zhhealthcare wrote on Friday, June 03, 2011:
Brady et al,
In trying to put together a mailbox for patients, I am wondering if there is a place in OpenEMR where we store all communications sent to the patient, bet it reminders, SMS, Email et cetera. If we don’t have one we would be happy to work on it based on your ideas.
Shameem
tmccormi wrote on Friday, June 03, 2011:
That’s what patient notes are for. There is already a note type for patient reminders, other types could be added or a general type called something like “e-communications” could be added.
-Tony
zhhealthcare wrote on Friday, June 03, 2011:
Tony
I see “patient reminders” under demographics and it has some interesting stuff on there. I was wondering if those are integrated with patient notes. I just tried to create a note with patient reminder subject and it did not show up in the reminders page. Would it do it the other way around when a reminder is generated under the rules, and then that shows up in the patient note? In other words if a reminders is sent from there would it populate the notes section?
What I am looking at is to have all this in one place, even when a sms or email is sent for the patient appointment et cetera.
Regards
Shameem
tmccormi wrote on Friday, June 03, 2011:
Conceptually, It should work the second way, when reminders are sent they are logged in the notes, but I didn’t write any of that stuff and I have not looked at it closely, myself.
-Tony
zhhealthcare wrote on Friday, June 03, 2011:
Hopefully Brady can shed some light on this. It looks like he was the engine behind this 
Thanks
Shameem
bradymiller wrote on Friday, June 03, 2011:
hey,
All CDR reminders are stored in the patient_reminders table. To find messages that were sent, simply query for items that are not NULL or not empty at the date_sent column. The patient_reminders table and associated functions are rather sophisticated (automatically generate and inactivate), so no reason to try to “copy” them into a central place; plus all the patient notes are not meant for the patients. You’ll likely just want to show the CDR reminders and several of the patient note categories. Also, I don’t know how/where the appointment reminders are stored (hopefully at some point the CDR reminders will take over the appointment reminders in the future; I placed a bunch of appointment reminder “placemarker” items in the CDR reminder engine, just haven’t had time to get it functional (note it may be a long time before I get to it).
-brady
bradymiller wrote on Friday, June 03, 2011:
hey,
Probably even better thing to do is to grab the applicable (ie. active) CDR reminders by using the fetch_reminders() function in library/reminders.php .
-brady
zhhealthcare wrote on Friday, June 03, 2011:
I agree, we have to be able to select what notes the patient should see. Also selecting non null from reminders table is good. So now we have two to merge into the mailbox. Are there any other places in OpenEMR from where any messages are send to the patients?
I dont think the appointment reminders or sms are logged anywhere in the system. Would it be a good idea to add some functionality in the sms/email code to log those traffic?
Your CDR engine would be a great idea. We could take a shot at it after we finish with the basic portal.
What I am trying to do is this: When the patient logs into the portal he must be able to see all the reminders and messages the provider have sent him. I am also trying to see if the patient can reply or send messages back in case he needs a referral, prescription refill et cetera. Is it ok to use the Patient notes to incorporate that aspect?
Thanks
Shameem
zhhealthcare wrote on Friday, June 03, 2011:
I meant to add one more thing: it is not enough for the patient to see only the active reminders but also historical data. Also, can we add a status to see if the patient actually read such messages?
jpmd wrote on Friday, June 03, 2011:
Please also be mindful that the provider should have the option of not incorporating messages from patients directly into the chart from a patient portal. There are times that patients are not as respectful or nice about comments/messages and having this imported automatically into the patient chart may not be desirable or wanted.
Jude
zhhealthcare wrote on Friday, June 03, 2011:
Jude
You mean when you take a chart(report) from within EMR, the messages from patient should be a separate check box that can be included or not at the provide’s option? Maybe we should also have the option to select/deselect individual messages from the patient.
Then again, should any of these messages back and forth should be included in the report at all?
Shameem
jcahn2 wrote on Saturday, June 04, 2011:
Anyone with legal experience here? Seems to me that any communication from patient to doctor and v-v must become a permanent part of the record and be available to the patient on request. Our intra-office communication is held closer to the vest, but could well be accessed on demand so that it becomes clear who knew what when and what actions were taken.
Basically, don’t put anything in the record that you would feel badly about later when it is shared with the patient, or others for that matter.
And we will also be required to provide a log of who accessed the patient record, and when; and with whom information from the record was shared and when. This ancillary information will consume more disk space than the pertinent patient information, I’m sure.
Jack
jpmd wrote on Saturday, June 04, 2011:
“Then again, should any of these messages back and forth should be included in the report at all?”
That is the important question. Some request do not ask for patient communications. If they do then Jack is correct. Physicians should be aware of the ramifications of having ALL patient communications imported directly into the chart from a patient portal.
Jude
bradymiller wrote on Sunday, June 05, 2011:
zhhealthcare,
Regarding your last technical questions:
1) In cdr, the patient reminders are never removed. and when deactivated, a reason is placed in the table. So, all the information is there to allow you to show historical data.
2) To flag when these are read by patient in portal, could always place a flag for this in the table.
-brady
zhhealthcare wrote on Monday, June 06, 2011:
Brady et al
let’s take a stab at it. We’ll create a page for that and give it as a link to the demo page called “mailbox” Is this ok?
As far as the rest of the discussion, we will provide an option in the portal for the provider to choose if he wants the patient to send him communications or not. Another option would be to give the patient option to select from a predefined subject with no ability to write notes, but that would not be in the spirit of the patient portal where interaction have to take place.
Shameem