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clinical_rules.php
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clinical_rules.php
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<?php
/**
* Clinical Decision Rules(CDR) engine functions.
*
* These functions should not ever attempt to write to
* session variables, because the session_write_close() function
* is typically called before utilizing these functions.
*
* @package OpenEMR
* @link https://www.open-emr.org
* @author Brady Miller <[email protected]>
* @author Medical Information Integration, LLC
* @author Ensofttek, LLC
* @copyright Copyright (c) 2010-2018 Brady Miller <[email protected]>
* @copyright Copyright (c) 2011 Medical Information Integration, LLC
* @copyright Copyright (c) 2011 Ensofttek, LLC
* @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
*/
require_once(dirname(__FILE__) . "/patient.inc");
require_once(dirname(__FILE__) . "/forms.inc");
require_once(dirname(__FILE__) . "/options.inc.php");
require_once(dirname(__FILE__) . "/report_database.inc");
/**
* Return listing of CDR reminders in log.
*
* @param string $begin_date begin date (optional)
* @param string $end_date end date (optional)
* @return sqlret sql return query
*/
function listingCDRReminderLog($begin_date = '', $end_date = '')
{
if (empty($end_date)) {
$end_date=date('Y-m-d H:i:s');
}
$sqlArray = array();
$sql = "SELECT `date`, `pid`, `uid`, `category`, `value`, `new_value` FROM `clinical_rules_log` WHERE `date` <= ?";
array_push($sqlArray, $end_date);
if (!empty($begin_date)) {
$sql .= " AND `date` >= ?";
array_push($sqlArray, $begin_date);
}
$sql .= " ORDER BY `date` DESC";
return sqlStatement($sql, $sqlArray);
}
/**
* Display the clinical summary widget.
*
* @param integer $patient_id pid of selected patient
* @param string $mode choose either 'reminders-all' or 'reminders-due' (required)
* @param string $dateTarget target date (format Y-m-d H:i:s). If blank then will test with current date as target.
* @param string $organize_mode Way to organize the results (default or plans)
* @param string $user If a user is set, then will only show rules that user has permission to see.
*/
function clinical_summary_widget($patient_id, $mode, $dateTarget = '', $organize_mode = 'default', $user = '')
{
// Set date to current if not set
$dateTarget = ($dateTarget) ? $dateTarget : date('Y-m-d H:i:s');
// Collect active actions
$actions = test_rules_clinic('', 'passive_alert', $dateTarget, $mode, $patient_id, '', $organize_mode, array(), 'primary', null, null, $user);
// Display the actions
$current_targets = array();
foreach ($actions as $action) {
// Deal with plan names first
if (isset($action['is_plan']) && $action['is_plan']) {
echo "<br><b>";
echo xlt("Plan") . ": ";
echo generate_display_field(array('data_type'=>'1','list_id'=>'clinical_plans'), $action['id']);
echo "</b><br>";
continue;
}
// Collect the Rule Title, Rule Developer, Rule Funding Source, and Rule Release and show it when hover over the item.
$tooltip = '';
if (!empty($action['rule_id'])) {
$rule_title = getListItemTitle("clinical_rules", $action['rule_id']);
$ruleData = sqlQuery("SELECT `developer`, `funding_source`, `release_version`, `web_reference` " .
"FROM `clinical_rules` " .
"WHERE `id`=? AND `pid`=0", array($action['rule_id']));
$developer = $ruleData['developer'];
$funding_source = $ruleData['funding_source'];
$release = $ruleData['release_version'];
$web_reference = $ruleData['web_reference'];
if (!empty($rule_title)) {
$tooltip = xla('Rule Title') . ": " . attr($rule_title) . "
";
}
if (!empty($developer)) {
$tooltip .= xla('Rule Developer') . ": " . attr($developer) . "
";
}
if (!empty($funding_source)) {
$tooltip .= xla('Rule Funding Source') . ": " . attr($funding_source) . "
";
}
if (!empty($release)) {
$tooltip .= xla('Rule Release') . ": " . attr($release);
}
if ((!empty($tooltip)) || (!empty($web_reference))) {
if (!empty($web_reference)) {
$tooltip = "<a href='".attr($web_reference)."' rel='noopener' target='_blank' style='white-space: pre-line;' title='".$tooltip."'>?</a>";
} else {
$tooltip = "<span style='white-space: pre-line;' title='".$tooltip."'>?</span>";
}
}
}
if ($action['custom_flag']) {
// Start link for reminders that use the custom rules input screen
$url = "../rules/patient_data.php?category=" . attr_url($action['category']);
$url .= "&item=" . attr_url($action['item']);
echo "<a href='" . $url . "' class='medium_modal' onclick='return top.restoreSession()'>";
} else if ($action['clin_rem_link']) {
// Start link for reminders that use the custom rules input screen
$pieces_url = parse_url($action['clin_rem_link']);
$url_prefix = $pieces_url['scheme'];
if ($url_prefix == 'https' || $url_prefix == 'http') {
echo "<a href='" . $action['clin_rem_link'] .
"' class='medium_modal' onclick='return top.restoreSession()'>";
} else {
echo "<a href='../../../" . $action['clin_rem_link'] .
"' class='medium_modal' onclick='return top.restoreSession()'>";
}
} else {
// continue since no link is needed
}
// Display Reminder Details
echo generate_display_field(array('data_type'=>'1','list_id'=>'rule_action_category'), $action['category']) .
": " . generate_display_field(array('data_type'=>'1','list_id'=>'rule_action'), $action['item']);
if ($action['custom_flag'] || $action['clin_rem_link']) {
// End link for reminders that use an html link
echo "</a>";
}
// Display due status
if ($action['due_status']) {
// Color code the status (red for past due, purple for due, green for not due and black for soon due)
if ($action['due_status'] == "past_due") {
echo " (<span style='color:red'>";
} else if ($action['due_status'] == "due") {
echo " (<span style='color:purple'>";
} else if ($action['due_status'] == "not_due") {
echo " (<span style='color:green'>";
} else {
echo " (<span>";
}
echo generate_display_field(array('data_type'=>'1','list_id'=>'rule_reminder_due_opt'), $action['due_status']) . "</span>)";
}
// Display the tooltip
if (!empty($tooltip)) {
echo " ".$tooltip."<br>";
} else {
echo "<br>";
}
// Add the target(and rule id and room for future elements as needed) to the $current_targets array.
// Only when $mode is reminders-due
if ($mode == "reminders-due" && $GLOBALS['enable_alert_log']) {
$target_temp = $action['category'].":".$action['item'];
$current_targets[$target_temp] = array('rule_id'=>$action['rule_id'],'due_status'=>$action['due_status']);
}
}
// Compare the current with most recent action log (this function will also log the current actions)
// Only when $mode is reminders-due
if ($mode == "reminders-due" && $GLOBALS['enable_alert_log']) {
$new_targets = compare_log_alerts($patient_id, $current_targets, 'clinical_reminder_widget', $_SESSION['authId']);
if (!empty($new_targets) && $GLOBALS['enable_cdr_new_crp']) {
// If there are new action(s), then throw a popup (if the enable_cdr_new_crp global is turned on)
// Note I am taking advantage of a slight hack in order to run javascript within code that
// is being passed via an ajax call by using a dummy image.
echo '<img src="../../pic/empty.gif" onload="alert(\''.xls('New Due Clinical Reminders').'\n\n';
foreach ($new_targets as $key => $value) {
$category_item = explode(":", $key);
$category = $category_item[0];
$item = $category_item[1];
echo generate_display_field(array('data_type'=>'1','list_id'=>'rule_action_category'), $category) .
': ' . generate_display_field(array('data_type'=>'1','list_id'=>'rule_action'), $item). '\n';
}
echo '\n' . '('. xls('See the Clinical Reminders widget for more details'). ')';
echo '\');this.parentNode.removeChild(this);" />';
}
}
}
/**
* Display the active screen reminder.
*
* @param integer $patient_id pid of selected patient
* @param string $mode choose either 'reminders-all' or 'reminders-due' (required)
* @param string $dateTarget target date (format Y-m-d H:i:s). If blank then will test with current date as target.
* @param string $organize_mode Way to organize the results (default or plans)
* @param string $user If a user is set, then will only show rules that user has permission to see
* @param string $test Set to true when only checking if there are alerts (skips the logging then)
* @return string html display output.
*/
function active_alert_summary($patient_id, $mode, $dateTarget = '', $organize_mode = 'default', $user = '', $test = false)
{
// Set date to current if not set
$dateTarget = ($dateTarget) ? $dateTarget : date('Y-m-d H:i:s');
// Collect active actions
$actions = test_rules_clinic('', 'active_alert', $dateTarget, $mode, $patient_id, '', $organize_mode, array(), 'primary', null, null, $user);
if (empty($actions)) {
return false;
}
$returnOutput = "";
$current_targets = array();
// Display the actions
foreach ($actions as $action) {
// Deal with plan names first
if ($action['is_plan']) {
$returnOutput .= "<br><b>";
$returnOutput .= xlt("Plan") . ": ";
$returnOutput .= generate_display_field(array('data_type'=>'1','list_id'=>'clinical_plans'), $action['id']);
$returnOutput .= "</b><br>";
continue;
}
// Display Reminder Details
$returnOutput .= generate_display_field(array('data_type'=>'1','list_id'=>'rule_action_category'), $action['category']) .
": " . generate_display_field(array('data_type'=>'1','list_id'=>'rule_action'), $action['item']);
// Display due status
if ($action['due_status']) {
// Color code the status (red for past due, purple for due, green for not due and black for soon due)
if ($action['due_status'] == "past_due") {
$returnOutput .= " (<span style='color:red'>";
} else if ($action['due_status'] == "due") {
$returnOutput .= " (<span style='color:purple'>";
} else if ($action['due_status'] == "not_due") {
$returnOutput .= " (<span style='color:green'>";
} else {
$returnOutput .= " (<span>";
}
$returnOutput .= generate_display_field(array('data_type'=>'1','list_id'=>'rule_reminder_due_opt'), $action['due_status']) . "</span>)<br>";
} else {
$returnOutput .= "<br>";
}
// Add the target(and rule id and room for future elements as needed) to the $current_targets array.
// Only when $mode is reminders-due and $test is FALSE
if (($mode == "reminders-due") && ($test === false) && ($GLOBALS['enable_alert_log'])) {
$target_temp = $action['category'].":".$action['item'];
$current_targets[$target_temp] = array('rule_id'=>$action['rule_id'],'due_status'=>$action['due_status']);
}
}
// Compare the current with most recent action log (this function will also log the current actions)
// Only when $mode is reminders-due and $test is FALSE
if (($mode == "reminders-due") && ($test === false) && ($GLOBALS['enable_alert_log'])) {
$new_targets = compare_log_alerts($patient_id, $current_targets, 'active_reminder_popup', $_SESSION['authId']);
if (!empty($new_targets)) {
$returnOutput .="<br>" . xlt('New Items (see above for details)') . ":<br>";
foreach ($new_targets as $key => $value) {
$category_item = explode(":", $key);
$category = $category_item[0];
$item = $category_item[1];
$returnOutput .= generate_display_field(array('data_type'=>'1','list_id'=>'rule_action_category'), $category) .
': ' . generate_display_field(array('data_type'=>'1','list_id'=>'rule_action'), $item). '<br>';
}
}
}
return $returnOutput;
}
/**
* Process and return allergy conflicts (when a active medication or presciption is on allergy list).
*
* @param integer $patient_id pid of selected patient
* @param string $mode either 'all' or 'new' (required)
* @param string $user If a user is set, then will only show rules that user has permission to see
* @param string $test Set to true when only checking if there are alerts (skips the logging then)
* @return array/boolean Array of allergy alerts or FALSE is empty.
*/
function allergy_conflict($patient_id, $mode, $user, $test = false)
{
// Collect allergies
$res_allergies = sqlStatement("SELECT `title` FROM `lists` WHERE `type`='allergy' " .
"AND `activity`=1 " .
"AND ( `enddate` IS NULL OR `enddate`='' OR `enddate` > NOW() ) " .
"AND `pid`=?", array($patient_id));
$allergies = array();
for ($iter=0; $row=sqlFetchArray($res_allergies); $iter++) {
$allergies[$iter]=$row['title'];
}
// Build sql element of IN for below queries
$sqlParam = array();
$sqlIN = '';
$firstFlag = true;
foreach ($allergies as $allergy) {
array_push($sqlParam, $allergy);
if ($firstFlag) {
$sqlIN .= "?";
$firstFlag = false;
} else {
$sqlIN .= ",?";
}
}
// Check if allergies conflict with medications or prescriptions
$conflicts_unique = array();
if (!empty($sqlParam)) {
$conflicts = array();
array_push($sqlParam, $patient_id);
$res_meds = sqlStatement("SELECT `title` FROM `lists` WHERE `type`='medication' " .
"AND `activity`=1 " .
"AND ( `enddate` IS NULL OR `enddate`='' OR `enddate` > NOW() ) " .
"AND `title` IN (" . $sqlIN . ") AND `pid`=?", $sqlParam);
while ($urow = sqlFetchArray($res_meds)) {
array_push($conflicts, $urow['title']);
}
$res_rx = sqlStatement("SELECT `drug` FROM `prescriptions` WHERE `active`=1 " .
"AND `drug` IN (" . $sqlIN . ") AND `patient_id`=?", $sqlParam);
while ($urow = sqlFetchArray($res_rx)) {
array_push($conflicts, $urow['drug']);
}
if (!empty($conflicts)) {
$conflicts_unique = array_unique($conflicts);
}
}
// If there are conflicts, $test is FALSE, and alert logging is on, then run through compare_log_alerts
$new_conflicts = array();
if ((!empty($conflicts_unique)) && $GLOBALS['enable_alert_log'] && ($test===false)) {
$new_conflicts = compare_log_alerts($patient_id, $conflicts_unique, 'allergy_alert', $_SESSION['authId'], $mode);
}
if ($mode == 'all') {
if (!empty($conflicts_unique)) {
return $conflicts_unique;
} else {
return false;
}
} else { // $mode = 'new'
if (!empty($new_conflicts)) {
return $new_conflicts;
} else {
return false;
}
}
}
/**
* Compare current alerts with prior (in order to find new actions)
* Also functions to log the actions.
*
* @param integer $patient_id pid of selected patient
* @param array $current_targets array of targets
* @param string $category clinical_reminder_widget, active_reminder_popup, or allergy_alert
* @param integer $userid user id of user.
* @param string $log_trigger if 'all', then always log. If 'new', then only trigger log when a new item noted.
* @return array array with targets with associated rule.
*/
function compare_log_alerts($patient_id, $current_targets, $category = 'clinical_reminder_widget', $userid = '', $log_trigger = 'all')
{
if (empty($userid)) {
$userid = $_SESSION['authId'];
}
if (empty($current_targets)) {
$current_targets = array();
}
// Collect most recent action_log
$prior_targets_sql = sqlQuery("SELECT `value` FROM `clinical_rules_log` " .
"WHERE `category` = ? AND `pid` = ? AND `uid` = ? " .
"ORDER BY `id` DESC LIMIT 1", array($category,$patient_id,$userid));
$prior_targets = array();
if (!empty($prior_targets_sql['value'])) {
$prior_targets = json_decode($prior_targets_sql['value'], true);
}
// Compare the current with most recent log
if (($category == 'clinical_reminder_widget') || ($category == 'active_reminder_popup')) {
//using fancy structure to store multiple elements
$new_targets = array_diff_key($current_targets, $prior_targets);
} else { // $category == 'allergy_alert'
//using simple array
$new_targets = array_diff($current_targets, $prior_targets);
}
// Store current action_log and the new items
// If $log_trigger=='all'
// or If $log_trigger=='new' and there are new items
if (($log_trigger=='all') || (($log_trigger=='new') && (!empty($new_targets)))) {
$current_targets_json = json_encode($current_targets);
$new_targets_json = '';
if (!empty($new_targets)) {
$new_targets_json = json_encode($new_targets);
}
sqlStatement("INSERT INTO `clinical_rules_log` " .
"(`date`,`pid`,`uid`,`category`,`value`,`new_value`) " .
"VALUES (NOW(),?,?,?,?,?)", array($patient_id,$userid,$category,$current_targets_json,$new_targets_json));
}
// Return new actions (if there are any)
return $new_targets;
}
/**
* Process clinic rules via a batching method to improve performance and decrease memory overhead.
*
* Test the clinic rules of entire clinic and create a report or patient reminders (can also test
* on one patient or patients of one provider). The structure of the returned results is dependent on the
* $organize_mode and $mode parameters.
* <pre>The results are dependent on the $organize_mode parameter settings
* 'default' organize_mode:
* Returns a two-dimensional array of results organized by rules (dependent on the following $mode settings):
* 'reminders-due' mode - returns an array of reminders (action array elements plus a 'pid' and 'due_status')
* 'reminders-all' mode - returns an array of reminders (action array elements plus a 'pid' and 'due_status')
* 'report' mode - returns an array of rows for the Clinical Quality Measures (CQM) report
* 'plans' organize_mode:
* Returns similar to default, but organizes by the active plans
* </pre>
*
* @param integer $provider id of a selected provider. If blank, then will test entire clinic. If 'collate_outer' or 'collate_inner', then will test each provider in entire clinic; outer will nest plans inside collated providers, while inner will nest the providers inside the plans (note inner and outer are only different if organize_mode is set to plans).
* @param string $type rule filter (active_alert,passive_alert,cqm,cqm_2011,cqm_2014,amc,amc_2011,amc_2014,patient_reminder). If blank then will test all rules.
* @param string/array $dateTarget target date (format Y-m-d H:i:s). If blank then will test with current date as target. If an array, then is holding two dates ('dateBegin' and 'dateTarget').
* @param string $mode choose either 'report' or 'reminders-all' or 'reminders-due' (required)
* @param string $plan test for specific plan only
* @param string $organize_mode Way to organize the results (default, plans). See above for organization structure of the results.
* @param array $options can hold various option (for now, used to hold the manual number of labs for the AMC report)
* @param string $pat_prov_rel How to choose patients that are related to a chosen provider. 'primary' selects patients that the provider is set as primary provider. 'encounter' selectes patients that the provider has seen. This parameter is only applicable if the $provider parameter is set to a provider or collation setting.
* @param integer $batchSize number of patients to batch (default is 100; plan to optimize this default setting in the future)
* @param integer $report_id id of report in database (if already bookmarked)
* @return array See above for organization structure of the results.
*/
function test_rules_clinic_batch_method($provider = '', $type = '', $dateTarget = '', $mode = '', $plan = '', $organize_mode = 'default', $options = array(), $pat_prov_rel = 'primary', $batchSize = '', $report_id = null)
{
// Default to a batchsize, if empty
if (empty($batchSize)) {
$batchSize=100;
}
// Collect total number of pertinent patients (to calculate batching parameters)
$totalNumPatients = buildPatientArray('', $provider, $pat_prov_rel, null, null, true);
// Cycle through the batches and collect/combine results
if (($totalNumPatients%$batchSize) > 0) {
// not perfectly divisible
$totalNumberBatches = floor($totalNumPatients/$batchSize) + 1;
} else {
// perfectly divisible
$totalNumberBatches = floor($totalNumPatients/$batchSize);
}
// Fix things in the $options array(). This now stores the number of labs to be used in the denominator in the AMC report.
// The problem with this variable is that is is added in every batch. So need to fix it by dividing this number by the number
// of planned batches(note the fixed array will go into the test_rules_clinic function, however the original will be used
// in the report storing/tracking engine.
$options_modified=$options;
if (!empty($options_modified['labs_manual'])) {
$options_modified['labs_manual'] = $options_modified['labs_manual'] / $totalNumberBatches;
}
// Prepare the database to track/store results
$fields = array('provider'=>$provider,'mode'=>$mode,'plan'=>$plan,'organize_mode'=>$organize_mode,'pat_prov_rel'=>$pat_prov_rel);
if (is_array($dateTarget)) {
$fields = array_merge($fields, array('date_target'=>$dateTarget['dateTarget']));
$fields = array_merge($fields, array('date_begin'=>$dateTarget['dateBegin']));
} else {
if (empty($dateTarget)) {
$fields = array_merge($fields, array('date_target'=>date("Y-m-d H:i:s")));
} else {
$fields = array_merge($fields, array('date_target'=>$dateTarget));
}
}
if (!empty($options)) {
foreach ($options as $key => $value) {
$fields = array_merge($fields, array($key=>$value));
}
}
$report_id = beginReportDatabase($type, $fields, $report_id);
setTotalItemsReportDatabase($report_id, $totalNumPatients);
// Set ability to itemize report if this feature is turned on
if (( ($type == "active_alert" || $type == "passive_alert") && ($GLOBALS['report_itemizing_standard']) ) ||
( ($type == "cqm" || $type == "cqm_2011" || $type == "cqm_2014") && ($GLOBALS['report_itemizing_cqm']) ) ||
( ($type == "amc" || $type == "amc_2011" || $type == "amc_2014" || $type == "amc_2014_stage1" || $type == "amc_2014_stage2") && ($GLOBALS['report_itemizing_amc']) ) ) {
$GLOBALS['report_itemizing_temp_flag_and_id'] = $report_id;
} else {
$GLOBALS['report_itemizing_temp_flag_and_id'] = 0;
}
for ($i=0; $i<$totalNumberBatches; $i++) {
// If itemization is turned on, then reset the rule id iterator
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
$GLOBALS['report_itemized_test_id_iterator'] = 1;
}
$dataSheet_batch = test_rules_clinic($provider, $type, $dateTarget, $mode, '', $plan, $organize_mode, $options_modified, $pat_prov_rel, (($batchSize*$i)+1), $batchSize);
if ($i == 0) {
// For first cycle, simply copy it to dataSheet
$dataSheet = $dataSheet_batch;
} else {
//debug
//error_log("CDR: ".print_r($dataSheet,TRUE),0);
//error_log("CDR: ".($batchSize*$i)." records",0);
// Integrate batch results into main dataSheet
foreach ($dataSheet_batch as $key => $row) {
if (!$row['is_sub']) {
//skip this stuff for the sub entries (and use previous main entry in percentage calculation)
$total_patients = $dataSheet[$key]['total_patients'] + $row['total_patients'];
$dataSheet[$key]['total_patients'] = $total_patients;
$excluded = $dataSheet[$key]['excluded'] + $row['excluded'];
$dataSheet[$key]['excluded'] = $excluded;
$pass_filter = $dataSheet[$key]['pass_filter'] + $row['pass_filter'];
$dataSheet[$key]['pass_filter'] = $pass_filter;
}
$pass_target = $dataSheet[$key]['pass_target'] + $row['pass_target'];
$dataSheet[$key]['pass_target'] = $pass_target;
$dataSheet[$key]['percentage'] = calculate_percentage($pass_filter, $excluded, $pass_target);
}
}
//Update database to track results
updateReportDatabase($report_id, $total_patients);
}
// Record results in database and send to screen, if applicable.
finishReportDatabase($report_id, json_encode($dataSheet));
return $dataSheet;
}
/**
* Process clinic rules.
*
* Test the clinic rules of entire clinic and create a report or patient reminders (can also test
* on one patient or patients of one provider). The structure of the returned results is dependent on the
* $organize_mode and $mode parameters.
* <pre>The results are dependent on the $organize_mode parameter settings
* 'default' organize_mode:
* Returns a two-dimensional array of results organized by rules (dependent on the following $mode settings):
* 'reminders-due' mode - returns an array of reminders (action array elements plus a 'pid' and 'due_status')
* 'reminders-all' mode - returns an array of reminders (action array elements plus a 'pid' and 'due_status')
* 'report' mode - returns an array of rows for the Clinical Quality Measures (CQM) report
* 'plans' organize_mode:
* Returns similar to default, but organizes by the active plans
* </pre>
*
* @param integer $provider id of a selected provider. If blank, then will test entire clinic. If 'collate_outer' or 'collate_inner', then will test each provider in entire clinic; outer will nest plans inside collated providers, while inner will nest the providers inside the plans (note inner and outer are only different if organize_mode is set to plans).
* @param string $type rule filter (active_alert,passive_alert,cqm,cqm_2011,cqm_2104,amc,amc_2011,amc_2014,patient_reminder). If blank then will test all rules.
* @param string/array $dateTarget target date (format Y-m-d H:i:s). If blank then will test with current date as target. If an array, then is holding two dates ('dateBegin' and 'dateTarget').
* @param string $mode choose either 'report' or 'reminders-all' or 'reminders-due' (required)
* @param integer $patient_id pid of patient. If blank then will check all patients.
* @param string $plan test for specific plan only
* @param string $organize_mode Way to organize the results (default, plans). See above for organization structure of the results.
* @param array $options can hold various option (for now, used to hold the manual number of labs for the AMC report)
* @param string $pat_prov_rel How to choose patients that are related to a chosen provider. 'primary' selects patients that the provider is set as primary provider. 'encounter' selectes patients that the provider has seen. This parameter is only applicable if the $provider parameter is set to a provider or collation setting.
* @param integer $start applicable patient to start at (when batching process)
* @param integer $batchSize number of patients to batch (when batching process)
* @param string $user If a user is set, then will only show rules that user has permission to see(only applicable for per patient and not when do reports).
* @return array See above for organization structure of the results.
*/
function test_rules_clinic($provider = '', $type = '', $dateTarget = '', $mode = '', $patient_id = '', $plan = '', $organize_mode = 'default', $options = array(), $pat_prov_rel = 'primary', $start = null, $batchSize = null, $user = '')
{
// If dateTarget is an array, then organize them.
if (is_array($dateTarget)) {
$dateArray = $dateTarget;
$dateTarget = $dateTarget['dateTarget'];
}
// Set date to current if not set
$dateTarget = ($dateTarget) ? $dateTarget : date('Y-m-d H:i:s');
// Prepare the results array
$results = array();
// If set the $provider to collate_outer (or collate_inner without plans organize mode),
// then run through this function recursively and return results.
if (($provider == "collate_outer") || ($provider == "collate_inner" && $organize_mode != 'plans')) {
// First, collect an array of all providers
$query = "SELECT id, lname, fname, npi, federaltaxid FROM users WHERE authorized = 1 ORDER BY lname, fname";
$ures = sqlStatementCdrEngine($query);
// Second, run through each provider recursively
while ($urow = sqlFetchArray($ures)) {
$newResults = test_rules_clinic($urow['id'], $type, $dateTarget, $mode, $patient_id, $plan, $organize_mode, $options, $pat_prov_rel, $start, $batchSize, $user);
if (!empty($newResults)) {
$provider_item['is_provider'] = true;
$provider_item['prov_lname'] = $urow['lname'];
$provider_item['prov_fname'] = $urow['fname'];
$provider_item['npi'] = $urow['npi'];
$provider_item['federaltaxid'] = $urow['federaltaxid'];
array_push($results, $provider_item);
$results = array_merge($results, $newResults);
}
}
// done, so now can return results
return $results;
}
// If set organize-mode to plans, then collects active plans and run through this
// function recursively and return results.
if ($organize_mode == "plans") {
// First, collect active plans
$plans_resolve = resolve_plans_sql($plan, $patient_id);
// Second, run through function recursively
foreach ($plans_resolve as $plan_item) {
// (if collate_inner, then nest a collation of providers within each plan)
if ($provider == "collate_inner") {
// First, collect an array of all providers
$query = "SELECT id, lname, fname, npi, federaltaxid FROM users WHERE authorized = 1 ORDER BY lname, fname";
$ures = sqlStatementCdrEngine($query);
// Second, run through each provider recursively
$provider_results = array();
while ($urow = sqlFetchArray($ures)) {
$newResults = test_rules_clinic($urow['id'], $type, $dateTarget, $mode, $patient_id, $plan_item['id'], 'default', $options, $pat_prov_rel, $start, $batchSize, $user);
if (!empty($newResults)) {
$provider_item['is_provider'] = true;
$provider_item['prov_lname'] = $urow['lname'];
$provider_item['prov_fname'] = $urow['fname'];
$provider_item['npi'] = $urow['npi'];
$provider_item['federaltaxid'] = $urow['federaltaxid'];
array_push($provider_results, $provider_item);
$provider_results = array_merge($provider_results, $newResults);
}
}
if (!empty($provider_results)) {
$plan_item['is_plan'] = true;
array_push($results, $plan_item);
$results = array_merge($results, $provider_results);
}
} else {
// (not collate_inner, so do not nest providers within each plan)
$newResults = test_rules_clinic($provider, $type, $dateTarget, $mode, $patient_id, $plan_item['id'], 'default', $options, $pat_prov_rel, $start, $batchSize, $user);
if (!empty($newResults)) {
$plan_item['is_plan'] = true;
array_push($results, $plan_item);
$results = array_merge($results, $newResults);
}
}
}
// done, so now can return results
return $results;
}
// Collect applicable patient pids
$patientData = array();
$patientData = buildPatientArray($patient_id, $provider, $pat_prov_rel, $start, $batchSize);
// Go through each patient(s)
//
// If in report mode, then tabulate for each rule:
// Total Patients
// Patients that pass the filter
// Patients that pass the target
// If in reminders mode, then create reminders for each rule:
// Reminder that action is due soon
// Reminder that action is due
// Reminder that action is post-due
//Collect applicable rules
// Note that due to a limitation in the this function, the patient_id is explicitly
// for grouping items when not being done in real-time or for official reporting.
// So for cases such as patient reminders on a clinic scale, the calling function
// will actually need rather than pass in a explicit patient_id for each patient in
// a separate call to this function.
if ($mode != "report") {
// Use per patient custom rules (if exist)
// Note as discussed above, this only works for single patient instances.
$rules = resolve_rules_sql($type, $patient_id, false, $plan, $user);
} else { // $mode = "report"
// Only use default rules (do not use patient custom rules)
$rules = resolve_rules_sql($type, $patient_id, false, $plan, $user);
}
foreach ($rules as $rowRule) {
// If using cqm or amc type, then use the hard-coded rules set.
// Note these rules are only used in report mode.
if ($rowRule['cqm_flag'] || $rowRule['amc_flag']) {
require_once(dirname(__FILE__)."/classes/rulesets/ReportManager.php");
$manager = new ReportManager();
if ($rowRule['amc_flag']) {
// Send array of dates ('dateBegin' and 'dateTarget')
$tempResults = $manager->runReport($rowRule, $patientData, $dateArray, $options);
} else {
// Send target date
$tempResults = $manager->runReport($rowRule, $patientData, $dateTarget);
}
if (!empty($tempResults)) {
foreach ($tempResults as $tempResult) {
array_push($results, $tempResult);
}
}
// Go on to the next rule
continue;
}
// If in reminder mode then need to collect the measurement dates
// from rule_reminder table
$target_dates = array();
if ($mode != "report") {
// Calculate the dates to check for
if ($type == "patient_reminder") {
$reminder_interval_type = "patient_reminder";
} else { // $type == "passive_alert" or $type == "active_alert"
$reminder_interval_type = "clinical_reminder";
}
$target_dates = calculate_reminder_dates($rowRule['id'], $dateTarget, $reminder_interval_type);
} else { // $mode == "report"
// Only use the target date in the report
$target_dates[0] = $dateTarget;
}
//Reset the counters
$total_patients = 0;
$pass_filter = 0;
$exclude_filter = 0;
$pass_target = 0;
// Find the number of target groups
$targetGroups = returnTargetGroups($rowRule['id']);
if ((count($targetGroups) == 1) || ($mode == "report")) {
// If report itemization is turned on, then iterate the rule id iterator
if (!empty($GLOBALS['report_itemizing_temp_flag_and_id'])) {
$GLOBALS['report_itemized_test_id_iterator']++;
}
//skip this section if not report and more than one target group
foreach ($patientData as $rowPatient) {
// First, deal with deceased patients
// (for now will simply skip the patient)
// If want to support rules for deceased patients then will need to migrate this below
// in target_dates foreach(guessing won't ever need to do this, though).
// Note using the dateTarget rather than dateFocus
if (is_patient_deceased($rowPatient['pid'], $dateTarget)) {
continue;
}
// Count the total patients
$total_patients++;
$dateCounter = 1; // for reminder mode to keep track of which date checking
// If report itemization is turned on, reset flag.
if (!empty($GLOBALS['report_itemizing_temp_flag_and_id'])) {
$temp_track_pass = 1;
}
foreach ($target_dates as $dateFocus) {
//Skip if date is set to SKIP
if ($dateFocus == "SKIP") {
$dateCounter++;
continue;
}
//Set date counter and reminder token (applicable for reminders only)
if ($dateCounter == 1) {
$reminder_due = "soon_due";
} else if ($dateCounter == 2) {
$reminder_due = "due";
} else { // $dateCounter == 3
$reminder_due = "past_due";
}
// Check if pass filter
$passFilter = test_filter($rowPatient['pid'], $rowRule['id'], $dateFocus);
if ($passFilter === "EXCLUDED") {
// increment EXCLUDED and pass_filter counters
// and set as FALSE for reminder functionality.
$pass_filter++;
$exclude_filter++;
$passFilter = false;
}
if ($passFilter) {
// increment pass filter counter
$pass_filter++;
// If report itemization is turned on, trigger flag.
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
$temp_track_pass = 0;
}
} else {
$dateCounter++;
continue;
}
// Check if pass target
$passTarget = test_targets($rowPatient['pid'], $rowRule['id'], '', $dateFocus);
if ($passTarget) {
// increment pass target counter
$pass_target++;
// If report itemization is turned on, then record the "passed" item and set the flag
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
insertItemReportTracker($GLOBALS['report_itemizing_temp_flag_and_id'], $GLOBALS['report_itemized_test_id_iterator'], 1, $rowPatient['pid']);
$temp_track_pass = 1;
}
// send to reminder results
if ($mode == "reminders-all") {
// place the completed actions into the reminder return array
$actionArray = resolve_action_sql($rowRule['id'], '1');
foreach ($actionArray as $action) {
$action_plus = $action;
$action_plus['due_status'] = "not_due";
$action_plus['pid'] = $rowPatient['pid'];
$action_plus['rule_id'] = $rowRule['id'];
$results = reminder_results_integrate($results, $action_plus);
}
}
break;
} else {
// send to reminder results
if ($mode != "report") {
// place the uncompleted actions into the reminder return array
$actionArray = resolve_action_sql($rowRule['id'], '1');
foreach ($actionArray as $action) {
$action_plus = $action;
$action_plus['due_status'] = $reminder_due;
$action_plus['pid'] = $rowPatient['pid'];
$action_plus['rule_id'] = $rowRule['id'];
$results = reminder_results_integrate($results, $action_plus);
}
}
}
$dateCounter++;
}
// If report itemization is turned on, then record the "failed" item if it did not pass
if (!empty($GLOBALS['report_itemizing_temp_flag_and_id']) && !($temp_track_pass)) {
insertItemReportTracker($GLOBALS['report_itemizing_temp_flag_and_id'], $GLOBALS['report_itemized_test_id_iterator'], 0, $rowPatient['pid']);
}
}
}
// Calculate and save the data for the rule
$percentage = calculate_percentage($pass_filter, $exclude_filter, $pass_target);
if ($mode == "report") {
$newRow=array('is_main'=>true,'total_patients'=>$total_patients,'excluded'=>$exclude_filter,'pass_filter'=>$pass_filter,'pass_target'=>$pass_target,'percentage'=>$percentage);
$newRow=array_merge($newRow, $rowRule);
// If itemization is turned on, then record the itemized_test_id
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
$newRow=array_merge($newRow, array('itemized_test_id'=>$GLOBALS['report_itemized_test_id_iterator']));
}
array_push($results, $newRow);
}
// Now run through the target groups if more than one
if (count($targetGroups) > 1) {
foreach ($targetGroups as $i) {
// If report itemization is turned on, then iterate the rule id iterator
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
$GLOBALS['report_itemized_test_id_iterator']++;
}
//Reset the target counter
$pass_target = 0;
foreach ($patientData as $rowPatient) {
// First, deal with deceased patients
// (for now will simply skip the patient)
// If want to support rules for deceased patients then will need to migrate this below
// in target_dates foreach(guessing won't ever need to do this, though).
// Note using the dateTarget rather than dateFocus
if (is_patient_deceased($rowPatient['pid'], $dateTarget)) {
continue;
}
$dateCounter = 1; // for reminder mode to keep track of which date checking
// If report itemization is turned on, reset flag.
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
$temp_track_pass = 1;
}
foreach ($target_dates as $dateFocus) {
//Skip if date is set to SKIP
if ($dateFocus == "SKIP") {
$dateCounter++;
continue;
}
//Set date counter and reminder token (applicable for reminders only)
if ($dateCounter == 1) {
$reminder_due = "soon_due";
} else if ($dateCounter == 2) {
$reminder_due = "due";
} else { // $dateCounter == 3
$reminder_due = "past_due";
}
// Check if pass filter
$passFilter = test_filter($rowPatient['pid'], $rowRule['id'], $dateFocus);
if ($passFilter === "EXCLUDED") {
$passFilter = false;
}
if (!$passFilter) {
$dateCounter++;
continue;
} else {
// If report itemization is turned on, trigger flag.
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
$temp_track_pass = 0;
}
}
//Check if pass target
$passTarget = test_targets($rowPatient['pid'], $rowRule['id'], $i, $dateFocus);
if ($passTarget) {
// increment pass target counter
$pass_target++;
// If report itemization is turned on, then record the "passed" item and set the flag
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
insertItemReportTracker($GLOBALS['report_itemizing_temp_flag_and_id'], $GLOBALS['report_itemized_test_id_iterator'], 1, $rowPatient['pid']);
$temp_track_pass = 1;
}
// send to reminder results
if ($mode == "reminders-all") {
// place the completed actions into the reminder return array
$actionArray = resolve_action_sql($rowRule['id'], $i);
foreach ($actionArray as $action) {
$action_plus = $action;
$action_plus['due_status'] = "not_due";
$action_plus['pid'] = $rowPatient['pid'];
$action_plus['rule_id'] = $rowRule['id'];
$results = reminder_results_integrate($results, $action_plus);
}
}
break;
} else {
// send to reminder results
if ($mode != "report") {
// place the actions into the reminder return array
$actionArray = resolve_action_sql($rowRule['id'], $i);
foreach ($actionArray as $action) {
$action_plus = $action;
$action_plus['due_status'] = $reminder_due;
$action_plus['pid'] = $rowPatient['pid'];
$action_plus['rule_id'] = $rowRule['id'];
$results = reminder_results_integrate($results, $action_plus);
}
}
}
$dateCounter++;
}
// If report itemization is turned on, then record the "failed" item if it did not pass
if ($GLOBALS['report_itemizing_temp_flag_and_id'] && !($temp_track_pass)) {
insertItemReportTracker($GLOBALS['report_itemizing_temp_flag_and_id'], $GLOBALS['report_itemized_test_id_iterator'], 0, $rowPatient['pid']);
}
}
// Calculate and save the data for the rule
$percentage = calculate_percentage($pass_filter, $exclude_filter, $pass_target);
// Collect action for title (just use the first one, if more than one)
$actionArray = resolve_action_sql($rowRule['id'], $i);
$action = $actionArray[0];
if ($mode == "report") {
$newRow=array('is_sub'=>true,'action_category'=>$action['category'],'action_item'=>$action['item'],'total_patients'=>'','excluded'=>'','pass_filter'=>'','pass_target'=>$pass_target,'percentage'=>$percentage);
// If itemization is turned on, then record the itemized_test_id