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
