Issues and Immunizations

Here Dr. Betty Black will continue her session from the previous section's encounter. She will add a couple of "issues" and an immunization.

An "issue" is a medical problem, allergy, medication, surgery or dental issue. We lump these things together because they have something in common: they can all be associated with multiple encounters.

This is especially useful with medical problems, sometimes called "episodes of care", where we may want to quickly determine which encounters treated a particular problem, or which problems were treated by a particular encounter.

There's currently no connection between medications defined as issues, and prescriptions. This is an area that needs some work. There's also some question as to whether any of the issue types other than medical problems really need to be associated with multiple encounters; this is open for discussion.

Here is the patient's current summary:

Betty clicks on Medical Problems in the lower left portion of her screen to bring up the display of issues:

There are currently no issues. Betty clicks the Add Issue button to add a medical problem that she thinks is worth keeping track of:

This pops up the "Add New Issue" dialog. The type defaults to Problem.

For each issue type there is a handy pick-list of commonly selected titles (you can customize these), or a different one can be typed into the text box below the list. Betty types "bronchitis" as the issue's title. She also selects a begin date.

Betty has now clicked on the "Occurrence" drop-down and is selecting "Chronic/Recurrent" as the type of occurrence. Then she clicks the Save button to save the new issue.

Now Betty is adding an allergy to penicillin. Note the handy date selection widget which is used in many places in OpenEMR.

The allergy is also saved, so now we see two issues listed for this patient.

Notice the column labeled "Enc" on the right. This is the number of encounters linked to each issue, currently zero for both. Betty clicks on the 0 for the bronchitis line; this brings up the "Issues and Encounters" dialog:

This window is used to set (and view) the relationships between issues and encounters. Notice that the "bronchitis" issue, whose line in the previous window was just clicked, is highlighted.

Betty now clicks on the one encounter listed in the right column:

This causes the selected encounter to be linked with the selected issue. Clicking Save now saves this relationship to the database.

Now that the bronchitis issue is linked to an encounter, Betty can select its diagnosis. It will be useful in reporting to have a chief diagnosis, when applicable, for each issue.

She clicks the "bronchitis" title to bring up its edit dialog. Clicking on the Diagnosis drop-down lists all of the diagnoses associated with all of the linked encounters (in this case just one). She selects the diagnosis and clicks the Save button.

Now the issues list shows all current information for both issues. Betty clicks the Back button to return to the patient summary.

Next, Betty clicks Immunizations in the lower left portion of her screen to add an immunization:

She enters the relevant information and clicks "[Save Immunization]".

Notice that the new immunization is now listed at the bottom of the window.

"Immunizations (Back)" is clicked to return to the summary page.

Notice that the lower left portion of the patient summary now shows a brief list of all active issues, immunizations and prescriptions.