[Article] How to use the Visits AI Agent

Now that you're logged in and have assigned the correct permissions to the Circadia app, it's time to learn how to use the Visits AI Agent!

If you are looking to get help with downloading and setting up the app, please see Getting started with Circadia.

You can access the Visits AI Agent page by selecting the Visits AI Agent icon from the toolbar:

The Visits AI Agent page has two sections: Upcoming Visits, which lists all your upcoming visits in this clinic for this week, and Visit Notes, which lists all your past visits in this clinic. You can view your scheduled visits for later weeks by clicking on the right arrow next to the dates in the Upcoming Visits box.

Because Circadia is connected to HomeCare HomeBase (HCHB), all the visits scheduled for you in HCHB should appear on this page. However, if you don't see your scheduled visits, or you need to add a new visit for any reason, you can add a new visit by selecting the blue + New Visit button.

Visits that are created by you in Circadia, instead of scheduled for you in HCHB, are marked with a blue Circadia tag.

If you need to access your visits from a different clinic, you can switch clinics by selecting the Settings icon in the upper right corner.

After you click on the Settings icon, you'll be taken to the Settings page, where you can switch clinics from the dropdown in the upper right corner.

To start your visit, first select a scheduled visit by clicking on the patient's name, or create a new visit by selecting +New Visit as described above. You should be taken to a new page displaying the patient name, as well as the date and time of the visit.

If you are creating a new visit, you will also be prompted to enter the patient name, as well as the date and time of the visit. You can select an existing patient or enroll a completely new patient from here.

From here, you'll be able to start your visit recording by clicking the red "Start AI Scribe" button in the upper right. You can always pause your recording and add on to it later, even if you've already generated a narrative (see Narrative section below).

The Visit AI Agent will record and transcribe your recording, then automatically generate a complete patient narrative based on a visit template that you select, complete with patient information, history, medications, an assessment and plan, goals of care, and more. You don't need to change the way you conduct your visit while this recording is ongoing; the AI agent can tell if it's you, the patient, or another caretaker speaking. Just try to say your thought process aloud as much as possible.

If for any reason the patient doesn't consent to use of the AI agent, you can also use the AI agent as a dictation tool, and record information relevant to your visit after it's completed.

Before you generate your narrative, you should check to see whether a patient has consented to being recorded, or add new consent documentation. You can do this using the Side Peek, described later in this article.

You may also want to familiarize yourself with each of the visit subtabs: Prechart, Transcript, Narrative, Coding, Plan, and Schedule.

In the Prechart tab, you can upload contextual documents in PDF or Word format, or paste in relevant contextual information. These contextual documents can be any format or style, whether it's a medication list, patient referral documents, prescriptions, or just shorthand notes. The Prechart documents will be saved to that patient's profile, and will inform the Narrative that the AI agent generates after you complete your visit. Prechart information carries over from visit to visit, so if you complete multiple visits with one patient, you'll only ever need to upload those contextual documents once.

To upload documents, click the Add Contextual Documents button on the bottom left, then select the relevant files from your tablet or computer. Alternatively, you can simply paste text into the body where the light-gray text says Enter prechart note.

If you upload documents (instead of pasting information in), Circadia AI will automatically summarize the document before adding it to the prechart.

The Transcript tab displays the exact transcript of your recording. Please note that, in order to protect patient information, the recording will be deleted after 7 days, and the transcript will be deleted after 14 days.

The Narrative tab displays the AI-generated narrative created from your visit recording and any contextual prechart information.

To create the narrative, click on the green Generate button after completing your recording, then select a visit template from the dropdown list. The available visit templates are based on your role and type of visit.

The exact AI-generated sections in your Narrative depend on the template you've selected.

You can see where the AI got each piece of information by clicking on the citations (small circled numbers in gray). In the example below, you can see that the AI agent got Jane Doe's date of birth from the transcript.

Because the narrative is generated by AI, you must review the information for inaccuracies before submitting your note in PointCare. You can edit, delete

If you need to add an additional recording, upload additional information into Prechart, or change templates, you can do so without losing your edits. All you need to do is regenerate the narrative by clicking the green Generate button again. The AI agent will remember your edits and incorporate your changes into your next draft.

If you make edits you don't like, or accidentally delete your narrative, you can always revert to the most recent AI-generated version by clicking on the Revert icon, then on the Revert to latest version button at the bottom of the popup. Both buttons are highlighted in the following image:

After you've edited your note to your satisfaction, you will need to submit your note in PointCare. When you scroll to the bottom of the narrative, you will see three buttons: Discrete Fields, Copy Contents, and Submit.

Select Copy Contents to easily copy your narrative text. You will see options to copy all the narrative text, copy Part 1 (before Assessment & Plan), or copy Part 2 (Assessment & Plan, GOC, etc.). Copying Part 1 and Part 2 should make it easier to paste the text into your associated template in PointCare.

Selecting Discrete Fields will open a sidebar showing a specific breakdown information consolidated in the narrative. The discrete fields shown will depend on the narrative template you have chosen. The example image below shows fields for a Provider - Follow-Up visit.

Finally, when you've finished editing your note and copying the contents into PointCare, press Submit to complete your documentation. You must submit the narrative for the visit to be completed, and once you've submitted your narrative, you will no longer be able to edit it.

The AI agent also generates relevant coding for your visit based on the content and length of your visit.

To quickly view information about your patient, click on the Side Peek button in the upper right corner of the visit box, highlighted in the image below. The Side Peek contains the most important information about your patient, consolidated across multiple visits, in an easy-to-access view. You can also upload documents and add new consents from the Side Peek.

At the top, you'll see the Safety Note, which can be edited by any provider, nurse, or member of the interdisciplinary team. Next, you'll see a collaborative Comments space where any user can leave a comment for all others to see. You can delete your own comments, but not anyone else's.

Beneath that, in the Insights section, you'll see a summary of your patient's information, generated by Circadia AI. This Insights section is designed to give you an understanding of the patient's entire medical history, journey, and needs at a glance, and includes both patient background and clinical recommendations. The Insights section is continuously improving, and you can regenerate insights at any time by clicking the three dots in the header of the Insights section, then clicking Refresh insights.

Next, you can view the Code Status for your patient, and edit it by selecting the three dots in the header of that section.

The Diagnoses, Medications, and Allergies sections of the Side Peek contain patient information pulled from HCHB, so these sections are not editable.

Finally, the last sections of the Side Peek are the Visits and Documents sections. All visits, whether they were created in Circadia or HCHB, will be shown here, along with the name of the provider, nurse, or IDT team member who conducted the visit. The visit you are currently viewing will be highlighted in yellow.

The Documents section contains all documents uploaded into any visit for this patient, including consent documents and anything uploaded into the Prechart for any visit.

You can add a new consent by selecting the green New Consent button in the Documents section at the bottom of the the Side Peek.

After you click New Consent, you will be prompted to choose which type of consent you want your patient to fill out.

If you select Ambient Listening Verbal Consent, the patient's consent will be recorded in a PDF listing the patient's name and date of consent.

If you select New Compassus Full Consent or New Providence Full Consent, a fillable PDF consent document will appear on your tablet.

Places where the patient must sign will be highlighted in blue and marked Click to sign. You can apply the patient's signature to all places, or ask the patient to sign each place individually.

The second way to create a visit is to create one through the Circadia overlay on your Android tablet. When the Circadia app is running, even if your tablet is displaying a different app, you'll notice that the Circadia icon is always present. You can move this icon around your screen by touching the icon and dragging it.

Click on this icon to see the full Circadia overlay. The overlay has two sections: Patient and Visit Type. From this overlay, you can see your existing visits, create a new patient or visit, and select a visit type.

The Patient dropdown displays your scheduled visits, labeled by patient name and ordered by date. If you don't see your patient in the dropdown menu, you can add the patient by typing directly into the menu. If you are creating a new patient, please note that you must type the patient name in the format First Last.

The Visit Type dropdown displays the same template options that are displayed in the Narrative tab in the Circadia web app, and will affect the narrative generated by Circadia's Visits AI Agent. Select the correct visit type for your role and type of visit.

To start your visit, simply click on the blue Record button in the overlay. The overlay will switch to a waveform view and give you the option to pause your recording, upload your recording, and show Guided Questions. If you toggle on Guided Questions, you will see a list of suggested questions based on the Visit Type you selected when you began your visit.

These guided questions are meant to help you conduct your visit by providing an easy reference in case you want a reminder of what you have and haven't covered. As you speak, the AI agent will detect which questions have been addressed and add a green check mark next to those questions. These guided questions are only a guideline and not a hard requirement; as the provider, you should ensure that you are addressing all patient needs during the visit.

You can pause your visit at any time and continue recording by pressing Resume.

Please note that a paused visit has not been uploaded to Circadia. Once you have completed your visit, you must press the green Upload button to send the recording to Circadia and generate the narrative for this visit.

To view the narrative for this visit, select the View button next to the name of the patient whose visit you have just completed. Clicking View will take you into the Narrative section of the Circadia web app.

From there, the workflow is the same as described in the section above. You must edit the narrative in Circadia, copy the narrative contents into PointCare, and submit your narrative in Circadia.