MU Stage1 Final Rule - Record and Chart Vital Signs

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

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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 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.

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

Here is the current documentation, which is sparse.

Pediatric Growth Charts

wget http://downloads.sourceforge.net/phpgrowthcharts/php-growth-charts-1.1.zip wget http://downloads.sourceforge.net/phpgrowthcharts/php-growth-charts-1.1.tar.gz

As root: apt-get install apache2 apt-get install php5 php5-gd php5-cli php5-common libapache2-mod-php5 cd /etc/apache2/mods-enabled cp /etc/apache2/mods-available/php5.conf /etc/apache2/mods-enabled/ cp /etc/apache2/mods-available/php5.load /etc/apache2/mods-enabled/ /etc/init.d/apache2 restart

If you don't have this directory, make it and unpack the attached file into it

truetype.tgz

/usr/X11R6/lib/X11/fonts/

Now that Apache is in, check to see if you can connect to your server and get a report that says "It Works". 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.

Now, for Debian, become root and load up the PHP Growth Chart application

cd /var/www mkdir PGC cd PGC cp /home/user/php-growth-charts-1.1.tar.gz ./ tar -xzvf php-growth-charts-1.1.tar.gz php-growth-charts-1.1.tar.gz

To make this all work with ssl (i.e., https) instead on a port that will not interfere with the java application server for GUI Registration

To enable ssl on Debian, with Apache2 installed which normally already has mod-ssl

run these commands to make a self signed key: You may use a commercial signer if you prefer. Create a private key

THERE ARE TWO WAYS TO DO IT BELOW:

FIRST WAY

Apache2 Server Key Commands

openssl genrsa -des3 -out server.key 1024 openssl req -new -x509 -nodes -sha1 -days 365 -key server.key -out server.crt

SECOND WAY

	$ openssl genrsa -des3 -out server.key 1024

If you want ot generate server.pem openssl rsa -in server.key -out server.pem but in my case, I don't

Create a self-signed Certificate (X509 structure) with the RSA key you just created (output will be PEM formatted):

       $ openssl req -new -x509 -nodes -sha1 -days 365 -key server.key -out server.crt

You should now have two files: server.key and server.crt. Note pass phrase on edu2 is worldvista257

The following files shoud be altered from the defaults

1. /etc/apach2/apache2.conf

Add the following lines at the end: DocumentRoot /var/www ServerAdmin webmaster@localhost

1. ServerName edu2.opensourcevista.net

SSLEngine On SSLCertificateFile /etc/apache2/server.crt SSLCertificateKeyFile /etc/apache2/server.key

2. The ports file. I chose a port other than 80 to avoid interfering with the GUI Registration Application Change Listen 80

Listen 9500

3. cp all of the files beginnig with ssl from /etc/apache2/mods-available/ to /etc/apache2/mods-enabled/

cp /etc/apache2/mods-available/ssl* /etc/apache/mods-enabled/

My mods-enabled directory now looks like this: /etc/apache2# ls mods-enabled/ alias.load authz_groupfile.load cgi.load mime.load setenvif.load auth_basic.load authz_host.load dir.conf negotiation.load ssl.conf authn_file.load authz_user.load dir.load php5.conf ssl.load authz_default.load autoindex.load env.load php5.load status.load

The apache2 directory when I am done looks like this, and the sites-enabled directory is empty.

/etc/apache2# ls -al total 100 drwxr-xr-x 7 root root 4096 Jul 15 22:14 . drwxr-xr-x 55 root root 4096 Jul 15 21:46 .. -rw-r----- 1 root root 0 Jul 15 02:12 = -rw-r----- 1 root root 24370 Jul 15 23:58 apache2.conf -rw-r----- 1 root root 24178 Jul 15 22:14 apache2.confBU drw-r----- 2 root root 4096 Jul 4 18:42 conf.d -rw-r----- 1 root root 895 Mar 27 12:58 envvars -rw-r----- 1 root root 0 Jul 15 22:11 httpd.conf drw-r----- 2 root root 4096 Jul 15 22:50 mods-available drw-r----- 2 root root 4096 Jul 15 23:59 mods-enabled -rw-r----- 1 root root 13 Jul 15 23:52 ports.conf -rw-r----- 1 root root 1391 Jul 15 04:24 server.crt -rw-r----- 1 root root 963 Jul 15 04:23 server.key drw-r----- 2 root root 4096 Jul 15 14:53 sites-available drw-r----- 2 root root 4096 Jul 15 21:57 sites-enabled

Install the PGCHTML.KID Then worldvista:~# gtm

GTM>S DUZ=9

GTM>D ^XUP

Setting up programmer environment This is a TEST account.

Terminal Type set to: C-VT320

Select OPTION NAME: GTM>D ^XPAREDIT

                        --- Edit Parameter Values ---

Select PARAMETER DEFINITION NAME: GMRV PED

    1   GMRV PED GROWTH CHART FOLDER     Pediatric Growth Chart Directory
    2   GMRV PED GROWTH CHART SERVER     Pediatric Growth Chart HTML Server

CHOOSE 1-2: 1 GMRV PED GROWTH CHART FOLDER Pediatric Growth Chart Directory

-- Setting GMRV PED GROWTH CHART FOLDER for System: BETA.VISTA-OFFICE.ORG -- Value: /var/www/PGC

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