True. What I really need is an AI that will look at the patient’s insurance and the requested procedure, and then go back through prior chart notes to document most recent and ongoing conservative care, meds previously tried, and supportive imaging and physical exam findings.
This is what I'm looking at with my dev team- automated PA criteria completion, as well as working the note to max out billing criteria.
I do have an interim solution regarding so-called "conservative care"-
I created my own customized intake form process that makes the patient provide all of that conservative care data to the standard of our most stringent payor (BCBS). It also collects and calculates Oswestry and does the stupid MDC fall risk calculation while collecting some other MPS measures. It does the PHQ2, but so many patients have pre-existing depression it gets skipped. The conservative care section IS effort dependent on the part of the patient, but many patients really do fill it out completely. The data is collected using Google Forms, which then sends it to a Google Sheet. A script cleans up and structures the data, and then it gets sent to Chat GPT to create a narrative (probably unnecesary if you're feeding this to an AI scribe, but the narrative can usually be cut and pasted as the HPI). The PCP data is collected from the NPPES database based on the patient's input of their doc's name. The form is designed to streamline the intake process with Athena so me or whoever is doing the intake portion can just plug in all the info without asking the patient any questions.
I feed this whole form into my AI scribe, as it's sent to me in a text file via email, and a PDF copy goes to my assistant for the chart:
**Patient Demographics:**
- Name: Jane Doe
- Date of Birth: [snip]
- Address: [snip]
- Phone: [snip]
- Email: [snip]
- Insurance: Anthem, Policy Number: [snip]
- Does the Patient Require PCP Referral: NO
- Primary Care Physician(s): [snip]
- Primary Care Physician NPI: [snip]
- Primary Care Physician Location: [snip]
- Primary Care Physician Phone: [snip]
- Primary Care Physician Fax: [snip]
- Preferred Pharmacy: [snip]
- Recent MRI Imaging: [snip]
**Athena Intake Section:**
- Height & Weight: 5 ‘ 6” 134 lbs
- VAS: 8
- Allergies: No known drug allergies
- Previous Surgical Interventions: CATARACT SURGERY, HYSTERECTOMY
- Other Medical History: ACID REFLUX (GERD), ANXIETY DISORDER, HERNIA, OSTEOPOROSIS
**Medicare Quality Metrics:**
- Smoking Status: FORMER SMOKER
- Tobacco Use: NO
- Smokeless Tobacco Use: NEVER
- Cancer Screenings: [Include information]
- Depression Screening: [Include information from PHQ-2 or other screening tools]
- Fall Risk Screening Total Score/100: 11/100
**Pain Details:**
- **Body Region Affected**: Low Back + Buttock/Leg(s)
- **Personal Story**: Sciatica bulging disc per mri
- **Last Normal Date**: First of April 2024
- **Problem Duration**: 4-8 weeks
- **Onset Event**: Exercise machine to start. Hard massage or sciatia muscle and I couldn’t walk%
- **Highest Pain Score**: 8
- **Pain Timing**: Constant (always same severity)
- **Pain Quality**: Burning
- **Functional Impairments - Self Care**: Preparing Food
- **Functional Impairments - Activities of Daily Living**: Work, Recreation, Exercise
- **Oswestry Disability Index**: 31
**Red Flags:**
- Anesthesia Issues: No
- Current Infection: No
- Pregnancy Possible: No
- Blood Thinner Medications: None of These
**Conservative Care:**
- Options Tried: Trial of Rest, Oral Pain Medications, Physical Therapy, Physician or PT Directed Home Exercise Program
- Start Date: 6/17/2024
- Treatments: Trial of Rest, Activity Modification, Physical Therapy
- Reevaluation Date: 8/20/2024
- PT Exercise Dates: July 5 first session was walking fine- did at home stretches all week. Second visit pt massaged my sciatic nerve really hard. Next day so painful could not walk. Went to [snip] out pt ortho- had x rays and sent for an MRI. I have been in really bad pain since and still on a walker. Can put no pressure on my left leg.
- Medication Classes Tried: Tylenol/NSAIDs, Oral Steroids, Muscle Relaxants
- PT Details: July 5 and July 12
- Chiropractic Details: Na
**Pain History Narrative:**
**Patient Demographics:**
- Full Name: [snip]
- Gender: [snip]
- Date of Birth: [snip]
- Age: [snip]
**Medical History:**
- Recent Health Issue: Bulging disc in the lower back sciatic region.
- Symptom Onset: Sciatica was triggered during exercise and was exacerbated by a hard massage.
- Problem Duration: Symptoms have been persistent for 4-8 weeks since April 1, 2024.
- Pain Score: Patient reports a highest pain intensity of 8 on a scale of 0-10.
- Pain Characteristics: Pain is described as a constant burning sensation, focused on the low back and extending to the buttock/leg(s).
**Medicare Quality Indicators:**
- Functional Impairments in Self-Care: Patient reports difficulty in preparing food.
- Functional Impairments in Activities of Daily Living: Pain has interfered with her ability to Work, Recreation, and Exercise.
- Oswestry Disability Index: The patient's score is 31 indicating a moderate level of disability due to the sciatic pain.
**Narrative for Pain History:**
Mrs. [snip] is experiencing a constant and severe pain in her lower back region, which consistently extends to her buttock and legs, a condition indicative of Sciatica. She first started feeling the pain after using an exercise machine, but it was notably aggravated after receiving a hard massage on her sciatic muscle which resulted in her being incapable to walk. Since that second episode, which occurred in April 2024, she hasn't experienced any relief in her symptoms despite the passage of upwards to 8 weeks.
The pain, which Mrs. [snip] describes as burning, is persistent and has become progressively unbearable, scoring as high as 8 on the pain scale. As such, it has hindered her basic day-to-day activities, affecting her ability to prepare food or engage in recreational activities. Notably, her work and exercise routines have been significantly disrupted, illustrating the severity and detrimental impact of her condition on her overall lifestyle and physical capabilities.
(sciatic muscle... yeah, you do need to double-check AI)
