Episode summaries are automatically generated in Axxess AgencyCore, so clinicians do not need to spend time manually collecting and documenting episode information. This functionality enhances ease of use, reduces documentation time, and optimizes organizational efficiency.
Types of Automated Episode Summaries:
- End-of-Episode Summary (Auto-Generated)
- Discharge Summary (Auto-Generated)
- Transfer Summary (Auto-Generated)
- Intra-Episode Summary (Auto-Generated)
Accessing Episode Summaries
End-of-Episode, Transfer, and Discharge Summaries are automatically generated when the respective OASIS assessment is signed by the clinician:
- End-of-Episode Summary: Generated when an OASIS Recertification assessment is signed
- Discharge Summary: Generated when an OASIS Discharge assessment is signed
- Transfer Summary: Generated when an OASIS Transfer assessment is signed
- Intra-Episode Summary: Generated by the user on the Episode Summaries page (instructions below)
To generate an Intra-Episode Summary:
- Select Patient Charts under the Patients tab.
- Select Episode Summaries from the Quick Reports For This Patient menu on the right side of the Patient Chart.
- Click the Create Episode Summary button in the top right corner of the Episode Summaries page.
Patients tab>Patient Charts>Quick Reports For This Patient>Episode Summaries>Create Episode Summary
Intra-Episode Summaries can be labeled with any of the summary titles shown below:
Intra-Episode Summaries reflect the status of the patient as of the day the report is generated.
Generate an Intra-Episode Summary to review interventions and goals of all disciplines and monitor progress toward treatment goals (met versus unmet).
Use Intra-Episode Summaries to discuss patient progress during meetings and case conferences.
Episode Summaries Page
In addition to Intra-Episode Summary generation, the Episode Summaries page features the following items and capabilities:
- Tool tips provide helpful information including the description, intent, and impact of system features.
- A Help Center hyperlink provides direct access to step-by-step instructions from within the AgencyCore system.
- The video icon directs users to a short video with information on the Episode Summaries feature.
- Select an episode from the drop-down menu in the top left to see completed summaries for that episode.
- The search feature enables users to search for Episode Summaries by documentation type, date, user, etc.
- Summaries that are auto-generated are labeled “Auto-Generated” in parentheses next to the summary name.
- Manually generated summaries can also be viewed from the Episode Summaries screen when scheduled and completed.
- All Intra-Episode Summaries are generated from the Episode Summaries page.
Episode Summary Flow
Episode summaries are automatically generated when the OASIS assessment is signed by the clinician, unless the option to automatically generate the summary is deselected on the signature page of the OASIS assessment.
Once the clinician signs the respective OASIS assessment:
- Discharge and Transfer Summaries automatically generate and flow to the QA Center to be reviewed and approved by designated users (based on permissions). Once approved, summaries flow to Orders Management in Sent to Physician status.
- Remember that a physician signature is no longer required by CMS, as outlined in the Home Health Conditions of Participation (CoPs). While not required, users can download and print End-of-Episode Summaries from the Episode Summaries page, if required by agency policies and procedures.
- End-of-Episode and Intra-Episode Summaries automatically flow to the QA Center to be reviewed and approved by designated users (based on permissions). Once approved in QA, the summaries flow to the patient’s chart in Completed status.
Content of Episode Summaries
- Patient/Agency Information
- Insurance ID/Payer Name
- Clinical Manager/Case Manager
- Attending Physician
- Home Health Dates of Service
- Emergency Contact Information/Emergency Preparedness
- Advance Care Plan
- Primary and Secondary Diagnoses
- All Disciplines/Frequency of Visits/Total Provided/Date of last visit for each discipline
- Reason for Admission to Home Health/Continued Services
- Services Provided
- Patient Goals per Discipline
- Total Number of Goals
- Goal Attainment Rate %
- Vital Sign Ranges
- Additional Physicians on the Case
The Visit Narrative entered in the OASIS Recertification assessment populates in the End-of-Episode Summary.
The following items flow from the OASIS Discharge assessment to the Discharge Summary:
- Discharge Notification (Summary tab)
- Reason for Discharge (Summary tab)
- Discharge Instructions Given To (Summary tab)
- Discharge Readiness (Summary tab)
- Condition at Discharge (Summary tab)
- Discharge Narrative (Summary tab)
- Discharge Disposition (M2420)
The following items flow from the OASIS Transfer assessment to the Transfer Summary:
- Copy of Summary Sent To: (Summary tab)
- Transfer Narrative (Summary tab)
Correcting Info in Episode Summaries
Information in the automated episode summaries can be corrected by adjusting the information in the document of origin (e.g., OASIS assessment, Plan of Care Profile, or Patient Chart).
When a Recertification or Discharge OASIS assessment is re-opened for corrections, the user receives the following warning message:
If the user does not want another summary to be created, then the option to not replace the current summary should be selected.
Goals and interventions are updated and resolved in the Plan of Care Profile. Access the Plan of Care Profile through OASIS assessments, the Plan of Care edit screen in the QA Center, clinician notes and/or physician orders.
When clinicians perform their discharge visits or resolve interventions and goals between visits, updates to the Plan of Care Profile are automatically reflected in the Episode Summaries.
Note: Goals that have not been resolved as met/unmet are automatically marked as unresolved by the system at discharge. Goals must be marked as met or unmet in the Plan of Care Profile.