/**
* 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,amc,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 $batchSize number of patients to batch (when batching process)
* @return array See above for organization structure of the results.
*/
function test_rules_clinic($provider = '', $type = '', $dateTarget = '', $mode = '', $patient_id = '', $plan = '', $organize_mode = 'default', $options = array(), $pat_prov_rel = 'primary', $start = NULL, $batchSize = NULL)
{
// If dateTarget is an array, then organize them.
if (is_array($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, $batchSize);
if (!empty($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, $batchSize);
if (!empty($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, $batchSize);
if (!empty($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);
} else {
// $mode = "report"
// Only use default rules (do not use patient custom rules)
$rules = resolve_rules_sql($type, $patient_id, FALSE, $plan);
}
foreach ($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 || $mode == "report") {
//skip this section if not report and more than one target group
foreach ($patientData as $rowPatient) {
// Count the total patients
$total_patients++;
$dateCounter = 1;
// for reminder mode to keep track of which date checking
foreach ($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
$reminder_due = "past_due";
}
}
// First, deal with deceased patients
// (for now will simply not pass the filter, but can add a database item
// if ever want to create rules for dead people)
// Could also place this function at the total_patients level if wanted.
// (But then would lose the option of making rules for dead people)
// Note using the dateTarget rather than dateFocus
if (is_patient_deceased($rowPatient['pid'], $dateTarget)) {
continue;
}
// 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++;
} else {
$dateCounter++;
continue;
}
// Check if pass target
$passTarget = test_targets($rowPatient['pid'], $rowRule['id'], '', $dateFocus);
if ($passTarget) {
// increment pass target counter
$pass_target++;
// send to reminder results
if ($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'];
$results = reminder_results_integrate($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'];
$results = reminder_results_integrate($results, $action_plus);
}
}
}
$dateCounter++;
}
}
}
// 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, $rowRule);
array_push($results, $newRow);
}
// Now run through the target groups if more than one
if (count($targetGroups) > 1) {
foreach ($targetGroups as $i) {
//Reset the target counter
$pass_target = 0;
foreach ($patientData as $rowPatient) {
$dateCounter = 1;
// for reminder mode to keep track of which date checking
foreach ($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
$reminder_due = "past_due";
}
}
// First, deal with deceased patients
// (for now will simply not pass the filter, but can add a database item
// if ever want to create rules for dead people)
// Could also place this function at the total_patients level if wanted.
// (But then would lose the option of making rules for dead people)
// Note using the dateTarget rather than dateFocus
if (is_patient_deceased($rowPatient['pid'], $dateTarget)) {
continue;
}
// Check if pass filter
$passFilter = test_filter($rowPatient['pid'], $rowRule['id'], $dateFocus);
if ($passFilter === "EXCLUDED") {
$passFilter = FALSE;
}
if (!$passFilter) {
// increment pass filter counter
$dateCounter++;
continue;
}
//Check if pass target
$passTarget = test_targets($rowPatient['pid'], $rowRule['id'], $i, $dateFocus);
if ($passTarget) {
// increment pass target counter
$pass_target++;
// send to reminder results
if ($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'];
$results = reminder_results_integrate($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'];
$results = reminder_results_integrate($results, $action_plus);
}
}
}
$dateCounter++;
}
}
// 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' => $percentage);
array_push($results, $newRow);
}
}
}
}
// Return the data
return $results;
}
/**
* Function to update reminders.
*
* Function that updates reminders and returns an array with a specific data structure.
* <pre>The data structure of the return array includes the following elements
* 'total_active_actions' - Number of active actions.
* 'total_pre_active_reminders' - Number of active reminders before processing.
* 'total_pre_unsent_reminders' - Number of unsent reminders before processing.
* 'total_post_active_reminders' - Number of active reminders after processing.
* 'total_post_unsent_reminders' - Number of unsent reminders after processing.
* 'number_new_reminders' - Number of new reminders
* 'number_updated_reminders' - Number of updated reminders (due_status change)
* 'number_inactivated_reminders' - Number of inactivated reminders.
* 'number_unchanged_reminders' - Number of unchanged reminders.
* </pre>
*
* @param string $dateTarget target date (format Y-m-d H:i:s). If blank then will test with current date as target.
* @param integer $patient_id pid of patient. If blank then will check all patients.
* @param integer $start applicable patient to start at (when batching process)
* @param integer $batchSize number of patients to batch (when batching process)
* @return array see above for data structure of returned array
*/
function update_reminders($dateTarget = '', $patient_id = '', $start = NULL, $batchSize = NULL)
{
$logging = array();
// Set date to current if not set
$dateTarget = $dateTarget ? $dateTarget : date('Y-m-d H:i:s');
// Collect reminders (note that this function removes redundant and keeps the most distant
// reminder (ie. prefers 'past_due' over 'due' over 'soon_due')
// Note that due to a limitation in the test_rules_clinic function, the patient_id is explicitly
// needed to work correctly. So rather than pass in a '' patient_id to do the entire clinic,
// we instead need to pass in each patient_id separately.
$collectedReminders = array();
$patient_id_complete = "";
if (!empty($patient_id)) {
// only one patient id, so run the function
$collectedReminders = test_rules_clinic('', 'patient_reminder', $dateTarget, 'reminders-due', $patient_id);
$patient_id_complete = $patient_id;
} else {
// as described above, need to pass in each patient_id
// Collect all patient ids
$patientData = buildPatientArray('', '', '', $start, $batchSize);
for ($iter = 0; $row = sqlFetchArray($rez); $iter++) {
$patientData[$iter] = $row;
}
$first_flag = TRUE;
foreach ($patientData as $patient) {
// collect reminders
$tempCollectReminders = test_rules_clinic('', 'patient_reminder', $dateTarget, 'reminders-due', $patient['pid']);
$collectedReminders = array_merge($collectedReminders, $tempCollectReminders);
// build the $patient_id_complete variable
if ($first_flag) {
$patient_id_complete .= $patient['pid'];
$first_flag = FALSE;
} else {
$patient_id_complete .= "," . $patient['pid'];
}
}
}
$logging['total_active_actions'] = count($collectedReminders);
// For logging purposes only:
// Collect number active of active and unsent reminders
$logging['total_pre_active_reminders'] = count(fetch_reminders($patient_id_complete));
$logging['total_pre_unsent_reminders'] = count(fetch_reminders($patient_id_complete, 'unsent'));
// Migrate reminders into the patient_reminders table
$logging['number_new_reminders'] = 0;
$logging['number_updated_reminders'] = 0;
$logging['number_unchanged_reminders'] = 0;
foreach ($collectedReminders as $reminder) {
// See if a reminder already exist
$sql = "SELECT `id`, `pid`, `due_status`, `category`, `item` FROM `patient_reminders` WHERE " . "`active`='1' AND `pid`=? AND `category`=? AND `item`=?";
$result = sqlQueryCdrEngine($sql, array($reminder['pid'], $reminder['category'], $reminder['item']));
if (empty($result)) {
// It does not yet exist, so add a new reminder
$sql = "INSERT INTO `patient_reminders` (`pid`, `due_status`, `category`, `item`, `date_created`) " . "VALUES (?, ?, ?, ?, NOW())";
sqlStatementCdrEngine($sql, array($reminder['pid'], $reminder['due_status'], $reminder['category'], $reminder['item']));
$logging['number_new_reminders']++;
} else {
// It already exist (see if if needs to be updated via adding a new reminder)
if ($reminder['due_status'] == $result['due_status']) {
// No change in due status, so no need to update
$logging['number_unchanged_reminders']++;
continue;
} else {
// Change in due status, so inactivate current reminder and create a new one
// First, inactivate the previous reminder
$sql = "UPDATE `patient_reminders` SET `active` = '0', `reason_inactivated` = 'due_status_update', " . "`date_inactivated` = NOW() WHERE `id`=?";
sqlStatementCdrEngine($sql, array($result['id']));
// Then, add the new reminder
$sql = "INSERT INTO `patient_reminders` (`pid`, `due_status`, `category`, `item`, `date_created`) " . "VALUES (?, ?, ?, ?, NOW())";
sqlStatementCdrEngine($sql, array($reminder['pid'], $reminder['due_status'], $reminder['category'], $reminder['item']));
}
}
}
// Inactivate reminders that no longer exist
// Go through each active reminder and ensure it is in the current list
$sqlReminders = fetch_reminders($patient_id_complete);
$logging['number_inactivated_reminders'] = 0;
foreach ($sqlReminders as $row) {
$inactivateFlag = true;
foreach ($collectedReminders as $reminder) {
if ($row['pid'] == $reminder['pid'] && $row['category'] == $reminder['category'] && $row['item'] == $reminder['item'] && $row['due_status'] == $reminder['due_status']) {
// The sql reminder has been confirmed, so do not inactivate it
$inactivateFlag = false;
break;
}
}
if ($inactivateFlag) {
// The sql reminder was not confirmed, so inactivate it
$sql = "UPDATE `patient_reminders` SET `active` = '0', `reason_inactivated` = 'auto', " . "`date_inactivated` = NOW() WHERE `id`=?";
sqlStatementCdrEngine($sql, array($row['id']));
$logging['number_inactivated_reminders']++;
}
}
// For logging purposes only:
// Collect number of active and unsent reminders
$logging['total_post_active_reminders'] = count(fetch_reminders($patient_id_complete));
$logging['total_post_unsent_reminders'] = count(fetch_reminders($patient_id_complete, 'unsent'));
return $logging;
}