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Health maintenance guidelines are published "best practise" backed by evidence based medicine by various authorities.

We intend to implement these as a user configurable option - ie. you can either choose to apply them, or ignore them.

The intent is that a list of applicable guidelines will be visible during the consultation.  Those that need action will be highlighted in some visible way.

To satisfy a HMG will require that tests will need to be added in a way recognisable to the system.  So, if a diabetic patient has a retinal examination, that examination needs to be added as a result with a specific LOINC ( or other vocabulary ) code so that the HMG can be automatically satisfied.

My understanding is that HMGs are based upon age, gender, and disease criteria.  So, we will allow you to create your own HMG, and allow you to include the URL for the specific recommendation.  For those of you participating in P4P schemes, this will help you to satisfy their criteria.

Comments welcome.

I am now starting to implement HMGs.

Anyone got a good link to some useful HMGs?

Graham:

I am now starting to implement HMGs.

Anyone got a good link to some useful HMGs?

What's the general plan of attack ?

The HMGs themselves are the easy part, easily added by the enduser.

HGM dialect (provisional specification)

age [ greaterthan | lessthan ] integer

This specifies the age boundary in years.  The defaults if not used are 0 - 110

eg: age greaterthan 49 age lessthan 71 

sex [ male | female | all ]

This specifies  which gender the rule applies to.  The default is to both.

eg. sex male

 diagnosis [ ...  list of ICD9, snomedCT, or readcodes ]

This specifies that the HMG only applies to persons with these diagnoses.  The codes are whatever are being used.

eg: diagnosis [ 250 C10 ]

Which applies the rule to patients with diabetes using ICD9 codes, and Read Codes.  This uses a wild card match so that it will match 250.00 and so forth.

medication word

This specifies that the HMG applies to persons taking this medication.

eg. medication Lithium 

result word

This specifies that the HMG will be satisfied with a text result

eg. result Mammogram, or result "Diabetic Foot Examination"

LOINC [ .. list of LOINC codes ]

This specifies that the HMG will be satisfied with one of the following LOINC codes as found in the numerical results.

eg: LOINC [ "17855-8" ]

which is a test for HBA1c.  Note that Loinc codes must be enclosed in quotes.

Period n [ month | months | year | years ]

This specifies what period the test has to have been done from the current date

eg: period 2 years

means that the HMG will be satisfied if done within the last 2 years.

I'll add CT scan, and Ultrasound

As for satisfying Eye Exams - well, if the patient tells you they had it done, I can't see any other easy way of adding a result ...

And as for Foot Exams - monofilament testing etc, maybe they can be satisfied within the consult some how.  I'll have to ponder this.

This is to allow the entry of all the possible results/interventions .. but primarily those that are used to satisfy to HMG.

So, Ba enema yes .. others no.

The others can be typed in the field. 

A user configurable selection list would be important. 

Certainly some should be hard coded but different doctors will want different things.