Flow sheets

cmswest wrote on Saturday, March 23, 2013:

I’ve had 2 requests to implement flow sheets for health maintenance, anitcoagulation, chronic narcotics, and medication therapy. can someone refer me to some documentation on how best to implement this?

I guess I’ll play around with Layout Based Forms but would appreciate any advice.

cmswest wrote on Sunday, March 24, 2013:

Looks like I could solve this by using the rules like for  a clinical reminder. 

I was hoping there was a grid control in the layout based forms where it would be more presentable but I don’t see one.

anonymous wrote on Sunday, March 24, 2013:

Having flow sheets would be a great addition to OpenEMR for us in family practice … from anti coagulation monitoring, prenatal visits, diabetic or hypertensive care …data from multiple entries available for quick review on an single page that can be added to a future visits.  
Thanks for your hard work on improving OpenEMR!

cverk wrote on Sunday, March 24, 2013:

Clinical reminders to match CDC immunization rules for both kids and adults would be a big plus as well. Perhaps populating a schedule like the CDC produces every year as immunizations are entered and making it printable for schools, etc. Interfacing that for immunization registry reporting would also be an upcoming need.

yehster wrote on Sunday, March 24, 2013:

I am working with Mi-Squared on workflow improvements specific to immunization.  Dr. Kay is providing financial support.  I can put up a demo video if you are interested.

As for more generic “workflow.”  This has been a topic of discussion during the OEMR Ad-hoc for the past year or so.  We have been trying to define specifications to improve the clinical decision rules engine to manage workkflow.  The first implementation is supposed to be for “treatment plan” based workflow in the context of behavioral health, but with the hope that what is developed can be easily adapted for other purposes.

However, as I mentioned the discussion has been taking place for about a year now, and one of the key obstacles with no solution is how to fund this ambitious project.

blankev wrote on Sunday, March 24, 2013:

Please count me in on this topic.

As a general practitioner  I would love to see a flow sheet “generalization” in which you can give input on timely consultations and results, and anticipation for future consultations to work towards a better implementation of controls-in-time to prevent different problems due to, lack of/or due to unexpected differences in what is called a normal progression of any issue.

I am not a programmer, but I feel confident to give some support in ordinary workflow for possible prevention and control of the different from normal.

DM
Blood pressure
Pregnancy
Kidney disease
Familiair cancer options

and possible many more……

Pimm

fairflowers wrote on Tuesday, March 26, 2013:

Hi,  (yes, Pimm, I’m back.  :slight_smile: )

I just created a prenatal sheet using the XML form generator today after spending mucho time learning, downloading, installing, trying to find a single missing symbol in my code…  ;-) 

I call it a flow sheet, however, I haven’t learned how they take the data and actually make it “flow” so that you can see everything at a glance, as is possible with “Vitals.”

This seems to be a BIG need for any EMR out there.  I’ve played with several.  I mean, this is supposed to help us give better care, with fewer mistakes is it not?  I still haven’t found an EMR that gives me the information that a single page, hand written, prenatal flow record on paper does. 

Anyway, I will keep creating forms and will try to pick apart how the Vitals form works and see if I can apply it to my prenatal form.  OR, if some whiz-bang developer (which I am NOT) out there can take my form and make the vital data “flow” onto a single summary page, then maybe we can get some of these needs met.

Diane (midwife)

tmccormi wrote on Tuesday, March 26, 2013:

Diane and All,
  OpenEMR does exactly what Diane describes.   All you need to do is select a patient report from the top of the Patient Summary (Demographics page). Click the link “Report”, then select “Check All” …  Click Generate and you will see ALL of the patients encounter history in date order.  This can be refined to not show everything by unchecking what you don’t care about…

-Tony

fairflowers wrote on Tuesday, March 26, 2013:

Well shut my mouth. 

I hadn’t investigated that link yet.  You can even make the report display by problem.  Nice.  And since I have tried every form available for my prenatal encounters, I can see which layout is the easiest to “scan” for information - important when I have to transfer my records to someone else.

Thanks, Tony… 

Could you use the immunization checkboxes on the Well Infant form along with the infant’s age to set up clinical reminders for immunizations?  It’s not a full list, but the critical ones are there.  Something like, if infant age <2 months and box OPV1=0 then generate a reminder?

Diane

blankev wrote on Wednesday, March 27, 2013:

Diane,

this is very nice! You are back and even have time to do something more than writing notes on the old fashioned paper IT equipment.

Great you found some forms that might be available for prenatal controls.

Let me know if you have something to explore, so I can use my spare time to whatever I might come up with to make things work for the midwifes. I have some knowledge, but only the basics of the basics so indeed if we can some preliminary work we might even find an interested developer.

Tell me where I should start reading for better understanding the way you want to travel to improve registration for mother, unborn en others in the family that might have something to do like hereditary diseases, history and possible traps to avoid when helping the unborn and mother.

Or are you a convinced WHO-, PAHO- follower…,

Gr, Pimm

fairflowers wrote on Wednesday, March 27, 2013:

Pimm,

I simply want to give women and their babies the best care available.  Sometimes that means sending them to a doctor or a surgeon.  An EMR can be very helpful in making that transfer when necessary.  EMR’s can make it easier to chart accurately and thoroughly and they make it easy to share records with both the patient (client) and other health care professionals.  They can also make it easier to document care and get reimbursement from insurance companies. 

Where should you start reading?  How about Ina May Gaskin’s books?  - just kidding. 
I don’t need to improve registration.  I need to improve communication with higher-level medical providers and facilities.  And while an EMR can help, unfortunately, the problem runs much deeper than the paperwork.  :-/  I need to be able to take everything with me wherever I go.  Half of my charting is done in the office, the other half in people’s homes.  I need something that doesn’t require a four-hour seminar to teach an assistant (or a backup midwife) to use.  

I’m not sure what else I need.  As I work thru OpenEMR with a couple of old charts to input information from, maybe I’ll find something.  But it really seems pretty complete for my little practice, though I prefer using Google calendar for keeping track of my appointments and other professional duties.

The flowsheet thing was a biggy.  I’m glad I got an answer to that. 
I’ll stay in touch and keep an eye on the forum…

Diane

blankev wrote on Wednesday, March 27, 2013:

This is what WIKI has to say about your profession:

A practitioner of midwifery is known as a midwife, a term used in reference to both women and men, although the majority of midwives are female. In addition to providing care to women during pregnancy and birth, many midwives also provide primary care to women, well-woman care related to reproductive health, annual gynecological exams, family planning, and menopausal care.

In comparison with the pencil and paper you have to decide what will be your future. A tablet of I-pad like devise. Synchronize your work on the go, or once a day with the main Server idea. Even on a tablet OEMR will run, but this will means that your assistant must have either your tablet or is in need of a synchronized copy on another tablet.

Since the original idea of OEMR was to make it available world wide I prefer to stick to some kind of Internationalization like WHO/PAHO/UNESCO Etc, or most probably even with May Gaskin who might give  even better care and include better control mechanisms than the bare basics used by huge above mentioned International Organizations.

For the FLOW-SHEET I imagine the following:

(-1. Minus one. Give pre-conception counseling to mother and father for a healthy approach to pregnancy.)

1. Give care to mother and unborn baby
2. Give care to the mother and baby in the transition state of being separated to give rise to two persons, i.e. mother and child.
3. a. Give care to the mother after birth, 3. b. give care to the child after birth.
4. Take care if needed of the whole family in times of post delivery depression or other well observed cases.

Let me know your thoughts.

For the time being I will use CTRL-TAB to switch between Google-Calender and OEMR.  ;-))

ADVISE: Keep exploring, it is a great way of keeping your professional standards up to date and beyond.

Gr. Pimm

cmswest wrote on Saturday, March 30, 2013:

nice to see so much activity on the flow sheet topic but just to be clear, does the patient report feature list the clinical reminder info?

It seems that the current status of workflow development is with yehster’s efforts toward immunizations?  how difficult is it to custom define a few extra fields in the vitals table and have that added to the historical view that shows up once an encounter history is created?

jerryfriedrice wrote on Thursday, April 18, 2013:

One of my next priorities is to work on a flow sheet for the Prenatal Form and others, using the Vitals form as an example as fairflowers said.

I haven’t had time to register with the forum or post or anything, I have basically just been doing work for the clinic here including making adjustments and upgrades to existing forms. I’m focusing on functionality first before graphics. Eventually I will figure out (read) the process of sharing them with the contrib folder for future openemr versions.

I can post something when I have a working version of the flow charts but I am guessing that may not be until June with my schedule.

jerryfriedrice wrote on Tuesday, June 11, 2013:

I finished a very basic flow sheet graph that to keep track of prenatal flow (just gestation and fundal height) over time. This form could be used to develop further ones or perhaps a dynamic one where you enter whatever y-axis you want to keep track of over time.

However, it requires putting a jquery program in the js directory, and a css file in the css directory. It would be nice to use existing js and css, but I found the one I used to create the graphs the easiest.

tmccormi wrote on Tuesday, June 11, 2013:

Any LBF form can have fields designated as “graphable” without any coding
(caveat emptor: I have not tried this myself). The Vitals has built in
graphing for any field you add there (do that a lot lately). Which means
you could use the charting.php code as a base.

Jquery and CSS are also good options and if the tools are setup as a
library resource other things could be done that way.

Tony McCormick, CTO
Medical Information Integration, LLC

@MI2_OpenEMR

On Tue, Jun 11, 2013 at 5:44 AM, jerryfriedrice <jerryfriedrice@users.sf.net

wrote:

I finished a very basic flow sheet graph that to keep track of prenatal
flow (just gestation and fundal height) over time. This form could be used
to develop further ones or perhaps a dynamic one where you enter whatever
y-axis you want to keep track of over time.

However, it requires putting a jquery program in the js directory, and a
css file in the css directory. It would be nice to use existing js and css,
but I found the one I used to create the graphs the easiest.

flow sheetshttps://sourceforge.net/p/openemr/discussion/202504/thread/a4ff6371/?limit=25#db9b

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