values are appropriate and complete scheduling the appointment. 63
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8
Q

Video: What is in the PRC Masterfile?

A

The visit type

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9
Q

True or False: Accessibility is accessible to care?

A

True, it is the ability to seek and receive care at an organization.65

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10
Q

How is wait defined?

A

How many days we need to look ahead to find an opening for a particular provider, department, or hospital, the number of days is the wait for that provider, department, or hospital.65

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11
Q

True or False: Epic has flexibility to look at any number of openings (3rd, 4th, 5th, etc)?

A

True, this is referred to as the Nth next available appointment. whatever value the N is, it is called the occurrence.61

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12
Q

What master file would you use for accessibility calculations?

A

SNR master file. Each record represents a different set of search criteria, and we can have multiple SNR records generating data at the same time.65

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13
Q

If we want to calculate different accessibility numbers using different combinations of criteria, how can we do this?

A

This is accomplished by setting up different accessibility configuration records in the SNR master file. Each record represents a different set of search criteria, and we can have multiple SNR records generating data at the same time.65

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14
Q

Each time an accessibility batch is run, what does it search?

A

It searches using the SNR records criteria and stores the data as a new contact on the SNR record.66

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15
Q

Accessibility configurations calculate their numbers in three steps, what are they?

A
  1. Define the date on which to perform the search.
    A. This is determined by the scheduled batch job.
  2. Find the date of the occurrence for each entity and level.
    A. While the occurrence is frequently the 3rd next available appointment, this can change based on SNR build.
  3. Calculate the difference in days between the dates from parts 1 and 2.
    A. Depending on SNR build, this may only count business days. 66
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16
Q

What do the no-add items and overtime items store?

A

the no-add items store the search criteria, and the overtime items store the search results.66

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17
Q

What is the difference between Access_All_Dep & Access_Dep & Access_Prov

A

ACCESS_CONFIG: has 1 row per accessibility configuration.
ACCESS_ALL_DEPS: 1 row per search run. What this means is I do not care what department it is in just get me to the 3rd next in all departments.

ACCESS_DEP: 1 row per dept per search run. I want to find the 3rd next in ICU, MED serg, PEds, etc. It is a specific department. I do not care who the provider is.

ACCESS_PROV: 1 row per provider per search run. I want to find the providers 3rd next available. 67

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18
Q

Explain how you get the days wait in the picture in the granularity of provider.

A

He counts the next 3 appoints. 68

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19
Q

True or False Accessibility numbers are set in stone when evaluating appointments.

A

False, accessibility numbers rely on hypotheticals- after all they are not evaluating actual appointments.69

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20
Q

What is lead time?

A

Lead time represents the number of days between creation of an actual appointment and the appointment date.69

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21
Q

What table would I use to find the lead time for an appointment?

A

VisitFact.AppointmentLeadTimeInDays.69

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22
Q

If you wanted to find this column VisitFact.AppointmentLeadTimeInDays in slicerdicer what would it be?

A

This column is used in slicerdicer by visits data model with the lead time filter record. 69

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23
Q

To determine lead time goal per visit type across a facility, what should I use?

A

Use the LOC_SA_LEAD_TIME_GOALS table. 69

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24
Q

If an organization sets department -level lead time goals, what should we use?

A

Use the DEPT_LEAD_TIME_GOALS table. 69

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25
Q

What are appointment requests?

A

Appointment requests are most used for new patients appointments and requests for specialty care. Scenaries that could produce an appointment request include a patient calling for an appointment, a doctor indicating that the patient should have a follow up visit and schedulable orders.70

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26
Q

How does chronicles store appointment requests?

A

As ORD records70

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27
Q

What table would you use for appointment requests?

A

Appt_request 70

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28
Q

True or False: appointment requests have base statuses but no override statuses?

A

False, appointment requests have base statuses and override statuses.71

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29
Q

What is the granularity of Appt_request?

A

Each appointment request appears as a row in the appt_request table.

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30
Q

True or False: all base status values are not epic released?

A

All base status values are Epic-released, and customers cannot add or remove any base status values.71

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31
Q

True or False: the system uses base statues to drive scheduling workflows?

A

True 71

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32
Q

What tables would you use in base statuses?

A

They appear in APPT_REQUEST in the BASE_STATUS_C column, but they do not appear to users in hyperspace. 71

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33
Q

Video Question: What is Status_C and Base_Status_C

A

Cogito Trainer: Think of “Base_status” as meaning “Epic status.” Your org can’t change that list of options because the values in Base Status drive a lot of scheduling functionality and metrics. But your org CAN build custom statuses which appear in status_c. Each custom status is “mapped” to a base status so our software continues to work. So if a scheduler was asking you for a report, they would probably expect to see the status from status_C since that’s the custom list used by your org. Base_status would only be needed if you want to investigate the mapping between those custom statuses and the underlying epic-defined list.

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34
Q

How do the released based status values appear ?

A

The released base statuses values also appear in the override status category list, but customers may add more override statuses. 71

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35
Q

True or False: Override status are what appear to users in hyperspace?

A

True, the override statuses are what appear to users in hyperspace, and they may rely on additional rules to communicate helpful information to users on how to progress with the request. 71

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36
Q

What does the APPT_REQ_APPT_LINKS table list?

A

It lists any relevant appointment scheduled from the request.
This table stores links between appointment requests and appointments scheduled from them.72

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37
Q

What does the APPT_REQ_APPT_LINKS table include?

A

It includes both an ASN and CPT CSN pointer. 72

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38
Q

What does the EPT CSN pointer return?

A

It returns the CSN of the final rescheduled appointment in a cancel/Reschedule chain, while you can use the ASN to find all appointments in such a chain. 72

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39
Q

What does The APPT_REQ_AUDIT table focus on?

A

It focuses on the outcomes of actions on each individual request. Each of its lines represent the state of the request after some event happened in the history of the request. This table contains information about the history of an appointment request. Each row of the table captures the state of certain key data elements after the change was made. 73

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40
Q

Video: What is the granularity of the The APPT_REQ_AUDIT

A

This table contains information about the history of an appointment request. Each row of the table captures the state of certain key data elements after the change was made

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41
Q

What is a work queue?

A

A work queue is a list of records that require users to review each record and act to progress the record.73

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42
Q

What type of master files are work queues?

A

They are records in the WQF master file and each record that appears in a work queue is represented with a WQL record.73

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43
Q

What are the main database objects for appointment requests?

A

SCHED_ORDERS_WQ

SCHED_ORDERS_WQ_ITEMS

SCHED_ORDER_HX

AND V_ZC_SCHED_WQ_TAB
73

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44
Q

What does the database object SCH_ORDERS_WQ DO?

A

This table contains information about appointment request workquesues (WQF records). 73

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45
Q

What does every appointment need?

A

Patient,
provider/department,
start date /time,
Appointment length
74

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46
Q

When looking at the Provider/Department what happenings when thinking of this concept?

A

When thinking about appointments, it is best to think about the provider and department as a pair. The appointment is scheduled with the combination of a particular provider in a particular department-you cannot schedule with just one or the other.74

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47
Q

True or False: an Appointment for an MRI can only be scheduled in a limited longer of places?

A

True 74

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48
Q

When looking at appointment details what happens with patient?

A

When we create an appointment, we are creating a contact on an EPT record.74

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49
Q

True or False: scheduling rules are encapsulated in Visit types?

A

True 74

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50
Q

True or False: A new patient appointment typically takes longer than a check-up?

A

True 74

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51
Q

What does the start date/Time do for an appointment?

A

The appointment date denies the contact date.74

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52
Q

True or False: Different types of appointments have different scheduling needs?

A

True 74

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53
Q

What does the appointment length do?

A

The appointment will have a length in some multiple of 5 mins.74

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54
Q

What does visit types encapsulate?

A

Different types of appointments have different scheduling needs. These scheduling rules are encapsulated in visit types. 74

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55
Q

What type of record is a visit type?

A

A visit type is a record n the PRC master file that contains information about how the appointment is to be scheduled: default appointment lengths, allowed providers and departments, patient questionnaires, and much more. all cadence appointments are scheduled using visit types. 74

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56
Q

What are the two core database objects for reporting on scheduling?

A

In caboodle it is VIsitFact.
In Clarity it is V_sched_appt 74

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57
Q

What is the granularity for VisitFact?

A

VisitFact is part of caboodle and the granularity is a row for every visit. 74

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58
Q

What is the granularity of V_Sched_Appt?

A

The V_Sched_Appt is part of clarity and returns a row for every appointment. 74

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59
Q

What is the difference between V_Sched_Appt and VisitFact

A

The two may return different numbers of rows because one is about visits and the other is about appointments. 74

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60
Q

True or False: In Epic, an appointment is an EPT contact?

A

True, an appointment is any EPT contact that has defined an appointment status, provider, department, and visit type. 74

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61
Q

What do visits include?

A

Visits include appointments and any other encounters that are of a type that an organization specified. For example, telephone encounters, telemedicine visits, and in home visits are not classically considered appointments, but many organizations choose to consider them under the term of visit. 74

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62
Q

If I want to report on visit volume what should I use?

A

If a report is focused on visit volume, which is the outpatient portion of patient care, it will likely use VisitFact over V_Sched_Appt. 74

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63
Q

What is a visit type?

A

A visit type is a record in the PRC master file that contains information about how the appointment is to be scheduled: default appointment lengths, allow providers and departments , patient questionnaire, and must more. 74

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64
Q

True or False: All cadence appointments are scheduled using visit types?

A

True. 74

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65
Q

What are the core database objects for reporting on scheduling?

A

The core database objects for reporting on scheduling are caboodles. VisitFact and Clarities V_Sched_Appt. Visit Fact has a row for every visit, while V_sched_Appt returns a row for every appointment.74

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66
Q

True or False: Are visitFact and V_SCHED_APPT return the same number of rows?

A

False, the two tables may return different numbers of rows because one is about visits and the other is about appointments.74

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67
Q

What is the difference between VistitFact and V_SCHED_APPT?

A

The core database objects for reporting on scheduling are caboodle’s VisitFact and Clarity’s V_SCHED_APPT. VistitFact has a row for every visit, while V_SCHED_APPT returns a row for every appointment.74

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68
Q

What is an appointment?

A

In Epic, an appointment is any EPT contact that has defined an appoint status, provider, department and visit type.74

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69
Q

Video: What are the differences between visitFact and V_Sched_Appt?

A

74

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70
Q

What is a visit?

A

Visits include those appointments and only other encounters that are have a type that an organization specified. For example, telephone encounters, telemedicine visits, and in home visits are not classically considered appointments, but many organization choose to consider then under the term visit.74

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71
Q

What are joint appointments?

A

Appointments with multiple providers or resources are referred to as joint appointments. 75

  • Appointments that occupy multiple schedules
  • Multiple providers, resources, and/or departments.
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72
Q

How does V_SCHED_APPT store appoints if there are multiple providers?

A

If there are multiple departments or providers associated with an with an appointment, then V_SCHED_APPT only stores the ID of the first department and provider in the list. 75

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73
Q

For an appointment to be considered joint, what must be done or selected?

A

For an appointment to be considered joint, the times selected must be the same, overlap, or touch for all providers/resources involved. 75

74
Q

Explain this concept: Appointments are visits but not all visits are appointments.

A
75
Q

True or False: Joints are stored as a single contact in EPT?

A

True, or an appointment to be considered joint, the times selected must be the same, overlap, or touch for all providers. resources involved. this is stored as a single contact in EPT and as a single row in V_SCHED_APPT 75

76
Q

True or False, you will not be able to get a list of all the appointment providers, you can only get the primary provider?

A

False, for most reports, the primary provider will be all you need. However, you may want to include all appointment providers or departments on a report. The list of providers for an appointment is stored in EPT 7040 and the list of departments is stored in EPT 7070.76

77
Q

True or False: Caboodle does not have a table that stores all departments?

A

false, caboodle does not have a table that stores departments beyond the first listed department. however, VisitFact does not store up to the forth provider listed.76

78
Q

What does the PAT_ENC_APPT table do?

A

This table has a line for each provider within an appointment and the appropriate department. The values stored in the first line correspond to the providers and department that will appear in the V_SCHED_APPT and VisitFact for that appointment. 76

The PAT_ENC_APPT table contains basic information about the appointment records in your system. Since one patient encounter can be an appointment with multiple providers and resources (joint appointment), the primary key of this table comprises PAT_ENC_CSN_ID, and LINE in which LINE is used to identify each provider within the appointment.

79
Q

What table in caboodle allows me to see how the organization used phone, video, and other Telehealth options?

A

Use VisitFact.TeleHealthMode to see how your organization used phone, video, clinic to clinic, and other Telehealth options. 76

80
Q

How are video visits captured in chronicles?

A

In chronicles, video lists are captured as LVV records.76

81
Q

What are video visits?

A

A video visit is an encounter in which a clinician interacts with a patient or remote physicians through live audio and video. 76

82
Q

What table would I use in caboodle to report on encounter level information on video lists?

A

Use VideoVisitFact to report on encounter-level information on video visits, like the total duration and the moments that patient and provider first connected.76

83
Q

True or False, book it is the new scheduling activity for Cadence and it is replacing make Appointments?

A

True, Book It is replacing make appointment as the core scheduling interface that users interact with on a day to day basis. It is on by default with the Feb 22 release and always on for customers after the transition to hyperdrive.76

84
Q

If I wanted to connect the video visits to encounters table, how would I do that in caboodle?

A

To connect video visits to other information about the visit in caboodle, use VideoVisitEncounterMappingFact to join to EncounterFact.76

85
Q

What table would I use if I need a detailed audit train of events that occurred during the visit, like each connection or disconnection of a user?

A

Use the VideoVisitEventFact in caboodle 76

86
Q

What type of information does PAT_ENC_6.APPT_SCHEDULING_MODE_C give?

A

The column from PAT_ENC_6.APPT_SCHEDULING_MODE_C indicated which view was active when scheduling the appointment. A value of 1 means that the scheduler used the solutions view. 77

87
Q

What does the solutions view show in solutions?

A

In the solutions view, the system shows solutions immediately as schedulers enter search criteria, and more solutions are displayed by default. If Schedulers use this view, it suggests that they trust schedule template build.77

88
Q

What table would I use to find which view are active when scheduling the appointment?

A

The PAT_ENC_6.APPT_SCHEDULING_MODE_C column indicated which view was active when scheduling the appointment. A value of 1 means that the scheduler used the solutions view.77

89
Q

If I want a detail view of each action a user takes to schedule an appointment, what would I use?

A

If you require even more detail, Clarity’s PAT_ENC_ES_AUD_ACT table has a row for each action a user takes to schedule an appointment. It is useful for questions like:
In which department is a user logged in when they schedule an appointment?
What actions are users taking to schedule appointments?
Use this table when you require detailed audit information beyond what is available in VisitFact or V_SCHED_APPT.77

90
Q

What does appointment serial numbers do?

A

In some cases, a natural relationship exists between multiple contacts. For example canceled appointments are related to the appointments rescheduled from them. Appointment serial numbers (ASN) tie these contacts together.78

91
Q

True or False, when we schedule an appointment for the first time, it is assigned an ASN that is equal to its CSN.

A

True, If additional contacts are created due to cancelation and rescheduling, they will have new CSNs but the same ASN. In other words, the ASN value is determined by the original CSN in a series. Here are some examples of when ASN is used to link to contacts:
Wait list entries and appointments scheduled from the wait list
Canceled and rescheduled appointments78

92
Q

True or False: if a patient canceled a June 7, 2022 appointment and rescheduled it for June 19,2022, each appointment would be a row in VisitFact?

A

True, for example, if a patient canceled a June 7, 2022 , appointment and rescheduled it for June 19,2022, each appointment would be a row in VisitFact. As they are part of the same series, they will have the same ASN value - this ASN value is inherited from the CSN of the original June 7 appointment. 78

93
Q

True or False: If a patient canceled a June 7, 2022, appointment and rescheduled it for June 19, 2022, each appointment would be a row in VisitFact. As they are part of the same series, they will not have the same ASN value ‐ this ASN value is inherited from the CSN value of the original June 7 appointment.74

A

False, they are part of the same series, they WILL have the same ASN value ‐ this ASN value is inherited from the CSN value of the original June 7 appointment. 78

94
Q

What would happen if an appointment has been canceled but not rescheduled?

A

its AppointmentStatus value would be Canceled and its RescheduledVisitKey value would be ‐1. Appointments that have been canceled and rescheduled will have a RescheduledVisitKey value greater than 0. 78

95
Q

What table and columns would I use for additional context about cancelations?

A

VisitFact’s ReasonAppointmentCanceled, CancellationInitiator, and CancellationLeadTimeInDays columns provide additional context about cancelations.79

96
Q

What does The ReasonAppointmentCanceled column return?

A

The ReasonAppointmentCanceled column returns the full name of that cancel reason.79

97
Q

If you need to identify who was ultimately responsible for the appointment’s cancellation ‐ was it due to the provider, the patient, or neither? What would you use?

A

Use the CancellationInitiator column. This returns values of Provider, Patient, or Other.79

98
Q

What does the IsLateCancel column indicates?

A

The IsLateCancel column indicates patient-initiated late cancels. By default, the late cancels are those made within 24 hours of the appointment, although an organization can override this.79

99
Q

What is Fast pass?

A

Fast Pass is a wait list feature in Cadence that automatically sends patients text or email messages to notify them of a wait list appointment offering. Upon receiving the message, patients can then log in to MyChart and claim the offer if it is still available or decline the offer to keep the original appointment and wait for another offer.79

100
Q

How can I report on Fast Pass’s Effectiveness?

A

You can find key measures in SlicerDicer’s Visits data model, or you can use two columns from VisitFact:

DaysSavedByAutoWaitList

SecondsToRespondToAutoWaitListOffer 79

101
Q

What is Utilization?

A

Utilization is a measure of how effectively an organization uses the time of its providers and resources.81

102
Q

Where does Cadence place schedule information?

A

Cadence places scheduling information in the M global data structures that exist outside of the chronicles hierarchy to allow for specialized indexes optimized for rapid schedule searches.81

103
Q

What do globals do?

A

These globals are optimized for efficient searching, and have names like ^SAP, ^SPT, and ^SCHED. While many of these global names have 3 letters, it is important to note that these are not master file INIs.81

104
Q

True or False: the AVAILABILITY table uses special extract process to extract scheduling data?

A

Many schedule‐based tables like the upcoming AVAILABILITY table use special extract processes to only extract scheduling data in specified date ranges. 81

105
Q

True or False: By default, the AVAILABILITY table updates rows in the date range of T-4 to T+120

A

True, By default, such tables update rows in the date range of T‐4 to T+120. This specified date range will account for Cadence End of Day processes. 81

106
Q

True or False:In order to conserve disk space, the schedule is not actually built in the system until it is needed.

A

In order to conserve disk space, the schedule is not actually built in the system until it is needed. For example, a provider could have a template for 9 A.M. to 5 P.M. from August 1 through November 30. However, if no scheduler has yet viewed November 30, then the schedule hasn’t been created for that date. Subsequently, the schedule‐based tables would not contain rows for November 30. 81

107
Q

What is Slot?

A

A schedule range of time in a providers schedule. Slots have a begin time and an end time; the length must be increment of 5 mins. Each is identified by the combination of provider, department, and slot beginning time. 81

Video: A span of time on the schedule were we would allow care.

108
Q

What is an opening?

A

An opening represents the ability to schedule an appointment into a slot. An opening may be filled by a single appointment at most. To allow a provider to be scheduled to have more than one appointment at a given time, a slot can have more than on opening. All the openings within a given slot have the same length. 81

109
Q

Overbook opening?

A

Some schedules allow schedulers to overbook appointments beyond the number of regular appointment openings. each slot has a nu Ub er (zero or more) of overbook openings specified, which only scheduler with overbook security may fill once and all openings are filled. 81

110
Q

Super Overbook

A

One all regular and overbook openings are used, only users with super overbook security can schedule additional appointments into a slot. There is no limit to the number of super overbook appointments. The appointments that result from super overbooks may appear outside of the normal slots for the providers scheduled template.82

111
Q

Schedule

A

Schedules are created from templates. They capture the actual scheduling activity, including each slot, each appointment in each slot, and each block in each slot. This data is also stored in M globals. Each schedule is specific to a combination of provider and department. 82

112
Q

Appointment

A

An appointment is a specific date and time that a patient is scheduled to see a specific provider in a specific department, for a specific visit type, for a specific length of time. 82

113
Q

Joint Appointment

A

A joint appointment is an appointment scheduled with more than one provider or resource. For an appointment to be considered joint, the times selected must be the same, overlap, or touch all providers/resourses involved. 82

114
Q

Block

A

Used in Cadence to reserve time slots on a provider’s schedule for specific types of patients or visits. Examples include specific appointment times set aside for new patients, same day patients, or inpatients. Similarly, blocks can reserve certain types of procedures for times when limited resources like machines, rooms, or technicians are available. 82

115
Q

Split Slot

A

If an appointment does not require the entire length of the slot the slot will be split into two, leaving a slot with a length equal to the remaining time in the original slot. Even though the resulting two slots were not defined in the template, the schedule will display the two slots separately. As the leftover time in the new slot often is insufficient to accommodate a new appointment, the resulting time often goes unused. Split slots are an indicator of ineffective schedule strategy. 83

116
Q

Spanned Slot

A

If an appointment requires a length that is longer than a slot, the appointment can span two or more slots. The schedule will still display the two slots, but the appointment will appear in both of them. There will still only be one appointment contact in EPT. 83

117
Q

How is utilization measured?

A

Utilization is most often measured in 2 ways:

Provider utilization
Schedule utilization

both measures are based on time rather than the number of slots, openings, or appointments. 83

118
Q

What is Provider Utilization?

A

Provider utilization is about how much time providers actually spent providing care. Epic calculates this as a percent of a schedule’s regular available time. Put simply, provider utilization is :

Completed/Appointment time/Regular available time

119
Q

When using this formula:
Completed Appointment Time / Regular Available Time

what does a lower provider utilization indicate?

A

A lower provider utilization indicates that the provider spends less time with patients than they expect. 83

120
Q

When using this formula:
Completed Appointment Time / Regular Available Time

What does a high utilization indicate?

A

a higher provider utilization indicates that the provider is spending as much time with patients as their schedule allows

121
Q

True or False: When using this formula, can you expect values to surpass 100%

Completed Appointment Time / Regular Available Time

A

True, yes. Values may exceed 100% with this formula. 83

122
Q

What is Schedule Utilization?

A

Schedule utilization is about how full a providers schedule is. 83

123
Q

How does Epic calculate Schedule Utilization?

A

Epic calculates this as the total amount of booked time, plus any unused time in regular openings due to late patient-initiated cancellations. Put another way, schedule utilization is:

( Noncanceled Appointment Time + Time Lost to Late Cancels ) / Regular Available Time 83

124
Q

When using this formula
( Noncanceled Appointment Time + Time Lost to Late Cancels ) / Regular Available Time

What does it mean when you have a provider with high schedule utilization?

A

A provider with high schedule utilization has a schedule that is consistently filled with appointments. 83

125
Q

When using this formula
( Noncanceled Appointment Time + Time Lost to Late Cancels ) / Regular Available Time

What does it mean when you have a provider with low schedule utilization?

A

A provider with low schedule utilization regularly has unused openings on their schedule. 83

126
Q

True or False: When using this formula, can you expect values to surpass 100%

( Noncanceled Appointment Time + Time Lost to Late Cancels ) / Regular Available Time

A

True, yes. Values may exceed 100% with this formula. 83

127
Q

Why does Epic released provider utilization and schedule utilization use time rather than number of slots, openings, or appointments?

A

Different slots, openings, and appointments may take up different amounts of time. 83

128
Q

Regular available time?

A

The sum of time associated with regular openings in the schedule. 84

129
Q

Completed appointment time

A

The sum of time used in appointments with statuses of completed, arrived, or any custom statuses the organization considers completed. If calculating provider utilization for future dates, this also includes appointments in a status of scheduled. 84

130
Q

Noncanceled Appointment time

A

The sum of time associated with appointments that weren’t canceled. This includes no-show appointments. This is sometimes called booked time. 84

131
Q

Time lost to late cancels

A

The sum of time lost to patient‐initiated late cancelations of appointments. This is sometimes called unmitigated patient‐initiated late‐cancels. If there are more late‐cancels in a slot than there are unfilled openings, this will use the time associated with unfilled openings instead. After all, it wouldn’t make sense to claim that there was more time lost to late cancels than there was unfilled time to begin with. 84

132
Q

What is the Provider Utilization health Report?

A

It is an epic released reporting workbench template that returns one row per unique combination of provider and department that matches the search terms you include. 86

133
Q

What is Schedule Slot Type Utilization Report Template?

A

The template focuses on utilization numbers for slot types. You can think of it as a system‐level deep dive into the Slot Type detail report available for any row returned by the Provider Utilization Health Report Template. For a given slot type, the report returns what percent of time that slot represents when compared to all slot types considered in the report and the schedule utilization for that slot type. 87

134
Q

What does the ES Upcoming Schedule (Opening Based) Component look at?

A

It allows users to quickly glance at the number of openings remaining in the upcoming 6 days by default. 87

135
Q

What does the table F_SCHED_APPT_STATS do?

A

The table contains summarized appointment information for each date, department, and provider combination. 88

136
Q

True or False: V_Availability has a primary key?

A

False, there is no primary key, it has 2 different granularities. 1 row per slot on a schedule and 1 row per appointment in each slot. 88

137
Q

What does the V_AVAILABILITY table provide?

A

It provides a view based on the availability table, is more granular and flexible than F_SCHED_APPT_STATS. This table returns one row per slot and one row per appointment in each slot.88

Video: When what you want is more specific than a day.

138
Q

Video: For V_AVAILABILITY, if I wanted some sort of primary key what would it be?

A

It would be 4 columns Department_ID, Slot_begin_time, Prov_ID. Appt_number

This would not be documented because of the double granularity.
Access Day 2 part 8 9:11

139
Q

True or False: V_AVAILABILITY does not include canceled appointments?

A

True, It does not include canceled appointments because canceled appointments are no longer reserved on the provider’s schedule. 91

140
Q

Video: How would I find the total regular available time?

A

You would take Slot_len * Org_reg 90 Access Day 2 part 8 14:15

141
Q

True or False: Block utilization is a representation of what proportion of block time is actually used by appointments?

A

True, however, as multiple blocks can occupy the same opening, the numbers may initially appear strange. 91

142
Q

True or False: Schedule utilization and Provider utilization require appointment information in their formulas?

A

True,

Schedule utilization needs to add back in the time lost to late cancels.

Provider utilization needs to subtract the time associated with no-show appointments. 92

143
Q

If I wanted to find relevant appointments for a slot, what tables would I join?

A

How should we join from V_AVAILABILITY to find the appointment information? Remember that V_AVAILABILITY excludes canceled appointments ‐ this means we cannot join from its appointment rows and expect to find canceled appointments. We need another way to identify the relevant appointments for a slot.
Epic’s released metrics use slot‐level columns to join to PAT_ENC_APPT on multiple conditions to:
1. Maintain a slot‐focused granularity
2. Properly account for appointments that occupy multiple schedules (joint appointments) 3. Most accurately reflect provider time
Consider the following code example modeling the join from V_AVAILABILITY to PAT_ENC_APPT:
The purpose of this join is to find all appointments associated with slots. An appointment is defined by its department, provider, and span of time for care. The join has clear conditions about the department and provider, but what’s happening with the time? Why don’t we just set V_AVAILABILITY.SLOT_BEGIN_TIME = PAT_ENC_APPT.PROV_START_TIME?
92

144
Q

What are blocks?

A

Blocks are a way to reserve slots for specific types of patients or visits and to reserve time with resources with limited availability, like machines. 94

145
Q

True or False: A slot can have more blocks than openings?

A

True, a slot can have more blocks than openings. For example, a slot with two openings could have two Consult blocks and two Physical blocks. The slot would have at most two appointments, and they could be Consult or Physical appointment 94

146
Q

What does the Time release of blocks do?

A

If the scheduled time approaches and a block appears that it will go unused, the time release of blocks functionality can convert it into a different block that is more likely to be filled. For example, if a consult block were unfilled as the appointment time approaches, the schedule could automatically convert it into a same day block or convert the slot into an unblocked slot altogether.94

147
Q

What does the AVAIL_BlOCK table do?

A

The AVAIL_BLOCK table allows you to report on scheduling block data as it relates to provider utilization. It contains information about blocks and block usage in each slot in provider template.94

148
Q

How would you join AVAIL_BLOCK and V_AVAILABILITY?

A

What we need to do is find the slot identifier in AVAIL_BLOCK and join from there to V_AVAILABILITY. As a slot is identified by its department, begin time, and provider, a feasible join could appear as follow.

SELECT /* columns */ FROM AVAIL_BLOCK
INNER JOIN V_AVAILABILITY
ON AVAIL_BLOCK.DEPARTMENT_ID = V_AVAILABILITY.DEPARTMENT_ID
AND AVAIL_BLOCK.SLOT_BEGIN_TIME = V_AVAILABILITY.SLOT_BEGIN_TIME AND AVAIL_BLOCK.PROV_ID = V_AVAILABILITY.PROV_ID

149
Q

What does the Line mean in AVAIL_BLOCK?

A

AVAIL_BLOCK has one line per block type the slot either uses or has available as of the last extract. If Time Release of Blocks replaces a block type, then AVAIL_BLOCK will either update the replaced block type’s row or create a new row:
An additional row will be added for each block type that converted if, and only if, the original block was in use by an appointment
If all original block types are unused and Time Release of Blocks converts the block types, then the existing rows will be updated
The behavior of the BLOCK_C and REL_BLOCK_C columns indicate how Time Release of Blocks acted.
96

150
Q

What does Block_C mean in AVAIL_BLOCK?

A

For any line of AVAIL_BLOCK, BLOCK_C identifies a block type that occupies the slot.
BLOCK_C can be null if Time Release of Blocks removes a block type without replacing it with a new block type. The same BLOCK_C value may appear multiple times for one slot. For example, if a slot had two block types, Consult and New Patient, and Time Release of Blocks changed both to Same Day, two lines would identify Same Day with BLOCK_C.

151
Q

What does REL_BLOCK_C mean in AVAIL_BLOCK?

A

For any line that Time Release of Blocks produced or altered, REL_BLOCK_C identifies the original block type that was replaced. Otherwise, REL_BLOCK_C is null. You could use this column in conjunction with BLOCK_C to determine which block types are consistently being replaced due to being unfilled and thereby triggering Time Release of Blocks.

152
Q

What does Blocks used in AVAIL_BLOCK mean?

A

The number of block openings used by appointments for this LINE and BLOCK_C block type. If the original block type was released to unblocked time and then an appointment was scheduled into the slot, BLOCKS_USED will remain as 0 or NULL because the line now represents an unblocked slot and technically no block types are being used.98

153
Q

What does session limits do?

A

Visit type session limits control how many visits of certain visit types can be scheduled for a certain time of day or ranges of dates, which are referred to as sessions. For example, some providers might want to limit the number of physicals that they see in a day or a week, or a mass immunization center might limit how many immunizations a resource can provide per day to avoid having more appointments than doses. Use the ES Session Limit Summary Report Template to report on how these sessions are utilize. 98

154
Q

Accessibility Configuration

A

Accessibility, or access to care, is the ability to seek and receive care at an organization. The industry standard when reporting the next available appointment is to look on the 3rd next available. This accounts for cancelations, and it does not mess up our numbers. Cadence completes regularly scheduled batches to calculate accessibility numbers. We might want to calculate different accessibility numbers using different combinations of criteria. This is accomplished by setting up different accessibility configuration records in the SNR master file. Each record represents a different set of search criteria, and we can have multiple SNR records generating data at the same time.65

When looking up our next available appointment, if it is 0 that means there is no wait, I found the third next today. If you get a null, that means that there is no next appointment in the 180 days.

155
Q

Global

A

Epic builds globals and optimizes them to search for provider schedules. 81 A global is a different type of data structure in Chronicles. Some data is stored in master files, some is stored in globals. This is why there is’nt an ini and item number listed for the table AVAILABILITY in Clarity

156
Q

Appointment Request

A

Appointment requests are most used for new patient appointments and requests for specialty care. Chronicles stores appointment requests as ORD records. As a result, you may hear people refer to appointment requests as schedule orders. Each appointment request appears as a row in the APPT_REQUEST table. 70

157
Q

Joint Appointment

A

Appointments with multiple providers or resources are referred to as joint appointments. For an appointment to be considered joint, the times selected must be the same, overlap, or touch for all providers/resources involved. This is stored as a single contact in EPT and as a single row in V_SCHED_APPT. 75

158
Q

Slot

A

A schedulable range of time in a provider’s schedule. Slots have a begin time and an end time; the length must be an increment of 5 mins. Each is identified by combination of provider, department, and slot beginning time

159
Q

Opening

A

An opening represents the ability to schedule an appointment into a slot. An opening may be filled by a single appointment at most. To allow a provider to be scheduled to have more than one appointment at a given time, a slot can have more than one opening. All the openings within a given slot have the same length. 81

160
Q

Block:

A

Used in cadence to reserve time slots on a providers schedule for specific types of patient or visits. Examples include specific appointment times set aside for new patients, same day patients, or inpatients. Similarly, blocks can reserve certain types of procedures for times when limited resources like machines, rooms, or technicians are available. 82

161
Q

Schedule:

A

Schedules are created from templates. They capture the actual scheduling activity, including each slot, each appointment in each slot, and each block in each slot. This data is also stored in M global. Each schedule is specific to a combination of provider and department. 82

162
Q

Schedule Utilization

A

Schedule utilization is about how full a provider’s schedule is. Epic calculates this as the total amount of booked time, plus any unused time in regular openings due to late patient-initiated cancellations.

(Noncanceled Appointment Time +Time Lost to Late Cancels) / Regular Available Time

A provider with high schedule utilization has a schedule that is consistently filled with appointments. A provider with low schedule utilization regularly has unused openings on their schedule. Values may exceed 100% with this formula. 83

163
Q

Provider Utilization:

A

Provider utilization is about how much time providers actually spent providing care. Epic calculates this as a percent of a schedule’s regular available time.

Completed Appointment Time / Regular Available Time

A lower provider utilization indicates that the provider spends less time with patients than they expected, while a higher provider utilization indicates that the provider is spending as much time with patients as their schedule allows. Values may exceed 100% with this formula. 83

164
Q

Determine how long it would take a patient to get an appointment with a specific provider in a specific department.

A

When investigating to see how long it would take per provider, I would use the ACCESS_PROV in SSMS table to find the occurrence and then filter by department. If I set each provider equal to yes, I am saying I want to find Cindy’s (The provider) or any provider’s 3rd next available appt. Using Access_Prov, I would get one row per provider per search run. 66-68

165
Q

Determine how long it would take a patient to get an appointment in a specific department.

A

If I want to get a specific department, such as pediatrics, I would set access to each department to yes. When I set it to yes, I am saying I want to find the 3rd next in ICU, Med Surge, or Pediatrics. Who the provider is, does not matter, but what I want is to get the next opening for the department. For this I would be using ACCESS_DEP. This gets me one row per department

166
Q

Determine how long it would take a patient to get an appointment in any department.

A

If I want to get information on any department, the specific department or provider does not matter, then I would use ACCESS_ALL_DEPS. When I click on all departments and click yes, I am pretty much saying I do not care what department it is just get me in somewhere. The table ACCESS_ALL_DEPS granularity is 1 row per search run

167
Q

Describe how to use an accessibility configuration.

A

ACCESS_CONFIG has the granularity of 1 row per SNR record. This table is used to learn what are the configurations of SNR records. SNR records can be found in record viewer and from there you can find the configuration.

168
Q

Identify appointments built from appointment requests.

A

Appointment requests are most used for new patient appointment and requests for specialty care. Chronicles stores appointment requests as ORD records which means that they are orders. Each appointment request appears as a row in the APPT_REQUEST table. This tale will return one row per every appointment request. An appointment request will have a request_ID and an appointment request will have base statuses and override status. If we want to link the appointment requests to appointments, we can use the APT_REQ_APPT_LINKS table. This table lists any relevant appointments scheduled from requests and includes both the ASN and EPT CSN pointer. 72

169
Q

Audit actions taken on appointment requests.

A

If we wish to report on the actions taken on the appointment requests, we will use the APPT_REQ_AUDIT table. This table focuses on the outcomes of action on each individual request. Each of its lines represents the state of the request after some event happened in the history of the request. You can see when it happens, the base status, and just the overall history.73

170
Q

Recognize characteristics of appointments.

A

Different appointments have different scheduling needs. For example, a new patient will have a longer time than an appointment for an MRN. But every appointment needs the following information: 74

*Patient

*Provider/Department

*Start Date/Time

*Appointment Length

171
Q

Distinguish appointments and visits

A

In Epic, an appointment is any EPT contact that has defined an appointment status, provider, department, and visit type. In contrast, visits include those appointments and any other encounters that are of a type that an organization specified. For example, telephone encounters, telemedicine visits, and in-home visits are not classically considered appointments, but organizations can choose to consider them under the term visits. 7

172
Q

Identify and display the visit type of a visit.

A

VisitFact and V_SCHED_APPT are two different tables that one can use to report on visits. VisitFact has a row for every visit, while V_SCHED_APPT returns a row for every appointment.

USE Clarity

Select top 10

PRC_ID – Visit Type

From V_SCHED_APPT

USE CDW

Select top 10

Visit Type

From VisitFact

173
Q

Identify which appointments are joint appointments

A

Appointments with multiple providers or resources are referred to as joint appointments. For an appointment to be considered joint, the times selected must be the same, overlap or touch for all providers/resources involved. This is stored as a single contact in EPT as a single row in V_SCHED_APPT

If you want to include a report on the appointment providers or departments, the list of providers for an appointment is stored in EPT 7040 and the list of departments is stored in EPT 7070. These appear in the PAT_ENC_APPT table. This table has a line for each provider within an appointment and the appropriate department.

174
Q

Describe how appointment serial numbers link EPT contacts.

A

Natural relationships exist between multiple contact. For example, canceled appointments are related to the appointments rescheduled from them. Appointment serial numbers (ASN) tie these contacts together. When we schedule an appointment for the first time, it is assigned an ASN that is equal to its CSN. If additional contacts are created due to cancelation and rescheduling, they will have new CSN but the same ASN. In other words, the ASN value is determined by the original CSN in a series. Examples include, wait list entries and appointments scheduled from the wait list and canceled and rescheduled appointments. 78

175
Q

Identify how Scheduling data is stored and processed on the operational database.

A

The providers schedule is not stored in any master files. Cadence places schedule information in M global data structures that exist outside of the chronicles hierarchy to allow for specialized indexes optimized for rapid schedule searches. These “globals” are optimized for efficient searching. Many tables like availability use special extract processes to only extract scheduling data in specific data ranges. To conserve space, the schedule is not actually built in the system until it is needed. For example, a provider could have a template for 9 AM to 5 PM from Aug 1 through November 30. However, if no scheduler has yet viewed November 30, then the schedule hasn’t been created for that date. Subsequently, the schedule-based tables would not contain rows for November 30.81

176
Q

Differentiate schedule and provider utilization.

A

When looking at utilization, we are looking at provider and schedule activity. For provider utilization, we are investigating how much time did providers spend providing care. In schedule utilization, we are looking at how much time was reserved on schedules to provider care. 83

177
Q

Determine the original blocks used in a slot.

A

Blocks allow providers to take time on schedule and reserve it for a specific type of care. For example, if I want to reserve new patients everyday at 9AM –9:15AM I can have those blocks. Now blocks can also be bad because a provider can block off the entire schedule and it makes it hard for a patient to get the care they need. 94

A slot can be a block but it is specific for a category for example new patient or physicals. Not all slots are blocks but all blocks are slots.

178
Q

How schedule data is dependent on non-chronicles data

A

Cadence places schedule information in M global data structures that exist outside of the Chronicles hierarchy to allow for specialized indexes optimized for rapid schedule searches.81

179
Q

The distinction between appointment serial numbers and contact serial numbers.

A

An appointment serial number is a unique id that comes about when we schedule an appointment for the first time, it is assigned an ASN that is equal to its CSN. A contact serial number is an encounter if additional contacts are created due to cancelation and rescheduling, they will have new CSNs but the same ASN. 78

180
Q

The different ways to calculate utilization

A

The measures are calculated by times instead of number of slots, openings, or appointments. 83

Provider Utilization- Completed appointment time/Regular available time.

Schedule Utilization- (Noncancelled appointment time + Time lost to late cancels)/ Regular available time.

Access Data Model (7 decks)

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