Openemr Vs ONC NIST Testing

visolveemr wrote on Thursday, September 23, 2010:

We have tested Openemr with NIST procedures and we found some inconsistencies in
problem list and medication allergies.

A. Problem list

1)According to NIST test data, While adding problem details, We have to enter the
“status” of the problem.(NIST’s recommended  status - active,resolved and inactive).

As per the current logic, if the end date is blank,the status is considered as active.

For compliance with NIST test procedures, We can rename the existing field ‘outcome’
as ‘status’ & the other stasuses(inactive,resolved) can be added.

2)NIST rules also demands displaying the “status” along with the problem. So we can
add a column named ‘status’ in the display
list.

B. In Medication Allergy

1) As per NIST rules, there should be a field to denote the ‘Reaction to the allergy’.

For compliance with NIST, we can include a input field for ‘Reaction’ in the allergy
form .

and we can add a field named ‘reaction’ in ‘lists’ table. Do let us known if  this
will affect the current setup.

2)The status and the reaction should be displayed in the medication allergy
list.
So we can add a column named ‘Reaction’ in the  medication-allergy list.

Thanks,
VicarePlus Team,
services@vicareplus.com

tmccormi wrote on Tuesday, September 28, 2010:

In case anyone is interested Visolve is keeping details of the tests and results on the OEMR Wiki at:

http://www.openmedsoftware.org/wiki/OpenEMR_QA_against_NIST

-Tony

visolveemr wrote on Wednesday, October 06, 2010:

Hi,

We have posted the patch to fix the issues in problem list and medication allergy list (Issues faced when tested against NIST test procedures) in the tracker - http://sourceforge.net/tracker/?func=detail&atid=1245239&aid=3082117&group_id=60081

Do share your views.

Thanks,
Vicareplus Team,
services@vicareplus.com

visolveemr wrote on Thursday, October 07, 2010:

Hi,

We found one inconsistency in smoking status according to NIST procedures version 1.1 (effective from October 24).

Inconsistency: The smoking status should be represented with its CDC recodes .

We have fixed the issue and placed the patch in the tracker
http://sourceforge.net/tracker/?func=detail&atid=1245239&aid=3082933&group_id=60081

Thanks,
Vicareplus Team,
services@vicareplus.com

bradymiller wrote on Thursday, October 07, 2010:

hey,
Plan to look/test your patches soon. Something to think about is how to upgrade previous installations (i think your changes would break/wipe out previous smoking status entries).
-brady

bradymiller wrote on Thursday, October 07, 2010:

Regarding the smoking, can you point me to the guidelines document.
thanks,
brady

bradymiller wrote on Friday, October 08, 2010:

Hey,

Just tested it out. Agree with moving the tobacco field to the top. Rather than remove the current smoking status, can’t you just add this as a  separate field. Then can join the two with javascript (ie. if select current smoker… then select active in the other and vice versa etc). Then you avoid any upgrade issues, fulfill NIST and give users more flexibility in reporting smoking status (for example, a quit date (clinically important) and a free text field). Very interested to see what others think; I put the code on github here:
http://github.com/bradymiller/openemr/tree/visolve-smoking_1

-brady

visolveemr wrote on Friday, October 08, 2010:

Hi Brady,

Agreed. Will modify the patch and post the same in a couple of days.

NIST test procedure of smoking status is available at http://healthcare.nist.gov/docs/170.302.g_smokingstatus_v1.1.pdf
NIST test procedures for all MUO items are available at http://healthcare.nist.gov/use_testing/effective_requirements.html

Could you please review the patch that fixes the NIST incompatibility in problem list and medication allergy list and share your views.

Thanks,
Vicareplus Team

bradymiller wrote on Saturday, October 09, 2010:

Hi,

Starting to look at the problem list-med allergy stuff now. Put a github branch of it here for others to review.test:
http://github.com/bradymiller/openemr/tree/visolve-prob-all_1

Pertinent NIST docs:
http://healthcare.nist.gov/docs/170.302.c_problemlist_v1.1.pdf
http://healthcare.nist.gov/docs/170.302.e_allergylist_v1.1.pdf

Also, quick question. Are these NIST docs the official MU requirments needed for certification?

-brady

visolveemr wrote on Saturday, October 09, 2010:

Hi Brady,

Yep… The temporary certification should follow these test procedures for certifiying EHRs .

Thanks
ViCarePlus Team

tmccormi wrote on Monday, October 11, 2010:

Brady,

I believe that EMRTech (Verbus Counts) is already working on this and is supposed to present a plan and code on Monday at the MU Meeting.

Please make sure you are not duplicating efforts by the other developers.  

I don’t know that you are, but just making sure you know what Verbus’ team is working on.

-Tony

visolveemr wrote on Monday, October 11, 2010:

Hi Brady/Tony,

We have started testing ‘Electronic syndromic surveillance’ feature in OpenEMR. In OpenEMR, HL7 2.5.1 version is used for generating the syndromic surveillance message. It is stated in NIST test procedures, if HL7 2.5.1 is used as version, the message should be tested against the ‘case notification message mapping guide’ to check whether the message is conformant or not.

Could you please specify which ‘case notification mapping guide’ OpenEMR is using to generate HL7 message?

Electronic syndromic surveillance NIST test procedure is available at
http://healthcare.nist.gov/docs/170.302.l_PublicHealthSurveillance_v1.1.pdf

Thanks,
Vicareplus Team

tmccormi wrote on Monday, October 11, 2010:

Selvi,

Dr Brody team produced the code.  If his teamd did not include that information on the wiki page for this item then he will need to answer the question you have.

-Tony

bradymiller wrote on Monday, October 11, 2010:

Tony and Visolve,

I’m simply reviewing Visolve’s code and providing input. But I (and Visolve) definitely don’t want duplicate any efforts. Would it be best for Visolve(any myself) to wait on any more patches until EMRTech weighs in?

-brady

visolveemr wrote on Friday, October 15, 2010:

Hi,

We found an inconsistency in demographics according to NIST procedures and CMS final rule.

Inconsistency: Race and Ethnicity should be entered in separate fields and to follow the standard specified by 'The Office of Management
and Budget Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity,Statistical Policy Directive No. 15, October 30, 1997.
At present, OpenEMR is getting either ‘Race’ or ‘Ethnicity’ and specified standards are not followed.

Proposed Solution: An additional field to enter ‘Ethnicity’ can be included keeping the present field to enter ‘Race’.
For the data entered previously, a migration script will be given which will compare the values in the old field with the standard codes of race and ethnicity. If any match found will move the data to corresponding field and will be displayed in patient demographics.

NIST test procedure for Demographics: http://healthcare.nist.gov/docs/170.304.c_RecordDemographicsAmb_v1.1.pdf

Please do share your views.

Thanks,
Vicareplus Team
services@vicareplus.com

visolveemr wrote on Monday, October 18, 2010:

Hi,

We found one inconsistency in audit log according to NIST procedures 

Inconsistency: The audit log should be sorted with Patient Identification.

We have fixed the issue and placed the patch in the tracker
https://sourceforge.net/tracker/?func=detail&aid=3089749&group_id=60081&atid=1245239

Thanks,
Vicareplus Team,
services@vicareplus.com

visolveemr wrote on Tuesday, October 19, 2010:

Hi,

Included the suggestions mentioned by Brady for smoking status and placed the patch in the tracker
https://sourceforge.net/tracker/?func=detail&aid=3082933&group_id=60081&atid=1245239

Thanks,
Vicareplus Team,
services@vicareplus.com

bradymiller wrote on Wednesday, October 20, 2010:

hey,
Put review for the smoking here (very nicely done; just have some minor issues):
http://sourceforge.net/tracker/index.php?func=detail&aid=3082933&group_id=60081&atid=1245239#
For others, github branch for their code is here (they also have a patch in the tracker link above):
http://github.com/bradymiller/openemr/tree/visolve-smoking_2
-brady

visolveemr wrote on Friday, October 22, 2010:

Hi,

Incorporated Brady’s suggestions and posted the patch in the tracker
http://sourceforge.net/tracker/?func=detail&atid=1245239&aid=3082933&group_id=60081

Thanks,
Vicareplus Team,
services@vicareplus.com

visolveemr wrote on Wednesday, December 01, 2010:

Hi,

The inconsistency in demographics(regarding Race and Ethnicity),against NIST rule, is fixed and we have placed the patch in the tracker for review

http://sourceforge.net/tracker/?func=detail&aid=3122211&group_id=60081&atid=1245239

Thanks,
Vicareplus Team,
services@vicareplus.com