Updated solution: 05/30/2017: This issue was corrected in the annual update to include substance allergy datatype. Original response: Measure developers are encouraged to limit adding, altering or removing data elements during the annual update process. A data element with the QDM Category and Data Type ‘Medication, Allergy’ or ‘Medication, Adverse Event’ would require RxNorm – but since an egg allergy is not a medication, ‘Substance, Allergy’ or ‘Substance, Adverse Event’ is the more appropriate QDM Category and Data Types and would be captured in SNOMED-CT, per the CMS MMS Blueprint. We can consider adding this during the next cycle of annual updates, if this would produce valid coding for a data element such as this and is considered within the scope of allowed changes. Feel free to submit feedback in the "Comments" section of this ticket regarding what should be included.

Brief description of the measure CMS147 looks at the percentage of patients aged 6 months and older seen for at least two visits or at least one preventive visit during the measurement period and seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization. It has medical, patient and system reason denominator exceptions.   Description of the issue and rationale for the change Allergy to egg is one of the allowable medical exceptions for not receiving influenza immunization. In the current measure specification, allergy to egg is specified as a diagnosis using ICD-9-CM, ICD-10 CM, and SNOMED CT coding systems. However, based on the feedback received from the field, egg allergy is not always captured as a diagnosis in the EHR system. Commenters suggested incorporating other QDM datatypes, for instance, “Medication, Allergy” and “Substance, Allergy,” to specify an allergy to egg.   Current logic: o OR: § AND: "Occurrence A of Diagnosis: Allergy to Eggs" overlaps "Measurement Period" § AND NOT: "Occurrence A of Diagnosis: Allergy to Eggs" > 89 day(s) starts after start of "Measurement Period" § AND NOT: "Occurrence A of Diagnosis: Allergy to Eggs" <= 89 day(s) ends after start of "Measurement Period" Proposed solution and goal of CRP review PCPI seeks feedback on the following proposed changes to the measure: 1.) PCPI proposes to introduce additional logic in the denominator exception using QDM datatype “Substance, Allergy” to provide an alternate option to capture an egg allergy. Current logic: o OR: § AND: "Occurrence A of Diagnosis: Allergy to Eggs" overlaps "Measurement Period" § AND NOT: "Occurrence A of Diagnosis: Allergy to Eggs" > 89 day(s) starts after start of "Measurement Period" § AND NOT: "Occurrence A of Diagnosis: Allergy to Eggs" <= 89 day(s) ends after start of "Measurement Period" Proposed logic o OR: § AND: "Occurrence A of Diagnosis: Allergy to Eggs" overlaps "Measurement Period" § AND NOT: "Occurrence A of Diagnosis: Allergy to Eggs" > 89 day(s) starts after start of "Measurement Period" § AND NOT: "Occurrence A of Diagnosis: Allergy to Eggs" <= 89 day(s) ends after start of "Measurement Period" o OR: § AND: "Occurrence A of Substance, Allergy: Eggs" overlaps "Measurement Period" § AND NOT: " Occurrence A of Substance, Allergy: Eggs" > 89 day(s) starts after start of "Measurement Period" § AND NOT: " Occurrence A of Substance, Allergy: Eggs" <= 89 day(s) ends after start of "Measurement Period"   2.) PCPI proposes to use Lantana’s “Eggs” value set (2.16.840.1.113883.3.666.5.2443) existing in the VSAC, which is not currently used in Stage 2 measures. The value set contains the following SNOMED CT concepts: 102263004 Eggs (edible) (substance) 226881001 Dried egg (substance) 226885005 Raw egg (substance) 229955000 Dried egg white (substance) 256442007 Egg yolk (substance) 256443002 Egg white (substance) 286550009 Hen's egg (substance) 303300008 Egg protein (substance) 414074006 Egg product (substance)   We would apply this value set to the proposed logic addition noted in the previous step, using the QDM Category/Datatype “Substance, Allergy”. PCPI seeks comments on the proposed changes, as well as proposed coding to include for the purposes of the measure.

​1.) PCPI proposes to introduce additional logic in the denominator exception using QDM datatype “Substance, Allergy” to provide an alternate option to capture an egg allergy. Current logic: o OR: § AND: "Occurrence A of Diagnosis: Allergy to Eggs" overlaps "Measurement Period" § AND NOT: "Occurrence A of Diagnosis: Allergy to Eggs" > 89 day(s) starts after start of "Measurement Period" § AND NOT: "Occurrence A of Diagnosis: Allergy to Eggs" <= 89 day(s) ends after start of "Measurement Period" Proposed logic o OR: § AND: "Occurrence A of Diagnosis: Allergy to Eggs" overlaps "Measurement Period" § AND NOT: "Occurrence A of Diagnosis: Allergy to Eggs" > 89 day(s) starts after start of "Measurement Period" § AND NOT: "Occurrence A of Diagnosis: Allergy to Eggs" <= 89 day(s) ends after start of "Measurement Period" o OR: § AND: "Occurrence A of Substance, Allergy: Egg Substance" overlaps "Measurement Period" § AND NOT: " Occurrence A of Substance, Allergy: Egg Substance" > 89 day(s) starts after start of "Measurement Period" § AND NOT: " Occurrence A of Substance, Allergy: Egg Substance" <= 89 day(s) ends after start of "Measurement Period"   2.) PCPI proposes to use Lantana’s 'Egg Substance' value set (2.16.840.1.113883.3.666.5.2443) existing in the VSAC, which is not currently used in Stage 2 measures. The value set contains the following SNOMED CT concepts:             102263004 Eggs (edible) (substance)             226881001 Dried egg (substance)             226885005 Raw egg (substance)             229955000 Dried egg white (substance)             256442007 Egg yolk (substance)             256443002 Egg white (substance)             286550009 Hen's egg (substance)             303300008 Egg protein (substance)             414074006 Egg product (substance)  3.) PCPI will create a Grouping value set for the 'Egg Substance' value set.