Clinical Decision Support and Emergency Acces

loutran63 wrote on Tuesday, May 24, 2011:

Re this item in MU, I looked at both the interface and code but could not found:
1) Which rule(s) did OpenEMR implement (1 rule at minimum)? or All 16 rules?
2) How your implemented rules met the requirement since all 4 criteria must be met (demographic, problem, medication and lab results).

Based on your latest 4.1 structure, does this mean your structure allow the user/practice to additionally configured the current 16 rules (CQM) for CDR (i.e. to meet all 4 criteria, demographic, problem, medication and lab results)?

Reference:
http://www.openmedsoftware.org/wiki/Clinical_Decision_Rules
http://www.openmedsoftware.org/wiki/CDR_Project_QA/Testing

Perhaps, I interpreted 170.302e requirements incorrectly but your clarification re this implementation is much appreciated.

Also, the way OpenEMR implemented Emergency Access required admin user to change the user access to emergency.  This would fail the requirement in certification testing where no intervention is needed for a user to acquire emergency access (other than configuring that user with this access from the start).  Is there a way to test this correctly in OpenEMR? 

tmccormi wrote on Tuesday, May 24, 2011:

Also, the way OpenEMR implemented Emergency Access required admin user to change the user access to emergency. This would fail the requirement in certification testing where no intervention is needed for a user to acquire emergency access (other than configuring that user with this access from the start). Is there a way to test this correctly in OpenEMR?

We already passed all security certification tests, including that one.  The way is works that that the Admin creates an emergency account and "hides’ it in advance.  The login information is then placed behind a “break glass in emergency” kind of physical location.  In an emergency ANYONE can break the glass, use the info to login.  All access in logged and reported to the configured email address.   After the emergency is over and new account is created.

-Tony

bradymiller wrote on Tuesday, May 24, 2011:

hey,

Here’s documentation on the Clinical Rules Engine:
http://wiki.oemr.org/wiki/CDR_User_Manual

I’d suggest working through above and then you will have a good idea of how this works. There is a difference between the standard rules and the AMC/CQM rules. The standard rulesets are kept in the database and can be modified/added via Administration->Rules. The AMC/CQM were simply way to complicated, so these are instead modified/added via a coding framework (contributed by Ken of MI^2) which are kept at /openemr/library/classes/rulesets; the CQM reports are almost done (just a couple kinks being worked out) and the AMC reports are about one-third complete.

-brady

loutran63 wrote on Monday, May 30, 2011:

Hi Tony.  Thanks for your info.  I’m using 4.0 for a client but how do I configure for the emergency access?  If I have an existing user, say “Tom”, and he has Clinician ACL.  How do I use the same user for Emergency ACL?  What I don’t understand is how user “Tom” can “break the glass” to get Emergency ACL.  Thanks.

loutran63 wrote on Monday, May 30, 2011:

Hi Tony.  Thanks for your info.  I’m using 4.0 for a client but how do I configure for the emergency access?  If I have an existing user, say “Tom”, and he has Clinician ACL.  How do I use the same user for Emergency ACL?  What I don’t understand is how user “Tom” can “break the glass” to get Emergency ACL.  Also, is the Emergency Email setup required?  I understood that it is more for audit.  Finally, please clarify, “After the emergency is over and new account is created.”. 

Thanks.

loutran63 wrote on Monday, May 30, 2011:

Hi Brady, I read through the CDR_User_Manual and I see that the “Action” for each rule is where the “Care Plan” supposed to be set.  The only “Plan” already set is for Diabetes but it lacks information.  Is this where I can customized on what the “Care Plan” should be? 

Thanks,
Lou

bradymiller wrote on Monday, May 30, 2011:

Hi,
The plans can not be yet modified in the Admin GUI (Adminstration->Rules); this feature would be simple to add, but has taken a back seat to other Certification projects. That being said, the plans and rule mapping are very simple(if you have experience with the Administration->Other->Database(ie. phpmyadmin), then you could likely create/modify them). The plans are stored in the ‘clinical_plan’ table (use either dm_plan or prevent_plan as examples to mimick), and the plan-rule mappings are stored in the  ‘clinical_plans_rule’ table(again, use eihter dm_plan or prevent plan to as examples to mimick). Note that the rule_id goes in the mapping table (ie. not the action id).
-brady

tmccormi wrote on Monday, May 30, 2011:

Lou,
  You don’t give specific users emergency access, you set up a separate user account that is hidden.   When ANYONE in the clinic needs emergency access the use that user id/password and the system notifies and logs the use of it.
-Tony

loutran63 wrote on Tuesday, May 31, 2011:

Hi Brady,
Ok, I can see the clinical_plan and others in Database.  I’m still perplexed as to how OEMR implement CDR.  I thought the requirement for this states that the rule must be based on 4 conditions (demographic, problem, medication and lab results) and when a patient meets these conditions then a real-time notifcation is alerted with care suggestion.  When testing this for a client, I found that I only need to enter the encounter with issue for Diabetes, then the rule is triggered.  I did not have to enter any other conditions (i.e. medication, lab results).  Is this the correct interpretation of this rule?

Thanks,
Lou

loutran63 wrote on Tuesday, May 31, 2011:

Tony, thanks a lot for your information.  It’s clear for me now.

bradymiller wrote on Thursday, June 02, 2011:

Hi,
My interpretation of this is that each rule does not need to be based on all 4 conditions. It’s just that rules/mechanism needs to be in place that in sum base on the 4 conditions. For example, the flu shot rule uses age (demographics), the diabetes rule uses diagnosis (problem), and the coumadin rule uses medication and lab result. There is also a Custom Result feature in the CDR that is flexible and could carry any of this type of information.
-brady

loutran63 wrote on Friday, June 03, 2011:

I received confirmation from another source and that your interpretation is correct.  Thanks, Brady.