NHANES data in LibreEHR

@rhoyt I don’t code in php and I am unaware of the EHR codebase but I plan on spending some time in the next week reviewing the educational content … I would also like to see some radiology data integrated in there …

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We need to network together. For the fun of it, because Jimmy Jennings has the diagnosis of COPD I uploaded a stereotypical chest xray under documents, along with a fake radiology report. With your help I know we can do better

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An “issue type” for surgeries exists, but isn’t enabled by default when the EHR is installed. I’ve turned it on now for the demo site.

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Thanks. Nice to have that feature enabled. I just added 16 common surgeries to the drop down list. I did note that I can add an ICD-10 to these surgeries, which is good. In spite of adding a date for surgeries and allergies, the dates don’t show up on the summary sheet (unless you type appendectomy 1960) in the first box).

We should put on our future to do list to import allergies and immunizations, in order to populate the patient summary

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I have two pretty complete patients that could be used for teaching

  1. Jimmy Jennings. I added more demographics I got from synthetic data. I dictated an encounter note and added two images under documents
  2. Everett Monroe. Added some demographics, surgeries, allergies, patient encounter note and EKG under documents.

As an educational team it would be good to have a cadre of maybe 20 complete patients (adult men and women and children). Please let me know your opinions

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I think 20 complete patients would be amazing… I think two are fine too. We need additional material that can put the student/instructor in motion. Lets discuss this further on the other thread that @yehster started - Educational Goals

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OK. Here is a pack of forms covering some 23 clinical area such as AOE, Sinusitis, Diabetes, etc… Nothing in the EHR_Forms repo has been merged yet, as I recently started the repo and have been adding things to it…and have not had any reviews or anything yet. These forms essentially have a single purpose, and that is to add outcome codes to a patient’s billing records. The importance of the forms is that they collate and represent clinically related stratum at the patient-centric level. Seeing as how there is a current interest in expanding fake/redacted data sets and fleshing them out, I though this might be useful as either a way to input reportable empirical data points, or to provide reference line items that someone may want to use as a checklist of sorts when adding patient encounters and narratives. With these data elements added, further scripts could be run to add matching boilerplate narratives to clinical forms. These forms were created by my company, (author bclee) by a script consuming tables of data. They are therefore pretty cookie-cutter and basic, but they do the job. For fleshing out clinical data, we need recommendations for more forms (production or research quality) that have specific visit/procedure types, and contain both narrative elements, as well as easily reportable empirical data elements from enumerated code lists.

I added the NHANES Demo site to the demos page.

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I meet with Sam at the OSEHRA Summit and he is very interested in this project. I have encouraged him sign up and join the converation.

–Sam Habiel, Pharm.D. habiels@osehra.org Technical Fellow Open Source Electronic Health Records Alliance (OSEHRA)

He offers the following:

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Are these templates to use for a visit for e.g. diabetes? If so, how can I see a few?

BTW, I see that my student on his own began a simple PDF with screen shots. This might be adequate if he hits all of the high points EHR Tutorial (Pages).pdf (323.3 KB)

These are data entry forms that allow you to enter various outcome/status codes (reportable) for items in related NQF standards. Simple (brutal actually) but with a bit of help text included. Sample here: http://suncoastconnection.com/Downloads/index.html

So these are electronic clinical quality measures (eCQMs)? They are probably valuable for some of our clinical instructors. I am assuming that they would be part of the newer value based reimbursement by MACRA docs will be using instead of meaningful use stage 3. I’ll have to defer this to others and will bounce this off a HIM instructor today for feedback

These are created off of the 2016 PQRS Group Measures. We used these for the few folks that couldn’t get the idea that they could enter a list of patients that had a measure value easier than they could enter data for all measures patient-by-patient. They really are not that outdated in basic content. We have all the 243 registry/claim measure calculations/weighting/benchmarking for 2017 MIPS/MACRA QPP stuff, but we are trying to earn money off of those at the moment.

I bet you know more about MPP than I do but wonder if we might be able to borrow just one of these sheets for e.g. diabetes. Throughout all of the tutorials, I will probably focus on chronic disease, specifically diabetes. I would not want to do anything to interfere with your income from these forms

These forms are last-year’s cast-offs. These are all in a Librehealth repo (pull request branch only…no-one seems to be interested in doing reviews/merging there.)

Ok. I have created a go-by for an instructors and students user guide, organized around the menu features. This is just an outline so the steps and screen shots will have to be created by the student.

I’m now going to work on the exercises that hopefully will appeal to a broad audience of clinical and non-clinical students. At first blush, here are a few ideas about advanced functionality we could use to create more cognitive exercises. Please add to this list (aimed at graduate HI students primarily)

  1. Clinical Decision Rules (CDRs) a. Menu >> Administration >> Rules b. Current clinical decision rules are listed for the clinic c. Click on the first rule “Adult Weight Screening and Follow Up”. You can edit the reminder interval, edit the demographic filter, edit the clinical targets and actions d. Plans Configuration e. Click on first (Go button): Select the preventive care plan and you find 11 rules to generate reminders. Select the Diabetes Mellitus plan and you find 4 rules f. Add rule. Go to ePSS web site for ideas based on national recommendations
  2. Electronic clinical quality measures (eCQMs)
  3. Generating a HL7 message for a lab request
  4. Generating a C-CDA to send as a patient summary to a consultant
  5. Patient Portals
  6. Generating Clinic Reports
  7. Analytics?

Is there a way to change the default FROM date in the reports section to a time prior to December 31 2016? The lab work (NHANES Panel) has the default date of December 31 2016, so if students run a query with a date after that they will not get results.

I’ve updated NHANES to run as a site of ehr; this involves no change other and the old subdomain will continue to work.

You can now access it in two ways:

and preferably use:

This will work until I get around to moving EHR to rackspace, at which time the only way to access it will be the latter.

@yehster,

Old db dumps now can be accessed via: https://ehr.librehealth.io/downloads/nhanes/

and are in /opt/ehr/downloads/nhanes

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@yehster, I can see a few downloads on the link - https://ehr.librehealth.io/downloads/nhanes/ Which one is the final one that should be used for a new setup?