Object documentationTab at Header Level

 

Depending on the order types in use, the clinical order can contain tab pages for the order header. These header level tab pages are used to enter generally valid information on the clinical order and do not refer to the order items.

Note Note

In the order type, system administration defines which tab pages should be available to you in the order header when you create a clinical order, their names and the content (area) of each tab page.

See Set Up Order Type

Furthermore system administration can use the Business Add-In (BAdI) Control Dialogs for Header Components to define, whether the system should display header components in expanded or collapsed form. Note that an implementation of this BAdI overrides the user parameter N1CORD_HEAD.

See Customer-Specific Enhancements for the Clinical Order

End of the note.

The system can flag the header component tab pages of a clinical order with LEDs (icons) as follows:

  • Green LED: Indicates that all entry fields required for a status change are filled

  • Red LED: Indicates that not all entry fields required for a status change are filled

Note Note

The system will only display these indicators if the system administrator has activated them either using the system parameter N1COICON or if you have activated them using the user parameter of the same name.

See Set Up Functions for the Clinical Order

End of the note.

Structure

In general, the following content can be available on tab pages for entering information:

General Medical Data

The General Medical Data area provides the fields for entering various general medical data on the patient in the clinical order.

Note Note

The diagnosis overview in SAP Patient Management (IS-H) will not display a diagnosis entered in a clinical order, because the diagnosis is not created as case-related. The diagnosis overview only displays case-related diagnoses, therefore the diagnosis from the clinical order will only be visible in the diagnosis overview following admission.

End of the note.
Comment

The Comment area provides the option of entering a comment text for the clinical order.

Context

The Context area provides the fields for creating a reference to a context for the clinical order.

You can use the clinical order to order or preregister a surgery or treatment appointment or an inpatient admission appointment for a patient.

As well as these two appointments, it is also possible to plan further visit appointments for the organization of the treatment process from the clinical order, request services for concomitant examinations or treatments.

The system will present these additional visit appointments or services in the clinical order, grouped into treatment contexts.

Depending on the order type which you entered when creating the clinical order, the system will also provide additional tab pages with the titles of these treatment contexts. For each context which system administration has assigned to the order type, the system will display one tab page.

Example Example

You can request all services which must be executed as preparatory procedures for a surgery as the Preparation treatment context from the freely definable Preparation tab page.

End of the example.
Procedures

The Procedures area provides the fields for entering procedures for surgeries.

  • If, in the clinical order with preregistered items, you enter a free text in the Surgery Code field and then choose Code (Code), you will branch to the external coding program. This program determines the surgical procedure code and corresponding text and transmits the determined data back to the SAP System. Multiple selection is possible here. Confirm the input. The system does not save free texts.

  • If you know the surgical procedure code, you can enter it directly in the OP Code field. If you then select Enter, the system will determine the corresponding description for the surgery code.

    You can select multiple surgical procedure codes in the value help for the OP Code field.

    The check for valid entries takes place when the entire clinical order is saved.

In the Catalog column the system displays the basic procedure catalpog which you defined in the implementation guide under Start of the navigation path Industry-Specific Component Clinical System Next navigation step Global Settings Next navigation step System Parameters Next navigation step Set Up Time-Dependent Institution End of the navigation path under Surgical Procedure Guide (e.g. ICPM Catalog) for Surgery Code Entry (technical name: OP_TARIF) for your institution. The field cannot be changed in the clinical order.

Note Note

If the localization in the service master of a procedure is flagged as obligatory on the Other tab page, the system checks whether a localization was entered for this procedure when it was entered.

End of the note.

The following SAP standard processing functions for tables are available to you for procedure entry:

  • Cut

  • Copy

  • Paste with Overwrite

  • Paste with New Row

  • Undo

  • Add Row

  • Insert Row

  • Delete Row

  • Duplicate Row

Insurance

The Insurance area provides the fields for entering insurance relationships for the patient in the clinical order.

Waiting List

The Waiting List area provides the fields for entering the addition to, removal from, and absences for waiting list management.

  • In case of an entry in the Waiting List field or an Inclusion Date for the waiting list, the patient is added to the corresponding waiting list. System administration can store the waiting list in which the patient should be included in the order type.

    You can accept this proposal or select a different waiting list using the input help.

  • At any time, you can remove a clinical order with preregistered order items from a waiting list by entering a removal reason, removal date, and, where necessary a further-treating hospital. Patients can also be removed from the waiting list during the documentation process at the following times:

    • Planning the admission or surgery/treatment appointment

    • Admission of the patient or creation of the visit

    • Documenting of surgery/treatment

    • Discharge of the patient

  • You enter temporary absences from the waiting list by entering the start and end date and a reason for the absence.

    If you include absences as selection criteria in the Preregistrations view type, you can, for example, display all patients waiting for a surgery appointment who are not absent.

    Note Note

    System administration executes the definition of the order types. Waiting lists are views of the Preregistrations view type in the clinical work station.

    End of the note.