These instructions are for installing the version 6 of popHealth in a production like environment. The instructions are based on installing from the v6 branch of the popHealth repository, which should be considered a work in progress until it's been recertified.
There is also a development environment installation instructions. The instruction for the development environment is simpler but has performance issue due to memory leakage. The main difference between the two installations is that these set of instructions use Phusion Passenger/Apache as the web application server. With this installation you gain significant performance via optimization provided by the Passenger / Apache application server. For those who wants to try out popHealth and is concerned with the system performance of popHealth, you should use these set of instructions.
You will need an NLM VSAC account to download the 2018 measure and value set definitions for 2019 reporting period. You can sign up for an NLM VSAC account at https://uts.nlm.nih.gov/home.html (click the "Sign Up" link in the upper right corner of the page.)
The instructions assume that a system user named 'pophealth' wants to install the app in their home directory, i.e., /home/pophealth. This is not a requirement; any user with sudo privileges can install pophealth. Just be sure to adjust the directory paths in the commands below. Also, make sure to update your /etc/hosts file to include the line
else, you might receive "sudo: unable to resolve host my-machine-name” warning when running sudo commands.
1. Installing Ubuntu
The ISO for ubuntu 16.04 LTS can be downloaded from the following URL: http://releases.ubuntu.com/xenial/
These instructions were developed against the "64-bit PC (AMD64) server install CD" (ubuntu-16.04-server-amd64.iso).
Installing Ubuntu is a fairly straight-forward process, but for more details on installing Ubuntu please visit the following URLs:
Graphical install using the desktop CD: https://help.ubuntu.com/community/GraphicalInstall
Installation using the Alternate CD (more configuration options): https://help.ubuntu.com/16.04/installation-guide/index.html
Once Ubuntu has been installed you need to update the software on the computer using Apt. Apt is a software package management system used by Ubuntu. Note: the last command in the group below is only necessary if any packages were actually upgraded.
sudo apt-get update sudo apt-get -y upgrade sudo reboot
2. Configure Proxy Settings
This step is only required if the server you are installing popHealth onto needs to go through an HTTP proxy server to reach the internet. These steps will ensure that the appropriate proxy settings are in place for every user that logs into the system.
Use your favourite text editor to create a file in /etc/profile.d named http_proxy.sh with the following contents. In the sample below, replace your.proxy.host.com with the fully-qualified host name of your proxy server, and your.proxy.port with the port number that the proxy server uses.
# Set up system-wide HTTP proxy settings for all users http_proxy='http://your.proxy.host.com:your.proxy.port/' https_proxy='http://your.proxy.host.com:your.proxy.port/' export http_proxy https_proxy
Set proper permissions on the new file, and load the settings into the current environment. NOTE: the proxy settings will automatically be loaded when a user logs in, but we are manually loading them here, to avoid having to log out and log back in again.
sudo chmod 0644 /etc/profile.d/http_proxy.sh source /etc/profile.d/http_proxy.sh
Make sure that the sudo command will allow the new proxy settings to be passed to commands it launches. This is done by using your text editor to create a file in the /etc/sudoers.d directory named http_proxy (no extension) with the following contents:
# keep http_proxy environment variables. Defaults env_keep += "http_proxy https_proxy"
Set proper permissions on the new file:
sudo chmod 0440 /etc/sudoers.d/http_proxy
3. Installing Mongo DB, RabbitMQ, and Js-Ecqm-Engine Using Chef Scripts
Install chef-solo to run the chef script
cd /home/pophealth sudo apt-get -y install git-core wget wget https://packages.chef.io/files/stable/chefdk/2.0.26/ubuntu/16.04/chefdk_2.0.26-1_amd64.deb sudo dpkg -i chefdk_2.0.26-1_amd64.deb
Install chef script which will install MongoDB, RabbitMQ, and Js-Ecqm-Engine
git clone https://github.com/osehra/js-ecqm-engine-recipe.git cd js-ecqm-engine-recipe berks vendor cookbooks
sudo chef-client -z -j install_ecqmEngine.json
Please note the following:
If the installation pauses at the line “apt_package[esl-erlang] action install” then, press Enter key to continue.
At the end of installation, it might give an error message - “FATAL: Cannot load configuration from install_ecqmEngine.json”. This is a known bug in Chef, and we can ignore the message.
After the installation, we can verify whether js-ecqm-engine and RabbitMQ are running by using the following commands
systemctl status js-ecqm-engine systemctl status rabbitmq-server
You should see "active (running)" status from each command, type 'q' to exit the rabbitmq-server status command.
4. Installing RVM and Ruby 2.3.7
RVM is a system that allows managing different versions of Ruby. It will allow the correct version of ruby to be easily installed on the system. Ruby is the development language used for the popHealth application.
First we will need to install some dependencies:
cd ~ sudo apt-get install build-essential openssl libssl-dev libreadline6 libreadline6-dev curl zlib1g zlib1g-dev libyaml-dev libsqlite3-dev sqlite3 libxml2-dev libxslt-dev autoconf libc6-dev ncurses-dev automake libtool bison subversion pkg-config unzip
Next install RVM. This will install RVM for all users
sudo gpg --keyserver hkp://pool.sks-keyservers.net --recv-keys 409B6B1796C275462A1703113804BB82D39DC0E3 7D2BAF1CF37B13E2069D6956105BD0E739499BDB curl -sSL get.rvm.io | sudo bash -l -s stable
Source the RVM environment so we can use it here:
bash source /usr/local/rvm/scripts/rvm
Log out, and then log back in again so that the settings RVM installs will be loaded in your environment. Once you have logged back in, run the following commands. These will install some more dependencies.
We will install these dependencies using an admin console. The admin console can be opened with the following command:
Next we want to set the autolibs flag in rvm
rvm autolibs enable
Next we want to install Ruby 2.3.7 using RVM
rvm install 2.3.7
If you get a message about installing dependencies, press 'q'. We have already installed everything we will need.
Set ruby version 2.3.7 to be the default version:
rvm --default 2.3.7
Finally install bundler. Bundler is a Ruby Gem that allows downloading additional dependencies once we have the popHealth source code:
gem install bundler -v '1.17.1'
Close the admin console by running:
setup rvm for the admin user:
source /etc/profile.d/rvm.sh rvm use 2.3.7 rvm --default 2.3.7
*****NOTE: If the above path (/etc/profile.d/rvm.sh) does not exist, try replacing it with: ~/.rvm/scripts/rvm *****
5. Check MongoDB
MongoDB is the database used by popHealth. Run the command below to test connection. If the command exits with a error about not being able to connect, then reboot, and log back in as the admin user. Sometimes mongodb fails to create a network socket when it is started immediately after installation. It should automatically start when the system is rebooted.
This should output MongoDB shell version: 3.4.x
Note that the version must read 3.4.5 or later.
Type 'exit' to exit the mongo shell
6. Downloading PopHealth source code
Downloading the pophealth source code from github. The following commands assume that your current directory is located at /home/pophealth
git clone https://github.com/osehra/popHealth.git -b v6 popHealth cd popHealth
Install popHealth and all its dependencies:
sudo apt-get install nodejs sudo apt install nodejs-legacy sudo apt-get install npm sudo npm install -g bower rm -rf vendor/assets/components/* bower install
7. Import the measure bundle
popHealth releases measure bundles that contain the measure artifacts that are needed to begin the measure calculation process:
In addition to the measure bundle, the value sets need to be loaded into popHealth from the NLM VSAC Service. You will need an NLM account in order to complete this step and load value sets from the VSAC service._ Register for an account at: https://uts.nlm.nih.gov/home.html
Run the following command to download and install the measure bundle
bundle exec rake pophealth:download_update_install version=2018 RAILS_ENV=production
Note that if you are working with the certification body such as InfoGard, please make sure to ask which measure bundle is used to generate the Cypress test deck. The CQM may not calculate correctly if there is a bundle mismatch.
After executing the above command, make sure that the following responses are displayed on the screen to show that the measure bundle is installed without any issue.
Bundle import successful Cleaning out records and caches
8. Configure popHealth mode
popHealth has two modes - 'Multiple Practice mode', and 'Regular mode'.
The 'Regular mode' functions the same way popHealth has been functioning since it was created by Mitre for use by a single organization.
The 'Multiple Practice mode' is for users that want to report on multiple organizations at once, and have aggregate report capabilities. This mode allows multiple sites/groups/practices/clinics in the same instance of popHealth, while segregating the data through user accounts and role based access.
The popHealth instance is set to 'Multiple Practice Mode' by default. To switch to the 'Regular mode', please do the following:
In the file popHealth.yml which resides in the config folder in the application directory, (filepath - config/popHealth.yml), change the line
Save and close the file. More information about 'Multiple Practice mode' and role-based access can be found in the Pull request here - https://github.com/OSEHRA/popHealth/pull/10
***Switching from one mode to another is not supported and may cause issues with the application. If you want to switch from one mode to the other, you have to first empty the collections for providers, patients, users, practices, and the caches from MongoDB, and then proceed with #7.
9. Creating an administrator user account
To create the default admin user account, run the following command:
bundle exec rake admin:create_admin_account RAILS_ENV=production
Default Username: pophealth, Password: pophealth
You can change the account password once you log in and go to the 'Edit Account' page from the top right menu.
10. Precompile Assets
To set up the asset pipeline and make sure all the images and fonts are included, run the following from the application directory
rake assets:precompile RAILS_ENV=production RAILS_RELATIVE_URL_ROOT=/home/pophealth/popHealth
11. Configure Startup Processes
Please note that the following scripts from step 11 to 13 assumes that the pophealth code are located at /home/pophealth/popHealth. Please modify the script accordingly if the code are placed at a different location
Configure delayed job to start up on server startup. At this point, you should still have a shell open as the pophealth user:
cd ~ echo -e '#!/bin/bash\ncd /home/pophealth/popHealth\n. /usr/local/rvm/scripts/rvm\nbundle exec rake jobs:work RAILS_ENV=production\n' > start_delayed_job.sh chmod +x start_delayed_job.sh cat << DELAYED_WORKER_END | sudo dd of=/etc/systemd/system/pophealth_delayed_worker.service [Unit] Description=delayed_worker After=mongod.service Requires=mongod.service [Service] Type=simple User=pophealth WorkingDirectory=/home/pophealth/popHealth ExecStart=/home/pophealth/start_delayed_job.sh TimeoutSec=120 [Install] WantedBy=multi-user.target DELAYED_WORKER_END
You will then need to start and enable the service:
sudo systemctl enable pophealth_delayed_worker sudo systemctl start pophealth_delayed_worker
12. Configure Passenger / Apache
Install apache and passenger with the following commands:
sudo -i apt-get install apache2=2.4.* gem install passenger -v '5.3.7'
These should be the dependencies required for passenger:
apt-get install libcurl4-openssl-dev apache2-dev libapr1-dev libaprutil1-dev
Update the site configuration with (please note that the script below assume that the pophealth code is installed on /home/pophealth/popHealth):
cat << POPHEALTH_SITE_END > /etc/apache2/sites-available/pophealth <VirtualHost *:80> PassengerRuby /usr/local/rvm/wrappers/ruby-2.3.7/ruby DocumentRoot /home/pophealth/popHealth/public TimeOut 1200 <Directory /home/pophealth/popHealth/public> AllowOverride all Options -MultiViews Require all granted </Directory> </VirtualHost> POPHEALTH_SITE_END
Make the default apache site be the pophealth provided content:
rm /etc/apache2/sites-enabled/000-default* ln -s ../sites-available/pophealth /etc/apache2/sites-enabled/000-default.conf
Update the apache configuration with the following commands:
cat << POPHEALTH_MOD_END > /etc/apache2/conf-available/pophealth SetEnv SECRET_KEY_BASE `cat /dev/urandom | env LC_CTYPE=c tr -dc 'a-e0-9' | fold -w 64 | head -n 1` POPHEALTH_MOD_END ln -s /etc/apache2/conf-available/pophealth /etc/apache2/conf-enabled/pophealth.conf cat << PASSENGER_CONF_END > /etc/apache2/mods-available/pophealth.conf LoadModule passenger_module /usr/local/rvm/gems/ruby-2.3.7/gems/passenger-5.3.7/buildout/apache2/mod_passenger.so <IfModule mod_passenger.c> PassengerRoot /usr/local/rvm/gems/ruby-2.3.7/gems/passenger-5.3.7 PassengerDefaultRuby /usr/local/rvm/gems/ruby-2.3.7/wrappers/ruby </IfModule> PASSENGER_CONF_END ln -f -s /etc/apache2/mods-available/pophealth.conf /etc/apache2/mods-enabled/pophealth.conf
Install the apache passenger module. If you need other dependencies, the installer will tell you:
At the end of the installation, you should see a line that says: Everything looks good. :-)
service apache2 restart
Exit the root shell:
To open the popHealth web app you'll need the server IP address. Open a web browser and enter
13. Importing test patients
There are two methods for importing patient data into popHealth - manual upload of patient file via the popHealth UI or patient API upload via http post. For testing purpose, you can download a test QRDA CAT I patient zip file derived from the Cypress tool version 4.0.2 and manually import the zip file using the popHealth administrator user interface. The Cypress test patient zip file can be accessed from
Unzip the patient zip file. You will find a series of zip files for each of the measures used for the Cypress attestation. To import, login into the popHealth application. The import function is located under the Administrator->Patients menu at the top right corner of the user interface. Assuming that you are using the "Multiple Practice" mode, first create a practice, then select the newly created practice when importing a specific patient zip file for a given measure. Wait for the import process to complete, i.e., the number of patients stop incrementing. To perform the CQM calculation, go to the Administrator->Providers menu, and select the practice provider. This will take you to the CQM dashboard. Select reporting period from 1-1-2019 to 12-31-2019 (default) and the measure associated with the patient files to perform the eCQM calculation. You can find the measure quickly by typing the measure, i.e., cms9 in the "measure or group title" input box on the left side panel.