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Configuring and extending features on the Patient 360 profile

Suggest edit Updated on May 11, 2021

You can configure features on the Patient 360 profile to meet your business needs. Use the Care Management Configuration page to configure a number of features, from modifying the patient to-do list to setting the categories of Social Determinants of Health for tracking.

The following topics include configuration steps:

  • Extending the header status in the member profile in the Patient 360
  • Patient header data pages
  • Changing the setting for locking patient notes in the Patient 360
  • Changing the source on the Patient Risk Score data page in the Patient 360
  • Configuring recent vital items for display in the Patient 360 banner
  • Configuring the to-do list in the Patient 360
  • Recent activity

Extending the header status in the member profile in the Patient 360

You can modify the when rule to change the number of days that a patient's discharge status from the hospital is displayed on the Patient 360 header. The default value is 90 days.

For more information about when rules, see When Condition rules.
  1. In the header of Dev Studio, enter IsDischargeDuration.
  2. Open the when rule in the PegaHC-Care-Work class.
  3. Change the numeric value to equal the number of days for the patient status to display in the header.
  4. Click Save as.

Patient header data pages

The patient header is an introductory section of the Patient 360 view and contains preliminary information about the patient such as name, gender, date of birth, age, address, and spoken language. There is a SHOW MORE link at the bottom of the patient header which expands the patient header with more information on it. You can use these data pages to customize the patient header.

Data page rules for the patient header

Rule namePurposeParameters
D_MemberRecentBarriersPatient active barrier listMemberID
D_GetSocialDeterminantsListByMemberPatient social determinants of health listMemberID, SDOHCategory, Status
D_GetMedicationListPatient medication list- Retrieves the PegaHC-Data-Prescription instancesMemberID
D_MemberMedicationsPatient medication list – Retrieves the FHIR-compliant PegaHC-Data-PatientMedications entities, the default data model for medications from 8.4MemberID
D_GetRecentDiagnosisConditionsPatient medical history and claim datacustomerID
D_GetNonClaimMedicalHistoryPatient medical history and diagnosis information from authorization and admission casesMemberID, Source
D_GetMemberClaimsPatient claimsMemberID
D_DisplayFamilyHistoryPatient family historyMemberID
D_MemberNotes Patient notes added by a care giver in the Patient summaryMemberID
D_MemberNotesEdit Update the Patient notesMemberID

Configuring the timeframe for editing a patient summary

You can edit the patient notes in the patient summary in the header of the Patient 360.

  1. In Dev Studio, click Care ManagementCare Management Configuration.
  2. On the Care Management Application configuration page, click the Other settings tab,
  3. In the Timeline to edit the patient sumary (in days) field, enter the number of days in which you can update the patient summary note.
  4. Click Save.

Changing the setting for locking patient notes in the Patient 360

You can change the default number of days of 3 to allow a care team member to edit patient notes. After the specified number of days, the notes are locked and unavailable for editing. For example, your organization might update records for a period up to seven days.

  1. In the header of Dev Studio, enter MemberNotesEdit and press Enter.
  2. Open the report definition rule in the PegaHC-Data-MemberNotes class where the patient notes are captured and saved.
  3. Click Save AsSpecialize by class or ruleset to save the report definition to your implementation layer ruleset.
  4. On the Query tab, go to the Edit filters section.
  5. In the Condition B row, in the Relationship list, click a relationship and enter the number in the Value field that meets your organization's needs.
    Setting for locking patient notes
  6. Click Save, and then click Check in.

Changing the source on the Patient Risk Score data page in the Patient 360

The Patient Risk Score is a health risk score value for the patient which is calculated based on client-defined methodology. Different organizations might choose to have different ways of storing and displaying patient score. Modify the source on the PatientRiskScore data page to indicate how your organization calculates patient risk scores.

Patient risk scores are calculations that are used to identify the risk levels of patients. Typically, patients are classified as high-, medium-, or low-risk. Additionally, risk scores are created to review risks in various areas such as readmission risk or future risk of an event happening in a certain time period, for example, three, six, or twelve months.

By consistently using the patient risk score, you segment the patient population into manageable categories. Low- and medium-risk members might be managed by using email, tests, or electronic coaching. High-risk members need person-to-person interaction with a care manager. Risk scores are dynamic and case managers can measure patient progress through the decrease or increase in their risk score.

  1. In the navigation pane of Dev Studio, click App.
  2. Enter and search for the PegaHC-Data-RiskScore class.
  3. Click Data ModelData PageD_PatientRiskScore.
    Patient risk score data page
  4. Save the data page to your implementation-layer ruleset.
    For more information, see Data pages.
  5. In the Data sources section, in the Source list, select how to populate the patient risk score.For example: If the patient risk scores come from an external system, you might select a connector or a data transform.
  6. Based on the Source method that you select, update the fields to describe how you are getting information or calculating information for the patient risk score.
  7. Click Save, and then click Check in.

Configuring recent vital items for display in the Patient 360 banner

You can configure the items that you want to display as recent vital readings in the banner of the Patient 360.

Because look-up data pages do not support dynamic class referencing, you need to save the D_RecentVitals rule in the appropriate implementation-layer class context so that the data page can fetch the implementation-layer specific data. Otherwise, the look-up fails and the data page does not return any data.

  1. In the header of Dev Studio, click ConfigureCare Management Configuration.
  2. Click the Patient events tab.
  3. In the Recent vitals section, click the plus sign icon to add a row.
  4. In the Vital column, enter a value for a vital sign and then select it from the list that appears.For example: You might enter Glucose.
  5. In the Display name column, enter the name that you want to display for the vital sign.
    The value in the Code column is filled in.
  6. Click Save and Close.
    To fetch the recent vital signs from the configuration page, use the D_RecemtVitalsProfile data page. The parameter is MemberID. For more information, see Data pages.

Configuring the to-do list in the Patient 360

To meet your organization's business needs, you can define additional cases that you want to display in the patient to-do-list. For example, you might want to add the Discharge worksheet case.

The patient to-do list includes a list of the tasks (cases) that are associated with the patient. Each record has a Begin button to start the task. If you leave the task without finishing it, the button label changes to Continue, which allows you to resume the work where you left it. Along with the other cases, task cases that occur with a start date in the next 7 days are also displayed in the to-do list.

By default, Pega Care Management displays the following cases in the patient to-do-list:

  • Prior authorization
  • Admission
  • Admission notification
  • Program referral
  • Task
  • Case conference
  • Visit
  • Discharge Plan
  • Concurrent review
  • UM Case
  • Incident
  • MTM
  1. In the header of Dev Studio, click ConfigureCare Management Configuration.
  2. On the Care Management Application configuration page, click the drop-down arrow at the right of the tabs, and click Patient events.
  3. In the To do list cases section, click the Add a row icon.
  4. In the new field, click and press the Down arrow to display a list of class names for case types. For example: If you are adding Discharge worksheet case, select the PegaHC-Care-Work-DischargeWorksheet class to display the discharge worksheet cases on the patient to-do list.
  5. Click Save.
    To fetch the cases that are related to a patient, use the D_MemberToDoListCases data page. For more information, see Data pages.

Suppressing non-automated resolution tasks in the patient task list in the Patient 360

You can suppress tasks from appearing in the patient task list by modifying the when rule. Some tasks that appear in the patient task list are not automatically resolved. This occurs when you create a task and do not select the Auto resolve check box. For example, you might suppress an email task.

  1. In the header of Dev Studio, enter ShowBeginOrContinue and press Enter.
  2. In the row where the Type column is labeled When, in the PegaHC-Care-Work-Task class, click ShowBeginOrContinue.
  3. To save this change to your implementation-layer ruleset, click Save as.
  4. On the Save as When page, complete the fields.
    For more information, see Creating a When rule.
  5. Click Create and open.
  6. On the Edit When page, add the task categories that you want to suppress.
  7. Click Save and then click Check in.

Suppressing non-automated resolution tasks in the patient to-do list in the Patient 360

In Pega Care Management, some tasks that appear in the patient to-do list do not require any action. This occurs when you create a task and you do not select the Auto resolve check box. You might want to suppress tasks such as Notify Case Owner or Send Email.

  1. In the header of Dev Studio, enter MemberToDoList in the search field, and press Enter.
  2. In the Report Definition row, in the PegaHC-Care-Work class, click MemberToDoList.
  3. To save the change to your implementation-layer ruleset, click Save as.
  4. On the Save as Report Definition page, complete the fields.
    For more information, see Report Definition rule form.
  5. Click Create and open.
  6. On the Edit Report Definition page, scroll to the Edit filters section.
  7. In the F4 row (.CMTask.pyCategory in the Column source column), in the Value column, enter the name of the task that you want to suppress.
    Enclose the name of the task in quotation marks.
  8. Click Save and then click Check in.

Recent activity

You can configure the recent activities of patients. For example, this section might contain events such as out-of-range lab results, phone visits, patient notes updated, home visit follow-up, incidents and authorizations. A care manager can view the list of activities and quickly understand the patient interactions.

Configuring the default settings for the Recent activity section in the Patient 360 profile

You can choose the items that automatically appear in the Recent activity section of the Patient 360 profile. This section provides an overview to help the care manager understand recent interactions with the patient.

For example, you might choose to display visits and incidents.
  1. In the header of Dev Studio, click ConfigureCare Management Configuration.
  2. Click the Patient events tab.
  3. In the Recent activity section, select the check boxes in the Loaded by default? column to represent the items that you want to automatically display in the patient Recent activity section of the Patient 360 profile.
  4. Click Save and then Close.

Changing the event order in the Recent activity section of the Patient 360

Based on the priorities of your organization, you can change the order of the events in the Recent activity section in the CM Care Manager Portal. The Recent activity section contains events such as out-of-range lab results, phone visit, patient notes updated, home visit follow-up, and authorization.

  1. In the header of Dev Studio, click ConfigureCare Management Configuration.
  2. Click the Patient events tab.
  3. In the Recent Activity section, in the Display order column, modify the numbers to reflect the order of events for display.
  4. Click Save.
    To fetch the last engagement filters, use the D_GetDefaultLoadRecents data page. For more information, see Data pages.

    To fetch the list of recent activity configured on the configuration page under patient event, use the D_RecemtActivity data page and the RecentActivity data transform. For more information, see Data pages and Data transforms.

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