Help needed on adding clinical rules

Day-to-Day Users
1

navier98 wrote on Tuesday, June 12, 2012:

Hi:

Can anyone help me on using the clinical rules?

(1) I was trying to create a clinical rule using “Custom Table” for demographic filter.  Does the “frequency” mean the number of times it should happen in one year?  If yes, then how do we use the “>”, “>=”, “<”, “<=” in the frequency dropdown list?

(2) Is there a way to get a list of patients who are selected by the demographic filter?

(3) Is there a way to get a list of patients with clinical reminders to a certain rule(s)?  I only see the “Patient Reminder” in the Administration tab.

(4) What does “optional” and “required” mean?

(5) What’s a “clinical target” and an “action” in the Target/Action Groups section and how to add to the “Category” and “Item” lists?

Sorry about all the questions.  I spent much time online trying to find more document about using the rules but was not able to find clear instructions.

thank you for your help in advance.
-navier

2

bradymiller wrote on Tuesday, June 12, 2012:

Hi Navier,

1. This is an odd thing to have (a frequency without an interval in the filter)… I’d consider this a bug (should not be asked) and the frequency is really only meant for targets where both an interval period and frequency can be entered in and checked by the CDR engine. Probably best to leave these items blank in the filters.

2. This feature does not exist, but is something that could be added to the Reports->Clinic-> Standard Measures report.

3. To help differentiate, Clinical Reminders are basically real-time generated reminders that are not recorded in the database (used while seeing patient or to create real-time reports). The Patient Reminders are meant to be created (and stored in the database in patient_reminders sql table) in order to send patients reminders via email/phone. In order to get a list of patients with clinical reminders would be the same answer as number 2 above.

4. Required means that the filter item must pass to for the patient to pass “The Rule Filter”, whereas optional means that this is not the case. For example, if filter two diagnosis codes as optional (such as 250.00 and 250.01), then only one needs to exist for the patient to pass the filter. However, if set both the diagnosis codes as required, then both diagnosis codes need to exist for the patient to pass the filter.

5. If a patient passes a filter on a rule (ie. age is > 50), then the rule then checks for a target. If the target does not exist, then the action happens. To add to the Category and Item lists, just simply need to type the new entry in. You can also view and edit these lists at Administration->Lists->‘Clinical Rule Action Item/Category’.

To give some background here, the CDR engine is pretty complicated and the documentation is limited, so very understandable to have questions. I actually find it easier myself to enter the rules into the database manually than using the Rules Editor GUI, but I am definitely a minority in this opinion. There are some instructions here:
http://www.open-emr.org/wiki/index.php/CDR_User_Manual
http://www.open-emr.org/wiki/index.php/CDR_Engine
http://www.open-emr.org/wiki/index.php/Clinical_Decision_Rules

Also, note this annoying bug here when making intervals for targets in the CDR Rule Editor GUI with work around discussed in this thread:
http://sourceforge.net/projects/openemr/forums/forum/202504/topic/5320933

If still having problems, then let us know what you are trying to do with the rule engine and can provide more specifics.

-brady
OpenEMR Project

3

bradymiller wrote on Tuesday, June 12, 2012:

Additionally, check out this wiki section:
http://www.open-emr.org/wiki/index.php/Clinical_Decision_Rules#Notes_and_Issues
(it’s more developer talk, but covers what filters and targets are)

4

navier98 wrote on Wednesday, June 13, 2012:

Hi Brady:

Thanks for all the info!  It’s very helpful.

One more question if you don’t mind:  What’s the “Completed: Yes/No” field is for in the “clinial target”->add->Custom section?

Also, I’ve noticed a possible inconsistency on the “Required” and “Optional” in the demo filter.  For any of the diabetes rules, all the filter criteria have the characteristics of “Required”.  But a patient only needs to satisfy one of the conditions to be selected by the filter which is more like “Optional”.  Is this a bug?

Thank you.
Navier

5

bradymiller wrote on Wednesday, June 13, 2012:

Hi Navier,

You’ll note in the Clinical Reminders widget on the Patient Summary screen, that some of the reminders can be clicked and some can not. If you click on one that can be clicked, a pop up opens giving user ability to enter date and whether it was Completed (this is where the Completed:Yes/No comes into play). If you make a custom action (make the target first if adding new Category/Item) and set this and then set up a equivalent target and set the Custom Input to Yes, then you will now create a clickable item that can be tracked.

Appear to be lost of bugs in the gui rules editor; I have noted so far in the rules admin gui per this thread:
1. Should not be a frequency setting in the Filter settings (Custom Table)
2. Inconsistencies in what is displayed for Required/Optional in the filter diagnosis settings (at least). Although the database settings show it is optional, the gui shows it to be required
3. Inconsistencies in the Custom Input setting in the Targets (although set to be Custom Input yes in the database, it shows no in the editor
4. Unable to add a new Action item/category in the Set Target Custom section.

-brady
OpenEMR

6

bradymiller wrote on Wednesday, June 13, 2012:

clarification:
disregard the (make the target first if adding new Category/Item)
If you are creating a new action category/item, you need to create the Action before setting the Target.

7

bradymiller wrote on Wednesday, June 13, 2012:

Another clarfication on bug 3 above:
3. Inconsistencies in the Custom Input setting in the Actions (although set to be Custom Input yes in the database, it shows no in the editor)

8

Hello
I am pretty new in the clinical rules area - not in openemr implementation. Would appreciate any note clarifying the following case:
I´ve created a rule for a laboratory test result. This lab test - configured in the procedures area, has a result value ranges, so I wanted to create an alert, based on the case that the result value is out of the range given

the steps to create the rule did not give any issue, but nothing is come up in the patient summary page, although I already set the altert on where corresponds.

Thanks in advance

9

hi @anamariaelsal, are you following this guide? http://www.open-emr.org/wiki/index.php/CDR_User_Manual

10

yep. although I`m trying with the 5.1x version of the system. My misunderstanding is how to setup a specific lab test result to give an alert if the result is out of range… it seems not working for me… any other documentation I can check?

Thanks Stephen

11

messed around with the INR rule on this dev demo to show you how to trigger it
https://seven.openemr.io/a/openemr/interface/login/login.php?site=default

main thing is to make sure you are recording a result value for the lab

creating procedure orders and their children (discrete result) can be tricky too so you can look at the simple setup under Procedures tab

12

Thanks!. I was able to create finally. and yes, I updated some fake patient records with lab test and results.

Thanks again!

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