Terminology for Discussion: "Treat

yehster wrote on Tuesday, July 24, 2012:

Even though we all understand that what Art hopes to implement for Mental Health is applicable to other scenarios everyone has a slightly different idea of what the term “Treatment Plan” really means.  So I’d like to propose some vocabulary.

1. Action Item
An action item is something that needs to be done over the course of a patient’s treatment.
Examples from mental health might be:
a. Initial Mental Health Evaluation
b. Traditional Therapy Session: (lay on the couch and chat)
c. Cognitive Behavioral Therapy
d. Group Therapy
Example for chronic conditions:
e. Hemoglobin A1C blood test/ BUN/Cr etc… (routine labs for Diabetes Management)
f. Diabetic Foot Exam
g. Diabetic Retina Exam
Examples for acute condition:
h: Wound check/suture removal
i: Any Clinical Reminders would also be action items.

Each action item would have it’s status tracked.  (due in X time frame, completed on.  Canceled, etc…) and possibly be linked to a problem/diagnosis

2.** Action List**
This would simply be a presentation of all action items for a given patient.  It would be dynamically generated for a given patient, and

3. Action Plan(or maybe Action Set?)
This is a predefined grouping of Action Items that can be assigned to a given patient.
As an example, for Art’s group, maybe at referral time the “initial patient” action set which consists of “Initial Evaluation” and “Create Treatment Plan”.  Would be assigned.  But then over the course of creating the “Treatment Plan” additional action items (6 Counseling Sessions + 1 CBT session?) could be added as a package.
Action Plans for various conditions could be defined based on current clinical guidelines/best practices. 
e.g. Action plan for poorly control Diabetes
a.  Nutrition Counseling with dietician
b. Follow up in X weeks for detailed review of blood sugar log with PA
c. Follow up in X+Y weeks with Physician 

Anyway if folks think this might be useful terminology I propose we try to start using it for these discussion.  Like I said though, it seems pretty clear to me that “Treatment Plan” means something different to Art than it does to Sam, Jack and Brady.

bradymiller wrote on Wednesday, July 25, 2012:

Hi,

Sounds good. To help out the current CDR engine utilizes:
Action Items are contained in the rule_action_item sql table.
An example of an Action List is what is shown in the Clinical Reminders widget on the patient summary screen.
The Action Plan can be customized in the Clinical Reminders widget at Edit->Admin . Note the limitation here is that is just allows to run on/off global rules for the patient. To customize patient specific rules is a feature that will need to be added (it can be done with some finesse of the current CDR engine).
The Action Sets are stored in clinical_plans and mapped to rules in clinical_plans_rules.

-brady
OpenEMR