Clinical Decision Rule

MU Requirements

Meaningful Use Measures:

Implement 5 clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II(A)(3).

Certification Criteria for EHR:

1. Implement automated, electronic clinical decision support rules (in addition to drug-drug and drug-allergy contraindication checking) according to specialty or clinical priorities that use demographic data, specific patient diagnoses, conditions, diagnostic test results and/or patient medication list.

2. Automatically and electronically generate and indicate (e.g., pop-up message or sound) in realtime, alerts and care suggestions based upon clinical decision support rules and evidence grade.

3. Automatically and electronically track, record, and generate reports on the number of alerts responded to by a user.

From CCHIT:

1. AM 35.01 The system shall provide the ability to update the clinical content or rules utilized to generate clinical decision support reminders and alerts. "Growth charts, CPT-4 codes, drug interactions would be an example. Any method of updating would be acceptable. Content could be third party or customer created."

2. AM 23.09 The system shall provide the ability to automatically generate reminder letters for patients who are due or are overdue for disease management, preventive or wellness services. "The term 'automatically' means that the system is able to generate patient recalls for all due or overdue reminders for an individual patient based on the current date, regardless of whether a user initiates this action, or if the action is triggered by pre-set parameters in the system. An example would be generating a letter to all patients overdue for a screening mammography. It is acceptable if the output allows generation of letters, such as a mail merge file."

See Patient Reminders for specifications.

Proposed Solution

1. Create a health plan management system for adding health maintenance (preventive services), disease management, and wellness plans.

2. The provider can assign any health plan to any patient. Here are some of the pre-built health plans:

3. The provider can also do a group assignment by rule, e.g. all women between 30 and 50 years old.

4. CKEditor or Word (MS/OpenOffice) will be integrated for managing the email and letter templates.

5. Create a rule-based patient alert system for #1. The alerts are for screen display.

Effected Code, Tables, etc

1. Here's a proposal on the tables needed:

Proposed CDR Tables

In addition to meeting the MU requirements here, we also take into consideration of the CMS Quality Reporting MU requirements.

Owner and Status

Thomas Wong

Status as of 1/22/2010: 78% completed, finalizing clinical alerts

Links

• CCHIT_MU_2011_Project
• OpenEMR Office Visit Workflow
• U.S. Preventive Services Task Force: http://www.ahrq.gov/CLINIC/uspstfix.htm
• Associated with Sourceforge forum thread: http://sourceforge.net/projects/openemr/forums/forum/202506/topic/3494342
• Associated with Sourceforge forum thread: http://sourceforge.net/projects/openemr/forums/forum/202506/topic/3531568 (although this is a clinical reminder thread, there is discussion here related to clinical decision rules, health plans, and clinical alerts)