How an Electronic Medical Record Works

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An electronic medical record (EMR) is the ultimate alternative to paperwork at a health resort. Doctors see all the information about their patients, prescribe treatments with a simple click of a button, dictate notes, track lab and test results without filling out dozens of documents by hand or calling colleagues.

In Jivi, a patient’s EMR is created at check-in. An attending doctor gets a notification that they have a new patient and can track their treatment program passage.

How an Electronic Medical Record Works

Initial Consultation

At the first appointment, a doctor fills out a patient’s initial consultation form. The set of fields can be customized. Instead of manual typing, doctors check boxes and select options from the drop-down menus. With Jivi doctors spend 65% less time on paperwork and more time with their patients. With a built-in speech recognition system they can fill everything out by simply speaking into a microphone.

An initial consultation protocol includes all the necessary fields:

  • Patient complaints about any body system (cardiovascular, nervous, digestive, etc.).

How an Electronic Medical Record Works

  • History of present illness, general history (hereditary background, risk factors), and other data, such as weight, height, pulse, etc.

How an Electronic Medical Record Works

  • Detailed reports for each body system, pre-filled with normal values by default. Tabs on the left side of the screen let a doctor quickly move between sections.
  • Diagnoses. This field shows all the diagnoses a patient has. You can remove them or add new ones from the ICD-10 directory. ICD-10 codes can be changed to the clinical terms used at your facility or the ones written in a patient’s health resort record. Each term is saved in the system and can be used for other patients with the same diagnosis. There are categories for prime and associated diagnoses, as well as for newly diagnosed pathologies. 
  • Prescriptions. Based on the diagnoses and a treatment package, a doctor prescribes consultations, tests, treatments, and medication. In the relevant fields they can choose a specific specialist, a payment method, add any comments, mark it as “Cito!”, or mark areas on a schematic body depiction. For example, for mud therapy.

When an appointment is over, a doctor can print a document showing the results and their recommendations. A schedule for the prescribed treatments and exams can be made by a doctor or by any staff member with the right access. 

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Treatment Program Passage

The middle medical staff barely have to enter data into the system. Their main job is to identify a patient, provide the services, and record everything in the system. This means they do not need computers; inexpensive tablets are enough.

When a patient arrives for their treatment, they can identify themselves by tapping an RFID card or a bracelet on a tablet reader, by scanning a barcode on their health resort booklet, or by finding their name on a treatment schedule. After a procedure, a staff member presses a button to mark it as done. Services are considered provided, and the right amount of medical syringes, mud, oils, gloves, and other supplies is automatically written off. This provides strong protection against fraud by staff and prevents treatments from being done off the books.

As a patient undergoes all the consultations and exams prescribed by their doctor, new health information might come up. New diagnoses, symptoms, and test results are visible in the system along with a list of recommended treatments. It can be customized, or you can use the standard one.

Great tools work best when paired with great knowledge.

The Jivi Telegram channel is a helpful resource for doctors, executives, managers, and marketers who work in health resorts and wellness centers. We cut through the noise to deliver insights that matter:

  • In-depth articles and case studies
  • Latest industry trends and news
  • Practical tools and smart approaches turned into simple how-to guides
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Health Resort Discharge Process

At their final appointment, a patient receives an automatically generated discharge epicrisis, either electronically or on paper. It includes the results of all the exams, tests, and specialist consultations, as well as all the recommendations for further treatment and lifestyle. This Health Passport can be styled with a health resort’s logo and contact information. You can also add a special progress model showing the “before and after” results.

Repeat Visits

When a patient returns, their data is easy to find in the system. There are no medical archive requests and no time wasted searching for the right paper. The EMR database can also be shared across an entire network of health resorts. A patient does not need to bring a pile of documents every time. 

Find out how EMR cuts paperwork by 65%.
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