tag:blogger.com,1999:blog-11381765415204106522024-03-05T12:38:20.803-08:00Dynamic Health IT - Quality Measure and Interoperability Solutions Dynamic Health IT, Inc. (DHIT) was established in 1999 and is headquartered in New Orleans. Our company is dedicated to developing technology to benefit healthcare providers and vendors. We specialize in clinical quality measure and interoperability solutions. Our team embraces opportunities to resolve intricate technical challenges.Jeff Robbinshttp://www.blogger.com/profile/05743306808974585977noreply@blogger.comBlogger88125tag:blogger.com,1999:blog-1138176541520410652.post-56408599836143391522020-01-15T10:50:00.000-08:002020-01-15T10:50:23.811-08:002020 Hospital eCQM Reporting
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<p style="font-size: 14px; line-height: 1.2; word-break: break-word; mso-line-height-alt: 17px; margin: 0;"><strong><span style="font-size: 20px; color: #5e97a6;"><span style="color: #000000;">IQR eCQM Requirements</span> </span></strong></p>
<p style="font-size: 14px; line-height: 1.2; word-break: break-word; mso-line-height-alt: 17px; margin: 0;"><br/>For 2020 there’s good news: CMS has reduced the number of eCQMs you can choose from. In 2019, there were 16, now only 8. Participants must report on 4 CQMs from the list below:</p>
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<p style="line-height: 1.2; word-break: break-word; mso-line-height-alt: NaNpx; margin: 0;">The reporting period continues to be one self-selected quarter of the 2020 calendar year. While you are only required to submit 4 eCQMs, your EHR must be certified for all 8 eCQMs listed above.</p>
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<p style="line-height: 1.2; word-break: break-word; mso-line-height-alt: NaNpx; margin: 0;">More good news! The Quality Net site has been totally re-done. Hands-on users report that the new site is much easier to use than the old.</p>
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<p style="line-height: 1.2; word-break: break-word; mso-line-height-alt: NaNpx; margin: 0;"><strong><span style="color: #000000;"><span style="font-size: 20px;">Joint Commission </span></span></strong></p>
<p style="line-height: 1.2; word-break: break-word; mso-line-height-alt: NaNpx; margin: 0;"><br/>Here’s a quick overview of eCQM submission for the Joint Commision (TJC):</p>
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<li style="line-height: 1.2; mso-line-height-alt: NaNpx;">Hospitals are now required to submit via the Direct Data Submission (DDS) platform, which was optional last year.</li>
<li style="line-height: 1.2; mso-line-height-alt: NaNpx;">Report for a minimum of one self-selected calendar quarter of data for calendar year 2020</li>
<li style="line-height: 1.2; mso-line-height-alt: NaNpx;">Submission deadline for 2020 data is 3/15/2021. For the 2019 reporting year, the deadline is 3/16/2020.</li>
<li style="line-height: 1.2; mso-line-height-alt: NaNpx;">For 2020, TJC is keeping ePC-01 (Elective Delivery) in their eCQM portfolio although this measure has been sunset by CMS.</li>
<li style="line-height: 1.2; mso-line-height-alt: NaNpx;">More excitement: TJC has a new eCQM not included in the IQR list.</li>
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<p style="line-height: 1.2; word-break: break-word; mso-line-height-alt: NaNpx; margin: 0;"><strong><span style="font-size: 20px;">ePC-02 (Cesarean Birth)</span></strong></p>
<p style="line-height: 1.2; word-break: break-word; mso-line-height-alt: NaNpx; margin: 0;"><br/>ePC-02 is a new measure not available under the CMS IQR program. ePC-02 reports the rate of Cesarean Births among pregnant women who have never delivered a baby before and where the baby presents in a normal position. So, getting a bit more technical:</p>
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<p style="line-height: 1.2; word-break: break-word; mso-line-height-alt: NaNpx; margin: 0;">Numerator = Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth</p>
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<p style="line-height: 1.2; word-break: break-word; mso-line-height-alt: NaNpx; margin: 0;">Denominator = Inpatient hospitalizations for nulliparous patients delivered of a live term singleton newborn >= 37 weeks' gestation</p>
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<p style="line-height: 1.2; word-break: break-word; mso-line-height-alt: NaNpx; margin: 0;"><strong>Any DHIT clients interested in reporting ePC-02 should let us know ASAP.</strong></p>
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</html>Michelle Bondhttp://www.blogger.com/profile/02590557557316607140noreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-91770320977937798082020-01-10T09:09:00.001-08:002020-01-15T09:48:44.348-08:00MIPS/QPP 2020<br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Now that 2020 is here, how about 20/20 vision to focus on an
outstanding MIPS score?<span style="mso-spacerun: yes;"> </span>If that’s your
goal, we hope this blog will help!<span style="mso-spacerun: yes;"> </span>In
case you weren’t paying attention, this is the 3<sup>rd</sup> year of the
Quality Payment Program (QPP) which spawned the <a href="https://qpp.cms.gov/mips/overview" target="_blank">Merit-based Incentive Program (MIPS)</a>
and <a href="https://qpp.cms.gov/apms/overview" target="_blank">Advanced Alternative PaymentModels (APMs)</a>.<span style="mso-spacerun: yes;"> </span>The <a href="https://qpp-cm-prod-content.s3.amazonaws.com/uploads/739/2020%20QPP%20Final%20Rule%20FAQs.pdf">MIPS
2020 Final Rule</a> was published November 1<sup>st</sup> but maybe you missed
reading due to its 996 page length, the busy holiday season, etc.<span style="mso-spacerun: yes;"> </span>So here’s our synopsis – for the sake of
brevity, we’ll skip the eligibility and APM criteria and focus on requirements
for those who opt in (voluntarily or kicking and screaming!) for MIPS/QPP.<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_Owc2H94JhCfOPl6lZHu0JFSio1DNLzgO7RzAwctZJgnknpB3eeH-_aR34kWzW6quAsEuNuyx7w5z6OK9w3qPjWKifOrMebpQhAGM3nckcprLSHxtTzCXx-QiBYiVPYBQwPZn2QrvGCs/s1600/Focus+on+MIPS.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="354" data-original-width="576" height="245" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_Owc2H94JhCfOPl6lZHu0JFSio1DNLzgO7RzAwctZJgnknpB3eeH-_aR34kWzW6quAsEuNuyx7w5z6OK9w3qPjWKifOrMebpQhAGM3nckcprLSHxtTzCXx-QiBYiVPYBQwPZn2QrvGCs/s400/Focus+on+MIPS.png" width="400" /></a></div>
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<h3>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Overall Scoring and Financial Incentives</span></h3>
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<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Quality: 45%, Cost 15%, Promoting Interoperability (PI) 25%, Improvement Activities (IA) 15% -- these are all the same as last year and the weighting is unchanged, although CMS is mandated to make all categories 30% by 2022.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"> The Performance Threshold increased from 30 points to 45 points. For clinicians, this means you’ll have to score at least 45 points to avoid a penalty. Conversely, the exceptional performance threshold increased from 70 to 85 points.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"> Greater financial penalties and rewards – non-participants get dinged 9%. Theoretically, bonuses could also be up to 9% but probably won’t be that high due to budget neutrality requirements.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"> Reminder that starting with 2018 (Year 2) data, MIPS scores will be publicly reported on the <a href="https://www.medicare.gov/physiciancompare/">Physician Compare website</a>.</span></li>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Quality Performance Category</span></h3>
<ul>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Medicare Part B Claims measures: 70% sample of Medicare Part B patients (up from 60%) for the performance period</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> QCDR measures, MIPS CQMs, and eCQMs: 70% sample of clinician's or group's patients (up from 60%) across all payers – no “cherry picking” is allowed.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"> Driven by the Meaningful Measures initiative, CMS removed 42 measures (quality ID #’s): 046, 51, 68, 91, 109, 131, 160, 165, 166, 179, 192, 223, 255, 262, 271, 325, 328, 329, 330, 343, 345, 346, 347, 352, 353, 361, 362, 371, 372, 388, 403, 407, 411, 417, 428, 442, 446, 449, 454, 456, 467 and 474. Of these, 4 were eCQMs: 160, 192, 371 and 372. </span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.federalregister.gov/documents/2019/11/15/2019-24086/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other" target="_blank">On page 63214 of the Federal Register Final Rule</a>, there is a table of recommended CQMs by medical specialty. I don’t normally endorse reading the Federal Register but this is a valuable resource. The following specialty areas were added for 2020:</span></li>
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</span></span><!--[endif]-->Audiology<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="mso-list: Ignore;">o<span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Clinical Social Work<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="mso-list: Ignore;">o<span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Chiropractic Medicine<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="mso-list: Ignore;">o<span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Endocrinology<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="mso-list: Ignore;">o<span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Nutrition/Dietician<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="mso-list: Ignore;">o<span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Pulmonology<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="mso-list: Ignore;">o<span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><!--[endif]-->Speech Language Pathology<o:p></o:p></span></div>
<h2>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></h2>
<h3>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Improvement Activities Performance Category</span></h3>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
</div>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]-->There are 2 new IAs, 7 modified IAs and 15 that
were removed. </span></li>
</ul>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyN_2FgJHX3T1Y_fGvaAvvlGZXVqY6tv_wbYo5art0qC9VakHuEJ3A8xbIbddZGQbJxrsJrxnZbAzg3nTsn_WH5JsnQqGgw3Xj5JwJaU0jkebpRXwMOZCqsRU7bTFmNdvEqeKf8i2HnHY/s1600/table.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="434" data-original-width="875" height="315" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyN_2FgJHX3T1Y_fGvaAvvlGZXVqY6tv_wbYo5art0qC9VakHuEJ3A8xbIbddZGQbJxrsJrxnZbAzg3nTsn_WH5JsnQqGgw3Xj5JwJaU0jkebpRXwMOZCqsRU7bTFmNdvEqeKf8i2HnHY/s640/table.png" width="640" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div>
<ul>
<li><a href="https://www.federalregister.gov/documents/2019/11/15/2019-24086/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other" target="_blank">Page 63514 of the Federal Register</a> has a table of all 2020 IAs.</li>
<li> For groups, the threshold re. number of clinicians for an IA has increased from just 1 to at least 50% of the group for any continuous 90-day period.</li>
</ul>
</div>
<!--[if !supportLists]--><br />
<div class="MsoNormal">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="mso-no-proof: yes;"><!--[if gte vml 1]><v:shape
id="Picture_x0020_2" o:spid="_x0000_i1026" type="#_x0000_t75" style='width:468pt;
height:232.5pt;visibility:visible;mso-wrap-style:square'>
<v:imagedata src="file:///C:\Users\jrobbins\AppData\Local\Temp\msohtmlclip1\01\clip_image002.png"
o:title=""/>
</v:shape><![endif]--><!--[if !vml]--><!--[endif]--></span><o:p></o:p></span></div>
<h3>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Promoting Interoperability Performance Category</span></h3>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
</div>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">The optional Query of PDMP measure will require
a Yes/No response instead of a numerator/denominator.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">The optional Query of PDMP measure has been
removed.</span></li>
</ul>
<!--[if !supportLists]--><br />
<h3>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Cost Performance Category</span></h3>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
</div>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">There are 10 new episode-based measures:</span></li>
</ul>
<!--[if !supportLists]--><br />
<table border="1" cellpadding="0" cellspacing="0" class="GridTable4Accent1" style="border-collapse: collapse; border: none; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: -1;">
<td style="background: #4472C4; border-right: none; border: solid #4472C4 1.0pt; mso-background-themecolor: accent1; mso-border-bottom-alt: solid #4472C4 .5pt; mso-border-bottom-themecolor: accent1; mso-border-left-alt: solid #4472C4 .5pt; mso-border-left-themecolor: accent1; mso-border-themecolor: accent1; mso-border-top-alt: solid #4472C4 .5pt; mso-border-top-themecolor: accent1; padding: 0in 5.4pt 0in 5.4pt; width: 256.25pt;" valign="top" width="342"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 5; text-align: center;">
<span style="color: white; mso-bidi-font-weight: bold; mso-themecolor: background1;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Measure<o:p></o:p></b></span></span></div>
</td>
<td style="background: #4472C4; border-left: none; border: solid #4472C4 1.0pt; mso-background-themecolor: accent1; mso-border-bottom-alt: solid #4472C4 .5pt; mso-border-bottom-themecolor: accent1; mso-border-right-alt: solid #4472C4 .5pt; mso-border-right-themecolor: accent1; mso-border-themecolor: accent1; mso-border-top-alt: solid #4472C4 .5pt; mso-border-top-themecolor: accent1; padding: 0in 5.4pt 0in 5.4pt; width: 175.25pt;" valign="top" width="234"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 1; text-align: center;">
<span style="color: white; mso-bidi-font-weight: bold; mso-themecolor: background1;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Episode Measure Type</b><o:p></o:p></span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 0;">
<td style="background: #D9E2F3; border-top: none; border: solid #8EAADB 1.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent1; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 256.25pt;" valign="top" width="342"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 68;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Acute Kidney
Injury Requiring New Inpatient Dialysis<o:p></o:p></span></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent1; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent1; mso-border-left-themetint: 153; mso-border-right-themecolor: accent1; mso-border-right-themetint: 153; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 175.25pt;" valign="top" width="234"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 64; text-align: center;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Procedural<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid #8EAADB 1.0pt; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent1; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 256.25pt;" valign="top" width="342"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 4;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Elective Primary
Hip Arthroplasty<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent1; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent1; mso-border-left-themetint: 153; mso-border-right-themecolor: accent1; mso-border-right-themetint: 153; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 175.25pt;" valign="top" width="234"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Procedural<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="background: #D9E2F3; border-top: none; border: solid #8EAADB 1.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent1; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 256.25pt;" valign="top" width="342"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 68;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Femoral or
Inguinal Hernia Repair<o:p></o:p></span></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent1; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent1; mso-border-left-themetint: 153; mso-border-right-themecolor: accent1; mso-border-right-themetint: 153; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 175.25pt;" valign="top" width="234"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 64; text-align: center;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Procedural<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid #8EAADB 1.0pt; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent1; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 256.25pt;" valign="top" width="342"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 4;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Hemodialysis Access
Creation<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent1; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent1; mso-border-left-themetint: 153; mso-border-right-themecolor: accent1; mso-border-right-themetint: 153; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 175.25pt;" valign="top" width="234"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Procedural<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="background: #D9E2F3; border-top: none; border: solid #8EAADB 1.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent1; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 256.25pt;" valign="top" width="342"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 68;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Inpatient Chronic
Obstructive Pulmonary Disease (COPD) Exacerbation<o:p></o:p></span></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent1; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent1; mso-border-left-themetint: 153; mso-border-right-themecolor: accent1; mso-border-right-themetint: 153; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 175.25pt;" valign="top" width="234"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 64; text-align: center;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Acute inpatient medical condition<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid #8EAADB 1.0pt; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent1; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 256.25pt;" valign="top" width="342"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 4;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Lower Gastrointestinal Hemorrhage (applies to
groups only)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent1; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent1; mso-border-left-themetint: 153; mso-border-right-themecolor: accent1; mso-border-right-themetint: 153; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 175.25pt;" valign="top" width="234"><div align="center" class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Acute inpatient
medical condition<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="background: #D9E2F3; border-top: none; border: solid #8EAADB 1.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent1; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 256.25pt;" valign="top" width="342"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 68;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Lumbar Spine
Fusion for Degenerative Disease, 1-3 Levels<o:p></o:p></span></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent1; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent1; mso-border-left-themetint: 153; mso-border-right-themecolor: accent1; mso-border-right-themetint: 153; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 175.25pt;" valign="top" width="234"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 64; text-align: center;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Procedural<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7;">
<td style="border-top: none; border: solid #8EAADB 1.0pt; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent1; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 256.25pt;" valign="top" width="342"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 4;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Lumpectomy Partial Mastectomy, Simple Mastectomy<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent1; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent1; mso-border-left-themetint: 153; mso-border-right-themecolor: accent1; mso-border-right-themetint: 153; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 175.25pt;" valign="top" width="234"><div align="center" class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Procedural<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 8;">
<td style="background: #D9E2F3; border-top: none; border: solid #8EAADB 1.0pt; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent1; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 256.25pt;" valign="top" width="342"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 68;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Non-Emergent Coronary Artery Bypass Graft (CABG)<o:p></o:p></span></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent1; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent1; mso-border-left-themetint: 153; mso-border-right-themecolor: accent1; mso-border-right-themetint: 153; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 175.25pt;" valign="top" width="234"><div align="center" class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; mso-yfti-cnfc: 64; text-align: center;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Procedural<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 9; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid #8EAADB 1.0pt; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent1; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 256.25pt;" valign="top" width="342"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 4;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Renal or Ureteral Stone Surgical Treatment<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent1; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent1; mso-border-left-themetint: 153; mso-border-right-themecolor: accent1; mso-border-right-themetint: 153; mso-border-themecolor: accent1; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent1; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 175.25pt;" valign="top" width="234"><div align="center" class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-align: center;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Procedural<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>To Summarize:</b><b> </b> CMS has once again raised the
bar and the financial stakes, so we recommend starting your MIPS/QPP planning
ASAP and monitoring scores regularly throughout the reporting year. Our Dynamic Registry platform has great tools
for this and is available with or without contracting for our services as a <a href="https://www.dynamichealthit.com/dynamic-registry">QPP Qualified Registry</a>.<o:p></o:p></span></div>
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<br />Jeff Robbinshttp://www.blogger.com/profile/05743306808974585977noreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-59053342532161667072019-07-16T16:10:00.002-07:002019-07-16T16:14:08.228-07:00Da Vinci Connectathon and the Challenge of eCQM Data Capture<br />
<div class="MsoNormal">
Dynamic Health IT (DHIT) was in attendance for the Da Vinci
FHIR Connectathon hosted by GuideWell <span style="mso-spacerun: yes;"> </span>(parent company of Florida Blue) in
Jacksonville Florida.<span style="mso-spacerun: yes;"> </span>For those of you
not familiar, the Da Vinci Project is a collaboration of trail-blazers in the
healthcare space who are looking to revolutionize information sharing.<span style="mso-spacerun: yes;"> </span>It is a private sector initiative comprised
of experts from some of the largest and most prestigious payer, provider and
vendors in the healthcare marketplace.<span style="mso-spacerun: yes;">
</span>Their goal is to accelerate the adoption of HL7® FHIR® as the standard
to support and integrate data exchange for value-based care (VBC) with a focus
on provider/payer data exchange.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The Connectathon featured three different tracks.<span style="mso-spacerun: yes;"> </span>We participated in the Clinical Reasoning
Track, which focuses on exploring the use of FHIR to calculate Clinical Quality
Measures (CQMs). As we’ve contributed to this track, we’ve also increased our
understanding of issues related to migrating to FHIR-based CQMs. For DHIT, this
means the integration of separate products - Dynamic FHIR Server with
CQMsolution.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As it stands today, FHIR data types are not used in the
calculation of eCQMs. (eCQMs are the Clinical Quality Measures generated
directly from EHR data with no intervening manual abstracting process). But Da
Vinci members are looking to obsolete the Quality Data Model (QDM) data
elements currently used for calculation and presentation in the QRDA Cat I
files and replace them with FHIR. <span style="mso-spacerun: yes;"> </span>A FHIR
Measure Report could replace the QRDA Cat I and QRDA Cat III files. FHIR also
offers new operations that instruct the FHIR server to perform measure
calculation.<span style="mso-spacerun: yes;"> </span>Tangentially, DHIT has
explored the use of the 2.1 CCDA as a data source for calculating eCQMs (more
on that later).<o:p></o:p></div>
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvbO9N8lBvAnxYWgujjktdZKuqdTE3G8P6mC5HLJc7QAMAZftM_s7cQUET95Fh76pCEo3cZmP4lx8wXQfqk0w0MhoyW9YgYWI_c0uwIadYnDzzAOyIPLKZyqqCJRO55b3TZUBMz8GbV8I/s1600/arrows.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="253" data-original-width="450" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvbO9N8lBvAnxYWgujjktdZKuqdTE3G8P6mC5HLJc7QAMAZftM_s7cQUET95Fh76pCEo3cZmP4lx8wXQfqk0w0MhoyW9YgYWI_c0uwIadYnDzzAOyIPLKZyqqCJRO55b3TZUBMz8GbV8I/s320/arrows.jpg" width="320" /></a></div>
<br />
<div class="MsoNormal">
The Clinical Reasoning Track is evolving as well. Previous
iterations used "normal" QDM-based eCQMs but relied on FHIR patient
data that was converted using QDM to QI Core Mappings. Developers have been
hard at work doing a trial run to populate existing eCQMs by using FHIR data
types. This will make it possible to run FHIR-based eCQMs against FHIR data
elements.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
DaVinci has expanded this track include additional
operations related to submitting and collecting data. These include the
submission of data from the producer to the consumer. <span style="mso-spacerun: yes;"> </span>In this scenario, an EHR might submit data directly
to a Payer. Additionally, consumers can request data from the producer using a
“Collect Data” operation or subscribe to the producer's Subscription Service to
be notified when CQM data becomes available. <span style="mso-spacerun: yes;"> </span>All of these operations limit the scope of
data collected to what is required by the measures.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
During this Connectathon we focused on one CQM - Venous
Thromboembolism Prophylaxis (VTE-1). Some of the issues we faced were the sheer
scope of changes required to begin this process. <span style="mso-spacerun: yes;"> </span>For example, the version of the CQL language
itself differs between the current CMS version of the measure and the newly
released FHIR version of the measure. <span style="mso-spacerun: yes;"> </span>In
the end Dynamic Health IT was able to make considerable progress towards the
goal of the track. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Times New Roman";">Back to
the challenge of using </span>the 2.1 CCDA as a data source for calculating
eCQMs:<span style="mso-spacerun: yes;"> </span>Based <span style="mso-bidi-font-family: "Times New Roman";">on our research to-date, many current eCQMs cannot be
accurately calculated from standard 2.1 CCDA data elements. NCQA offers an eCQM
certification process that involves calculating quality measures from CCDA
documents but it only includes a subset of the MIPS/QPP eCQMs and some are
older definitions.<span style="mso-spacerun: yes;"> </span>Why is this?<span style="mso-spacerun: yes;"> </span>We suspect it is because the remainder are
problematic to calculate from a CCDA.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Times New Roman";">There
are several reasons for this: <o:p></o:p></span></div>
<ul>
<li><span style="mso-bidi-font-family: "Times New Roman";">Many measures include exceptions and exclusions and these
are not captured in a standard CCDA. <span style="mso-spacerun: yes;"> </span>For
example, skipping a Breast Cancer screening for a woman with bi-lateral
mastectomies would be an exclusion.<span style="mso-spacerun: yes;"> </span>“Patient
refused to get a flu shot” would be an exception.<span style="mso-spacerun: yes;"> </span>Calculating eCQMs without exceptions and
exclusions is possible but will result in an inaccurate and lower score.<span style="mso-spacerun: yes;"> </span></span></li>
<li><span style="mso-bidi-font-family: "Times New Roman";">A typical 2015 Edition Certified 2.1 CCDA (the kind produced
by most EHRs) lacks a standard representation for the</span> Adverse Event used
by CMS347v2 (Statin Therapy). </li>
<li><span style="mso-bidi-font-family: "Times New Roman";">Some measures call for Assessments but there's no standard way to convey the result of the Assessment in the CCDA.</span></li>
</ul>
<div class="MsoNormal">
DHIT’s
flagship product ConnectEHR is certified for CCDA creation. We are currently
working with HL7 to expand the CCDA data elements to accommodate more of the
eCQM measure requirements. Most current adjustment to CCDA is related to
negation. There are also other issues relate to using a CCDA as a data source, such
as values being provided as free-text, rather than being codified and different
EHR systems capturing the same clinical values/events in different ways. Despite these obstacles, we continue to
pursue the eCQM data capture challenge and look forward to participating
in the next Connectathon in Atlanta.
Hope to see you there!<o:p></o:p></div>
<br />Jeff Robbinshttp://www.blogger.com/profile/05743306808974585977noreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-11066007437688924492019-05-15T06:41:00.001-07:002019-05-15T12:35:33.095-07:002019 MIPS – What You Need to Know<br />
<div class="MsoNormal">
You’ve completed 2018 MIPS – everything is submitted and
filed away.<span style="mso-spacerun: yes;"> </span>Time to relax?<span style="mso-spacerun: yes;"> </span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIWM5IHf0H_NIO2HR-jOFT5bvNqMYwM9cab1i8xCMHPHeHnIf-MztiN9iVMO1Qf7mOe361dcAl7JQ6g1XOF88xhg87e1xgegVVuOa2no6KMIhSSFsZ14veIXAaDz9QEiXBlEIwLjNLRWQ/s1600/don%2527t+loose+sight+of+MIPS.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="445" data-original-width="605" height="235" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIWM5IHf0H_NIO2HR-jOFT5bvNqMYwM9cab1i8xCMHPHeHnIf-MztiN9iVMO1Qf7mOe361dcAl7JQ6g1XOF88xhg87e1xgegVVuOa2no6KMIhSSFsZ14veIXAaDz9QEiXBlEIwLjNLRWQ/s320/don%2527t+loose+sight+of+MIPS.jpg" width="320" /></a></div>
<span style="mso-spacerun: yes;"></span>Well you certainly deserve some R&R but
don’t lose sight of the upcoming MIPS challenges and opportunities for 2019
reporting year.<span style="mso-spacerun: yes;"> </span>Increasingly, MIPS
success will mean a year-round focus as CMS ratchets down on scoring thresholds
and imposes greater penalties for weak and non-performers.<span style="mso-spacerun: yes;"> </span>Here is our roundup of changes that will
present challenges and opportunities in the upcoming year.</div>
<h2>
</h2>
<h2>
Opportunities</h2>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l3 level1 lfo7; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span>By June of 2019, CMS will have digested and
posted MIPS scores in a patient-friendly format on the <span class="MsoHyperlink"><a href="https://www.medicare.gov/physiciancompare">Medicare
Physician</a></span> Compare website.<span style="mso-spacerun: yes;">
</span>The site will have a new hyperlink indicating “Performance information
available”.<span style="mso-spacerun: yes;"> </span>This “Performance
information” is derived from MIPS scoring and may be used not just by patients
and prospective patients but by any other interested parties.<span style="mso-spacerun: yes;"> </span>So, even though your practice may provide
excellent patient care, a sub-standard MIPS score could drag you down.</div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo7; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Strong performers can submit both as group and
individual and then choose the highest score. <span style="text-indent: -0.25in;">Eligible Clinicians now include </span><span style="text-indent: -0.25in;">Physical therapist, Occupational therapists, Qualified speech-language pathologists, Qualified audiologists, Clinical Psychologists, and Registered dieticians/nutrition professionals.</span><span style="text-indent: -0.25in;"> </span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l3 level1 lfo7; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>eCQMs, <span style="mso-bookmark: _Hlk8732100;"><span style="mso-fareast-font-family: "Times New Roman";">Promoting Interoperability
and Improvement Activities (details below) can now all be submitted via the new
QPP API, eliminating the old manual upload process. </span></span></div>
<span style="mso-bookmark: _Hlk8732100;"></span>
<br />
<h2>
Challenges</h2>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l5 level1 lfo6; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">2015
Certified software must be in place during the entire reporting period,
although it is permissible for the certification to happen after the start of
the reporting period, as long as it is prior to the end of the reporting
period. 2014 Certified software is no longer acceptable for 2019 reporting. </span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l5 level1 lfo6; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">To
avoid a penalty, the minimum score is 30 points as opposed to 15 points in 2018.
Likewise, the exceptional performance bonus threshold is up from 70 points to
75 points.</span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNcTGe05LUF9KmMhZi4QhCqjysDXueaaa8E4-6jml6XlbXISRm00_0zbZ-lUyk00Ch4PZJ5rbuWatr2P0eUJsyqXYNMT1-ptz_6JYxXOdyXXJTzOYL1i4lWw3mvjx4j7qBLJc0d7RrMTQ/s1600/2019MIPS.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="323" data-original-width="684" height="186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNcTGe05LUF9KmMhZi4QhCqjysDXueaaa8E4-6jml6XlbXISRm00_0zbZ-lUyk00Ch4PZJ5rbuWatr2P0eUJsyqXYNMT1-ptz_6JYxXOdyXXJTzOYL1i4lWw3mvjx4j7qBLJc0d7RrMTQ/s400/2019MIPS.jpg" width="400" /></a></div>
<span style="mso-fareast-font-family: "Times New Roman";"><br /></span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l4 level1 lfo1; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">The
4 categories from 2018 remain but some percentages have been adjusted<span style="mso-spacerun: yes;"> </span>for 2019:</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l4 level1 lfo1; text-indent: -.25in;">
<span style="mso-fareast-font-family: "Times New Roman";"><br /></span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Quality 45% (decrease of 5%)</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Minimum
of 6 measures for 1 year </span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">1
must be an outcome or High Priority Measures (awarded higher points)</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Bonus
points awarded if you choose the same measure and show improvement from 2018</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Avoid
topped out measures, since scoring is capped at a maximum of 7 points</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">On
the overall list of Quality Measures, 26 were removed and 8 were added 8 (6 of
which are high priority -- see chart below)</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="mso-bookmark: _Hlk8741142;"><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Of
the 26 and 8, some eCQMs changed:</span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.75in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l2 level2 lfo3; text-indent: -.25in;">
<span style="mso-bookmark: _Hlk8741142;"><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-fareast-font-family: "Times New Roman";">CMS 249 and CMS 349 have been
added</span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.75in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l2 level2 lfo3; text-indent: -.25in;">
<span style="mso-bookmark: _Hlk8741142;"><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-fareast-font-family: "Times New Roman";">CMS 65, CMS 123, CMS 158, CMS
164, CMS 167, CMS 169 were removed</span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.75in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l2 level2 lfo3; text-indent: -.25in;">
<span style="mso-bookmark: _Hlk8741142;"><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-fareast-font-family: "Times New Roman";">CMS166 -previously for
Medicaid-only submission – has been phased out.</span></span></div>
<span style="mso-bookmark: _Hlk8741142;"></span>
<br />
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">New
for 2019: CMS will aggregate eCQMs collected through multiple collection types;
if the same measure is collected, the greatest number of measure achievement points
will be awarded.</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTable15Grid4Accent5" style="border-collapse: collapse; border: none; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: -1; mso-yfti-lastfirstrow: yes;">
<td style="background: #4472C4; border-right: none; border: solid #4472C4 1.0pt; mso-background-themecolor: accent5; mso-border-bottom-alt: solid #4472C4 .5pt; mso-border-bottom-themecolor: accent5; mso-border-left-alt: solid #4472C4 .5pt; mso-border-left-themecolor: accent5; mso-border-themecolor: accent5; mso-border-top-alt: solid #4472C4 .5pt; mso-border-top-themecolor: accent5; padding: 0in 5.4pt 0in 5.4pt; width: 57.75pt;" valign="top" width="77"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 5;">
<b><span style="color: white; mso-themecolor: background1;">Measure
ID</span></b></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 5;">
<br /></div>
</td>
<td style="background: #4472C4; border-bottom: solid #4472C4 1.0pt; border-left: none; border-right: none; border-top: solid #4472C4 1.0pt; mso-background-themecolor: accent5; mso-border-bottom-alt: solid #4472C4 .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themecolor: accent5; mso-border-top-alt: solid #4472C4 .5pt; mso-border-top-themecolor: accent5; mso-border-top-themecolor: accent5; padding: 0in 5.4pt 0in 5.4pt; width: 54.5pt;" valign="top" width="73"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 1;">
<b><span style="color: white; mso-themecolor: background1;">eCQM
ID</span></b></div>
</td>
<td style="background: #4472C4; border-bottom: solid #4472C4 1.0pt; border-left: none; border-right: none; border-top: solid #4472C4 1.0pt; mso-background-themecolor: accent5; mso-border-bottom-alt: solid #4472C4 .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themecolor: accent5; mso-border-top-alt: solid #4472C4 .5pt; mso-border-top-themecolor: accent5; mso-border-top-themecolor: accent5; padding: 0in 5.4pt 0in 5.4pt; width: 289.55pt;" valign="top" width="386"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 1;">
<b><span style="color: white; mso-themecolor: background1;">New
Measures for 2019:</span></b><span style="color: white; mso-themecolor: background1;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 1;">
<b><span style="color: white; mso-themecolor: background1;">Name</span></b></div>
</td>
<td style="background: #4472C4; border-left: none; border: solid #4472C4 1.0pt; mso-background-themecolor: accent5; mso-border-bottom-alt: solid #4472C4 .5pt; mso-border-bottom-themecolor: accent5; mso-border-right-alt: solid #4472C4 .5pt; mso-border-right-themecolor: accent5; mso-border-themecolor: accent5; mso-border-top-alt: solid #4472C4 .5pt; mso-border-top-themecolor: accent5; padding: 0in 5.4pt 0in 5.4pt; width: 65.7pt;" valign="top" width="88"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 1;">
<b><span style="color: white; mso-themecolor: background1;">Measure
Type</span></b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 0;">
<td style="background: #D9E2F3; border-top: none; border: solid #8EAADB 1.0pt; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent5; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 57.75pt;" valign="top" width="77"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 68;">
<b>468</b></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 54.5pt;" valign="top" width="73"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">None</span></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 289.55pt;" valign="top" width="386"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">Continuity of
Pharmacotherapy for Opioid Use Disorder</span></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 65.7pt;" valign="top" width="88"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
High Priority</div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid #8EAADB 1.0pt; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent5; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 57.75pt;" valign="top" width="77"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 4;">
<b>469</b></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 54.5pt;" valign="top" width="73"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">None</span></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 289.55pt;" valign="top" width="386"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">Average Change in
Functional Status Following Lumbar Spine Fusion Surgery</span></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 65.7pt;" valign="top" width="88"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
High Priority</div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="background: #D9E2F3; border-top: none; border: solid #8EAADB 1.0pt; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent5; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 57.75pt;" valign="top" width="77"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 68;">
<b>470</b></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 54.5pt;" valign="top" width="73"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">None</span></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 289.55pt;" valign="top" width="386"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">Average Change in
Functional Status Following Total Knee Replacement Surgery</span></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 65.7pt;" valign="top" width="88"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
High Priority</div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid #8EAADB 1.0pt; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent5; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 57.75pt;" valign="top" width="77"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 4;">
<b>471</b></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 54.5pt;" valign="top" width="73"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">None</span></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 289.55pt;" valign="top" width="386"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">Average Change in
Functional Status Following Lumbar Discectomy Laminectomy Surgery</span></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 65.7pt;" valign="top" width="88"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
High Priority</div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="background: #D9E2F3; border-top: none; border: solid #8EAADB 1.0pt; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent5; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 57.75pt;" valign="top" width="77"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 68;">
<b>472</b></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 54.5pt;" valign="top" width="73"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">CMS249v1</span></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 289.55pt;" valign="top" width="386"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">Appropriate Use of
DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor
Profile for Osteoporotic Fracture</span></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 65.7pt;" valign="top" width="88"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
High Priority</div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid #8EAADB 1.0pt; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent5; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 57.75pt;" valign="top" width="77"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 4;">
<b>473</b></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 54.5pt;" valign="top" width="73"><div class="MsoNormal" style="background: white; line-height: 15.0pt; margin-bottom: 3.0pt; margin-left: 2.25pt; mso-list: l0 level1 lfo8; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: #404040; font-family: "symbol"; font-size: 10.0pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">None</span></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 289.55pt;" valign="top" width="386"><div class="MsoNormal" style="background: white; line-height: 15.0pt; margin-bottom: 3.0pt; margin-left: 2.25pt; mso-list: l0 level1 lfo8; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 10.0pt;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">Average
Change in Leg Pain Following Lumbar Spine Fusion Surgery</span></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 65.7pt;" valign="top" width="88"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
High Priority</div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="background: #D9E2F3; border-top: none; border: solid #8EAADB 1.0pt; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent5; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 57.75pt;" valign="top" width="77"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 68;">
<b>474</b></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 54.5pt;" valign="top" width="73"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">None</span></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 289.55pt;" valign="top" width="386"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">Zoster (Shingles)
Vaccination</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
<br /></div>
</td>
<td style="background: #D9E2F3; border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-background-themecolor: accent5; mso-background-themetint: 51; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 65.7pt;" valign="top" width="88"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 64;">
Process</div>
</td>
</tr>
<tr style="mso-yfti-irow: 7; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid #8EAADB 1.0pt; mso-border-alt: solid #8EAADB .5pt; mso-border-themecolor: accent5; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 57.75pt;" valign="top" width="77"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-yfti-cnfc: 4;">
<b>475</b></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 54.5pt;" valign="top" width="73"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">CMS349v1</span></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 289.55pt;" valign="top" width="386"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: #404040; font-family: "arial" , sans-serif; font-size: 10.5pt;">HIV Screening</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
</td>
<td style="border-bottom: solid #8EAADB 1.0pt; border-left: none; border-right: solid #8EAADB 1.0pt; border-top: none; mso-border-alt: solid #8EAADB .5pt; mso-border-bottom-themecolor: accent5; mso-border-bottom-themetint: 153; mso-border-left-alt: solid #8EAADB .5pt; mso-border-left-themecolor: accent5; mso-border-left-themetint: 153; mso-border-right-themecolor: accent5; mso-border-right-themetint: 153; mso-border-themecolor: accent5; mso-border-themetint: 153; mso-border-top-alt: solid #8EAADB .5pt; mso-border-top-themecolor: accent5; mso-border-top-themetint: 153; padding: 0in 5.4pt 0in 5.4pt; width: 65.7pt;" valign="top" width="88"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
Process</div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in;">
<br /></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Promoting Interoperability
25% </span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l7 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Minimum
of 90 days</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l7 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Only
one set of objectives & measures (reduced from 2 in 2018)</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l7 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">4
Objectives include: e-Prescribing, Health Info Exchange, Provider to Patient
Exchange and Public Health & Clinical Data Exchange</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l7 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">50
point “base value”/bonus from 2018 has been removed</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Improvement Activities 15%</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l6 level1 lfo5; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Minimum
of 90 days</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l6 level1 lfo5; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Added
6, Modified 5, removed 1 = 118 total Improvement Activities</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l6 level1 lfo5; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Bonus
removed</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Cost 15% (increase of 5%)</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l6 level1 lfo5; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">1
year</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; mso-list: l6 level1 lfo5; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">No
actual submission</span><br />
<span style="mso-fareast-font-family: "Times New Roman";"><br /></span>
<span style="mso-fareast-font-family: "Times New Roman";"><br /></span></div>
<h2>
Deadlines</h2>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l4 level1 lfo1; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Groups
must register by June 30.</span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l4 level1 lfo1; text-indent: -.25in;">
<span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-fareast-font-family: "Times New Roman";">Submission
Deadline: <span style="mso-spacerun: yes;"> </span>March 31, 2020</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The bottom line (in our opinion):<span style="mso-spacerun: yes;"> </span>Don’t wait until the year is over to take
action to improve your MIPS score.<span style="mso-spacerun: yes;">
</span>Remember, the bar is set higher for 2019 and the financial incentives
and penalties are also greater.<span style="mso-spacerun: yes;"> </span><span style="mso-fareast-font-family: Calibri;"></span></div>
<div class="MsoNormal">
<br /></div>
<br />Jeff Robbinshttp://www.blogger.com/profile/05743306808974585977noreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-48972042471238823662019-05-02T09:41:00.000-07:002019-05-06T13:18:52.113-07:00Prepping for 2019 Hospital Quality Reporting<br />
<div class="MsoNormal" style="margin-left: .25in;">
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Now that the 2018 reporting year has
been wrapped up and submitted, this is a good opportunity to examine what
worked and what areas need improvement to ensure a successful 2019 reporting
year.</span><br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<span style="font-family: "arial" , "helvetica" , sans-serif;"> <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<h2 style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Rear-View Mirror<o:p></o:p></span></h2>
<div class="MsoNormal" style="margin-left: .25in;">
</div>
<ul>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDybyi6QpJs3Vhrb8TWi4u7XLSW3I0dAapNrmjiPebXrwkR12MMWn8LTvy48NaNq3vAToue1Yuz_-RflH3y9dg14lJxnZWgAAlVmUwNrks-BoZ9rDi7-Ud-7du9kmb7TwRNOnLTPfmx9U/s1600/2018+Quality+Reporting.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="145" data-original-width="397" height="115" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDybyi6QpJs3Vhrb8TWi4u7XLSW3I0dAapNrmjiPebXrwkR12MMWn8LTvy48NaNq3vAToue1Yuz_-RflH3y9dg14lJxnZWgAAlVmUwNrks-BoZ9rDi7-Ud-7du9kmb7TwRNOnLTPfmx9U/s320/2018+Quality+Reporting.jpg" width="320" /></a>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">On the Quality Net site, we
experienced issues with generating reports and site speed.<span style="mso-spacerun: yes;"> </span>Apparently, others had the same issues.<span style="mso-spacerun: yes;"> </span>Fortunately, CMS extended the 2018 deadline
from February 28 to April 14. </span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">To compound the frustration,
Quality Net lacks an open forum for support tickets.<span style="mso-spacerun: yes;"> </span>MIPS, Cypress, CDA 2.0 and C-CDA and FHIR all
have open Jira or Google Groups for support, allowing developers, implementers, and users to comment and ask questions using a transparent process. CMS does
not. </span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">The support process is tedious and
time-consuming.<span style="mso-spacerun: yes;"> </span>Undisclosed reporting
tool issues created “false alarms” for our calculations and turnaround on
support tickets moved slowly.<span style="mso-spacerun: yes;"> </span>Nonetheless,
we worked with the CMS help desk and technical support to ensure that our <span class="MsoHyperlink"><a href="http://bit.ly/2IVWypa" target="_blank">CQMsolution</a></span>
calculations matched Quality Net.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">In spite of these obstacles, our
new ‘Submit to DHIT’ button made testing and submitting a much smoother process.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>All
clients submitted successfully prior to the deadline.</span></li>
</ul>
<br />
<h2 style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Challenges<o:p></o:p></span></h2>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .25in; margin-right: 0in; margin-top: 0in;">
</div>
<ul>
<li><span style="mso-fareast-font-family: "Times New Roman";"><span style="font-family: "arial" , "helvetica" , sans-serif;">2015 Certified EHR Technology
(CEHRT) must be in place during the entire reporting period, although it is
permissible for the certification to happen later, as long as it is posted on
the ONC CHPL prior to the end of the reporting period.<span style="mso-spacerun: yes;"> </span></span></span></li>
<li><span style="mso-fareast-font-family: "Times New Roman";"><span style="font-family: "arial" , "helvetica" , sans-serif;">In case you still have
doubts, 2014 Certified software is not acceptable for 2019 reporting. </span></span></li>
<li><span style="mso-fareast-font-family: "Times New Roman";"><span style="font-family: "arial" , "helvetica" , sans-serif;">2019 Promoting
Interoperability (formerly Meaningful Use) now has a MIPS-like scoring system,
although unlike MIPS, Quality Measures are not part of the scoring. </span></span></li>
<li><span style="mso-fareast-font-family: "Times New Roman";"><span style="font-family: "arial" , "helvetica" , sans-serif;">The big challenge for EHR
vendors and other suppliers of eCQM software is the transition to <span class="MsoHyperlink"><a href="http://dynamichealthit.blogspot.com/2018/11/2019-cqm-changes-whats-it-all-about.html">Clinical
Quality Language (CQL)</a></span> but, if done correctly, this transition
should be transparent to software users.</span></span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Keep in mind that your CQM results
are digested and posted to the <span class="MsoHyperlink"><a href="https://www.medicare.gov/hospitalcompare/search.html?">Medicare Hospital
Compare</a></span> website.</span></li>
</ul>
<br />
<h2 style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Opportunities for Success<o:p></o:p></span></h2>
<div class="MsoNormal" style="margin-left: .25in;">
</div>
<ul>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikxAx_-Vjm43bbkbbsLO5CTGh6vpc3ZHQFQJZqIC9Xq56M6UqdNrf0RZUAu5lVhRFdWk4gVOWKaBU5rbmJYGJKPEOVneOVq8zgIuV0MgQvbz4f_QJ2YNWZDOfMapGfu6fY44MwWYf1KlM/s1600/2019+Quailty+Reporting+Success.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="500" data-original-width="780" height="128" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikxAx_-Vjm43bbkbbsLO5CTGh6vpc3ZHQFQJZqIC9Xq56M6UqdNrf0RZUAu5lVhRFdWk4gVOWKaBU5rbmJYGJKPEOVneOVq8zgIuV0MgQvbz4f_QJ2YNWZDOfMapGfu6fY44MwWYf1KlM/s200/2019+Quailty+Reporting+Success.jpg" width="200" /></a>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">By submitting eCQMs to the IQR
program, you will meet PI (MU) requirements for EHR submission.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Start running CQM reports early to
identify problem areas and home in on CQMs that are best suited to your
hospital.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">In spite of CMS’ new “Meaningful
Measures” initiative, the actual eCQMs and reporting period requirements are not changing
for 2019: <span style="mso-spacerun: yes;"> </span>You still choose a minimum of
4 eCQMs for one self-selected calendar quarter.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">The overall list of hospital CMS
eCQM measures in 2019 will stay the same, except for one adjustment:</span></li>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">CMS 55 is discontinued in the IQR
program, but will remain in TJC (see below).</span></li>
</ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="font-family: "arial" , "helvetica" , sans-serif;">For 2020, CMS is proposing to
remove the 7 eCQMs (highlighted in blue, below) so you may want to take this
into consideration when choosing your 2019 eCQMs:</span></li>
</ul>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqSneKxO9cjFKheqaJTRoXy-K95dz24qUnKUznPzw9TgP61cxbDD_w5bWV8JpaFiy0SEvTF8mWNIn_PUFMgtG5gxakPBWue1EKEeBA2cop0mN1Cf_jVHV0Vzi6sYZUtygj84wM66LY9VQ/s1600/EH+Quality+Measure+2019+Reporting.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="561" data-original-width="852" height="260" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqSneKxO9cjFKheqaJTRoXy-K95dz24qUnKUznPzw9TgP61cxbDD_w5bWV8JpaFiy0SEvTF8mWNIn_PUFMgtG5gxakPBWue1EKEeBA2cop0mN1Cf_jVHV0Vzi6sYZUtygj84wM66LY9VQ/s400/EH+Quality+Measure+2019+Reporting.jpg" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
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<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">For 2021, CMS is proposing to
adopt two new opioid-related eCQMs:<span style="mso-spacerun: yes;"> </span></span></li>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Safe Use of Opioids – Concurrent
Prescribing eCQM, and</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">Hospital Harm – Opioid-Related
Adverse Events eCQM.</span> </li>
</ul>
</ul>
<h2 style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></h2>
<h2 style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">TJC Submission<o:p></o:p></span></h2>
<div class="MsoNormal" style="margin-left: .25in;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoa_dZp2tHbiI3lyRRU4vheBk2yQYPeYKLwK5HTiO7xSLuS96Rm8BvACrzmEYmvQJ6qhstryc5ITE75g4qDF8wzmN75fOQLhSxl7e2MwiA-IOAWetCIUG3jKmo8zb1dql2VQ5bMN9bKTc/s1600/ORYX+2019.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="154" data-original-width="291" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoa_dZp2tHbiI3lyRRU4vheBk2yQYPeYKLwK5HTiO7xSLuS96Rm8BvACrzmEYmvQJ6qhstryc5ITE75g4qDF8wzmN75fOQLhSxl7e2MwiA-IOAWetCIUG3jKmo8zb1dql2VQ5bMN9bKTc/s1600/ORYX+2019.jpg" /></a></div>
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">The big news is that next year
Joint Commission ORYX vendors will assist hospitals using their Direct Data
Submission Platform (DDSP).<span style="mso-spacerun: yes;"> </span>Additional
communication regarding the transition is supposed to be released this Spring.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">2019 Measure selection was due on
12/31/2018. Hospitals that still need to select can do so by contacting <span class="MsoHyperlink"><a href="mailto:hcooryx@jointcommission.org">hcooryx@jointcommission.org</a></span>
. </span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">2019 Measures: (no changes from
2018), hospitals choose a minimum of 4 measures for 1 quarter.</span></li>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;">We submitted to ORYX for a number
of clients and found that the calculations from our CQMsolution software were
consistent with TJC across the board. </span></li>
</ul>
<br />
<div class="MsoNormal" style="margin-left: .25in;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">We hope this helps with your 2019
reporting process and, as always, welcome your feedback.<o:p></o:p></span></div>
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<span style="font-family: "calibri" , sans-serif "msorm"; font-size: 11.0pt; line-height: 107%;"><o:p><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></o:p></span></h2>
<br />Jeff Robbinshttp://www.blogger.com/profile/05743306808974585977noreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-13881445609471982962019-02-21T12:51:00.000-08:002019-02-21T16:44:54.104-08:00FHIR Heats Up HIMSS<div class="MsoNormal">
In the middle of eCQM submissions for our EH and EP clients, and Carnival season here in New Orleans, it seems impossible that something would be able to pull us away from our office in the Crescent City. However, HIMSS accomplishes this on an annual basis and we were eager to arrive in Orlando for the 2019 conference last week. ONC had just announced a new proposed rule, including the endorsement and mandatory incorporation of FHIR, and the news was traveling faster than the Boeing 737 we were on. This was quite the way to start off our eighth HIMSS conference. Fortunately, we also frequent FHIR Connectathons and have been, and continue to, prepare for the FHIR-based changes ahead.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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<b><br /></b></div>
<h3>
<b>The New Proposed Rule</b></h3>
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“FHIR” and “API” were two of the hottest acronyms at this year’s HIMSS Conference. This is still a proposed rule that is open for comments but, if finalized, ONC would require EHR vendors to offer a well-documented API that:</div>
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<li><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Uses FHIR to support USCDI data classes and data elements</li>
<li><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Supports the SMART Application Launch Framework Implementation Guide</li>
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USDCI expands on the Common Clinical Dataset that was introduced with the 2015 Edition final rule and includes two additional data classes: Clinical Notes and Provenance. Clinical Notes is aptly named and may include notes detailing assessment, a plan of care, patient teaching, and other relevant data points. While defining Provenance is not as straightforward, the objective is using metadata that defines the creator and owner of an element to deepen trust in and alleviate audit pains with that dataset as it is passed between systems and APIs.<br />
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We were also gifted an abbreviated version of “API Resource Collection in Healthcare” as the proposed rule introduced us to the acronym ARCH. ARCH is aligned with the proposed USCDI and references 15 FHIR resources that certified vendors would be required to support. To help achieve this goal, ONC has created an open source (and still under development) tool for testing if patients can access their health data as expected. Fans of Dante, Dan Brown, and Tom Hanks are delighted with the naming of the new tool and “Inferno” is available at: <span class="MsoHyperlink"><a href="https://inferno.healthit.gov/inferno/">https://inferno.healthit.gov/inferno/.</a></span> </div>
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More details on the testing suite can also be found here: <span class="MsoHyperlink"><a href="https://www.healthit.gov/buzz-blog/interoperability/onc-is-fhird-up-unwrapping-the-new-inferno-testing-suite">https://www.healthit.gov/buzz-blog/interoperability/onc-is-fhird-up-unwrapping-the-new-inferno-testing-suite</a>. </span>Additionally, the proposed rule would require adoption of SMART (Substitutable Medical Applications, Reusable Technologies) which uses OAuth2 to provide a layer of security for FHIR interfaces. OAuth2 is a widely used industry standard that, coupled with OpenID Connect, provides a level of authentication and authorization that is outside of FHIR’s scope. It also describes a process by which an EHR application can launch an external application while preserving the patient and user context, thus providing secure access to EHR data.</div>
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Information blocking (including seven exceptions) is also a large part of the proposed rule and attempts to codify the concept of patients, rather than their health systems, owning their data and being entitled to access that data free of charge. As CMS administrator Seema Verma noted, “The idea that patient data belongs to providers or vendors is an epic misunderstanding. Patient data belongs to patients.” <o:p></o:p></div>
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Final Thoughts</h3>
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Of course, the highlight of our HIMSS experience is interacting with our peers who are equally passionate about healthcare IT. Throughout the event, current and prospective DHIT clients stopped by our booth to chat and the energetic environment of HIMSS left us with additional motivation and a renewed commitment to healthcare IT and providing our client base with outstanding customer service. <o:p></o:p></div>
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Our promise is continuing to strive towards an impactful footprint in the HIT industry by providing research, news, and innovative development. If you missed us at HIMSS, plan to meet us at the next FHIR Developer Days, FHIR Connectathon, or ONC Annual Meeting as we dive deep into ongoing development on FHIR Resources and C-CDA requirements. We have a blog on NPRM, comments to ONC, newsletters, and emails all coming soon and, in the meantime, you can join us on Twitter @DynamicHealthIT.<o:p></o:p></div>
Jeff Robbinshttp://www.blogger.com/profile/05743306808974585977noreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-10186592668370656312019-01-30T13:04:00.001-08:002019-01-31T08:54:24.283-08:00HL7 January 2019 Working Group Meeting, FHIR Connectathon and C-CDA IAT: A Recap (Part II)<span style="font-family: "arial" , "helvetica" , sans-serif;"><i>For the week following January 12th, a delegation from the Dynamic Health IT development team was on hand in San Antonio for the HL7 Working Group Meeting and FHIR Connectathon. Our team shared technical approaches and a vision for the future of FHIR, C-CDA and our industry at large. This is Part II of our recap of the week’s events.</i></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">While the Working Group Meeting (WGM) covered the entire week’s festivities, FHIR and C-CDA got the intensive treatment over the weekend of January 12th. While FHIR had its own discussion track at the WGM, in-depth technical discussions of interoperability at the document and data levels reigned over the weekend.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">As in any technological meeting of minds, some of the discussion can become obscure. But it is just this level of detail that is pushing the maturity of the standards and is proving crucial to adoption.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Among other efforts over a busy weekend, our team discussed important use cases for the standards, reviewed USCDI data elements, shared our methodology for C-CDA to FHIR (not to be confused with C-CDA on FHIR) and went deep into the details of Clinical Notes. There were also, as always, a range of tracks offered to put developers through their paces.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">In Part II, we summarize few more of these important flash points.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Provenance comes of age<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAUlvtnGsUX1hhOX0CI77F0rmgHj1QrP5TY2YMLx1EBCwuz47gqFdD4msH381rBSwNboMZntK2O6gpCFXBsHhr1uRvA9RSknJz2ksOO2VtHAT0LPN8oQ4-SAiA454g-4d-2EK3zh6JAYc/s1600/0F279814-4DE1-44AC-8D98-A2FE8A179911.jpeg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="960" data-original-width="1280" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAUlvtnGsUX1hhOX0CI77F0rmgHj1QrP5TY2YMLx1EBCwuz47gqFdD4msH381rBSwNboMZntK2O6gpCFXBsHhr1uRvA9RSknJz2ksOO2VtHAT0LPN8oQ4-SAiA454g-4d-2EK3zh6JAYc/s320/0F279814-4DE1-44AC-8D98-A2FE8A179911.jpeg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">DHIT team in a rare moment of down time.</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Provenance is “data and metadata for who and when information was/is created, for the purposes for trust, traceability and identification.” And it’s been hot topic of conversation in some recent C-CDA events and this time was no different. To show that it’s arrived (and needs to be taken seriously) it has been included in the expanded USCDI.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">If document-level meta-data can be verified and included as a matter of course, it will go along way to breaking down barriers of distrust between providers and systems.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Patient Summary vs. Encounter Summary</b></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">We discussed Encounter Summary documents at length in our previous post in which we reviewed some of the <a href="https://medium.com/@DynamicHealthIT/common-sense-in-ccda-comparing-carequality-commonwell-ccda-to-r2-1-878fd54e4b8a">Carequality/CommonWell recommendations</a>. Whereas an encounter summary is meant to be limited to a specific episode of care, patient summary documents contain a record of care over a period of time, including multiple encounters. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">But as debated at the IAT, how do we represent a problem list – should it show a snapshot in time, a net problem list or be in some way shifted to another document type or section to avoid any confusion? Most clinicians, at any given time, want condensed data that provides direct insight to the patients’ current state of being – so what happens to the history when a document is compiled?</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Meds and Labs</b></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Shades of meaning become increasingly important as standards are defined down to the last character. While a ‘Medication, Administered’ should indicate that a clinician confirmed that the patient took the med, medication “complete” is another story.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">There was a consensus for putting all lab results in the results section, while some associated procedures may be essential dual-entered in the procedures section.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzuRtK61zrL0dptkqwluyZvEIAvVAghJaZXlWAGG6Z6NMMDShBYKvEg8w0gXYOpSg1_uriRXcIHsPJonyhVHm23YiPqyGKiSC4WWx2tnz6P2Y8G4NWcSkvjxX_jixx7bMOFNMgFjVoxs8/s1600/puzzle.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="799" data-original-width="1200" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzuRtK61zrL0dptkqwluyZvEIAvVAghJaZXlWAGG6Z6NMMDShBYKvEg8w0gXYOpSg1_uriRXcIHsPJonyhVHm23YiPqyGKiSC4WWx2tnz6P2Y8G4NWcSkvjxX_jixx7bMOFNMgFjVoxs8/s400/puzzle.jpg" width="400" /></a></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Close quarters at Connectathons, while at times chaotic, have the virtue of providing sustained and meaningful interaction. Many questions that may get overlooked during a normal workday back at each of our respective offices get answered.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">If the spirit of the event is “share and share alike,” then San Antonio was another roaring success. When it comes to interoperability, the learning and collaboration never stops.</span><br />
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<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-89032400679651513602019-01-23T09:02:00.001-08:002019-01-23T09:04:38.872-08:00HL7 January 2019 Working Group Meeting, FHIR Connectathon and C-CDA IAT: A Recap (Part I)<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeQOgp8FvFy4r4TE1856U6ZgnuerJcM2tkrkkJQRzopw35V_8dn000jY74F8NM2VrMPllrpjK3SVZqpKNDT88d7Jsf8CInG6nQ8ZdtPjHSCFNbqOtK_ng9qvsHfjptfqLMd09Xg3CpnSs/s1600/image002.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="747" data-original-width="536" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeQOgp8FvFy4r4TE1856U6ZgnuerJcM2tkrkkJQRzopw35V_8dn000jY74F8NM2VrMPllrpjK3SVZqpKNDT88d7Jsf8CInG6nQ8ZdtPjHSCFNbqOtK_ng9qvsHfjptfqLMd09Xg3CpnSs/s320/image002.jpg" width="228" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Tower of the Americas, San Antonio, TX.</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">For the week following January 12th, a delegation from the Dynamic Health IT development team was on hand in San Antonio for the HL7 Working Group Meeting and FHIR Connectathon. Our team shared technical approaches and a vision for the future of FHIR, C-CDA and our industry at large. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">For the uninitiated, the event is an interoperability extravaganza, allowing implementers to dive deep and uncover best practices in health data sharing. The Connectathon portion now also hosts the C-CDA Implementation-a-Thon (IAT), allowing in-depth collaboration with industry leading EHR developers.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Major policymakers, developers and stakeholders are in attendance for an ambitious look at interoperability from practical and conceptual standpoints. The free flow of information on display mirrors what interoperability itself aspires to be: open and unencumbered. Perhaps most importantly, it reminds us that our human connections are essential to our virtual ones.</span><br />
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<b><span style="font-family: "arial" , "helvetica" , sans-serif;">FHIR: Is the future now?</span></b><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br />The FHIR Connectathon added the C-CDA IAT track, which allowed for exploration of the connection between FHIR and C-CDA documents. We continued our active engagement in this collaboration as we hammered out the C-CDA to FHIR Mapping. A CDA to FHIR and FHIR to CDA roundtrip allows implementers who only do CDA (or who only do FHIR) to communicate with each other.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">One of the greatest challenges in this effort is to decide on and maintain the conversion mechanism that translates a C-CDA document into a FHIR C-CDA document (and vice versa). C-CDAs rendered in XML do not always map neatly to FHIR resources and there are all sorts of judgment calls to be made; though it should be said: getting these two to play nicely is a key goal for HL7 policymakers and the next major release of FHIR (R5) will have more support for migrating data to and from v2.1 CDA documents.<br /><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5NfB1dEIKH1LdyC1Kr4rL3zpBLKQuFU2Hwm7O0YE9WgX-3WsiT4Nj9gNWR64n4FK_plKEQxg2f3qlqRfXliJSMWeNtcmU_qg3v0tmMUBcOtslFgstsVeRc2jsOagrMS9ChvNZAZTne3c/s1600/image007.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="410" data-original-width="848" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5NfB1dEIKH1LdyC1Kr4rL3zpBLKQuFU2Hwm7O0YE9WgX-3WsiT4Nj9gNWR64n4FK_plKEQxg2f3qlqRfXliJSMWeNtcmU_qg3v0tmMUBcOtslFgstsVeRc2jsOagrMS9ChvNZAZTne3c/s400/image007.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">FHIR Connectathon swag.</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">One conceptual hurdle, aside from mapping, is the fact that a C-CDA document tells a clinical story and is therefore more legible. FHIR’s resources are more abstract and, while highly flexible. Therefore, they’re better positioned to serve as the clearinghouse: to be “read” directly by EHRs and mobile applications. But clinicians and other human readers require the narrative quality that a discrete document format provides.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The Dynamic team shared its experience with implementing CCDA to FHIR in and our decision to emphasize the use of a document repository that creates FHIR resources on the fly. We have rolled this all the way up to a prototype mobile app for patient end-users, while our near terms goals include having Apple HealthKit talking directly to our Dynamic FHIR product.</span><br />
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<b><span style="font-family: "arial" , "helvetica" , sans-serif;">Quality Measures – they’re everywhere</span></b><br />
<span style="font-family: arial, helvetica, sans-serif;"><br />Clinical quality measures calculation from FHIR (or CCDA) remains a nascent field of inquiry. The data sources for CQMs currently in the field are overwhelmingly based on mapping measure logic to some existing relation data format used by the EHR. But as our team has shown in previous Connectathon events, CQM calculation can work hand-in-hand with FHIR.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">With the advent of Clinical Quality Language (CQL) in 2019, there is further hope that this more interpretable logic will enable more interoperability in CQMs. In theory, CQL files should be easier to create, read and share across domains beyond CQM compliance (for instance, clinical decision support). And by extension, they should dovetail more easily with FHIR resources.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">There is plenty of cause for optimism here, including the fact that the team beyond CQL offers a wealth of open source tooling and some emerging recommendations that CQM programs support more of the code systems under 2015 Edition.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Here is another example of the way in which clinical documents are colliding with CQMs: The CPC+ program, which includes a subset of required CQMs, will also be requiring the output of a Care Plan document. Dynamic Health IT, along with a handful of other vendors, has previously implemented the Care Plan C-CDA in a production environment.<br /><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl9kWTUdxWSLsvaw2BRkRjZzplKKVbRJO4H2UJmsw3K9Ca8efFWNnK8WXOVLqI3Jq0jI1b5tijz8KS1Z7WFw7RMxNmFxio8oxdjrRvqc0H1nQ54U9bKv94XhBbGJcxjin1rYHESz5k1T0/s1600/image004.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="432" data-original-width="1028" height="167" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl9kWTUdxWSLsvaw2BRkRjZzplKKVbRJO4H2UJmsw3K9Ca8efFWNnK8WXOVLqI3Jq0jI1b5tijz8KS1Z7WFw7RMxNmFxio8oxdjrRvqc0H1nQ54U9bKv94XhBbGJcxjin1rYHESz5k1T0/s400/image004.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Connecting and collaborating.</td></tr>
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<b><span style="font-family: "arial" , "helvetica" , sans-serif;">C-CDA Scorecard rubric updates</span></b><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">Many EHRs have implemented some version of incoming C-CDA grading consistent with 2015 Edition. Use of the ONC-engineered Scorecard Tool is not required for certification, but some form validation similar to that made available by ONC via API is needed. The Scorecard, which provides the additional flourish of a letter grade, was ONC’s way of allowing users to check the quality of the C-CDA from a sending system and provide a channel for accountability.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">However, there has been some pushback by EHRs that the analysis provided by the tool is too blunt and users of the tool are getting caught up in the grade, as opposed to what the grade represent (not unlike college). EMR vendors seem to prefer a Progress Bar allowing the end-user to understand where progress can be made to improve the provided data. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">ONC has some enhancements coming to provide more meaningful feedback to implementers by indicating the number of tests graded and number of tests passed, while indicating the number of unique issues.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">There has also been a request from EHR vendors for more clarity in error messaging, which may be addressed in part by further education.</span><br />
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<i><span style="font-family: "arial" , "helvetica" , sans-serif;">Stay tuned for our next post for more information on some of the lead-edge discussions around interoperability standards.</span></i><br />
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-75753551356428413752018-12-17T08:17:00.000-08:002019-01-02T11:11:18.858-08:00Common Sense in C-CDA: Comparing Carequality/CommonWell C-CDA to r2.1<div style="background-color: white; margin: 0in 0in 0.0001pt; padding: 0px;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">The history of shared clinical documents is marked by decades of industry-wide deliberation. In recent years, catalyzed by ONC Certification, there has been widespread adoption and refinement of the standard. </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Data EHRs were required to record and share under ONC Certification were originally called Meaningful Use Data and represented a list of basic chart elements. These were later reformulated as the more expansive Common Clinical Data Set (CCDS) in 2015 Edition Certification. The emergence of 2015 Edition criteria also removed the requirement for the encounter-based document previously required in 2014 Edition - the ambulatory Clinical Summary - making the test data for the latest edition of Health IT certification effectively patient-based.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The current ONC-sanctioned R2.1 version of the C-CDA document, upon which the sharing of these minimum data elements is based, includes long-discussed enhancements that have lead to much greater clarity. But there remain<b><i> </i></b>issues of reliability, relevance and provenance surrounding the standard and its implementation, particularly at the encounter level. Some of these issues, particularly with respect to provenance, are being addressed in the underlying data with the <a href="https://www.healthit.gov/sites/default/files/draft-uscdi.pdf" style="color: black; outline: none;" target="_blank" title="This external link will open in a new window"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;">Draft U.S. Core Data for Interoperability</span></a><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> (USCDI), which is slated to replace the Common Clinical Data Set (CCDS).</span></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">There have also been efforts provide constructive recommendations on the structure of the document itself. Earlier this year, Carequality and CommonWell Content Work Groups released a white paper, using the C-CDA R2.1 Companion Guide as a baseline to provide "complementary, not conflicting guidance." CommonWell is a not-for-profit trade association focused on interoperability, while Carequality represents a similar industry-wide collaborative, convening healthcare stakeholders on interoperability issues.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The goal of the collaboration was a more clinically-relevant and parsimonious C-CDA. The collaborative work group tackled the following issues:</span><br />
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<li class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">"Unacceptably large" C-CDA documents</span></li>
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<li class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">A general absence of clinical notes </span></li>
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<li class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Need for encounter summary support</span></li>
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<li class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Need for version management</span></li>
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<tr><td class="tr-caption" style="text-align: center;">Clinical Notes should follow the encounter. (Credit: Max Pixel)</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The white paper has a wide range of common-sense recommendations, but we'll discuss some of the recommendations most relevant to implementing CCDA R2.1 under 2015 Edition Certification and USCDI (which is slated to replace CCDS).</span><br />
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<li class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Problems - only those addressed during the encounter </span></li>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br />While conditionality in general can get thorny, these recommendations make a good deal of clinical sense. If events are not touched by the encounter, updating and sending them makes little sense.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Specific to the USCDI, the work group judged the data set to contain "valuable data elements and should be exchanged to improve patient care." But they go on to say that Clinical Notes should not simply be a data dump: when they are supported, support for Encounter Summary documents should be added to ensure<span style="color: red;"> </span>the note follows the encounter.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The recommendations focus on Encounter Summary documents (Progress Note Document and Discharge Summary) and preserve all sections required in the base C-CDA document template. After setting that foundation, they map out a "priority subset" of clinical data from the ONC Common Clinical Data Set (CCDS) and draft US Core Data for Interoperability (USCDI). The idea is to weed out data that is stale or irrelevant to the clinical encounter.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The prioritized sections for 'always include' have data within them that should appear conditional based on the events of the encounter:</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">In theory at least, the C-CDA as tested under 2015 Edition would become easier to interpret and implement. There also a few general guidelines for non-priority elements:</span></div>
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<span style="color: black; font-family: "arial" , "helvetica" , sans-serif;">Systems SHOULD send a ‘No information’ assertion template if nothing is available for one of the priority subset data elements. </span></div>
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<span style="color: black; font-family: "arial" , "helvetica" , sans-serif;">Systems MAY send additional data elements, beyond the priority subset, if relevant to the encounter. For these additional data elements, systems should not send a ‘No information’ template if nothing is available.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The concept of 'no information,' while ostensibly straightforward, is crucial here. It's the "known unknown," that provides more certainly to the receiver of the C-CDA that in fact nothing clinically relevant appears under that section, as opposed to having been omitted for an unknown reason.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The recommendations also touch the world of Fast Healthcare Interoperability Resources (FHIR), which implications for how its resources are used. The CommonWell-Carequality alliance is deeply involved in FHIR workgroups and its recommendations may, through governance of the standard, help shape efforts to ensure C-CDA and FHIR resource play more nicely together. Currently, there is a significant amount of subjectivity in getting the sections of a C-CDA in and out of FHIR.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Dynamic Health IT has been reviewing its C-CDA practices and guidance to make sure we help our clients send and receive documents that are clinically-relevant and readable. True interoperability requires nothing less.</span></div>
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<i><span style="font-family: "arial" , "helvetica" , sans-serif;">We're looking forward to seeing you at the C-CDA IAT meeting. You can find the Track Agenda <a href="https://confluence.hl7.org/display/IAT/C-CDA+Implementation-A-Thon+Track+Agenda">here</a>.</span></i><br />
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-45630586453921972942018-12-07T08:52:00.001-08:002018-12-09T14:09:34.659-08:00ONC Annual Meeting 2018 RecapOn November 29-30, 2018, Health IT policymakers and implementers met in DC for the Annual ONC Meeting. As always, the agenda was full to the brim with <a href="https://www.healthit.gov/news/events/onc-2018-annual-meeting">discussions on the state-of-the-health IT industry</a>.<br />
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Interoperability and the future of 2015 Edition CEHRT were central themes, but the agenda content reveals just how far-reaching ONC's influence reaches - and by extension, the use of health IT systems and applications. Sessions tackled subjects as wide-ranging as care coordination, interoperability strategies, APIs, disaster response and opioid prescribing.<br />
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<a href="https://c1.staticflickr.com/8/7154/6538420329_854261ea92_b.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="Image result for washington dc" border="0" height="270" src="https://c1.staticflickr.com/8/7154/6538420329_854261ea92_b.jpg" width="400" /></a>Jeff Robbins, Dynamic Health IT President, attended the meeting. His enthusiastic takeaway was that the conference was very beneficial, providing a survey trends in health IT today and learn about innovative approaches to our most pressing challenges. While it's impossible to attend all sessions (or even to summarize them in a single blog post), we'll review a few highlights.<br />
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The breakout session “Improving Opioid Prescribing through Electronic Clinical Decision Support Tools” focused on the solving the challenges posed by the Opioid Epidemic in the Prescription Drug Monitoring Program (PDMP). As part of monitoring, prescribing physicians can be securely notified of non-fatal overdose episodes, but this is currently uncommon. By connecting providers to PDMPs more widely, we can ensure that they have timely information that can limit drug-seeking, modulate prescription behavior and point to important connections to limit the spread of opioid abuse.<br />
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While we acknowledge the depth of the challenges facing the industry currently - particularly with respect to interoperability - there were plenty of success stories in evidence. DHIT was impressed by case studies showing enthusiastic adoption of the HL7 Fast Healthcare Interoperability Resource (FHIR) data standard for provider-payer data exchange. A private sector-led initiative — the Da Vinci Project — has progressed quickly enough to enlist government sponsorship from the ONC and then spawned the <a href="https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/P2+FHIR+Task+Force+Home">P2 FHIR Taskforce</a>. The task force is supporting FHIR development efforts and turning its focus to challenges preventing adoption.<br />
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The “FHIR Implementation and Transition Planning” session was another opportunity to discuss EHR vendor Application Programming Interfaces (APIs). The 21st Century Cures Act calls for the development of APIs to promote data-sharing and the ONC 2015 Edition Test Method includes three measures (g7, g8, g9) encompassing patient data APIs - though neither explicitly mandate FHIR. During the Q&A session, Cerner and Epic were in the hot seat with application and personal health record (PHR) developers seeking broader access to their FHIR APIs.<br />
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On Friday, a lively panel discussion on “Data and Value-Based Care" was held. Economist Mark Pauly discussed the proverbial elephant in the room - a subject that is often avoided: cost/benefit of healthcare and the need to set dollar limits on individual healthcare plan coverage. Mark posed the hypothetical of whether there should be marginal dollar limits for coverage.<br />
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Finally, it's worth reflecting on the future of ONC's latest health IT test method: 2015 Edition CEHRT. With funding in questions and transition in both programs, Certification and Meaningful Use have both seen grave pronouncements within the last few years. But 2015 Edition CEHRT is still required in 2019 for providers reporting MIPS. And for those providers targeting the “end-to-end bonus" for eCQM reporting, that must be done in conjunction with a system that meets 2015 Edition CEHRT.<br />
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Our challenges - and the policy initiatives designed to meet them - aren't going anywhere.<br />
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-1008801871527122012018-11-16T08:28:00.002-08:002018-11-16T08:37:27.230-08:002019 CQM changes – what’s it all about?<div class="separator" style="clear: both; text-align: center;">
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Each year, there are a host of changes to clinical quality measure logic, reporting requirements and CMS quality program policy. Come 2019, the usual cycle of CQM turnover is joined by an overhaul of CQM logic methodology: Clinical Quality Language (CQL).<br />
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In our previous post, we discussed 2018 changes. In this post, we’ll handle the changes coming for the <b>2019 Reporting Year</b>. Those fall into five categories:<br />
<ol>
<li><b>CQL transition: </b>Clinical Quality Language (CQL) is a measure authoring language standard that will replace the measure logic previously defined by the Quality Data Model (QDM) and QDM in 2019.</li>
<li><b>Value Set Changes:</b> changes to official codes and code sets used by CMS quality measures</li>
<li><b>Measure Specification and Logic Changes:</b> changes in the manner of calculation and/or specific codes and code sets included in each measure</li>
<li><b>QRDA-I/III reporting format changes: </b>changes in the XML requirements (QRDA-I or QRDA-III) for major CQM reporting programs (such as MIPS, HQR and Joint Commission)</li>
<li><b>Reporting changes: </b>High-level program changes such as menu and number of required of measures, method of reporting, etc.</li>
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<b>CQL transition</b></div>
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The conversion of eCQMs to Clinical Quality Language (CQL) has been a hot topic ever since CMS announced that, starting with the 2019 reporting period, eCQMs would move from logic based on an HQMF XML modeling language to CQL. In little more than two months, CQL will become the lingua franca of eCQMs.<br />
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CQL has been chosen for its ability to give quality measure authors more flexibility in creating precise definitions of quality measures that are human readable. But what does this mean for health care providers and EHR vendors? If implemented smoothly, it should be barely noticeable by providers. Measure changes between 2018 and 2019 will be absorbed by the CQL measures and calculated as expected, versions notwithstanding.<br />
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The impact on EHR developers is far more significant. While developers providing calculation and analysis tools based on CQL have flexibility to use the files that integrate best into their software (ie, ELM vs JSON), they will need to overhaul their measure specifications at the root level to ensure they are using a CQL basis.</div>
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CQL makes calculation logic more readable and transparent. For example ability to calculate within the logic itself. Previously, a concept like “cumulative medication duration” was a derived</div>
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element that could not be expressed with QDM-based logic. CQL expresses this kind of calculation in a computable format within the logic.<br />
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Fortunately, DHIT has rendered eCQMS (and a wide range of non-eCQMs) in JSON well in advance of the 2019 reporting deadlines.</div>
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<b>Value Set Changes</b></div>
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As discussed in Part 1, there are annual value set changes that affect eCQMs differently each reporting year. The National Library of Medicine (NLM) maintains the Value Set Authority Center (VSAC), which releases value set updates annually. The entirety of these value set changes are incorporated into our CQMsolution application each release year, with backward compatibility maintained for previous reporting years. The only way to fully implement these changes is to be sure that value sets and their respective codes crosswalk perfectly to the VSAC release.<br />
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<b>Measure Specification and Logic Changes</b></div>
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Each new reporting year brings a new batch of measure versions. The United States Health Information Knowledge base (USHIK) offers a comparison tool for visualizing changes in measures across years. The tool is accessible directly from the eCQI Resource Center, but as of this writing is not yet accessible for 2019 eCQMs. Changes to the measure specifications can range from adjusted wording in the measure overview to an adjustment to how a measure population is calculated and its data elements. Examples of new data criteria include the attributes ‘prevalencePeriod’ and ‘components.’</div>
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<b>QRDA-I/III reporting format changes</b></div>
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Here is a rundown of the most relevant changes to the requirements in QRDA-I and QRDA-III submission files:<br />
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<i>QRDA-I:</i></div>
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<li>Changes to accepted date time formats: made more expansive</li>
<li>Data types of CD or CE SHALL have either code or nullFlavor but not both</li>
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<i>QRDA III:</i></div>
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<ul>
<li>Changes to group-level reporting identification (for MIPS-Group and MIPS Virtual Groups). MIPS Groups will use such that it SHALL be the group's TIN, while the virtual group will use its Virtual Group Identifier</li>
<li>Changes across the XML to support transition from ‘ACI’ to ‘Promoting Interoperability’</li>
<li>Standard measure identifier changes (UUIDs)</li>
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<b>Reporting changes</b></div>
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The overall list of CMS eCQM measures in 2019 will stay the same for hospitals, but there are a few program-level measure adjustments for hospitals:</div>
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<li>CMS 55 is discontinued in the IQR program, but will remain in TJC</li>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg83FjlHva2NrNDCGKHiYKLaad2yGMB7OiS7Hb11OO0EENkk0oBAoxCEScdjfWDg0x6y5khWHvvU4Fs_5olZyTuXFLwLpEdDPiGWlHz0Xjjcf0YfJou4GiGw0iIE5a0lNLk_XWwvop7M5c/s1600/measure_EH_chart.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="764" data-original-width="360" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg83FjlHva2NrNDCGKHiYKLaad2yGMB7OiS7Hb11OO0EENkk0oBAoxCEScdjfWDg0x6y5khWHvvU4Fs_5olZyTuXFLwLpEdDPiGWlHz0Xjjcf0YfJou4GiGw0iIE5a0lNLk_XWwvop7M5c/s320/measure_EH_chart.jpeg" width="149" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">2019 EH measures by Program</td></tr>
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On the EP/EC side, there are some changes to the overall menu of measures:</div>
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<li>CMS 249 and CMS 349 are added</li>
<li>CMS 65, CMS 123, CMS 158, CMS 164, CMS 167, CMS 169 are removed</li>
<li>CMS166 -previously for Medicaid-only submission – has been phased out.</li>
</ul>
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Reporting for eligible clinicians has expanded to include the use of the MIPS-API, which has undergone evolution since introduction in 2018.</div>
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One significant change on the hospital side is that a QRDA-I submitted and accepted into production will overwrite any preexisting file based on the exact match of five key elements identifying the file: CCN, CMS Program Name, EHR Patient ID, EHR Submitter ID, and the reporting period specified in the Reporting Parameters Section.</div>
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<div>
For those submitting Joint Commission eCQMs, the program will be shifting to the Direct Data Submission (DDS) Platform, in which hospitals will submit measures directly. DHIT will offer a full suite of consulting and data review services to support this.</div>
<div>
<br /></div>
<div>
<br /></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-47881748583111007512018-10-23T15:10:00.000-07:002018-10-31T09:15:52.785-07:002018 CQM changes – what’s it all about?Finding yourself unsure about recent developments in Clinical Quality Measures? Join the club.<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
Each year, there are a host of changes to clinical quality measure logic, reporting requirements and CMS quality program policy. And currently, the usual cycle of CQM turnover is joined by an overhaul of CQM logic methodology for the 2019 CQM definitions: Clinical Quality Language (CQL).<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://c.pxhere.com/photos/58/a3/hourglass_clock_time_deadline_hour_rush_hurry_minute-484055.jpg!d" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="533" data-original-width="800" height="213" src="https://c.pxhere.com/photos/58/a3/hourglass_clock_time_deadline_hour_rush_hurry_minute-484055.jpg!d" width="320" /></a></div>
<br />
Suffice it to say, there’s a lot to keep on your radar right now in the CQM world. And the deadline for eCQM submission will be here before we know it:<br />
<br />
<ul>
<li><b>Hospital Quality Reporting:</b> February 28, 2019, 11:59pm PT</li>
<li><b>Quality Payment Program (MIPS) eCQMs (non-Web Interface submission):</b> April 2, 2019, 5pm PT</li>
</ul>
<br />
<br />
We prepared two posts to break down and interpret some of the changes that have occurred in 2018 and those that are coming in 2019. Our goal is to provide some action steps for CQM implementers.<br />
<div>
<br /></div>
<div>
<div class="MsoNormal" style="margin-bottom: 12.0pt;">
The changes for 2018 submission
fall into four categories:<o:p></o:p></div>
<div>
<ol>
<li><b>Value Set:</b> changes to official codes and code sets used by CMS quality measures</li>
<li><b>Measure Specification and Logic:</b> changes in the manner of calculation and/or specific codes and code sets included in each measure</li>
<li><b>QRDA-I/III format and submission:</b> changes in the XML requirements (QRDA-I or QRDA-III) for major CQM reporting programs (such as MIPS, HQR and Joint Commission)</li>
<li><b>Reporting:</b> changes in high-level quality reporting program requirements</li>
</ol>
<div>
<div class="MsoNormal">
For those reporting Joint Commission (TJC) ORYX eCQM in
addition to CMS, it’s important to note that TJC has aligned their measures
closely with CMS, but there are some programmatic changes they we’ll note
below.<o:p></o:p></div>
</div>
</div>
</div>
<div>
<br /></div>
<div>
<div class="MsoNormal">
As you dig into the changes, an invaluable resource is the <span class="MsoHyperlink"><a href="https://ecqi.healthit.gov/">eCQI Resource Center</a></span>,
hosted by CMS. The eCQI site also has an annual Implementation Checklist that
is helpful in preparing for CQM submission. The Implementation steps contain a
list of steps to understand year-over-year changes.<o:p></o:p></div>
</div>
<div>
<div class="MsoNormal">
To varying degrees, these changes require workflow and/or
back-end changes by EHR vendors. But take heart – if the data exists somewhere,
Dynamic Health IT’s quality measure bolt-on software, CQMsolution, can take
care of the rest. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Value Set Changes<o:p></o:p></b></div>
<div class="MsoNormal">
The National Library of Medicine (NLM) maintains the Value
Set Authority Center (VSAC), which releases value set updates annually. The
entirety of these value set changes are incorporated into our CQMsolution
application each release year, with backward compatibility maintained for
previous reporting years.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The update of value set changes contains changes that have
the potential to affect all eCQMs in a given release year. The only way to
fully implement these changes is to be sure that value sets and their
respective codes crosswalk perfectly to the VSAC release.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
VSAC also includes some retired and legacy codes in order to
accommodate a lookback period for measure calculation, so it’s important to
keep in mind that the eCQM value sets do not always correspond to strictly the
latest version of any code set (such as ICD-10 vs ICD-9). CMS makes a
determination of which code system versions they will approve for use during
the measure year.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Measure and Measure Logic Changes<o:p></o:p></b></div>
<div class="MsoNormal">
While the high-level identifier (eg, “CMS 2”) and
description for measures may stay the same across years, each year generally
brings a new batch of measure versions.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The United States Health Information Knowledgebase (USHIK)
offers a comparison tool for visualizing changes in measures across years. The
tool is accessible <span class="MsoHyperlink"><a href="https://ecqi.healthit.gov/eligible-professional-eligible-clinician-ecqms?field_year_value=2">directly
from the eCQI Resource Center</a></span>. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Changes to the measure specifications can range from
adjusted wording in the measure overview to an adjustment to how a measure
population is calculated. For instance, in 2018, CMS 128 added an exclusion for
patients who were in hospice care during the measurement year. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
Each measure release year also has a Technical Release Notes
document attached. Where the USHIK compare tool has a side-by-side descriptive
comparison, the Release Notes provide granular list of all changes to a
measure. These changes must be incorporated into the measure logic used to
power all reporting and this update is done within CQMsolution’s calculation
engine 12-16 months in advance of measure reporting cycles.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>QRDA-I/III reporting format changes</b></div>
<div class="MsoNormal">
Each year, there are changes great and small to the formatting of XML documents that must be submitting for both eligible clinicians (ECs) and eligible hospitals (EH). Many of these changes are absorbed directly into the files themselves. However, here are the changes that have the potential to affect data capture and workflow on the provider side:</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-indent: .5in;">
<b>Eligible Hospital QRDA-Is
(patient-level XML file):<o:p></o:p></b></div>
<div class="MsoNormal">
</div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoListParagraphCxSpFirst" style="margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1;">Medicare
Beneficiary Identifier (MBI) is not required for HQR but can and should be
be submitted if the payer is Medicare and the patient has an MBI<o:p></o:p></li>
<li class="MsoListParagraphCxSpMiddle" style="margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1;">CMS
EHR Certification Identification Number is now required for HQR.<o:p></o:p></li>
<li class="MsoListParagraphCxSpLast" style="margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1;">TIN
is no longer required<o:p></o:p></li>
</ul>
<div class="MsoNormal" style="text-indent: .5in;">
<b>Eligible Clinician QRDA-IIIs
(aggregate XML file or JSON via API):<o:p></o:p></b></div>
<div class="MsoNormal">
</div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoListParagraphCxSpFirst" style="margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1;">The
performance period under MIPS can be reported at either of the following
levels:<o:p></o:p></li>
<ul style="margin-top: 0in;" type="circle">
<li class="MsoListParagraphCxSpMiddle" style="margin-left: .25in; mso-add-space: auto; mso-list: l0 level2 lfo1;">The
individual measure level for the MIPS quality measures and at the
individual activity level for the MIPS improvement activities (IA), or<o:p></o:p></li>
<li class="MsoListParagraphCxSpMiddle" style="margin-left: .25in; mso-add-space: auto; mso-list: l0 level2 lfo1;">The
performance category level for Quality and IA performance categories<o:p></o:p></li>
</ul>
<li class="MsoListParagraphCxSpMiddle" style="margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1;">Virtual
Groups can now be reported in QRDA-III (under a CMS program name code
created called “MIPS_VIRTUALGROUP”) <o:p></o:p></li>
<li class="MsoListParagraphCxSpMiddle" style="margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1;">Eight
new Promoting Interoperability PI measures can be reported to indicate
active engagement with more than one registry.<o:p></o:p></li>
<li class="MsoListParagraphCxSpLast" style="margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1;">The
2015 Edition (c)(4) filter certification criterion (45 CFR 170.315(c)(4))
is no longer a requirement for CPC+ reporting (practices must continue to
report eCQM data at the CPC+ practice site level)<o:p></o:p></li>
</ul>
<div class="MsoNormal">
For eligible clinicians submitting via API to the Quality Payment Program (as opposed to file upload), the QRDA-III file is converted to JSON (or is submitted directly via JSON). In 2018, some technical changes have been made to that process and updates to measure names to include "Promoting Interoperability (PI)" in the identifiers. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
ECs can submit via API when using the Registry method. Dynamic Health IT is an authorized Registry with API submission privileges to QPP.<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
</div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
<b>Reporting changes<o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
For eligible clinicians, there were changes in 2018 related
to both measures lists and measure count thresholds for reporting. The overall
list of CMS-sanctioned eCQMs previously shrunk in 2017 and in 2018 CMS added
two EP eCQMs:<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://cdn-images-1.medium.com/max/600/1*o18XamnK4F8zisS-FaKvpA.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="408" data-original-width="600" height="217" src="https://cdn-images-1.medium.com/max/600/1*o18XamnK4F8zisS-FaKvpA.png" width="320" /></a></div>
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 0in; mso-add-space: auto; mso-list: l0 level1 lfo1;"><span style="mso-fareast-font-family: "Times New Roman";">CMS347v1<o:p></o:p></span></li>
<li class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: 12.0pt; margin-left: 0in; mso-add-space: auto; mso-list: l0 level1 lfo1;"><span style="mso-fareast-font-family: "Times New Roman";">CMS645v1<o:p></o:p></span></li>
</ul>
<div class="MsoNormal">
Note that these measures are NOT available for Medicaid EHR
Incentive Program for Eligible Professionals.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In 2017, clinicians could submit a minimum of 1 measure for
1 patient for 1 day. But for 2018 data, clinicians must submit at least 6
measures for the 12-month performance period (January 1 - December 31, 2018).
The percentage of the overall MIPS score comprising quality has also been
modified from 60 to 50%.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As in 2017, hospitals will still select at least four (4) of
the 15 available electronic clinical quality measures (eCQMs) for one
self-selected quarter of 2018 data (Q1, Q2, Q3, or Q4) during the same
reporting period. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In 2017, the Joint Commission’s ORYX eCQM reporting was
modified to require a minimum of four eCQMs, over a minimum of one
self-selected calendar quarter. This will remain the same in 2018.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Bringing it all back home<o:p></o:p></b></div>
<div class="MsoNormal">
The most important consideration for EHR vendors is to
minimize workflow impacts for the user interface and user processes, while
ensuring adequate data capture for CQM calculation and reporting. One virtue of
using a calculation and analysis package such as CQMsolution is that once
you’ve captured and mapped the data elements, we handle all of the changes
described above. That means you can beginning running reports as soon as data
is available.<span style="color: red;"><o:p></o:p></span></div>
</div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-23938417010562563512018-10-09T09:12:00.002-07:002018-10-09T12:37:09.781-07:00DHIT at Connectathon 19: Unpacking CQMs, Compositions and the Future of FHIR <a href="http://wiki.hl7.org/index.php?title=FHIR_Connectathon_19">FHIR Connectathon 19</a> took place September 29 and 30th in Baltimore, Maryland. Overlooking historic Baltimore Harbor, attendees flocked to collaborate and compare notes on the standard. The continued momentum in FHIR implementation is evident in the capacity crowds and raises the hope that this critical mass will conquer some of the outstanding obstacles to adoption.<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifY9Pp8HXJGjrjjU_Y8uB9SSDB8PYjJXuL6Qx9YvWvNALUVudSX-ygyu_AvjBd2wg2gdycALgmq0vhX0jNG-SB8Uf4WJcdniqC_Iq3kYPsm5RxVvSStLoXM5I3XeA0sSZXQlmJ51tgNQc/s1600/1539102172380.JPEG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifY9Pp8HXJGjrjjU_Y8uB9SSDB8PYjJXuL6Qx9YvWvNALUVudSX-ygyu_AvjBd2wg2gdycALgmq0vhX0jNG-SB8Uf4WJcdniqC_Iq3kYPsm5RxVvSStLoXM5I3XeA0sSZXQlmJ51tgNQc/s400/1539102172380.JPEG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Baltimore Inner Harbor</td></tr>
</tbody></table>
<div style="text-align: right;">
</div>
<br />
The backdrop of the harbor served as a visual metaphor for the navigation required of implementers. As in global shipping, we move valuable product (in our case, data) around the world and the care for each aspect – packaging, chain of custody, containers – requires thoughtful attention to detail (as you’ll see below, especially the containers).<br />
<br />
The Dynamic Health IT team focused efforts on two subject-based tracks: Clinical Reasoning, which centered around CQMs; and FHIR Documents, which involved creating and consuming FHIR-specific documents to a server.<br />
<br />
<b>The Documents Track</b><br />
For the <a href="http://wiki.hl7.org/index.php?title=201809_FHIR_Documents">FHIR Documents Track</a>, participants tackled both creation and consumption of FHIR documents, with the primary goal of sending a <a href="https://www.hl7.org/fhir/composition-definitions.html">composition</a>. In FHIR, a composition is meant to “provide a single coherent statement of meaning” as well as provide a clear identification attribution for the document. While it may seem obscure, getting this right is essential to transparency and trust on which true interoperability depends.<br />
<br />
On the creation side, we were tasked with assembling a FHIR document – defined as a “bundle containing a Composition and supporting resources” and submitting that document to a FHIR server. There were a number of approaches to document creation. From the beginning, ours has been to use C-CDA R2.1 XML as the basis and create FHIR resources accordingly. This is the transformation on which our <a href="https://www.dynamichealthit.com/copy-of-dynamic-fhir-api">Dynamic FHIR API</a> is based. This foundation enables us to support the use of familiar conventions and data types in CDA r2.1, while introducing clients to the FHIR standard and providing a method for fully meeting the 2015 ONC Certification API requirement.<br />
<br />
Another point of discussion in document creation was the need to use the “contains” operator to create the Composition. In FHIR, ‘contains’ has a very specific use case and most agreed that it is not meant for creating a composition. The main takeaway here is that by wrapping a composition in a ‘contains,’ the data is rendered non-interoperable.<br />
<br />
The consumer side of the Documents track presented fewer hurdles conceptually. The goal was to retrieve a FHIR document from a reference server and prove its validity. One way to do this was to use an XSL stylesheet to display the human readable version of the document retrieved. The DHIT team’s preparation in mapping FHIR to CDA R2.1 in the forward direction paid dividends here.<br />
<br />
<b>Clinical Reasoning Track</b><br />
The <a href="http://wiki.hl7.org/index.php?title=201809_Clinical_Reasoning">clinical reasoning track</a> dealt was a intersection of DHIT’s core competencies in quality measures and interoperability. Participants set out to integrate FHIR with clinical quality measures, focusing on the CMS-based electronic CQMs. DHIT specifically focused on testing against the latest versions of CMS 124, 125, and 130.<br />
<br />
Our team’s preparation going into the Connectathon was an essential prerequisite for success. In the lead up to the event, this meant taking FHIR-based CQM data and converting to Quality Data Model (QDM) format to enable calculation. This is certainly not the only approach our team will be adopting as FHIR-based CQMs evolve. But as long as the Quality Data Model remains relevant, it provides a direct link between the measure logic and the underlying FHIR data.<br />
<br />
This intermediary requires that QDM-based concepts such as ‘Encounter, Performed’ (which do not exist in FHIR) need to be converted to FHIR-standardized data. Our approach has been to convert the data coming in:<br />
<br />
<i>FHIR server with FHIR data --> CQMsolution data format --> QRDA-I/QRDA-III/FHIR MeasureReport</i><br />
<br />
Data can be gathered from FHIR and filtered by hospital, clinic, clinician, etc, for calculation by CQMsolution’s engine.<br />
<br />
FHIR’s <a href="http://wiki.hl7.org/index.php?title=201809_Bulk_Data">proposed Bulk Data extraction method</a>, for use with large datasets, has great potential to expand quality measure interoperability. When interacting with FHIR servers that do not perform calculation, our CQMsolution application would make use of this standardized bulk transfer method on a specified group of patients as dictated by the client and receive a ready status when the bulk export is available for calculation and analysis.<br />
<br />
During the Connectathon, we performed calculation and manual analysis to compare our results to the reference server, comparing against synthetic FHIR-based patients there. The exercises were largely focused on proof of concept and tracking data from point-to-point. The next steps in FHIR CQMs will likely involve more validation of calculations and to start looking at more exotic data types, such as negated elements or embedded events.<br />
<br />
Our team is eager to identify use cases for data required by Quality Measures across the spectrum.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJmMVzbMx9IKIgKsUGdy2AYJ4VJZXpXqBqe5yh9SNq4R-VFqsGaLeJ8eJ0cX5GdFMhOyVDGY2-6wbPssdGVPLPJxWR6dtjIMVnekiCJ6O3nRBcrYXZ5UOp4jrzJExEshpBqDa9TqsM7Ko/s1600/IMG_09102018_113632_0.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="877" data-original-width="1054" height="331" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJmMVzbMx9IKIgKsUGdy2AYJ4VJZXpXqBqe5yh9SNq4R-VFqsGaLeJ8eJ0cX5GdFMhOyVDGY2-6wbPssdGVPLPJxWR6dtjIMVnekiCJ6O3nRBcrYXZ5UOp4jrzJExEshpBqDa9TqsM7Ko/s400/IMG_09102018_113632_0.png" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<b>Looking ahead</b><br />
With another Connectathon come and gone, there’s still plenty to unpack. We’re looking ahead to wider adoption of DSTU4 and to the emergence of bulk data processing, while devoting current efforts to resolving the very real challenges facing the community at present. As consensus builds, implementers will be able to make fewer compromises between maintaining interoperability and steering toward the standard.<br />
<br />
Keep in touch and check out our website for more information <a href="https://www.dynamichealthit.com/copy-of-dynamic-fhir-api">where we’re going with FHIR</a>.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-70177874085580802022018-08-28T13:45:00.005-07:002018-08-29T10:46:43.235-07:00DHIT Goes to Washington: Behind the Scenes at the ONC #InteropForum<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAvw808tzmg49XB9MLm8zs9X3T3UpODhypKPinAnSK1LB7tAw9DnR-vBp0ATIHdSbqsAywGel5G2Cb3E79bNbXuv9vjIoobFNKcclQH7mRXk5VFvIW9bcoKt8xMIXwpUR89HnaflKSDCk/s1600/Urban-Cityscape-Washington-Dc-City-C-Cities-1624419.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="655" data-original-width="960" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAvw808tzmg49XB9MLm8zs9X3T3UpODhypKPinAnSK1LB7tAw9DnR-vBp0ATIHdSbqsAywGel5G2Cb3E79bNbXuv9vjIoobFNKcclQH7mRXk5VFvIW9bcoKt8xMIXwpUR89HnaflKSDCk/s320/Urban-Cityscape-Washington-Dc-City-C-Cities-1624419.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Credit: <a href="https://www.maxpixel.net/Urban-Cityscape-Washington-Dc-City-C-Cities-1624419">Max Pixel</a>.</td></tr>
</tbody></table>
The Office of the National Coordinator for Health IT (ONC) hosted the the 2nd Interoperability Forum from August 6th to 8th, 2018 in Washington, DC.<br />
<br />
The event was an interdisciplinary meeting-of-minds on interoperability, with plenary sessions and break-out, topic-based panel discussions. Dynamic Health IT staff participated in all three days, with our VP of Development, Raychelle Fernandez, giving a panel talk on the second day of the event and our team taking a deep dive into the collaborative atmosphere throughout.<br />
<br />
The event featured a variety of “tracks” to facilitate focused discussion and information sharing. These centered around application programming interfaces (APIs), clinician experience, patient matching, security and others. The tracks are overseen by ONC and other industry experts, allowing for a direct line to those shaping policy in this sphere.<br />
<br />
The final day of the Forum consisted of recap and presentation from each track lead.<br />
<br />
<b>Hot Topics</b><br />
One big-picture issue discussed at the Forum was the future ONC role in advancing interoperability. With the recent pivot of the Advancing Care Information (ACI) program to “Promoting Interoperability,” it’s clear how central this is to both CMS and ONC’s missions, but what will be levers for real change? Everyone has their thoughts, but much of the discussion will come down to picking winners among the available standards and championing their success.<br />
<br />
In any contemporary discussion of interoperability, you’re likely to hear about FHIR, Blockchain, Patient Engagement, data blocking and the roadblocks perceived in the leading standards the inhibit broader implementation. The Forum was no different, but what was eminently useful about the event is the breadth of perspectives – the attendees really attacked the issues from all sides.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiBSYK0xVDFlcWuJl78N-8jq0JSoqxq5exGarrbDTOYJinYDTinR4KaCdC6rcV5X__OLSuIdB2YerMAiL_YXAFE9pDe2dko36TBuovU92xJRqAy17RXf539iXmwpD2mzawzAsS6yv6r1Y/s1600/Screenshot_20180807-073548_Twitter.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="461" data-original-width="987" height="186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiBSYK0xVDFlcWuJl78N-8jq0JSoqxq5exGarrbDTOYJinYDTinR4KaCdC6rcV5X__OLSuIdB2YerMAiL_YXAFE9pDe2dko36TBuovU92xJRqAy17RXf539iXmwpD2mzawzAsS6yv6r1Y/s400/Screenshot_20180807-073548_Twitter.jpg" width="400" /></a></div>
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The discussion of Patient Engagement went well beyond Portals, into newer methods or delivery and patient involvement. There was a discussion of current EMR/bolt-on software development punctuated by remarks from the panel on how patients will (or will not) benefit from there trends. As Mark Scrimshire (<a href="https://twitter.com/ekivemark">@ekivemark</a>) mentioned on Twitter, in order to start better joining data together “we have got to start involving patients in our efforts to resolve patient matching challenges.” Blue <a href="https://twitter.com/ekivemark">Button 2.0</a>, a patient-facing, FHIR-based API and a treasure trove of CMS data, is another major channel for engagement.<br />
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<div>
In the halls of application development, it can be difficult to get a direct perspective on the burden on the patient and feasibility of tasks such as patient matching without costly studies with uncertain value. And patient users are often at least degree removed from developers, who are not on the ground as service providers.</div>
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<b style="mso-bidi-font-weight: normal;"><span style="mso-fareast-font-family: "Times New Roman";">Clinician perspectives<o:p></o:p></span></b></div>
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<span style="color: #14171a; letter-spacing: 0.2pt;">As Dr. Steve Lane put it, "If
you're not satisfying the needs of the clinician you are missing the mark."
<br /><br /><o:p></o:p></span></div>
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<span style="color: #14171a; letter-spacing: 0.2pt;">For one specific example of where data
requirements and providers, there was much discussion about how clinicians
document when something is NOT done. While it’s true you can’t prove a
negative, it’s important to understand why another clinician did not perform a
task and to get that info in a clinical note. </span>This concept of 'Reason
not done' data is required for eCQMs, but currently isn't represented in CCDA. <o:p></o:p></div>
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<b>Where there’s Interop, there’s FHIR</b></div>
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FHIR is always near the top of the marquee for any interoperability event. But like many ballyhooed technologies, it is still largely opaque to its end users – both patients and clinicians.</div>
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There were a number of other discussions that entered into practical applications of interoperability, including an implementation of the Bulk FHIR API. Our team previewed items for discussion at the upcoming FHIR Connectathon and Roundtable, including CCDA on FHIR, our Dynamic FHIR API and Health Lock-It Mobile App. Having certified and refine our FHIR API, we are afforded time to participate in the ongoing CCDA-FHIR mapping discussion and pivot to new challenges in the FHIR orbit. At the Connectathon, our focus will be we on CQMs and FHIR, with special attention paid to the <a href="http://wiki.hl7.org/index.php?title=201809_Clinical_Reasoning">Clinical Reasoning track</a>.</div>
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Apple has made its presence known at recent interoperability and FHIR events and wherever they go, they have a tendency to move markets. One way in which this directly affects DHIT and other development shops is the need to support FHIR DTSU 2 to be in the HealthKit ecosystem.</div>
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<b><br />DHIT: Our Implementer Story</b></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyCdeupyBDKP2G8Y0vwxFGRBJqURrRWX3d1Z7FkTX0mWRxygLDG0dbpr08EP7nywxLEsW5uzy62IS2-8SFqrhGGInUHCSyh0VY75HVlQtM4ti0gLqSuJZxjf6n7DM4hLQNeuBZX5K4tE4/s1600/1534865847090.JPEG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyCdeupyBDKP2G8Y0vwxFGRBJqURrRWX3d1Z7FkTX0mWRxygLDG0dbpr08EP7nywxLEsW5uzy62IS2-8SFqrhGGInUHCSyh0VY75HVlQtM4ti0gLqSuJZxjf6n7DM4hLQNeuBZX5K4tE4/s400/1534865847090.JPEG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Raychelle Fernandez speaking at the Implementer's Story panel.</td></tr>
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Raychelle Fernandez, DHIT’s VP of Development, participated in the Implementer's Story panel and shared insights related to our development of FHIR resources, ‘FHIR on the Fly’, API, Mobile application development and relevant tools.</div>
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Raychelle also discussed integration with a wide range of EMRs and the need for U.S. Core Data for Interoperability Task Force (USCDI) to expand data elements and ensure proper use cases exist to minimize the burden on implementers. For example, we should not require specialties like Optometrists, Orthopedics, Podiatrists, or Chiropractors to capture Immunizations if it has no clinical relevance.</div>
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These are exciting and fast-moving times in our field. Stay tuned for more.</div>
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-46323425540967024912018-05-15T14:34:00.002-07:002018-05-15T14:35:48.356-07:002015 Certification: 6 Things to KnowSteve Jobs famously remarked that users “don’t know what they want until you show it to them.” This is often true in the software development world as a whole, while in Healthcare IT much of what we do is essentially client-driven.<br />
<br />
But what about when a feature is neither? Such is the case with some of the requirements found ONC 2015 Edition Certification. When faced with 2015 Edition Certification, EMR developers have a lot of questions, starting with “Why should we do this in the first place?”<br />
<br />
Drawing on experience from our <a href="https://chpl.healthit.gov/#/product/9154">own certification</a> and that of our clients, we’ll address some of the most pressing concerns in this post.<br />
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<b>1. 2015 Certification software has become increasingly compulsory<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoPHL_k-ggrfUICHImk02VtTESHMa6rlxJ8xX5E5pK287_6ZFvjlO1qfYBUG1P-e4LRdT4PzrkfVcPHxVZEQY04Q0Y5GuzuhpKlbQ9oW9LVBRM1EP_AG5HqYQzrZs2u21OVEWGVE2wdxQ/s1600/ehr_adoption.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="550" data-original-width="1332" height="165" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoPHL_k-ggrfUICHImk02VtTESHMa6rlxJ8xX5E5pK287_6ZFvjlO1qfYBUG1P-e4LRdT4PzrkfVcPHxVZEQY04Q0Y5GuzuhpKlbQ9oW9LVBRM1EP_AG5HqYQzrZs2u21OVEWGVE2wdxQ/s400/ehr_adoption.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">SOURCE: <a href="https://dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php">ONC</a></td></tr>
</tbody></table>
</b><br />
At its inception, EMR developers fairly asked, given limited time and resources, whether there was any immediate reason to broadly adopt 2015 Certification criteria. It’s been essential to keep current on clinical quality measures in order to report to CMS programs (QPP, HQR, Joint Commission and CPC+), but Certification criteria as a whole has become more relevant with time.<br />
<br />
Part of this is catching up with early adopters for competitive and marketing reasons. MIPS requirements for ambulatory providers have also been a driver - certified electronic health record technology is required for participation in the Advancing Care Information category of the QPP and only a 2015 Edition certification that includes automated measure calculation will enable reporting on ACI measures past the “Transition” phase.<br />
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<b>2. Self-declaration takes some of the pressure off</b><br />
Perhaps the most important thing to note about self-declaration is that the technical requirements for “self-declare” measures have not been eased. And there is a good bit of documentation required to prove the testing you have conducted independently. However, the inclusion of a wide swath of self-declaration (non-live testing) measures has eased some of the burden for developers. The stakes and costs are lower now that you can test iteratively and do not have to schedule extra live testing (and potential re-testing) with your proctor. Keep in mind also that your proctor can ask at any time to review the self-declaration criteria.<br />
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<b>3. Building an API for Patient Engagement means knowing your endpoints</b><br />
If you know you’re going to be certifying the 2015 Edition “API” measures (g7 – g9), you’ll need to decide on technologies for delivering clinical data resources and authenticating user. We recommended FHIR and OAuth, respectively. There are pros and cons for both, but our decision was based on which technologies are best-positioned for where Health IT interoperability is headed.<br />
<br />
It’s also worth exploring how patient-accessible APIs are going to work in the wild. The 2015 Certification measure provides a pathway to certifying that you can make XML/JSON available per patient and filterable by common clinical dataset sections and date. But it doesn’t connect the dots between accessing the raw resources from the API and getting it into a consolidated location that is usable by a non-technical patient user. For that, you’ll need to consider the extent to which you’ll take that leap into Patient Health Record development – or tailor your solution for compatibility with big players in this space such as Apple (which is, for now at least, pursuing a FHIR-based mobile record).<br />
<br />
<b>4. (b)(1) Transition of Care is a many-layered measure</b><br />
The (b)(1) measure is proof that a world of functionality can lurk in a single sentence. In addition to sending and receiving a variety of transition of care documents through your chosen protocol(s), b1 also requires you to:</div>
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<ul>
<li>Detect valid and invalid ToC/referral summaries and provide an accounting of errors</li>
<li>Display a human-readable C-CDA for BOTH r1.1 and r2.1 CCDA</li>
<li>For both r1.1 and r2.1, allow your users to display only the data within a particular C-CDA section, set a preference for the display order and set the initial number of sections to be displayed.</li>
</ul>
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<b>5. (b)(6) Data Export is about more than just CCDAs</b></div>
<div>
The 2015 Edition Data Export measure (b6) shares a similarly ambitious goal with the API: that all patient data can be made portable and requested from an EMR at any given time. For data export, not only are you asked to pull out patient data in CCDA form, but you need to be able to slice the patient data in several different ways, exporting either in real-time or scheduled ahead.</div>
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The different permutations for exporting under this measure are often a source of confusion, so here are the discreet taste cases to help make things more intelligible:</div>
<div>
<ul>
<li><b>On-demand (export runs immediately):</b></li>
<ul>
<li>Request all patients from a specific start date and time until the present</li>
<li>Request all patients from a specific start date and end date, with the end date occurring prior to the present</li>
<li>Request a subset of patients from a specific start date and time until the present</li>
<li>Request a subset of patients from a specific start date and end date, with the end date occurring prior to the present</li>
</ul>
<li><b>Scheduled (configured for a future date-time):</b></li>
<ul>
<li>Relative (a recurring scheduled report)</li>
<ul>
<li>Request all patients based upon a relative date and time from the date range in the data (e.g., generate a set of export summaries from the prior month on the first of every month at 1:00 a.m.)</li>
<li>Request a subset of patients based upon a relative date and time from the date range in the data</li>
</ul>
<li>Specific (a one-time scheduled report)</li>
<ul>
<li>Request all patients based upon a specific date from the entered start and end dates and times (e.g., generate a set of export summaries with a date range between 01/01/2015 and 03/31/2015 on 04/01/2015 at 1:00 a.m.).</li>
<li>Request a subset of patients based on upon a specific date from the entered start and end dates and times</li>
</ul>
</ul>
</ul>
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<b>6. Automated measure calculations and usability testing involve a lot of data-gathering </b></div>
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Automated measure calculations are based on an expansive spreadsheet of <a href="https://www.healthit.gov/topic/certification-ehrs/2015-edition-test-method">test cases furnished by ONC</a>. These cases ensure that your measure calculations follow the expected measure logic faithfully. There’s really no corner-cutting on these, but one limiting factor is the measures you are certifying overall. If, for instance, you aren’t certifying ePrescribing, you will not be on the hook for those calculations. Also, if you know the programs and stages of Medicare MU/Promoting Interoperability, Medicaid MU and ACI that apply to your users, you can hone in on just the calculations that are relevant. </div>
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For usability testing, you will be in good shape by modeling your study and write-up after an established usability process approved by ONC. Your proctor should provide you with a sample list of functions subject to testing. The estimated time to conduct the study and complete the write-up would be 3 weeks, but this will be contingent on difficulty of recruitment, your own test design and then post-test editorial/graphic design considerations for the doc itself. The results of the testing will be posted on CHPL.</div>
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<i><span style="font-family: inherit;">For
vendors seeking support on 2015 Edition measures, <a href="https://www.dynamichealthit.com/">check out our site</a> to see how our
bolt-on certification solutions can fit into your certification plan.<o:p></o:p></span></i></div>
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<span style="font-family: inherit;"><span class="MsoHyperlink"><i><span style="border: 1pt none windowtext; color: windowtext; padding: 0in;">Copyright</span></i></span><span class="MsoHyperlink"><span style="border: 1pt none windowtext; color: windowtext; padding: 0in;"> </span></span><em><span style="border: 1pt none windowtext; padding: 0in;"><a href="https://www.dynamichealthit.com/"><span style="color: windowtext; text-decoration-line: none;">Dynamic
Health IT ©, Inc</span></a> 2018.<b> </b>We specialize in ONC-certified
solutions, CQMs and system interoperability via standards such as HL7®, CDA®,
CCD and FHIR® using our flagship products - <span style="color: #4472c4;"><a href="https://www.dynamichealthit.com/cqmsolution" target="_blank"><span style="color: #4472c4; text-decoration-line: none;">CQMSolutions</span></a></span>, <span style="color: #4472c4;"><a href="https://www.dynamichealthit.com/connectehr" target="_blank"><span style="color: #4472c4; text-decoration-line: none;">ConnectEHR</span></a></span>, <span style="color: #4472c4;"><a href="https://www.dynamichealthit.com/patientportal" target="_blank"><span style="color: #4472c4; text-decoration-line: none;">ConnectEHR-Portal</span></a></span>, <span style="color: #4472c4;"><a href="https://www.dynamichealthit.com/dynamic-fhir-api" target="_blank"><span style="color: #4472c4; text-decoration-line: none;">DynamicFHIR</span></a></span> and <span style="color: #4472c4;"><a href="https://www.dynamichealthit.com/hl7interface" target="_blank"><span style="color: #4472c4; text-decoration-line: none;">The Interface
Engine(TIE)</span></a></span>. </span></em></span></div>
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-42703263658097720282018-04-16T12:19:00.000-07:002018-04-16T12:19:02.000-07:00Quality Measure Submission: A Brief Review, A Look Ahead<div class="separator" style="clear: both; text-align: center;">
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For most, the 2017 submission period for eCQMs is over. Not only did we survive, we thrived. Dynamic Health IT worked with clients submitting measures to CMS for the Hospital Quality Reporting (HQR) program and Quality Payment Program (QPP) to improve timelines for submission as compared to 2016.<br />
<br />
On the Ambulatory side, this was everyone’s first trip through MIPS submission and, in light of that fact alone, the process was a great success. DHIT worked with clients to submit both individual and group data, rolling out some new validation and user experience enhancements to ensure continuity between the submission program and the output.<br />
<br />
We assisted clients in file validation using a series of newly-developed APIs, received files securely for validation via a cloud-based submission server and assisted our clients in both data troubleshooting and making an informed decision regarding submission type by comparing measure outcomes.<br />
<br />
Achieving successful submission doesn’t mean we haven’t learned something along the way – quite to the contrary – so we wanted to share a few lessons learned in this space. CQMs have become a perpetual development and submission cycle, which means we can’t pause long before looking ahead.<br />
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<div>
<div>
<b>Lessons from 2017 submission</b></div>
<div>
The 2017 submission cycle was highly educational, particularly on the Ambulatory side (QPP/MIPS submission). Here are a few lessons to carry into 2018:</div>
<div>
<ol>
<li><b>Make sure to choose your most clinically-relevant
measures:</b>
Reaching consensus in your organization about measure selection prior to
data review will eliminate inconvenient reversals later in the process.
Running an initial report with all available measures for the previous
and/or current years can aid in this process (CQMsolution excludes all
non-MIPS EP measures from QRDA-III output specific to MIPS). </li>
<li><b>Review data early and often: </b>The most time-consuming aspect of eCQM reporting is making sure data is complete, accurate and does not trigger submission errors. To ease the burden, we have upgraded our specs, error handling and validation options to get data client into shape. In our CQM specs, we want you to know exactly what has changed from the previous submission period so you can move quickly from stored procedure changes to measure performance review. A quarterly submission option is available on the Inpatient side to facilitate incremental quality checks.</li>
<li><b>Weigh your options:</b> With CQMsolution, you can run reports using a variety of reporting periods, measures and outputs to compare ahead of time choose your best performance. The MIPS program enables providers to submit with their group and/or as an individual, taking the best performance. The key here, as always, is giving yourself the time for this step.</li>
<li><b>Know your core data elements: </b>We have ramped up validation options to catch warnings and errors as soon as a report is complete, but you can also get a lead on these errors by checking a few important values and identifiers:</li>
<ul>
<li>General (across programs): Check to make sure you have mapped essential rows for identifying patients, clinicians and encounters</li>
<li>HQR: Make sure you know your hospital’s TIN, CCN, CMS EHR Certification Number and, if available, the Medicare Beneficiary Identifier (MBI) for your patient.</li>
<li>QPP Group: Make sure your practice is providing a TIN (CQMsolution will take it in your data or you can provide on the UI) and sending all data for the entire group practice of clinicians under that TIN (whether virtual or not)</li>
<li>QPP Individual: Make sure you provide a TIN and a single NPI and make sure your data is filtered by a unique identifier (most commonly, NPI)</li>
<li>General (across programs): Check to make sure you have mapped essential rows for identifying patients, clinicians and encounters</li>
</ul>
<li><b>Ensure quick turn around on pre-submission validation:</b> When your files are ready for pre-submission
validation, we will work with you on an option that makes the most sense,
including available APIs to DHIT to provide Data Submission Vendor services and
direct submission and feedback from the MIPS program.</li>
<li><b>Be prepared for Value Set and Measure changes: </b>The change to Inpatient value sets for Q4 was highly disruptive and while CMS is working to avoid similar, there’s no guarantee there won’t be mid-stream changes afoot in 2018.</li>
</ol>
<b>Next Steps</b><br />
It’s a relief to get submission in on time, but quality measure submission now allows for less down time than ever. In addition to getting ready for HQR and QPP 2018, here are a few things to consider:<br />
<ul>
<li><b>Hardship exemption deadlines: </b>Some providers affected by disasters in 2017 have deadlines extended (and now looming)</li>
<li><b>Joint Commission:</b> If you are submitting Inpatient eCQMs for the ORYX program, the deadline was extended until June 29, 2018. DHIT is an approved vendor for the program.</li>
<li><b>Medicaid Submission:</b> Do you have any clients submitting to states? CQMsolution offers support for <a href="https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Medicaid_StateGuide.pdf">Medicaid Submission </a>for all States</li>
<li><b>MIPS feedback: </b>MIPS Preliminary Feedback is now available. If you submitted data through the Quality Payment Program website, you are now able to review your preliminary performance feedback data. </li>
<li><b>Hybrid Measures:</b> If you’re a hospital submitting HQR, you can submit this optional measure to QualityNet to assist in risk-adjustment</li>
<li><b>Get in touch with your DSV or Registry early: </b>Along with our CQMsolution full-service quality measure application, server as a Data Submission Vendor (DSV) and MIPS Registry.</li>
</ul>
We’d love to talk to you about data submission that fits yourschedule and show you our expanded roster of measures, new error validation processes and submission management/archiving.</div>
</div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-6958984719004403472017-11-07T09:46:00.001-08:002017-11-07T09:46:42.677-08:00<div class="MsoNormal">
<span style="background: white; color: #222222; font-family: "Arial",sans-serif; font-size: 10.0pt; line-height: 115%;">DHIT participated in the HL7
Digital Quality Summit November 1<sup>st</sup> and 2<sup>nd</sup> in
Washington, DC. The event was jointly
hosted by HL7 and NCQA and provided a unique opportunity to discuss overlapping
issues between quality tracking and interoperability. The interactive sessions were an excellent
forum for peer networking, discussing challenges and showing off the latest solutions. <o:p></o:p></span></div>
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<span style="background: white; color: #222222; font-family: "Arial",sans-serif; font-size: 10.0pt; line-height: 115%;">The hot discussion topic at
the meeting was the CMS announcement that starting with the 2019 reporting
period, eCQMs would be transitioned from the current HQMF XML modeling language
to the new Clinical Quality Language (CQL) standard. CQL gives quality measure authors much more
power and flexibility in creating precise definitions of quality measures that are
</span><span style="background: white; color: #333333; font-family: "Helvetica",sans-serif; font-size: 10.5pt; line-height: 115%;">human readable yet structured enough for
processing a query electronically. CQL
replaces the logic expressions currently defined in the </span><a href="https://ecqi.healthit.gov/qdm"><b><span style="background: white; color: #026397; font-family: Helvetica, sans-serif; font-size: 10.5pt; line-height: 115%; text-decoration-line: none;">Quality Data Model (QDM)</span></b></a>.
Going forward, QDM<span style="background: white; color: #333333; font-family: "Helvetica",sans-serif; font-size: 10.5pt; line-height: 115%;"> will include only the
conceptual model for defining data elements (the data model).</span><span style="background: white; color: #222222; font-family: "Arial",sans-serif; font-size: 10.0pt; line-height: 115%;"><o:p></o:p></span></div>
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Jeff Robbinshttp://www.blogger.com/profile/05743306808974585977noreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-32356704904513667372017-02-09T09:34:00.001-08:002017-02-09T09:35:03.331-08:00FHIR and CCDA Implementation-a-thon 4: Care Plans, Root IDs and much more<div class="MsoNormal">
Last month, Dynamic Health IT was in attendance for another meeting of minds hosted by HL7 International down in San Antonio, TX. While these events around CCDA and FHIR have become a regular part of our travel schedule, there's nothing routine about taking a deep dive into healthcare standards. Each trip provides an opportunity to combine ground-level development with high-level policy-making, up to and including interactions with HL7 and ONC policy-makers.<br />
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://pbs.twimg.com/media/CskLLO1WYAA9SfM.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://pbs.twimg.com/media/CskLLO1WYAA9SfM.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Coding away.</td></tr>
</tbody></table>
The ultimate goal, as always, is healthcare data interoperability. San Antonio, with its backdrop of canals, struck a fitting visual metaphor. As with man-made waterways, engineering
connectivity in healthcare presents challenges at ever turn. </div>
<div class="MsoNormal">
<b><span class="mw-headline"><span lang="EN"></span></span></b><br /><b><span class="mw-headline"><span lang="EN"></span></span></b>
<span class="mw-headline"><span lang="EN"><b>CCDA Implementation-a-Thon 4</b></span></span><br />
<br />
San Antonio hosted the <a href="http://wiki.hl7.org/index.php?title=C-CDA_Implementation-a-Thon_4">fourth-ever CCDA Implementation-a-thon</a>. The scope of CCDA v2.1 - and its corresponding implications for 2015 Edition Certification - have made for wide-ranging discussions at each of these events. We'll focus on just a few highlights.</div>
<div class="MsoNormal">
<br />
There was considerable interest in clarifying the links between concerns, goals and intervention. A source of confusion is that, as of this writing, there is an issue with the <a href="https://sitenv.org/ccda-smart-scorecard/">ONC CCDA Scorecard</a> not scoring Care Plan documents correctly.<br />
<br />
For health concerns, there were a number of clarifications that proved helpful. Concerns expressed by patient need not be collapsed into a code and, by nature, <a href="http://wiki.hl7.org/index.php?title=C-CDA_Implementation-a-Thon_4">will often need narrative</a>:<br />
<blockquote class="tr_bq">
<i>Health concerns may be coded, but may need to be represented in narrative form as there are likely to be terminology system gaps </i></blockquote>
On the topic of goals, there was discussion around differentiating between <i>patient </i>goals and <i>provider</i> goals. This may not always be a fine distinction captured by codesets, but where possible it will be defined by the author concept. Goals that have <i>both</i> a patient and provider author are coded as shared or negotiated goals
<br />
<br />
The concept of document-level authorship in general was conceptually challenging. Vendors can generate and recognize their own document roots, but may extends only within your own vendor system in many cases.<br />
<br />
The CCDA event also featured <a href="http://wiki.hl7.org/images/b/b0/Vsac-CCDAthon-2017.pdf">a presentation</a> by the Value Set Authority Center (VSAC). VSAC offers a Support Center to promote closer collaboration with value set implementers. <br />
<br />
For those in the midst of 2015 Edition Certification, there was a discussion of Care Plan certification test data used in 170.315 (b)(9) and 170.315(e)(1).</div>
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<br />
<b>FHIR Connectathon 14</b></div>
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<br /></div>
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FHIR itself is very accessible as far as resources and the
rest API is concerned. But getting a broader understanding of everything FHIR touches and how it behaves - the goal for any given Connectathon - can be more daunting. For the 14th Connectathon, our focus was on the CCDA on FHIR track.<br />
<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Over the course of the weekend, we were able to get a better understanding
of the current status and purpose of CCDAs on FHIR in general as well as the following key insights:<br />
<o:p></o:p></div>
<div class="MsoNormal">
<ul>
<li>Difference between composition and bundles.<o:p></o:p> </li>
<li>How to reference a different server
for resources used in our composition<o:p></o:p></li>
<li>How to style and render our bundle as retrieved from
the server<o:p></o:p> </li>
<li>Search parameters and where to find them<o:p></o:p> </li>
<li>How CCDA on FHIR imposes additional constraints on
existing resource types<o:p></o:p></li>
</ul>
</div>
<div class="MsoNormal">
The DHIT team was able to make it
through all of the producer and some of the consumer scenarios, which we counted as a major success in two short days.<o:p></o:p> Outside of our development track, we were able to gain quite a bit of
information about strategies for integrating FHIR servers into our ecosystem,
the viability of the Spark Production server, strategies for integrating
OAuth, and more.<o:p></o:p></div>
</div>
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<br /></div>
<div class="MsoNormal">
Organizationally, it is good to know for those coming into the FHIR fold that Work Group Meetings are where a lot of the development work on FHIR happens.
Numerous work groups will be considering FHIR change proposals, working
on FHIR profiles and resources and debating other aspects of FHIR
implementation.<br />
<br />
As well, there will be meetings of the <a href="http://wiki.hl7.org/index.php?title=FHIR_Governance_Board" title="FHIR Governance Board">FHIR Governance Board</a> and <a href="http://wiki.hl7.org/index.php?title=FHIR_Management_Group" title="FHIR Management Group">FHIR Management Group</a>
discussing policies relating to FHIR. Within this framework, attendees and group members discuss items of interest such as
tooling, new domains, particular technical issues, etc.<br />
<br />
We hope to see you at the next stop!</div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-87217125640384198492016-12-06T11:40:00.001-08:002017-01-11T07:12:10.426-08:00New Era of CQMs, Part I: Quality Measures in The Age of MIPSThe first performance year for the CMS Merit-based Incentive Payment System (MIPS) begins on January 1 of next year, yet much of the healthcare world is still in the dark about large portions of the program. Or even unaware of its existence entirely.<br />
<br />
Perhaps one of the most misunderstood aspects of the program: MIPS does not apply to Medicaid Meaningful Use or eligible hospital Meaningful Use (MU) programs.<br />
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</div>
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</div>
<div style="text-align: right;">
</div>
<br />
With MIPS beginning in earnest and ramping up over the next few years, we wanted to provide a series of plain-language posts and address how it will affect your use of clinical quality measures.<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-n73C_mPGofDvYbo7xFKlBOurChOs6BpboSFFEix1J2ChcAooAOzYoxjlGSFqPvBcDPomAchu-bvoFzG2VBdXf5bsGP4oEbpRz11rzvC4PxdM0ojO9ThFFOMwcPXVhnBfowRmOcKQM1A/s1600/MIPS_breakdown.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-n73C_mPGofDvYbo7xFKlBOurChOs6BpboSFFEix1J2ChcAooAOzYoxjlGSFqPvBcDPomAchu-bvoFzG2VBdXf5bsGP4oEbpRz11rzvC4PxdM0ojO9ThFFOMwcPXVhnBfowRmOcKQM1A/s320/MIPS_breakdown.png" width="242" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Via <a href="https://qpp.cms.gov/measures/aci">CMS</a></td></tr>
</tbody></table>
<br />
Our goal as the program unfolds is to grow our CQMsolution software to support as many measures as possible.<br />
<br />
<b>Background</b><br />
MACRA sets up a new system of quality-based reimbursement for clinicians called the Quality Payment Program. Within this new model, there are two pathways to select:<br />
<ul>
<li>The Merit-based Incentive Payment System (MIPS)</li>
<li>Advanced Alternative Payment Models (APMs)</li>
</ul>
For this post, we will focus on quality assessment within the context of MIPS. Multiple quality reporting programs are folded into MIPS:<br />
<ul>
<li>Physician Quality Reporting System (PQRS)</li>
<li>Value-Based Payment Modifier (VBM)</li>
<li>Medicare Electronic Health Records (EHR) Incentive Program (ie, Meaningful Use)</li>
</ul>
<div>
As with the current PQRS program, multiple clinicians can participate in MIPS as an individual or a group.<br />
<b><br />Payment adjustment</b><br />
In determining the payment adjustment based on MIPS, clinicians will received a composite score, weighting four different categories of performance:</div>
<div>
<ul>
<li>Quality</li>
<li>Resource user</li>
<li>Clinical practice improvement activities</li>
<li>Advancing care information </li>
</ul>
</div>
<div>
<b><br />Quality Measures under MIPS</b></div>
<div>
Quality receives the highest weight under MIPS and to determine quality score. The program has taken PQRS and the value-based modifier, mashed them up and provided a menu of quality measures that will determine reimbursement.<br />
<br />
MIPS-eligible clinicians and groups can select their measures from either the list of all<br />
MIPS measures or a subset of specialty-specific measure as identified by CMS. Unlike the current requirements under PQRS, clinicians will not be required to report a "cross-cutting measure." The program has been positioned to allow clinicians to select measures that are the most relevant to their practice.<br />
<br />
In the transition from the current state of quality reporting (PQRS/VBM/MU) to MIPS, there are a few other key points to bear in mind:</div>
<div>
<ul>
<li>Registry, EHR and QCDR reporting measures currently require 9 measures across three quality domains, but thew new requirement is 6 measures</li>
<li>Measures can now have any combination of NQF quality domains, though the 6 selected must include an outcome measure (as opposed to strictly process, for example)</li>
<li>MAV process changed (more on this in future posts)</li>
<li>PQRS registry measures group method is eliminated</li>
<li>Registry and QCDR reporting requires meeting a "data completeness" standard: 50% of patients in the denominator</li>
</ul>
There are more complexities to explore - and changes and clarifications in the coming months, as always. We look forward to staying on top of these and simplifying the process for each of our clients.<br />
<br /></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-29740162510099488372016-10-21T10:06:00.001-07:002016-10-21T10:06:26.178-07:00FHIR works: Notes from Baltimore Plenary Meeting and Virginia CCDA 2.1 ImplementationathonWe say this every time we attend a meetup, but it remains true: interest in HL7 interoperability standards continues to grow remarkably. As FHIR in particular matures, we see proliferation of attendees, ballot comments and general buzz. As Graham Grieve mentioned over on the FHIR Directors Blog, the most recent meetup was most likely HL7's <a href="https://onfhir.hl7.org/2016/09/27/fhir-report-from-baltimore-meeting/">largest meeting to date</a>.<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://upload.wikimedia.org/wikipedia/commons/5/51/Pier_5_and_the_Power_Plant_Building_in_SE_Baltimore_by_D_Ramey_Logan.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="180" src="https://upload.wikimedia.org/wikipedia/commons/5/51/Pier_5_and_the_Power_Plant_Building_in_SE_Baltimore_by_D_Ramey_Logan.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Baltimore at night.</td></tr>
</tbody></table>
<br />
Members of the DHIT team traversed the DMV (that's DC-Maryland-Virginia, in Beltway-speak) last month, heading to Baltimore for the annual plenary meeting and Arlington, VA, for the C-CDA Implementation-A-Thon.<br />
<br />
<b>News on FHIR</b><br />
As the FHIR Chief himself, Grahame Grieve, mentions <a href="https://onfhir.hl7.org/2016/09/27/fhir-report-from-baltimore-meeting/">over at his blog</a>, there were some major headlines at the very well-attended FHIR plenary event:<br />
<ul>
<li><b>FHIR release 3</b> is slated for release at the end of this year.</li>
<li>New communities are cropping up, including from medical disciplines that hadn't previously shown up on the FHIR scene</li>
<li>The FHIR Foundation will continue to be a key player, supporting the "implementation process of standard"</li>
<li>The site <b>fhir.registry.org</b> will go live soon</li>
<li>Discussion of whether to support logical reference; in short, a "URL-based view of the world," as Grahame puts it, may be incomplete.</li>
</ul>
As Grahame also mentioned, the "most significant single decision" made at the plenary was to take the specification known previously as “DAF-core” and rename it the US Realm Implementation guide. That may sound like inside baseball, but it's another symbolic leap in the maturity of the standard.<br />
<br />
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From the DHIT standpoint, we are well underway developing features in our flagship interoperability application, ConnectEHR, and across our product line to support EMR clients, including the development of testing and production FHIR servers. Our overriding goal is for our clients to move forward in interoperability as they meet the latest edition of ONC Certification Standards (2015 Edition).<br />
<br />
We anticipate that FHIR may one day become an explicitly mandated standard and, as it stands, is a boon not only to interoperability but meeting meaningful use in Stage 3 and beyond.<br />
<br />
We participated in the "CCDA on FHIR" track as document creator as well as document consumer, testing our implementation against multiple servers (including those of other participants as well as the reference servers from Grahame Grieve and Furore). Our coding was done in C# using the fhir-net-api provided by fellow FHIR Chief Ewout Kramer.</div>
<br />
<b>CCDAs in VA</b><br />
HL7 hosted its third C-CDA Implementation-A-Thon last week in Arlington, VA. The DHIT team kept up its perfect attendance, convening with other CCDA developers and experts just outside DC.<br />
<br />
In addition to the usual networking and educational opportunities afforded at HL7 Events, it's always interesting to chart the development progress of the industry as a whole. And the "real-world" scenarios provided at the event - creating and exchanging live data - are worth the trip alone.<br />
<br />
As is typical of healthcare standards-based Connectathons, clinical scenarios are laid out for participants to navigate. In this case, the exercises were related to the exchange of v2.1 documents, discharge summaries and electronic referrals. We're proud to report that we all the CCDA Homework Scenarios were accomplished. 'A+' goes to the DHIT developers on hand.<br />
<br />
<b>Valueset OIDs</b><br />
Valueset OIDs continue to be a point of some controversy. There was a presentation at the event providing background and information on the process of creating them. For the initiated, value sets for use in EMRs, CQMs, research and other contexts are created by professionals and organizations and submitted to be approved by the National Library of Medicine (NLM), under its Unified Medical Language System (UMLS) arm. The code sets are validated and checked for duplicates. However, our development has uncovered some of the codes may be subject to duplication and we've requested some further information from NLM.<br />
<br />
<div>
<b>Lessons learned</b></div>
<div>
We left with some takeaways on the process of generating a v2.1 CCDA and we wanted to share with our audience:<br />
<ul>
<li>Often overlooked, developers should pay a little bit more attention to <a href="http://wiki.hl7.org/index.php?title=Act.moodCode">mood codes</a> and their usage even though it may complicate the data that is requested from a client</li>
<li>C-CDA Scorecard is a very useful checkpoint in development</li>
<li>Having lower score in the scorecard doesn’t mean that the CCDA will fail the validation. Higher scores will determine that the CCDA is much closer to the expected standard</li>
<li>Display name should come from the code system otherwise it will lower the score. </li>
<li>Narrative Text for all sections and textual clinical notes</li>
<li>The task of categorizing results may tolerate multiple pathways. Example: CT scans go to Procedures or Results or both</li>
<li>Allergies and problems should always have time recorded</li>
<li>For effectiveTime of immunizations, do not use low+high when moodCode=EVN</li>
</ul>
</div>
<br />
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-72277162301476678662016-10-12T07:40:00.003-07:002016-10-12T07:40:49.100-07:00NTT's Optimum and Dynamic Health IT Partner on Forward-Thinking Solution for CQMs<div class="MsoNormal">
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXD-BEERP_yv6zj111K-kuiw-jcp3trw2a4s0agqzTtwPTsiaZAjuAAL74BxA8FqWgnMF_G2eWp8Sk5PMd0nHzeRTpFV6T0dtQaxCTziENjiSSBnLe3RnYvROw84Hn3pOIkCd53Ux-PCg/s1600/Presentation1.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="171" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXD-BEERP_yv6zj111K-kuiw-jcp3trw2a4s0agqzTtwPTsiaZAjuAAL74BxA8FqWgnMF_G2eWp8Sk5PMd0nHzeRTpFV6T0dtQaxCTziENjiSSBnLe3RnYvROw84Hn3pOIkCd53Ux-PCg/s320/Presentation1.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">DHIT President Jeff Robbins addressing the <br />
NTT Data Client Conference</td></tr>
</tbody></table>
After wrapping up our <a href="http://dynamichealthit.blogspot.com/2016/10/cqmsolution-blazes-trail-as-first-2015.html">successful ONC certification testing for CQMsolution</a> in early September, we headed to Newport Beach, CA, for the NTT Data Client Conference. Held annually, the conference offers clients of NTT Data products and services a wide range of educational sessions, networking opportunities and face-time with NTT DATA staff.<br />
<br />
The event was a great opportunity to meet with implementers and users of CQMsolution. We were able to provide specific education on our application through the lens of the NTT's Optimum clinical ecosystem. CQMsolution is developed as universal quality measure solution, but context always matters, of course.<br />
<br />
In keeping with the mission of the conference, we also spent time discussing some policy specifics to help NTT users prepare for changes in quality measurement. This included a glimpse into the future to MIPS/MACRA and Meaningful Use Stage 3.<br />
<br />
We also expressed our confidence that our solution will continue to be among the first - if not the very first - to update with each successive release of CMS measures. Among other benefits, this allows maximal testing and educational opportunities in the lead-up to submission.<br />
<br />
As with all DHIT clients, we seek to offer a full range of development, quality assurance, support and project management resources, tailored to the environmental needs of the specific implementation and user base. Our close collaboration with NTT has yielded a solution that allows their EMR team to focus on development and customer support, while we provide an effective and aggressively-supported tool to attack quality measures.<br />
<div>
<br /></div>
</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeSA_O5g4s1TR2bKeAhuZ1482M9jlANWtPrkGZGGvPCQAmceqC3rSy8A17NKKyf1gFee35RSyPRdfvq6Xl9EppT6mmMVrlmm5Ds17RwKBUYg2eTnZaVpda9uJkCnbMINzdYhfMpjKeDAw/s1600/Presentation2.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="159" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeSA_O5g4s1TR2bKeAhuZ1482M9jlANWtPrkGZGGvPCQAmceqC3rSy8A17NKKyf1gFee35RSyPRdfvq6Xl9EppT6mmMVrlmm5Ds17RwKBUYg2eTnZaVpda9uJkCnbMINzdYhfMpjKeDAw/s320/Presentation2.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">DHIT VP Raychelle Fernandez providing<br />
clinical background for CQM calculation process.</td></tr>
</tbody></table>
By way of demonstration, DHIT gave a detailed presentation on CQMsolution and showed key elements of the software using a specific clinical use case: Ischemic/Hemorrhagic Stroke (via CMS measure 102v4). With our goal of guiding clients through CQMs from start to finish, we discussed not only the calculation and display of measures in CQMsolution, but the process of submission.<br />
<br />
It's our hope that CQMsolution, like that Southern California weather, makes everything a little sunnier.<br />
<br />
<br />
<br />
<br /></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-12144206260228023632016-10-10T14:42:00.003-07:002016-10-11T08:12:31.532-07:00CQMsolution blazes trail as first 2015 Edition Certified CQM product<div class="MsoNormal">
<span style="font-family: "times new roman" , serif; font-size: 12pt;">Dynamic Health IT is
proud to announce that we're the first software developer to be certified for
Clinical Quality Measures under the latest ONC Health IT Certification (2015
Edition).<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , serif; font-size: 12pt;">But don't take our word
for it: our listing on the ONC CHPL website is viewable <a href="https://chpl.healthit.gov/#/product/8069"><span style="color: blue;">here</span></a>.</span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: "times new roman" , serif; font-size: 12pt;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAC5TY3esIK39whOxcTp8MlNa3qlHM0zqky5Kyj7hb_V6hP-O3Z2zniAaVu5EyVLKyX7C2CDyBbsZ2pTKX8wIhyZ-z6UfA2wBvrf2udYPZPn-Qz0bwd4GDvj31xmynIQrZQtCBbChe95w/s1600/cqmsolution_cert.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="120" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAC5TY3esIK39whOxcTp8MlNa3qlHM0zqky5Kyj7hb_V6hP-O3Z2zniAaVu5EyVLKyX7C2CDyBbsZ2pTKX8wIhyZ-z6UfA2wBvrf2udYPZPn-Qz0bwd4GDvj31xmynIQrZQtCBbChe95w/s320/cqmsolution_cert.png" width="320" /></a></span></div>
<span style="font-family: "times new roman" , serif; font-size: 12pt;"><o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12pt;">The process of
certification testing gives our clients confidence that our product can support
eligible clinicians and eligible hospitals in meeting CMS EHR Incentive Program
objectives. We have developed the product with an eye on not only the current formulation
of Meaningful Use, PQRS, IQR and other quality measurement programs, but the
changes to come under MIPS/MACRA.
<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , serif; font-size: 12pt;">“Dynamic Health IT
remains a trailblazer in clinical quality measures software development. We’re
very proud to be the first vendor to certify for 2015 Edition Quality Measures
Quality Measures for Cypress 3.0,” said Jeff Robbins, President of Dynamic
Health IT.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , serif; font-size: 12pt;">Certification is proud
achievement, but also a way station to further development. DHIT continues to
enhance our software to include bulk, automated practice and user adds, API
access and a number of other new features. We hope to provide our client not only quality
measure compliance, but a transparent user interface that enables easy
analysis.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , serif; font-size: 12pt;">CQMsolution 3.0 certification meets the following certification
CQM-related criteria:<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">170.315(c)(1) Clinical Quality Measures- Capture And Export<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">170.315(c)(2) Clinical Quality Measures- Incorporate And Calculate<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">170.315(c)(3) Clinical Quality Measures- Reporting<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">170.315(c)(4) Clinical Quality Measures- Filter<o:p></o:p></span></li>
</ul>
<div class="MsoNormal">
<span style="font-family: "times new roman" , serif; font-size: 12pt;">CQMsolution Version 3.0
also includes new interface enhancements driven by 170.315(C) (4) - a brand new
module in 2015 Edition - allowing users to filter report data on a number of
demographic categories. In addition, we also certified our solution on:<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">170.315(g)(4) Quality Management System<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">170.315(d)(1) Authentication, access control, authorization<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">170.315(d)(2) Auditable events and tamper-resistance<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">170.315(d)(3) Audit report(s)<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">170.315(d)(5) Automatic access time-out<o:p></o:p></span></li>
</ul>
<div class="MsoNormal">
<span style="font-family: "times new roman" , serif; font-size: 12pt;">The clinical quality
measures to which CQMsolution has been certified include:<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">All
29 updated measures for eligible hospitals<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">All
64 updated measures for eligible professionals<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;">All
64 aligned PQRS measures for EPs (additional PQRS measures can be
supported)<o:p></o:p></span></li>
</ul>
<div class="MsoNormal">
<span style="font-family: "times new roman" , serif; font-size: 12pt;">This marks the fourth
ONC-certified version of CQMsolution, the previous certification coming in
conjunction with the release of Cypress 3.0 validation software.<o:p></o:p></span><br />
<span style="font-family: "times new roman" , serif; font-size: 12pt;"><br /></span>
<span style="font-family: "times new roman" , serif; font-size: 12pt;"></span><br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="font-family: "times new roman", serif; margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://upload.wikimedia.org/wikipedia/commons/3/36/Horse_Race_Finish_Line_(11888565543).jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://upload.wikimedia.org/wikipedia/commons/3/36/Horse_Race_Finish_Line_(11888565543).jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px; text-align: center;">Photo credit: MJ Boswell</td></tr>
</tbody></table>
</div>
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<br /></div>
<div class="MsoNormal">
<i><span style="font-family: "times new roman" , serif; font-size: 12pt;">Version 3.0 was
certified by ICSA Labs, an Office of the National Coordinator-Authorized
Certification Body (ONC-ACB) and is compliant in accordance with applicable
criteria adopted by the Secretary of Health and Human Services (HHS). </span></i><span style="font-family: "times new roman" , serif; font-size: 12pt;"><o:p></o:p></span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-11629626527503105572016-08-15T05:24:00.003-07:002016-08-15T05:28:55.736-07:00Eliminating the Hurdles of Clinical Quality Measures for the 2016 Reporting Year<div class="MsoNormal">
<span style="line-height: 18.4px;"><b>Dynamic Health IT</b> is proud to announce we have successfully pilot-tested with ICSA Labs for 2015 Edition CQM-related measures (c)(2) and (c)(3).</span><br />
<span style="line-height: 18.4px;"><br /></span><span style="line-height: 18.4px;">That's a bit of a mouthful, but it means that our software, <a href="http://www.dynamichealthit.com/CQMsolution.html">CQMsolution</a>, remains at the forefront in providing meaningful, submission-ready clinical quality measure output. CQMsolution supports 93 CMS eCQMs and the 64 aligned PQRS measures.</span><br />
<br /></div>
<div class="MsoNormal">
<span style="line-height: 18.4px;">Under 2015 Edition, Clinical Quality Measure reporting has been made more comprehensive. The three existing measures (c)(1), (c)(2) and (c)(3) have been revised:</span></div>
<div class="MsoNormal">
</div>
<ul>
<li><span style="line-height: 18.4px;"><a href="http://www2.mitre.org/work/health/himss/pdf/HIMSS16-FH29-Sayer.pdf">Cypress 3.0</a> validation software, which includes more robust testing relative to 2.6.1, must be supported</span></li>
<li><span style="line-height: 18.4px;">The latest set of measure versions for the 2016 reporting year, validated by Cypress, must be supported</span></li>
<li><span style="line-height: 18.4px;">Required data export capability is expanded</span></li>
<li><span style="line-height: 18.4px;">Data import should be more accessible (“without developer assistance”)</span></li>
<li><span style="line-height: 18.4px;">Exported data file must meet R2 implementation guide for QRDA</span></li>
</ul>
<div class="MsoNormal">
<span style="line-height: 18.4px;">The three CQM measures are also joined by a new measure: <a href="https://www.healthit.gov/sites/default/files/2015Ed_CCG_c4-CQM-filter.pdf">measure(c)(4) - filtering</a>. In meeting (c)(4), </span><span style="line-height: 18.4px;"><a href="https://www.healthit.gov/sites/default/files/2015Ed_CCG_c4-CQM-filter.pdf">EHRs must be able to filter quality measure results at the patient and aggregate levels by a list of variables</a></span><span style="line-height: 18.4px;">. The filtered results must be made available in a human-readable format and data file.</span><br />
<span style="line-height: 18.4px;"><br /></span><b>Not reinventing the wheel, replacing tires</b><br />
<br />
Our developers put in rigorous work over the last quarter, incorporating feedback from clients, to dramatically enhance the software, making it easier-to-use, more robust and, of course, certification-ready for ONC 2015 Edition and Cypress 3.0.<br />
<br />
We saw this development cycle as a great opportunity to take everything we have learned over the past few years - in the form of our feature enhancements and performance improvements - and integrate it fully with new development.<br />
<br />
This meant taking the principles behind engine and UI that worked and preserving them, while using the regulatory changes in measure logic and output as a chance for a coordinated re-design. <span style="line-height: 18.4px;">The CQMsolution calculation engine uses the eMeasure HQMF files, which are based on the </span><a href="https://ecqi.healthit.gov/qdm" style="line-height: 18.4px;">Quality Data Model</a><span style="line-height: 18.4px;"> (QDM), as the basis for evaluation. We use these files to create the data structures through which we process patient data. </span><br />
<br />
In contrast to feature-specific roll-outs, this was a bottom-up version. It is not often you get a chance to re-write core parts of your application. This can be a perilous process, but there were two factors that made it successful:<br />
<ul><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSJqSsU3GMu993y-F_m_4j99cGsJD6Q-5o6u8-uxYCZulxfh24XRaveYzPKztdmiaXq1Tou3pnPCbMt5Ak2M3RmAhdB-zmfkmBDaeGpaclQFH0Eom8y_ws2fpWmdEHm66ngWBowCbIvKs/s1600/hurdles-track_1940x900_33807.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSJqSsU3GMu993y-F_m_4j99cGsJD6Q-5o6u8-uxYCZulxfh24XRaveYzPKztdmiaXq1Tou3pnPCbMt5Ak2M3RmAhdB-zmfkmBDaeGpaclQFH0Eom8y_ws2fpWmdEHm66ngWBowCbIvKs/s320/hurdles-track_1940x900_33807.jpg" width="320" /></a>
<li>The ability to create a completely new calculation engine for 2016 reporting year without altering previous reporting year calculation engines meant we were not required to maintain backwards compatibility in the new code</li>
<li>After identifying our time parameters and client needs, our development team realized complete development focus would be needed. The project was afforded development time in a distraction-free environment.</li>
</ul>
<br />
CQM data intake and calculation were worked all at once, allowing for a holistic approach. Combined with extensive testing, relying in part on a more exhaustive Cypress data set, the result was a robust upgrade, built on clean code.<br />
<br />
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
-<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal;"> </span><o:p></o:p><b>Key changes</b></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
-<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal;"> </span></div>
<span style="line-height: 18.4px;">The changes from the 2014 release measure to the 2015/2016 release measures were dramatic, requiring a rewrite of major portions of CQMsolution. </span><span style="line-height: 18.4px;">Example of these changes can be seen in the text of the measures. New subset operators were added and new temporal operators that make the measures more clear. </span><br />
<div>
<br /></div>
<span style="text-indent: -24px;">The changes in QRDA format also called for a rewrite to the parsing and generating pieces that enable our clients' certification and submission of CQMs.</span><br />
<span style="text-indent: -24px;"><br /></span><span style="text-indent: -24px;">On top of the CQM engine, we integrated user experience changes to make both certification testing and day-to-day use of the application easier and reflective of technical changes. These changes range from easier report tracking in the UI, to one-click certification testing through single-upload "compound" report and API to Cypress.</span><br />
<b style="text-indent: -0.25in;"><br /></b><b style="text-indent: -0.25in;">Improvements ahead</b><br />
<div class="MsoListParagraph" style="text-indent: -0.25in;">
-<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal;"> </span></div>
<span style="line-height: 18.4px;">CQMsolution 3.0 is now in beta testing with clients, pending final ONC certification. </span><span style="line-height: 18.4px;">The development cycle is perpetual and we intend to stay at the forefront of CQM development. </span><span style="line-height: 18.4px;">By year's end, 2017 reporting year support should be complete and a </span><span style="line-height: 18.4px;">number of features are in the pipeline for the near term, including API-based data collection from client EMRs. </span><br />
<br />
We look forward to rolling those out and, of course, to our full certification on all four CQM measures. Stay tuned!</div>
Raychelle Fernandezhttp://www.blogger.com/profile/17903139577068535533noreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-16626410847028112322016-08-02T15:35:00.000-07:002016-08-02T15:35:34.655-07:00FHIR Applications Roundtable at Harvard Medical School<div class="MsoNormal">
The DHIT Team has been an active participant in FHIRConnectathons during the past two years. Among the benefits of these events is the unique glimpse they provide into what the industry is delivering with FHIR and how the standard continues to evolve through active development.<br />
<br />
Our team is also eager to find connections between out interoperability expertise and real-world healthcare problems. With those (and other) goals in mind, our President Jeff Robbins attended the 1<sup>st</sup>
annual FHIR Applications Roundtable at Harvard Medical School in Boston
to learn more. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Although FHIR is a relatively new standard, it has great potential and forward-thinking healthcare IT
organizations are already deploying FHIR solutions. </div>
<div class="MsoNormal">
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://upload.wikimedia.org/wikipedia/commons/thumb/2/25/Harvard_Medical_School_HDR.jpg/1280px-Harvard_Medical_School_HDR.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="212" src="https://upload.wikimedia.org/wikipedia/commons/thumb/2/25/Harvard_Medical_School_HDR.jpg/1280px-Harvard_Medical_School_HDR.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Harvard Medical School</td></tr>
</tbody></table>
<br /></div>
<div class="MsoNormal">
The Roundtable consisted of
a series of 15 minute presentations by academics, software developers and
consultants highlighting FHIR-related projects.<br />
<br />
The projects on display included patient
and provider-facing apps, Clinical Decision Support, clinical collaboration
platforms, patient education, all the way up to a complete, native FHIR-based
EHR. The expansiveness of the applications and implementations discussed demonstrates just how far the standard has come from its days in draft status.<br />
<br />
On the policy front, Steve Posnack, Director of the Office of Standards and Technology at the Office of the National Coordinator for Health Information Technology spoke about efforts to encourage interoperability through FHIR developement and the <a href="https://www.healthit.gov/techlab/innovation/connecting-accelerating-fhir-app-ecosystem">HL7 FHIR App Ecosystem</a>. ONC is encouraging market-ready FHIR support through its "challenges."<br />
<br />
DHIT plans to offer a CCDA-to-FHIR converter in the near
future. Stay tuned!<o:p></o:p></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1138176541520410652.post-64414145286970621742016-07-18T08:13:00.002-07:002016-07-19T12:07:50.391-07:00Solving 2015 Edition Certification: CCDA and Common Clinical Data Set<div class="MsoNormal">
<span style="color: #111111; line-height: 18.4px;">ONC's</span><b style="color: #111111; line-height: 18.4px;"> <a href="https://www.federalregister.gov/articles/2015/10/16/2015-25597/2015-edition-health-information-technology-health-it-certification-criteria-2015-edition-base">2015 Edition</a></b><span style="color: #111111; line-height: 18.4px;"><a href="https://www.federalregister.gov/articles/2015/10/16/2015-25597/2015-edition-health-information-technology-health-it-certification-criteria-2015-edition-base"> Health IT Certification Criteria</a> mark the l</span><span style="color: #111111; line-height: 18.4px;">atest chapter in the certification process for health information technology. The roster of measures </span><span style="color: #111111; line-height: 18.4px;">was made effective on </span><span style="color: #111111; line-height: 18.4px;">January 14, 2016, and t</span><span style="color: #111111; line-height: 115%;">he certification testing process has begun in earnest. </span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="color: #111111; line-height: 115%;"><a href="https://upload.wikimedia.org/wikipedia/commons/thumb/a/a6/Rubik's_cube.svg/2000px-Rubik's_cube.svg.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://upload.wikimedia.org/wikipedia/commons/thumb/a/a6/Rubik's_cube.svg/2000px-Rubik's_cube.svg.png" width="191" /></a></span></div>
</div>
<div class="MsoNormal">
<span style="color: #111111; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="color: #111111; line-height: 115%;">Despite the flurry of activity around 2015 Edition, i</span><span style="color: #111111; line-height: 115%;">t should be noted that there is not yet an expiration date for 2014 Edition testing,
which is expected to continue through the end of FY 2017. </span></div>
<div class="MsoNormal">
<span style="color: #111111; line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="color: #111111; line-height: 18.4px;">While vendors are not under <i>immediate</i> deadline, it is highly useful to adopt and certify, at minimum, the functionality that is relevant to your user base. There are a number of early adopter advantages, including the delivery of more interoperable software to users. </span><span style="color: #111111; line-height: 18.4px;">Now that the all-or-nothing "Complete EHR" certification is gone, developers may choose to focus "Base EHR" measures and/or those needed for their uses to meet Meaningful Use and/or other user objectives.</span></div>
<div class="MsoNormal">
<span style="color: #111111; line-height: 18.4px;"><br /></span></div>
<div class="MsoNormal">
<span style="color: #111111; line-height: 18.4px;">The 2015 measures </span><span style="color: #111111; line-height: 18.4px;">mark a significant overhaul to the previous 2014 Edition regulations. </span><span style="color: #111111; line-height: 18.4px;">A look at some of the major changes in the 2015 measures gives us a signal of where the industry is headed (or at least where it thinks it's going).</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="color: #111111; line-height: 115%;">
General themes</span></b><span style="color: #111111; line-height: 115%;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="line-height: 115%;">As Keith Boone </span><span style="line-height: 115%;"><a href="http://motorcycleguy.blogspot.com/2015/10/the-2015-edition-certification-and.html">pointed out</a></span><span style="line-height: 115%;">, 2015 Edition represents a pivot “from EHR focus
to Health IT focus.” ONC intends to make its Certification accessible to a broader range
of health IT applications than simply those directly in line with the CMS EHR
Incentive Programs, while attempting to galvanize broader interoperability.</span><br />
<span style="line-height: 115%;"><br /></span></div>
<div class="MsoNormal">
<span style="line-height: 18.4px;">This rationale is behind retiring the “Complete EHR” certification in 2015 Edition. It’s also why ONC has swapped out the term “EMR” for “health IT,” renamed the Common MU Data set the “Common Clinical Data Set” and provided more incentives for vendors to give patients access to their data using methods outside the traditional medical record, such as APIs and non-encrypted email.</span></div>
<div class="MsoNormal">
<span style="line-height: 18.4px;"><br /></span></div>
<div class="MsoNormal">
<span style="line-height: 18.4px;">ONC is also attempting to address health disparities by capturing more categories of race and ethnicity in EMR systems and there has been reaffirmation of the importance of privacy and security in the updated measures.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="line-height: 18.4px;"><b>CCDA</b></span></div>
<div class="MsoNormal">
<span style="line-height: 18.4px;">The Consolidated Clinical Document Architecture (</span><span style="line-height: 18.4px;">C-CDA)</span><span style="line-height: 18.4px;"> format remains vital to ONC's efforts to foster interoperability and data integrity. </span><br />
<span style="line-height: 18.4px;"><br /></span>
<span style="line-height: 18.4px;">To that end, C-CDA requirements have seen a major update in 2015 Edition. Vendors must support both v1.1 and v2.1 releases – and the latter must be backwards compatible. ONC is providing a “gold standard sample document” available to assist with adoption and has provided a <a href="https://sitenv.org/c-cda">"sandbox" of C-CDA resources</a>, including a tool for vendors can test against the standard with a </span><a href="https://sitenv.org/ccda-smart-scorecard/" style="line-height: 18.4px;">web-based scorecard</a><span style="line-height: 18.4px;">. </span><br />
<span style="line-height: 18.4px;"><br /></span>
<span style="line-height: 18.4px;">There are 3 C-CDA templates that must be supported for transition of care:</span></div>
<div class="MsoNormal">
</div>
<ul>
<li><span style="line-height: 18.4px;">CCD</span></li>
<li><span style="line-height: 18.4px;">Referral Note</span></li>
<li><span style="line-height: 18.4px;">Discharge Summary (Inpatient Only)</span></li>
</ul>
<span style="line-height: 18.4px;">Health IT must also support the number of preferences for display and usage of CCDA, including:</span><br />
<div class="MsoNormal">
</div>
<ul>
<li><span style="line-height: 18.4px;">Display only a particular section (or sections) at a time</span></li>
<li><span style="line-height: 18.4px;">Display order</span></li>
<li><span style="line-height: 18.4px;">Number of initial sections to display</span></li>
</ul>
<div class="MsoNormal">
<span style="line-height: 18.4px;"><b>Common Clinical Data Set (CCDS)</b></span></div>
<div class="MsoNormal">
<span style="line-height: 18.4px;">Formerly known as the Common MU Data Set, the CCDS is a series of data stipulated for use across the 2015 Edition measures. ONC has provided a <a href="https://www.healthit.gov/sites/default/files/commonclinicaldataset_ml_11-4-15.pdf">useful crosswalk</a>, comparing the 2014 Common MU Data Set with its new incarnation.</span></div>
<div class="MsoNormal">
<span style="line-height: 18.4px;"><br /></span></div>
<div class="MsoNormal">
<span style="line-height: 18.4px;">Common Clinical Data Set is comprised of data from </span><span style="line-height: 18.4px;">standards adopted by ONC, such as the CDC Race and </span><span style="line-height: 18.4px;">Ethnicity Code Set Version. </span><span style="line-height: 18.4px;">It is explicitly referenced in the following measures, often as a baseline that the certifying technology must receive, send out and/or make viewable:</span></div>
<div class="MsoNormal">
</div>
<ul>
<li><b>§ 170.315(b)(1):</b> Transitions of Care</li>
<li><b>§ 170.315(b)(4):</b> Common Clinical Data Set summary record – create</li>
<li><b>§ 170.315(b)(5):</b> Common Clinical Data Set summary record – receive</li>
<li><b>§ 170.315(b)(6):</b> Data export</li>
<li><b>§ 170.315(e)(1): </b>View, download, and transmit to 3rd party</li>
<li><b>§ 170.315(f)(5):</b> Transmission to public health agencies – electronic case reporting</li>
<li><b>§ 170.315(g)(6):</b> Consolidated CDA creation performance</li>
<li><b>§ 170.315(g)(8):</b> Application access – data category request</li>
<li><b>§ 170.315(g)(9): </b>Application access – all data request</li>
</ul>
<div class="MsoNormal">
<span style="line-height: 18.4px;"><b><br /></b></span>
<span style="line-height: 18.4px;"><span style="line-height: 18.4px;"><i>Stay tuned for more information on new CQM requirements and their implications for population health monitoring!</i></span></span></div>
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<span style="line-height: 115%;"><br /></span></div>
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Unknownnoreply@blogger.com0