Difference between revisions of "MU Stage1 Final Rule - Record and Chart Vital Signs"

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(updated NIST test script version number)
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(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)
 
(Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)
  
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There is a PHP based application already built for use with VistA but better documentation and installation instructions are needed. It is in use in Clinica Adelante and Nancy Anthracite is looking for volunteers to work on the documentation and updating the code packages it depends on if needed for PHP and JB chart, etc. The MUMPS code may need a KIDS build for the routines although they may already be in the package.  The BMI calculations needs to be check as there has been one report that they are not correct. One or more Volunteers is needed.  
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There is an all open source PHP based application already built for use with VistA. There is information and documentation at http://opensourcevista.net:8888/NancysVistAServer/PGC.
  
 
For international use, data files need to have the WHO data added and verified.  That is partially done but needs more work.
 
For international use, data files need to have the WHO data added and verified.  That is partially done but needs more work.
  
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Here is the current documentation, which is sparse.
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Once ePrescribing changes to CPRS that are necessary for Meaningful Use are done, changes will probably be made to the software to make it easier to install.
  
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Pediatric Growth Charts
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Kevin Toppenberg has also built a pediatric growth chart application which has one proprietary component that he has licensed on behalf of the community and runs only with the Internet Explorer browser and is easy to install.  
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wget http://downloads.sourceforge.net/phpgrowthcharts/php-growth-charts-1.1.zip
 
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wget http://downloads.sourceforge.net/phpgrowthcharts/php-growth-charts-1.1.tar.gz
 
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As root:
 
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apt-get install apache2
 
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apt-get install php5 php5-gd php5-cli php5-common libapache2-mod-php5
 
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cd /etc/apache2/mods-enabled
 
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cp /etc/apache2/mods-available/php5.conf  /etc/apache2/mods-enabled/
 
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cp /etc/apache2/mods-available/php5.load /etc/apache2/mods-enabled/
 
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/etc/init.d/apache2 restart 
 
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If you don't have this directory, make it and unpack the attached file into it
 
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truetype.tgz
 
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/usr/X11R6/lib/X11/fonts/
 
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Now that Apache is in, check to see if you can connect to your server and get a report that says "It Works".
 
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If not, check the error log in /var/log/apache2/error.log to see what the problem is.  Most likely, you need to open port 80 on you server or your ISP does not allow connections on port 80.
 
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Now, for Debian, become root and load up the PHP Growth Chart application
 
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cd /var/www
 
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mkdir PGC
 
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cd PGC
 
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cp /home/user/php-growth-charts-1.1.tar.gz ./
 
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tar -xzvf php-growth-charts-1.1.tar.gz
 
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php-growth-charts-1.1.tar.gz
 
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To make this all work with ssl (i.e., https) instead
 
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on a port that will not interfere with the java application server for GUI Registration
 
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To enable ssl on Debian, with Apache2 installed which normally already has mod-ssl
 
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run these commands to make a self signed key: You may use a commercial signer if you prefer.
 
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Create a private key
 
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THERE ARE TWO WAYS TO DO IT BELOW:
 
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FIRST WAY
 
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Apache2 Server Key Commands
 
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openssl genrsa -des3 -out server.key 1024
 
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openssl req -new -x509 -nodes -sha1 -days 365 -key server.key -out server.crt
 
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SECOND WAY
 
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$ openssl genrsa -des3 -out server.key 1024
 
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If you want ot  generate server.pem
 
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openssl rsa -in server.key -out server.pem but in my case, I don't
 
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Create a self-signed Certificate (X509 structure) with the RSA key you just created (output will be PEM formatted):
 
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        $ openssl req -new -x509 -nodes -sha1 -days 365 -key server.key -out server.crt
 
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You should now have two files: server.key and server.crt.  Note pass phrase on edu2 is worldvista257
 
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The following files shoud be altered from the defaults
 
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1.  /etc/apach2/apache2.conf
 
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Add the following lines at the end:
 
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DocumentRoot /var/www
 
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ServerAdmin webmaster@localhost
 
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#ServerName edu2.opensourcevista.net
 
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SSLEngine On
 
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SSLCertificateFile /etc/apache2/server.crt
 
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SSLCertificateKeyFile /etc/apache2/server.key
 
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2. The ports file.  I chose a port other than 80 to avoid interfering with the GUI Registration Application
 
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Change Listen 80
 
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Listen 9500
 
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3. cp all of the files beginnig with ssl from  /etc/apache2/mods-available/ to /etc/apache2/mods-enabled/
 
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cp /etc/apache2/mods-available/ssl* /etc/apache/mods-enabled/
 
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My mods-enabled directory now looks like this:
 
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/etc/apache2# ls mods-enabled/
 
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alias.load          authz_groupfile.load  cgi.load  mime.load        setenvif.load
 
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auth_basic.load    authz_host.load      dir.conf  negotiation.load  ssl.conf
 
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authn_file.load    authz_user.load      dir.load  php5.conf        ssl.load
 
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authz_default.load  autoindex.load        env.load  php5.load        status.load
 
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The apache2 directory when I am done looks like this, and the sites-enabled directory is empty.
 
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/etc/apache2# ls -al
 
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total 100
 
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drwxr-xr-x  7 root root  4096 Jul 15 22:14 .
 
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drwxr-xr-x 55 root root  4096 Jul 15 21:46 ..
 
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-rw-r-----  1 root root    0 Jul 15 02:12 =
 
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-rw-r-----  1 root root 24370 Jul 15 23:58 apache2.conf
 
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-rw-r-----  1 root root 24178 Jul 15 22:14 apache2.confBU
 
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drw-r-----  2 root root  4096 Jul  4 18:42 conf.d
 
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-rw-r-----  1 root root  895 Mar 27 12:58 envvars
 
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-rw-r-----  1 root root    0 Jul 15 22:11 httpd.conf
 
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drw-r-----  2 root root  4096 Jul 15 22:50 mods-available
 
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drw-r-----  2 root root  4096 Jul 15 23:59 mods-enabled
 
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-rw-r-----  1 root root    13 Jul 15 23:52 ports.conf
 
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-rw-r-----  1 root root  1391 Jul 15 04:24 server.crt
 
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-rw-r-----  1 root root  963 Jul 15 04:23 server.key
 
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drw-r-----  2 root root  4096 Jul 15 14:53 sites-available
 
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drw-r-----  2 root root  4096 Jul 15 21:57 sites-enabled
 
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Install the PGCHTML.KID
 
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Then
 
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worldvista:~# gtm
 
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GTM>S DUZ=9
 
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GTM>D ^XUP
 
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Setting up programmer environment
 
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This is a TEST account.
 
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Terminal Type set to: C-VT320
 
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Select OPTION NAME:
 
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GTM>D ^XPAREDIT
 
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                        --- Edit Parameter Values ---
 
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Select PARAMETER DEFINITION NAME: GMRV PED
 
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    1  GMRV PED GROWTH CHART FOLDER    Pediatric Growth Chart Directory
 
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    2  GMRV PED GROWTH CHART SERVER    Pediatric Growth Chart HTML Server
 
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CHOOSE 1-2: 1  GMRV PED GROWTH CHART FOLDER  Pediatric Growth Chart Directory
 
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-- Setting GMRV PED GROWTH CHART FOLDER  for System: BETA.VISTA-OFFICE.ORG --
 
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Value: /var/www/PGC
 
  
 +
WorldVistA will probably use Kevin's solution at least until ePrescribing is released and installation of the first solution gets easier.
  
 
'''DEPENDENCIES'''
 
'''DEPENDENCIES'''

Revision as of 03:11, 16 December 2010

SECTION # ' Section 170.302(e)—Record and Chart Vital Signs

MU OBJECTIVE Record and chart changes in vital signs: - Height - Weight - Blood pressure - Calculate and display BMI (Plot and display growth charts for children 2-20 years, including BMI)

MU STAGE 1 MEASURE For more than 50% of all unique patients age 2 and over seen by the EP or admitted to eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23), height, weight and blood pressure are recorded as structured data

CERTIFICATION CRITERION Interim Final Rule Text: (1)Vital signs. Enable a user to electronically record, modify, and retrieve a patient’s vital signs including, at a minimum, the height, weight, blood pressure, temperature, and pulse. (2)Calculate body mass index. Automatically calculate and display body mass index (BMI) based on a patient’s height and weight. (3) Plot and display growth charts. Plot and electronically display, upon request, growth charts for patients 2–20 years old. Final Rule Text: §170.302(f). (1)Vital signs. Enable a user to electronically record, modify, and retrieve a patient’s vital signs including, at a minimum, height, weight, and blood pressure. (2) Unchanged (3) Unchanged

STANDARDS N/A

TEST CRITERIA # §170.302 (f)
http://healthcare.nist.gov/docs/170.302.f.1_vitalsigns_v1.1.pdf
http://healthcare.nist.gov/docs/170.302.f.2_BMI_v1.1.pdf
http://healthcare.nist.gov/docs/170.302.f.3_growthcharts_v1.1.pdf

USERS CORE / MENU SOLUTION DEVELOPERS STATUS
All CORE TBD TBD

SOLUTION DESIGN / TECHNOLOGY (Add details here)

SOLUTION COMPONENTS (Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

There is an all open source PHP based application already built for use with VistA. There is information and documentation at http://opensourcevista.net:8888/NancysVistAServer/PGC.

For international use, data files need to have the WHO data added and verified. That is partially done but needs more work.

Once ePrescribing changes to CPRS that are necessary for Meaningful Use are done, changes will probably be made to the software to make it easier to install.

Kevin Toppenberg has also built a pediatric growth chart application which has one proprietary component that he has licensed on behalf of the community and runs only with the Internet Explorer browser and is easy to install.

WorldVistA will probably use Kevin's solution at least until ePrescribing is released and installation of the first solution gets easier.

DEPENDENCIES (Add details here)

COMMENTS / NOTES (Add details here)

PREVIOUS NOTES (none)

DEVELOPMENT STATUS (Add details here)

ACTION ITEMS / NEXT STEPS (Add details here)

OPEN ISSUES / QUESTIONS (Add details here)

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