Understanding how to use the Quality Measure Step by Step Documents

Understanding how to use the Quality Measure Step by Step Documents Step 1: Quality Measure Selection o The first step for Quality Measures is to ensure you know what the measures are looking for from a clinical perspective. Then you will need to decide what measures will be used in your organization. Quality measures can be selected on an individual provider basis. As an organization, you can limit the measures you want your providers to select from or you can even choose the measures for your providers. This is a decision that your organization should make and then review with your providers. o Core Measures: There are three Core Measures that are required for all providers to report on. These are as follows: NQF 0028 : Preventive Care and Screening Measure Pair: a. Tobacco Use Assessment Preventive Care and b. Tobacco Cessation NQF 0421: Adult Weight Screening and Follow-Up NQF 0013 Hypertension: Blood Pressure Measurement o A provider will need to report on all 3 Core Measures. If any of the core measures have a denominator = 0 (no patients in the population for the provider), the provider will need to also report on the Alternate Core Measures. If there is one Core Measure with a zero denominator, then the provider will need to choose 1 Alternate Core Measures to report on. If there are 2 Core Measures with zero denominators, then the provider will need to choose 2 Alternate Core Measures to report on. If there are 3 Core Measures with zero denominators, then the provider will need to choose 3 Alternate Core Measures to report on. o o o Alternate Core Measures: If any of the Core measures have a denominator of zero, the below are the Alternative Core Measures that a provider can choose from to report on. NQF 0024: Weight Assessment and Counseling for Children and Adolescents NQF 0038: Childhood immunization Status NQF 0070: Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old Specialty Measures: There are 38 additional Specialty Measures. All providers will need to choose 3 measures to report on. Stage 1 requirements are around reporting. There are not percentage thresholds to be met for the Quality Measures in Stage 1. Quality Measures can be classified as Pay for Reporting in Stage 1. Again, to meet the measure you simply must report on the measure, not achieve a certain level of compliance. Step 2: Quality Measure Setup o Setup your system to ensure that you can accurately capture the information needed for the Quality Measure calculations. The Quality Measure calculations are built on the specifications provided by CMS. CMS dictated the various code sets used in each measure (cpt codes, loinc codes, icd9 codes, etc). This document shows you various ways that you can build your system to capture those code sets.. In many cases, there is more Copyright 2011 Allscripts Healthcare Solutions, Inc. 1

than one type of code that can be used to satisfy the measure. When multiple code options are presented, It is not necessary to configure your system to utilize each type of code presented, but rather it is intended that you select the options that best fit your clinical workflow an documentation standards. Our hope is to ensure that you have enough flexibility for your workflows while still being prescriptive so that the reports can be calculated to CMS s standards. o Much of the build in this document can be done prior to 11.2 and prior to the Stimulus Set install. We recommend that this build is done prior to your integration with the Allscripts Clinical Data Warehouse, which is installed as part of the 11.2 Stimulus Set. o The codes that we outline in this document are not delivered as part of your 11.2 Upgrade. You will need to take action to manually update your system to capture these codes (ex. Assign a CPT code to an Order). o If you add the codes today, it will be update the past items documented on a patient s chart. o The codes identified in this document are provided by CMS. If you are using codes other than specified in this document, they will not be included in Quality Measure Report. o This document does not intend to change how you are currently billing for procedures. If you do change or modify codes used for biller, ensure that you are reviewing that with your Compliance/Billing team o Further information on the CMS codes can be located: http://www.cms.gov/ehrincentiveprograms/ Step 3: Allscripts Clinical Data Warehouse Integration o Once you are integrated with the Allscripts Clinical Data Warehouse, you will then be instructed to configure Basic Quality Measures. This is not outlined in this document. This includes setting up your providers for their measures, complete Data Mapping, and accessing the measures from EEHR. Step 4: Test Quality Measure Workflows for the measures selected Understanding Measurement Period The measurement period used for calculation of the measures and determination of the numerators, denominators, and exclusions for the measure. This is generally defined as the calendar year for the Medicare EHR Incentive Program. For CMS attestation, CMS does want you to report on the same date range for Quality Measures that you are using the rest of your Meaningful Use Objectives. For Stage 1, this period needs to be at least 90 days. Understanding How to Determine Visit Codes o CMS has designated that CPT Codes should be used to define the denominator to represent a visit with the patient, for example: Measure 0013 Hypertension: Blood Pressure Management Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits, with blood pressure (BP) recorded Office Visit defined as any of the following CPT codes: Copyright 2011 Allscripts Healthcare Solutions, Inc. 2

CPT Codes for Measure 0013 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, 99347-99350, 99384, 99394, 99455, 99456, 97001, 97003, 97802, 97803, 98960, 99324, 99325, 99326, 99327, 99328, 97001, 97003, 97802, 97803, 98960, o The preferred method to capture these visit charges is the Charge module. If you have fully implemented Charge across all EP s, you are capturing the necessary CPT codes today to calculate CQM s. If you have not completed or started your Charge Implementation you will be able to capture the CPT codes as part of the implementation of the Allscripts Clinical Data Warehouse. With the integration to Data Warehouse you will need to perform a data mapping exercise. This exercise will consist of mapping the user defined dictionary items that should be used to calculate Meaningful Use & Clinical Quality Measure objectives. Ex. Race, Ethnicity, Vital Signs o As part of this process, you will be able to map Appointment Types to the CMS Visit Concepts. This method does not give you a specific CPT Code for each unique patient visit, instead it provides CMS Concepts as a proxy to satisfy CMS intent for Stage 1 Quality Measure data. o Charge & Appointment Type mapping can be mixed, the Visit Code from Charge will always take precedence. If charge is not completely being used, you may still choose to may map your appointment types. If you choose to use charge and map your appointment types, the visit code from charge will take precedence. o It is anticipated that specific CPT codes will be required for MU Stage 2 Quality Measure reporting. To accommodate this, we recommend that you fully implement the Enterprise EHR Charge Module prior to beginning their MU Stage 2 reporting period. For additional information on how to begin this process if you have not already, please contact your Relationship Manager Copyright 2011 Allscripts Healthcare Solutions, Inc. 3

If Charge is fully deployed: You are ready! If Charge is partially deployed: Continue deployment for full Charge Use Appointment Type mapping for Stage 1 where needed If Charge deployment is not started: Use Appointment Type mapping for Stage 1 Begin Charge deployment (needed for Stage 2) Using Population Health - Population Health is a feature available with 11.2. It will allow you to create your own patient population query and use the system to take actions on those patients. An example of this would be create an Order Reminder for a Mammogram for female patients over the age of 50. Population Health is not a replacement to create your own Quality Measure queries, but can be useful for helping your providers managed specific patient population Using v11 Note Forms- In 11.2, the only Note Form that we be utilized to capture Quality Measure reporting information would be the Assessment Note Forms that are linked to Medcin. This will update the Patient s Problem list. In 11.3, additional note forms will be able to be used as well. Documenting Allergies There are a few allergies exclusions (Eggs, Baker s Yeast) where we recommend to document them via medication allergies as opposed to non-medication allergies. The reports will pick up the allergies if documented either way, but medication allergies will come into play with DUR checking, while non- medication allergies will not. Updating Orderable Items and Results for Basic Quality Measure Reporting What is a SNOMED Code? Specifically, the exact name is SNOMED Clinical Terms (SNOMED CT ). It is a comprehensive clinical terminology that provides clinical content and expressivity for clinical documentation and reporting. It can be used to code, retrieve, and analyze clinical data For 11.2 SNOMEDs can be assigned to Orderable Items. CMS has used SNOMED codes to identify specific pieces of clinical information needed for the quality measures. It will be called out in the Quality Measure Step by Step, if Orderable items need a specific SNOMED assigned to it, in order for the Quality Measure reports to recognize the orderable. How to associate a SNOMED code to an OID Items 1. Follow Steps in SSMT User Guide located in SalesForce for basic use of SSMT Product Documentation Allscripts Enterprise EHR SSMT & CMT All Types Starter_Set_Migration_Tool_User_Guide_V11.2_EnterpriseEHR.pdf 2. Pick the Category of OID Orderable Item Copyright 2011 Allscripts Healthcare Solutions, Inc. 4

3. Check the checkbox Show Headers in Extracted Data 4. Choose a Order Type and Parent Class Filter 5. Click Extract Data 6. Open an Excel spreadsheet, ensure the entire spreadsheet is formatted as data type Text 7. Copy entire extract data contents from SSMT and paste in Excel 8. Modify column SnoTermCode with appropriate SNOMED Code 9. Copy single modified row or Excel spreadsheet 10. Paste into SSMT 11. Click Load Data Note: The SNOMED code can only be seen via an SSMT Extract of the OID Orderable Item category in v11.2 GA. The OID dictionary UI will be updated in v11.2 SP 2 to view the SNOMED from the Dictionary Admin workspace. How are CPT codes being identified by the reports? The Quality Measure Reports will be able to pick up a CPT code in the following places: 1. Documenting specific Past Surgical History Problems 2. Use of Charge Module for billing procedures and visit codes 3. Documentation of Orders How to associate a CPT Code to an Orderable Item 1. Log into TWAdmin 2. Select Dictionaries Menu 3. Select Orderable Item Dictionary 4. Select/Search for Order 5. Go to the Charge/MN section 6. In the When to Charge field, select Never if you do not want this order to drop a charge onto the Encounter Form 7. Add CPT Code in the CPT4 Code 8. If you want to charge for this item, set the appropriate timing in the When to Charge field Copyright 2011 Allscripts Healthcare Solutions, Inc. 5

a. The system will then look at the value selected in the Charge Code field Starter Set Migration Tool (SSMT) 1. Follow Steps in SSMT User Guide located in SalesForce for basic use of SSMT Product Documentation Allscripts Enterprise EHR SSMT & CMT All Types Starter_Set_Migration_Tool_User_Guide_V11.2_EnterpriseEHR.pdf 2. Once logged in choose SSMT Content Category= OID- Orderable Item a. Choose appropriate Classification b. Extract and copy into excel c. If you are not going to drop a Charge: i. Update Column AA CPT4Code = CPT Code ii. Update Column AC When To Charge = Never d. If you are going to drop a charge i. Update Column AC When To Charge = one of the following options: 1. On Collection 2. On Order 3. Upon Completion 4. When Resulted ii. Update Column AD ChargeCodeList = CPT Code What are LOINC Codes? CMS has identified the use of LOINC values to identify specific results needed for the Quality Measures. Per the LOINC Database website: The purpose of the LOINC database is to facilitate the exchange and pooling of results for clinical care, outcomes management, and research. Copyright 2011 Allscripts Healthcare Solutions, Inc. 6

In EEHR you can associate a LOINC code to a result. For Meaningful Use Stage 1 you will not need to associate LOINC codes to all of your results, just those that are required for specify Quality Measures. The following results will need to be mapped to their appropriate LOINC Values. Represents this result value Combined Cholesterol score Chlamydia Ejection Fraction Group A Streptococcus Test Gleason Score HIV Screening Hemoglobin A1c HDL Cholesterol score LDL Cholesterol score LDL Laboratory Test PAP Test Pregnancy Test Prostate Specific Antigen Test Triglyceride Rh State Mother To review further information on LOINC: http://loinc.org/ How to Associate a LOINC Code to a Resultable Item Resultable Item Dictionary 1. Login with access to TWAdmin 2. Go to Dictionaries Menu 3. Select Resultable Item 4. Search for the appropriate result 5. Select the button next Copyright 2011 Allscripts Healthcare Solutions, Inc. 7

6. This will pull up a Search Window 7. Ideally, enter the LOINC code to search by code 8. Click on the Binoculars 9. Select the appropriate LOINC Code 10. Click Ok 11. Click on Save (now you have successfully assigned a LOINC Code to a Result) *If you find you do not see any results values in the search window, please put in a ticket to your support representative asking to populate the LOINC table. Starter Set Migration Tool (SSMT) 1. Follow Steps in SSMT User Guide located in SalesForce for basic use of SSMT Product Documentation Allscripts Enterprise EHR SSMT & CMT All Types Starter_Set_Migration_Tool_User_Guide_V11.2_EnterpriseEHR.pdf 2. Once logged in choose SSMT Content Category= RID- Resulable Item a. Choose appropriate Classification b. Extract and copy into excel c. Update Column I LOINCCode = LOINC Code IMPORTANT NOTICE: It is the client s responsibility to ensure that the meaningful use ( MU ) reports generated through use of Allscripts EHR software accurately capture and document all required data and ultimately meet the client s MU reporting, records, and other needs. Allscripts is not responsible for the accuracy or completeness of such reports (or any particular data result), which is dependent, in part, on (a) the proper implementation, configuration, deployment, and use of the associated certified Allscripts EHR software and workflows in accordance with Allscripts recommendations at all times during the reporting period, (b) strict adherence to the instructions specified in the associated Allscripts documentation, (c) client s collection of complete and accurate source data on which such reports are based, (d) client s proper and timely entry of all such data into the Allscripts prescribed database for the corresponding certified Allscripts EHR software ( Allscripts Copyright 2011 Allscripts Healthcare Solutions, Inc. 8

Database ), and (e) the proper design and configuration of such reports to capture all necessary data elements. Such reports are not designed to aggregate or account for electronic or other data from sources outsides of the Allscripts Database. Depending on the MU measure being reported on, the client may need to aggregate report data with additional data regarding unique patients whose information is not maintained in the Allscripts Database. Such reports may not identify whether the client is eligible for a potential exclusion of any given MU objective/measure from the client s MU requirements. The client is responsible for determining whether any such exclusion applies. Copyright 2011 Allscripts Healthcare Solutions, Inc. 9