CCHIT - Clinical Decision Support

OpenEMR Development
41

anonymous wrote on Sunday, January 10, 2010:

Brady and Rod, thanks for your reviews and comments. I will pass the code comments to the programmers and have them make changes.

Our current practice is to follow existing codes and GUIs in OpenEMR. The programmers are adjusting their coding styles to OpenEMR’s. For example, the comments are usually done at the documentation stage, but they will do so in the future.

Rod, I agree with you on the “unwieldy” comment. Would it be better if we use an editing table just like the one for Messages? We can also change the other sections.

As for Manage Categories, do you have any codes we can use? If we change it to tree view, what about the other sections? Please also provide a GUI example.

42

sunsetsystems wrote on Sunday, January 10, 2010:

For future reference, comments are not documentation.  They are for understanding the code and should be composed by the same person who writes the code and at the same time.

Yes I think your model for the messages GUI is good and something similar could be applied to health plans.

Re health plan categories, the obvious example is document categories.  However I think that’s written in Smarty which we are trying to get away from, and I don’t care much for that GUI anyway.  And of course there’s “tree view” code in the main navigation area.  So I guess you’d have to do something original.  Specifics may depend on how many health plans there might be.  If hundreds or thousands, then some AJAX-y stuff may be in order.

Rod
www.sunsetsystems.com

43

anonymous wrote on Saturday, January 23, 2010:

Hi Pimm,

I have reviewed your schemes and think that the Health Plans can handle almost all of them.

Include scheme:
1. All adults above the age of 60 years - use age rule
2. All pregnant women with pregnancy of at least 12 weeks - will work on this one
3. All persons with astma treatment - use diagnosis rule
4. All persons with some types of heart disease - use diagnosis rule
5. All persons with immune response problems - use diagnosis rule
6. All persons with diabetes, type one and type two - use diagnosis rule
7. All persons having some kind of medication - use NDC rule (US national drug code)

Exclude scheme:

1. Persons with any kind of allergy against one or more components of the vaccination fluids - use allergy rule
2. Pregnant women with less than 12 weeks pregnancy or persons who want to become pregnant - use pregnancy rule
3. Persons with any kind of severe allergic reactions in the past - use medication allergy rule
4. Persons who were vaccinated with the regular flu vaccination, if this vaccination was within a period of three weeks before the intended H1N1 vaccination, but needed to have their vaccination after this three weeks period. - this one is harder to do

You can preview the Health Plans setup in Administration. It’s almost done.
http://www.medbloom.com/
Username: test1
Password: test1

44

sunsetsystems wrote on Monday, January 25, 2010:

Here’s an update to my suggestion re a GUI for health plan categories.  See the code that I just checked in to manage the heirarchy of order types and test results:

interface/orders/types.php
interface/orders/types_ajax.php
interface/orders/types_edit.php

I think this could be a good model for you.

Rod
www.sunsetsystems.com

45

anonymous wrote on Sunday, February 07, 2010:

The work for clinical decision rules and patient reminders has been completed. An exception is the use of allergy as rules, which we will add shortly.

Please use this document to do testing: http://www.medbloom.com/CDRPT-Testing.pdf.

Testing can be done at http://www.medbloom.com/
Username: test1
Password: test1

Please email me at thomaswong.usa@gmail.com if you need Administration access.

46

bradymiller wrote on Saturday, February 13, 2010:

hey,
Here’ review of your code from here:
https://sourceforge.net/tracker/?func=detail&aid=2947585&group_id=60081&atid=1245239

-create fine-grained switches for this stuff in globals.php (iw. switch to turn on/off reminders, healthplans, and clinical alerts)
-overall lack of commenting
-Health plan categories is awkward. sub-categories does not show up in the health plan admin screen. All the health plan names are the same as the categories (ie. not really doing much)…
-the years to repeat function in health plan admin is confusing (seems redundant since have age filter…)
-for clinical alerts notifications consider placing a link in the tree menu grouped with health plans and clinical alerts also to show alerts (then make the popup optional in globals.php, since the popup going everytime one opens a encounter may drive some users insane)
-Cancer health plan makes absolutely no sense. A patient does not get routine cancer prevention health care (missing gi screening also) after they get a cancer. Each of your targets in this plan need to be focused on different sexes and age groups (again, pointing out the weakness of your targets without intervals or filters; in effect each of your cancer targets will need their own health plan to work correctly…)
-Lots of other medical issues with your plans. Why even take on attempting to create correct standard of care health plans? Can’t Maviq give you the health plans they use rather than attempt to build them??? Then can just convert them to your format. Seems like they would do this, since they’ll be getting lots of potential subscribers via OpenEMR in the future.
-When you add a new user, are they placed in all the appropriate health plans that are supposed to be activated for all patients?
-When I placed patch in my development, I got following mysql error if tried to ‘Activate Plan for All Patients’ and click ‘Update’:
ERROR: query failed: INSERT INTO clinical_alerts SET alert_name = ‘Smoking Cessation’, color =‘Black’, plan_id =‘12’, message =‘The patient is a candidate for “Smoking Cessation” health plan. Please consider asking him/her to enroll in the plan.’,past_due_message =‘One or more actions from Smoking Cessation Health Plan is past due. Please check the status with the patient.’
Error: Unknown column ‘past_due_message’ in ‘field list’

individual file reviews below:
interface/batchcom/batch_reminders.php:
-Aren’t the following already covered in classes library/classes/postmaster.php (settings in globals.php):
   mail->isMail();
   mail->Host = “localhost”;
   mail->Mailer = “mail”;
—If so, use the email mechanism you actually created (settings in globals.php), and test to ensure it works.
-Place Maviq’s setting in globals.php
—In the Maviq setting in globals.php, ensure to include a switch to turn it on/off

interface/main/left_nav.php:
-Remove the pseudochanges
-Having the ‘Clinical Alerts’ and ‘Health Plans’ mucks up the ‘Patient/Client’ menu. Place them into an appropriately named folder under ‘Patient/Client’
-Only show links if switched on in globals.php

interface/patient_file/encounter/forms.php:
-Only process if switched on in globals.php

interface/patient_file/health_plans/export.php:
-Seems odd in an open source project to only dump as an excel file. Why not a .csv file?

interface/patient_file/health_plans/health_plans_admin.php:
-Still don’t understand the year to repeat question?

sql/3_2_0-to-3_3_0_upgrade.sql:
-Color list not same as database.sql
-Alert Status list increment seq by 5’s

sql/database.sql
-Color list not same as 3_2_0-to-3_3_0_upgrade.sql
-Alert Status list increment seq by 5’s

-brady

47

anonymous wrote on Saturday, February 13, 2010:

Hi Brady and All,

The health plans are examples only. Please feel free to edit them. Maviq does not have any health plan or example for use.

The categories are good when you have multiple plans under the same category, e.g. a number of cancer plans can be put under the same category. You can also have multiple flu plans. It’s an option for organizing health plans.

The Excel file is a CSV file with pipe as the delimiter. The file extension is decided by PHP not us.

The Years to Repeat is an option for individual patients. Health Plans in Administration allows you to apply the age filters for all patients but you also need an option for a specific patient for some health plans. You don’t want to change the age filters for individual patients.

48

anonymous wrote on Saturday, February 13, 2010:

Also note that there are some changes to the codes since last week. So what you see at Medbloom may not match the codes. We are just about to submit a new patch but will hold it now.

The email codes that you see in batch_reminders are correct. That’s how the class in postmaster.php is used.

Maviq settings have already been moved to globals.php in the new patch.

49

bradymiller wrote on Saturday, February 13, 2010:

Thomas,
Regarding email; then what’s the point of the email settings in globals.php, if you’re gonna them hard code them into your code(ie. you are setting the host and the mail method…)? Another question regarding email, can i swipe the HTML_CHARSET variable and just always make it utf-8 (if not, I will change the name of variable since it can be confused with other more crucial charset stuff that is going on in openemr)?
-brady

50

anonymous wrote on Saturday, February 13, 2010:

I don’t see anything hardcoded in the new patch. Whatever was put there was done for testing.

Please add this line to the top of postmaster.php file. Otherwise, the variables in globals.php cannot be read:

require_once ($include_root . “/globals.php”); 

51

bradymiller wrote on Saturday, February 13, 2010:

Thomas,
Then add that in the next patch. I pointed out what was hard-coded above(below in effect will bypass the settings in globals.php):
mail->isMail();
mail->Host = “localhost”;
mail->Mailer = “mail”;
Please don’t make me explain it, just forward it to your programmer. Also, please test it, since it’s your code.
-brady

52

sunsetsystems wrote on Sunday, February 21, 2010:

I was just trying to test at http://www.medbloom.com/ but can’t find Health Plans under Administration.  Has the test site for this moved?

Rod
www.sunsetsystems.com

53

anonymous wrote on Sunday, February 21, 2010:

Sorry, we are updating the site and will have it ready by Monday.