MU2 Progress


(system) #301

bradymiller wrote on Wednesday, January 20, 2016:

Hi,

We need to refocus back on getting MU2 full certification. Here’s a quick review on what items are still needed for full certification(guessing will take 2 months or so).

a8. Clinical decision support:
This one has been a real doozy. We had a discussion with Milton last week and I think we can get this passed with a couple additional dummy rules and a well planned configuration and testing script(there is a sticky issue with Newcrop which we should be able to circumvent with a well planned testing script); I plan to go into more detail on this in a separate post.

b5. Incorporate lab tests and values/results:
It appears this one is ready to pass testing(Rod has already addressed the most recent set of issues); there appears to be a potential issue with highlighting abnormal labs, which should be able to be worked out with some testing.

c1-c3. Clinical quality measures:
The code for this is in the codebase, but has not yet been tested. Ensoftek contributed this code and has lots of experience with certification testing, so plan to see if they can do the testing on this one.

f2. Transmission to immunization registries:
The code for this is in the codebase, but has not yet been tested. Z&H contributed this code and has lots of experience with certification testing, so plan to see if they can do the testing on this one.

g1-g2. Automated measure calculation:
There are about 25 calculations and all of them have been completed except for 3. They still need to be tested. The 3 left are described(along with plan to complete them) in the comments at the bottom of the following commit(the ones that have TODO at the end of them):

-brady
OpenEMR


(system) #302

sunsetsystems wrote on Wednesday, January 20, 2016:

Hi Brady, if you tell me a bit more about the issue with b5 I’ll check it.

Rod
http://www.sunsetsystems.com/


(system) #303

bradymiller wrote on Thursday, January 21, 2016:

Hi Harley,

I was hoping to get some clarification for tiem b5. I didn’t find any obvious mention of highlighting abnormal results in the testing manual for item b5? Is this meant for item a8?

Are we ready to get b5 passed with Rod’s relatively recent changes?

-brady
OpenEMR


(system) #304

harleytuck wrote on Thursday, January 21, 2016:

Hi Brady-

I just read through the b5a and a8 test report template and my testing
notes again, and I do not find any requirement that abnormal labs be
highlighted. For b5a the results only have to be displayed properly (i.e.
in human readable form and with units, etc) and for a8 it just says a CDS
has to be triggered by abnormal lab values.

I’m nervous to say but I believe b5a should be ready to go.

As you mentioned, though, before we test it we are going to have to come up
with a list of the CDSs that are properly prepped to be used in the testing.

  • HT

I believe that

On Thu, Jan 21, 2016 at 12:51 AM, Brady Miller bradymiller@users.sf.net
wrote:

Hi Harley,

I was hoping to get some clarification for tiem b5. I didn’t find any
obvious mention of highlighting abnormal results in the testing manual for
item b5? Is this meant for item a8?

Are we ready to get b5 passed with Rod’s relatively recent changes?

-brady
OpenEMR http://www.open-emr.org/

MU2 Progress
https://sourceforge.net/p/openemr/discussion/oemr_501c3/thread/e0c8ffd8/?limit=25&page=12#490f/c484

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(system) #305

bradymiller wrote on Friday, January 22, 2016:

Hi Harley,
Lets test and certify just b5 for now then.
-brady


(system) #306

harleytuck wrote on Friday, January 22, 2016:

Roger, will line that up in the next couple weeks.

  • HT

(system) #307

aethelwulffe wrote on Saturday, January 23, 2016:

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/HardshipApplication.pdf


(system) #308

bradymiller wrote on Thursday, January 28, 2016:

Hi Harley,

ok, after considering the previous discussion with Milton, here is the plan for item a8. To organize it, I broke it down into 4 topics:
FIRST ITEM - RULES TO TEST.
SECOND ITEM - CCDA STUFF.
THIRD ITEM - ACCESS CONTROLS.
FOURTH ITEM - ALLERGY/MED STUFF.

FIRST ITEM - RULES TO TEST.
Rules to test:
1.Problem List
----Diabetes: Eye Exam
(enter ‘diabetes’ medical problem and an alert shows to get an Opthalmic exam)

2.Medication List
----Coumadin Management - INR Monitoring
(enter ‘Coumadin’ for a medication and an alert shows to measure a INR)

3.Medication Allergy List
----Assess Penicillin Allergy
(enter ‘penicillin’ allergy and an alert shows to Assess the Penicillin Allergy)

4.Demographics
----Cancer Screening: Mammogram
(for a woman patient, change age from 38 to 45 and an alert shows to measure a Mammogram)

5.Laboratory tests and values/results
----Measure INR
(if there is no INR then shows alert to measure a INR; when enter in a INR, the alert then goes away)
(note ensure patient age is > 1 year)

6.Vital signs
----Measure Blood Pressure
(if there is no blood pressure recorded then shows alert to measure a blood pressure; when enter in a blood pressure, the alert then goes away)
(note ensure patient age is > 1 year)

7.Combination Rule (combines a medical problem with a vital sign)
----Hypertension: Blood Pressure Measurement
(enter ‘HTN’ medical problem and an alert shows to measure a blood pressure; enter a BP in vitals and then the alert to measure a blood pressure goes away)

SECOND ITEM - CCDA STUFF.
For the CCDA, I attached 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.

THIRD ITEM - ACCESS CONTROLS.
For a nurse vs. doctor access control where the nurse sees it but the doctor doesn’t, then do the following to show this:
Go to Administration->ACL
Click ‘Groups and Access Controls’
Click ‘Physicians-write’->Edit
In the Active column, click ‘Sensitivities->Normal’ and then click ‘>>’ button
(note the ‘Sensitivities->Normal’ item has now moved to the Inactive column)
Now go to Administration->Alerts
For the ‘Hypertension: Blood Pressure Measurement’, for the ACO selection (selector at the right), select ‘Sensitivities: Normal’.
Then click ‘Save’.
Now create 2 new users:
1 user with the ‘Access Control’ setting of ‘Physicians’ - the Doctor
1 user with the ‘Access Control’ setting of ‘Clinicians’ - the Nurse
Now create a new patient and give set a Medical Problem of ‘HTN’
Now log out.
Now log in with the Nurse and the ‘Measurement: Blood Pressure’ alert will show up.
Now log in with the Doctor and the ‘Measurement: Blood Pressure’ alert will NOT show up.

FOURTH ITEM - ALLERGY/MED STUFF.
(goal is to bypass RXNORM issue here)
For the online link(and also can set a local copy of info) 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(for example, a ‘penicillin’ allergy), then if you click on it, you will be directed to a choice of viewing information via Medline or via local information(which we can set to anything we want).

-brady
OpenEMR


(system) #309

bradymiller wrote on Thursday, January 28, 2016:

Harley,
Note I just added the following 2 very simple(ie. “dummy”) CDR rules to OpenEMR’s codebase for above testing:
“Measure INR”
“Measure Blood Pressure”
-brady


(system) #310

tmccormi wrote on Wednesday, February 03, 2016:

Here’s a general OEMR letter about Hardship if someone needs it.


(system) #311

tmccormi wrote on Wednesday, February 03, 2016:

Here’s a general OEMR letter about Hardship if someone needs it.


(system) #312

harleytuck wrote on Thursday, February 11, 2016:

Hi Folks-
I got with Milton today to test the labs module and ran into some problems.

I’d prepped yesterday for the testing and it worked fine- uploaded the hl7 files to the server; it displayed all the results and everything. So I truncated the tables and left it ready for today. Today I got in there and when I went to upload the hl7 to the server I saw one hl7 file still in there. I deleted it and uploaded the hl7. Opened Electronic Reports and it showed one single result (attached). I truncated the tables, re- uploaded the hl7 and it still showed the one result No other results were shown in the other results locations (Pending Results etc).

I logged out and left it as it was when I cancelled the test, in case anybody wants to look at it.

Ideas?

System notes: in a Windows VBox VM, used Firefox to the MU site; Filezilla transferring the files by sftp.

  • Harley

(system) #313

sunsetsystems wrote on Thursday, February 11, 2016:

What exactly does “truncated the tables” mean?

Also make sure the web server has permission to delete the files in the upload directory.

Also please be clear as to what unexpected thing is happening or not happening. I want to be helpful but don’t have time to re-test everything.

Rod


(system) #314

sunsetsystems wrote on Thursday, February 11, 2016:

Checking my notes, here’s what I did to clean up between tests:

  1. Delete the patient (look up the patient in OpenEMR and click the Delete button. This deletes entries in various tables related to the patient.

  2. delete from procedure_order;

  3. delete from procedure_order_code;

  4. delete from procedure_report;

  5. delete from procedure_result;

Rod


(system) #315

tmccormi wrote on Thursday, February 11, 2016:

Perhaps the best way, in the future, to be of help is for the developer (of a particular module) to be present during the testing itself. I know that is what FSGL has proposed to the board.

Otherwise we get this kind of spin around every time.


(system) #316

sunsetsystems wrote on Thursday, February 11, 2016:

I guess you mean “available” rather than physically present. That can certainly be arranged, but in theory is unnecessary since the test procedure is fully known and can be prepared for in advance. Also troubleshooting with the clock ticking can be very expensive. Just sayin’.

Rod


(system) #317

harleytuck wrote on Thursday, February 11, 2016:

Sorry 'bout that Chief!

“truncated the tables”: when I got the original instructions from Vamsi on how to operate the module, he gave me a set of sql truncate commands to remove the lab results from the system:

truncate table procedure_order;
truncate table procedure_order_code;
truncate table procedure_report;
truncate table procedure_result;

I just copy/ paste that chunk of code into the sql window in the system’s phpMyAdmin. The truncate commands have been working fine in all the testing I’ve done up to yesterday, completely emptying the tables and the “Procedures/ Electronic Reports” display.

The unexpected things are:

  1. after ‘truncating the tables’ yesterday, I came back today in Filezilla to load in the new hl7 files for testing and saw one result file in the local results dir (/var/www/vhosts/openemr.mi-squared.com/mu2/openemr/sites/default/mu2_hl7_results). I manually deleted it with Filezilla and it went away.

  2. when I load 8 hl7 result files in for the MU testing, it’s supposed to display 8 results for 3 people, not just 1 (that pic attached to my earlier entry). This has worked properly up to yesterday.

  • HT

(system) #318

sunsetsystems wrote on Thursday, February 11, 2016:

Alright, then delete the patients also as I mentioned. I assume mu2_hl7_results is your upload directory? Make sure the hl7 files are being deleted from there as they are processed; if not it’s likely a permissions issue.

Rod


(system) #319

harleytuck wrote on Thursday, February 11, 2016:

I agree that would be an ideal arrangement, but practicalities intrude. Assuming the scheduling worked out, there’s still the question Rod raises: what could the dev do besides witness the workflow first hand? Which isn’t without value, of course.


(system) #320

tmccormi wrote on Friday, February 12, 2016:

Devs are smart and can fix the issue right then sometimes, keeping you from having to cancel and reschedule…