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Share with us #ACE14Copyright © 2014 Allscripts Healthcare Solutions, Inc.

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Allscripts Client Experience 2014

The Brave New World of 2014 EP CQMs

August 13, 2014


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Share with us #ACE14

Kintu Shah, Solutions ArchitectAllscripts


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Kintu Shah PMP, Solutions ArchitectKintu Shah is an Allscripts Solution Architect and has worked on the Clinical performance Management (SCA / CPM) team for the last 4 years, most recently with a focus on understanding the Meaningful Use CQM requirements and working with clients to operationalize them.

Kintu has worked with more than 40 Sunrise clients to help them successfully configure and attest to CQM requirements. He is a key contributor in the MU CQM configuration workshops. Prior to serving on the Clinical Performance Management team, Kintu led consulting engagements for the implementation of Sunrise Laboratory and Blood Bank products.

Kintu has over 14 years of experience in healthcare IT. His educational accomplishments include a Masters in Computer Applications and a Diploma in Business Management. He is a Certified Project Management Professional (PMP).


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The Brave New World of 2014 EP CQMsAgenda• Eligible Providers CQMs

• CQM Resources

• EP CQM Tips– Measure Components– Across the continuum of care– Super Bill– Cancer Staging– Documentation of Current Medications

• System Improvements

• Validation

Copyright © 2013 Allscripts Healthcare Solutions, Inc. 5


Eligible Providers CQMsThe Brave New World of 2014 EP CQMs


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Eligible Provider CQMs• 2014 - EPs must report on 9 of the 64 approved CQMs

– Recommended core CQMs – encouraged but not required • 9 CQMs for the adult population • 9 CQMs for the pediatric population • NQF 0018 strongly encouraged since controlling blood pressure is high

priority goal in many national health initiatives, including the Million Hearts campaign

– Selected CQMs must cover at least 3 of the National Quality Strategy domains


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National Quality Strategy domains• Patient and Family Engagement (4)

• Patient Safety (5)

• Care Coordination (1)

• Population/Public Health (9)

• Efficient Use of Healthcare Resources (4)

• Clinical Process/Effectiveness (41)

Selected CQMs must cover at least 3 of the National Quality Strategy domains

For additional information and full list of measures and the domains: 2014_EP_MeasuresTable_June2013.pdfhttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_EP_MeasuresTable_June2013.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_EP_MeasuresTable_June2013.pdf




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Recommended CQMs for the AdultseMeasure ID

CQM Title Measure Steward

Domain

CMS165v1NQF 0018

Controlling High Blood Pressure

NCQA Clinical Process / Effectiveness

*CMS156v1NQF 0022

Use of High-Risk Medications in the Elderly

NCQA Patient Safety

CMS138v1NQF 0028

Tobacco Use: Screening and Cessation Intervention

AMA-PCPI

Population / Public Health

CMS166v1NQF 0052

Use of Imaging Studies for Low Back Pain

NCQA Efficient Use of Healthcare Resources

*CMS2V1NQF 0418

Screening for Clinical Depression and Follow-Up Plan

CMS Population / Public Health

* Indicates New measure in 2014


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Recommended CQMs for the Adults

Source: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_AdultRecommend_CoreSetTable.pdf

eMeasure ID


Domain

*CMS68v1NQF 0419

Documentation of Current Medications in the Medical Record

CMS Patient Safety

CMS69v1NQF 0421

Body Mass Index (BMI) Screening and Follow-Up


*CMS50v1

Closing the referral loop: receipt of specialist report

CMD Care Coordination

*CMS90v1

Functional status assessment for complex chronic conditions

CMS Patient and Family Engagement


http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_AdultRecommend_CoreSetTable.pdf




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Recommended CQMs for the PediatricseMeasure ID


Domain

CMS146v1NQF 0002

Appropriate Testing for Children with Pharyngitis

NCQA Efficient Use of Healthcare Resources

CMS155v1NQF 0024

Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents

NCQA Population / Public Health

CMS153v1NQF 0033

Chlamydia Screening for Women


CMS126v1NQF 0036

Use of Appropriate Medications for Asthma


CMS117v1NQF 0038

Childhood Immunization Status




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Recommended CQMs for the Pediatrics

Source: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_PrediatricRecommended_CoreSetTable.pdf

eMeasure ID


Domain

*CMS154v1NQF 0069

Appropriate Treatment for Children with Upper Respiratory Infection (URI)

NCQA Effective Use of Healthcare Resources

*CMS136v1NQF 0108

Follow-Up Care for Children Prescribed Attention Deficit/Hyperactivity Disorder (ADHD) Medication


*CMS2v1NQF 0418

Screening for Clinical Depression and Follow-Up Plan


*CMS75v1

Children who have dental decay or cavities

MCHB-HRSA

Clinical Process / Effectiveness


http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_PrediatricRecommended_CoreSetTable.pdf




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However….1. The eMeasures are still a work-in-progress; feedback

is incorporated from experience in the field and there will be annual updates.

2. There are still no thresholds to be met for CQMs

3. There is no plan to publish comparative results

4. Electronic submission is optional for 2014



CQM ResourcesThe Brave New World of 2014 EP CQMs


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Clinical Quality Measures Resources

http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html

https://vsac.nlm.nih.gov/ (you will need UMLS account)

http://onc-project-tracking.org/secure/Dashboard.jspa (you will need to create an account)



https://vsac.nlm.nih.gov/

http://onc-project-tracking.org/secure/Dashboard.jspa


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Resources – CMS eCQM Library


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EH Updates: April / EP Updates: June


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Clinical Quality Measures Resources• Allscripts Client Connect

– CQM Recommendation Detail Spreadsheet– CQM Reference Guides– Clinical Performance Management Group

https://clientconnect.allscripts.com/groups/arra




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CQM Reference Guides

https://clientconnect.allscripts.com/docs/DOC-24032




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CQM Recommendation Detail


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CPM: Product Community



EP CQM Tips


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Measure Components• Initial Patient Population

• Denominator

• Denominator Exclusions

• Denominator Exceptions

• Numerator


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Initial Patient Population

• Refers to all patients to be evaluated by a specific performance eMeasure who share a common set of specified characteristics within a specific measurement set to which a given measure belongs.

• Details often include information based upon specific age groups, diagnoses, diagnostic and procedure codes, and enrollment periods.


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Denominator

• The denominator can be the same as the initial patient population or a subset of the initial patient population to further constrain the population for the purpose of the eMeasure.

• Different measures within an eMeasure set may have different Denominators.

• The members of the IPP are classified using the Denominator criteria, and those satisfying the criteria are included in the Denominator.


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Denominator Exclusions

• Patients who should be removed from the eMeasure population and denominator before determining if numerator criteria are met.

• Denominator exclusions are used in proportion and ratio measures to help narrow the denominator.

• The members of the Denominator are classified using the Denominator Exclusion criteria, and those satisfying the criteria are included in the Denominator Exclusions.


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Denominator Exceptions

• Are those conditions that should remove a patient, procedure or unit of measurement from the denominator only if the numerator criteria are not met.

• Allow for adjustment of the calculated score for those providers with higher risk populations.

• Allow for the exercise of clinical judgment. Specifically defined to capture information in a structured manner that fits the clinical workflow. Reasons fall into 3 categories: 1. Medical reasons 2. Patient reasons 3. System reasons.

• Those members of the Denominator that were considered for membership in the Numerator, but were rejected, are classified using the Denominator Exceptions criteria, and those satisfying the criteria are included in the Denominator Exceptions.


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What does it meanMeasure Numerat

orDenominator

Measure Rate

IPP Exclusions

Exceptions

NQF 0018 29 66 43.94% 83 7 3

Initial Patient Population = 83

Denominator = 66

Exception = 3

Exclusion = 7

Numerator = 29


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Exclusions

Den Exclusion

Exclusion


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Exception

Numerator

Exception

Den-Excl

Exception

Numerator


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EP CQM Measures• Across the continuum of care

– EP CQMs are patient based (Counts MRNs)– Looks across the visits for Results / Documents / Orders etc.– Denominator – Add Patient only if has required types of visit(s)

during attestation period– Looks back for Numerators – Can look outside the bounds of

attestation period– Provider should be associated to the visit with appropriate

Provider role– If multiple providers associated to the visit, both gets the credit

for the work


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Encounter Codes• Visit Information for Ambulatory workflow

• NLM value sets contain the CPT codes

• Two value sets do not contains CPT codes, they are SNOMEDCT– Face to Face Encounters– Patient Provider Interactions

• Measures were certified using Super Bill

• Clients that do no use Super Bill– Identify other options to capture CPT codes

• Health Issues (V12 New feature)• Observations / Orders - UDDIs

– With Observations or Orders – limitation when 2 visit count are required– This limitation will not falsely improve numbers, so some client are opting to

capture only one encounter for these measures - with a workflow to make sure things are done every visit.


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Cancer Staging• Cancer Staging Module

• Allscripts did not certify using the Cancer Staging Module

• This module was not used in any of the oncology CQMs

• Cancer staging in the CQMs was done using Observations

• A Document is in circulation(Author unknown) that says the Cancer staging module and the ITT can be used – This is false information and we apologize for it

• At this time, no clients plan to use the cancer staging CQMs


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NQF 0419: Documentation of Current Meds• OMP Review

– Not needed for Medication Reconciliation– Is used for Documentation of Current Medications in the Medical

Record– Ambulatory Configuration Tool > Prescription Writer > Medication

List Codes– Code: 42819100012410– SNOMEDCT


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Diagnosis Dates• Diagnosis dates, many measures use them but most

organizations do not capture onset / resolved dates.

• System falls back to create dtm

• You may still use the measure, but it will miss some of the intended nuances



System Improvements


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System Improvements (V12.2)• One Patient profile for all Providers

• Patient Profile Freeze

• Patient Profile Build with ETL

• Content Deployment – Can Deploy One measure at a time

• Quality Events – Record Timestamps for events in chart

• Population set – Copy groups, Name the Group

• Context Sensitive help

• Customizable Visit list for Population sets and Indicators

• Visit Details / Patient Details drill through from every report

• Audit Reports


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One Patient Profile for all Providers• Profile Definition

– Profile selects Providers by Roles


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Patient Profile Freeze• Profile Definition

– Freeze Date– Frozen


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Patient Profile Build with ETL• A new Phase in ETL process

• All profiles with future Freeze date


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Quality Events• A way to record Time stamp – when something occurred in

chart

• Uses new Indicator Type – ProviderMeasureEvents– 225 rules – out of box – inactivate the rules you do not use– You may have more indicators by measure group – you may

inactivate them

• Search type – Quality Event– Must have a value set in rule(Coded data only)– Value set name is the even name– Aware search type


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Quality Event Timings (QETs)• Report to look at configuration

– Indicators > QET– Spreadsheet – check with your IC


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QET Validation• Find Quality Events (Reference Sets) used by QET

• Test Quality Event independently– Create Test Population Set– Table: Quality Event, Field: Reference Set

• If have counts, create two groups and test both together


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QET Validation• If you need to check with SQL

SELECT v.EncounterNumber , qe1.StartDtm, qe1.QDMDataType ,qe2.StartDtm, qe2.QDMDataType, QET.<Name of QET Field>,

FROM [CPM_AcuteCare].[dbo].SCAVisit v

Inner join [CPM_AcuteCare].[dbo].SCAQualityEvent qe1 ON qe1.VisitID = v.VisitID AND qe1.ReferenceSet = ‘Value Set 1 Name‘

Inner join [CPM_AcuteCare].[dbo].SCAQualityEvent qe2 ON qe2.VisitID = v.VisitID AND qe2.ReferenceSet = ‘Value Set 2 Name'

Inner join [CPM_AcuteCare].[dbo].[SCAQualityEventTiming] qet on qet.VisitID = v.VisitID

Where v.EncounterNumber = '1000017765‘ – Optional use it only if you want to check particular visit only



Validation for EP measures


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Validation• Production Validation vs. Test Cases

• Production Validation– Out of box reports / Audit Reports

• Test Cases– Spreadsheet of test cases


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Validation: Out of Box - Audit Reports • Codification

– Code set Cross Reference Table (ITT)– Dimension Table

• Admit Types• Allergens• Care Levels• Coded Observations• Demographics• Diagnosis Types• Discharge Dispositions• Insurance Types• Locations• Medication Routes• Medications• Order Catalog• Order Statuses• Services• Visit Types

• Configuration Validation– Visit List - Population Set Visits– Visit List – Indicator Visits– Patient Profile Results

• Configuration Audit– Indicator Summary– Population Set Summary– Reference Set Summary– Patient Profile Measure Details

• Chart Review– Visit Details– Patient Details


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Validation: Out of Box Measure Reports • Eligible Professional Measures

– Behavioral Health Measures (NQF: 0004, 0104, 0105, 0108, 0110, 0418)

– Cardiac Measures (NQF: 0068, 0070, 0075, 0081, 0083, CMS: 90)

– CMS Adult Measures (NQF: 0018, 0022, 0028, 0052, 0421, CMS: 50)

– CMS Pediatric Measures (NQF: 0002, 0024, 0036, 0069, CMS: 75) – Diabetes Measures (NQF: 0055, 0056, 0059, 0060, 0062 and 0064)

– Episode Based Measures (NQF: 0069, 0384, 0419)

– Infectious Disease Measures (NQF: 0403, 0405, CMS: 77)

– Oncology Measures (NQF: 0384, 0385, 0387, 0389)

– Ophthalmology Measures (NQF: 0086, 0088, 0089, 0101, 0564, 0565)

– Prevention Screening Measures (NQF: 0031, 0032, 0033, 0034, 0038, 0041, 0043, 0608, CMS: 74)


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Measure Reports


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Validation: Out of Box Other Reports • Other reports

– Provider Comparison– Provider Measures Dashboard– Provider Rate Comparison– Provider Summary


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Other Reports – Provider Rate Comparison


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Other reports – Provider Comparison


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Validation: Test casesPatient Visit Admit Health issue Scope BP DOB Pass /

FailTest, BP 1 4/1/201

4 ICD9:401.1 General 145/92 1/1/1975Existing

CPT:99213 Visit

27/2/201

4CPT:99213 Visit 134/80 1/1/1975Register New

Patient Visit Admit Health issue

Scope DOB Observation Pass / Fail

Test Tobacco 17/2/2014ICD9:401.1 General 1/1/1965Existing

Non smoker(105539002 or other code from value set)

CPT:99213 Visit

27/24/2014CPT:99214 Visit 1/1/1965

Register New

Test Tobacco Out

111/2/2013ICD9:401.1 General 1/1/1965Existing

Non smoker(105539002 or other code from value set)

CPT:99213 Visit

2 7/3/2014ICD9:401.1 General 1/1/1965Existing CPT:99213 Visit

3 7/19/2014CPT:99214 Visit 1/1/1965Register New


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Allscripts Client Experience 2014

Questions

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