Optimum & Dynamic Health IT: Your Go Forward Solution for CQM Submission 2016 ecqm for 2017 Reporting Year Worksheet Changes Gina Barrett RT, R, CT

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1 Optimum & Dynamic Health IT: Your Go Forward Solution for CQM Submission 2016 ecqm for 2017 Reporting Year Worksheet Changes Gina Barrett RT, R, CT 09/13/ NTT DATA Client Conference Copyright 2016 NTT DATA Corporation

3 Optimum CQM Updates QRDA 1 Report- Removed (Performed in Dynamic Health IT application) CQM Reports-Removed (Performed in Dynamic Health IT application) Patient Manual Generation- Added Default login screen Select Patient (Discharged patients will have blue hyperlink under Patient Name) Will display Clinical Quality Measure, Created USER and Created Date Created date will be the date the extract was sent to DHIT To generate an extract update to selected patient select Generate Extract Batch Manual Generation- Added Select from Menu This function will run the extract auto job process. Press the Run Extract Auto button to begin the process. Screen will display To generate a batch extract update to all patients select Run Extract Auto Note: Depending on the data size, this may take several hours Copyright 2016 NTT DATA Corporation 3

7 ecqm Updates: Stroke (1 of 3) ecqm# 71 Anticoagulation Therapy for Atrial Fibrillation/Flutter Value Set Code Update: Reason for not prescribing Anticoagulant Therapy at Discharge : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). ecqm# 72 Antithrombotic Therapy By End of Hospital Day 2 Value Set Code Update: Reason for not prescribing Antithrombotic Therapy while inpatient : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Copyright 2016 NTT DATA Corporation 7

8 ecqm Updates: Stroke (2 of 3) ecqm# 91 Acute Ischemic stroke patients who arrive at this hospital within 2 hours of time last known well and for whom IV t-pa was initiated at this hospital within 3 hours of time last known well Modified time parameters: Did the patient get IV TPA during or before Admission, BP with systolic > 185, BP with diastolic > 110 and Reason for not prescribing Thrombolytics while inpatient change the Informational Message parameter from 180 minutes to 270 minutes. Add question: Did the patient get IV AntiHypertensives before admission? Also track the before and after values in the Audit. Value Set OID Update: Did the patient have an intravenous or intra-arterial TPA before admission? there are currently two OID Value Sets referenced for this question; AND Remove the OID Value Set of from this question. Copyright 2016 NTT DATA Corporation 8

9 ecqm Updates: Stroke (3 of 3) ecqm# 102 Assessed for Rehabilitation Value Set OID Update: Did the patient have an intravenous or intra-arterial TPA before admission? there are two OID Value Sets referenced for this question; AND Remove the OID Value Set of ecqm# 104 Discharged onantithrombotic Therapy Value Set Code Update: Reason for not prescribing Antithrombotic Therapy at discharge : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). ecqm# 105 Discharged on Statin Medication Value Set Code Update: Reason for not prescribing Statins at discharge : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). ecqm# 107 Stroke Education Value Set Code Update: Follow-Up after Discharge : Value set Instructions for Follow Up After Discharge ( ): Added 1 SNOMEDCT code ( ) and deleted 1 SNOMEDCT code ( ).). Copyright 2016 NTT DATA Corporation 9

11 ecqm Updates: AMI (1 of 4) ecqm# 30 Acute Myocardial Infarction (AMI) patients who are prescribed a statin at hospital discharge Removed NQF Endorsement: This measure was previously endorsed by NQF but is no longer endorsed by NQF. All references to the NQF ID for ecqm# 30 removed from the informational messages. Affects the following questions: (Q #2) If a Comfort Measure was ordered for the patient, indicate the intervention ordered (Q #3) If the patient received comfort measures only, indicate intervention performed (Q #5) If statin was not prescribed during the inpatient visit, indicate reason: (Q #7) If statin was not prescribed upon discharge, indicate reason: (Q #9) LDL-c result less than 100mg/dL within 30 days before admission, enter value: NQF Value Set Code Update: If statin was not prescribed during the inpatient visit, indicate reason Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Value Set Code Update: If statin was not prescribed upon discharge, indicate reason Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Copyright 2016 NTT DATA Corporation 11

12 ecqm Updates: AMI (2 of 4) ecqm# 53 Primary PCI Received within 90 Minutes of Hospital Arrival Value Set Code Update: If diagnosis of acute or evolving MI was made via ECG, confirm by selecting a value here: Value set Acute or Evolving MI ( ): Added 9 SNOMEDCT codes ( , , , , , , , , and ) and deleted 1 SNOMEDCT code ( ). Value Set Code Update: If patient was transferred from another healthcare facility to the hospital, select where the patient was transferred from here: Value set Ambulatory surgical center ( ): Added 2 SNOMEDCT codes ( , ). Value Set Code Update: "If diagnosis of acute or evolving MI was made via ECG, confirm by selecting a value here": Value set STEMI Exclusions ( ): Added 3 SNOMEDCT codes ( , , and ). Copyright 2016 NTT DATA Corporation 12

13 ecqm Updates: AMI (3 of 4) ecqm# 60 Acute myocardial infarction (AMI) patients with ST-segment elevation on the ECG closest to arrival time receiving fibrinolytic therapy during the hospital stay and having a time from hospital arrival to fibrinolysis of 30 minutes or less Removed NQF Endorsement: This measure was previously endorsed by NQF but is no longer endorsed by NQF. References to the NQF ID for ecqm# 30 removed. Affects the following Questions (Q #1) If patient was transferred from another healthcare facility to the hospital, select where the patient was transferred from here (Q #8) If Fibrinolytic Therapy not started within 30 minutes of hospital arrival, indicate reason: (Q #10) If ECG performed within 1 hour prior to hospitalization, specify procedure performed: (Q #11) If diagnosis of acute or evolving MI was made via ECG, confirm by selecting a value: (Q #12) If PCI was not performed within 90 minutes of hospital arrival, indicate reason: Value Set Code Update: If diagnosis of acute or evolving MI was made via ECG, confirm by selecting a value here: Value set Acute or Evolving MI ( ): Added 9 SNOMEDCT codes ( , , , , , , , , and ); deleted 1 SNOMEDCT code ( ). NQF Copyright 2016 NTT DATA Corporation 13

14 ecqm Updates: AMI (4 of 4) ecqm# 60 Acute myocardial infarction (AMI) patients with ST-segment elevation on the ECG closest to arrival time receiving fibrinolytic therapy during the hospital stay and having a time from hospital arrival to fibrinolysis of 30 minutes or less continued: Value Set Code Update: If patient was transferred from another healthcare facility to the hospital, select where the patient was transferred from here: Value set Ambulatory surgical center ( ): Added 2 SNOMEDCT codes ( , ). Value Set Code Update: "If diagnosis of acute or evolving MI was made via ECG, confirm by selecting a value here": Value set STEMI Exclusions ( ): Added 3 SNOMEDCT codes ( , , and ). ecqm# 100 Aspirin Prescribed at Discharge Value Set Code Update: If aspirin was not prescribed during the inpatient visit, indicate reason : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Value Set Code Update: If aspirin was not prescribed upon discharge, indicate reason : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Copyright 2016 NTT DATA Corporation 14

16 ecqm Updates: Perinatal ecqm# 9 Exclusive Brest Milk Feeding Removed Question: Patient communicated breast feeding intention from the worksheet. Removed Question: Estimated Gestational Age at Birth. Add Question: Estimated Due Date after question Date and Time of Delivery. Added a formula that will calculate the Estimated Gestational Age at Birth based on the Estimated Due Date. ecqm# 113 Elective Delivery Removed Question: Estimated Gestational Age at Delivery. ecqm# 185 Healthy Term Newborn Note: CMS suggests eligible hospitals participating in the Medicare & Medicaid EHR Incentive Programs not select CMS185/NQF0716: Healthy Term Newborn as one of their additional electronic clinical quality measures (ecqms) for meaningful use. The measure steward is making substantial changes to this measure and is working with NQF on endorsement of the revised measure. CMS will review the changes to this measure and assess its feasibility for future implementation. Value Set Code Update: Estimated gestational age > = 37 weeks : Value set Gestational age >= 37 weeks ( ): Added 7 ICD10CM codes (Z3A.37, Z3A.38, Z3A.39, Z3A.40, Z3A.41, Z3A.42, Z3A.49). Copyright 2016 NTT DATA Corporation 16

18 ecqm Updates: VTE (1 of 5) ecqm# 73 This measure assesses the number of patients diagnosed with confirmed VTE who received an overlap of parenteral (intravenous [IV} or subcutaneous [subcu]) anticoagulation and warfarin therapy. Value Set Code Update: If parenteral anticoagulant we not prescribed during the inpatient visit, indicate reason : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Value Set Code Update: Reason for not parenteral anticoagulant at discharge : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Value Set Code Update: "VTE diagnostic test result confirmed within 4 days before patient admission indicate result and test": Value set VTE Diagnostic Test ( ): Deleted 12 LOINC codes. Copyright 2016 NTT DATA Corporation 18

19 ecqm Updates: VTE (2 of 5) ecqm# 108 This measures assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission. Value Set Code Update: If none of the above medications were ordered, indicate reason : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Value Set Code Update: If none of the above devices were ordered, indicate reason : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Value Set Code Update: If any of the ordered devices was not applied, indicate reason : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Copyright 2016 NTT DATA Corporation 19

20 ecqm Updates: VTE (3 of 5) ecqm# 109 This measure assesses the number of patients diagnosed with confirmed VTE who received intravenous (IV) UFH therapy dosages and had their platelet counts monitored using defined parameters such as a nomogram or protocol Value Set Code Update: "VTE diagnostic test result confirmed within 4 days before patient admission indicate result and test": Value set VTE Diagnostic Test ( ): Deleted 12 LOINC codes. ecqm# 110 V Venous Thromboembolism Discharge Instructions Value Set Code Update: "VTE diagnostic test result confirmed within 4 days before patient admission indicate result and test": Value set VTE Diagnostic Test ( ): Deleted 12 LOINC codes. Copyright 2016 NTT DATA Corporation 20

21 ecqm Updates: VTE (4 of 5) ecqm# 114 This measure assesses the number of patients diagnosed with confirmed VTE during hospitalization (not present at admission) who did not receive VTE prophylaxis between hospital admission and the day before the VTE diagnostic testing order date. Value Set Code Update: If none of the above medications were ordered, indicate reason : Value set Medical Contraindication ( ): Deleted 1 SNOMEDCT code ( ). Value Set Code Update: If none of the above devices were ordered, indicate reason : Value set Medical Contraindication ( ): Deleted 1 SNOMEDCT code ( ). Value Set Code Update: If any of the ordered devices was not applied, indicate reason : Value set Medical Contraindication ( ): Deleted 1 SNOMEDCT code ( ). Value Set Code Update: "VTE diagnostic test result confirmed within 4 days before patient admission indicate result and test": Value set VTE Diagnostic Test ( ): Deleted 12 LOINC codes. Copyright 2016 NTT DATA Corporation 21

22 ecqm Updates: VTE (5 of 5) ecqm# 190- This measure assesses the number of patients who received VTE prophylaxis or have documentation why VTE prophylaxis was not given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) surgery end date for surgeries that start the day of or the day after ICU admission (or transfer). Value Set Code Update: If none of the above medications were ordered, indicate reason : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Value Set Code Update: If none of the above devices were ordered, indicate reason : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Value Set Code Update: If any of the ordered devices was not applied, indicate reason : Value set Medical Reason ( ): Deleted 1 SNOMEDCT code ( ). Copyright 2016 NTT DATA Corporation 22

25 ecqm Updates: ED & Updated Admission (ED&IP) Worksheet 2017 ecqm# 32 Median Time from ED Arrival to ED Departure for Discharged ED Patients Change to the logic, eliminating the previously required admission to the Encounter Inpatient within 6 hours of ED visit. No change to the worksheet. ecqm# 55 Median Time from ED Arrival to ED Departure for Admitted ED Patients Add question: If patient transferred from another hospital, specify the setting and the date and time patient left that setting: ecqm# 111 Median Admit Decision Time to ED Departure Time for Admitted Patients Add question: If patient transferred from another hospital, specify the setting and the date and time patient left that setting: Copyright 2016 NTT DATA Corporation 25