Patient 360 Administrative tab

The Care team section displays care team details and contains three labels, as shown in the following figure: Internal Team, Personal Support, and Care Provider. Each category has a primary contact, for example, the Care Provider category indicates the primary care physician (PCP).

Each section displays the care team members who are associated with the category. By default, up to three care team members for each category are displayed, but you can view all team members at once by clicking SHOW MORE. You can also add a care team member by clicking Add care team member in the upper-right corner of the tab.

The data class for the care team contacts is PegaHCCMF-Data-Party-Contact. The data model for the care team is maintained through this class.

 As shown in the following figure, clicking on a care team member slot displays a pop-up with additional information and functionality.

The Activate option is displayed if the care team patient is in a deactivated state and the Deactivate option is displayed when the care team patient is in an activated state. The Remove option is displayed if the contact is not a primary care physician and the contact should not be associated with any case conferences or visit cases.

When you expand the tree grid structure, as shown in the figure below, the Admissions section displays all types of cases, either active or resolved, with their respective child items, such as Concurrent review, Discharge plan, Discharge worksheet, and any related tasks.

The Utilization management section displays all the Utilization management cases that are either active or resolved. There can be only one active Admission or Utilization Management case at any given time.

As shown in the following figure, the Authorizations section displays cases with active or resolved statuses. In the Actions column, the Peer review action is available for authorizations with the Resolved-Denied status. The Re-Open action is available for authorizations with the Resolved-Cancelled status.

The Declined programs section displays program referrals that are declined or rejected. As shown in the figure below, you can re-open or activate the declined programs after a certain threshold period (measured in days).

The Declare_CM_ENV.Value) rule represents the threshold period (in days) after which you can refer for declined programs. The Declare_CM_ENV.Value rule is where you select the workbasket to which declined programs are routed. (CM_NONPARTICIPATINGPROGRAM_WORKBASKET ).

As shown in the figure below, the Appeals and grievances section displays appeals that are requested for denied authorizations. As part of the appeal review, if the decision is overturned, then the denied authorization is reopened.

The Claims section displays all medical, pharmaceutical, and dental claims, as shown in the following figure:

The data class for this information is PegaHC-Data-Claim. The data model for claims is maintained through this class.

As shown in the following figure, the Programs section displays a list of the programs in which a patient is enrolled.

Each program has Opt-in or Opt-out options. If a program is active, the Opt-out option is displayed. You must select comments and a reason when you opt out of a selected program. If a program is inactive, the Opt-in option is displayed. Confirmation of opting in is displayed, and the post-submission selected program is then opted-in on the backend. An Opt-out of all programs button is also displayed. After each opt-out or opt-in action, a new row is added in the Program enrollment history, with the date that the action was performed.

The Encounters section displays all the interactions between a patient and their healthcare provider, in the provision of healthcare services and assessment of their health status, as shown in the following figure:

Conversations are logged for tasks, alerts, goals, barriers, and interventions during case resolution, and also when a medication is added or updated.

As shown in the figure above, if you customize the ShowContextInfo section with the necessary properties, clicking Context displays a pop-up window with additional details. This extension is applicable for all conversation logs except Medications.

Because look-up data pages do not support dynamic class referencing, you need to save the D_GetWO 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.

Extending fields for conversation details in the Patient 360 view

As shown in the following figure, you can add or modify the fields that provide the details in the Context Information dialog box during patient conversations.

1. In the header of Dev Studio, in the Search field, enter ShowContextInfo, and then press Enter.
2. Click the Section rule.
3. On the Section page, on the Design tab, use the controls in the right pane to edit the existing fields or add new fields.
   
   For example, you might want to add a field for an assessment, a phone call, or the next visit.
    
4. Click Save.
   

As shown in the figure below, the Incidents section displays all types of incidents that are stored in the PegaHC-Data-Incident class. When you click the Incident ID, the respective case or work object opens.

To add more details in the Review Incident content section seen when clicking Incident ID, you can customize the ReviewIncidentContent section in Dev Studio.

Check your knowledge with the following interaction: