Clinical reminders and rules

Day-to-Day Users
#1

Unless I am not using it correctly (or this is the way it’s supposed to be), it appears that there are a few problems with Clinical Reminders and Clinical rules. I am trying to fix it, but clinical_rules.php is pretty complicated to decipher, so I need some help.

  1. Clinical Reminders is searching for any entry in the database for the specified target, not just the latest one. For example, for the tobacco intervention reminder, if a patient is a former smoker, who recently quit, the reminder will keep coming up, even though the patient has already quit. Similarly, I have a reminder for BMI counseling if BMI under Vitals is high. However, once it’s high, even if goes down later (or if someone entered the values incorrectly and I later correct the values), the reminder doesn’t go away. How can I fix this behavior to only pull in the latest data?
  2. It looks like the influenza vaccine measure is not set up correctly. The reminder is only supposed to come up between October 1 and March 31 and the actual vaccine admin date is supposed to be beginning in August of the flu season. Currently, if you put in admin date as August or September, it will still pull influenza vaccine as due.
  3. What exactly is optional vs required when I set up a new clinical rule? Under rule edit, the third selection from the top is “Optional: Yes No”. What exactly does that do? How does it affect the behavior of the rule?
  4. It appears that the only way that multiple clinical targets are set up is with an AND connector. For example, under flu vaccine, there are multiple codes for different flu vaccine, but if all of them are added to the rule under Target/Action Groups → Clinical Targets, it looks like it will continue to come up as due even if one of the codes has been entered as administered. Is there a way to combine different clinical targets with different connectors (AND and OR). Maybe if they are listed under the same Clinical Target tab, they are treated as AND, and if they are listed under separate Clinical Target tabs (there is a second one below), they are treated as OR. Maybe that’s the way it is now, but it’s not clear from any description that I’ve seen.

Thanks,
Alex.

#2

Hi @cerber98
Clinical Reminders is an incredibly complex module full of counterintuitive requirements to make it work properly. However, as far as I can tell it does function as designed, if you hold your tongue just right when you click the button. Not that I know how to make it work, just that from the few questions I’ve asked about it over the years, it has always come up working.

@brady.miller has said the module is up for a simplification redesign/ rewrite but that was a while ago and I don’t know what the status is on that project.

Have you searched for other posts on the subject?
https://community.open-emr.org/search?q=clinical%20reminders

Good luck- Harley

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