MU2 Progress

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#281

harleytuck wrote on Tuesday, December 29, 2015:

Hi Folks-

In this morning’s Infogard session Milton and I only covered a8-CDS and we discovered a few new issues of varying triviality and one not trivial.

Comparatively trivial:

  • The abnormal lab rule didn’t trigger on a manually entered abnormal lab result. I suspect the rule isn’t built right though it appears to look for 'abnormal = “Yes” ’ in the lab results table. Probably can be corrected pretty easily.
    Keeping in mind, the rule will need to trigger when an abnormal lab comes in by hl7 file, also.

  • The fine grained ‘data entry - ssn’ rule is not clinical activity. CDS is for CLINICAL rules; showing the fine grained capability for any rule doesn’t qualify- we need to show it for clinical activity.

  • Remember: The CCDA import will need to trigger 3 rules: meds, allergy, problem list. Either all in one CCDA import, or between 2 separate ones.

Fairly trivial?

  • OpenEMR doesn’t have rules that trigger on the right things. E.g., the htn rule we have is ok triggering on dx and problem list but it’s not a ‘vital signs’ rule: we need one that looks in the vs and trigger on abn values. Also, the coumadin reminder is not a ‘lab’ rule: it looks at med orders, not at lab values that trigger reevaluation of the coumadin order.

Not trivial:

  • The drug allergy alert as coded does not qualify: it must show a reminder like the rest of the CDS rules do in the Clinical Reminder widget, not just a popup when there’s a med ordered that is on the allergy list.

  • When any CDS alert is triggered the user needs to be able to view some source of information on that specific event. If it’s a drug allergy/ sensitivity conflict, a drug/ drug interaction, an abnormal lab value, abnormal VS values, etc.

I refer to the ‘?’ at the right end of the passive reminder, which when hovered over displays the resource info, and when clicked links to a web page discussing that condition. E.g., if a penicillin allergy alert is triggered, must make available info on penicillin allergic reactions. If it’s a codeine reaction must see info on codeine reactions. If it’s a drug/ drug interaction, the user must have access to info on those particular drugs interacting.

I told Milton that OpenEMR depends on NewCrop to provide those. He said that OpenEMR just has to take the messages that NewCrop gives it about the reactions and alert on those messages. Or be able to detect the conflicts itself if the user does not subscribe to NewCrop.

Milton has one block of time left: Thu 31 Dec 3p - 5p.

I told him I would ask the Community devs if there was any chance that every one of these problems could be fixed and working properly by then. If so, we would reserve the time. If not, he can use that time for other purposes. I said I would tell him by first thing tomorrow morning, i.e., have the email waiting for him when he opened shop at 9am.

-HT

#282

tmccormi wrote on Tuesday, December 29, 2015:

Note: NewCrop is a MU requirement with OpenEMR, the user does not have the option to “Not Subscribe” if they want MU payments.

#283

harleytuck wrote on Tuesday, December 29, 2015:

So I’ve heard. But Milton’s interpretation is… what I said.

#284

bradymiller wrote on Wednesday, December 30, 2015:

Hi Harley,

If coding is needed, then won’t be ready to address a8 issues by 12/31 slot. Sounds like labs won’t be ready either. My thoughts though are that all can be accomplished with configuration(read below).

At this point, I think I have the testing criteria for a8 memorized, and some of the testers input seems way out of scope.

To address all of the tester’s concerns:

My first section below contains the logic flaws by the tester, which I think needs to be addressed at a higher level(ie. perhaps Tony with the testing folks):

  1. The first thing that is very odd is the attempted definition of a “trigger”. CDR rules are not that simple. It’s best to think in terms of a rule being “based” on certain elements in the database. For example, the Hypertension rule uses the following:
    a. Is Hypertension a medical problem for the patient?
    b. Is a blood pressure recorded for the patient?
    To attempt to classify one element as the trigger is arbitrary. The fact that this rule is using a vital sign element in the database to reach a decision means it is using a vital sign element; to me this concept seems really simply.
    As a quick mental exercise, then what would be the “trigger” if we changed the Hypertension rule to just use the following:
    a. Is a blood pressure recorded for the patient?
    In fact, the certification even requires a rule that test a combination of two different categories. If that is the case, then again, they can’t both be “triggers” according to the testers current flawed logic. For example, the rule that does that in OpenEMR is the Coumadin INR rule, which uses the following:
    a. Is the patient on coumadin? (checks a medication element)
    b. Does the patient not have an INR lab within the last 4 months? (checks a lab element)
    If we were to follow the testers flawed logic, then we can make the “lab” the trigger, by instead doing only the following:
    a. Does the patient not have an INR lab within the last 4 months? (checks a lab element)
    (it would be a less meaningful rule, but now the lab is the supposed “trigger”)

2.The second logic flaw is forcing allergy/drug and drug/drug interaction section by native OpenEMR when Newcrop does this already and Newcrop is required for MU2. I am simply at a loss of words on this one… Note the wording of these test in the testing guide use the following phrase “Using the Vendor-identified EHR function(s),”… Meaning we get to choose what to use…

3.In the testing book criteria for item a8, there is an explicit note to the tester that the structure of the intervention is not explicitly defined. Meaning the actual workflow/process is up to us. Here is the quote from the testing guide for this issue:
“The following points have been added as clarification for the Tester:”
“The structure of a clinical decision support intervention is not explicitly defined. The Vendor may
choose to define an intervention in a variety of ways, including, but not limited to: automated
workflow modifications, prompting or facilitation of clinical documentation (e.g., condition-specific
flowsheets, highlighting or making available additional structured documentation based upon
triggers, data-driven care plans and documentation templates, CDS rules engine, hard-coded
interventions), suggested orders/order sets, or user-facing messages, reminders, or warnings”
I can guarantee you that this clarfication was added for a good reason…
This means that all of the details of using active/passive and where to place reminders is not up to the testers; it is up to us… Again, the tester is going way out of scope on these types of issues.
For example, for the vital sign rules, they don’t need to be encapsulated within the Clinical reminder widget; just highlighting an abnormal vital signs when showing the vitals would even suffice; this is the same for the labs; this is the same for allergies. As long as there is something that makes some sort of decision regarding the data element, it is fair game. And it can be ugly, pretty, awkward, or even make farting noises(as long as they occur automatically and electronically); it is up to us :slight_smile:

Now on to how to fix issues(which I think are all just configuration issues):

  1. The abnormal lab highlighting: didn’t we solve this issue already by using the Procedures->Lab Overview gui?

  2. For the fine grained CLINICAL rule, this can done by configuration, which I already showed how to do for the Hypertension rule in a post above.

  3. For the CCDA, I emailed you a CCDA that has following elements to activate rules:
    a. HTN medical problem (activates check blood pressure alert)
    b. Penicillin prescription (activates allergy/med alert)
    c. Penicillin allergy (activates allergy/med alert and activates the penicillin allergy rule; note the penicillin allergy rule needs to be turned on in Administration->Alerts)
    So that is 3 rules using the 3 elements.

  4. For the allergy issue, placing it in the Clinical Reminder section would be really awkward, and as discussed above is up to us where to place(Do note the allergy does show up in the Active Alert popup along with the active reminders, which is the testers preferred mechanism anyways). For the online link to information, then we can take advantage of the “Patient-specific education resources” stuff added by Rod. If you go to the Patient Summary->Issues page, you will see the column ‘Coding (click for education)’. If there is a code there associated with the allergy, then if you click on it, you will be directed to a choice of viewing information via Medline or via local information.

Keep up the perseverence,
-brady
OpenEMR

#285

harleytuck wrote on Wednesday, December 30, 2015:

Amen, Brother.
I’ve heard viscious gossip that OpenEMR is going for MU3 next year- hopefully we can get these principles settled before we start testing that.

  • HT
#286

fsgl wrote on Wednesday, December 30, 2015:

Fear not, Harley.

A little bird (not Margalo) tells me that there will be plenty of time (unfortunately) to get MU2 done.

#287

harleytuck wrote on Wednesday, December 30, 2015:

Hi fsgl-
Oh, REALLY? (a la Jack Benny)?? I think that’s good news, all in all.
Where, pray tell, might I watch to see some public announcement/ confirmation?
-HT

#288

fsgl wrote on Wednesday, December 30, 2015:

Probably no public announcements, so rely on the grape vine.

#289

harleytuck wrote on Wednesday, December 30, 2015:

Roger. I’ve become quite attuned to the SF forum lately; guess I will just keep on watching it.

#290

teryhill wrote on Thursday, December 31, 2015:

So what is the Bird saying?

#291

aethelwulffe wrote on Thursday, December 31, 2015:

We are in a peck of trouble.

#292

sunsetsystems wrote on Friday, January 01, 2016:

I’m expecting to have the lab updates done tomorrow. Testing now.

Rod

#293

sunsetsystems wrote on Friday, January 01, 2016:

Lab updates are checked in. I ran through the tests and it seems OK, with the following caveats:

  1. We do not collect or display the lab-specific patient ID. We have no place to put this, and no reason I know of to care what it is.

  2. We do not collect or display a patient name suffix (e.g. “Jr”). OpenEMR has no standard place to put it.

  3. Report date is stored and displayed as a date only, not a date/time.

Will the testers care about any of this?

Rod

#294

tmccormi wrote on Saturday, January 02, 2016:

Easy to add suffix to patient data if that’s a requirement.
Date/Time are generally required for everything in MU these days.

Tony McCormick, CTO


Support: 866-735-0897, Direct: 713-574-6709
My Calendar: http://bit.ly/XznvDo
“I am and always will be the optimist. The hoper of far-flung hopes and the
dreamer of improbable dreams.” — The Doctor, Season 6

On Fri, Jan 1, 2016 at 10:27 AM, Rod Roark sunsetsystems@users.sf.net
wrote:

Lab updates are checked in. I ran through the tests and it seems OK, with
the following caveats:

We do not collect or display the lab-specific patient ID. We have no
place to put this, and no reason I know of to care what it is.
2.

We do not collect or display a patient name suffix (e.g. “Jr”).
OpenEMR has no standard place to put it.
3.

Report date is stored and displayed as a date only, not a date/time.

Will the testers care about any of this?

Rod

MU2 Progress
https://sourceforge.net/p/openemr/discussion/oemr_501c3/thread/e0c8ffd8/?limit=25&page=11#c96d

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#295

sunsetsystems wrote on Saturday, January 02, 2016:

Thanks Tony. I’ve changed report date to a datetime.

Rod

#296

harleytuck wrote on Tuesday, January 12, 2016:

Hi Folks-

Our MU 2 Testing is finished; our modular cert will not include Labs or CDS. Tony had decided that we could afford to invest this week on more testing if necessary but to wait no longer. Per my talk with Milton today he has no testing time avilable this week.

For what it’s worth, Rod, the Labs display does provide what Milton wanted so it probably won’t need re-coding for MU3. Dang good work it is, too.

The philosophical disagreement was never settled between OEMR and Infogard, regarding native CDS med/ med/ allergies alerts /vs/ provided by NewCrop. Milton doesn’t know if Infogard will be handling our MU3 testing so I imagine we can have a meeting of the minds down the road to clarify that with whoever we’ll be working with.

MU–ving right along… (couldn’t resist; won’t do it again)

I will be collecting my notes and get them into the docs for the upcoming release asap.

REgards- Harley

#297

tmccormi wrote on Tuesday, January 12, 2016:

Harley,
We are not done with MU2, just done with what has been tested and will get Modular certification. We will finish the MU2 testing when we get the AMC, CQM and the CDS issues resolved. Next month, no doubt.
–Tony

#298

bradymiller wrote on Tuesday, January 12, 2016:

Hi Harley,

To avoid any confusion, note we are still pursuing MU2 complete certification. Just not with the next OpenEMR release(version 4.3.0), which will only have Modular Certification(let me know when the Modular certification for 4.3.0 is official, so can then get the release ready).

So, we still need to pursue testing and discussion with Milton etc to get MU2 Complete certification( which will then be version 4.4.0 in the future).

Just want to make sure we are all on the same page. The MU2 machine must keep moving forward.

-brady
OpenEMR

#299

harleytuck wrote on Tuesday, January 12, 2016:

SORRY FOLKS!
My misstatement! This chunk of the MU testing is done, for now. The modules that aren’t tested at this point will be tested later.
Muy apologia- HT

#300

harleytuck wrote on Tuesday, January 12, 2016:

Hi Brady-
Yes, thanks for the detailed clarification. It will probably be welcome reading for other forum browsers as well as for me.
Rgds- Harley