CQM - Few clarifications

OpenEMR Development
1

drbowen wrote on Tuesday, June 28, 2011:

Hi Brady,

We suppose, you have committed CQM code to github code base  and we took the code from github for testing (Since you didn’t specified any particular github branch).

If so, we would like to get few clarifications or else please let us know the code base for testing

1. What does the plan set field mean? If I choose official CQM measure groups, it just displays 6-7 measures.

2. In case of childhood immunization status, as per rule 9 combination rates should get measured, But I could see 12 combination rates. (I have chosen ‘Ignore’ plan set). In the same way, Weight Assessment and Counseling for Children and Adolescents (CQM) also got listed up many times.

3. When we click on Generate PQRI report, php code is getting displayed.

Thanks,
Sathya Priya

2

drbowen wrote on Tuesday, June 28, 2011:

Hi,

(sorry, Tony, my time is rather limited, so gonna reply real quick to keep the QA moving along)

Yes, you are correct, all the CQM code has been committed to the sourceforge master branch (which gets mirrored to github).

1. Note this groups by PQRI Measure Groups (since only several of the rules actually have PQRI numbers and are categorized, this is why it only several of the rules)(Note that the second PQRI report button also actually organizes the PQRI report by PQRI Measure Group).
2. Ken can better address these questions, since he wrote those rules.
3. That is a bug, it should open a popup that contains a textfield (read only) box with the PQRI formatted code. Nobody has reported this bug. I can’t confirm this, can somebody else confirm this? Lots of times seeing php is a short tag issue, so perhaps allowing short tags will fix it.

thanks,
-brady

3

drbowen wrote on Tuesday, June 28, 2011:

Re: 2:

According to the “Childhood Immunization Status” report specification, there are 12 numerators, which means there should be 12 statistics reported. Similarly, with weight report, there are 3 separate patient populations, with 3 separate numerators, so there should be 9 different statistics reported.  I have attached the specification for the “Childhood Immunization Status”, and “Weight Assessment and Counseling” for reference.

Let me know if you have any further questions.

Thanks,
Ken

4

visolveemr wrote on Wednesday, June 29, 2011:

Hi Ken,

Thanks for the specification document.

We started to test “Adult weight screening and follow up measure” having today’s development tip.

When the vitals (either of BMI status normal, underweight or obesity) are loaded and on clicking ‘submit’ button in quality measures screen, none of the measures are getting displayed other than table titles.

Steps to reproduce:
1. Create a patient of age greater 65 (for numerator a)
2. Check the quality measures screen (Report -> clinic -> Quality measures) and click submit button (to verify for measures listing)
3. Now create a visit and enter vital information for the patient created.
4. Go to quality measures screen and click submit.
5. Notice, only the titles are getting displayed rather than the calculated measures.

Thanks,
ViCarePlus Team

5

kchapple wrote on Wednesday, June 29, 2011:

ViCarePlus,

I just ran through your steps, and I’m unable to produce the bug.  Let me detail what I did:

1. Create a patient of with DOB: 1944-06-29 Age: 67
2. Check the quality measures screen (Report -> clinic -> Quality measures) and click submit button (to verify for measures listing)
3. Now create an office visit, using the default of today’s date and enter a BMI of 25 kg/m^2 (system doesn’t understand subjective terms like “Normal”)
4. Go to quality measures screen and click submit.
5. see results:

Adult Weight Screening and Follow-Up (CQM) ( PQRI:128 NQF:0421 ), Population Criteria 1, Numerator 1 1 1 0 1 100%
Adult Weight Screening and Follow-Up (CQM) ( PQRI:128 NQF:0421 ), Population Criteria 2, Numerator 2 1 0 0 0 0%

For all of the detailed specifications of the reports, please refer to this link on the openemr wiki:
http://www.openmedsoftware.org/wiki/File:EP_MeasureSpecifications.zip

Thanks,
Ken
http://www.mi-squared.com/

6

visolveemr wrote on Thursday, June 30, 2011:

Hi Ken,

We reproduced the same issue in OpenEMR demo site (http://opensourceemr.com:2089/openemr). Steps we have followed are

1. Created a patient (Test, ViSolve)
2. Created a visit. Entered 56 kg weight and 177 cm height and saved the vitals forms. (I dint furnish any other details in vitals screen)
3. In clinical quality measures screen, titles alone getting displayed.

Did we miss anything here? If needed, we can even send you the screenshots.

Thanks,
ViCarePlus Team

7

kchapple wrote on Thursday, June 30, 2011:

Yes, On the demo site, I do see this behavior.

I will inquire about which version is running, and how to access PHP error log.

Thanks,
Ken
http://www.mi-squared.com/

8

kchapple wrote on Thursday, June 30, 2011:

Fixed with this commit:
https://github.com/kchapple/openemr/commit/a03247069df5667bb88158ff10103f768a5b69d7

Thanks,
Ken
http://www.mi-squared.com/

9

bradymiller wrote on Friday, July 01, 2011:

hi,
Just committed Ken’s fix to sourceforge.
-brady

10

visolveemr wrote on Friday, July 01, 2011:

Hi Ken,

Adult weight screening and follow up measure is working properly now.

We would like to get clarified on few measures.

1. For the measures Diabetes Control: Haemoglobin A1C > 9.0% (NQF 0059) and Diabetes control: LDL < 100 mg/dl (NQF 0064), Whether the manually entered lab results are taken into consideration? or how the numerator count are calculated?

2. For diabetes control measures: When we create a visit and enter the issue as ‘Diabetes - 250.12’, in quality measures screen only the titles are displayed.Tested in openemr demo site too.

3. For NQF 0041 - Preventive care and screening, we created the patient of age greater than 50 years and two visits. The denominator get counted. But when we entered the influenza vaacine( CVX:141), numerator doesnot get counted. We tried multiple times. Did we miss something that resists the numerator count?

4. For NQF 0024, in all the population criteria, Numerator 1 - even though BMI is recorded, the numerator count is not getting increased.

5. For NQF 0038, Numerator 9 - rotavirus vaccine, Numerator is not getting counted. I have tried with vaccines of CVX codes 116,122,74. We are not sure of numerator 12 calculation. We entered vaccines for numerator 1-7 for a single patient as given in specification document. Even then, numerator count is not getting increased.

Thanks,
ViCarePlus Team

11

kchapple wrote on Friday, July 01, 2011:

1. For the measures Diabetes Control: Haemoglobin A1C > 9.0% (NQF 0059) and Diabetes control: LDL < 100 mg/dl (NQF 0064), Whether the manually entered lab results are taken into consideration? or how the numerator count are calculated?

These measures run off CPT codes and procedure results.  Here are the CPT codes used:

      

LabResult::HB1AC_TEST => array(
            'CPT' => array( '83036','83037' )
        ),
        LabResult::LDL_TEST => array(
            'CPT' => array( '80061','83700','83701','83704','83721')
        ),

I see that I forgot to add CPT codes for LDL test, so they are added in this commit:

https://github.com/kchapple/openemr/commit/135035dcf175585f48da39b916b1c5df870769d9

2. For diabetes control measures: When we create a visit and enter the issue as ‘Diabetes - 250.12’, in quality measures screen only the titles are displayed.Tested in openemr demo site too.

There was a bug here, and fixed with commit :
https://github.com/kchapple/openemr/commit/0d54535718e24623de2fc56fbbd732e42c4631dd

Make sure you enter the ICD9 code using the pop-up selector.

More later.

Thanks for you help.
Ken
http://www.mi-squared.com/

12

bradymiller wrote on Saturday, July 02, 2011:

Hi,
Just committed Ken’s most recent fixes to sourceforge.
-brady

13

blankev wrote on Saturday, July 02, 2011:

Brady,

once committed, after how much time are these committed files available in new snapshot Unstable Version for VMWare Player to test?

TNX Pimm

14

bradymiller wrote on Tuesday, July 05, 2011:

The Appliance pulls code from the git repository (which is mirrored from sourceforge every 30 minutes). So, if you start up a new appliance (or reset a current appliance to previous snapshot), then will get most recent code on github.
-brady

15

rammohan70 wrote on Tuesday, July 05, 2011:

Visolve,

I have not been able to reproduce issue #3:

“When we click on Generate PQRI report, php code is getting displayed”

What are the sequence of steps ?

Thanks
Ram(Ensoftek)

16

visolveemr wrote on Wednesday, July 06, 2011:

Hi Ram,

The issue arises when php short tags (Short_open_tag) is set to off.

Thanks,
ViCarePlus Team

17

rammohan70 wrote on Wednesday, July 06, 2011:

Hi Visolve,

I fixed this issue(“When we click on Generate PQRI report, php code is getting displayed”) and pushed
out a branch for Brady to take a look and pull the changes in.

Thanks
Ram

18

bradymiller wrote on Thursday, July 07, 2011:

Hi,
Committed Ram’s fix to sourceforge.
-brady

19

kchapple wrote on Friday, July 08, 2011:

3. For NQF 0041 - Preventive care and screening, we created the patient of age greater than 50 years and two visits. The denominator get counted. But when we entered the influenza vaacine( CVX:141), numerator doesnot get counted. We tried multiple times. Did we miss something that resists the numerator count?

There was a bug in the query, fixed in the below commit.  Also, please make sure to add the CVX code under immunizations.  So, you’d have to add two visits, and then add an immunization with the same date as at least one of the visits.

406ded0 fixed NFQ 0041 gt lt error in date part of query

Thanks,
Ken
http://www.mi-squared.com/

20

bradymiller wrote on Friday, July 08, 2011:

hi,
Just committed Ken’s fix to sourceforge.
-brady