public function execute()
{
// If itemization is turned on, then iterate the rule id iterator
//
// Note that when AMC rules suports different patient populations and
// numerator caclulation, then it will need to change placement of
// this and mimick the CQM rules mechanism
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
$GLOBALS['report_itemized_test_id_iterator']++;
}
$numerator = $this->createNumerator();
if (!$numerator instanceof AmcFilterIF) {
throw new Exception("Numerator must be an instance of AmcFilterIF");
}
$denominator = $this->createDenominator();
if (!$denominator instanceof AmcFilterIF) {
throw new Exception("Denominator must be an instance of AmcFilterIF");
}
$totalPatients = count($this->_amcPopulation);
// Figure out object to be counted
// (patients, labs, transitions, visits, or prescriptions)
$object_to_count = $this->getObjectToCount();
if (empty($object_to_count)) {
$object_to_count = "patients";
}
$numeratorObjects = 0;
$denominatorObjects = 0;
foreach ($this->_amcPopulation as $patient) {
// If begin measurement is empty, then make the begin
// measurement the patient dob.
$tempBeginMeasurement = "";
if (empty($this->_beginMeasurement)) {
$tempBeginMeasurement = $patient->dob;
} else {
$tempBeginMeasurement = $this->_beginMeasurement;
}
// Count Denominators
if ($object_to_count == "patients") {
// Counting patients
if (!$denominator->test($patient, $tempBeginMeasurement, $this->_endMeasurement)) {
continue;
}
$denominatorObjects++;
} else {
// Counting objects other than patients
// First, collect the pertinent objects
$objects = $this->collectObjects($patient, $object_to_count, $tempBeginMeasurement, $this->_endMeasurement);
// Second, test each object
$objects_pass = array();
foreach ($objects as $object) {
$patient->object = $object;
if ($denominator->test($patient, $tempBeginMeasurement, $this->_endMeasurement)) {
$denominatorObjects++;
array_push($objects_pass, $object);
}
}
}
// Count Numerators
if ($object_to_count == "patients") {
// Counting patients
if (!$numerator->test($patient, $tempBeginMeasurement, $this->_endMeasurement)) {
// If itemization is turned on, then record the "failed" item
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
insertItemReportTracker($GLOBALS['report_itemizing_temp_flag_and_id'], $GLOBALS['report_itemized_test_id_iterator'], 0, $patient->id);
}
continue;
} else {
$numeratorObjects++;
// If itemization is turned on, then record the "passed" item
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
insertItemReportTracker($GLOBALS['report_itemizing_temp_flag_and_id'], $GLOBALS['report_itemized_test_id_iterator'], 1, $patient->id);
}
}
} else {
// Counting objects other than patients
// test each object that passed the above denominator testing
foreach ($objects_pass as $object) {
$patient->object = $object;
if ($numerator->test($patient, $tempBeginMeasurement, $this->_endMeasurement)) {
$numeratorObjects++;
// If itemization is turned on, then record the "passed" item
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
insertItemReportTracker($GLOBALS['report_itemizing_temp_flag_and_id'], $GLOBALS['report_itemized_test_id_iterator'], 1, $patient->id);
}
} else {
// If itemization is turned on, then record the "failed" item
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
insertItemReportTracker($GLOBALS['report_itemizing_temp_flag_and_id'], $GLOBALS['report_itemized_test_id_iterator'], 0, $patient->id);
}
}
}
}
}
// Deal with the manually added labs for the electronic labs AMC measure
if ($object_to_count == "labs") {
$denominatorObjects = $denominatorObjects + $this->_manualLabNumber;
}
$percentage = calculate_percentage($denominatorObjects, 0, $numeratorObjects);
$result = new AmcResult($this->_rowRule, $totalPatients, $denominatorObjects, 0, $numeratorObjects, $percentage);
$this->_resultsArray[] = $result;
}
/**
* 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 || $mode == "report") {
// If report itemization is turned on, then iterate the rule id iterator
if ($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++;
$dateCounter = 1;
// for reminder mode to keep track of which date checking
// If report itemization is turned on, reset flag.
if ($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);
}
}
}
$dateCounter++;
}
// If report itemization is turned on, then record the "failed" item if it did not pass
if ($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' => $percentage);
// If itemization is turned on, then record the itemized_test_id
if ($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);
}
}
}
}
// Return the data
return $results;
}
private function testNumerator($patient, $numerator, &$numeratorPatientPopulations)
{
if ($numerator instanceof CqmFilterIF) {
if ($numerator->test($patient, $this->_beginMeasurement, $this->_endMeasurement)) {
$numeratorPatientPopulations[$numerator->getTitle()]++;
// If itemization is turned on, then record the "passed" item
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
insertItemReportTracker($GLOBALS['report_itemizing_temp_flag_and_id'], $GLOBALS['report_itemized_test_id_iterator'], 1, $patient->id, $numerator->getTitle());
}
} else {
// If itemization is turned on, then record the "failed" item
if ($GLOBALS['report_itemizing_temp_flag_and_id']) {
insertItemReportTracker($GLOBALS['report_itemizing_temp_flag_and_id'], $GLOBALS['report_itemized_test_id_iterator'], 0, $patient->id, $numerator->getTitle());
}
}
} else {
throw new Exception("Numerator must be an instance of CqmFilterIF");
}
}
