Overview
OpenEyes uses an episode-based, event-driven clinical workflow model. This architecture provides structured clinical documentation while maintaining flexibility for various ophthalmic specialties.The episode-event model is central to OpenEyes. Understanding this structure is essential for effective clinical documentation.
Episode-Based Architecture
What is an Episode?
An episode represents a continuous period of care for a specific condition in a particular subspecialty.Episode Components
- Patient
- Subspecialty (e.g., glaucoma, cataract)
- Firm (clinical team)
- Principal diagnosis
- Affected eye(s)
- Status (active, discharged)
Episode Lifecycle
- Created at first contact
- Remains open during active care
- Can be closed and reopened
- Tracks start and end dates
Episode Types
OpenEyes supports different episode categories:- Standard Episodes
- Support Service Episodes
- Legacy Episodes
Regular clinical episodes for subspecialty care:
- Glaucoma
- Cataract
- Medical Retina
- Oculoplastics
- Each tied to a specific subspecialty and firm
Creating Episodes
Check Existing Episodes
System displays all episodes for the patient
- Active episodes shown in green
- Closed episodes shown in gray
Add New Episode
If no episode exists for current subspecialty:
- Click Add New Episode
- System associates with selected firm
- Subspecialty determined by firm
Episode Management
Viewing Episodes:- Patient summary shows all episodes
- Click episode to view details
- See all events within episode
- Review episode timeline
- Navigate to episode view
- Click Edit tab (if permitted)
- Update principal diagnosis
- Change episode status
- Save changes
- Active: Ongoing clinical care
- Closed: Episode completed
- Episode end date set when closed
Event-Driven Documentation
What is an Event?
An event is a specific clinical encounter or documentation instance within an episode.Event Properties
- Event type (examination, operation, etc.)
- Event date
- Associated episode
- Creating user and firm
- Custom elements per event type
Event Types
- Examination
- Prescription
- Operation booking
- Biometry
- Correspondence
- Custom module events
Event Lifecycle
Once saved, events are generally locked for audit purposes. If changes are needed, the event may need to be deleted (soft delete) and recreated.
Creating Events
Add Event
- Click Add Event button
- Select event type from dropdown
- System creates event in current episode
Complete Event Elements
Each event type has specific elements:
- Examination: VA, IOP, anterior segment, etc.
- Prescription: Medications, dosage, instructions
- Operation: Procedure, laterality, booking details
Event Elements
Each event type contains multiple elements:Examination Event Elements
Examination Event Elements
- History: Presenting complaint, history of presenting complaint
- Visual Acuity: Aided/unaided, right/left/both eyes
- Refraction: Sphere, cylinder, axis for each eye
- Intraocular Pressure: IOP readings and method
- Anterior Segment: Slit lamp findings with EyeDraw
- Posterior Segment: Fundus findings with EyeDraw
- Diagnoses: Update or confirm diagnoses
- Management: Clinical plan and follow-up
- Conclusions: Summary and next steps
Prescription Event Elements
Prescription Event Elements
- Drug Selection: Search formulary
- Dose & Frequency: Standard or custom
- Route: Topical, oral, injection
- Laterality: Right eye, left eye, both, or systemic
- Duration: Treatment period
- Instructions: Patient directions
- Prescriber Details: Regulatory information
Operation Event Elements
Operation Event Elements
- Procedure: SNOMED-coded operation
- Laterality: Eye to be operated
- Surgeon: Operating consultant
- Anaesthetic: Local, general, or sedation
- Priority: Routine, urgent, emergency
- Booking Details: Date, time, location
- Consent: Documentation reference
Event Drafts
Drafts allow work-in-progress:- Save Draft: Preserves partial work
- Resume Draft: Continue from where you left off
- Draft List: View all pending drafts
- Auto-save: Periodic saving (if enabled)
- Draft Age: System tracks how long drafts are pending
Clinical Pathways Integration
Events can be linked to clinical pathways:Pathway Steps
Events can fulfill pathway steps:- Check-in
- Pre-assessment
- Examination
- Procedure
- Follow-up
Worklist Integration
Events created from worklists:- Automatically link to worklist patient
- Update pathway status
- Track wait times
- Measure clinic efficiency
See the Worklists guide for detailed information on pathway-based workflows.
Event Validation
Date Validation
Event dates must:- Not be in the future (unless allowed by configuration)
- Be logical in sequence (generally after episode start)
- Be after patient date of birth
- Be before date of death (if deceased)
Required Elements
Each event type has mandatory elements:- Cannot save without completing required fields
- System highlights missing elements
- Validation messages guide completion
Business Rules
Events follow clinical rules:- Prescription requires valid prescriber
- Operation must have laterality specified
- Examination requires at least one finding
- Correspondence must have recipient
Event Hierarchy and Relationships
Parent-Child Events
Events can have hierarchical relationships:- Parent Event: Original event (e.g., operation booking)
- Child Events: Follow-up events (e.g., post-op review)
- Navigation between related events
- Maintains clinical context
Event Groups
Events can be grouped:- Same-day events
- Related procedures
- Linked correspondence
- Grouped viewing and printing
Viewing Events
Timeline View
Patient summary displays events chronologically:- Most recent events first
- Color-coded by event type
- Quick view of event date and type
- Click to open full event
Episode View
View events within an episode:- Filtered by episode
- Shows progression of care
- Track diagnosis changes
- Review management over time
Lightning Viewer
Quick access to document events:- Grouped by type (letters, reports, etc.)
- Organized by year
- Side-by-side comparison
- Print-friendly view
Lightning Viewer is useful for quickly reviewing correspondence, biometry reports, and other documents without navigating through full events.
Event Deletion and Modification
Soft Delete
Events can be soft-deleted:- Open event view
- Click Delete (if permitted)
- Enter deletion reason
- Event marked as deleted (not removed)
- Audit trail maintained
Audit Trail
All event actions are logged:- Creation timestamp and user
- Modifications (if allowed)
- Views and prints
- Deletion with reason
- Complete audit trail for governance
Multi-Specialty Workflow
Multiple Episodes
Patients can have concurrent episodes:- Different subspecialties
- Different clinical teams
- Independent management plans
- Shared patient context
Episode Switching
Switch between episodes:- View patient summary
- See all active episodes
- Click episode to set context
- New events added to selected episode
Cross-Episode View
Some views show all episodes:- Complete patient timeline
- All visual acuity measurements
- All prescriptions
- Comprehensive clinical picture
Firm-Based Workflow
Firm Context
Clinical work is firm-specific:- Select firm at session start
- Events created under selected firm
- Episodes associated with firm
- Worklists filtered by firm
Multi-Firm Access
Clinicians can belong to multiple firms:- Switch firms in header
- View changes to show current firm’s patients
- Maintain separate worklists per firm
- Cross-firm patient access maintained
Advanced Workflows
Automated Events
Some events can be automated:- Imported from devices (biometry, OCT)
- Auto-generated from pathways
- Scheduled follow-ups
- System-triggered notifications
- Events marked with
is_automatedflag - Source system recorded in JSON
- Different validation rules
- Audit trail includes automation details
Template-Based Events
Use templates for efficiency:- Pre-populate common findings
- Standard letters
- Routine examinations
- Custom templates per firm/user
Event Attachments
Attach files to events:- Imaging results
- External reports
- Correspondence received
- Supporting documents
Attachments are grouped by event for easy access. Supported formats include PDF, images, and medical imaging standards.
Best Practices
Episode per Subspecialty
Create separate episodes for each subspecialty to maintain clear clinical focus
Complete Events Promptly
Finalize event documentation during or immediately after the clinical encounter
Accurate Event Dates
Ensure event date reflects actual clinical encounter, not documentation date
Meaningful Diagnoses
Set principal diagnosis that best represents the episode’s clinical focus
Troubleshooting
Cannot create episode
Cannot create episode
Possible causes:
- No firm selected
- Insufficient permissions (need OprnCreateEpisode)
- Patient record issues
- Select firm from header dropdown
- Contact administrator for permission review
- Verify patient record is valid and not deleted
Event won't save
Event won't save
Common issues:
- Missing required elements
- Invalid date (future date not allowed)
- Validation errors in element data
- Review red error messages
- Complete all required fields (marked with *)
- Check date is not in future
- Verify eye-specific data is logical
Cannot see events
Cannot see events
Possible reasons:
- Wrong episode selected
- Insufficient view permissions
- Events exist but are drafts
- Deleted events (need special view)
- Verify correct episode is active
- Review user permissions with admin
- Look in drafts section
- Check if OprnViewClinical permission granted
Episode shows wrong diagnosis
Episode shows wrong diagnosis
To update:
- Navigate to episode view
- Click Edit tab (need OprnEditEpisode permission)
- Update principal diagnosis
- Select correct affected eye
- Optionally update diagnosis date
- Save changes
Next Steps
Clinical Modules
Explore specific event types and clinical modules
Examination Module
Learn detailed examination documentation
Prescriptions
Master prescription creation and management
Operations
Understand operation booking and management