DBIA1900-A    ICR (1900)

Visit Tracking is a utility that can be used by a variety of VISTA modules
(usually via PCE), with potential benefits for clinical, administrative,
and fiscal applications. Visit Tracking will allow VISTA packages to link
an event to a patient visit entry, thereby linking that event to any
number of events occurring throughout the hospital during the patient's
outpatient and/or inpatient episode.

Visit Tracking is not a stand-alone application. Other packages will
normally call PCE, which will handle the calls to Visit Tracking.


The key to the creation of visits will be to ensure the clinical
meaningfulness of visits.  The creation of visits is facilitated by the
Visit Tracking module. In order to ensure a consistent implementation of
visit creation across packages, each package needs to have an agreement
with the Visit Administrator to create visits.


This section describes the guidelines which should be used for VA
developers populating visits in the Visit file. These guidelines are based
on a combination of the experience of Albuquerque's joint venture sharing,
IHS' PCC pilot test at Tucson VAMC, MCCR data capture pilots, HSR&D
workload reporting studies at Hines VAMC, and DMMS/DSS event data capture.

The purpose of the VISIT file in the VA:

The VISIT file has multiple purposes. The primary role is to record when
and where clinical encounters related to a patient have occurred. Visits
will be recorded for both Outpatient and Inpatient encounters.

Outpatient encounters include scheduled appointments and walk-in
unscheduled visits.

Inpatient encounters include the admission of a patient to a VAMC and
any clinically significant change related to treatment of that
patient. For example, a treating specialty change is clinically
significant, whereas a bed switch is not. The clinically significant
visits created throughout the inpatient stay are related to the
inpatient admission visit.

If the patient is seen in a clinic while an Inpatient, a separate
visit will be created representing the appointment visit?this visit
is related to the Admission visit.

A clinician's telephone communications with a patient may be
represented by a separate visit.

The clinical visits can be viewed from two approaches: 1) a team of
providers can be associated with a primary clinical visit (this is
the traditional view taken by IHS); or 2) a primary clinic visit can
represent the primary provider's care, and a separate visit can be
created to reflect the secondary provider's care.

Additionally, the VISIT file can provide a breakdown of other
ancillary services provided during the clinically significant visit.
Laboratory or Radiology services are other examples of services
provided that could have a separate visit reflecting the service
involvement related to a clinic appointment on the same day.

Create and/or Match Visit Using Input Criteria

^VSIT

INPUT:
VSIT                   <visit date [and time] in FM format>
VSIT("VDT") may be used instead of VSIT.
(time will default to 12 noon if not
specified)

DFN                    <patient file pointer>
VSIT("PAT") may be used instead of DFN.

[VSIT(0)]              <a string of characters that defines how
the visit processor will function, see
package-wide variables>

[VSIT("<xxx>")]        <array with mnemonic subscript>
(used in match logic if VSIT(0)["M")
(for SVC, TYP, INS, CLN, ELG, LOC)
Note: For multiple field values use
[<field value>[^...]]
i.e., VSIT("SVC")="H^D"  (will find both)

VSITPKG                <package name space>
VSIT("PKG") may be used instead of
VSITPKG.

OUTPUT:
VSIT(<ien>)            N^S[^1]
where:
N = <internal entry number of visit>
or -1 if could not get a visit
or -2 if calling package is not
active in Visit Package Parameters
S = <value of .01 field of visit>
1 = <indicates that a new visit was added

VSIT(<xxx>)            array passed in with all the entries
defined and the defaulted values added

VSIT(<ien>,<xxx>)      returns the data that is stored in the
Visit file in the same format as
VSIT(<xxx>)

Variable descriptions:

VSIT(<xxx>)         Variable Names for VISIT file fields,
Where <xxx> is a general reference to the field
mnemonic.
file: 9000010, global: ^AUPNVSIT(

Key                 Indicates

r                   indicated a required field m
matching/screening logic can/does apply s                   system
generated e                   strongly encouraged

Key     Field    Variable         Description

.001    VSIT("IEN")     NUMBER (visit internal entry number) rm
.01     VSIT("VDT")     VISIT/ADMIT DATE&TIME (date) s       .02
VSIT("CDT")     DATE VISIT CREATED (date) m       .03     VSIT("TYP")
TYPE (set) rm      .05     VSIT("PAT")     PATIENT NAME (pointer PATIENT
file
#9000001) (IHS file DINUMed to PATIENT
file #2) m       .06     VSIT("INS")
LOC. OF ENCOUNTER (pointer LOCATION
file #9999999.06) (IHS file DINUMed to
INSTITUTION file #4)
.07     VSIT("SVC")     SERVICE CATEGORY (set) ms      .08
VSIT("DSS")     DSS ID (pointer to CLINIC STOP file)
.09     VSIT("CTR")     DEPENDENT ENTRY COUNTER (number)
.11     VSIT("DEL")     DELETE FLAG (set)
.12     VSIT("LNK")     PARENT VISIT LINK (pointer VISIT file
#9000010) s       .13     VSIT("MDT")
DATE LAST MODIFIED (date)
.18     VSIT("COD")     CHECK OUT DATE&TIME (date)
.21     VSIT("ELG")     ELIGIBILITY (pointer ELIGIBILITY CODE
file #8) rm      .22     VSIT("LOC")
HOSPITAL LOCATION (pointer HOSPITAL
LOCATION file #44)
.23     VSIT("USR")     CREATED BY USER (pointer NEW PERSON
file #200)
.24     VSIT("OPT")     OPTION USED TO CREATE (pointer
OPTION file #19)
.25     VSIT("PRO")     PROTOCOL (pointer PROTOCOL file #101)
.26     VSIT("ACT")     PFSS ACCOUNT REFERENCE (pointer
PFSS ACCOUNT file #375)
2101    VSIT("OUT")     OUTSIDE LOCATION (free text)
80001   VSIT("SC")      SERVICE CONNECTED (set)
80002   VSIT("AO"       AGENT ORANGE EXPOSURE (set)
80003   VSIT("IR")      IONIZING RADIATION EXPOSURE (set)
80004   VSIT("EC")      PERSIAN GULF EXPOSURE (set)
80005   VSIT("MST")     MILITARY SEXUAL TRAUMA (set)
15001   VSIT("VID")     VISIT ID (free text)
15002   VSIT("IO")      PATIENT STATUS IN/OUT (set)
15003   VSIT("PRI")     ENCOUNTER TYPE (set)
81101   VSIT("COM")     COMMENTS r       81202   VSIT("PKG")
PACKAGE (pointer PACKAGE file #9.4)
81203   VSIT("SOR")     DATA SOURCE (pointer PCE DATA SOURCE file
#839.7)

r               VSIT(0)         A string of characters that defines how
the visit processor will function.
F    Force adding a new entry.
I    Interactive mode
E    Use patient's primary eligibility if not
defined on call with VSIT("ELG").
N    Allow creation of new visit.
D    Look back "n" number of days for match,
defaults to one (1). D[<number of days>]
i.e., VSIT(0)="D7" e.g., VSIT(0)="D5"
(visit date to visit date - 4) use "D0"
to require exact match on visit date and
time.
M    Impose criteria on matching/screening of
visits. Uses the VSIT(<xxx>) array:
Matching elements must equal their
corresponding field.

mr              DFN             Internal entry number of the patient file.
If not defined the VSIT("PAT") will be
used.

mr              VSIT            The date (and time) of the visit.
If not defined then VSIT("VDT") will be
used.

r               VSITPKG         Package Name Space.
If not defined then VSIT("PKG") will be
used.

VSIT(<ien>) N^S[^1]
where:
N = <internal entry number of visit>
S = <value of .01 field of visit>
1 = <indicates that a new visit was
added>