Description AMC

Patient(s) selection

The first thing that is done is the selection of patients if a physician is chosen for the calculations.

• Pertinent code from the library/clinical_rules.php file (test_rules_clinic() function)

  // Collect all patient ids
  $patientData = array();
  if (!empty($patient_id)) {
    // only look at the selected patient
    $patientData[0]['pid'] = $patient_id;
  }
  else {
    if (empty($provider)) {
      // Look at entire practice
      $rez = sqlStatement("SELECT `pid` FROM `patient_data`");
      for($iter=0; $row=sqlFetchArray($rez); $iter++) {
       $patientData[$iter]=$row;
      } 
    }
    else {
      // Look at one provider
      $rez = sqlStatement("SELECT `pid` FROM `patient_data` " .
        "WHERE providerID=?", array($provider) );
      for($iter=0; $row=sqlFetchArray($rez); $iter++) {
       $patientData[$iter]=$row;
      }
    }
  }

AMC Measures

The vital parts of each measure are the category counted (patients, labs, encounters, prescriptions, transitions-in or transitions-out), the denominator criteria and the numerator criteria. Note this information can be found hard-coded at library/classes/rulesets/Amc/reports .

1. Maintain an up-to-date problem list of current and active diagnoses. 170.302(c)

• Category Counted: patients
• Denominator criteria: encounter
• Numerator criteria: at least one medical problem or explicitly 'no medical problems' entered for patient

2. Maintain active medication list. 170.302(d)

• Category Counted: patients
• Denominator criteria: encounter
• Numerator criteria: at least one medication or explicitly 'no medications' entered for patient

3. Maintain active medication allergy list. 170.302(e)

• Category Counted: patients
• Denominator criteria: encounter
• Numerator criteria: at least one allergy or explicitly 'no allergies' entered for patient

4. Record and chart changes in vital signs. 170.302(f)

• Category Counted: patients
• Denominator criteria: encounter
• Numerator criteria: ensure a weight, height, bp, and BMI are entered for patient

5. Record smoking status for patients 13 years old or older. 170.302(g)

• Category Counted: patients
• Denominator criteria: encounter and age >= 13
• Numerator criteria: smoking status is entered for patient

6.Incorporate clinical lab-test results into certified EHR technology as structured data. 170.302(h)

• Category Counted: labs
• Denominator criteria: none (equals number of all lab results, both electronic and manual)
• Numerator criteria: none (equals only number of electronic lab results)

7. The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. 170.302(j)

• Category Counted: transitions-in
• Denominator criteria: none (equals number of instances a medication reconciliation is applicable)
• Numerator criteria: Medication Reconciliation completed for patient

8. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. 170.302(m)

• Category Counted: patients
• Denominator criteria: encounter
• Numerator criteria: patient specific education provided to patient

9. Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. 170.304(a)

• Category Counted: patients
• Denominator criteria:
• Numerator criteria:

10. Generate and transmit permissible prescriptions electronically. 170.304(b)

• Category Counted: prescriptions
• Denominator criteria:
• Numerator criteria:

11. Record demographics. 170.304(c)

• Category Counted: patients
• Denominator criteria:
• Numerator criteria:

12. Send reminders to patients per patient preference for preventive/follow up care. 170.304(d)

• Category Counted: patients
• Denominator criteria:
• Numerator criteria:

13. Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request. 170.304(f)

• Category Counted: patients
• Denominator criteria:
• Numerator criteria:

14. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP. 170.304(g)

• Category Counted: patients
• Denominator criteria:
• Numerator criteria:

15. Provide clinical summaries for patients for each office visit. 170.304(h)

• Category Counted: encounters
• Denominator criteria:
• Numerator criteria:

16. The EP, eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral. 170.304(i)

• Category Counted: transitions-out
• Denominator criteria:
• Numerator criteria:

AMC Measures Tracking Mechanisms

Some of the measures had new tracking mechanisms built into OpenEMR:

1. Incorporate clinical lab-test results into certified EHR technology as structured data. 170.302(h)

• Need to manually enter the non-electronic labs in the report at Reports->Clinical->Automated Measures (AMC)

2. The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. 170.302(j)

• Clickable entry placed in main encounter screen

3. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. 170.302(m)

• Clickable entry placed in main encounter screen

4. Generate and transmit permissible prescriptions electronically. 170.304(b)

• Clickable entry placed in prescription editing screen

5. Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request. 170.304(f)

• The request can be submitted from the Patient/Client->Records->Patient Record Request page.
• The request can be tracked on the Reports->Clinic->AMC Tracking page.

6. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP. 170.304(g)

• Note it relies on the existance of a patient portal
• New Patient Portal Authorization in the patient demographics->Choices section.
• New column in the patient_data table to hold the Patient Portal Authorization.

7. Provide clinical summaries for patients for each office visit. 170.304(h)

• Clickable entry placed in main encounter screen
• Can be tracked at Reports->Clinic->AMC Tracking

8. The EP, eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral. 170.304(i)

• Clickable entry placed in Patient Transactions
• Can be tracked at Reports->Clinic->AMC Tracking

Potential Issues

• Note the per-provider patient selection algorithm above may not be correct, and may need to instead look for existing encounters (form_encounter mysql table; both the provider_id and supervisor_id columns; note date possibly more accurately mapped to mysql forms table) within the selected dates.
• Potential issue that a provider must be explicitly involved in the action if they have contact (ie. an encounter) with a patient. From a clinical common sense meaningful use standpoint, this seems awkward to me. For example, if a patient usually sees doctor A, but one day sees doctor B for a specific complaint, such as a headache; is doctor B:

• now responsible for explicitly entering his/her own smoking status, allergies, CPOE prescription, complete vital signs including BMI, complete problem list, etc?
• or is it simply important that it has already been charted by doctor A previously. For example, if smoking history was charted a month ago by doctor A, is it really meaningful that doctor B also charts/records it.