An Annual Wellness Visit (AWV) is a yearly clinician guided exam in which a patient's physical, mental, and emotional health are examined and documented. An AWV appointment focuses on identifying the patient’s health risk along with providing appropriate counseling in order to promote a healthy lifestyle. This might include, but is not limited to, recommending reading material or educational programs, advocating for preventative services, or providing referrals that are particular to the patient’s risk factors.

The Initial Preventative Physical Examination (IPPE), also known as the 'Welcome to Medicare Visit,' is only available to a patient within their first 12 months after enrolling in Medicare. Once a patient's initial 12 months in Medicare pass they will no longer be eligible to receive this benefit. However, they will be eligible for an initial annual wellness visit.

Actions Involved in an IPPE:

The Initial Annual Wellness Visit (IAWV) can only be completed once by a Medicare patient, however it yields yearly benefits and there is no co-pay. This form of the AWV exam is more comprehensive than the IPPE assessment, so the reimbursement is higher. If a patient has participated in the IPPE, 12 months must pass before they become eligible for the Initial Annual Wellness Visit. However, if a patient has not used their IPPE within the first year of Medicare enrollment, they become eligible for their IAWV.

Actions Involved in an IAWV:

The Subsequent Annual Wellness Visit (AWV) is only offered to Medicare patients 12 months after they have completed their Initial Annual Wellness Visit.

Actions Involved in an AWV:

Proceed to a patient’s chart to begin an AWV. Start by searching for the patient from the dashboard by First Name, Last Name or Patient EHR ID.

To Navigate to the Patient View Page click the patient's EHR ID, Name, or 'View' under the Actions column.

On the patient chart, click the 'Wellness' tab and then the ‘AWV’ button to bring up the patient's AWV status and overview.

Users can click the ‘Edit/Choose Dates’ option to enter in a patient’s Medicare ID or to add previous AWV dates to the chart.

When ‘Edit/Choose Dates’ is selected, a 'Confirm Exam Type' modal will appear. To learn about exam types, read through the pop-up for a brief explanation of the different AWV exams available. When finished click the 'Continue to Dates' button

Notice that text boxes will appear next to the options listed in the 'Medicare Information' section. Click within any of these boxes to add/edit the recorded information.

When a user is finished updating the patient's Medicare Information, they can select the 'Save' button to verify the changes to the patient's information.

Once a Medicare ID is saved, the patient's eligibility should instantly be checked. If eligible, a green box will be displayed indicating that the patient is eligible for an AWV. Select the 'Open AWV Page' button to begin the AWV.

When a user clicks 'Edit/ Choose Dates', they'll receive a pop up box asking them to 'Confirm Exam Type'. Click the 'Skip entering dates and begin exam now' drop-down.

Next, choose the correct exam type from the list provided. In this example we will be choosing the Initial AWV.

Once the exam type is chosen click the 'Start exam' button to open the AWV.

Once the AWV is started the user will be taken directly to the AWV landing page. An AWV example is shown below.

Before starting the HRA, users can choose or edit the Clinical Reviewer and the Provider Reviewer for the AWV taking place.

From the AWV landing page, users will be directed to proceed along to the Health Risk Assessment.

Once ready, users should click on the ‘Health Risk Assessment’ bubble.

At the bottom of the section, a clinical reviewer may review the three ways for a patient to complete their questionnaire:

The Clinician-Guided assessment allows a clinician to complete the HRA with patient responses.

Here users can click to continue as a clinician, as the patient, or to send the HRA to the email listed on the patient’s chart.

If the patient is set to provide their own HRA responses, then a clinician may choose to either start the HRA in patient mode by clicking the appropriate button or they may send the HRA assessment to a patient’ email.

When a patient receives their email from ThoroughCare with an assessment link, they will be asked to enter in the DOB listed on their patient chart before being able to begin the exam.

The patient-guided HRA has functionality to allow patients to enter in clinical data with structured fields for details when it comes to Medications, Allergies, and the Providers that a patient sees.

To access this functionality, proceed along to the HRA and to navigate to the ‘Providers and Suppliers’ section and the ‘Medications and Allergies’ section.

Under the respective questions asking for Provider, Medication, or Allergy entries, patient users can click on the ‘+Add’ buttons which will display structured fields for patients to enter their information into.

If any entries were done in error, then click the ‘Remove’ button to delete the entry and any information entered within the fields.
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The entry fields for medications will allow a patient to search through the database of medications provided by ThoroughCare and select the most appropriate medication form. These entries will be reviewed by a clinician later in the AWV workflow before getting added to the patient chart.

If the patient already has clinical data information on their patient chart, then a patient will be able to review it and indicate to a clinician if such medications, allergies, and/or providers are no longer active or if changes need to be made.

If the patient reviews the clinical items already listed and does not want to make changes, then they can click the ‘N/A’ checkbox.

Medications will allow a user to mark that they are no longer taking an item. If marked as ‘Not Taking’ then an option ‘Stopped’ field will be displayed for a user to enter in the date they stopped taking a medication.

For providers, patients can mark them for removal.

For allergies, patients can mark them as ‘No Longer Active.’

Once the user, whether clinician or patient, has completed all the questions within the HRA, they can click the 'Finalize Assessment' button to finish the assessment.

Once the assessment is finalized, notice that the ‘Patient Questionnaire’ bubble will have a green checkmark inside it.

Once the HRA is completed, a user may navigate to the ‘Office Tests’ section and proceed to enter their patient’s vitals into the appropriate fields.

When entering patient height and weight, a patient’s BMI will be calculated and displayed within the Vitals area. Blood pressure values can be entered below.

After vitals have been entered, the Additional Tests area houses several fields to input a patient’s vision test results, their A1C value, TUG test results, and record whisper test attempts.

If the patient is having their IPPE, also known as the ‘Welcome to Medicare Visit,’ then users may complete the ‘Office Tests’ section with all vitals and additional tests imputed by clicking the ‘Mark as Reviewed’ button.

If users are completing an IAWV or a Subsequent AWV for their patient, then the Cognitive Assessment section will be displayed below the Vitals and Additional Tests areas of the ‘Office Tests’ section.

The cognitive assessment includes the following exercises:

Once the patient has completed the exercises, record the scores at the bottom of the page underneath the ‘Scoring’ area.

After entry, ThoroughCare will calculate a ‘Total Score’. If the score receives a green message that means the patient has passed the cognitive assessment.

Finally, users may enter a note connected to the cognitive assessment.

Within the ‘Assessment & Plan’ section, users are able to review the information entered within a patient’s HRA, review risks based on the HRA answers, and mark clinical actions along with notations for each section of risks identified.

The ‘Patient Reported History’ is gathered from the following sections of the HRA:

Under the ‘Medical History’ card, users can review any current and past conditions that were entered or displayed on the respective HRA section. Any notes entered on health conditions or hospitalizations & surgeries will be displayed in the text entry fields.

The following clinical data cards underneath (Medications, Allergies, and Providers) will have differing displays dependent on whether the HRA was completed by a clinician or by the patient.

If a clinician completes the HRA, then any clinical items added directly through a table within the HRA will be displayed within their respective cards of the section.

From each table displayed, a user may click the ‘New (Clinical Item)’ button to add any clinical items or they may click the ‘Edit’ button to modify the items through the modals that pops-up

Each clinical item card has an open-entry note field for clinicians to add any additional notes into.

If clinicians chose to enter clinical item updates as free text notes during HRA completion, then those notes will carry through to these note fields within the ‘Assessment & Plan’ section of the AWV.

Medications can also be reconciled from the ‘Medications’ card within the ‘Assessment & Plan’ section of the AWV. Click on the ‘Reconcile Medications’ to record the action with a date/timestamp and current user.

If a patient decides to add clinical data items (Medications, Allergies, and/or Providers) during their HRA completion then those answers will populate within the left side of their respective cards under the ‘Review Patient Reported History’ section.

Each patient entry will be displayed within structured fields for clinicians to review. All entry fields can be edited for any corrections needed or empty fields can be filled in.

On the right side is the display of the patient’s clinical data table in a shortened format. The information displayed here parallels the information displayed under the patient’s Clinical Data tab within their chart.

New clinical items like medications can be added by selecting the ‘New (Clinical Item)’ button located above each shortened table within this AWV section. The ‘Add/Edit’ modal for the selected clinical item will then be displayed for a user to input their data.

Once saved, the clinical data item will populate within the shortened table of the respective card. Each clinical item is hyperlinked and when clicked will display the full clinical data table within a pop-up modal. Full editing capabilities are available within the modal.

When a clinical item has been reviewed and is ready to be added to a patient chart, then the associated checkbox can be selected and the ‘Update Chart’ button pressed.

Once the ‘Update Chart’ button is clicked, a confirmation message will be displayed to the user. Clicking ‘Confirm’ within the modal will let a user proceed with their action.

Once confirmed, the clinical item will be displayed on the clinical data table. If all patient HRA responses have been managed then the full clinical data table will be displayed across the entire card.

A user can also choose to add a ‘Stopped’ date to any patient added medication. If that stopped medication is added to a patient chart, it will appear on the ‘Inactive’ filter for the medication table.

If a patient marks that an active medication was stopped during their HRA then that medication will be displayed on the left side of the Medications card under the ‘Not Taking’ header. A stopped date can be added to the medication before it is transferred to the patient chart.

The ‘Allergies’ card will follow the same workflow as the ‘Medications’ card when the patient adds clinical items during the HRA. The entry will be displayed and can be edited before being transferred to the patient chart or declined from getting updated.

The entry will be displayed and can be edited before being transferred to the patient chart or declined from getting updated.

Patients can also mark an allergy as no longer being active during their HRA.and a clinician can choose to update the chart with the answers.

Unlike medications, when an allergy is updated as no longer active, then the ‘Active’ column within the ‘Allergies’ table will display ‘No’.

Patient added providers from the HRA can also be reviewed and transferred to patient charts.

As mentioned, any clinical items that can be added through structured fields during the patient HRA can be declined by clinicians from getting added to the patient chart. To do so, select the checkbox next to the intended items and press the ‘Decline’ button.

No action will be taken to the clinical data table, the clinical item will be removed from review on the left, and if all clinical items have been reviewed then the full table for the respective item type will be displayed.

Finally, the ‘Suppliers’ card will display any notes entered from the HRA question asking about Suppliers and Resources. Notes can be further edited within the field or added to.

Further down the ‘Assessment & Plan’ section, users may view HRA answers, see identified risks triggered off the HRA answers, view considerations that a clinician can take, mark actions taken towards the patient, and add any notes necessary.

Under the ‘Possible Risk Factor Identified’ tab, users can review the patient's possible risk factors triggered from their answers in the HRA.

The box to the right titled ‘Considerations based on patient responses:’ gives the user suggestions to help manage the risks that were identified.

The tab labeled ‘Assessment Responses' lists the HRA responses that were collected in the assessment.

If the user decides to take action to manage the patient's risk, the AWV provides check boxes to mark what action was taken per each section. These options are:

Adding Notes to a Review Section

If a user needs to add any notes to a section, click into the ‘Additional Info’ box and begin typing.

Once a user is finished reviewing a particular section, that portion of the ‘Review Assessment for Risk’ can be collapsed by clicking the 'Arrow' icon located in the upper right hand corner of the target section.

Once clicked, notice the section has been collapsed into a smaller card. Click the arrow again to expand the card out to display its contents.

Preventive measures such as immunizations, labs, and screenings can be documented on within the ‘Personalized Prevention Plan’ (PPP) section of the AWV.

Each set of preventative measure cards can be quickly expanded or collapsed through the text buttons displayed next to each header. By default, PPP cards will be collapsed when navigating to the AWV section.

When a user is ready to document a preventative measure, the intended card can be expanded to display the entry table.

The table for each measure will contain the latest CMS recommendations and intended frequency for follow-up.

Click the ‘Add’ button to bring up the entry modal for the selected preventative measure.

Once all required and optional fields have been entered, the user may save the preventative measure information and have it populate within the associated table.

If modifications need to occur to a record, a user may click the ‘Edit’ button to bring up the entry modal for that preventative measure. If a measure was entered in error, a user may click the ‘Remove’ button to delete the record.

The ‘Next Due’ field can be utilized to document when the next follow-up actions for a preventative measure should occur. Any date selected will be displayed in the entry box.

Some preventative measures contain multiple sub-types that can be selected to document on. These sub-types won’t initially be displayed when the card for a measure is expanded. Instead, click the dropdown button within to display a list of related measures to select from.

Once a sub-type is selected, the table for it will be displayed and a user can select the ‘Add’ button to begin building out the record.

Unlike other cards, measures with sub-types can be exited out of so that they no longer display ONLY IF there is no data previously entered for them.

Multiple sub-types for a specific measure can be chosen up to the max amount offered to document on for the AWV. Users can keep selecting from the dropdown button to populate.

If all sub-types for a measure are displayed, the dropdown button will no longer appear.

If a preventative measure is not recommended for a patient then a user may select the ‘Not Recommended’ checkbox under the ‘Next Due’ header.

Once selected, the header will change to ‘Note’ and the date-entry box will become an open note-field to optionally document.

If the patient is completing their IAWV or Subsequent AWV then the ‘Advance Care Planning’ (ACP) section will be displayed along with the other section workflow bubbles.

The patient reported answers from the HRA will appear on the left-hand side of the ACP section. ​

On the right-hand side are the options presented for the clinician to choose from to complete the section.

Click the blue button labeled 'Patient will Begin ACP at a Later Date'.

If the patient wishes to continue with the ACP during their AWV simply click the ‘Patient Consents to ACP Counseling - Begin Now’ button.

Scroll down the page to view and answer the patient's ACP questions.

If at any time you would like to cancel the ACP click the ‘Cancel ACP’ drop-down button and select the reason why the patient is declining the ACP.

Select all topics covered during the patient's ACP.

The next four questions of the ACP (Numbers 2-5) are open ended. Click within a target text box and begin typing to record the patient's answers to each question.

Once all ACP answers have been recorded, click to select how much time was spent completing the patient's ACP in question 6.

When question 6 is completed, the user should then record the date in which the ACP was finished within the ‘Date Completed’ entry box.

Once the completed date is recorded, the user should select the provider who is set as the ‘AWV Provider Reviewer’ as the ‘Provider to the ACP’.

When ready, click the ‘Save and Complete’ button to complete the section. ThoroughCare will ask you if you are sure you want to complete the ACP. Click 'OK' to continue.

When all sections have been reviewed and completed, users may proceed to the last step and finalize the AWV.

The first section under ‘Finalize Wellness Visit’ will ask the user if the patient would like to participate in the CCM program (if applicable).

To enroll a patient in CCM click the blue 'Change Status' button and the enrollment modal will appear.

Within the modal, click the ‘Change enrollment status to’ drop-down and select ‘Active’.

The modal will extend to document patient enrollment. Complete the enrollment form with the patient as usual.

When the form is completed click the ‘Save’ button at the bottom of the pop-up.

Once the patient is enrolled, the ‘Evaluate Chronic Care Management’ section will populate the date in which the enrollment was completed.

The following section is designated for printing the AWV Summary Report.

Users wishing to open a web-browser based preview for the AWV Summary Report should choose the 'Print/ Preview Summary' button,

Users who would like to download the document should click the ‘Download PDF Document’ button.

Select the ‘Mark that Patient Received a Copy’ checkbox once a patient has been given a summary report of their AWV.

When ready, have the provider reviewer sign-off on the patient's AWV by clicking the check box to the left of the statement ‘I sign off that this AWV had been completed’.

Next, make sure the ‘Date Completed’ field is correct to the date that the AWV was finished. The current date will automatically be populated.

If all checkboxes on the AWV section have been selected, then the green ‘Finalize and Bill’ button will become enabled and clickable.

Select the button to finalize the AWV.

If the AWV is successfully completed, ThoroughCare will notify the user in the upper right hand corner of the screen.

If the user wishes to open the AWV after completion, click the blue link to the intended AWV and review the sections as necessary.

Before or after the AWV is finalized, users have the ability to print a summary report encompassing the completed AWV for both the patient and provider.

Proceed to the ‘Finalize Wellness Visit’ section of the AWV, then scroll down the page until you see the section labeled ‘Provide Personalized Screening Plan to Patient’ and select between one of the two options:

If the user would like to open a print preview of the AWV report in their chrome browser, click the ‘Print / Preview Summary’ button.

If the user would prefer to create a report that is directly downloaded into the user's browser, select the ‘Download PDF Document’ button.

Once an option is selected, the selection modal for the AWV Summary Report will be displayed.

Once the desired checkboxes are selected, clock the green button within the modal to generate the report.

While the report is generating, the modal will show a blue ‘Generating document. Please wait’ message. The report may take a moment to generate.

Once ready, the AWV Summary Report will open up in a new tab within the user's browser or as a downloaded file.

When an AWV is finalized, the associated Summary Report can be accessed quickly from the ‘Documents’ tab located on the patient chart.

Find the finalized AWV you wish to view the report for and click the ‘View’ button.