zhhealthcare wrote on Friday, October 28, 2011:
I dont think anybody is claiming certification. If you need to be certified you have to use the same software combination as was certified.
For those who do not want that but just wants to use the EMR this is a good choice, albeit a clunky one.
Shameem
woesau wrote on Friday, October 28, 2011:
Obviously, you still don’t get it.
Any change made to a certified feature needs to be reviewed by the certification body to see if re-certification is required.
A fool is someone who thinks he knows but he really doesn’t know.
bradymiller wrote on Friday, October 28, 2011:
What certified feature has been changed?
cverk wrote on Friday, October 28, 2011:
I started using allscripts about 6 months before openemr became certified, mostly to try and practice better medicine for my patients with complex medication historys. I put a lot of work into building up my patient database there, so going to a different system seemed like starting over. As I go back from allscripts and reenter prescriptions, I am updating medication lists and performing computerized physician order entering. Once I am there looking at medication lists, I am trying to udate problem and allergy lists as well. Allscripts was listed as modular certified for the eprescribing and there didn’t seem to be a problem adding it to my list with openemr for registration. I am trying to add constructive input, not break something. My practice is less than 5% medicare and no medicaid, so frankly this isn’t about incentive money for me. I am just trying not to become obsolete. I also find it intellectually stimulating and if I can help others improve their care out there, all the better. I am still hand writing some prescriptions for simple stuff, but I hope to make the 40% threshold.
yehster wrote on Friday, October 28, 2011:
As it is now, if cverk were to try to attest to meaningful use if he were to use the automated measure calculation feature that currently exists in OpenEMR, it’s going to report zero for the numerator for number of ePrescriptions. No way around that currently. However, in reality, the actual metric won’t be zero as he is/has been using Allscripts.
So what is he supposed to do and what is he allowed to put in the boxes for numerator and denominator for ePrescribing in this scenario when he goes to attest? I’m not sure of the answer. But I’m trying to figure it out.
What Automated Measure Calculation reports and reality being different is a situation that isn’t unique,
http://www.fierceemr.com/story/accuracy-meaningful-use-reports-ge-systems-question/2011-10-27
Big EMR systems have been having this problem too.
Brady, can you give a quick description of how AMC generates a numerator and denominator for ePrescriptions? Specifically, what rows does it count?
Do we need a certification body review for other people’s work:
https://github.com/openemr/openemr/commit/8695bf5c729457ed88d70fb52f9f8757dee48d85
As there have been changes to ePrescribing already.
When zhservices pushes these changes out to their customers does it break certification? I’m pretty sure it doesn’t, but I could be wrong.
bradymiller wrote on Friday, October 28, 2011:
Hi,
Quick overview of what is measured in the AMC rules is here:
http://www.open-emr.org/wiki/index.php/Description_AMC#AMC_Measures
(see number 10 for the eprescribe calculation)
For this tracking mechanism of the pertinent AMC rules, see here:
http://www.open-emr.org/wiki/index.php/Description_AMC#AMC_Measures_Tracking_Mechanisms
(see number 4 for the eprescibe one)
These rules (and the CQM also) are written within an OO framework. Here are the eprescribing calculation pertinent files:
http://github.com/openemr/openemr/blob/master/library/classes/rulesets/Amc/reports/AMC_304b.php
http://github.com/openemr/openemr/blob/master/library/classes/rulesets/Amc/reports/AMC_304b/Denominator.php
http://github.com/openemr/openemr/blob/master/library/classes/rulesets/Amc/reports/AMC_304b/Numerator.php
(the above files are very short and self-descriptive, so rec looking at them to understand the calculation)
The amcCollect() method can be found here:
http://github.com/openemr/openemr/blob/master/library/amc.php
(nice quick description of the pertinent functions and sql table that is utilized)
So, it basically counts all prescriptions in the denominator, and then counts only the prescriptions that have been tagged in the amc_misc_data table (this is set by an ajax call on the toggle in the create/edit prescription screen). Note the NewCrop module also sets this when it brings back/creates prescriptions.
My opinion is that the best way to integrate the Allscripts to ensure MU is to have some method to pull the data back into OpenEMR.
Another option is to allow manual entry of the AMC report values (note, to get certification, I think it’s only required to have a method to calculate them either manually or automatically).
Also, I’ve added this Allscript integration subject as an ISSUE#3 at the bottom of the following wiki page:
http://www.open-emr.org/wiki/index.php/Description_AMC#Potential_Issues
-brady
yehster wrote on Friday, October 28, 2011:
I am wrong about cverk’s system reporting 0 for his numerator, as it seems that if you enter the prescription manually in OpenEMR and flag it on the prescription screen as an ePrescription, that makes it count towards the numerator. I’m not sure how you correctly count handwritten scripts in the denominator against yourself though.
I guess we can get achieve a correct ACM for ePrescribing if the prescriptions and amc_misc_data tables are populated appropriately.
It seems that pulling data back from Allscripts through some sort of process (either interactive or batch) would go a long way towards improving patient care by increasing provider efficiency.
bradymiller wrote on Friday, October 28, 2011:
Hi,
To count manually written scripts, would likely require doing something akin to the labs calculation. Note at the top of the AMC Report, there is a entry for Number labs:__ . This basically gets added to the denominator of the of:
Incorporate clinical lab-test results into certified EHR technology as structured data. ( AMC:170.302(h) ).
To begin thinking about the process to bringing the data back to OpenEMR, could look at this code:
http://github.com/mdsupport/openemr/commit/5cfe09b97d27d953827b8f5fa77439927420c121
which is discussed here:
http://sourceforge.net/projects/openemr/forums/forum/202506/topic/4503616
-brady
cverk wrote on Saturday, October 29, 2011:
I couldn’t really find instructions on it, but I have been clicking the e-prescription button when I entered a prescription I sent electronically.I figured I would have to count them manually. Obviously, somebody out there doesn’t understand how someone could be motivated by altruistic principal, or they have too much skin in the e-prescribing newcrop thing. It’s not the first time I have been misinterpreted by people who only look at money as motivation, but you don’t work as a solo primary care doc because you think you are going to get rich. But I judge from a distance that Brady understands.
zhhealthcare wrote on Saturday, October 29, 2011:
Hi, The newcrop thing is developed by ZH Healthcare and MI2, and let me assure you that I have no idea who this guy is who wants to be more catholic than the pope. On our part (and I believe Tony will be in agreement with me) we are for as many choices as can be.
The other thing I wanted to note: even if you were using allscripts all these while, when you switch over to newcrop, it will download all the previous eRxs into your OpenEMR for each of your patients. So you dont have to reenter anything.
Regards
Shameem
tmccormi wrote on Saturday, October 29, 2011:
What odd conversation. Any user can certify with any combination of certified modules, including choosing Allscripts instead of NewCrop. The caveat here is that you might need to produce the AMC reports by hand instead of automatically or use the reports provided by the certified module chosen.
PS: MI2 and ZHH and GoldenLeaf investors (ZMG, LLC) developed the NewCrop connector. It was not contributed by OEMR, but by a joint venture of vendors. At the same time Phyaura created a certified version of OpenEMR using RelayHeath eRX and Ensoftek created a certified version using DrFirst for eRX.
Lots of choices. That’s the way I like it.
Tony
www.mi-squared.com / @tonymi2
oemr.org / @OEMR_org
bradymiller wrote on Saturday, October 29, 2011:
Hi cverk,
Some of the AMC calculations required some controls/tracking features to be built in. For example, the e-prescription toggle is one. To get more details which calculations have these control/tracking features, check out the following wiki page:
http://www.open-emr.org/wiki/index.php/Description_AMC#AMC_Measures_Tracking_Mechanisms
(for example, number 4 in this list describes the e-prescription toggle)
-brady
bradymiller wrote on Saturday, October 29, 2011:
Hi,
I’m gonna go out on a short limb here and state that the Phyaura and Ensoftek are really not options for OpenEMR users unless they contribute/integrate their code with the OpenEMR codebase.
-brady
bradymiller wrote on Saturday, October 29, 2011:
to clarify above, meant to say:
the Phyaura and Ensoftek e-prescribing solutions
cverk wrote on Saturday, October 29, 2011:
Now there is useful information from Shameem in the proper spirit. I did not know that you could transfer between e-prescription options without starting over with your patient and prescription database. Do the vendors think they will be interested in producing some form of standardized and reasonably secured HIPAA compliant data tunnel from local instances of openemr to a variety of offsite services such as patient portals, eprescribing, lab interface, etc.
zhhealthcare wrote on Saturday, October 29, 2011:
The eRx system, even in Allscripts, allows you to see all of the patient’s prescription history even if it was not written by you. So the advantage of using the newcrop eRx is a) it is fully integrated with OpenEMR with upstream and downstream exchange of data which includes allergies as well. b) you can upload your paper prescriptions to the eRx databases so that there is a complete prescription history for other practitioners to see.
So in essence even if you have all your eRx’s done through Allscripts you lose no data when you switch over to ZMG/Newcrop or any other eRxsystem. All of them is only a gateway to connect to surescripts which is mother of eRx. Of course all these gateways are at a charge: So is allscripts if you want them to integrate with your EMR. The free version of Allscripts only allows you the standalone feature where you enter the demographics of each new patient.
Presently the ZH Healthcare’s FREE (:)) patient portal is built in the same system as the eRx applications, using webservices and SOAP protocols which encrypts and transfers data. The drawback here is that there needs to be a static ip for the OpenEMR instance. We are trying to find a method whereby this static IP requirement can be avoided: please see discussion at https://sourceforge.net/projects/openemr/forums/forum/202505/topic/4769926
Hope this helps
Shameem
cverk wrote on Saturday, October 29, 2011:
Obviously that helps, because I was the one who started that discussion thread. I think I am representative of the audience you wish to reach. I am a doctor in a small US practice, more comfortable with windows than linux and more comfortable in my ability to run and secure my office server system than I am opening my office data to the internet. A simple plug and play windows system for openemr with a built in secured (at least to HIPAA) access to a menu of offsite services from all the various vendors should be a runaway hit. It seems an xampp system that came ready for production use with a built in vpn/ssh tunnel would be an easy startup and provide a lot of potential customers. As this goes along it seems the offsite service possibilities would expand as new uses are thought of. I believe the tunnel access should be applicable to all registered vendors to allow them to compete on service and price in some straight forward sense perhaps through the nonprofit organization.
nursejeff wrote on Monday, December 05, 2011:
I am having problem with the below link. When I click on the “Install” button it pulls up the script but it does not ask me to install the greasemonkey add-on. Anybody got any ideas, what I am doing wrong?
----- http://userscripts.org/scripts/show/116438
Updated version of the script. DOB should load correctly on AddPatient screen. Link from OpenEMR should work better as well. -----
Thanks again,
Jeff Guillory
NP Health Clinic
yehster wrote on Monday, December 05, 2011:
Greasemonkey is a seperate install.
https://addons.mozilla.org/en-US/firefox/addon/greasemonkey/
After you have installed greasemonkey in Firefox, try visiting the userscripts link again.
-Kevin Yeh
kevin.y@integralemr.com
nursejeff wrote on Tuesday, December 06, 2011:
I got it installed and it is working but the DOB won’t transfer. Weird.
Jeff