Welcome to the Instinct EMR Reference Guide! Use this handy guide to get up to speed on the basics of Instinct EMR.
Table of Contents
- Find the Instinct icon on your computer and open it.
- Enter your PIN.
A few things to keep in mind:
- Don’t know your PIN? Please contact your hospital administrator.
- Putting Instinct on a TV screen? Log in using the TV Mode PIN of “0000”. This will not auto log off and is only used for displaying Instinct on TV screens. We can also add multiple TV Mode users if needed!
- Instinct will log out after 5 minutes of inactivity. Use ctrl+space as a shortcut for logging out.
Instinct EMR can be broken up into the following simple parts:
- Status Board: This is your home base where you’ll find a list of checked-in patients with key data
- Business Office: Schedule, view, & manage different appointment types as well as access all Patient/Account/Referrer information
- Comm Log: A simple way to document and reference all patient-related communication
- Charts: Where you can create custom exam forms and quickly record patient information
- Treatment Plan: Click on a patient name to access their Tx Sheet and other information
- Vitals: Click on the Vitals button to see key trends for a visit
- Estimates: Create estimates and turn any completed estimate into an organized treatment sheet, all within Instinct
- Prescriptions: Manage prescriptions, print labels, and utilize other helpful patient safety tools
- Invoice: An audit tool for a patient’s invoice
The Status Board is your home base for finding lists of patients and is split into a few different boards.
- This is your personalized list of patients. It is unique to you and will only display your patients or the patients you’ve pinned.
- Veterinarians: Any patient assigned to you will automatically display in “My Board”.
- Other staff: Any patient you “pin” will appear in “My Board”.
📓 Please Note: To “pin” a patient, you’ll need to locate the patient on another board first. Then click the icon to the left of the patient’s name to pin them to your board. More on pinning can be found here.
OP Board (Outpatient Board)
- All hospital outpatients can be displayed in this section.
IP Board (Inpatient Board)
- All hospital inpatients can be displayed in this section.
- If your hospital has a boarding facility or has frequent medical boarders, you can use this board to keep those patients separate. You can also use this board as a sandbox for practice patients while learning Instinct. Please only use practice patients with the name ‘Test’ in them as these are omitted from reporting.
📓 Please Note: To move a patient from board to board, find a patient, click on the 3-dot menu to the left of their name, and then choose “OP”, “IP”, or “BP” (for outpatient, inpatient, or boarding boards, respectively).
- This board allows you to make Add Chart documents and/or create Tx Sheets in advance of a patient’s arrival.
- Follow the on-screen instructions to add future patients to the OTW board ahead of time. Once they are checked in to Instinct, you can select which board (OP, IP, BP) you’d like them displayed on.
💡 Status Board ProTips
- Click the “brain” icon (Instinct logo) at the top left hand corner from any screen to return to the Status Board.
- Use the magnifying glass icon (look up) in the left navy menu to find previous visits. Please note this will only retrieve visits, so patients will not appear here if they’ve never been seen before.
- Sorting: The OP, IP and BP boards can be sorted by patient name or check in time using the little orange/gray arrows or by triage tags using the clock icon:
- Tx View Toggle: This feature allows for toggling between the default cage card info and treatment schedule overview. The medical team usually keeps the Tx View on. The front desk team usually views Instinct with it off.
- Colors: Completed orders show in grey, orders due now show in yellow, upcoming orders show in green, and overdue orders show in red.
- Numbers: These represent the number of treatments at the given hour for that patient.
- Hover over a block in the Tx View to display a preview of the tasks to complete during that time block.
- Status Board Filters: You can filter your patients in a variety of ways. Apply multiple filters to further refine your patient list. To remove a filter, click the ‘filters’ button and choose ‘clear filters’.
The Business Office encompasses many non-treatment features of Instinct EMR, including scheduling appointments and searching for patient/account/referrer information.
- Appointments – add, edit, or remove scheduled appointments
- Events – a separate calendar designed to track specific events, including cleaning or vacation schedules
- Patient Registration – search/add new patients, retrieve previous medical history, and check patients in/out
- Accounts – search/add a new account (owner) and transfer patient ownership
- Referrers – document how a patient was referred to your hospital, including the practice name and veterinarian
When clicking on ‘Business Office’, you’ll be brought to ‘My Calendar’ by default. This is your own personal calendar and you can use the dropdown menu towards the upper left of the screen to view Groups or other Doctor/Staff calendars.
📓 Please Note: All users have their own personal calendar, either under Doctor or Staff. Anyone can schedule appointments, availabilities, and drop-offs on their own calendar or another user’s calendar as necessary.
Group Appointments Calendar
Calendar Groups can be created within the Admin section to include different doctors based on department (Cardiology as shown below) or schedule. Once a Group is selected on the Appointments Calendar, a list of users within that group are shown in the left filters bar.
The ‘Only Available’ toggle can be turned on to show each doctor’s availability for the selected day. You can un-select any doctor to remove them from this view or turn off the ‘Only Available’ toggle to see scheduled appointments and availability. You may also select a specific appointment time to search for Availability, either by date only or by both date and time.
💡ProTip: Check out Careville for a more in depth view in the Appointment & Event Calendar Guide.
Events Appointments Calendar
Events calendars function very similar to personal/group Appointment calendars and can be used to schedule miscellaneous events, including discharges, transfers, surgery OR rooms, staff lunches, staff meetings/CE Events, team birthdays, and cleaning schedules. New Event Calendar types are created within the Admin section.
To schedule a new Event on any of your Event Calendars, simply click ‘+ New Event’ and select which Calendar you’d like to schedule this under followed by the Start time, Duration, and any specific Notes.
You can also Edit or Cancel any Event via 3-dot menu. At this time, we do not have a way to schedule recurring events but this feature will be available in the future.
Patient Search: Use the search bar to find existing Instinct patients, using patient first and/or last names. The search bar will provide not only exact matches, but also close matches, in case of accidental misspellings!
Search will only work for currently registered patients
Existing Account: Finding existing client accounts is as easy as searching by owner first or last name in the Accounts tab, using the search bar at the top
Existing clients can also be found when registering a new patient, simply by selecting that option in the patient registration window:
Existing Referring Veterinarians (rVet): Selecting an rVet is optional, but if you know where the patient is being referred from, it’s a good habit to enter the rVet every time.
Finding existing rVets is as easy as using the search bar in the ‘Referrers’ tab.
💡 ProTip: Check out our Referrers Guide for more info!
Patient Registration For New Patients / Clients / rVets
To register a new patient, go to Business office > Patient Registration > and click ‘+ New Patient’.
Fill out all applicable and required fields.
New/Existing Account and rVet
A new or existing account and rVet can be added within the Patient Registration window as shown above.
If selecting a new Account or rVet, you can use the 3-dot menus next to each field to add multiple addresses, e-mails, and phone numbers as needed. Alternate contacts can be added by clicking the ‘New Alternate Contact’ button as shown above and a Preferred contact method can be indicated which marks the contact method via orange star.
Comm Log (Communication Log)
The Instinct Communication Log (Comm Log), is a streamlined, simple way to document and reference all patient-related communication. This can include conversations with the referring veterinarian, owners, specialists, or your own internal hospital notes.
How to access the Comm Log
The Comm Log can be accessed several ways, allowing users to quickly log a note without navigating away from the current patient screen:
- Top right hand corner of any Patient Visit
- Keyboard shortcut CTRL + L while in any patient visit
- Bottom of the Status Board (This is the preferred method when adding a Comm Log entry for a patient who is currently checked out.)
Once the ‘Comm Log’ button is clicked from the bottom of the Status Board, the patient field will be blank by default. Search by patient name or PIMS ID to view previous entries or create a new one.
How to enter a Comm Log note
Select your Method of communication from the drop down list and type out your notes in the field below. Comm Log entries are autosaved and a completion time select box is available to the left of the orange ‘Log’ button to adjust the time a communication was made.
📓 Please Note – There is one special type of communication Method called ‘Internal Practice Notes’. These are a protected type of notes useful for recording internal-only communications that will not export in patient records when sending externally. When recorded, internal practice notes appear with a yellow background for easy differentiating.
How to send a Comm Log email
Email messages can also be sent from the Comm Log which is a great tool to give quick updates to owners or referring/specialty veterinarians. Please note that sending emails from the Comm Log may not be available at your hospital and if desired, hospital administrators can contact us at firstname.lastname@example.org to enable this feature.
Select ‘Send’ at the top of the Comm Log to send an email directly from Instinct. Please note that this is one-way communication only.
View, Edit, and Copy/Paste Comm Log history
Viewing – All patient logs are displayed in reverse-chronological order by their recorded time. Each log displays the recorded date and time, completed date and time, user details, and full entry log.
Editing – The Comm Log 3-dot menu is used to edit, void, and undo void. Edits to the Comm Log can be made as long as it’s within 24 hours of the original entry. After 24 hours, an entry can only be voided.
Copy Logs – To copy/paste a patient’s entire Comm Log, simply click the ‘Copy Logs’ icon at the bottom of the screen. The information copied to your computer includes the date the Comm Log was entered, method, user, and note. Voided notes and internal practice notes are not copied.
💡 ProTip: Check out our Comm Log guide for more info!
Charts Screen and Cover Page Overview
The Charts section (accessed at the top of any patient page) includes a helpful Cover Page spanning the history of the patient’s visits. It also includes easy access to all medical records, such as physical exam forms, discharge instructions, SOAPs, consent forms and other custom-built forms by your admin team.
As seen above, the top of the Cover Page includes Main Problem/DX and Account Patients sections. The Visit section below that is referred to as a Visit Card (more on this section below).
Main Problem/DX – This running list is part of the patient medical record where you can add a problem or diagnosis at any time by clicking ‘+ Add Problem/Dx’. When a problem is added to a checked in patient, it will appear within the current visit. When a problem is added to a checked out patient, it will appear within the last active Visit Card.
Keep in mind you can add/edit/resolve/unresolve items at any time. If you resolve a Problem/Dx, it moves to the bottom of the list with a timestamp of the current date (see ‘abscess’ and ‘abdominal hernia’ in the screenshot above).
The Main Problem/DX list can also be added to Charts templates by use of a Snippet, either ‘Active’ or ‘All’ (which includes active and resolved) problems. This Snippet is labeled MPL (Main Problem List).
Account Patients List – All patients listed under the client’s Account appear within this list. If multiple patients exist, you may click the patient name to navigate to that patient’s Charts screen.
Visit Cards – Visits are organized into ‘Cards’ and display the following from top to bottom in the screenshot below:
- Duration (hours or days)
- Reason for Visit
- Invoice Total
- Patient/Visit Alerts
- Chart Documents
- ‘Go to Visit’ button
- Check In/Out date and time (when applicable)
- Main Problems/DX
Full Record Download – Lastly, a ‘Print Record’ button is available at the bottom of the Charts screen to download/print records. Using the check boxes, you can easily select which documents to include in the full record download.
💡ProTip: Check out our EMR Charting Guide to learn more about creating custom exam forms and quickly recording patient information!
Click on a patient’s name on the Status Board to go to their Treatment Plan.
Billing: on the bottom of the left side menu, you’ll see a handy snapshot of billing information including the high end of the estimate, current invoice total, payments made, visit balance (minus any payment made), the total amount spent in the last 24 hours, and predicted estimates representing what the bill will be in total in 12, 24, 48, and 72 hours (if the scheduled plan of treatments occurs as listed).
A Guide to Ordering Treatments
- To add orders to a Tx Sheet, find the top box that says “+Add Order” and start typing.
After finding the item you need, enter the details for your order.
- Enter a quantity
- Enter a frequency
- Enter the start date/time
- Enter the end date/time, if you wish (the default is Check Out)
- Enter any relevant order notes (best practice is to over-communicate order information in this section)
- If you want to require a note when completing, use the “mandatory treatment notes” toggle
- Change the doctor (who the charge will be listed under), if indicated
3. Ordering by using Groups
- Groups allow you to quickly add a set of related treatments.
- To order a group, search in the “+Add Order” bar and groups will appear in their own section.
- When using a group, you can select or deselect any product in that group (orange/gray button). You can also change the frequency and quantity of each order. The orange dot means the order is ON, and the grey dot means the order is OFF. You can also select/deselect all using the button at the top.
- When you are in the group order window, you can modify all of the properties one by one or in bulk by using the “Bulk Edit” button at the top. Bulk Edit will edit the items selected in orange at that time.
- Once ready, click “Order” at the bottom of the screen to populate all orders onto the Tx sheet.
A Guide to Completing Treatments
- Instinct is designed to mirror how you think and work. Example: When ready to do treatments, you think, “I want to do the 8am treatments.”
- When you are ready to complete treatments, simply click on the time or column for the hour you want to complete.
- Clicking on the time or column will bring you to an organized to-do list of treatments due/overdue/upcoming for that hour. This is called the completion screen.
- You can also get to any patient’s completion screen right from the Status Board.
Patient vitals are charted here so you can quickly and easily view trends throughout each visit.
- Vitals are recorded by completing treatments on the Tx Sheet or by recording them directly in the vitals screen.
- Enter a vital measurement in the Vitals screen using the relevant boxes towards the right and click “record”.
- The value box and note box are both optional. For each vital you only need to record something in one of the boxes. This means you can leave a dropdown field blank and simply leave a note, if needed.
- Use the the toggle to “only show active” vitals if you want to see only the vitals scheduled on the Tx Sheet. Turn it off to show all the vitals you can trend for patients.
💡 ProTip: The high/low value for the visit displays to the left of the vital graph.
💡 ProTip: Click on the Vitals History button at the bottom left of the vitals screen to see a table view of vitals for the patient’s entire life (across all visits).
Click ‘Estimates’ at the top of any patient to enter the estimate screen.
When viewing a patient’s estimate screen for the first time, a new estimate will be created automatically. The name of the estimate defaults to the current date/time and can be edited in the Estimate Name field. If the patient already has items on their invoice, current invoice charges can also be added or removed from an estimate by toggling ‘Start With Current Invoice Total’ and new estimates can be created by clicking ‘+ New Estimate’.
📓 Please Note: Estimates can be created for patients who are not checked in (as long as the patient has had a previous visit in Instinct).
Adding Items to an Estimate
Use the search field to add items via Product Name or PIMS ID and use the associate drop down boxes to quickly add Exam, Ward, and Hospitalization charges. You can also add groups to estimates either using existing groups or by creating Estimate-only groups in your Instinct Product Group Admin. Non-billable items can be added to an estimate with a $0 charge and Miscellaneous items can be added to create custom price line items.
Products with a default Frequency and Quantity (set in Admin) will be added to an estimate with the same Frequency.
Completing an Estimate
To Complete an Estimate, click the orange ‘Complete’ button towards the bottom right hand corner of the Estimate screen and select ‘Complete’ or ‘Complete and Generate Tx Sheet’.
Complete – Completes the estimate which then becomes available in the treatment sheet search to order as a group.
Complete and Generate Tx Sheet – Completes the estimate and automatically opens the Treatment Sheet Product Group modal to easily add estimate items to the treatment sheet.
📓 Please Note: This option does not fill in the Exam, Ward, or Hospitalization dropdowns – these will always need to be manually selected on the Treatment Sheet after the estimate is complete. For safety reasons, the Frequency and Quantity entered on the estimate will not export to the treatment sheet group and these fields will follow the normal product default Frequency and Quantity set in the product Admin. If no default Frequency or Quantity is set, these fields will be blank and can be selected upon ordering.
💡ProTip: Check out our Estimate Guide to learn more about adding automatic charges, how patient safety warnings are displayed, and more!
The ‘Prescription’ icon is located at the top right hand corner of any patient screen to the left of the ‘One-off’ button:
Adding a New Prescription
For any checked-in patient, simply click the ‘Prescription’ icon to search for a product to prescribe:
After searching for and selecting the desired medication, Instinct will open the dose calculator to help you prescribe. It also offers Plumb’s, provides pricing, and includes your normal medication safety warnings.
By default, the doctor and expiration (1 year from prescription) will be set, but both can be adjusted. There is also a PRN option for unlimited refills.
Snippets can be added (managed by Admins) to include common prescription instructions:
After entering all prescription instructions, click the orange ‘Prescribe’ button and Instinct will instruct your label printer to print a label (more on this below). If there is a price associated with the item, it will also appear on the Instinct Invoice. If there is a Medication Guide linked to the medication, a notification will display in the bottom left-hand corner of Instinct alerting the prescriber. Clicking on the Open Medication Guides button in the alert, the prescriber is able to print a PDF of the Medication Guide.
💡ProTip: Order ‘Prepare TGH Meds’ on the treatment sheet with detailed instructions in order notes:
First, Instinct will continue to automatically populate the Instinct Invoice from completed treatments and automatic charges. You can also add items directly to the Invoice, too!
To add items directly to a Patient Invoice, simply search by Product Name or PIMS ID. You can edit the Label, Quantity, Dr., and Price until the patient is Checked Out. Click the orange checkmark to add an item to the patient invoice or click the grey “x” to cancel.
Please note that any items added directly to the Invoice do not impact current/scheduled treatments. This means if something is added directly to the invoice but is also scheduled and completed on the treatment sheet, both charges will then appear on the Invoice (they won’t cancel eachother).
It is also important to note that while you can add any item to the invoice directly, any associated automatic charges will not appear on the invoice unless entered separately. For instance, if ‘IV fluids’ with an automatic charge is added to the invoice, the automatic charge would need to be added separately.
Adding Invoice Product Groups
Invoice Product Groups are designed to help your team quickly load custom Product Groups onto a patient’s invoice. Here’s how it works:
1. Head to the Invoice screen and search for any Invoice Product Group you’d like to use.
2. A doctor field is required in order to add items to the invoice and will default to the currently assigned doctor. If a doctor is not assigned yet, you’ll need to select one from the dropdown before adding the Invoice Product Group.
3. All billable items included in an Invoice Product Group will be added to the invoice.
💡 Please Note: If a non-billable order has an attached fee (like an automatic charge) – that fee will not be added to the invoice, but you can still add the fee manually to the invoice if desired!
Click the item itself, or the 3-dot menu next to any invoice item, and choose ‘edit’ to change the Time, Label, Quantity, Invoice Tags, Dr., and Price. Please note the PIMS ID is not editable.
💡 ProTip: Check out our EMR Invoice Guide for more details!
📓 Please Note: For staff to access the Financials & Account Ledger screens, a hospital administrator must add at least one of the following permissions to your preferred user roles: Payment Record, Payment Refund, Payment Void, or Financial Ledger. Users who only have the Financial Ledger permission added to their role will have view-only access of the Account Ledger screen. In addition, your hospital must also have our Payments feature previously enabled by contacting us at email@example.com.
📒 Account Ledger
The Account Ledger displays Account Information, visit invoices and transactions for all patients in the Account, as well as their Account Balance and Balance ages (over 30, 60, 90, and 120 days). There are two ways to navigate to the Account Ledger screen:
- Clicking ‘Business Office’ > ‘Financials’ > then searching/selecting an Account.
- Clicking on the ‘Payments & Ledger’ button on the patient’s Invoice screen.
In the Financials section of the Business Office, each column can be sorted using the carrot (downward pointed triangle) to the right of the column in descending or ascending order.
You can also search by the Account name in the Financials screen using the search bar in the top right. By default, this screen will only display Accounts that have Balances; however, you can always search any Account in the database if needed.
Once in the Account Ledger for that Account, the top section of the Ledger will contain the Account information and the Balance totals along with Balance ages.
You can also Filter the ledger rows by Transaction Type, Payment Method, Visit, and Patient.
Clicking on any transaction row will open up the Payments Pane to the right, and clicking on any Visit Invoice row will open up the selected Invoice screen for the patient.
All Payment transactions are processed through the patient’s Account Ledger screen, either by navigating through ‘Business Office’ > ‘Financials’ > then searching/selecting an Account, or clicking on the ‘Payments & Ledger’ button on the patient’s Invoice screen.
💡 ProTip: Using Gravity Payments? Check out our Gravity Payments User Guide for more info!
You will see a list of all financial history for the patient as well as their Account Balance and Balance ages (over 30, 60, 90, and 120 days). The Payments pane will also automatically open on the right hand side for you to capture a Payment, if needed.
You can also make a payment by navigating to the Business Office > Financials > clicking on the Account row > selecting ‘Payments’ at the bottom of the screen. The Payments Pane will open on the right and the Patient can be selected from the drop down field. Once a patient is selected, the rest of the fields (previously grayed out) will become available.
📓 Please Note: The Patient drop down field will only display patients associated to the account that have had previous visits or an active visit.
Invoice – Drop down menu including all previous invoices for easy reference.
Type – Transaction Type, either Payment or Refund.
Method – Accepted Methods for non-Gravity Payment customers include Cash, Visa, Mastercard, American Express, Discover, Check, Care Credit, Insurance and Other.
* Non-Gravity Payment customers must process Credit/Debit card transactions using your facility’s card terminals. The “Payment” module in Instinct Invoice merely documents that the transaction has been processed elsewhere.
** Gravity Payment customers will see a specific Credit/Debit Card option instead of displaying Visa, Mastercard, American Express, and Discover. These customers can process a card transaction directly from the Instinct Invoice using their Clover (Gravity) device. More on this below!
If processing via Credit/Debit Card, a Transaction ID field appears and is required.
If processing via Insurance, a required Insurance Type field and optional Transaction ID appear.
If processing via Other, the Notes field is required.
Amount – Select a dropdown to quickly enter the Current Balance, % of Balance, or % of Estimate in the Amount field. You can also enter any amount by typing it in directly.
Note – Notes field for all Methods. This is required for any ‘Other’ Payment Methods.
Once a payment has been processed, the Payments screen will update in real time and display a confirmation message as shown below.
Account Payoff Tab
The Account Payoff tab is used to apply payments across all patient visits with a current balance due that are associated with the client account.
The total Account Balance is shown and consists of all credits and balances due that are on the client’s Account Ledger.
Patient Visits will be display by check-in date and time from newest to oldest and will show the current visit balance due for each visit. Any visits that currently have a credit will not display on the Account Payoff tab.
Payment made when there are multiple visit balances due, will be applied to the oldest visit balance first, and any remaining payment will will be applied to the next oldest and so on. The visit balance will display a preview of how the payment will be divided and what the new Account Balance will be.
📝 Please Note: The amount of payment can not be greater than the Account Balance. To apply a payment as a credit, go to the Visit tab and associate the payment to an individual visit.
Patient Transaction History
For convenience, a historical log of all patient transactions is shown towards the bottom of the Payments screen, in reverse chronological order. Click the angle brackets as shown below to expand the Payment history for any visits.
Each visit is labeled by date, and includes information such as payment/refund method, ID/notes, and amount. The Invoice Total, Payments Total, and Visit Balance are also displayed.
💡 ProTip: Check out our EMR Account Ledger Guide for more details!
🧠Test your knowledge with our Careville Quiz!