MU2 Progress

Archived OEMR Non Profit Organization
#181

bradymiller wrote on Monday, December 14, 2015:

REGARDING ISSUE #3 ABOVE:
To get this party started, I just committed a small fix to address ISSUE #3 above. Now, when a user hovers the mouse over an item in the Clinical Reminders widget, it will always show the following:
Rule title, rule developer, rule funding source, and rule release(only shows the information that exists).
After looking through the official testing script, this code should put this small issue to rest. As I discussed above, I could find no where in the official testing script that the items need links to data entry etc.

-brady
OpenEMR

#182

harleytuck wrote on Monday, December 14, 2015:

Re: #3 above: Sorry my reference to ‘data entry’ was confusing. What I was talking about is that as it’s coded now, when you go to record compliance with whatever the Clinical Reminder refers to, you click on the linked text of the CR (MU-CR-0.png). The panel comes up and you enter the specifics of your response to the CR. At the bottom of that panel you can observe the rule title, dev, funding sourse etc (MU-CR-1.png). That’s step 8 in the testing template. But in step 15, per Milton, you also need to be able to view literature justifying the rule- “15. Access diagnostic and therapeutic reference information”. Different sort of references.

Ensoftek left it so that you can click on the CR link and in the popup record your response to the CR and/or view the rule title, dev, funding sourse etc, to fulfill step 8.

OR<, if you put a URL in the rule config (MU-CR-2.png) when the linked CR text is clisked you can have the user view a website giving justification for the rule per step 15 (MU-CR-3.png).

But you can’t do both step 8 and 15 for the same CR.

#183

harleytuck wrote on Monday, December 14, 2015:

‘couple others’ detailed in tony’s note “Notable details on a8:” below.

#184

harleytuck wrote on Monday, December 14, 2015:

RE: issue 2 above: Milton wants an actual popup or some other immediate visual signal to appear when a CDS is activated, e.g., by adding an issue to a pt’s problem list or by activating the rule in the pt’s CR Admin tab.

Tony suggested the CDS be created as an active alert but as far as I can tell that popup only appears when the CR is due, not when it’s created.

In other news, Milton’s response to our request for the published specs requiring the items listed above (specifically #1 fine grained CDS activation permissions; #2 activation notification; #3 step 8 and 15 references) :

“For the CDS information I gave you on the phone last week it is based on the InfoGard and ONC interpretation of the requirement.”

  • HT.
#185

bradymiller wrote on Tuesday, December 15, 2015:

Hi Harley,

i just added code to the codebase that should put this ISSUE #3 to rest. Note that Ensoftek’s use of that link in the target is not a good idea (since you can not predict what rule the target will be associated with). Better to associate the web site link directly with the rule, which is what I did. I also placed a mechanism so all the remindesr work the same on the widget in this regard (there is a tooltip character to right of each reminder that shows the required information when hover over it and can be clicked on if there is a website reference that is set).

Included two screenshotes:
cdr_fix_1.png shows where to enter in the Reference website in the Administration->Rules gui.
cdr-fix-2.png shows where the tooltip character is in the Clinical Reminders widget.

To avoid confusion and the unnecessary placement of useless information, I also removed the information from the custom_rule target screen(the gui where can enter in results for the custom rules) since it can all now be viewed from the widget(this is the gui in your above MU-CR-1.png screenshot).

Let me know if there are issues with this strategy for ISSUE #3.

thanks,
-brady
OpenEMR

#186

bradymiller wrote on Tuesday, December 15, 2015:

Hi Harley,

ok, for ISSUE #2 above:
Milton point 1: When you add an issue to a pt’s problem list it needs to display an active notification that a CDR has been added- having the Clinical Reminder simply appear in the CR widget doesn’t qualify.
Milton point 2: Milton wants an actual popup or some other immediate visual signal to appear when a CDS is activated, e.g., by adding an issue to a pt’s problem list or by activating the rule in the pt’s CR Admin tab.

Some points by myself to get to a solution(especially first point):
1.These rules can be used on all datapoints in OpenEMR and turning a rule on/off is arbitrary. So, really need clarification on these two key issues:
a.Does a popup need to be displayed when a new action shows up(ie. a rule was triggered by an event)?
----Solution on this is moderately complicated and it would actually by a useful option(that would be turned off by most non-MU2 users, though), solution would be to have a new table clinical_rules_log(columns for id, datetime, user, pid, type(clinical_reminder_widget), targets) that simply stored all active targets in json(with target ids and associated rule ids) whenever the patient summary screen loads up(and if there’s a new target which can be seen by comparing current targets to previous targets, then throw a popup); a global would control this feature(will always record the targets, but the global would control whether to throw the popup).
b.Or does a popup need to be displayed when a rule is turned on/off?
----Solution on this is simple, but it would be nonsensical. This is because the turning on/off of the rules means nothing; it only means something if the rule gets activated/triggered.

2.Also important to keep usability in mind, since popups are well known to drive physicians mad, so we need to ensure we fix the right things.

-brady
OpenEMR

#187

bradymiller wrote on Tuesday, December 15, 2015:

Hi,

I am pretty much only focusing on CDR stuff now.
Does anybody want to pick up the remaining AMC items(there are 4 left; and Z&H is working on 1 of them)?
For details on these items, see comments at the bottom of this commit:

thanks,
-brady
OpenEMR

#188

harleytuck wrote on Tuesday, December 15, 2015:

Hi Brady-
I’m trying to re-create the moment in the testing and so maybe divine what Milton was saying is needed.
I logged in as a user who is able to activate a CDS rule. I opened a patient’s record, clicked on the CR ‘edit’ button and added diabetes as a medical problem. Went back to the pt summary screen and said, “there, in the CR widget the CDS rules for diabetes have been activated”. He said, “It needs to tell you when it’s activated. Like a popup or something. Just adding a new CR to the list doesn’t qualify”.

Your a) point above: Milton and I didn’t address needing a popup when an action is triggered; seems like the existing choice between active and passive reminders takes care of that.

so, b), I got the impression that he was concerned with knowing when a new rule was added to a pt’s list of CRs, rather than when a new one had been created for general use. And by extension seems reasonable to announce when it’s turned off for that pt.

Seems reasonable that it could pop up on user’s return to the pt summary screen, after the CR had been activated elsewhere (e.g., in Issues or edit CR/ Admin tab): “Rule [rule name] has been activated for [pt name]”, or something.

As far as popup fatigue, these would only happen to confirm an action the user just took so I don’t see them as having much startle -> fatigue potential. Unless they’re bright orange and real loud… message in all caps…

On the general topic of testing, I have another session tomorrow 16 Dec 10a Pac time. We’re supposedly going to re-do the labs and the CDS. I believe I have the labs ready to go but these CDS seem to need some work yet. Especially the part about importing the CCD-A with values that trigger the CDS. You said that was ZH’s project and the code is already included but I haven’t been able to call anybody there to learn how to do it so I guess will need to resched the CDS.

Another thing is that Tony set up https://openemr.mi-squared.com/mu2/openemr/ which I’ve been testing on. Any new code would have to be moved over there and Tony’s off the grid all of today, Tue. Unless I can switch back and forth between servers in the middle of testing? (joke)

  • HT
#189

bradymiller wrote on Wednesday, December 16, 2015:

Hi Harley,

Regarding ISSUE #2, your first paragraph clarifies to me what Milton is looking for. I am working on this issue now (hopefully done by tomorrow).

Agree with bumping CDR testing until get ISSUE #2 and ISSUE #1 completed (I plan to do #1 after I complete #2). Regarding the CCD-A part, need to just import a CCD-A through ZH’s Care Coordination module (via the method that has already been certified). When the CCD-A is imported, it gets placed into OpenEMR’s database and the clinical rules will work on them like any other data.

Is there a way to start marching through the AMC rules over multiple testing sessions or does it all need to be done in 1 session(then could keep scheduling sessions and do the AMC stuff if there is nothing else to test). Note for AMC, the only items not completed yet are 7, 8, 14 and 20.

Can also go through cqm if still awaiting other items, which in theory should be ready. Agree that you need your testing codebase to contain the most up to date codebase.

-brady
OpenEMR

#190

bradymiller wrote on Wednesday, December 16, 2015:

Hi Harley,

I just committed the solution to ISSUE #2 to the codebase. Whenever a user opens up the patient summary screen (or it gets refreshed), a popup will show any new reminders. For example, if enter diabetes for medical problem, and then go back to the patient summary screen, then see the below screenshot.

So, only left to do is ISSUE #1, which hopefully get done in next couple days :slight_smile:

-brady
OpenEMR

#191

harleytuck wrote on Wednesday, December 16, 2015:

Hi Brady-
That panel looks good to me, will ask Milton if it meets his needs. Also will ask him if we can test AMCs piecemeal, though I do remember him saying the AMC session would take something like 6 hrs… bleah.
Thanks much- more in a bit- HT

#192

harleytuck wrote on Thursday, December 17, 2015:

Re: doing AMCs piecemeal, Milton says yes we can do that but time is short: he has 2 more sessions available- next Mon 21 Dec from 330p - 530p; Tue 22 Dec 10a - 4p (all Pac time). I reserved both those blocks.

Milton asked if it was possible to have one of the devs on the call when we went through these problems because the issues all seem to be coding problems. I said I would ask. However, since next week’s sessions are the last ones available that might be academic.

The question has come up of going for modular certification. I asked Milton what would be the next step if we were to do that, dropping c 1-2-3 CQMs. He sent me the application to change to modular cert, which I forwarded on to Tony.
We will need to do:
a8 cds
g3 usability,
b5a labs
g2 amc
f2 imunization registry,

Milton’s examples of what he wants on issue 1, fine grained triggering of the CDSs:

  • log in as a nurse and do some action that triggers the rule.
  • log in as a dr and do the same action but it does not trigger the rule
  • another example: if front desk user enters a pt’s VS it won’t necessarily trigger the HTN rule depending on the frontDesk user’s TRIGGER POWER setting (my caps).

So he’s not only talking about the capability to make a rule apply to a particular pt; he also means the capability to trigger the reminder by some action.

He did say Brady’s mod (for Issue #2 above) was good (show new CDS’s when returning to the pt screen after activating one).

Got most of the way through b5a Labs today but some things were missing in the display. He reminded that we can find exactly what he’s looking for in the juror document for each lab hl7 file.
151216jurorDoc.png

When labs were uploaded they show in ‘Procedures/Electronic Reports’ just fine.
However, Janet’s results are the rejected ones. Her listing doesn’t show rejection reason
151216JanNoRej

Juror doc says the display is supposed to show somewhere “Quantity not sufficient” and “Cool”
151216JurorRejInfo

In ‘Procedures/Pending Review’ the comments aren’t displaying in the comments box
151216NoComments

In pt recs the units aren’t showing
151216LabsNoUnits

That’s it for the Labs. I’ll start testing the AMCs here pretty quick.

Rgds- HT

#193

harleytuck wrote on Thursday, December 17, 2015:

BTW, which AMCs have been tested or do I have my pick? I’m doing 5-Med List so don’t anybody else do that one!

  • HT
#194

tmccormi wrote on Thursday, December 17, 2015:

FYI:

Testing and certification has surpassed the expected length of time stated in our contract. To avoid any cancellation or fees the final payment must be arranged.

So … I have send InfoGard the remaining $9K we agreed ot despite the fact that we are not finished and we will have to pay hourly for any further testing. The last extra block of time cost $3000 (for about 24 hrs)

#195

harleytuck wrote on Thursday, December 17, 2015:

Hola Brady-
I’d hate to be wrong about this, because it means I’ll have to do the entire Med List measure again to check.
But- got to the last 2 test cases, 5.1 and 5.2.
T d n f
4.1 11 11 10 1 91%
4.2 12 12 10 2 83%
4.3 13 13 10 3 77%
4.4 14 14 10 4 71% num staying at 10 as it should. 19-07-23.pdf (attached)

5.1 14 14 0 14 0% num drops to 0 19-11-48.pdf (attached)
5.2 15 14 0 14 0% this increments the way it should, i.e., only total

This is not correct is it?
Using report period 1 - 30 Nov '15
For 5.1 that pt already had an active med. I added another one within the rept period via a new encounter’s issues panel, saved the encounter, went to the Issues screen and inactivated both meds.

  • HT
#196

bradymiller wrote on Thursday, December 17, 2015:

Hi Harley,
They will all need testing (I coded them to work in theory, but somebody needs to go through the testing script for all of them). Note items 7, 8, 14 and 20 are not yet completed.
-brady
OpenEMR

#197

bradymiller wrote on Thursday, December 17, 2015:

Hi,
Isn’t g3 already certified?
-brady
OpenEMR

#198

bradymiller wrote on Thursday, December 17, 2015:

Hi,
If coding fixes are needed for b5a labs, can we request Rod to do this?
thanks,
-brady
OpenEMR

#199

bradymiller wrote on Thursday, December 17, 2015:

Hi Harley,

When run the reports, make sure you explicitly select the ‘Rule Set’ setting to either:
2014 Automated Measure Calculations (AMC) - Stage I
or
2014 Automated Measure Calculations (AMC) - Stage II

Don’t choose the All Automated Measure Calculations (AMC) selection. Weird things could potentially happen with this setting. That being said, that is very odd for the numerator to zero like that (almost like it may be running the wrong rule; perhaps the ‘Maintain active medication allergy
list.’ rule above it). Adding or removing meds should not change this (since it will always get captured in the lists_touch lookup).

Let me know if still getting this on repeat testing even if select specific Stage report.

-brady
OpenEMR

#200

bradymiller wrote on Thursday, December 17, 2015:

Also,

You should have a Excluded Patients column in your report?

This is because you are not selecting a Stage I or Stage II specific report and I am guessing that is where the bug lies. If this is the case(it works when select a stage I or Stage II specific report), then let me know, and I will remove the option to even select ‘All Automated Measure Calculations (AMC)’ in the report.

-brady