MU2 Progress

system · November 19, 2015, 7:27pm

sunsetsystems wrote on Thursday, November 19, 2015:

I downloaded and ran the 10 HL7 files in the GU section. They all loaded without error, but I noticed 3 bugs that may or may not matter for MU2 testing:

One of the result data types is not recognized and the result value shows up as an odd string of text with “^” characters included.
The “rejected” result shows up as an empty report with no clear indication of rejection.
Clicking on “Show All Results” seems to cause signing of the results instead.

I’ll look into these. If you find any other problems please let me know.

By the way the lab provider should be set up with protocol set to Local Filesystem, Results Only. In this way it’s not necessary to create any patients or orders in advance.

Rod
http://www.sunsetsystems.com/

system · November 19, 2015, 10:54pm

sunsetsystems wrote on Thursday, November 19, 2015:

I’m going to need some guidance from Ensoftek re bugs #1 and #2 above. Do they have more recent code in these areas needed to pass MU2? If not, what if anything needs to be done?

Re #1, this is OBX data type CWE meaning “Coded With Exceptions”. The result value can be coded using up to two different coding systems, as well as including the “original text”. What do we have to do with these to satisfy MU2? Is it sufficient to just store the original text?

Re #2, I see in receive_hl7_results.inc.php that a variable $specimen_reject_reason was defined but never set or used. The suggestion is that some code related to specimen rejection was started but never completed. What’s up here?

I’ll be checking in the fix for #3 shortly.

Rod
http://www.sunsetsystems.com/

system · November 20, 2015, 1:14am

tmccormi wrote on Friday, November 20, 2015:

I have sent your request to them, since they don’t look a the forum much at all.

system · November 20, 2015, 1:57am

sunsetsystems wrote on Friday, November 20, 2015:

Thanks Tony. In the meantime, here are some notes about how to load the sample results into a fresh OpenEMR install.

Download the HL7 results data from http://hl7v2-lab-testing.nist.gov/mu-lab/ to your PC. Repeat the following until all files are retrieved:

a. Click “EHR Context-based Validation”.
b. Select a leaf item from the tree on the left.
c. Click “Select”.
d. Click “Save Message”.

Then:

Create a results directory somewhere on the server. It will need write permissions for the web server as well as for the person who puts the data in there.
Create an OpenEMR address book entry for the lab. Type must be “Lab Service”.
Go to Procedures -> Providers and create the provider entry. Set protocol to Local Filesystem, Results Only. Fill in the full path to your results directory from step 1.
Copy one or more (depending on the test procedure) of the results files to the results directory that you created in step 1. I used “scp” for this.
Click Procedures -> Electronic Reports. To see a results page, click on its order date.

Return to step 4 as needed.

To clean up for next time, delete all patients as well as all rows in the procedure_result, procedure_report, procedure_order_code and procedure_order tables.

Rod
http://www.sunsetsystems.com/

system · November 22, 2015, 4:06am

bradymiller wrote on Sunday, November 22, 2015:

Hi,

Just committed first commit for the AMC rules fixes to the codebase:

Will continue working on this on the following branch(I redirected the above demo link to this branch also for easy testing):

-brady
OpenEMR

system · November 30, 2015, 2:32am

harleytuck wrote on Monday, November 30, 2015:

Hi Brady-
I’m playing with the AMC reports in http://demo.open-emr.org:2108/ and wondering what you used to indicate the date a medication was recorded. I’ve tried creating a new medication issue in an encounter w/ DOS outside the report period but neither denom nor numerator registered. Any other method I know of ordering a med registers the current date, including NewCrop.
Rgds- Harley

system · November 30, 2015, 9:04am

bradymiller wrote on Monday, November 30, 2015:

Hi Harley,

Here’s the code that does the numerator calculation:

github.com

bradymiller/openemr/blob/master/library/classes/rulesets/Amc/reports/AMC_302d/Numerator.php#L20-L33


    // Have at least one entry or an indication that no medications are known for the
    // patient recorded as structured data.
    //  (true if an entry in lists_touch(medication token) or an active entry in lists)
    //  (In the lists_touch, theres is also a special case entry to support the NewCropRx module
    //   since that module also manages medications. These special case entries use the prescription_erx
    //   token.)
    $firstCheck = sqlQuery("SELECT * FROM `lists_touch` WHERE `pid`=? AND (`type`=? OR type=?)", array($patient->id,'medication','prescription_erx'));
    $secondCheck = sqlQuery("SELECT * FROM `lists` WHERE `activity`='1' AND `pid`=? AND `type`=?", array($patient->id,'medication'));
    if (!(empty($firstCheck)) || !(empty($secondCheck))) {
        return true;
    } else {
        return false;
    }
}

From looking at the testing data, it appears a DOS outside the report period should not register anything. The denominator calculation for this rule is here:

github.com

bradymiller/openemr/blob/master/library/classes/rulesets/Amc/reports/AMC_302d/Denominator.php#L23-L31


    // Seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23)
    //  (basically needs an encounter within the report dates)
    $options = array( Encounter::OPTION_ENCOUNTER_COUNT => 1 );
    if (Helper::checkAnyEncounter($patient, $beginDate, $endDate, $options)) {
        return true;
    } else {
        return false;
    }
}

Let me know if that helps,
-brady
OpenEMR

system · December 1, 2015, 7:33pm

harleytuck wrote on Tuesday, December 01, 2015:

Hi Brady- Yes, thanks, it did.
So far everything’s looking good.
Rgds- Harley

system · December 1, 2015, 8:51pm

tmccormi wrote on Tuesday, December 01, 2015:

Looks like recent commits include new AMC code. Should I update the official test site yet?

system · December 1, 2015, 11:22pm

harleytuck wrote on Tuesday, December 01, 2015:

Hi Brady-
Yes, one would think so and that’s what I got just now.
But this is what I have in my test data: it looks like it wants the same result for a med recorded within the RP as for outside.
1.1 N Crawford David 8/12/1946 M Within Within Active 1 1 1
1.2 N Peabody Yvette 12/18/1935 F Within Outside Active 1 1 1

HT

system · December 2, 2015, 12:01am

harleytuck wrote on Wednesday, December 02, 2015:

On another topic, can somebody tell me where to find this information?

Hello Milton-
Running through (a)(8) in the spreadsheet 24 - 2014 Edition Test Report Template V2 5 it appears that step 8 wants the EMR to display some metadata about the CD rules, then further down [it mentions] the reference resources. Do I read that right?
Regards- Harley

Harley,
Correct. The user must be able to view the reference source of the CDS that was triggered.
Regards,
Milton Padilla

system · December 2, 2015, 8:07am

bradymiller wrote on Wednesday, December 02, 2015:

Hi Tony,
Makes sense to keep it updated. Hopefully will get out another commit with more AMC fixes in the near future.
-brady
OpenEMR

system · December 2, 2015, 8:14am

bradymiller wrote on Wednesday, December 02, 2015:

Hi,

This makes sense since you want to capture patients whom have the encounter within the range, but have a medication either listed (or explicitly listed as none) at basically any time. So, the user only needs to enter in a medication (or ‘none’) once at any time.

This makes sense when the medication is added before the date range(which is what the test code now does for this item). What does not make sense is using it if it is added after the date range; doesn’t seem right that changes after the date range should count (may want to clarify this with Milton).

-brady
OpenEMR

system · December 2, 2015, 8:20am

bradymiller wrote on Wednesday, December 02, 2015:

Hi Harley,

Ensoftek already added code to support this:

Recommend touching base with Enosftek on the workflow they used with this in the testing.

Check out my post above where it is not clear what the issue is with getting this item(a(8)) passed:
https://sourceforge.net/p/openemr/discussion/oemr_501c3/thread/e0c8ffd8/?limit=25&page=5#ade0

-brady
OpenEMR

system · December 2, 2015, 8:44pm

harleytuck wrote on Wednesday, December 02, 2015:

Had informative talk with Milton this am.

Attached is the latest update of the testing requirements. Milton says because they change all the time we ought to get OpenEMR completely ready then test all at once. However, my appt next week to test b5a and a8 should still be good- the reqs haven’t changed in this latest update.

In g2 they have removed some testing items, though that shouldn’t require re- coding.

It’s not clear why a8 failed last time unless it was viewing the citations and references for the CDR rules? I have a call in to Vamsi for this and other questions.

Rgds- Harley

system · December 6, 2015, 10:13am

bradymiller wrote on Sunday, December 06, 2015:

Hi,

Here’s an update on the AMC rules for MU2.

I just committed some more fixes here:

At this point, still have the following AMC rules left to fix:
Number 7(cpoe): Still doing analysis on this.
Number 8(eprescription): Still doing analysis on this.
Number 14-measure-B(patient view/download/transmit): Need input by ZH Healthcare how this is logged in the offsite patient portal.
Number 20(Imaging): Need input by Rod how radiology imaging is stored with the current procedures mechanism.

Note I have not been testing these (just getting the code to make sense), so would be very helpful if folks continued testing these on the following demo:
http://www.open-emr.org/wiki/index.php/Development_Demo#192.168.1.133

Here is a link to the testing data:
http://healthit.gov/sites/default/files/170.314g12_2014_td_approved_v2.0.xlsx

Here is my current working code branch for this project:

-brady
OpenEMR

system · December 6, 2015, 10:27am

bradymiller wrote on Sunday, December 06, 2015:

Hi Rod,

Was hoping to get some input how radiology imaging is stored in the current procedures mechanism. AMC calculation number 20 requires the following:
Denominator: Ordered labs that have imaging as result.
Numerator: Imaging result is available.

I was hoping to use something like the following for the denominator(ie. a way to distinguish between orders that will produce an image). Is there a way to distinguish them; I noted at bottom of gui when enter in a procedure that there is a selector which includes “Imaging”:

github.com

openemr/openemr/blob/master/library/classes/rulesets/Amc/library/AbstractAmcReport.php#L263-L270


    break;
case "image_orders":
    $sql = "SELECT pr.* FROM procedure_order pr ".
    "INNER JOIN procedure_order_code prc ON pr.procedure_order_id = prc.procedure_order_id ".
    "WHERE pr.patient_id = ? ".
    "AND prc.procedure_order_title LIKE '%imaging%' ".
    "AND (pr.date_ordered BETWEEN ? AND ?)";
    array_push($sqlBindArray, $patient->id, $begin, $end);

And for the numerator, I am clueless. Just don’t know how imaging results are stored. The current numerator does not seem sensical:

github.com

openemr/openemr/blob/master/library/classes/rulesets/Amc/reports/AMC_314g_1_2_20/Numerator.php

<?php
/**
 *
 * AMC 314g_1_2_20 STAGE1 Numerator
 *
 * Copyright (C) 2015 Ensoftek, Inc
 *
 * LICENSE: This program is free software; you can redistribute it and/or
 * modify it under the terms of the GNU General Public License
 * as published by the Free Software Foundation; either version 2
 * of the License, or (at your option) any later version.
 * This program is distributed in the hope that it will be useful,
 * but WITHOUT ANY WARRANTY; without even the implied warranty of
 * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
 * GNU General Public License for more details.
 * You should have received a copy of the GNU General Public License
 * along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
 *
 * @package OpenEMR
 * @author  Ensoftek

This file has been truncated. show original

thanks,
-brady
OpenEMR

system · December 6, 2015, 10:31am

bradymiller wrote on Sunday, December 06, 2015:

Hi ZH Healthcare,

Was hoping to get some input on how you are logging patient view/download/transmit in your offsite portal. Need to know this for AMC calculation rule 14(Measure B). Here is where the calculation will need to go:

github.com

openemr/openemr/blob/master/library/classes/rulesets/Amc/reports/AMC_314g_1_2_14/Numerator.php

<?php
/**
 *
 * AMC 314g_1_2_14 STAGE1 Numerator
 *
 * Copyright (C) 2015 Ensoftek, Inc
 *
 * LICENSE: This program is free software; you can redistribute it and/or
 * modify it under the terms of the GNU General Public License
 * as published by the Free Software Foundation; either version 2
 * of the License, or (at your option) any later version.
 * This program is distributed in the hope that it will be useful,
 * but WITHOUT ANY WARRANTY; without even the implied warranty of
 * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
 * GNU General Public License for more details.
 * You should have received a copy of the GNU General Public License
 * along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
 *
 * @package OpenEMR
 * @author  Ensoftek

This file has been truncated. show original

thanks,
-brady
OpenEMR

system · December 6, 2015, 10:46am

bradymiller wrote on Sunday, December 06, 2015:

Hi,

“MU2 panic button” has been pushed.
(guessing we have less than 3 weeks, since as I recall last year the certification folks went on vacation the last week of the year)

Here’s the most updated MU2 barometer:
http://www.open-emr.org/wiki/index.php/OpenEMR_Certification_Stage_II_Meaningful_Use#Completion_Barometer

It appears that now ready to test a8(Harley), b2(ZH Healthcare), b5(Harley), c1(who?), c2(who?), c3(who?), and f2(ZH Healthcare). Can these be tested ASAP?

Then it appears the last remaining items are AMC calculations g1 and g2, which is getting close to completion and it appears may be able to test these piecemeal(so can also test those that currently pass the testing scripts ASAP).

-brady
OpenEMR

system · December 6, 2015, 4:56pm

sunsetsystems wrote on Sunday, December 06, 2015:

Hi Brady,

A lab result can include an “embedded document” in the OBX or ZEF segment, in which case you will see a nonzro value in the corresponding procedure_result.document_id (which will be a reference to documents.id).

However an embedded document is not necessarily a radiology image (it is more commonly a PDF report), and radiology images can be huge and impractical to return in HL7. I wonder if it would be more practical to include in the order (or order code entry in the compendium) an indicator of whether an image is expected, and in the report (perhaps at signoff time) an indicator that one was received.

EDIT: To check for the received image, perhaps assign a document category for radiology images and then look for a document in that category for that visit.

Rod
http://www.sunsetsystems.com/