QHR Product Ideas

Motivation:

OHIP billing rules can be difficult to keep track of. They can both affect the way we bill and the way we approach scheduling appointments. Rather than manually verifying that the conditions are met, we would like to automate certain checks we regularly.

Note: This was also previously mentioned in a Q-and-A (see question 2: https://accuroemr.com/wp-content/uploads/2019/05/Connect-Q-and-A-3009-Regina.pdf).

Specifications:

• Provide the ability to define a "check"

  • can have the result: pass / fail

  • can be regarding patient information, ex:

    • demographics

    • provider enrollment history

    • past appointments:

      • for all time

      • within a date range relative to the current date

  • can be programmed to be run:

    • when scheduling a new appointment

    • when marking a patient as "arrived"

    • when billing for a particular procedure code

• Desired result:

  • if the "check" is met, then do nothing

  • if the "check" is not met, then present a pop-up

    • this should notify the user what condition was not met

Note: As a "nice to have", known checks related to OHIP (or other billing types) could be pre-programmed. Then, there would be the option to configure our software to make use of them.

Example Scenarios: billing with OHIP code Q040

Scenario 1: Pass

GIVEN

a patient has exactly 3 billings in the past 365 days with code K030

WHEN

we bill code Q040 in the same 365 day period

THEN

no pop-up appears (and the original functionality is maintained)

Scenario 2: Fail

GIVEN

a patient does not have 3 billings in the past 365 days with code K030

WHEN

we bill code Q040 in the same 365 day period

THEN

a pop-up appears specifying that the condition of "having 3 billings in the past 365 days with code K030" is not met