Kintu Shah Allscripts_2014 ACE

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Copyright © 2014 Allscripts Healthcare Solutions, Inc.
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Allscripts Client Experience 2014
The Brave New World of
2014 EP CQMs
August 13, 2014

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Kintu Shah, Solutions
Architect
Allscripts

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Kintu Shah PMP, Solutions Architect
Kintu Shah is an Allscripts Solution Architect and has worked on the Clinical
performance Management (SCA / CPM) team for the last 4 years, most recently
with a focus on understanding the Meaningful Use CQM requirements and
working with clients to operationalize them.
Kintu has worked with more than 40 Sunrise clients to help them successfully
configure and attest to CQM requirements. He is a key contributor in the MU
CQM configuration workshops. Prior to serving on the Clinical Performance
Management team, Kintu led consulting engagements for the implementation of
Sunrise Laboratory and Blood Bank products.
Kintu has over 14 years of experience in healthcare IT. His educational
accomplishments include a Masters in Computer Applications and a Diploma in
Business Management. He is a Certified Project Management Professional
(PMP).

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The Brave New World of 2014 EP
CQMs
Agenda
• Eligible Providers CQMs
• CQM Resources
• EP CQM Tips
– Measure Components
– Across the continuum of care
– Super Bill
– Cancer Staging
– Documentation of Current Medications
• System Improvements
• Validation

Copyright © 2013 Allscripts Healthcare Solutions, Inc. 5
Eligible Providers CQMs
The Brave New World of 2014 EP CQMs

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Eligible Provider CQMs
• 2014 - EPs must report on 9 of the 64 approved CQMs
– Recommended core CQMs – encouraged but not required
• 9 CQMs for the adult population
• 9 CQMs for the pediatric population
• NQF 0018 strongly encouraged since controlling blood pressure is high priority
goal in many national health initiatives, including the Million Hearts campaign
– Selected CQMs must cover at least 3 of the National Quality Strategy
domains

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National Quality Strategy domains
• Patient and Family Engagement (4)
• Patient Safety (5)
• Care Coordination (1)
• Population/Public Health (9)
• Efficient Use of Healthcare Resources (4)
• Clinical Process/Effectiveness (41)
Selected CQMs must cover at least 3 of the National Quality Strategy domains
For additional information and full list of measures and the domains:
2014_EP_MeasuresTable_June2013.pdf
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_EP_MeasuresTable_June2013.pdf

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Recommended CQMs for the Adults
eMeasure
ID
CQM Title Measur
e
Steward
Domain
CMS165v1
NQF 0018
Controlling High Blood Pressure NCQA Clinical Process /
Effectiveness
*CMS156v
1
NQF 0022
Use of High-Risk Medications in
the Elderly
NCQA Patient Safety
CMS138v1
NQF 0028
Tobacco Use: Screening and
Cessation Intervention
AMA-
PCPI
Population / Public
Health
CMS166v1
NQF 0052
Use of Imaging Studies for Low
Back Pain
NCQA Efficient Use of
Healthcare
Resources
*CMS2V1
NQF 0418
Screening for Clinical Depression
and Follow-Up Plan
CMS Population / Public
Health
* Indicates New measure in 2014

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Recommended CQMs for the Adults
Source: http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_AdultRecommend_CoreSetTable.pdf
eMeasure
ID
CQM Title Measur
e
Steward
Domain
*CMS68v1
NQF 0419
Documentation of Current
Medications in the Medical Record
CMS Patient Safety
CMS69v1
NQF 0421
Body Mass Index (BMI) Screening
and Follow-Up
Health
*CMS50v1 Closing the referral loop: receipt of
specialist report
CMD Care Coordination
*CMS90v1 Functional status assessment for
complex chronic conditions
CMS Patient and Family
Engagement

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Recommended CQMs for the Pediatrics
eMeasure
ID
CQM Title Measur
e
Steward
Domain
CMS146v1
NQF 0002
Appropriate Testing for Children
with Pharyngitis
NCQA Efficient Use of
Healthcare
Resources
CMS155v1
NQF 0024
Weight Assessment and
Counseling for Nutrition and
Physical Activity for Children and
Adolescents
NCQA Population / Public
Health
CMS153v1
NQF 0033
Chlamydia Screening for Women NCQA Population / Public
Health
CMS126v1
NQF 0036
Use of Appropriate Medications for
Asthma
NCQA Clinical Process /
Effectiveness
CMS117v1 Childhood Immunization Status NCQA Population / Public

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Recommended CQMs for the Pediatrics
Source: http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_PrediatricRecommended_CoreSetTable.pdf
eMeasure
ID
CQM Title Measur
e
Steward
Domain
*CMS154v
1
NQF 0069
Appropriate Treatment for
Children with Upper Respiratory
Infection (URI)
NCQA Effective Use of
Healthcare
Resources
*CMS136v
1
NQF 0108
Follow-Up Care for Children
Prescribed Attention
Deficit/Hyperactivity Disorder
(ADHD) Medication
NCQA Clinical Process /
Effectiveness
*CMS2v1
NQF 0418
Screening for Clinical Depression
and Follow-Up Plan
Health
*CMS75v1 Children who have dental decay
or cavities
MCHB-
HRSA
Clinical Process /
Effectiveness* Indicates New measure in 2014

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However….
1. The eMeasures are still a work-in-progress; feedback is
incorporated from experience in the field and there will be
annual updates.
2. There are still no thresholds to be met for CQMs
3. There is no plan to publish comparative results
4. Electronic submission is optional for 2014

CQM Resources
The Brave New World of 2014 EP CQMs

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Clinical Quality Measures Resources
http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html
https://vsac.nlm.nih.gov/ (you will need UMLS account)
http://onc-project-tracking.org/secure/Dashboard.jspa (you will need to create an account)

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Resources – CMS eCQM Library

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EH Updates: April / EP Updates: June

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Clinical Quality Measures Resources
• Allscripts Client Connect
– CQM Recommendation Detail Spreadsheet
– CQM Reference Guides
– Clinical Performance Management Group
https://clientconnect.allscripts.com/groups/arra

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CQM Reference Guides
https://clientconnect.allscripts.com/docs/DOC-24032

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CQM Recommendation Detail

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CPM: Product Community

EP CQM Tips

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Measure Components
• Initial Patient Population
• Denominator
• Denominator Exclusions
• Denominator Exceptions
• Numerator

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Initial Patient Population
• Refers to all patients to be evaluated by a specific performance
eMeasure who share a common set of specified characteristics within
a specific measurement set to which a given measure belongs.
• Details often include information based upon specific age groups,
diagnoses, diagnostic and procedure codes, and enrollment periods.
29

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Denominator
• The denominator can be the same as the initial patient population or a
subset of the initial patient population to further constrain the
population for the purpose of the eMeasure.
• Different measures within an eMeasure set may have different
Denominators.
• The members of the IPP are classified using the Denominator criteria,
and those satisfying the criteria are included in the Denominator.
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Denominator Exclusions
• Patients who should be removed from the eMeasure population and
denominator before determining if numerator criteria are met.
• Denominator exclusions are used in proportion and ratio measures to
help narrow the denominator.
• The members of the Denominator are classified using the
Denominator Exclusion criteria, and those satisfying the criteria are
included in the Denominator Exclusions.
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Denominator Exceptions
• Are those conditions that should remove a patient, procedure or unit of
measurement from the denominator only if the numerator criteria are
not met.
• Allow for adjustment of the calculated score for those providers with
higher risk populations.
• Allow for the exercise of clinical judgment. Specifically defined to
capture information in a structured manner that fits the clinical
workflow. Reasons fall into 3 categories: 1. Medical reasons 2. Patient
reasons 3. System reasons.
• Those members of the Denominator that were considered for
membership in the Numerator, but were rejected, are classified using
the Denominator Exceptions criteria, and those satisfying the criteria32

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What does it mean
Measure Numerator Denominat
or
Measure
Rate
IPP Exclusions Exceptions
NQF 0018 29 66 43.94% 83 7 3
Initial Patient Population = 83
Denominator = 66
Excepti
on = 3
Exclusio
n = 7
Numerator =
29

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Exclusions
Den Exclusion
Exclusion

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Exception
Numerator
ExceptionDen-Excl
Exception
Numerator

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EP CQM Measures
• Across the continuum of care
– EP CQMs are patient based (Counts MRNs)
– Looks across the visits for Results / Documents / Orders etc.
– Denominator – Add Patient only if has required types of visit(s) during
attestation period
– Looks back for Numerators – Can look outside the bounds of attestation
period
– Provider should be associated to the visit with appropriate Provider role
– If multiple providers associated to the visit, both gets the credit for the work

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Encounter Codes
• Visit Information for Ambulatory workflow
• NLM value sets contain the CPT codes
• Two value sets do not contains CPT codes, they are SNOMEDCT
– Face to Face Encounters
– Patient Provider Interactions
• Measures were certified using Super Bill
• Clients that do no use Super Bill
– Identify other options to capture CPT codes
• Health Issues (V12 New feature)
• Observations / Orders - UDDIs
– With Observations or Orders – limitation when 2 visit count are required
– This limitation will not falsely improve numbers, so some client are opting to capture
only one encounter for these measures - with a workflow to make sure things are done
every visit.

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Cancer Staging
• Cancer Staging Module
• Allscripts did not certify using the Cancer Staging Module
• This module was not used in any of the oncology CQMs
• Cancer staging in the CQMs was done using Observations
• A Document is in circulation(Author unknown) that says the Cancer
staging module and the ITT can be used – This is false information
and we apologize for it
• At this time, no clients plan to use the cancer staging CQMs

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NQF 0419: Documentation of Current
Meds
• OMP Review
– Not needed for Medication Reconciliation
– Is used for Documentation of Current Medications in the Medical Record
– Ambulatory Configuration Tool > Prescription Writer > Medication List
Codes
– Code: 42819100012410
– SNOMEDCT

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Diagnosis Dates
• Diagnosis dates, many measures use them but most organizations do
not capture onset / resolved dates.
• System falls back to create dtm
• You may still use the measure, but it will miss some of the intended
nuances

System Improvements

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System Improvements (V12.2)
• One Patient profile for all Providers
• Patient Profile Freeze
• Patient Profile Build with ETL
• Content Deployment – Can Deploy One measure at a time
• Quality Events – Record Timestamps for events in chart
• Population set – Copy groups, Name the Group
• Context Sensitive help
• Customizable Visit list for Population sets and Indicators
• Visit Details / Patient Details drill through from every report
• Audit Reports

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One Patient Profile for all Providers
• Profile Definition
– Profile selects Providers by Roles

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Patient Profile Freeze
• Profile Definition
– Freeze Date
– Frozen

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Patient Profile Build with ETL
• A new Phase in ETL process
• All profiles with future Freeze date

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Quality Events
• A way to record Time stamp – when something occurred in chart
• Uses new Indicator Type – ProviderMeasureEvents
– 225 rules – out of box – inactivate the rules you do not use
– You may have more indicators by measure group – you may inactivate
them
• Search type – Quality Event
– Must have a value set in rule(Coded data only)
– Value set name is the even name
– Aware search type

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Quality Event Timings (QETs)
• Report to look at configuration
– Indicators > QET
– Spreadsheet – check with your IC

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QET Validation
• Find Quality Events (Reference Sets) used by QET
• Test Quality Event independently
– Create Test Population Set
– Table: Quality Event, Field: Reference Set
• If have counts, create two groups and test both together

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QET Validation
• If you need to check with SQL
SELECT v.EncounterNumber , qe1.StartDtm, qe1.QDMDataType ,qe2.StartDtm, qe2.QDMDataType, QET.<Name of QET
Field>,
FROM [CPM_AcuteCare].[dbo].SCAVisit v
Inner join [CPM_AcuteCare].[dbo].SCAQualityEvent qe1 ON qe1.VisitID = v.VisitID AND qe1.ReferenceSet = ‘Value Set 1
Name‘
Inner join [CPM_AcuteCare].[dbo].SCAQualityEvent qe2 ON qe2.VisitID = v.VisitID AND qe2.ReferenceSet = ‘Value Set 2
Name'
Inner join [CPM_AcuteCare].[dbo].[SCAQualityEventTiming] qet on qet.VisitID = v.VisitID
Where v.EncounterNumber = '1000017765‘ – Optional use it only if you want to check particular visit only

Validation for EP
measures

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Validation
• Production Validation vs. Test Cases
• Production Validation
– Out of box reports / Audit Reports
• Test Cases
– Spreadsheet of test cases

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Validation: Out of Box - Audit Reports
• Codification
– Code set Cross Reference Table
(ITT)
– Dimension Table
• Admit Types
• Allergens
• Care Levels
• Coded Observations
• Demographics
• Diagnosis Types
• Discharge Dispositions
• Insurance Types
• Locations
• Medication Routes
• Medications
• Order Catalog
• Order Statuses
• Services
• Visit Types
• Configuration Validation
– Visit List - Population Set Visits
– Visit List – Indicator Visits
– Patient Profile Results
• Configuration Audit
– Indicator Summary
– Population Set Summary
– Reference Set Summary
– Patient Profile Measure Details
• Chart Review
– Visit Details
– Patient Details

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Validation: Out of Box Measure Reports
• Eligible Professional Measures
– Behavioral Health Measures (NQF: 0004, 0104, 0105, 0108, 0110, 0418)
– Cardiac Measures (NQF: 0068, 0070, 0075, 0081, 0083, CMS: 90)
– CMS Adult Measures (NQF: 0018, 0022, 0028, 0052, 0421, CMS: 50)
– CMS Pediatric Measures (NQF: 0002, 0024, 0036, 0069, CMS: 75)
– Diabetes Measures (NQF: 0055, 0056, 0059, 0060, 0062 and 0064)
– Episode Based Measures (NQF: 0069, 0384, 0419)
– Infectious Disease Measures (NQF: 0403, 0405, CMS: 77)
– Oncology Measures (NQF: 0384, 0385, 0387, 0389)
– Ophthalmology Measures (NQF: 0086, 0088, 0089, 0101, 0564, 0565)
– Prevention Screening Measures (NQF: 0031, 0032, 0033, 0034, 0038, 0041, 0043, 0608, CMS:
74)

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Measure Reports

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Validation: Out of Box Other Reports
• Other reports
– Provider Comparison
– Provider Measures Dashboard
– Provider Rate Comparison
– Provider Summary

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Other Reports – Provider Rate
Comparison

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Other reports – Provider Comparison

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Validation: Test cases
Patient Visit Admit Health issue Scope BP DOB Pass /
Fail
Test, BP 1
4/1/2014ICD9:401.1 General 145/92 1/1/1975Existing
CPT:99213 Visit
2 7/2/2014CPT:99213 Visit 134/80 1/1/1975Register New
Patient Visit Admit Health
issue
Scope DOB Observation Pass /
Fail
Test Tobacco 1 7/2/2014ICD9:401.1 General 1/1/1965 Existing Non smoker(105539002 or other code from value set)
CPT:99213 Visit
2
7/24/2014CPT:99214 Visit 1/1/1965
Register
New
Test Tobacco Out 1 11/2/2013ICD9:401.1 General 1/1/1965 Existing Non smoker(105539002 or other code from value set)
CPT:99213 Visit
2 7/3/2014ICD9:401.1 General 1/1/1965 Existing
CPT:99213 Visit
3 7/19/2014CPT:99214 Visit 1/1/1965
Register
New

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Allscripts Client Experience 2014
Questions

Kintu Shah Allscripts_2014 ACE

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