anonymous wrote on Tuesday, December 22, 2009:
Greetings, this is a relatively simple feature that needs to be added to OpenEMR for meeting the MU requirement. Please comment on the proposed solution. Thanks.
bradymiller wrote on Tuesday, December 22, 2009:
hey,
I’d go even simpler (from a medicine perspective, the most important piece of information is whether the patient is currently smoking or not):
- Keep the Tobacco text field to allow free form entering of data, since can be complicated.( remote history, chewing tobacco, total pack years, etc.)
- Make a new ‘Smoking Currently’ entry with YES/NO, which is an extremely simple one liner in database.sql .
- See the ‘’ thread (message #9) for plan to tie this entry into a clinical reminder.
<br>
example of database.sql code (note parameter #5, which is ordering parameter, would need to be incremented in the entries below this):
<pre><code>INSERT INTO layout_options VALUES (‘HIS’, ‘smoking_status’, ‘4Lifestyle’, ‘Smoking Currently’ , 4, 1, 1, 0, 0, ‘yesno’, 1, 1, ‘’, ‘’, ‘Smoking Currently’);
</code></pre>
Also need to place a corresponding ‘smoking\_status’ entry in the ‘history\_data’ table.
-brady
: https://sourceforge.net/projects/openemr/forums/forum/202506/topic/3494342
drbowen wrote on Tuesday, December 22, 2009:
The Meaningful Use requirements include:
Whether or not a person is a smoker.
Whether or not they have been offered smoking cessation.
I think these both need to be discreet data to allow for reporting.
It seems that we ought to track when we offered smoking cessation to allow the practitioners to intermmittently go back and keep offering smoking cessation.
We might also ought to consider what we offered and how much time was spent on smoking cessation counseling.
I don’t think these last two items are required but the end goal here is to positively affect outcomes and this I think would be helpful to me as a practitioner?
What do you guys think? Brady, Michael?
Sam Bowen, MD<br>
http://www.openmedsoftware.org/
bradymiller wrote on Tuesday, December 22, 2009:
Sam,
Agreed. Above mechanism can collect al this information. Will collect the yes/no current smoker in the history section. Then the ‘Clinical Decision Rule’ model can be used to:
- Ensure this entry is filled out (noy left blank)
- If smoker, then offer cessation yearly(or every appt or monthly, etc.), and can get more details on the cessation intervention if needed.
<br>
The is vital here, because it also enables work flow of thing sthat need to be done clinically. via sets of rules. I think the underlying structure of the clinical decision needs to be very thought out to ensure we get the most flexible system possible. I’ve proposed a mechansim, but I’m a sql novice. It will be more interesting to see what Rod suggests.
-brady
: https://sourceforge.net/projects/openemr/forums/forum/202506/topic/3494342
sunsetsystems wrote on Tuesday, December 22, 2009:
Brady’s thoughts make sense to me. I’d only add that the details of a smoking cessation counseling session should be in an encounter form, not in demographics.
blankev wrote on Tuesday, December 22, 2009:
Seems a rather nice way to go, as Sam suggests.
Smoker YES/NO
But now it’s proven (?) that secondhand smoking is as also dangerous.
If “YES” to a SMOKING COMPLAINT, than it should invoke some kind of Form. A Form that has also some kind of flow sheet to be followed with steps and results of the smoking counseling.
My opinion is that this is not something found in OpenEMR jet, so it needs a new FORM to be made. Could be based on “Layout-Based visit Form”, but could also be a more permanent Forms drom a well known counseling provider.
For starters it could be implemented as all other Forms are implemented: Administration => Other => Forms.
But should be invoked from the History part of Demographics.
IMHO, Pimm
blankev wrote on Tuesday, December 22, 2009:
In “NEW ENCOUNTER FORM” the “ADD ISSUE” under “PROBLEM” could be used to implement the Problem: SMOKING.
You get “P: Smoking” (and this is a lifelong addiction so does not need “delete” options…….) ;-))
Than my suggestion would be to go with this P: Smoking goto the “FORM Smoking” continue with treatment session as suggestions made by SAM B.
I know you DEVELOPERS can do this…… but how? I leave it to the professionals.
Pimm
anonymous wrote on Wednesday, December 23, 2009:
Hi Pimm,
The proposed solution is to put smoking cessation under disease management. Please refer to Clinical Decision Rule to see if the plan form would work for smoking cessation.
Disease management plans are supported by alerts, patient reminders, and reporting tools.
: http://www.openmedsoftware.org/wiki/Clinical_Decision_Rule
blankev wrote on Wednesday, December 23, 2009:
***“The proposed solution is…………….,”*** it sounds like nothing else is important because decision has been taken with approval of all users.
Now here are my thoughts and some information to think about when taking the stand of “it has been decided”.
Use of the Demo versions of OpenEMR is a relative simple introduction to OpenEMR. If you want to use all options available you have to start implementing everything again, every new day, after every automatic daily reset of the OpenEMR demos.
**This is the least to be done to make use of simple demo versions:**
Input Facilities preferable more than one
Input of Users, more than one.
Input of clients more than a thousand.
Invoke CAMOS
If you will do want to use the most recent CVS versions you have to be very carefull not to pick the CVS’s with the wrong coding. AND DON’t OVERWRITE YOUR OWN CHANGES!
**But some rather restricted options, that should not be restricted are and always have been available, but can not be changed in the Demos versions:**
Like ISSUE and PROBLEM/MEDICATION/ALLERGY/DENTAL. It
has been there since I first had contact with OpenEMR. So THIS has
historic relevance.
Change ICD 9 into ICD10
etc.
I always wondered why it is an extra effort if you wanted to implement more PROBLEMS. They show like Problems and every practitioner is happy to view right away the PROBLEMS his/her client is treated for.
You need to have access in the structure of OpenEMR, the software *.php files to add more MEDICATION and more PROBLEMS. You CAN add them every time you invoke ISSUEs, but what you added is not added for automatic input in the future. To ADD more choices for PROLEMS you need to change the *.php file.
Please correct me if I am wrong, but this is what I remembered of my introductions to OpenEMR, Demos, CVS and updates.
**Question:** How difficult will it be to make the “P: PROBLEMS” in ISSUES to connect to you UM part. That UM disease is nice and great to have and easy to use…… but the connection with the logic world of every day practice.
In my simple everything is easy, but someone else has to implement it vision, the P: Problems part can invoke the use of Clinical Decisions once a certain criteria is met.
I never opened history to make a note of problems after a first intake. But the everyday routine is to be obliged to ADD ISSUES in New Encounter form enter ENCOUNTERS every time I start a new client contact.
Please take this into consideration when putting something in the history of the patient.
Pimm
blankev wrote on Wednesday, December 23, 2009:
**“Trigger Decision Support”** as mentioned right at the end of your wiki page will make this connection I want to see implemented so dearly. Sorry for the omission!
But that is for Developers to create and I did not register this little red remark. I must have read it before, but it did not hit my own mental hard-disk as obvious.
All materials relevant to some form of obvious treatment schedule has to be reintroduced during a new installation from scrach? Is this correct or can we make use of a link to Internet information? Or can we implement consensus in OpenEMR NEW INSTALLATIONS with a option to change with individual preferences?
Pimm.
bradymiller wrote on Wednesday, December 23, 2009:
Pimm,
Perhaps there’s a language miscommunication here, but proposed does not mean “it has been decided”. This is what I like to imagine for the end user for smoking:
1) First imagine the demographics screen becomes a patient medical summary where meds, medical issues, patient notes, encounters etc. are all summarized (Tony’s group is actively working on this).
2) Second, imagine in the patient summary screen at the top right is the advanced directives and right below this is a Clinical Reminder section to simplify all those pesky details of primary care (mammos, paps, psa’s, immunizations, and the dreaded diabetes drudge). One of those is smoking. If you have not completed the yes/no question in the history section, then there is a reminder there telling you to ask your patient this question. Then you click on it and put the answer there in the nifty pop-up. If the answer to the smoking question is yes, then you’ll be reminded to tell your patient to quit smoking however frequently you want. You can then click on this, place the date and put a quick explanation of what happened if you want.
3) Imagine that it is configurable (frequencies, others rules, etc. and to at least keep the door open to allow mapping to issues, icd-9, icd-10, snomed-ct codes, lab results, etc.) and upgradable (users upgrading getting this functionality).
-brady
blankev wrote on Wednesday, December 23, 2009:
Take my comment as an excuse for not having read the complete solution. Speaking before contemplation and understanding. By now I see the advantage and flexibility.
Encounter => YES; History => YES; Smoking => YES and solution right there.
It all should work with shortcuts for the practitioner.
Please forgive me my wrong wording, but in the heat of observations made, I wanted you all to be convinced of something that already had a good solution.
Let us get to use this feature and let me make some remark as: " YES" you all did it again! A great new feature in OpenEMR!
Pimm
anonymous wrote on Thursday, December 24, 2009:
Happy holidays!
Thanks for your excellent feedback. Please review the office visit workflow to see if it captures Brady’s ideas and how users would want to use OpenEMR.
: http://www.openmedsoftware.org/mw/images/3/3e/OpenEMR_Office_Visit_Workflow.pdf
anonymous wrote on Tuesday, January 05, 2010:
The current Tobacco field in Patient Lifestyle meets MU requirement. So the work for MU is considered done.
bradymiller wrote on Tuesday, January 05, 2010:
hey,
I think it will be important to add the current smoking status entry for clinical reasons (to be used with the clinical decisions model), so will add as a feature request here on sourceforge.
-brady
anonymous wrote on Wednesday, January 06, 2010:
Yes, we will add the smoking status entry for clinical decision support once it’s done. The free text field will not work well for reporting purpose.
From the latest MU rule (2009-31217_PI.pdf document):
> At least 80% of all unique patients 13 years old or older seen by the
> EP or admitted to the eligible hospital have “smoking status”
> recorded.
Here are some new thoughts regarding the layout. Do you think it’s a good idea to include other substances?
Tobacco Use: O Never O Current O Quit & Date: Comment:
Caffeine Use: O Never O Current O Quit & Date: Comment:
Alcohol Use: O Never O Current O Quit & Date: Comment:
Narcotic Drug Use: O Never O Current O Quit & Date: Comment:
anonymous wrote on Tuesday, January 19, 2010:
We are putting together a smoking cessation plan for OpenEMR. Our research shows that there is a variety of plans out there. Please review the following examples and see which one is the best fit.
1. http://www.americanheart.org/downloadable/heart/1137711832734PersonalQuitPlan.pdf
2. http://www.mayoclinic.com/health/nicotine-craving/SK00057
3. http://www.urmc.rochester.edu/news/story/index.cfm?id=2715
anonymous wrote on Saturday, January 23, 2010:
Status fields have been added to most of the items in Patient’s Lifestyle. Please review this new feature. I will post the codes for review shortly.
anonymous wrote on Saturday, January 23, 2010:
Demo site: http://www.medbloom.com/
Username: test1
Password: test1
Steps:
1. Select a patient from the Calendar.
2. Go to Patient/Client section. Click on Medical Record. Go to History.
3. Go to Lifestyle section to see the status options.