Patient Clinical Summaries

MU Requirements

Meaningful Use Measures:

Clinical summaries are provided to patients for at least 80% of all office visits.

Certification Criteria for EHR:

1. Enable a user to provide clinical summaries to patients (in paper or electronic form) or each office visit that include, at a minimum, diagnostic test results, medication list, medication allergy list, procedures, problem list, and immunizations.

2. If the clinical summary is provided electronically (i.e., not printed), it must be provided in: 1) human readable format; and 2) accordance with the standards % specified in Table 2A row 1 to provide to a patient on electronic media, or through some other electronic means.

Proposed Solution

The following SQL view is meant as an example of one way that you can gather all the typical information needed for Heathcare Data Management, continuing care reporting, etc ... contributed by tony and aron@mi-squared.com. Modified and updated by Thomas.

CREATE OR REPLACE VIEW current_insurance_vw AS
SELECT max(id) id, pid FROM insurance_data
 where type = 'primary'
 GROUP BY pid;

create or replace view encounter_ar_activity_vw as
select encounter, 
       ars.check_date as pay_date,	    
	   sum(pay_total) paid
  from ar_activity ara
  join ar_session ars on ara.session_id = ars.session_id
 group by encounter;

create or replace view history_data_latest_vw as 
select max(id) as id, pid
  from history_data
 group by pid;

/* general data of the encounter	*/
create or replace view encounter_report_vw as  
select enc.encounter as encounter,
       enc.date as encounter_date,
       pd.pid as pid,
       ifnull( isd.subscriber_ss, '') as ee_ssn, 
	   ifnull( pd.ss, '') as member_ssn,
	   pd.pubpid as account_number,
	   pd.pubpid as ee_id,
	   ifnull( pd.DOB, '') as member_dob,
	   ifnull( pd.sex, '') as member_sex,
	   ear.pay_date as paid_date,
	   ifnull( pu.npi, '') as provider_number,
       concat(pu.fname, ' ', pu.lname) as provider_name,
	   ifnull( fac.state, '') as provider_state,
       substr( fac.postal_code, 1, 3 ) as provider_zip3,
       ifnull( fac.postal_code, '') as provider_zip,
	   '' as vendor_tos,	
       '' as vendor_provider_type,	
       ifnull( fac.name, '') as clinic_identifier,
       ifnull( pcc.pc_catname, '') as visit_type, 
	   ifnull(bil.justify, '') AS diags,
	   ifnull( bil.code, '') as cpt,
       ifnull( bil.modifier, '') as cpt_modifier,
       ifnull( bil.units, '') as units,
       ifnull( hd.alcohol, '') as alcohol,
       ifnull( hd.tobacco, '') as smokes,
       ifnull( hd.exercise_patterns, '') as exercise,
       vitals.weight as weight,
       vitals.height as height,
       vitals.waist_circ as waist,
       '' as hip, 
       ifnull( vitals.bmi, '') as bmi,
       ifnull( vitals.bps, '') as systolic,
       ifnull( vitals.bpd, '') as diastolic,
       '' as triglycerides,
       ifnull(hd.exams,'') as exams,
       '' as platelet_count,
       ifnull(hd.value_1,'') as readiness_to_change_weight,        
       ifnull(hd.value_2,'') as readiness_to_quit_smoking,
       '' as other_risks_captured,
       '' as family_risk_factor,
       '' as risk_factor_indicator,
       '' as risk_factor_totals,
       '' as risk_factor_totals_panic,
         po.order_encounter_id,
         po.patient_id,
         po.date_ordered,
         po.patient_instructions,
         po.order_status,
         po.provider_id,
         pt.name,
         pt.procedure_code,
         pt.procedure_type,
         pt.body_site,
         pt.specimen,
         pt.route_admin,
         pt.laterality,
         pt.description
  from form_encounter enc 
  join patient_data pd on pd.pid = enc.pid
  left join users pu on pu.id = enc.provider_id
  left join facility fac on fac.id = pu.facility_id
  left join current_insurance_vw isv on isv.pid = pd.pid 
  left join insurance_data isd on isd.id = isv.id
  left join encounter_ar_activity_vw ear on ear.encounter = enc.encounter
  left join billing bil on ( bil.encounter = enc.encounter and bil.code_type = 'CPT4' )
  left join history_data_latest_vw hdl on hdl.pid = pd.pid
  left join history_data hd on hdl.id = hd.id
  left join forms enc_vitals on ( enc_vitals.encounter = enc.encounter and enc_vitals.form_name = 'Vitals' )
  left join form_vitals vitals on enc_vitals.form_id = vitals.id
  left join forms enc_exam on ( enc_exam.encounter = enc.encounter )
  left join procedure_order po on ( po.order_encounter_id = enc.encounter )
  left join procedure_type pt on ( pt.procedure_type_id = po.procedure_type_id )
  left join openemr_postcalendar_categories pcc on pcc.pc_catid = enc.pc_catid;


/*	Various issues - problem, medication, allergy ... + prescriptions
	may have multiple rows	*/
select   type, title, begdate, enddate, occurrence, classification, referredby, diagnosis, activity, comments, destination
from  lists 
where pid	      = [patient id]
and   date(date)	= [date of encounter]



/* prescriptions  */
select   ifnull(p.drug, p.drug_id).
         p.dosage,
         p.quantity,
         p.size,
         lof.title   form,
         lou.title   unit,
         lor.title   route,
         loi.title   interval,
         if(p.substitute=1,'substitute allowed','do not substitute'),
         p.refills,
         p.per_refill,
         p.note
from  prescriptions  p,
      list_options   lof,
      list_options   lou,
      list_options   lor,
      list_options   loi,
      users          u
where p.patient_id         = [patient id]
and   date(p.date_added)	= [date of encounter]
and   u.id                 = p.provider_id
and   lof.list_id          = 'drug_form'
and   lof.option_id        = p.form
and   lof.list_id          = 'drug_units'
and   lof.option_id        = p.unit
and   lof.list_id          = 'drug_route'
and   lof.option_id        = p.route
and   lof.list_id          = 'drug_interval'
and   lof.option_id        = p.interval



/*	if procedure_order.order_encounter_id != 0
	procedure ordered	*/
select   po.date_ordered,
         po.patient_instructions,
         po.order_status,
         pt.name,
         pt.procedure_code,
         pt.procedure_type,
         pt.body_site,
         pt.specimen,
         pt.route_admin,
         pt.laterality,
         pt.description,
         CONCAT(u.title, ' ', trim(fname), ' ', trim(lname))
from  procedure_order      po,
      procedure_type       pt,
      users                u
where po.patient_id           = [patient id]
and   po.order_encounter_id   = [encounter id]
and   pt.procedure_type_id    = po.procedure_type_id
and   u.id                    = po.provider_id



/*	if procedure_order.report_encounter_id != 0
	results of ordered procedure
	contains multiple rows	*/
select   pc.date_collected,
         pc.patient_instructions,
         pt.name,
         pt.procedure_code,
         pt.procedure_type,
         pt.body_site,
         pt.specimen,
         pt.route_admin,
         pt.laterality,
         pt.description,
         preport.date_report,
         preport.specimen_num,
         preport.report_status,
         presult.facility,
         presult.result,
         presult.units,
         presult.range,
         presult.abnormal,
         presult.comments,
         presult.result_status,
         CONCAT(u.title, ' ', trim(fname), ' ', trim(lname))
from  procedure_order      pc,
      procedure_type       pt,
      procedure_report     preport,
      procedure_result     presult,
      users                u
where pc.patient_id                 = [patient id]
and   pc.report_encounter_id        = [encounter id]
and   pt.procedure_type_id          = pc.procedure_type_id
and   preport.procedure_order_id    = pc.procedure_order_id
and   presult.procedure_report_id   = preport.procedure_report_id
and   pt.procedure_type_id          = presult.procedure_type_id
and   u.id                          = pc.provider_id


/* immunizations  */
select   lo.title,
         i.manufacturer,
         i.lot_number,
         i.note,
         CONCAT(u.title, ' ', trim(fname), ' ', trim(lname))
from  immunizations  i,
      list_options   lo,
      users          u
where i.patient_id               = [patient id]
and   lo.list_id                 = 'immunizations'
and   lo.option_id               = i.immunization_id
and   date(i.administered_date)  = [date of encounter]
and   u.id                       = i.administered_by_id

The following reports can be generated:

1. Patient Info (limited demographics)

2. Office Visit Info

3. Diagnosis

4. Treatment Plan/Progress Notes - Not available yet

5. Medication List

6. Allergy List

7. Medication Allergy List

8. Problem List

9. Procedures (need work, Referral Summary not available)

10. Immunization

11. Prescription

Effected Code, Tables, etc

All the tables and lists mentioned in the Proposed Solutions are affected. No work is needed except for those new tables or lists that need to be built.

Owner and Status

Design - Tony McCormick (MI2) and Thomas Wong (Intesync)

Coding - TBA

Links

• CCHIT_MU_2011_Project