Patient Management Module

Comprehensive patient/member record management spanning demographics, clinical history, insurance, care teams, and communication — the longitudinal health record.

Pages

API Endpoints

High-Priority Orgs

Requirements

Organization Relevance

MCO: High Health Plan: High ACO: High FQHC: High TPA: High IPA: Medium PHO: Medium MSO: Low

How It Works

The patient module provides a 360-degree view of each member. Demographics, insurance coverage, clinical conditions, medications, allergies, immunizations, and vital signs are maintained in a unified record. Care teams are assigned for coordination. Activity logs track all interactions. The module integrates with clinical, claims, and enrollment data to present a complete health profile.

Requirements

Master Patient Index (MPI) for identity management
FHIR Patient/Condition/Observation resources
EHR/HIE integration for clinical data
Insurance eligibility feeds
HIPAA-compliant access controls

Target Audience

Care Managers, Clinicians, Member Services, Quality Teams, Compliance Officers

Pages (21)

Page	Purpose	Key Features
Patient Profile	Comprehensive patient overview combining demographics, clinical, and coverage data	360-degree view, Summary dashboard, Quick navigation, Alert indicators
Activity Log	Chronological record of all patient interactions and system events	Timeline view, Activity filtering, User attribution, Export capability
Allergies	Manage patient allergy records including reactions and severity	Allergy list, Reaction recording, Severity tracking, Drug interaction alerts
Assessments	Patient clinical assessments with scoring and history	Assessment forms, Score calculation, History comparison, Care plan linkage
Billing Compliance	Patient billing compliance status and financial responsibility tracking	Billing status, Financial history, Compliance flags, Collection tracking
Care Notes	Clinical and care management notes with structured documentation	Note entry, Template support, Note search, Provider attribution
Care Plan	Patient-specific care plan with goals, interventions, and progress tracking	Goal setting, Intervention tracking, Progress monitoring, Team coordination
Care Team	Manage the patient's assigned care team members and roles	Team roster, Role assignment, Contact info, Communication log
Conditions	Active and historical condition list with ICD-10 coding	Condition list, ICD-10 coding, Status tracking, Onset dates
Demographics	Patient demographic information management	Personal info, Contact details, Language preferences, Address management
Medical Devices	Track patient medical devices and implants	Device registry, UDI tracking, Recall alerts, Maintenance schedule
Diagnoses	Diagnosis history with coding and clinical context	Diagnosis list, Code management, Provider attribution, Supporting evidence
Emergency Contacts	Manage patient emergency contact information and advance directives	Contact management, Relationship tracking, Priority ordering, Advance directives
Immunizations	Immunization history and due date tracking with registry integration	Immunization record, Due dates, Registry sync, Forecasting
Insurance	Patient insurance coverage history and current plan details	Coverage display, Plan details, History tracking, COB information
Medications	Patient medication list linked from medication management module	Active medications, History view, Adherence indicators, Interaction alerts
Memos	Patient-level administrative memos and notes	Memo creation, Category tagging, Priority flags, Follow-up tracking
Monthly Review	Structured monthly patient review for care management programs	Review checklist, Metric tracking, Action items, Review history
Screenings	Patient preventive screening tracking and results	Screening schedule, Results recording, Gap identification, Compliance reporting
SMS Communication	Patient SMS messaging for outreach and appointment reminders	Message sending, Template selection, Delivery tracking, Opt-out management
Vital Signs	Patient vital sign recording and trending	Vital entry, Trend charts, Alert thresholds, Device integration

API Integrations

FHIR Patient Access API
FHIR Clinical Data APIs (Condition, Observation, etc.)
Patient search API
Activity log API
Secure messaging API

Referenced Resources

HL7 FHIR US Core Profiles
USCDI Data Standards
HIPAA Privacy Rule
ONC Interoperability Standards

Expected Results

Complete, accurate patient records enabling coordinated care, informed clinical decisions, and regulatory compliance.