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  1. eCQM Issue Tracker
  2. CQM-1080

IQR VTE emeasure submission

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      When submitting VTE measures electronically, your organization should rely on the eCQM specifications. Similarly to the chart-abstracted measure, the eCQM specifications for VTE-1 and VTE-2 require that when a patient receives no VTE prophylaxis, there is a documented reason for both mechanical and pharmacological prophylaxis. Please consult the latest eCQM specifications (https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/ecqm_library.html​) for more details on how this is accomplished in the eCQM constructs.

      For certification, the intent is that clinicians and users have the ability to enter any data which should pull the patients into or out of the denominator and numerator. This could be accomplished for this set of exclusions, for example, by providing a check box that says "reason for no prophylaxis" and then allowing a drop down of choices or even a text box that is mapped to specific allowed reasons. Alternatively, it would be appropriate to also look at an active medication list to exclude the order from an order set or to turn off clinical decision support. If a system is not capable of recording the exclusions in the measure, it would not be considered to be compliant with certification to this measure, even though this datatype may not have been tested in the past. However, it is not clear how your particular system is recording the reasons after the fact.

      The measure report does require that you be specific in listing a reason for not including either type of prophylaxis and in fact only excludes patients who have reasons for both documented. The idea being that patients who cannot receive pharmacologic prophylaxis can often receive mechanical prophylaxis and occasionally vice versa and therefore not providing both is usually inappropriate.

      As mentioned above, the IQR and MU system will accept the measure as specified, and in this case, the documentation required in the measure will be accepted as documented in the measure logic and its associated value sets/data elements.
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      When submitting VTE measures electronically, your organization should rely on the eCQM specifications. Similarly to the chart-abstracted measure, the eCQM specifications for VTE-1 and VTE-2 require that when a patient receives no VTE prophylaxis, there is a documented reason for both mechanical and pharmacological prophylaxis. Please consult the latest eCQM specifications ( https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/ecqm_library.html ​) for more details on how this is accomplished in the eCQM constructs. For certification, the intent is that clinicians and users have the ability to enter any data which should pull the patients into or out of the denominator and numerator. This could be accomplished for this set of exclusions, for example, by providing a check box that says "reason for no prophylaxis" and then allowing a drop down of choices or even a text box that is mapped to specific allowed reasons. Alternatively, it would be appropriate to also look at an active medication list to exclude the order from an order set or to turn off clinical decision support. If a system is not capable of recording the exclusions in the measure, it would not be considered to be compliant with certification to this measure, even though this datatype may not have been tested in the past. However, it is not clear how your particular system is recording the reasons after the fact. The measure report does require that you be specific in listing a reason for not including either type of prophylaxis and in fact only excludes patients who have reasons for both documented. The idea being that patients who cannot receive pharmacologic prophylaxis can often receive mechanical prophylaxis and occasionally vice versa and therefore not providing both is usually inappropriate. As mentioned above, the IQR and MU system will accept the measure as specified, and in this case, the documentation required in the measure will be accepted as documented in the measure logic and its associated value sets/data elements.

      Dont know if this is correct to submit here but I submitted the following ? to QNET and they referred me to your website. Here is the ?.....This is a very broad question. I am working with an internal MU2 group. The consensus is that once IQR vte core measure set is electronically submitted, it will adopt MU guidelines. The group is in the process of looking at how orders should go into EPIC. There is a "reason for no VTE" order that we use currently and if a pt. does not have VTE ppx on HD 0 or 1 according to MU, if that order is on the chart it is enough to pass the measure VTE-1. THere are also available in Epic orders that read "reason for no VTE ppx-pharmacologic" and "reason for no VTE ppx-mechanical". My IQR hat says we should have those two orders because in the IQR world you need a reason for both mech and pharm. ppx not given if pt did not receive ppx on day 0 or 1 (and they are high risk).

      The broad question is
      1) when IQR VTE set is submitted via emeasure is it going to follow MU guidelines?
      2) when IQR VTE is emeasure is it going to follow IQR current guidelines?
      3) Are we going to have to distinguish between the two- MU/IQR?

      Again the consensus is we will submit MU and that covers our requirements for IQR as well even though there are differences in the guidelines. I would like to see us build up front the necessary orders instead of waiting until the 11th hour and then need to scramble and put orders in to meet IQR requirements. For whatever reason, I just cannot seem to understand how MU and IQR VTE sets are going to align with current guidelines? Before I spend lots of time and effort trying to convince people to include IQR VTE type orders and documentation up front, it would be nice to know if IQR VTE emeasure submission is going to disregard the current IQR guidelines and adopt MU which are less strict than IQR for the most part?

            mdardis Michelle Dardis (Inactive)
            kstadler@uwhealth.org Karla Stadler (Inactive)
            carol (Inactive), Michelle Dardis (Inactive), Rabia Khan (Inactive), Rute Martins (Inactive), Sharon J. Giarrizzo-Wilson (Inactive)
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