> ## Documentation Index
> Fetch the complete documentation index at: https://docs.bizaxl.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Clinical Investigations
> How to order, perform, and record eye care investigations - tonometry, OCT, visual fields, fundus photography, color vision testing, corneal topography, and biometry.
Clinical investigations are the tests and measurements your clinical team performs beyond the basic eye examination - OCT scans, visual field tests, fundus photographs, corneal measurements, and more. Each investigation is ordered from the eye examination record, performed by the ophthalmic technician, and the results are linked back to the patient's record for the doctor to review and interpret.
***
## Before You Start
* **Clinical Procedure Templates** must be set up for each investigation type your center performs.
* You need the **Healthcare Practitioner** role to order investigations.
* The **Nursing User** role (ophthalmic technician) is needed to perform and record investigations.
***
## Step 1: Set Up Clinical Procedure Templates (Admin Task)
Before investigations can be ordered and recorded, each type must have a template. Set these up once.
1. Go to Healthcare workspace → Consultation Setup card → **Clinical Procedure Template** → New
Recommended templates for an eye care center:
| Template Name | Item Group | Is Billable | Notes |
| ------------------------------ | ------------------ | ----------- | ------------------------------------------------------- |
| Non-Contact Tonometry (NCT) | Eye Investigations | Yes | Routine IOP screening |
| Goldmann Applanation Tonometry | Eye Investigations | Yes | Formal IOP measurement for glaucoma |
| OCT - Macula | Eye Investigations | Yes | For AMD, diabetic maculopathy, ERM |
| OCT - Optic Disc / RNFL | Eye Investigations | Yes | For glaucoma monitoring |
| OCT - Anterior Segment | Eye Investigations | Yes | For corneal conditions and angle |
| Visual Field Test (Perimetry) | Eye Investigations | Yes | For glaucoma and neurological cases |
| Fundus Photography (2D) | Eye Investigations | Yes | For diabetic screening and retinal documentation |
| Fluorescein Angiography (FFA) | Eye Investigations | Yes | For wet AMD, retinal vascular disease |
| Corneal Topography | Eye Investigations | Yes | For keratoconus, pre-LASIK assessment |
| Pachymetry | Eye Investigations | Yes | Corneal thickness for glaucoma and pre-LASIK |
| Biometry (IOL Calculation) | Eye Investigations | Yes | Pre-cataract surgery lens power calculation |
| Color Vision Test (Ishihara) | Eye Investigations | Yes | Congenital colour deficiency and optic nerve monitoring |
| Specular Microscopy | Eye Investigations | Yes | Corneal endothelial count pre/post surgery |
| B-Scan Ultrasound | Eye Investigations | Yes | When fundus view is poor |
| Gonioscopy | Eye Investigations | Yes | Angle assessment for glaucoma |
***
## Step 2: Order Investigations from the Eye Examination
When the doctor or optometrist orders an investigation during an eye examination:
1. Open the **Patient Encounter**
2. In the **Clinical Procedures** section, click Add Row
3. Select the investigation template (e.g., "OCT - Macula")
4. Add the service unit where the investigation is performed (e.g., "OCT Suite")
5. Save or Submit the encounter
If "Submit Orders on Save" is on, a Clinical Procedure record is created automatically for each ordered investigation.
***
## Step 3: Create the Investigation Record (If Not Auto-Created)
If the order was not auto-created:
1. Go to Healthcare workspace → Consultation card → **Clinical Procedure** → New
2. Fill in the details:
| Field | What to Enter |
| ----------------------- | ---------------------------------------------------------------------------------------- |
| Patient | The patient |
| Procedure Template | The investigation type (e.g., OCT - Macula) |
| Healthcare Practitioner | The doctor who ordered it |
| Service Unit | The room where it is performed (OCT Suite, Visual Field Room, etc.) |
| Start Date | Date of the investigation |
| Start Time | Time |
| Notes | Any specific instructions (e.g., "Dilated OCT required - please dilate before scanning") |
***
## Step 4: Perform the Investigation
The ophthalmic technician performs the investigation using the specialist equipment.
**For OCT:**
1. Open the Clinical Procedure record for this patient
2. Set status to **In Progress**
3. Perform the OCT scan
4. If the results are captured as an image (most OCT machines export a PDF or image), use the attachment feature to attach the report to the record
5. Set status to **Completed**
6. Submit
**For Visual Fields:**
1. Open the Clinical Procedure record
2. Set status to **In Progress**
3. Run the visual field test (Humphrey, Octopus, etc.)
4. Attach the printout or export file
5. Set status to **Completed**
6. Submit
**For Tonometry:**
1. Open the Clinical Procedure record
2. Record the IOP values in the Notes field (Right Eye: 14 mmHg, Left Eye: 16 mmHg)
3. Note the method used (NCT, Goldmann, iCare)
4. Set status to **Completed**
5. Submit
***
## Storing Investigation Results as Diagnostic Reports
For investigations with more complex results (OCT, fundus photography, FFA, visual fields), use the **Diagnostic Report** and **Observation** records for structured result storage.
### Creating an Observation Record for Investigation Results
1. Go to Healthcare workspace → Diagnostic Module card → **Observation** → New
2. Fill in:
| Field | What to Enter |
| -------------------- | ------------------------------------------------------------------------ |
| Patient | The patient |
| Observation Template | The investigation type (set up as an Observation Template) |
| Observation Category | Imaging (for OCT, photography, FFA), Exam (for visual fields, tonometry) |
| Status | Preliminary (first entry) → Final (when complete) → Approved |
| Result (Attach) | Attach the investigation report PDF or image |
| Description | The clinician's interpretation of the finding |
3. Submit the Observation
### Creating a Diagnostic Report to Group Observations
If multiple investigations belong together (e.g., OCT disc + OCT macula + visual fields for a glaucoma patient):
1. Go to Diagnostic Module card → **Diagnostic Report** → New
2. Link to the patient and practitioner
3. Reference the component Observations
4. Set status to **Approved** after the doctor reviews the findings
***
## Observation Templates for Eye Investigations
Set up Observation Templates for structured result recording:
| Template Name | Category | Data Type | Notes |
| ------------------------------------ | -------- | --------- | ------------------------------------------------------ |
| Visual Acuity - Distance (Right Eye) | Exam | Text | e.g., 6/6, 6/12, 6/36, CF, HM, PL, NPL |
| Visual Acuity - Distance (Left Eye) | Exam | Text | Same format |
| Visual Acuity - Near (Right Eye) | Exam | Text | e.g., N6, N8, N12 |
| Visual Acuity - Near (Left Eye) | Exam | Text | Same format |
| Intraocular Pressure (Right Eye) | Exam | Numeric | Unit: mmHg. Normal range: 10-21 |
| Intraocular Pressure (Left Eye) | Exam | Numeric | Unit: mmHg. Normal range: 10-21 |
| OCT - Macular Thickness (Right Eye) | Imaging | Numeric | Unit: microns |
| OCT - Cup:Disc Ratio (Right Eye) | Imaging | Numeric | Normal range: 0.0-0.5 |
| OCT - RNFL Thickness (Right Eye) | Imaging | Numeric | Unit: microns |
| Visual Field - MD (Right Eye) | Exam | Numeric | Mean Deviation in dB |
| Corneal Thickness (Right Eye) | Exam | Numeric | Unit: microns |
| Color Vision (Ishihara) | Exam | Select | Normal / Red-Green Deficiency / Blue-Yellow Deficiency |
| OCT Report (Right Eye) | Imaging | Attach | Full OCT printout |
| Fundus Photograph (Right Eye) | Imaging | Attach | Retinal photograph |
***
## Field Guide: Clinical Procedure
| Field | What It Contains |
| ----------------------- | ----------------------------------------- |
| Patient | The patient |
| Procedure Template | The investigation type |
| Healthcare Practitioner | Who ordered it |
| Service Unit | Room where performed |
| Start Date / Time | When performed |
| Status | Draft, In Progress, Completed, Submitted |
| Notes | Results, measurements, or observations |
| Invoiced | Whether the investigation has been billed |
***
## Monitoring Investigations
* **Clinical Procedures Status** chart on the Dashboard: how many investigations are pending, in progress, or complete
* **Clinical Procedures by Type** chart: which investigations are ordered most often
* Filter the Clinical Procedure list by status = "Pending" to see all outstanding investigations
***
## Troubleshooting
**An investigation record was not created after the examination was submitted**
Check that "Submit Orders on Save" is enabled in Healthcare Settings. If not, create the Clinical Procedure manually.
**I cannot attach the OCT report to the Clinical Procedure record**
The attachment button should be at the bottom of the Clinical Procedure form. If you cannot see it, scroll down or look for the Attach button in the form toolbar.
**The investigation shows as Completed but the doctor says results are not visible**
Check that the Clinical Procedure record has been submitted (not just saved). Submitted records appear in the Patient History.
***
## Best Practices
* Perform investigations in the order they were listed in the examination - if dilation is needed for some investigations (OCT, fundus photography), do the non-dilated tests first (tonometry, corneal topography) to avoid dilation affecting results
* Always note the investigation method and equipment in the Notes field - an IOP of 16 mmHg on a Goldmann tonometer means something different from 16 mmHg on a non-contact tonometer
* For visual field tests, note the reliability indices (fixation losses, false positives, false negatives) - an unreliable field test is not clinically usable
* Attach the full investigation report PDF rather than just entering a number - the clinical pattern (not just the summary number) is what the doctor needs to see
* Set up Observation Templates for the key numeric values (RNFL thickness, cup:disc ratio, MD) so these can be tracked over time as trends
***
## Related Features
* [Eye Examination](/health-wellness/eye-care-center/eye-examination): Investigations are ordered from the Patient Encounter
* [Diagnostic Reports](/health-wellness/eye-care-center/clinical-investigations): For structured result storage and grouping
* [Surgical Procedures](/health-wellness/eye-care-center/surgical-procedures): Biometry and other pre-op investigations feed into surgical planning
* [Billing and Finance](/health-wellness/eye-care-center/billing-finance): Investigations are billed separately from the consultation