CQM - Few clarifications

OpenEMR Development
21

kchapple wrote on Monday, July 11, 2011:

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

Numerator 1 for NFQ runs off of these ICD9 codes:

Weight Assessment and Counseling for Children and Adolescents	
BMI percentile
V85.5, V85.51, V85.52, V85.53, V85.54

At this point, there is no way to enter these codes into the system. 

I’d suggest adding a lists type for “physical_exam,” and when a BMI is entered, a lists item is created with the appropriate ICD9 code.  This will require someone who understands the codes in order to insert the correct value.

If Brady or anyone else has a better option, please speak up.  Perhaps the codes are not important, and we can test the Numerator 1 based on the existence of a BMI in the patient’s file.

The relevant code is in this file if anyone wants to take a look:

openemr/library/classes/ClinicalTypes/PhysicalExam.php

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

22

kchapple wrote on Monday, July 11, 2011:

5. For NQF 0038, Numerator 9 - rotavirus vaccine, Numerator is not getting counted.

I was able to generate a valid report for this CQM. 

Childhood immunization Status (CQM) ( NQF:0038 ), Numerator 9 	3	1	0	1	100%

This is a tricky report because it has many parameters:

1 - Create a patient between 1 and 2 years old of the report date (Initial Patient Population.)
2 - Create 1 office visit for that patient within the measurement period (Denominator.)
3 - Create 4 instances of Rotovirus immunization (Numerator.)  These must be more than 42 days and less than two years of the patient’s birth-date.

Let us know if you continue to have trouble, and I’ll try to provide more details.

I will continue to look into the rest of the complaints about the immunization report.

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

23

kchapple wrote on Monday, July 11, 2011:

2011-07-11 06:25:57 PDT
“4. For NQF 0024, in all the population criteria, Numerator 1 - even though BMI is recorded, the numerator count is not getting increased.” Numerator 1 for NFQ runs off of these ICD9 codes: Weight Assessment and Counseling for Children and Adolescents BMI percentile V85.5, V85.51, V85.52, V85.53, V85.54 At this point, there is no way to enter these codes into the system.

I have a work-around for report NFQ 0024.  For Numerator 1, we check for any BMI finding.  Tony informed me that there are 5 BMI classifications, and I think that the report is only interested in the fact that your BMI percentile was found, not which class you’re in. 

For the other 2 numerators, I check for any encounter, and assume that there was the communication necessary for the report: “counseling for nutrition” or “counseling for physical activity,” because I am not sure how to check in the DB.

46f0dd4 NFQ 0024 fixes check for any BMI finding, also any  encounter, assume communication to patient

These last fixes should allow the continuation of testing.

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

24

bradymiller wrote on Tuesday, July 12, 2011:

Hi,

Just checked in Ken’s (NQF0024 fix) into sourceforge.

For the counseling for nutrition/physical activity stuff, recommend mimicking what I did in CQM rule NQF:0028b (utilizing the custom table rule_patient_data).

-brady

25

kchapple wrote on Tuesday, July 12, 2011:

Hi Brady,

I found the patient_data.php file, and the UI in “Clinical Reminders,” and I’ll attempt to add the counseling communications.  It’s not exactly clear to me at this point how to add the necessary code since I’m not sure if those clinical types are built into the rules engine. 

If you have any pointers while I’m investigating, I’d appreciate it.

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

26

bradymiller wrote on Wednesday, July 13, 2011:

Ken,
What item(s) do you need to check on (for the other 2 numerators)? (I’d usually read through the cqm rules stuff to figure this out, but have limited time right now).
-brady

27

visolveemr wrote on Wednesday, July 13, 2011:

Hi Ken,

We tested your fixes. We would like to get clarified on few more items.

1. NQF 0041  Preventice care & screening: The numerator should get counted only if the influenza vaccine is administered in flu season (september thru february). But the numerator is getting counted even when I record influenza vaccine administration in july.

2. NQF 0038  Childhood immunization status: Numerator 12 calculation, it is combination of numerator 1 to 7. If we enter all vaccines( as per numerator 1 to 7) for a particular patient, numerator 12 is not getting calculated. Numerator 9 (rotovirus) is getting counted correctly.

3. NQF  0059, NQF 0064 we tried manual entry of lab results. But numerator didn’t get counted. Could you please give us exact steps so that we can test it accordingly.

4. NQF 0024 Numerator 2 and numerator 3 are getting counted if we create a visit for patients of corresponding. No other action item needed? Did we miss something here.

Thanks,
ViCarePlus Team

28

kchapple wrote on Wednesday, July 13, 2011:

Brady,

What item(s) do you need to check on (for the other 2 numerators)?

For NFQ 0024 Numerator 2 and Numerator 3:

    const COUNS_NUTRITION = 'comm_couns_nutrition'; // Communication to patient: counseling for nutrition
    const COUNS_PHYS_ACTIVITY = 'comm_couns_phys_activity'; // Communication to patient: counseling for physical activity

Currently, in the file “openemr/library/classes/ClinicalTypes/Communication.php” I am just checking for any encounter.  But the encounters should technically be a documented communication of the above two items.  It could be fine as is.  Just want to make sure.

Thanks,
Ken

   

29

kchapple wrote on Wednesday, July 13, 2011:

Hi Visolve,

1. NQF 0041  Preventice care & screening: The numerator should get counted only
if the influenza vaccine is administered in flu season (september thru february).
But the numerator is getting counted even when I record influenza vaccine
administration in july.

61bccfa fixed NFQ 0041 flu season date range

2. NQF 0038  Childhood immunization status: Numerator 12 calculation, it is
combination of numerator 1 to 7. If we enter all vaccines( as per numerator
1 to 7) for a particular patient, numerator 12 is not getting calculated. Numerator
9 (rotovirus) is getting counted correctly.

1503505 fixed NFQ 0038 numerator 12 not getting incremented

3. NQF  0059, NQF 0064 we tried manual entry of lab results. But numerator didn’t
get counted. Could you please give us exact steps so that we can test it
accordingly.

It is difficult to add procedure results with openEMR.  I’ve tried to document the steps, but if you continue to have trouble, perhaps Tony or Brady could offer advice. Also, at least on my system, I don’t have the correct CPT codes, so I extended the query to check for “procedure code” in addition to “standard code.”

Steps to add procedure:

Browse to “Procedure->configuration”
Click “Add Top Level”
Enter the title and description of HB1AC Test with procedure code 83036 (standard CPT code entry didn’t work on my system.)
Under “Patient/Client,” click “Procedure Order”
When you click on “Order Type” a box should pop up where you can select the procedure you previously created.
Change the status to “Routed”
Now go back to “Procedures” and click on “Pending Review.”  Make sure your user has the permission to sign results.  You can go to “Administration->Users” and make sure you have “Physician” privileges.
There should be one row for the procedure order you. Fill in values for each column, click on the “?” to bring up date pop up. 
Click “Sign Results”
Then, go to “Procedures->Patient Results” and you should see your test results listed.

Here is the commit with the enhancement to the query:

9396ce2 Fix for NFQ 0059 added check for procedure code in addition to standard code in lab result

More later….

Thanks,
Ken www.mi-squared.com

30

bradymiller wrote on Wednesday, July 13, 2011:

hi,
Just committed Ken’s fixes to sourceforge. Ken, I’ll look through and see which custom entries to use from the CDR (or if should create more) and ensure they pop up when needed in the clinical reminders widget.
-brady

31

bradymiller wrote on Wednesday, July 13, 2011:

Ken,
To clarify, above message is regarding NFQ 0024.
-brady

32

kchapple wrote on Wednesday, July 13, 2011:

4. NQF 0024 Numerator 2 and numerator 3 are getting counted if we create a visit
for patients of corresponding. No other action item needed? Did we miss something
here.

This is what Brady and I are currently working on.  At this point we are just checking for any encounter, which is what you’re seeing.  We will change it to be specific to the appropriate types.

Thanks,
Ken

33

visolveemr wrote on Friday, July 15, 2011:

Hi Ken,

Childhood immunization status Numerator 12 and Preventive care & screening are getting calculated correctly. However, we follow the steps you stated for NQF 0059 and NQF 0064. But the numerator is not getting calculated. It remains zero. We have added CPT code 83036 (HbA1c) ,80061(LDL) in procedures and entered the result too.

Thanks,
Sathya

34

kchapple wrote on Friday, July 15, 2011:

Syathya,

I’m not sure if you have direct access to the database, but is it possible to verify, and post the data dump from the `procedure_order`, `procedure_type`,  `procedure_result` and `procedure_report` tables?  When I do an export of the table data, it looks like this:

INSERT INTO `procedure_order` VALUES(1, 1, 1, 1, 4, '2011-07-13 07:36:00', '2011-07-13', 'high', 'routed', '', 1, 0);





INSERT INTO `procedure_type` VALUES(1, 0, 'HB1AC TEST', 0, '83036', 'ord', 'arm', '', '', '', 'HB1AC TEST', '', '', '', '', 0);





INSERT INTO `procedure_result` VALUES(1, 1, 1, '2011-07-13 08:45:19', 'Lab 1', '', '10', '10', 'high', 'Test', 0, 'final');




INSERT INTO `procedure_report` VALUES(1, 1, '2011-07-13 08:22:00', '2011-07-13', 0, '1', 'final', 'reviewed');

Thanks,
Ken

35

visolveemr wrote on Friday, July 15, 2011:

Hi Ken,

Here is the data dump from four tables. One difference we have noticed it, the date field of procedure_result table is getting recorded as NULL. We are not sure why the date field is not getting recorded.

INSERT INTO `procedure_order` VALUES
(1,2,1,4,7,‘2011-07-15 16:53:00’,‘2011-07-15’,‘high’,‘routed’,‘Fasting not necessary’,1,0),
(2,2,3,2,9,‘2011-07-15 16:59:00’,‘2011-07-15’,‘high’,‘routed’,‘’,1,0),
(3,4,3,2,9,‘2011-07-15 17:23:00’,‘2011-07-15’,‘normal’,‘routed’,‘’,1,0),
(4,4,3,1,2,‘2011-07-15 18:26:00’,‘2011-07-15’,‘high’,‘pending’,‘test’,1,0);

INSERT INTO `procedure_type` VALUES
(1,0,‘diabetes tests’,0,‘’,‘grp’,‘’,‘’,‘’,‘’,‘’,‘’,‘’,‘’,‘’,0),
(2,1,‘HbA1c’,2,‘83036’,‘ord’,‘arm’,‘blood’,‘inj’,‘left’,‘’,‘CPT4:83036’,‘’,‘’,‘’,0),
(3,2,‘HbA1c’,0,‘’,‘res’,‘’,‘’,‘’,‘’,‘’,‘’,‘’,‘percent’,‘6-8.5’,0),
(4,1,‘LDL’,2,‘80061’,‘ord’,‘arm’,‘blood’,‘inj’,‘left’,‘’,‘CPT4:80061’,‘’,‘’,‘’,0),
(5,4,‘LDL’,0,‘’,‘res’,‘’,‘’,‘’,‘’,‘’,‘’,‘’,‘mg_dl’,‘101-120’,0);

INSERT INTO `procedure_report` VALUES
(1,1,‘2011-07-15 16:56:00’,‘2011-07-15’,0,‘blood’,‘review’,‘reviewed’),
(2,2,‘2011-07-15 17:00:00’,‘2011-07-15’,0,‘blood’,‘final’,‘reviewed’),
(3,3,‘2011-07-15 17:24:00’,‘2011-07-15’,0,‘blood’,‘final’,‘reviewed’),
(4,4,‘2011-07-15 18:27:00’,‘2011-07-15’,0,‘blood’,‘final’,‘reviewed’);

INSERT INTO `procedure_result` VALUES
(1,1,3,NULL,‘’,‘’,‘9.5’,‘6-8.5’,‘high’,‘’,0,‘final’),
(2,2,3,NULL,‘’,‘’,‘10’,‘6-8.5’,‘high’,‘’,0,‘final’),
(3,3,5,NULL,‘’,‘’,‘98’,‘101-120’,‘low’,‘’,0,‘final’),
(4,4,5,NULL,‘’,‘’,‘99’,‘101-120’,‘yes’,‘’,0,‘final’);

Thanks,
ViCarePlus Team

36

bradymiller wrote on Saturday, July 16, 2011:

Visolve and Ken,

Just committed fix for NQF 0024 (Numerator 2 and numerator 3). Numerator 2 is now linked to Education: Nutrition link in the Clinical Reminders widget and numerator 3 is now linked to Education: Exercise link in the Clinical Reminders widget. So, if you record ‘YES’ for Completed entries in the applicable links then will fulfill the pertinent numerator. (note the new commit includes database changes/upgrades)

-Brady

37

kchapple wrote on Monday, July 18, 2011:

Visolve,

That’s the problem since the query looks at the procedure result date.  Thanks for investigating.  I’ll look into the procedure code to see why the date might be getting recorded as NULL.  If Brady has time, maybe he could think back to remember if that was by design, or if it’s a defect. Sounds like a defect, in which case we should fix the procedure module rather than the CQM query.

Ken

38

kchapple wrote on Monday, July 18, 2011:

Re: Procedure

I notice that Brady uses the procedure_report column date_collected in the AMC reports.  I will change the query in the CQM to use that instead because it appears to be working correctly.

Ken

39

kchapple wrote on Monday, July 18, 2011:

Re: Procedures

Here is the commit, seems to work.  Let me know if there are still problems.

5ff68b7 changed lab result type to check procedure report date instead of procedure result date, also added 4 to CPT codes

Ken

40

bradymiller wrote on Monday, July 18, 2011:

Hi,
Just committed Ken’s fix to sourceforge. I remember noting that issue with the procedure_result.date entry also, which is why I also used the procedure_report.date_collected instead.

Rod,
Is there a reason the procedure algorithms are not filling in the procedure_result.date sql entries(ie. are we missing a step)?

-brady