Article Section Links:

Select Report Details Pop-up

Patient Centered Care Plan Sections

Additional Care Plan Notes

Including Care Plan Progress

Including the Provider Review Notes

Including Provider-Only (Non-Patient-Facing) Notes

Including Patient Conditions

Including Program Consent

Including Program Updates

Including Patient Time Logs

RPM Device Notes and Readings

Specifying Date Range to Include Data From

Creating the Care Plan Report

Medicare requires that the patient's care plan be made available to the patient and the care team 24/7. Medicare also requires that the BHI and CCM summary and care plans be shared with the patient's other providers electronically. ThoroughCare makes both of these tasks simple!

For demonstration purposes, a fake CCM patient was used; however, the same steps apply when making a BHI or RPM summary for a patient.

Navigate to the Patient Program Page:

Once on the patient program page (e.g. CCM page shown below), click the blue "printer" icon underneath the time logger.

Note: You can also see these changes on the Mass Care Plan Report which can be found on any program worklist or the "Other Reports" page.

Select Report Details Pop-up:

By clicking the blue "Printer" icon, a "Select Report Details" pop-up should appear.

Note: Notice all the new reporting options added to the pop-up. There is now a whole second column of items Care Managers can choose to add or leave out of their care plan report.

Patient Centered Care Plan Sections:

The report automatically populates with the "Patient Centered Care Plan" option selected, along with all "Care Plan Sections" from "Goals Important to the Patient" to "Additional Care Plan Notes".

Note: CCM under "Include Conditions" is also checked because we are attempting to create this report from a patient's CCM page.

Note: The items listed under the "Care Plan Sections", highlighted in the screenshot above, correspond with the different listed notes sections under the "Care Plan Review" tab of the program page (shown in screenshot below).

If a user would like to de-select all of the pre-selected "Care Plan Sections" they can simply click the checkbox to the left of "Patient Centered Care Plan".

Additional Care Plan Notes:

Notice the sections not checked at the bottom of the "Care Plan Sections" list. Take a second to hover your mouse over these report options.

If the patient participates in the RPM program, a user will first see an "Additional RPM Updates" checkbox option. If you hover your mouse over this option, you will see that by checking this the report will include as follows:

  • Goals for monthly measurement

  • Average monthly measurement

  • Measurements out of range (alerts)

  • Provider notification of alerts (date and time)

  • Interventions (included those by physician and staff)

  • Patient education

  • Other RPM Notes

  • Patient Updates

Note: If your practice does not have the RPM program enabled this option will not be available.

Next, if one were to hover their mouse over the "New Conditions Notes" item, they would see that by selecting the "New Conditions Notes" checkbox their report will include:

  • New concerns identified by patients

  • Interventions to patient concerns

  • Patient Goals / to-do list for next 30 days

  • Care Team / to-do list for the nest 30 days

  • Other notes about this month's engagement

Finally, there is the "Other Notes" checkbox option. By selecting this, the report will include:

  • Other notes to appear on this month's Care Plan

  • Provider Monthly Review Notes

  • Appointment Notes

  • Time Logging notes

  • Treatment Notes / Recent Labs

  • Patient Updates

Including Care Plan Progress:

If a user would like to include the patient's care plan progress (e.g. goals and barriers), they can click the "Include Care Plan Progress" checkbox item.

Note: Notice that once clicked the "Goals", "Barriers", and "Interventions" options, underneath "Care Plan Progress" in the lower right hand corner of the pop-up, become selected.

Including the Provider Review Notes:

Note: The provider review notes is the notes section a user can view from the "Provider Review" tab on the patient's program management page (highlighted in screenshot below).

If a user would like to include these provider notes within the patient report they can simply select the "Provider review / Action Items".

Note: This does not include any "Provider-Only" notes.

Including Provider-Only (Non-Patient-Facing) Notes:

Note: Provider-only notes are located underneath the "Other Notes" tab located at the bottom of the patient's program page as shown in the screenshot below.

If a user would like to include the provider-only facing notes, they may select the "Include provider-only (non-patient-facing) notes" option highlighted below.

Including Patient Conditions:

If a user wishes to include a patient's managed conditions, they must click to select whichever program's conditions they wish to include when the report is created. For example, If "CCM" is checked only conditions that have been marked to be managed under CCM will be added to the report.

Note: The program checkboxes that are available will depend on the programs that the patient is/has been enrolled in. If a patient has only been in CCM then only the "CCM" checkbox should be visible.

Including Program Consent:

If a user wishes to include program consent, click to check the program that should have their consent added to the report. This means if "RPM" is checked, only RPM enrollment documentation will be included on the created report.

Including Program Updates:

If the report is meant to include updates made to the care plan, click to select the checkbox of the target program to have those care plan updates added to the report.

Including Patient Time Logs:

If the to be created report should contain a list of time logs, click to select the target program's checkbox underneath the "Include Time Logs" section.

RPM Device Notes and Readings:

If a patient is enrolled in RPM they will have the option to include both device notes and recorded readings. To include device notes click to select the "Remote Device Notes" checkbox. To add device readings click the checkbox labeled "Include Device Readings"

Note: Device notes and readings can be found under any of the "Device Details" views located within the "Patient Vitals" tab of the patient program page.

Specifying Date Range to Include Data From:

Click within the box labeled "Date Range", to bring up the mini calendar to outline which dates the report should pull data from. This means if a user selects a date range of an entire month, only data such as notes, updates, and time logs will be included within the selected date range will be included in the report.

Once the calendar pop-up appears click to select two dates from the calendar. Data will be pulled from the days in-between the two chosen dates as well as the days that are selected.

Creating the Care Plan Report:

Once all selections are made on the "Select Report Details" pop-up click either the "Open Review" or "Download PDF" buttons located at the bottom of the pop-up as shown below. For this example we are going to open a preview.

If the "Open Preview" button is clicked, a second window in the user's browser should open up for the care plan report summary. It should look similar to the report shown in the screenshot below.

If the user chooses the "Download PDF" option, a green "Import is ready" pop-up will appear in the upper right hand corner of the screen. Click this green box to directly download the Care Plan report.

Note: Once the green pop-up message is click the report will automatically download, If using a chrome browser the download will appear in the bottom left hand corner of the page.

For more information on our updates made to patient reports, not discussed in this article, chat with a ThoroughCare professional by clicking the blue chat bubble in the bottom right hand corner of every ThoroughCare screen!

Did this answer your question?