///<summary>Only called from FormEHR to load the patient specific MU data and tell the user what action to take to get closer to meeting MU.</summary>
public static List<EhrMu> GetMu(Patient pat) {
if(RemotingClient.RemotingRole==RemotingRole.ClientWeb) {
return Meth.GetObject<List<EhrMu>>(MethodBase.GetCurrentMethod(),pat);
}
List<EhrMu> list=new List<EhrMu>();
//add one of each type
EhrMu mu;
string explanation;
List<EhrMeasure> retVal=GetMUList();
List<MedicationPat> medList=MedicationPats.Refresh(pat.PatNum,true);
List<EhrMeasureEvent> listMeasureEvents=EhrMeasureEvents.Refresh(pat.PatNum);
List<RefAttach> listRefAttach=RefAttaches.Refresh(pat.PatNum);
for(int i=0;i<retVal.Count;i++) {
mu=new EhrMu();
mu.Met=MuMet.False;
mu.MeasureType=retVal[i].MeasureType;
switch(mu.MeasureType) {
#region ProblemList
case EhrMeasureType.ProblemList:
List<Disease> listDisease=Diseases.Refresh(pat.PatNum);
int validDiseaseCount=0;
if(listDisease.Count==0){
mu.Details="No problems entered.";
}
else{
bool diseasesNone=false;
if(listDisease.Count==1 && listDisease[0].DiseaseDefNum==PrefC.GetLong(PrefName.ProblemsIndicateNone)){
diseasesNone=true;
}
if(diseasesNone){
mu.Met=MuMet.True;
mu.Details="Problems marked 'none'.";
}
else{
for(int m=0;m<listDisease.Count;m++) {
DiseaseDef diseaseCur=DiseaseDefs.GetItem(listDisease[m].DiseaseDefNum);
if(diseaseCur.ICD9Code=="" && diseaseCur.SnomedCode=="") {
continue;
}
validDiseaseCount++;
}
if(validDiseaseCount==0) {
mu.Details="No problems with ICD-9 or Snomed code entered.";
}
else {
mu.Met=MuMet.True;
mu.Details="Problems with ICD-9 or Snomed code entered: "+validDiseaseCount.ToString();
}
}
}
mu.Action="Enter problems";
break;
#endregion
#region MedicationList
case EhrMeasureType.MedicationList:
if(medList.Count==0) {
mu.Details="No medications entered.";
}
else{
mu.Met=MuMet.True;
bool medsNone=false;
if(medList.Count==1 && medList[0].MedicationNum==PrefC.GetLong(PrefName.MedicationsIndicateNone)) {
medsNone=true;
}
if(medsNone) {
mu.Details="Medications marked 'none'.";
}
else{
mu.Details="Medications entered: "+medList.Count.ToString();
}
}
mu.Action="Enter medications";
break;
#endregion
#region AllergyList
case EhrMeasureType.AllergyList:
List<Allergy> listAllergies=Allergies.Refresh(pat.PatNum);
if(listAllergies.Count==0) {
mu.Details="No allergies entered.";
}
else{
mu.Met=MuMet.True;
bool allergiesNone=false;
if(listAllergies.Count==1 && listAllergies[0].AllergyDefNum==PrefC.GetLong(PrefName.AllergiesIndicateNone)) {
allergiesNone=true;
}
if(allergiesNone) {
mu.Details="Allergies marked 'none'.";
}
else{
mu.Details="Allergies entered: "+listAllergies.Count.ToString();
}
}
mu.Action="Enter allergies";
break;
#endregion
#region Demographics
case EhrMeasureType.Demographics:
explanation="";
if(pat.Birthdate.Year<1880) {
explanation+="birthdate";//missing
}
if(pat.Language=="") {
if(explanation!="") {
explanation+=", ";
}
explanation+="language";
}
if(pat.Gender==PatientGender.Unknown) {
if(explanation!="") {
explanation+=", ";
}
explanation+="gender";
}
if(PatientRaces.GetForPatient(pat.PatNum).Count==0) {
if(explanation!="") {
explanation+=", ";
}
explanation+="race, ethnicity";
}
if(explanation=="") {
mu.Details="All demographic elements recorded";
mu.Met=MuMet.True;
}
else {
mu.Details="Missing: "+explanation;
}
mu.Action="Enter demographics";
break;
#endregion
#region Education
case EhrMeasureType.Education:
List<EhrMeasureEvent> listEd=EhrMeasureEvents.RefreshByType(pat.PatNum,EhrMeasureEventType.EducationProvided);
if(listEd.Count==0) {
mu.Details="No education resources provided.";
}
else {
mu.Details="Education resources provided: "+listEd.Count.ToString();
mu.Met=MuMet.True;
}
mu.Action="Provide education resources";
break;
#endregion
#region TimelyAccess
case EhrMeasureType.TimelyAccess:
List<EhrMeasureEvent> listOnline=EhrMeasureEvents.RefreshByType(pat.PatNum,EhrMeasureEventType.OnlineAccessProvided);
if(listOnline.Count==0) {
mu.Details="No online access provided.";
}
else {
mu.Details="Online access provided: "+listOnline[listOnline.Count-1].DateTEvent.ToShortDateString();//most recent
mu.Met=MuMet.True;
}
mu.Action="Provide online Access";
break;
#endregion
#region ProvOrderEntry
case EhrMeasureType.ProvOrderEntry:
//int medOrderCount=0;
int medOrderCpoeCount=0;
for(int mo=0;mo<medList.Count;mo++){
//if(medList[mo].DateStart.Year>1880 && medList[mo].PatNote!=""){
if(medList[mo].IsCpoe){
medOrderCpoeCount++;
}
}
if(medList.Count==0) {
mu.Met=MuMet.NA;
mu.Details="No meds.";
}
else if(medOrderCpoeCount==0) {
mu.Details="No medication order in CPOE.";
}
else {
mu.Details="Medications entered in CPOE: "+medOrderCpoeCount.ToString();
mu.Met=MuMet.True;
}
mu.Action="(edit Rxs from Chart)";
break;
#endregion
#region CPOE_MedOrdersOnly
case EhrMeasureType.CPOE_MedOrdersOnly:
int medOrderCount=0;
medOrderCpoeCount=0;
for(int m=0;m<medList.Count;m++) {
//Using the last year as the reporting period, following pattern in ElectronicCopy, ClinicalSummaries, Reminders...
if(medList[m].DateStart<DateTime.Now.AddYears(-1)) {//either no start date so not an order, or not within the last year so not during the reporting period
continue;
}
else if(medList[m].PatNote!="" && medList[m].ProvNum==pat.PriProv) {//if there's a note and it was created by the patient's PriProv, then count as order created by this provider and would count toward the denominator for MU
medOrderCount++;
if(medList[m].IsCpoe) {//if also marked as CPOE, then this would count in the numerator of the calculation MU
medOrderCpoeCount++;
}
}
}
if(medOrderCount==0) {
mu.Details="No medication order in CPOE.";
}
else {
mu.Details="Medications entered in CPOE: "+medOrderCount.ToString();
mu.Met=MuMet.True;
}
mu.Action="(edit Rxs from Chart)";
break;
#endregion
#region CPOE_PreviouslyOrdered
case EhrMeasureType.CPOE_PreviouslyOrdered:
//first determine if this patient has ever had a medication ordered by this Provider
bool prevOrderExists=false;
for(int m=0;m<medList.Count;m++) {
//if this is an order (defined as having instructions and a start date) and was entered by this provider, then this pat will be counted in the denominator
if(medList[m].PatNote!="" && medList[m].DateStart.Year>1880 && medList[m].ProvNum==pat.PriProv) {
prevOrderExists=true;
break;
}
}
medOrderCpoeCount=0;
for(int mo=0;mo<medList.Count;mo++){
if(medList[mo].IsCpoe){
medOrderCpoeCount++;
}
}
if(medList.Count==0) {
mu.Met=MuMet.NA;
mu.Details="No meds.";
}
else if(!prevOrderExists) {
mu.Met=MuMet.NA;
mu.Details="No previous medication orders by this Provider.";
}
else if(medOrderCpoeCount==0) {
mu.Details="No medication order in CPOE.";
}
else {
mu.Details="Medications entered in CPOE: "+medOrderCpoeCount.ToString();
mu.Met=MuMet.True;
}
mu.Action="(edit Rxs from Chart)";
break;
#endregion
#region Rx
case EhrMeasureType.Rx:
List<RxPat> listRx=RxPats.GetPermissableForDateRange(pat.PatNum,DateTime.Today.AddYears(-1),DateTime.Today);
if(listRx.Count==0){
mu.Met=MuMet.NA;
mu.Details="No Rxs entered.";
}
else{
explanation="";
for(int rx=0;rx<listRx.Count;rx++) {
if(listRx[rx].SendStatus==RxSendStatus.SentElect){
continue;
}
if(explanation!="") {
explanation+=", ";
}
explanation+=listRx[rx].RxDate.ToShortDateString();
}
if(explanation=="") {
mu.Met=MuMet.True;
mu.Details="All Rxs sent electronically.";
}
else {
mu.Met=MuMet.False;
mu.Details="Rxs not sent electronically: "+explanation;
}
}
mu.Action="(edit Rxs from Chart)";//no action
break;
#endregion
#region VitalSigns
case EhrMeasureType.VitalSigns:
List<Vitalsign> vitalsignList=Vitalsigns.Refresh(pat.PatNum);
if(vitalsignList.Count==0) {
mu.Details="No vital signs entered.";
}
else {
bool hFound=false;
bool wFound=false;
bool bpFound=false;
for(int v=0;v<vitalsignList.Count;v++) {
if(vitalsignList[v].Height>0) {
hFound=true;
}
if(vitalsignList[v].Weight>0) {
wFound=true;
}
if(pat.Birthdate>DateTime.Today.AddYears(-3) //3 and older for BP
|| (vitalsignList[v].BpDiastolic>0 && vitalsignList[v].BpSystolic>0)) {
bpFound=true;
}
}
explanation="";
if(!hFound) {
explanation+="height";//missing
}
if(!wFound) {
if(explanation!="") {
explanation+=", ";
}
explanation+="weight";
}
if(!bpFound) {
if(explanation!="") {
explanation+=", ";
}
explanation+="blood pressure";
}
if(explanation=="") {
mu.Details="Vital signs entered";
mu.Met=MuMet.True;
}
else {
mu.Details="Missing: "+explanation;
}
}
mu.Action="Enter vital signs";
break;
#endregion
#region VitalSigns2014
case EhrMeasureType.VitalSigns2014:
List<Vitalsign> vitalsignList2014=Vitalsigns.Refresh(pat.PatNum);
if(vitalsignList2014.Count==0) {
mu.Details="No vital signs entered.";
}
else {
bool hFound=false;
bool wFound=false;
bool bpFound=false;
for(int v=0;v<vitalsignList2014.Count;v++) {
if(vitalsignList2014[v].Height>0) {
hFound=true;
}
if(vitalsignList2014[v].Weight>0) {
wFound=true;
}
if(pat.Birthdate>DateTime.Today.AddYears(-3) //3 and older for BP
|| (vitalsignList2014[v].BpDiastolic>0 && vitalsignList2014[v].BpSystolic>0)) {
bpFound=true;
}
}
explanation="";
if(!hFound) {
explanation+="height";//missing
}
if(!wFound) {
if(explanation!="") {
explanation+=", ";
}
explanation+="weight";
}
if(!bpFound) {
if(explanation!="") {
explanation+=", ";
}
explanation+="blood pressure";
}
if(explanation=="") {
mu.Details="Vital signs entered";
mu.Met=MuMet.True;
}
else {
mu.Details="Missing: "+explanation;
}
}
mu.Action="Enter vital signs";
break;
#endregion
#region VitalSignsBMIOnly
case EhrMeasureType.VitalSignsBMIOnly:
vitalsignList=Vitalsigns.Refresh(pat.PatNum);
if(vitalsignList.Count==0) {
mu.Details="No vital signs entered.";
}
else {
bool hFound=false;
bool wFound=false;
for(int v=0;v<vitalsignList.Count;v++) {
if(vitalsignList[v].Height>0) {
hFound=true;
}
if(vitalsignList[v].Weight>0) {
wFound=true;
}
}
explanation="";
if(!hFound) {
explanation+="height";//missing
}
if(!wFound) {
if(explanation!="") {
explanation+=", ";
}
explanation+="weight";
}
if(explanation=="") {
mu.Details="Vital signs entered";
mu.Met=MuMet.True;
}
else {
mu.Details="Missing: "+explanation;
}
}
mu.Action="Enter vital signs";
break;
#endregion
#region VitalSignsBPOnly
case EhrMeasureType.VitalSignsBPOnly:
vitalsignList=Vitalsigns.Refresh(pat.PatNum);
if(pat.Birthdate>DateTime.Today.AddYears(-3)) {//3 and older for BP
mu.Details="Age 3 and older for BP.";
mu.Met=MuMet.NA;
}
else if(vitalsignList.Count==0) {
mu.Details="No vital signs entered.";
}
else {
for(int v=0;v<vitalsignList.Count;v++) {
if(vitalsignList[v].BpDiastolic>0 && vitalsignList[v].BpSystolic>0) {
mu.Details="Vital signs entered";
mu.Met=MuMet.True;
}
else {
mu.Details="Missing: blood pressure";
}
}
}
mu.Action="Enter vital signs";
break;
#endregion
#region Smoking
case EhrMeasureType.Smoking:
if(pat.SmokingSnoMed=="") {//None
mu.Details="Smoking status not entered";
}
else {
mu.Details="Smoking status entered";
mu.Met=MuMet.True;
}
mu.Action="Edit smoking status";
break;
#endregion
#region Lab
case EhrMeasureType.Lab:
List<EhrLab> listLabOrders=EhrLabs.GetAllForPatInDateRange(pat.PatNum,DateTime.Today.AddYears(-1),DateTime.Today);
if(listLabOrders.Count==0) {
mu.Details="No lab orders";
mu.Met=MuMet.NA;
}
else {
int labResultCount=0;
for(int lo=0;lo<listLabOrders.Count;lo++) {
List<EhrLabResult> listLabResults=EhrLabResults.GetForLab(listLabOrders[lo].EhrLabNum);
if(listLabResults.Count>0) {
labResultCount++;
continue;//Only need one per lab order
}
}
if(labResultCount<listLabOrders.Count) {
mu.Met=MuMet.False;
mu.Details="Lab orders missing results: "+(listLabOrders.Count-labResultCount).ToString();
}
else {
mu.Details="Lab results entered for each lab order.";
mu.Met=MuMet.True;
}
}
mu.Action="Edit labs";
break;
#endregion
#region ElectronicCopy
case EhrMeasureType.ElectronicCopy:
List<EhrMeasureEvent> listRequests=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.ElectronicCopyRequested);
List<EhrMeasureEvent> listRequestsPeriod=new List<EhrMeasureEvent>();
for(int r=0;r<listRequests.Count;r++) {
if(listRequests[r].DateTEvent < DateTime.Now.AddYears(-1)) {//not within the last year
continue;
}
listRequestsPeriod.Add(listRequests[r]);
}
if(listRequestsPeriod.Count==0) {
mu.Met=MuMet.NA;
mu.Details="No requests within the last year.";
}
else {
int countMissingCopies=0;
bool copyProvidedinTime;
List<EhrMeasureEvent> listCopiesProvided=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.ElectronicCopyProvidedToPt);
for(int rp=0;rp<listRequestsPeriod.Count;rp++) {
copyProvidedinTime=false;
DateTime deadlineDateCopy=listRequestsPeriod[rp].DateTEvent.Date.AddDays(3);
if(listRequestsPeriod[rp].DateTEvent.DayOfWeek==DayOfWeek.Wednesday
|| listRequestsPeriod[rp].DateTEvent.DayOfWeek==DayOfWeek.Thursday
|| listRequestsPeriod[rp].DateTEvent.DayOfWeek==DayOfWeek.Friday)
{
deadlineDateCopy.AddDays(2);//add two days for the weekend
}
for(int cp=0;cp<listCopiesProvided.Count;cp++) {
if(listCopiesProvided[cp].DateTEvent.Date > deadlineDateCopy) {
continue;
}
if(listCopiesProvided[cp].DateTEvent.Date < listRequestsPeriod[rp].DateTEvent.Date) {
continue;
}
copyProvidedinTime=true;
}
if(!copyProvidedinTime) {
countMissingCopies++;
}
}
if(countMissingCopies==0) {
mu.Met=MuMet.True;
mu.Details="Electronic copy provided to Pt within 3 business days of each request.";
}
else {
mu.Met=MuMet.False;
mu.Details="Electronic copies not provided to Pt within 3 business days of a request:"+countMissingCopies.ToString();
}
}
mu.Action="Provide elect copy to Pt";//If this text ever changes then FormEHR grid will need to change for MU1
break;
#endregion
#region ClinicalSummaries
case EhrMeasureType.ClinicalSummaries:
List<DateTime> listVisits=new List<DateTime>();//for this year
List<Procedure> listProcs=Procedures.Refresh(pat.PatNum);
for(int p=0;p<listProcs.Count;p++) {
if(listProcs[p].ProcDate < DateTime.Now.AddYears(-1) || listProcs[p].ProcStatus!=ProcStat.C) {//not within the last year or not a completed procedure
continue;
}
if(!listVisits.Contains(listProcs[p].ProcDate)) {
listVisits.Add(listProcs[p].ProcDate);
}
}
if(listVisits.Count==0){
mu.Met=MuMet.NA;
mu.Details="No visits within the last year.";
}
else{
int countMissing=0;
bool summaryProvidedinTime;
List<EhrMeasureEvent> listClinSum=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.ClinicalSummaryProvidedToPt);
for(int p=0;p<listVisits.Count;p++) {
summaryProvidedinTime=false;
DateTime deadlineDate=listVisits[p].AddDays(3);
if(listVisits[p].DayOfWeek==DayOfWeek.Wednesday || listVisits[p].DayOfWeek==DayOfWeek.Thursday || listVisits[p].DayOfWeek==DayOfWeek.Friday){
deadlineDate=deadlineDate.AddDays(2);//add two days for the weekend
}
for(int r=0;r<listClinSum.Count;r++) {
if(listClinSum[r].DateTEvent.Date > deadlineDate) {
continue;
}
if(listClinSum[r].DateTEvent.Date < listVisits[p]) {
continue;
}
summaryProvidedinTime=true;
}
if(!summaryProvidedinTime) {
countMissing++;
}
}
if(countMissing==0) {
mu.Met=MuMet.True;
mu.Details="Clinical summary provided to Pt within 3 business days of each visit.";
}
else {
mu.Met=MuMet.False;
mu.Details="Clinical summaries not provided to Pt within 3 business days of a visit:"+countMissing.ToString();
}
}
mu.Action="Send clinical summary to Pt";
break;
#endregion
#region Reminders
case EhrMeasureType.Reminders:
if(pat.PatStatus!=PatientStatus.Patient) {
mu.Met=MuMet.NA;
mu.Details="Status not patient.";
}
else if(pat.Age==0) {
mu.Met=MuMet.NA;
mu.Details="Age not entered.";
}
else if(pat.Age>5 && pat.Age<65) {
mu.Met=MuMet.NA;
mu.Details="Patient age not 65+ or 5-.";
}
else {
List<EhrMeasureEvent> listReminders=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.ReminderSent);
//during reporting period.
bool withinLastYear=false;
for(int r=0;r<listReminders.Count;r++) {
if(listReminders[r].DateTEvent > DateTime.Now.AddYears(-1)) {
withinLastYear=true;
}
}
if(withinLastYear) {
mu.Details="Reminder sent within the last year.";
mu.Met=MuMet.True;
}
else {
mu.Details="No reminders sent within the last year for patient age 65+ or 5-.";
}
}
mu.Action="Send reminders";
break;
#endregion
#region MedReconcile
case EhrMeasureType.MedReconcile:
int countFromRef=0;
int countFromRefPeriod=0;
for(int c=0;c<listRefAttach.Count;c++) {
if(listRefAttach[c].IsFrom && listRefAttach[c].IsTransitionOfCare) {
countFromRef++;
if(listRefAttach[c].RefDate > DateTime.Now.AddYears(-1)) {//within the last year
countFromRefPeriod++;
}
}
}
if(countFromRef==0) {
mu.Met=MuMet.NA;
mu.Details="Referral 'from' not entered.";
}
else if(countFromRefPeriod==0) {
mu.Met=MuMet.NA;
mu.Details="Referral 'from' not entered within the last year.";
}
else if(countFromRefPeriod > 0) {
List<EhrMeasureEvent> listReconciles=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.MedicationReconcile);
int countReconciles=0;//during reporting period.
for(int r=0;r<listReconciles.Count;r++) {
if(listReconciles[r].DateTEvent > DateTime.Now.AddYears(-1)) {//within the same period as the count for referrals.
countReconciles++;
}
}
mu.Details="Referrals:"+countFromRefPeriod.ToString()+", Reconciles:"+countReconciles.ToString();
if(countReconciles>=countFromRefPeriod) {
mu.Met=MuMet.True;
}
}
mu.Action="Reconcile from received CCD";
mu.Action2="Enter Referrals";
break;
#endregion
#region SummaryOfCare
case EhrMeasureType.SummaryOfCare:
int countToRefPeriod=0;
for(int c=0;c<listRefAttach.Count;c++) {
if(!listRefAttach[c].IsFrom && listRefAttach[c].IsTransitionOfCare) {
if(listRefAttach[c].RefDate > DateTime.Now.AddYears(-1)) {//within the last year
countToRefPeriod++;
}
}
}
if(countToRefPeriod==0) {
mu.Met=MuMet.NA;
mu.Details="No outgoing transitions of care within the last year.";
}
else{// > 0
List<EhrMeasureEvent> listCcds=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.SummaryOfCareProvidedToDr);
int countCcds=0;//during reporting period.
for(int r=0;r<listCcds.Count;r++) {
if(listCcds[r].DateTEvent > DateTime.Now.AddYears(-1)) {//within the same period as the count for referrals.
countCcds++;
}
}
mu.Details="Referrals:"+countToRefPeriod.ToString()+", Summaries:"+countCcds.ToString();
if(countCcds>=countToRefPeriod) {
mu.Met=MuMet.True;
}
}
mu.Action="Send/Receive summary of care";
mu.Action2="Enter Referrals";
break;
#endregion
}
list.Add(mu);
}
return list;
}
///<summary>Only called from FormEHR to load the patient specific MU data and tell the user what action to take to get closer to meeting MU.</summary>
public static List<EhrMu> GetMu2(Patient pat) {
if(RemotingClient.RemotingRole==RemotingRole.ClientWeb) {
return Meth.GetObject<List<EhrMu>>(MethodBase.GetCurrentMethod(),pat);
}
List<EhrMu> list=new List<EhrMu>();
//add one of each type
EhrMu mu;
string explanation;
List<EhrMeasure> retVal=GetMU2List();
List<MedicationPat> medList=MedicationPats.Refresh(pat.PatNum,true);
List<EhrLab> ehrLabList=EhrLabs.GetAllForPat(pat.PatNum);
List<EhrMeasureEvent> listMeasureEvents=EhrMeasureEvents.Refresh(pat.PatNum);
List<RefAttach> listRefAttach=RefAttaches.Refresh(pat.PatNum);
for(int i=0;i<retVal.Count;i++) {
mu=new EhrMu();
mu.Met=MuMet.False;
mu.MeasureType=retVal[i].MeasureType;
switch(mu.MeasureType) {
#region Demographics
case EhrMeasureType.Demographics:
explanation="";
if(pat.Birthdate.Year<1880) {
explanation+="birthdate";//missing
}
if(pat.Language=="") {
if(explanation!="") {
explanation+=", ";
}
explanation+="language";
}
if(pat.Gender==PatientGender.Unknown) {
if(explanation!="") {
explanation+=", ";
}
explanation+="gender";
}
if(PatientRaces.GetForPatient(pat.PatNum).Count==0) {
if(explanation!="") {
explanation+=", ";
}
explanation+="race, ethnicity";
}
if(explanation=="") {
mu.Details="All demographic elements recorded";
mu.Met=MuMet.True;
}
else {
mu.Details="Missing: "+explanation;
}
mu.Action="Enter demographics";
break;
#endregion
#region Education
case EhrMeasureType.Education:
List<EhrMeasureEvent> listEd=EhrMeasureEvents.RefreshByType(pat.PatNum,EhrMeasureEventType.EducationProvided);
if(listEd.Count==0) {
mu.Details="No education resources provided.";
}
else {
mu.Details="Education resources provided: "+listEd.Count.ToString();
mu.Met=MuMet.True;
}
mu.Action="Provide education resources";
break;
#endregion
#region ElectronicCopyAccess
case EhrMeasureType.ElectronicCopyAccess:
List<EhrMeasureEvent> listOnline=EhrMeasureEvents.RefreshByType(pat.PatNum,EhrMeasureEventType.OnlineAccessProvided);
if(listOnline.Count==0) {
mu.Details="No online access provided.";
}
else {
mu.Details="Online access provided: "+listOnline[listOnline.Count-1].DateTEvent.ToShortDateString();//most recent
mu.Met=MuMet.True;
}
mu.Action="Provide online Access";
break;
#endregion
#region CPOE_MedOrdersOnly
case EhrMeasureType.CPOE_MedOrdersOnly:
int medOrderCount=0;
int medOrderCpoeCount=0;
for(int m=0;m<medList.Count;m++) {
//Using the last year as the reporting period, following pattern in ElectronicCopy, ClinicalSummaries, Reminders...
if(medList[m].DateStart<DateTime.Now.AddYears(-1)) {//either no start date so not an order, or not within the last year so not during the reporting period
continue;
}
else if(medList[m].PatNote!="" && medList[m].ProvNum==pat.PriProv) {//if there's a note and it was created by the patient's PriProv, then count as order created by this provider and would count toward the denominator for MU
medOrderCount++;
if(medList[m].IsCpoe) {//if also marked as CPOE, then this would count in the numerator of the calculation MU
medOrderCpoeCount++;
}
}
}
if(medOrderCount==0) {
mu.Details="No medication order in CPOE.";
}
else {
mu.Details="Medications entered in CPOE: "+medOrderCount.ToString();
mu.Met=MuMet.True;
}
mu.Action="(edit Rxs from Chart)";
break;
#endregion
#region CPOE_LabOrdersOnly
case EhrMeasureType.CPOE_LabOrdersOnly:
int labOrderCount=0;
int labOrderCpoeCount=0;
for(int m=0;m<ehrLabList.Count;m++) {
//Using the last year as the reporting period, following pattern in ElectronicCopy, ClinicalSummaries, Reminders...
Loinc loinc=Loincs.GetByCode(ehrLabList[m].UsiID);
string dateSt=ehrLabList[m].ObservationDateTimeStart.PadRight(8,'0').Substring(0,8);//stored in DB as yyyyMMddhhmmss-zzzz
DateTime dateT=PIn.Date(dateSt.Substring(4,2)+"/"+dateSt.Substring(6,2)+"/"+dateSt.Substring(0,4));
if(dateT<DateTime.Now.AddYears(-1)) {//either no start date so not an order, or not within the last year so not during the reporting period
continue;
}
else if((ehrLabList[m].OrderingProviderID==pat.PriProv.ToString()
|| ehrLabList[m].OrderingProviderID==Providers.GetProv(pat.PriProv).NationalProvID)
&& (loinc==null || !loinc.ClassType.Contains("%rad%"))) {//if there's a note and it was created by the patient's PriProv, then count as order created by this provider and would count toward the denominator for MU
labOrderCount++;
labOrderCpoeCount++;
}
}
if(labOrderCount==0) {
mu.Details="No Lab order in CPOE.";
}
else {
mu.Details="Labs entered in CPOE: "+labOrderCount.ToString();
mu.Met=MuMet.True;
}
mu.Action="Edit labs";
break;
#endregion
#region CPOE_RadiologyOrdersOnly
case EhrMeasureType.CPOE_RadiologyOrdersOnly:
int radOrderCount=0;
int radOrderCpoeCount=0;
for(int m=0;m<ehrLabList.Count;m++) {
//Using the last year as the reporting period, following pattern in ElectronicCopy, ClinicalSummaries, Reminders...
Loinc loinc=Loincs.GetByCode(ehrLabList[m].UsiID);
if(loinc==null) {
continue;
}
string dateSt=ehrLabList[m].ObservationDateTimeStart.PadRight(8,'0').Substring(0,8);//stored in DB as yyyyMMddhhmmss-zzzz
DateTime dateT=PIn.Date(dateSt.Substring(4,2)+"/"+dateSt.Substring(6,2)+"/"+dateSt.Substring(0,4));
if(dateT<DateTime.Now.AddYears(-1)) {//either no start date so not an order, or not within the last year so not during the reporting period
continue;
}
else if((ehrLabList[m].OrderingProviderID==pat.PriProv.ToString()
|| ehrLabList[m].OrderingProviderID==Providers.GetProv(pat.PriProv).NationalProvID)
&& loinc.ClassType.Contains("%rad%")) {//if there's a note and it was created by the patient's PriProv, then count as order created by this provider and would count toward the denominator for MU
radOrderCount++;
radOrderCpoeCount++;
}
}
if(radOrderCount==0) {
mu.Details="No Rad order in CPOE.";
}
else {
mu.Details="Rads entered in CPOE: "+radOrderCount.ToString();
mu.Met=MuMet.True;
}
mu.Action="Edit labs";
break;
#endregion
#region Rx
case EhrMeasureType.Rx:
List<RxPat> listRx=RxPats.GetPermissableForDateRange(pat.PatNum,DateTime.Today.AddYears(-1),DateTime.Today);
if(listRx.Count==0) {
mu.Met=MuMet.NA;
mu.Details="No Rxs entered.";
}
else {
explanation="";
for(int rx=0;rx<listRx.Count;rx++) {
if(listRx[rx].SendStatus==RxSendStatus.SentElect) {
continue;
}
if(explanation!="") {
explanation+=", ";
}
explanation+=listRx[rx].RxDate.ToShortDateString();
}
if(explanation=="") {
mu.Met=MuMet.True;
mu.Details="All Rxs sent electronically.";
}
else {
mu.Met=MuMet.False;
mu.Details="Rxs not sent electronically: "+explanation;
}
}
mu.Action="(edit Rxs from Chart)";//no action
break;
#endregion
#region VitalSigns
case EhrMeasureType.VitalSigns:
List<Vitalsign> vitalsignList=Vitalsigns.Refresh(pat.PatNum);
if(vitalsignList.Count==0) {
mu.Details="No vital signs entered.";
}
else {
bool hFound=false;
bool wFound=false;
bool bpFound=false;
for(int v=0;v<vitalsignList.Count;v++) {
if(vitalsignList[v].Height>0) {
hFound=true;
}
if(vitalsignList[v].Weight>0) {
wFound=true;
}
if(pat.Birthdate>DateTime.Today.AddYears(-3) //3 and older for BP
|| (vitalsignList[v].BpDiastolic>0 && vitalsignList[v].BpSystolic>0)) {
bpFound=true;
}
}
explanation="";
if(!hFound) {
explanation+="height";//missing
}
if(!wFound) {
if(explanation!="") {
explanation+=", ";
}
explanation+="weight";
}
if(!bpFound) {
if(explanation!="") {
explanation+=", ";
}
explanation+="blood pressure";
}
if(explanation=="") {
mu.Details="Vital signs entered";
mu.Met=MuMet.True;
}
else {
mu.Details="Missing: "+explanation;
}
}
mu.Action="Enter vital signs";
break;
#endregion
#region VitalSignsBMIOnly
case EhrMeasureType.VitalSignsBMIOnly:
vitalsignList=Vitalsigns.Refresh(pat.PatNum);
if(vitalsignList.Count==0) {
mu.Details="No vital signs entered.";
}
else {
bool hFound=false;
bool wFound=false;
for(int v=0;v<vitalsignList.Count;v++) {
if(vitalsignList[v].Height>0) {
hFound=true;
}
if(vitalsignList[v].Weight>0) {
wFound=true;
}
}
explanation="";
if(!hFound) {
explanation+="height";//missing
}
if(!wFound) {
if(explanation!="") {
explanation+=", ";
}
explanation+="weight";
}
if(explanation=="") {
mu.Details="Vital signs entered";
mu.Met=MuMet.True;
}
else {
mu.Details="Missing: "+explanation;
}
}
mu.Action="Enter vital signs";
break;
#endregion
#region VitalSignsBPOnly
case EhrMeasureType.VitalSignsBPOnly:
vitalsignList=Vitalsigns.Refresh(pat.PatNum);
if(pat.Birthdate>DateTime.Today.AddYears(-3)) {//3 and older for BP
mu.Details="Age 3 and older for BP.";
mu.Met=MuMet.NA;
}
else if(vitalsignList.Count==0) {
mu.Details="No vital signs entered.";
}
else {
for(int v=0;v<vitalsignList.Count;v++) {
if(vitalsignList[v].BpDiastolic>0 && vitalsignList[v].BpSystolic>0) {
mu.Details="Vital signs entered";
mu.Met=MuMet.True;
}
else {
mu.Details="Missing: blood pressure";
}
}
}
mu.Action="Enter vital signs";
break;
#endregion
#region Smoking
case EhrMeasureType.Smoking:
if(pat.SmokingSnoMed=="") {//None
mu.Details="Smoking status not entered";
}
else {
mu.Details="Smoking status entered";
mu.Met=MuMet.True;
}
mu.Action="Edit smoking status";
break;
#endregion
#region Lab
case EhrMeasureType.Lab:
if(ehrLabList.Count==0) {
mu.Details="No lab orders";
mu.Met=MuMet.NA;
}
else {
int labResultCount=0;
for(int lo=0;lo<ehrLabList.Count;lo++) {
List<EhrLabResult> ehrLabResults=EhrLabResults.GetForLab(ehrLabList[lo].EhrLabNum);
if(ehrLabResults.Count>0) {
labResultCount++;
}
}
if(labResultCount<ehrLabList.Count) {
mu.Details="Lab orders missing results: "+(ehrLabList.Count-labResultCount).ToString();
}
else {
mu.Details="Lab results entered for each lab order.";
mu.Met=MuMet.True;
}
}
mu.Action="Edit labs";
break;
#endregion
#region ElectronicCopy
case EhrMeasureType.ElectronicCopy:
List<EhrMeasureEvent> listRequests=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.ElectronicCopyRequested);
List<EhrMeasureEvent> listRequestsPeriod=new List<EhrMeasureEvent>();
for(int r=0;r<listRequests.Count;r++) {
if(listRequests[r].DateTEvent<DateTime.Now.AddYears(-1) || listRequests[r].PatNum!=pat.PatNum) {//not within the last year
continue;
}
listRequestsPeriod.Add(listRequests[r]);
}
if(listRequestsPeriod.Count==0) {
mu.Met=MuMet.False;
mu.Details="Patient has not viewed/downloaded/transmitted their health info";
}
else {
mu.Met=MuMet.True;
mu.Details="Patient has viewed/downloaded/transmitted their health info";
}
mu.Action="Patient must use the Patient Portal";
break;
#endregion
#region ClinicalSummaries
case EhrMeasureType.ClinicalSummaries:
List<DateTime> listVisits=new List<DateTime>();//for this year
List<Procedure> listProcs=Procedures.Refresh(pat.PatNum);
for(int p=0;p<listProcs.Count;p++) {
if(listProcs[p].ProcDate < DateTime.Now.AddYears(-1) || listProcs[p].ProcStatus!=ProcStat.C) {//not within the last year or not a completed procedure
continue;
}
if(!listVisits.Contains(listProcs[p].ProcDate)) {
listVisits.Add(listProcs[p].ProcDate);
}
}
if(listVisits.Count==0) {
mu.Met=MuMet.NA;
mu.Details="No visits within the last year.";
}
else {
int countMissing=0;
bool summaryProvidedinTime;
List<EhrMeasureEvent> listClinSum=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.ClinicalSummaryProvidedToPt);
for(int p=0;p<listVisits.Count;p++) {
summaryProvidedinTime=false;
DateTime deadlineDate=listVisits[p].AddDays(1);
if(listVisits[p].DayOfWeek==DayOfWeek.Friday) {
deadlineDate=deadlineDate.AddDays(2);//add two days for the weekend
}
for(int r=0;r<listClinSum.Count;r++) {
if(listClinSum[r].DateTEvent.Date > deadlineDate) {
continue;
}
if(listClinSum[r].DateTEvent.Date < listVisits[p]) {
continue;
}
summaryProvidedinTime=true;
}
if(!summaryProvidedinTime) {
countMissing++;
}
}
if(countMissing==0) {
mu.Met=MuMet.True;
mu.Details="Clinical summary provided to Pt within 1 business day of each visit.";
}
else {
mu.Met=MuMet.False;
mu.Details="Clinical summaries not provided to Pt within 1 business day of a visit:"+countMissing.ToString();
}
}
mu.Action="Send clinical summary to Pt";
break;
#endregion
#region Reminders
case EhrMeasureType.Reminders:
List<DateTime> listVisitsRem=new List<DateTime>();//for this year
List<Procedure> listProcsRem=Procedures.Refresh(pat.PatNum);
for(int p=0;p<listProcsRem.Count;p++) {
if(listProcsRem[p].ProcDate < DateTime.Now.AddYears(-2) || listProcsRem[p].ProcStatus!=ProcStat.C) {//not within the last year or not a completed procedure
continue;
}
if(!listVisitsRem.Contains(listProcsRem[p].ProcDate)) {
listVisitsRem.Add(listProcsRem[p].ProcDate);
}
}
if(listVisitsRem.Count<=1) {
mu.Met=MuMet.NA;
mu.Details="No two visits within the last two years.";
}
else if(pat.PatStatus!=PatientStatus.Patient) {
mu.Met=MuMet.NA;
mu.Details="Status not patient.";
}
else {
List<EhrMeasureEvent> listReminders=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.ReminderSent);
//during reporting period.
bool withinLastYear=false;
for(int r=0;r<listReminders.Count;r++) {
if(listReminders[r].DateTEvent > DateTime.Now.AddYears(-1)) {
withinLastYear=true;
}
}
if(withinLastYear) {
mu.Details="Reminder sent within the last year.";
mu.Met=MuMet.True;
}
else {
mu.Details="No reminders sent within the last year.";
}
}
mu.Action="Send reminders";
break;
#endregion
#region MedReconcile
case EhrMeasureType.MedReconcile:
int countFromRef=0;
int countFromRefPeriod=0;
for(int c=0;c<listRefAttach.Count;c++) {
if(listRefAttach[c].IsFrom && listRefAttach[c].IsTransitionOfCare) {
countFromRef++;
if(listRefAttach[c].RefDate > DateTime.Now.AddYears(-1)) {//within the last year
countFromRefPeriod++;
}
}
}
if(countFromRef==0) {
mu.Met=MuMet.NA;
mu.Details="Referral 'from' not entered.";
}
else if(countFromRefPeriod==0) {
mu.Met=MuMet.NA;
mu.Details="Referral 'from' not entered within the last year.";
}
else if(countFromRefPeriod > 0) {
List<EhrMeasureEvent> listReconciles=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.MedicationReconcile);
int countReconciles=0;//during reporting period.
for(int r=0;r<listReconciles.Count;r++) {
if(listReconciles[r].DateTEvent > DateTime.Now.AddYears(-1)) {//within the same period as the count for referrals.
countReconciles++;
}
}
mu.Details="Referrals:"+countFromRefPeriod.ToString()+", Reconciles:"+countReconciles.ToString();
if(countReconciles>=countFromRefPeriod) {
mu.Met=MuMet.True;
}
}
mu.Action="Reconcile from received CCD";
mu.Action2="Enter Referrals";
break;
#endregion
#region SummaryOfCare
case EhrMeasureType.SummaryOfCare:
int countToRefPeriod=0;
for(int c=0;c<listRefAttach.Count;c++) {
if(!listRefAttach[c].IsFrom && listRefAttach[c].IsTransitionOfCare) {
if(listRefAttach[c].RefDate > DateTime.Now.AddYears(-1)) {//within the last year
countToRefPeriod++;
}
}
}
if(countToRefPeriod==0) {
mu.Met=MuMet.NA;
mu.Details="No outgoing transitions of care within the last year.";
}
else {// > 0
List<EhrMeasureEvent> listCcds=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.SummaryOfCareProvidedToDr);
int countCcds=0;//during reporting period.
for(int r=0;r<listCcds.Count;r++) {
if(listCcds[r].DateTEvent > DateTime.Now.AddYears(-1)) {//within the same period as the count for referrals.
countCcds++;
}
}
mu.Details="Referrals:"+countToRefPeriod.ToString()+", Summaries:"+countCcds.ToString();
if(countCcds>=countToRefPeriod) {
mu.Met=MuMet.True;
}
}
mu.Action="Send/Receive summary of care";
mu.Action2="Enter Referrals";
break;
#endregion
#region SummaryOfCareElectronic
case EhrMeasureType.SummaryOfCareElectronic:
countToRefPeriod=0;
for(int c=0;c<listRefAttach.Count;c++) {
if(!listRefAttach[c].IsFrom && listRefAttach[c].IsTransitionOfCare) {
if(listRefAttach[c].RefDate > DateTime.Now.AddYears(-1)) {//within the last year
countToRefPeriod++;
}
}
}
if(countToRefPeriod==0) {
mu.Met=MuMet.NA;
mu.Details="No outgoing transitions of care within the last year.";
}
else {// > 0
List<EhrMeasureEvent> listCcds=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.SummaryOfCareProvidedToDrElectronic);
int countCcds=0;//during reporting period.
for(int r=0;r<listCcds.Count;r++) {
if(listCcds[r].DateTEvent > DateTime.Now.AddYears(-1)) {//within the same period as the count for referrals.
countCcds++;
}
}
mu.Details="Referrals:"+countToRefPeriod.ToString()+", Summaries:"+countCcds.ToString();
if(countCcds>=countToRefPeriod) {
mu.Met=MuMet.True;
}
}
mu.Action="Send/Receive summary of care via email";
mu.Action2="Enter Referrals";
break;
#endregion
#region SecureMessaging
case EhrMeasureType.SecureMessaging:
List<EhrMeasureEvent> listMsg=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.SecureMessageFromPat);
List<DateTime> listVisitsMsg=new List<DateTime>();//for this year
List<Procedure> listProcsMsg=Procedures.Refresh(pat.PatNum);
int msgCount=0;
for(int p=0;p<listProcsMsg.Count;p++) {
if(listProcsMsg[p].ProcDate < DateTime.Now.AddYears(-1) || listProcsMsg[p].ProcStatus!=ProcStat.C) {//not within the last year or not a completed procedure
continue;
}
if(!listVisitsMsg.Contains(listProcsMsg[p].ProcDate)) {
listVisitsMsg.Add(listProcsMsg[p].ProcDate);
}
}
for(int p=0;p<listMsg.Count;p++) {
if(listMsg[p].PatNum==pat.PatNum) {
msgCount++;
}
}
if(listVisitsMsg.Count==0) {
mu.Met=MuMet.NA;
mu.Details="No visits within the last year.";
}
else if(msgCount==0) {
mu.Met=MuMet.False;
mu.Details="No patient web mail messages.";
}
else {// > 0
mu.Met=MuMet.True;
mu.Details="Web mail message has been received.";
}
mu.Action="Patient must send a web mail message via the Patient Portal.";
break;
#endregion
#region FamilyHistory
case EhrMeasureType.FamilyHistory:
List<FamilyHealth> listFamilyHealth=FamilyHealths.GetFamilyHealthForPat(pat.PatNum);
if(listFamilyHealth.Count==0) {
mu.Met=MuMet.False;
mu.Details="No family members entered";
}
else {// > 0
mu.Met=MuMet.True;
mu.Details="Family Members: "+listFamilyHealth.Count;
}
mu.Action="Enter family history";
break;
#endregion
#region ElectronicNote
case EhrMeasureType.ElectronicNote:
ProcNote procNote=ProcNotes.GetProcNotesForPat(pat.PatNum, DateTime.Now.AddYears(-1), DateTime.Now.AddDays(1));
int notesSigned=0;
if(procNote==null) {
mu.Met=MuMet.NA;
mu.Details="No procedure notes";
}
else if(procNote.Signature!="" && procNote.Note!="") {
notesSigned++;
}
if(notesSigned==0) {
mu.Met=MuMet.False;
mu.Details="Unsigned procedure notes";
}
else {// > 0
mu.Met=MuMet.True;
mu.Details="Signed procedure note is present";
}
mu.Action="Sign all procedure notes";
break;
#endregion
#region LabImages
case EhrMeasureType.LabImages:
int labCount=0;
int labCountImages=0;
List<EhrLab> listEhrLabs=EhrLabs.GetAllForPatInDateRange(pat.PatNum,DateTime.Now.AddYears(-1),DateTime.Now.AddDays(1));
for(int img=0;img<listEhrLabs.Count;img++) {
if(EhrLabImages.IsWaitingForImages(listEhrLabs[img].EhrLabNum)) {
labCount++;
}
else if(EhrLabImages.Refresh(listEhrLabs[img].EhrLabNum).Count>0) {
labCount++;
labCountImages++;
}
}
if(labCount==0) {
mu.Met=MuMet.NA;
mu.Details="No labs are waiting for images";
}
else if(labCount>labCountImages) {
mu.Met=MuMet.False;
mu.Details="Labs currently waiting on images";
}
else if(labCount==labCountImages) {
mu.Met=MuMet.True;
mu.Details="All labs have images attached";
}
mu.Action="Manage Lab Images";
break;
#endregion
}
list.Add(mu);
}
return list;
}
///<summary></summary>
public static List<EhrMu> GetMu(Patient pat)
{
if(RemotingClient.RemotingRole==RemotingRole.ClientWeb) {
return Meth.GetObject<List<EhrMu>>(MethodBase.GetCurrentMethod(),pat);
}
List<EhrMu> list=new List<EhrMu>();
//add one of each type
EhrMu mu;
string explanation;
List<MedicationPat> medList=MedicationPats.Refresh(pat.PatNum,true);
List<EhrMeasureEvent> listMeasureEvents=EhrMeasureEvents.Refresh(pat.PatNum);
List<RefAttach> listRefAttach=RefAttaches.Refresh(pat.PatNum);
for(int i=0;i<Enum.GetValues(typeof(EhrMeasureType)).Length;i++) {
mu=new EhrMu();
mu.Met=MuMet.False;
mu.MeasureType=(EhrMeasureType)i;
switch(mu.MeasureType) {
case EhrMeasureType.ProblemList:
List<Disease> listDisease=Diseases.Refresh(pat.PatNum);
if(listDisease.Count==0){
mu.Details="No problems entered.";
}
else{
mu.Met=MuMet.True;
bool diseasesNone=false;
if(listDisease.Count==1 && listDisease[0].DiseaseDefNum==PrefC.GetLong(PrefName.ProblemsIndicateNone)){
diseasesNone=true;
}
if(diseasesNone){
mu.Details="Problems marked 'none'.";
}
else{
mu.Details="Problems entered: "+listDisease.Count.ToString();
}
}
mu.Action="Enter problems";
break;
case EhrMeasureType.MedicationList:
if(medList.Count==0) {
mu.Details="No medications entered.";
}
else{
mu.Met=MuMet.True;
bool medsNone=false;
if(medList.Count==1 && medList[0].MedicationNum==PrefC.GetLong(PrefName.MedicationsIndicateNone)) {
medsNone=true;
}
if(medsNone) {
mu.Details="Medications marked 'none'.";
}
else{
mu.Details="Medications entered: "+medList.Count.ToString();
}
}
mu.Action="Enter medications";
break;
case EhrMeasureType.AllergyList:
List<Allergy> listAllergies=Allergies.Refresh(pat.PatNum);
if(listAllergies.Count==0) {
mu.Details="No allergies entered.";
}
else{
mu.Met=MuMet.True;
bool allergiesNone=false;
if(listAllergies.Count==1 && listAllergies[0].AllergyDefNum==PrefC.GetLong(PrefName.AllergiesIndicateNone)) {
allergiesNone=true;
}
if(allergiesNone) {
mu.Details="Allergies marked 'none'.";
}
else{
mu.Details="Allergies entered: "+listAllergies.Count.ToString();
}
}
mu.Action="Enter allergies";
break;
case EhrMeasureType.Demographics:
explanation="";
if(pat.Birthdate.Year<1880) {
explanation+="birthdate";//missing
}
if(pat.Language=="") {
if(explanation!="") {
explanation+=", ";
}
explanation+="language";
}
if(pat.Gender==PatientGender.Unknown) {
if(explanation!="") {
explanation+=", ";
}
explanation+="gender";
}
if(pat.Race==PatientRace.Unknown) {
if(explanation!="") {
explanation+=", ";
}
explanation+="race, ethnicity";
}
if(explanation=="") {
mu.Details="All demographic elements recorded";
mu.Met=MuMet.True;
}
else {
mu.Details="Missing: "+explanation;
}
mu.Action="Enter demographics";
break;
case EhrMeasureType.Education:
List<EhrMeasureEvent> listEd=EhrMeasureEvents.RefreshByType(pat.PatNum,EhrMeasureEventType.EducationProvided);
if(listEd.Count==0) {
mu.Details="No education resources provided.";
}
else {
mu.Details="Education resources provided: "+listEd.Count.ToString();
mu.Met=MuMet.True;
}
mu.Action="Provide education resources";
break;
case EhrMeasureType.TimelyAccess:
List<EhrMeasureEvent> listOnline=EhrMeasureEvents.RefreshByType(pat.PatNum,EhrMeasureEventType.OnlineAccessProvided);
if(listOnline.Count==0) {
mu.Details="No online access provided.";
}
else {
mu.Details="Online access provided: "+listOnline[listOnline.Count-1].DateTEvent.ToShortDateString();//most recent
mu.Met=MuMet.True;
}
mu.Action="Provide online Access";
break;
case EhrMeasureType.ProvOrderEntry:
int medOrderCount=0;
for(int mo=0;mo<medList.Count;mo++){
if(medList[mo].DateStart.Year>1880 && medList[mo].PatNote!=""){
medOrderCount++;
}
}
if(medList.Count==0) {
mu.Met=MuMet.NA;
mu.Details="No meds.";
}
else if(medOrderCount==0) {
mu.Details="No medication order in CPOE.";
}
else {
mu.Details="Medications entered in CPOE: "+medOrderCount.ToString();
mu.Met=MuMet.True;
}
mu.Action="CPOE - Provider Order Entry";
break;
case EhrMeasureType.Rx:
List<RxPat> listRx=RxPats.GetPermissableForDateRange(pat.PatNum,DateTime.Today.AddYears(-1),DateTime.Today);
if(listRx.Count==0){
mu.Met=MuMet.NA;
mu.Details="No Rxs entered.";
}
else{
explanation="";
for(int rx=0;rx<listRx.Count;rx++) {
if(listRx[rx].SendStatus==RxSendStatus.SentElect){
continue;
}
if(explanation!="") {
explanation+=", ";
}
explanation+=listRx[rx].RxDate.ToShortDateString();
}
if(explanation=="") {
mu.Met=MuMet.True;
mu.Details="All Rxs sent electronically.";
}
else {
mu.Met=MuMet.False;
mu.Details="Rxs not sent electronically: "+explanation;
}
}
mu.Action="(edit Rxs from Chart)";//no action
break;
case EhrMeasureType.VitalSigns:
List<Vitalsign> vitalsignList=Vitalsigns.Refresh(pat.PatNum);
if(vitalsignList.Count==0) {
mu.Details="No vital signs entered.";
}
else {
bool hFound=false;
bool wFound=false;
bool bpFound=false;
for(int v=0;v<vitalsignList.Count;v++) {
if(vitalsignList[v].Height>0) {
hFound=true;
}
if(vitalsignList[v].Weight>0) {
wFound=true;
}
if(vitalsignList[v].BpDiastolic>0 && vitalsignList[v].BpSystolic>0) {
bpFound=true;
}
}
explanation="";
if(!hFound) {
explanation+="height";//missing
}
if(!wFound) {
if(explanation!="") {
explanation+=", ";
}
explanation+="weight";
}
if(!bpFound) {
if(explanation!="") {
explanation+=", ";
}
explanation+="blood pressure";
}
if(explanation=="") {
mu.Details="Vital signs entered";
mu.Met=MuMet.True;
}
else {
mu.Details="Missing: "+explanation;
}
}
mu.Action="Enter vital signs";
break;
case EhrMeasureType.Smoking:
if(pat.SmokeStatus==SmokingStatus.UnknownIfEver_Recode9) {
mu.Details="Smoking status not entered";
}
else {
mu.Details="Smoking status entered";
mu.Met=MuMet.True;
}
mu.Action="Edit smoking status";
break;
case EhrMeasureType.Lab:
List<MedicalOrder> listLabOrders=MedicalOrders.GetLabsByDate(pat.PatNum,DateTime.Today.AddYears(-1),DateTime.Today);
if(listLabOrders.Count==0) {
mu.Details="No lab orders";
mu.Met=MuMet.NA;
}
else {
int labPanelCount=0;
for(int lo=0;lo<listLabOrders.Count;lo++) {
List<LabPanel> listLabPanels=LabPanels.GetPanelsForOrder(listLabOrders[lo].MedicalOrderNum);
if(listLabPanels.Count>0) {
labPanelCount++;
}
}
if(labPanelCount<listLabOrders.Count) {
mu.Details="Lab orders missing results: "+(listLabOrders.Count-labPanelCount).ToString();
}
else {
mu.Details="Lab results entered for each lab order.";
mu.Met=MuMet.True;
}
}
mu.Action="Edit lab panels";
mu.Action2="Import lab results";
break;
case EhrMeasureType.ElectronicCopy:
List<EhrMeasureEvent> listRequests=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.ElectronicCopyRequested);
List<EhrMeasureEvent> listRequestsPeriod=new List<EhrMeasureEvent>();
for(int r=0;r<listRequests.Count;r++) {
if(listRequests[r].DateTEvent < DateTime.Now.AddYears(-1)) {//not within the last year
continue;
}
listRequestsPeriod.Add(listRequests[r]);
}
if(listRequestsPeriod.Count==0) {
mu.Met=MuMet.NA;
mu.Details="No requests within the last year.";
}
else {
int countMissingCopies=0;
bool copyProvidedinTime;
List<EhrMeasureEvent> listCopiesProvided=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.ElectronicCopyProvidedToPt);
for(int rp=0;rp<listRequestsPeriod.Count;rp++) {
copyProvidedinTime=false;
DateTime deadlineDateCopy=listRequestsPeriod[rp].DateTEvent.Date.AddDays(3);
if(listRequestsPeriod[rp].DateTEvent.DayOfWeek==DayOfWeek.Wednesday
|| listRequestsPeriod[rp].DateTEvent.DayOfWeek==DayOfWeek.Thursday
|| listRequestsPeriod[rp].DateTEvent.DayOfWeek==DayOfWeek.Friday)
{
deadlineDateCopy.AddDays(2);//add two days for the weekend
}
for(int cp=0;cp<listCopiesProvided.Count;cp++) {
if(listCopiesProvided[cp].DateTEvent.Date > deadlineDateCopy) {
continue;
}
if(listCopiesProvided[cp].DateTEvent.Date < listRequestsPeriod[rp].DateTEvent.Date) {
continue;
}
copyProvidedinTime=true;
}
if(!copyProvidedinTime) {
countMissingCopies++;
}
}
if(countMissingCopies==0) {
mu.Met=MuMet.True;
mu.Details="Electronic copy provided to Pt within 3 business days of each request.";
}
else {
mu.Met=MuMet.False;
mu.Details="Electronic copies not provided to Pt within 3 business days of a request:"+countMissingCopies.ToString();
}
}
mu.Action="Provide elect copy to Pt";
break;
case EhrMeasureType.ClinicalSummaries:
List<DateTime> listVisits=new List<DateTime>();//for this year
List<Procedure> listProcs=Procedures.Refresh(pat.PatNum);
for(int p=0;p<listProcs.Count;p++) {
if(listProcs[p].ProcDate < DateTime.Now.AddYears(-1)) {//not within the last year
continue;
}
if(!listVisits.Contains(listProcs[p].ProcDate)) {
listVisits.Add(listProcs[p].ProcDate);
}
}
if(listVisits.Count==0){
mu.Met=MuMet.NA;
mu.Details="No visits within the last year.";
}
else{
int countMissing=0;
bool summaryProvidedinTime;
List<EhrMeasureEvent> listClinSum=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.ClinicalSummaryProvidedToPt);
for(int p=0;p<listVisits.Count;p++) {
summaryProvidedinTime=false;
DateTime deadlineDate=listVisits[p].AddDays(3);
if(listVisits[p].DayOfWeek==DayOfWeek.Wednesday || listVisits[p].DayOfWeek==DayOfWeek.Thursday || listVisits[p].DayOfWeek==DayOfWeek.Friday){
deadlineDate.AddDays(2);//add two days for the weekend
}
for(int r=0;r<listClinSum.Count;r++) {
if(listClinSum[r].DateTEvent.Date > deadlineDate) {
continue;
}
if(listClinSum[r].DateTEvent.Date < listVisits[p]) {
continue;
}
summaryProvidedinTime=true;
}
if(!summaryProvidedinTime) {
countMissing++;
}
}
if(countMissing==0) {
mu.Met=MuMet.True;
mu.Details="Clinical summary provided to Pt within 3 business days of each visit.";
}
else {
mu.Met=MuMet.False;
mu.Details="Clinical summaries not provided to Pt within 3 business days of a visit:"+countMissing.ToString();
}
}
mu.Action="Send clinical summary to Pt";
break;
case EhrMeasureType.Reminders:
if(pat.PatStatus!=PatientStatus.Patient) {
mu.Met=MuMet.NA;
mu.Details="Status not patient.";
}
else if(pat.Age==0) {
mu.Met=MuMet.NA;
mu.Details="Age not entered.";
}
else if(pat.Age>5 && pat.Age<65) {
mu.Met=MuMet.NA;
mu.Details="Patient age not 65+ or 5-.";
}
else {
List<EhrMeasureEvent> listReminders=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.ReminderSent);
//during reporting period.
bool withinLastYear=false;
for(int r=0;r<listReminders.Count;r++) {
if(listReminders[r].DateTEvent > DateTime.Now.AddYears(-1)) {
withinLastYear=true;
}
}
if(withinLastYear) {
mu.Details="Reminder sent within the last year.";
mu.Met=MuMet.True;
}
else {
mu.Details="No reminders sent within the last year for patient age 65+ or 5-.";
}
}
mu.Action="Send reminders";
break;
case EhrMeasureType.MedReconcile:
int countFromRef=0;
int countFromRefPeriod=0;
for(int c=0;c<listRefAttach.Count;c++) {
if(listRefAttach[c].IsFrom && listRefAttach[c].IsTransitionOfCare) {
countFromRef++;
if(listRefAttach[c].RefDate > DateTime.Now.AddYears(-1)) {//within the last year
countFromRefPeriod++;
}
}
}
if(countFromRef==0) {
mu.Met=MuMet.NA;
mu.Details="Referral 'from' not entered.";
}
else if(countFromRefPeriod==0) {
mu.Met=MuMet.NA;
mu.Details="Referral 'from' not entered within the last year.";
}
else if(countFromRefPeriod > 0) {
List<EhrMeasureEvent> listReconciles=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.MedicationReconcile);
int countReconciles=0;//during reporting period.
for(int r=0;r<listReconciles.Count;r++) {
if(listReconciles[r].DateTEvent > DateTime.Now.AddYears(-1)) {//within the same period as the count for referrals.
countReconciles++;
}
}
mu.Details="Referrals:"+countFromRefPeriod.ToString()+", Reconciles:"+countReconciles.ToString();
if(countReconciles>=countFromRefPeriod) {
mu.Met=MuMet.True;
}
}
mu.Action="Reconcile medications";
mu.Action2="Enter Referrals";
break;
case EhrMeasureType.SummaryOfCare:
int countToRefPeriod=0;
for(int c=0;c<listRefAttach.Count;c++) {
if(!listRefAttach[c].IsFrom && listRefAttach[c].IsTransitionOfCare) {
if(listRefAttach[c].RefDate > DateTime.Now.AddYears(-1)) {//within the last year
countToRefPeriod++;
}
}
}
if(countToRefPeriod==0) {
mu.Met=MuMet.NA;
mu.Details="No outgoing transitions of care within the last year.";
}
else{// > 0
List<EhrMeasureEvent> listCcds=EhrMeasureEvents.GetByType(listMeasureEvents,EhrMeasureEventType.SummaryOfCareProvidedToDr);
int countCcds=0;//during reporting period.
for(int r=0;r<listCcds.Count;r++) {
if(listCcds[r].DateTEvent > DateTime.Now.AddYears(-1)) {//within the same period as the count for referrals.
countCcds++;
}
}
mu.Details="Referrals:"+countToRefPeriod.ToString()+", Summaries:"+countCcds.ToString();
if(countCcds>=countToRefPeriod) {
mu.Met=MuMet.True;
}
}
mu.Action="Send/Receive summary of care";
mu.Action2="Enter Referrals";
break;
}
list.Add(mu);
}
return list;
}
