Enhanced Amendment Workflow (Article)

Welcome to the guide for navigating the Enhanced Amendment Workflow! This workflow has been designed to manage the process of amending and deleting finalized Chart Items in a way that ensures control, oversight, and accountability by requiring additional approval for these actions from senior staff. Let’s walk through the process together, step by step.

Why was this workflow created?

Through experience, we found that not allowing users to change or delete finalized Chart Items makes it difficult, if not impossible, to handle correcting mistakes which do occur from time to time. On the other hand, permitting users to modify or delete finalized Chart Items without any restrictions leads to confusion and can even have unintended consequences on billing.      

To address this, we introduced the Enhanced Approval Workflow which allows anyone to request a modification or deletion of a finalized Chart Item, provided it is accompanied by an appropriate justification. Only authorized staff with special privileges--whom we will refer to as "super-approvers"--can approve or reject these requests.

What items require additional approval?

This workflow applies to all Chart Items that can be approved:

• Assessments
• Clinical Reports
• Progress Notes (Group, Individual, Family)

Please note: that in some scenarios Treatment Modifications require a two step approval process which differs from the Enhanced Approval Workflow For more information, please see the Managing Treatment Modifications article.

Step 1: Requesting an amendment or deletion

If you, as a user, want to amend or delete an approved Chart Item but don’t have the authority to approve the change, follow these steps:

1. Head over to the client's chart and locate the chart item you would like to "Amend" or "Delete". In this example we will amend be requesting to amend the chart item "Font Styling Report".
   
   
   
   
2. Once inside the artifact click on “Amend” or “Delete” on the approved Chart Item found in the upper right corner. In this example we will be taking you through the "Amend" process.
   
   
   
   
3. A dialog box will pop up, asking: “Why do you want to amend this [item]?”
   1. Provide a clear justification in the text field.
      
      
      
      
4. Once done, click ACCEPT to submit your request. You will then be prompted to select a qualified staff member who has the privilege to accept or deny the request.
   
   
   
   
5. You will then be taken back to your client's chart and a snackbar notification in the lower left-hand corner will confirm that the request has been successful.
   
   
   
   

Step 2: Approval process

Your request now enters the approval process. Here’s what happens:

1. Your request will be sent to a designated senior staff member (with the “Amend/Delete Approver” privilege)
   
   Please note: If there’s only one approver (such as a subscription owner) or if your supervisor matches one of the authorized approvers, they will be automatically selected.
   
   
2. Approval task: The approver receives a task to either approve or reject your request. The task will show up on their task listing page.
   
   This task will include:
   
   
   1. Details of the chart item
   2. The type of request (amendment or deletion)
   3. Any relevant session or assessment information
      
      
      
      
3. Viewing the request: When the approver reviews your request, they will see the justification you provided in a read-only format for reference.
   
   

Step 3: Making changes after approval (amendment task)

Once your amendment request is approved:

1. 1. Complete your task: Head over to your Task Listing and open the new AMEND task.
      
      
      
      
   2. Edit the chart Item: Make the necessary changes.
      
      
      
      
   3. Request re-approval: After making changes and clicking save, submit the item for re-approval by selecting “Request re-approval”.
      
      
      1. The approver who granted you permission will be preselected to approve the changes.
         
         
         
         
   4. Re-approval process: The re-approval will follow the same process as the initial approval. Once approved, your changes will be saved and the workflow will be complete.

Step 4: Handling delete requests

When a delete request is approved, no further action is required from the requester's side. The approver will confirm the deletion, and the item will be removed from the system. The requester be notified once the deletion is complete.

If the item has already been billed, an additional warning will appear, informing the approver that the billing will be reversed.

Rejecting a request

Approvers can reject requests if they don’t deem the change necessary. If rejected:

• The approver will enter a reason for the rejection.
• The requester of the amendment will be notified with details of the rejection.

Handling multiple requests

In some cases, after a staff member submits an Amend/Delete request, either they or another staff member might attempt to submit a second request. To ensure clarity and control, only one active request can be processed at a time.

Here’s how this works:

1. If another request is attempted while one is still pending, a warning dialog will appear, showing the justification provided for the first request.
   
   
   
   
2. The user can either proceed with the new request or select additional approvers to handle it. If they choose to add more approvers, a multi-select option will be provided, and additional approval tasks will be created for those selected.
   
   

Please note:

• Only one approver needs to approve the request. Once an approver completes their task, the approval is considered final, and their name will now be associated with the approval task.
• If an amendment has already been approved, and another approval request is made, an error dialog will inform the user that “[Superapprover Name] already approved a request to modify this chart item. [Editor’s Name] is now making the changes. No further action is necessary.”

Expiration of approval requests

Approval requests will expire after 21 days, unless configured otherwise. If the request expires, a new approval request must be submitted, but the original justification will remain visible in the log for future reference.

Who has approval privileges?

"Super-approval" privileges are granted to a select group of senior staff, such as Supervisors or those at the Administrative level, these "super-approvers" have specifically been assigned the “Amend/Delete Approver” privilege. This privilege is not automatically given to everyone; it must be explicitly assigned to those authorized to approve amendments or deletions of Chart Items. 

To have "super-approval" privileges, users must:

• Be at the Supervisor or Administrative level.
• Have the “Can manage clinical artifacts” privilege enabled.
• Have the “Can approve amendment/deletion requests” privilege turned on, which is typically done by an Administrator or the system Owner.
  
  

The Owner of the system always has all privileges, including approval rights by default.

Notes for re-approval:

• A re-approval will not alter the original billing date. For example, if the original item was approved and billed on may 1 and was subsequently amended on Oct 31, the original billing date will remain as May 1. 
• Re-approval tasks require individual attention and therefore cannot be approved in bulk.
• The most recent approval details will be stored and visible for future reference under “View justification.”
  
  
  
  

Conclusion

This Enhanced Approval Workflow ensures that all changes made to critical Chart Items are carefully reviewed and approved by senior staff, maintaining the integrity of clinical data. Whether you’re amending or deleting an item, this process provides clear guidance and accountability for everyone involved.