Inactive/Active Patient Indicator

OpenEMR Development
#1

mike-h30 wrote on Monday, April 02, 2012:

How are others flagging inactive patients?  Adding a custom field to the Misc section of Demographics?  I was thinking of adding an “inactive” field with a drop down list of reasons for a patient being “inactive”  (i.e. death, moving out of state/country, transferring to another physician, violating physician contract, etc.)  However it seems that some redundancy would be created now that Death Tracking is available in the Misc section of demographics .  Thoughts?

Mike

How to mark patients as inactive?
#2

bradymiller wrote on Monday, April 02, 2012:

Hi,
Seems like this will really depends on what you ultimately plan to use this field for. Don’t see much benefit in recording death in two different places.
-brady

#3

mike-h30 wrote on Monday, April 02, 2012:

Brady,

The “inactive indicator” could be useful to support Addiction Medicine specialists who are treating opioid addiction.  The Drug Addiction Treatment Act of 2000 (http://naabt.org/30_patient_limit.cfm) permits a buprenorphine-prescribing physician to treat 30 patients during their first year of receiving certification and a max of 100 patients after their first year of certification.  Some physicians have well over 100 patients that are listed as receiving buprenorphine treatment but less than 100 are active.

For the short term I could change the label of “Date Deceased” to “Date Inactive” and then “Reason Deceased” to “Reason” and perhaps add a drop down list of “reasons” which would include “deceased.”

I agree that recording death in two places isn’t good.   In the event that others may have a need to flag “inactive” patients (for various reasons) I was proposing that death tracking become a subset of an “Inactive” patient.

Mike

#4

anonymous wrote on Monday, April 02, 2012:

Adding a custom field to the Misc section of Demographics?

This is what our practice uses, although, our field mainly reflects claim status. We treat mostly acute injuries and short-term disabilities as a result of motor vehicle accidents, which means the insurance benefits (PIP) tend to exhaust quickly. Our custom field has options for “Active”, “Benefits Exhausted”, “Settled” and “N/A”. That way if a patient tries to schedule for a follow-up after their benefits have exhausted and a settlement payment has been received by the attorney, we know to transition them to cash-only.

#5

bradymiller wrote on Tuesday, April 03, 2012:

Hi,
As mcgillcutty illustrates, this type of field is really dependent on what you plan to use the field for. Above is used to count active narcotic patients and the other for disabilities. So, gonna be rather difficult to create a standard item list here. Really think death should get it’s own entry (also note a dead patient summary screen as Deceased on the top of it) because it’s a rather global indicator of a “inactive” patient (unless OpenEMR was being used in a morgue or organ donor unit, of course). In the narcotic case, could create a custom field with your inactive entries (except for death) and then make a report that tracks the patients that are not inactive (and not dead) and that are receiving burprenorphine per provider. If done well and clean enough could even then incorporate this optional feature into the globals (turn it on and option for max numbers pre/post first year certfication etc.).
-brady
OpenEMR

#6

mike-h30 wrote on Wednesday, April 04, 2012:

mcgillcutty,

Thanks for the suggestion.  I am leaning toward utilizing a similar custom field or possibly the radio buttons list feature.

Brady

Good points about death tracking.  I wasn’t sure how other EMR’s handled inactive patients.  I was basing this on brief experience with Amazing Charts which had an inactive checkbox with a drop down list of reasons including death.  Aside from tracking narcotics patients and death, should a “general” indicator be implemented in OpenEMR to flag inactive/active patients for reasons like “moving,” “transferring to another physician,” etc?? 

Mike

#7

@MatthewVita @brady.miller @stephenwaite @sjpadgett @sunsetsystems

The revival of this topic from 2012.
Five years later there is still no official making of patients active and inactive.
In building the Morphine Calculator we designated generic name 2 as the active-inactive flag that was just a one or zero.

I am suggesting that one of the leftover usertext1 - userlist7 be converted to the active/inactive flag. I know we have no idea who has done what with those fields over the years. I for one have never used those fields and as far as I know now, the userlist1 - 7 don’t even show up in the new patient’s chart. So, if we took userlist7 and renamed it inactive. This would help a lot of users in behavioral health and pain management for sure.

Thoughts

#8

User-defined fields are for custom stuff, not mainstream features.

I haven’t been following the Morphine Calculator. What’s the underlying need?

If it’s that patient data needs to be retained but there is no expectation of accessing it for a long time, then perhaps that is best addressed by an archive system… to improve system performance and reduce the daily backup volume.

#9

I’m not sure what advantage marking patients as inactive but, an archive feature is a good idea. Even if add an active/inactive still probably need to also add a date and reason e.t.c. I’ve often wondered how users were dealing with purging and seems adding an archive solution could relieve one more I.T task.

#10

The active patient data is permanent. The need is for the medication percentage calculation.

But this goes beyond the morphine calculator. It is for many other reports that are needed. I will contend that no matter what type of practice it is, every practice needs to know the number of active patients that are being seen at any given point to do accurate financial projection.

Without an accurate count of active patients, a practice is just shooting in the wind.

#11

@sjpadgett @sunsetsystems

The patient report is good to get a list of all patients but I have been asked to modify that report allow for both to get an active list of patients and an inactive list of patients.

Most practices will mark a patient inactive as a given period of time since their last appointment. Some practice will use the inactive list to contact patients to get them back into the office. This will help them to generate revenue from their current customer base rather than having to always get or rely solely on the new patient intake.

In running a business, a practice needs to know how many paying customers it has and if there are enough to meet the needs of the practice. This information is vital to running a profitable practice. Most doctors are not running a charity operation.

#12

@juggernautsei I certainly don’t disagree and is probably needed for the reasons you point out, plus some. I’t just piqued my interest when Rod brought up archiving. Whatever is agreed on, I’ll help ya do it if you need me too.

#13

@sunsetsystems @brady.miller @MatthewVita @robert.down Do you think maybe an archiving solution should be part of the Road Map? Too me it just seems a given for an enterprise.

#14

I don’t know if the archiving needs to be anything more than a flag on the record to not include it in the patient searches.
This flag could increase the speed at which search results are returned. And when the patient returns, the flag can be removed to unarchive the

#15

Archiving helps keep the active database trim. Over the years if 25% of your clients are no longer active then this amounts to bringing forward unneeded data for backups and/or speed of the overall system.

#16

Not sure how relevant this is to the discussion, but just as a general comment: if activity status is derived from the age of the last visit, then a report can get that easily enough. Optimization is better left as a separate task if/when that is found to be desirable.

#17

I understand where you are going. Same similar path. I am not skilled with such a process to archive as you are proposing. Not to say that I won’t try. Just will take me longer to formulate a plan.

To Rod’s point, it is easy enough to create a report to the fact of the last visit. However, the last visit is not standardized across all specialties. That could be a global setting so that a practice can set it for themselves and then the report can be generated. This seems very practical.

#18

Was just trying to help.

2 Likes
#19

Hi,

@juggernautsei , would recommend having your report sort out what an active vs inactive patient is; and we could go from there (ie. could in the end have a selector that had the available options, like the facility for example, where has all patient, patients seen within 1 year, etc; and could work in globals options as needed). Note the AMC and CQM calculations do this by usually looking at last encounter for its calculations, and notable what is in the denominator (ie. active vs inactive) is not always the same from rule to rule.

Regarding archiving, isn’t one of the benefits of computerized records to be able to get to records at the push of a button(no matter how old the records are). Would seem odd from a physician perspective that I would click for a patient records and it would no longer exist since it has been archived(there have been times where the only record of a simple hemoglobin from 10 years ago in a patient that presents to the hospital has been helpful).

Also, to add, even in the case of a deceased patient(where it seems like it would make sense to archive the data), I have sometimes had to field questions or fill in paperwork long after.

-brady

#20

@brady.miller thanks for your input.
In my opinion, active and inactive is not an arbitrary status. The staff is the lonely people that know who is and who is not. The practice this calculator was developed for, a pain clinic, asked for a place to mark patients inactive. By default the patient is active. The report can’t just pick this status without the input from the staff. So, that is why I started this conversation to get it into the code base.

What I will do is change the demographics to add the inactive status to the patient chart if no one objects to this being added as a permanent feature. I will put it in with the current PR.