User Guide — Encounter Oversight

athenaClinicals

athenaClinicals supports physician oversight of encounters rendered by midlevel providers, including reports for oversight providers and high-level administrators who review the work of rendering providers.

 

With Encounter Oversight, when a midlevel rendering provider closes an encounter, the encounter review document is automatically generated and assigned to the oversight provider in REVIEW status. This feature is especially useful for retail clinics, but it can also be useful to any practice with midlevels or residents, including urgent care facilities.

 

With another option — the "Encounter Oversight: Encounters with Medication Orders Only" feature — you can limit the number of encounters that require oversight to include only encounters with medication orders.

 

To support the Encounter Oversight workflow, athenaClinicals provides:

  • Encounter review documents, which indicate encounters that need oversight review and allow the oversight provider to correspond with the midlevel rendering provider privately.
  • The Oversight Provider Mapping page, where oversight providers are associated with the midlevel rendering providers whose work they oversee.
  • The Encounter Oversight Setup page, where the percentage and type of encounters to be reviewed can be configured per rendering provider.

  • The Encounter Oversight Checklist page, where the practice can set up a list of questions that should be answered for each encounter review.

  • The Report Builder type, "Clinicals — Encounters," which allows oversight providers and oversight superusers to research encounters and create additional encounter review documents, as necessary.
  • The Oversight Progress Report, a custom report that summarizes the encounters that have been reviewed per oversight provider and rendering provider and offers the option to show comments or oversight checklist results. When you export the report results to Excel, multiple rows are displayed for each encounter review document, with one row for each checklist element.
  • Two user roles, Clinicals: Oversight Provider and Clinicals: Oversight Superuser.

To request this functionality, please contact the CSC by selecting Support > Create Case or Call in the Main Menu.

 

After the Encounter Oversight feature is enabled for your practice, some setup is required. You will need to create oversight mappings and set up the encounter oversight configuration for each rendering provider. athenaOne then automatically creates encounter review documents for encounters with midlevel rendering providers associated with oversight providers.

 

 

 

  1. Contact the CSC by selecting Support > Create Case or Call in the Main Menu to request the Encounter Oversight: Encounters with Medication Orders Only feature.

  2. Grant the needed oversight roles to the appropriate providers and administrators in your practice.

  3. Configure the Encounter Oversight feature for each rendering provider on the Encounter Oversight Setup page.
  4. Create oversight mappings on the Oversight Provider Mapping page.

 

 

For oversight superusers (those who will oversee the oversight providers, monitor progress of completion of reviews, and monitor comments), we recommend these roles:

  • Clinicals: Oversight provider Superuser — To see all encounter review documents, across all oversight providers and rendering providers.
  • Clinicals or view only clinicals – To view charts.
  • Clinicals Admin — To set up the relationships between oversight providers and rendering providers, the percentage and types of encounters to be reviewed, and the encounter review checklist.
  • Report: Custom Reports — To view the Oversight Progress Report.
  • Report: Report Builder: Clinicals — To create Clinicals — Encounters reports that can be used to filter encounters by rendering provider, diagnosis, patient age, and patient sex.
  • Report: Report Library: Other — To view Clinicals — Encounters reports that were saved, which can be used to look for encounters for particular rendering providers or diagnoses.

 

 

For oversight providers (those who will oversee midlevel rendering provider), we recommend these roles, in addition to those given to typical providers:

  • Clinicals: Oversight provider — To be listed as an option on the Oversight Provider Mapping page.
    Note: Do not select Clinicals: Delete document or Clinicals Deletion. This way, providers cannot delete documents.
  • Report: Report Builder: Clinicals — To create Clinicals — Encounters reports that can be used to filter encounters by rendering provider, diagnosis, patient age, and patient sex.
  • Report: Report Library: Other — To view Clinicals — Encounters reports that were saved, which can be used to look for encounters for particular rendering providers or diagnoses.
  • Practice policies should determine whether oversight providers should have access to the Oversight Progress Report through the Report: Custom Reports role.

 

 

For rendering providers, we recommend that you grant the same roles you typically give to providers. No additional roles are required for oversight reporting,

 

To generate encounter review documents, you must set up the relationship between the oversight provider and the rendering provider on the Oversight Provider Mapping page. You can map a rendering provider to only one oversight provider.

Note: An oversight provider must have the Clinicals: Oversight Provider role in order to appear in the Oversight provider list on the Oversight Provider Mapping page.

 

 

 

Create a single mapping entry for each oversight provider, listing all the midlevel providers that they oversee. You can map a rendering provider to only one oversight provider.

 

Note: Your practice must set up rendering providers on either the Oversight Provider Mapping page or the Cosignature with Encounter Review Setup page. Please do not set up any providers or midlevel providers on both pages.

  1. Display the Oversight Provider Mapping page: On the Main Menu, click Settings > Clinicals. In the left menu, under Practice Links — Encounter Oversight, click Oversight Provider Mapping.
  2. Click Add new.
    Additional fields appear.
  3. Oversight provider — Select the oversight provider to map. The menu contains only providers who have the Clinicals: Oversight Provider role.
  4. Rendering providers — Select the midlevel providers that this oversight provider oversees.
    Note: All providers who do not have the Clinicals: Oversight Provider user permission appear in this list.
  5. Reassign existing encounter review documents — Select this option if you want to reassign open encounter review documents (from past encounters that are assigned to a different oversight provider) to the new Oversight provider that you selected above.
  6. Click Save.
  7. Click edit or delete to manage oversight provider mappings.

Note: To set the percentage and type of encounters that oversight providers should review for each rendering provider, use the Encounter Oversight Setup page.

 

 

 

Encounters that are marked for review based on the configurations on this page are marked as "Auto-generated" on the encounter review document and in reports.

 

Note: A rendering provider can be set up only once. If the rendering provider is not set up on the Encounter Oversight Setup page, the encounters for that rendering provider will not be automatically marked for review.

  1. Display the Encounter Oversight Setup page: On the Main Menu, click Settings > Clinicals. In the left menu, under Practice Links — Encounter Oversight, click Encounter Oversight Setup.
  2. Click Add new.
    Additional fields appear.
    Note: Click edit or delete to update existing encounter oversight setups.
  3. Rendering providers — Click All, or click Selected to select the midlevel providers who will have the same percentage of encounters reviewed and the same diagnoses excluded.
  4. % of encounters to be reviewed — Enter an integer from 0 to 100.
    Note: This percentage is calculated based on the number of reviews performed in the configured time period, or 30 day default. If the percentage of encounters sent for review over the past 30 days is less than the percentage set in this field, the next encounter closed by the rendering provider is flagged for review. If this percentage was edited less than 30 days ago, the calculation is based on that number of days.
  5. Diagnoses to exclude — Search for a SNOMED term to indicate which diagnosis to exclude from provider oversight. athenaOne will not generate encounter review documents for encounters with matching diagnoses.
    You can enter ranges and wildcards to describe a large number of related diagnoses. For example, V03-V06 excludes a range of vaccines, indicating that encounters with these diagnoses do not require review.
    Note: If an encounter has multiple diagnoses and only one of them is excluded, the encounter may still be selected for review.
  6. Click Save.

 

 

Your practice can set up a custom checklist of questions to appear in each encounter review document. Each question has a drop-down list associated with it, with the options blank, Yes, and No.

  1. Display the Encounter Oversight Checklist page: On the Main Menu, click Settings > Clinicals. In the left menu, under Practice Links — Encounter Oversight, click Encounter Oversight Checklist.
  2. Click add new.
    Additional fields appear.
  3. Name — Enter the question text.
  4. Ordering — Enter the question order.
    Tip: Space ordering numbers 10 apart, so it's easier to insert new questions or reorder, if necessary.
  5. Input — Enter the type of input you would like the oversight provider to see on the encounter review document.
    • Dropdown — Select this option to create a drop-down menu.
      • Yes/No — Select this to create a Yes/No option.
      • Custom — Select this to add as many options as you like.
    • Radio buttons — Select this option to create options.
      • Yes/No — Select this to create a Yes/No option.
      • Custom — Select this to add as many options as you like.
    • Freetext — Select this option to allow the user to enter free text.
      These fields will appear in the encounter review document.

 

 

To enable access to the Oversight Progress Report in the Report Library, use the Activate Reports page.

  1. Display the Activate Reports page: On the Main Menu, click Settings > Implementation. In the left menu, under Practice Links — Reports, click Activate Reports.
  2. In the Other section, place a check in the Activate column next to Oversight Progress Report.

  3. Click Save.

Note: When you run an oversight report, athenahealth highly recommends that you include the display column Clinical Encounter: Encounter Review Document Created Yes/No, and then filter this column, so that you do not try to generate additional Encounter Review documents, which produces an error.

 

 

 

 

 

Encounter review documents appear in the oversight provider's Clinical Inbox under Clinical Documents. The encounter review document includes a link to the encounter, so the oversight provider can review the data.

 

Note: An encounter document with the subclass ENCOUNTERDOCUMENT_ENCOUNTERREVIEW cannot be reassigned. Only the username of the person to whom it is currently assigned appears in the "Leave in [status] to" menu.

 

The oversight provider should review the encounter data and use the Oversight Checklist and Oversight Comments fields to correspond with the rendering provider privately, where appropriate.

 

Once you save the encounter review document, athenaOne time stamps the Oversight Comments field, and you can no longer update that particular comment. You can still enter additional comments, as necessary.

 

The Source field indicates whether the encounter was marked for review automatically based on settings on the Encounter Oversight Setup page (auto-generated) or was added manually using a Clinicals — Encounters report (manually generated).

 

As with other Clinical Inbox tasks, a link to view actions appears at the bottom of the document.

 

 

 

After reviewing the document, the oversight provider signs the encounter as follows:

  1. Click the Review Completed option.
  2. Select an option from the menu:
    • Close — Sign the encounter and close the document without comment.
    • Send Comment — Sign the encounter and send comments to the rendering provider. This action reassigns the document to the rendering provider in ACKNOWLEDGE status.

      The oversight provider should enter comments in the Oversight Comments field (these comments appear in the Oversight Progress Report). The oversight provider and rendering provider can use the Oversight Comments field in the encounter review document to communicate with each other.
  3. Clicks Save.

If the oversight provider adds comments and sends them back to the rendering provider, athenaOne adds the following information to the Encounter Sign-Off section:

Oversight: Encounter reviewed by [oversight provider name] and communicated to [rendering provider name] on [mm/dd/yyyy hh:mm am/pm]

If the oversight provider closes the encounter review without comment, athenaOne adds the following information to the Encounter Sign-Off section:

Oversight: Encounter reviewed by [oversight provider name] on [mm/dd/yyyy hh:mm am/pm]

If a rendering provider sends a comment back to the oversight provider, it appears with the status ACKNOWLEDGE, indicating that it has already been reviewed.

 

The oversight provider can also select these actions:

  • Leave in REVIEW to (oversight provider) — Take no action.
  • Delete — Removes the encounter review document (but not the encounter itself).
    Important: athenahealth strongly advises against deletion. Remove the Clinicals: Deletion and Clinicals: Delete Documents roles to prevent users from deleting documents.

 

 

 

  1. Display the Report Builder: On the Main Menu, click Reports. Under General, click Report Builder.
  2. Select "Clinicals - Encounter" as the report type.
  3. Select the display column "Clinicals Encounter ID."
  4. Select other display information as needed, for example, Encounter Date and Patient Name.
  5. Filter for "Clinical Encounter Date" based on the desired reporting period. You can include other filters as needed.
  6. In the report results, select any desired encounters and click "Assign for Review."

 

 

Oversight providers and oversight superusers might want to review groups of related encounters. For example, they might want to review encounters related to Earache, with ICD-10 code H9209.

  1. Display the Report Builder: On the Main Menu, click Reports. Under General, click Report Builder.
  2. On the Choose Report Type tab, click the Clinicals - Encounters option.
  3. Click the Choose Display Columns tab, and select your columns, including Clinical Encounter: Clinical Encounter ID, Clinical Encounter: Clinical Encounter Closed, and Diagnosis Code: ICD-10 Encounter Diagnosis Code.
  4. Click the Choose & Set Filters tab and select filters, including Diagnosis Code: ICD-10 Encounter Diagnosis Code. You must select at least one of the following options to run the report:
    • Clinical Encounter: Clinical Encounter Created
    • Clinical Encounter: Clinical Encounter Closed

Note: Other useful display columns and filters include:

  • Encounter Provider: Provider Full Name (refers to the rendering provider)
  • Patient: Patient Age
  • Patient: Patient Sex
  1. Select and enter any additional filter criteria, as necessary.
  2. Click Run Report.
  3. Select the report format and click OK .
  4. When the report results appear, check the boxes for the appropriate clinical encounters.
  5. Click Assign for Review.

 

 

Note: This custom report must be activated for your practice by a user with the permission Report: Custom Reports Activate.

  1. Display the Report Library: On the Main Menu, click Reports. Under General, click Report Library.
  2. Click the Other tab.
  3. Click run next to Oversight Progress Report.
  4. From date - To date — Select the date range of your request (required).
  5. Oversight Provider — Select Show All or choose a subset of the providers listed.
  6. Rendering Provider — Select Show All or choose a subset of the providers listed.
  7. Include encounters manually selected for review – Select this option to display encounters manually generated for review. By default, this report displays only encounters auto-generated for review.
  8. Drill down to comments — Select this option to display all encounters that meet the date and provider filters, with comments displayed.
  9. Include checklist feedback — Select this option to display all encounters that meet the date and provider filters, with checklist responses displayed.
    Note: To display the checklist questions and answers, you must select the HTML table option as the Report Format.
  10. Report Format — Select the report format.
  11. Report Options — Select one or more options.
  12. Click Run Report.

If you selected the Include encounters manually selected for review option (step 7), your report results include these columns:

 

 

 

 

In many cases, the oversight provider closes the encounter review document, indicating that no further action is required. In some cases, the oversight provider might choose to send a comment to a rendering provider. The encounter review document appears in the rendering provider's Inbox, under the Clinical Documents heading, in ACKNOWLEDGE status.

 

At this point, the rendering provider can select one of these actions:

  • Send Comment — Reply to the oversight provider with an additional comment, perhaps answering a question posed in the oversight provider's comment.
  • Close — Close the encounter review document, having read the oversight provider's comment and determined that no further action is required.
  • Delete — Removes the encounter review document (but not the encounter itself).

    Important: athenahealth strongly advises against this. Remove the Clinicals: Deletion and Clinicals: Delete Documents roles to prevent users from deleting documents.
  • Error Identified (Send back to Review) — Ask the oversight provider to review the document again. It is more typical to Send Comment instead as part of an ongoing conversation.
  • Leave in ACKNOWLEDGE — Do nothing at this time.

 

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