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Project - Quality Reporting

Quality reporting and collection of clinical metrics are a valuable tool for clinics. It allows self-assessment, quality improvement projects, and reporting of metrics to regulation entities. Goal is to integrate quality reporting into OpenEMR. Note this project will involve both choosing of which clinical metrics to assess and then developing these in OpenEMR.

Mentors:
@stephenwaite
@brady.miller

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Hi, I am Shreya Goyal, currently pursuing master’s in Health Informatics from IUPUI. I have a strong background in biomedical data analysis, Machine Learning and database management systems. I am also an EHR assistant as part of my graduate staudent hourly for one of the classes taught. I am responsible for setting up accounts for students and help the students in dealing with technical and authentication issues and errors. I believe that with this project, I can enhance my knowledge in EHR and can contribute towards the project.

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Hi, do you have some selection tests that we can perform before starting with the proposal?

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Hi @Shreya_Goyal and @Sayantan_Banerjee and welcome to the OpenEMR project!

This is a broad topic that can range from self assessments to standardized reporting metrics. There are several examples in OpenEMR that can be leveraged or can start anew depending on your project goals.

First example is something that was recently added to the codebase for support of Promis Health Measures (http://www.healthmeasures.net/explore-measurement-systems/promis). Can see details of that here:
easipro by bradymiller · Pull Request #2911 · openemr/openemr · GitHub

Second example is the CDR (Clinical Decision Rules) engine in OpenEMR, which allows creation of “standard” less complex rules (stored in database) and support of more complicated rules (hard-coded in classes) to CQM (Clinical Quality Measure) and AMC (Automated Measure Calculations) that were needed for OpenEMR to get ONC certification. If wish to go this route, then would recommend looking into using standard eCQM definitions directly rather than hard-coding them into classes.

These are just examples in the codebase and how they could possibly be leveraged. Could also build out a separate solution depending on your goals.

-brady

Hello!

I’m Kwasi Agyeman, an informatics pharmacist in California.

I don’t have that much programming experience (currently teaching myself that now), but I do have experience building clinical decision rules in EHRs and also configuring other clinical tools. I’d like to get involved if possible

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Hi @kagyeman ,

Recommend starting by getting a local OpenEMR repository/development/testing environment up and running. Many of the developers use this environment:
openemr/CONTRIBUTING.md at master · openemr/openemr · GitHub

-brady

Hi!,
My name is Naomi Bonnin. I am currently pursuing my BS in Computer Science. I currently work full time as a paramedic and have done so for the past 8 years. As such I use EMR’s/EHR’s/ePCRs on a daily basis. I am interested in contributing to the Quality Reporting project as part of the Google Summer of Code. My plan was to focus on the metrics that are tracked in US hospitals. Namely, 30 day readmissions, CLABSIs, CAUTIs, and VAPs. These metrics are a good start towards understanding a hospitals performance.

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welcome @naomi172839! thank you for your offer but how would you feel about looking into outpatient quality reporting?

It would be nice if these reports could also include the reporting requirements of HRSA UDS reports. There are a lot of Community Health Centers throughout the US of A and it’s territories having some centers located in poor communities and not financially able to afford custom software to generate such reports. I believe if this project icludes the UDS reporting requirements, a lot of CHCs will switch or start using OpenEMR.

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Hi,

My thoughts are to integrate the tool using clinical metrics like average length of stay, readmission rates, outpatient follow up rates for the purpose of quality reporting. These metrics will be beneficial to monitor, analyze and optimize the healthcare processes and services which will result in increasing patient satisfaction and quality od care provided.

The steps included will be as follows: Finding the clinical metrics and appropriate standardized measure for it to find the numerator and the denominator for measuring the performance and quality reporting purpose. Next step is to extract the required EHR data for calculating the clinical metric and the last step is to analyze the data using dynamic programming and understand the organization’s performance.

Please let me know your thoughts about it and I will keep working on the proposal.

hi @Shreya_Goyal, thank you for your interest. Since OpenEMR is an outpatient EMR it’s better to focus on those metrics. Please setup an instance of OpenEMR and try to get familiar with the Clinical Decision Rules engine. Thank you.

Thank you for the valuable response. The outpatient clinical metrics I am planning to look at are Imaging Efficiency Implementation including MRI Lumbar Spine for Low Back Pain, Abdomen CT–Use of Contrast Material and Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac, Low-Risk Surgery, Outcome Claims-Based including Admissions and Emergency Department (ED) Visits for Patients Receiving Outpatient Chemotherapy and Hospital Visits after Hospital Outpatient Surgery. I have set up an instance of OpenEMR in my local machine and became familiar with the OpenEMR database. The measures can be implemented into the OpenEMR codebase by developing the corresponding clinical decision rules (.php file) and calculating metrics using “If (criteria) is (this), then output (result)” statement.
Let me know your thoughts on it. Also can you please provide a brief explaination of the expectations from the proposal?

hi @Shreya_Goyal, would focus on the 2020 ecqms if go this route, https://ecqi.healthit.gov/ep-ec-ecqms

dream goal is to develop and begin to implement how we could dynamically add an ecqm based on the cql logic and underlying value set to the clinical reminders and reporting function of OpenEMR :slight_smile:

hi @Shreya_Goyal , I wasn’t able to comment on your google doc and considering the proposals are due in several hours, figured best to leave feedback here. You are on the right track with eCQM measures. Regarding the timeline, note you will be kind of starting from scratch (rather than simply updating the eCQM’s). I only say “kind of” because there is a clinical decision rule engine in place that you will be able to work from. Will make sense to basically iterate over each eCQM (and start from less complex to more complex) while building out the current clinical decision rule engine to support the eCQMs. The first couple eCQM measures will take the most time, so would only focus on several of the least complicated ones for the first month. Then a larger batch for month 2. Then an even larger batch for month 3.

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Hi @brady.miller, thank you for the valuable feedback. I will update the timeline accordingly and resubmit the proposal.
Thank you

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