yehster wrote on Tuesday, August 06, 2013:
I am curious if there are any other pediatricians or family practice physicians who might be interested in using a feature I just implemented for Dr. Kay.
It basically gives you a simple mechanism for tracking birth weights.
Attaching a couple of screenshots in a follow up post as again I don’t seem to have the option to include attachments in the initial post.
blankev wrote on Tuesday, August 06, 2013:
I did not check this, but was this not available in Vitals? Some time ago there was much discussion on birth and time in hours, days, months etc. But it is very nice to have the overview on the right side, but the graphic should give more info on the results of taken measures when you have a child with under or over weight.
What is the extra INFO you implemented?
mdsupport wrote on Tuesday, August 06, 2013:
Have you thought about using clinical reminders? That is great engine which probably needs a simple tweak to display database value(s) it used in the rule. If it did in the display, that feature will become much more generic for use by all practices.
yehster wrote on Tuesday, August 06, 2013:
What were you thinking the UI for entering the info in the context of clinical reminders would be?
yehster wrote on Tuesday, August 06, 2013:
I believe, (Dr. Kay correct me if I’m wrong) but creating an encounter and using the existing vitals form was deemed to be too many steps, and there also wasn’t a clean way to tell which entry specifically corresponded to the birth weight.
There is no additional information captured/analyzed.
I have implemented something that I believe will improve a workflow issue as I understand it in Dr. Kay’s office. It may not be useful to others.
drkay wrote on Tuesday, August 06, 2013:
Right, I thought it would be too many steps and too confusing to create an additional encounter for the birth weight. This is partly because I often see newborns on their date of birth at the hospital, but sometimes I do not see them until the day after birth, and sometimes I don’t see them at all in the hospital after they are born. If we always have an encounter for the date of birth, it would be hard for my biller to know if she needs to bill for that day or not. It would also be too many extra steps to create an encounter just for the date of birth.
blankev wrote on Tuesday, August 06, 2013:
I did not want to be offensive, let me make this clear.
Question: What is the use of birth-weight if you have no other graphical figures to compare? Is there a place where this new part of OpenEMR can be tested?
Can this birth weight and data be incorporated in the Vitals result table without taking extra steps?
I did not implement that birth-weight is of no value! I only want to make clear that birth-weight as such without any extra information is of very limited value.
mdsupport wrote on Tuesday, August 06, 2013:
The thought about using clinical reminders is like post-it notes for that patient file showing one or two simple values from patient related records. Using birth weight as an example :
Choose one of the unused notes fields in patient_data to record birth weight. Change the demographics form by making the chosen field optional.
Create a rule based on that (database table + field)
Standard behaviour of the current rules is to display the rule name in the clinical reminders - so it will display something like ‘Birth Weight (xxxx)’. In some rule types, it allows user to update that value - e.g. immunizations.
Even if update is not possible or desired, we will need to change the display to include actual value that triggered the rule. This will allow peds to have a clinical reminder like - Birth weight (6.8 lbs).
If this works, another practice could display other key figure(s). All key figures will be shown in one box. One could potentially save screen real-estate by replacing widgets like Advanced Directives to standard rules that can be turned on or off at practice or patient level…
The nice thing about rules approach is they can be set to turn themselves off when the pt is say 12 years old.
drkay wrote on Tuesday, August 06, 2013:
I think the Vitals form only works when associated with an encounter (as if we measured the birth weight in the office), so I don’t think it can be added to a Vitals form. For medical practice, it’s really a part of the Past Medical History (Birth History). Maybe it should go under the Issues section.
We need birth history for WIC forms, for filling out our billing sheets for our California low income program for kids up to 18 months of age, and for research.
Future possibilities: Kids of low birth weight (usually <2500gm) could be flagged for developmental tracking, and it could be used for research.
blankev wrote on Wednesday, August 07, 2013:
I just checked for verification in Demo Development OpenEMR.
You can open the first encounter on today, the baby was born in the past. Make an encounter for today, with whatever you want to do. Open Clinical and Vitals and get your vitals in. That is for today. Now Save. But this is what every pediatrician has to do during the first encounter after delivery, even something a nurse could do for the doctor
Do whatever you want to do. Open Vitals again and you can open another date. Let’s take the birth day. And for birth day and time you can fill all data gathered during and just after delivery.
What I could not check is if you want to do this in the weekend. But I think this is the option to make it work: Open a past encounter, go to Clinical, open Vitals and pick the day you want to make sure to enter the Vitals of that day in the past.
Only one Click away.
Now what I can’t check is if there is no encounter and no reason to suspect this baby will have an encounter in the future. It could be that for every encounter there is a charge for the visit for every encounter. But sure there is one Click to NOT make this encounter into a billing situation. You could make an encounter without a billing fee.
For compatibility I would suggest to go the Vital way and not make a separate table for just the birth weight.
fsgl wrote on Wednesday, August 07, 2013:
Pimm,
The problem with all these encounter generations is that a practice will have orphaned encounters hanging out in the Billing Manager that will never be billed. With patch 13 these “free” encounters are sent over to Billing automatically. This will drive the billing clerk nuts after a while.
The other problem is that it will mess up the Meaningful Use calculation for giving the patient (or the parent) the Clinical Summary. There is no reason to give a Clinical Summary if the patient is not seen for that particular encounter. If the number of Clinical Summaries falls below threshold, that would not only mean failure for a single measure, but doom for all other sucessful measures as well. It’s all or nothing with Meaningful Use Attestation.
Rest assured that Dr. Kay’s office is dutifully charting growth parameters and that it is not likely that any child who is failing to thrive has been overlooked.
blankev wrote on Wednesday, August 07, 2013:
I keep nagging you. But this will be the last time in efforts to convert. ;-(
I just entered the Demo OpenEMR developer site and the Ms Low Birthweight client was still available. Was visited by a doctor from Asia Clinic, but no entrances made for 7-Aug-2013, as far as I could check.
So I opened the past-encounter for 6-08-2013 this is yesterday for Curacao. So by opening an encounter in the past entered vitals of 4-August-2013. Without problems I could add the data, could have been only the birth-weight, but this poor under-weighed child had this already entered yesterday so for continuity I entered the data for 4-Aug-2013 and could have done this for all other days between birth and yesterday. Don’t think this will make an extra encounter/bill for 07-Aug-2013.
But I am terrible in financial administration, so you could be right about the billing issue.
I prefer to use vitals for data needed to be entered in the past. And also like to get these data from the Form-vitals table in any other form for continuity.
P.S. If you speed up a bit you could enter your own child data in the Demo Developer-site. Even change my data. Or try it on you own local Open-EMR version 4.1.x
yehster wrote on Wednesday, August 07, 2013:
Even though I’m currently tracking this birth weight in a separate table from the vitals, there are still ways to get the information onto the growth charts.
Modifying the growth chart to use the additional data point seems like an easier task than trying to make encounter creation and entry in to the vitals require less time and not potentially interfere with billing.
I’ve implemented this feature as a self-contained module. It is available for interested parties and may be useful to others even if it doesn’t go into the official project repository. I don’t want to force this change on people if it doesn’t meet their needs.
bradymiller wrote on Thursday, August 08, 2013:
Hi Kevin,
Seems like this is a nice option to have. Could also leverage this mechanism/method for other simple data entry widgets. Could even make it generic and allow LBF type adding of patient summary widgets. Where and how you store the birth weight in the database is likely more important than your UI, though. If database storage done well, then shouldn’t be tough to get other things (like CDR engine, growth charts, etc.) to access it. Where and how do you plan on storing it?
-brady
OpenEMR
yehster wrote on Thursday, August 08, 2013:
Currently using a purpose specific table. I decided against using any of the existing tables, because using form_vitals would have required also creating an encounter, and none of the “generic data” tables (lists,lbf_data, changes using layout editor to patient_data) support a true numeric value.
blankev wrote on Thursday, August 08, 2013:
Now you got my attention again… sorry for leaving.
Add a field called Birth weight (in lay-outs) under Demographics Misc. Move upwards so it is above Date and Reason Diseased. No encounter no other connections. Even better, you can change text into INT. Also add something like LBS or Kg since it is not accepted in my TEXT field for Birth wight.
Birth-date is not so important in Misc but time stamp might be added for time indication for pediatricians and gynecologists.
It is now in Demo Developer version till automatic changes happen.
For Pediatricians you might want to put the same field on Front-page first view after activation or in the header of the patient. (For the first couple of months.)
fsgl wrote on Thursday, August 08, 2013:
It takes a lot of character to reverse course. Thank you for being a “big” person (the opposite of 小 人).
bradymiller wrote on Friday, August 09, 2013:
Hi Kevin,
Do you think there is room for making this more generic? For example, a LBW-Layout Based Widgets (akin to LBF) that leverages the current LBF engine/methodology for layout based widgets, which yours would then drop into?
-brady
OpenEMR
bradymiller wrote on Friday, August 09, 2013:
Also meant to ask since your brought up lbf_data above, is it mandatory that they are stored in numeric sql columns?