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  1. eCQM Issue Tracker
  2. CQM-2216

Need a more effecient way to map "Reason to NOT" to meet physician workflow

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    • Kim Crady
    • 904-321-3735
    • Baptist Medical Center Nassau
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      Thank you for your question. We understand that your vendor system has capabilities that many other systems do not. The eCQM Logic and Implementation Guidance, available on the eCQI Resource Center, directs implementers to use null values to replace a specific code associated with a value set when describing activities that were negated or “not done.” We refer you to the implementation guidance for additional details.
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      Thank you for your question. We understand that your vendor system has capabilities that many other systems do not. The eCQM Logic and Implementation Guidance, available on the eCQI Resource Center, directs implementers to use null values to replace a specific code associated with a value set when describing activities that were negated or “not done.” We refer you to the implementation guidance for additional details.
    • Physician workflow efficiency and compliance and ease and consistency of mapping eCQM’s for the situation for all “Reason for NOT’s”

      Looking at the" Reasons for Not" for the eCQMs for Medications, such as in STK 5 or VTE 1 - or in "Reasons for Not" in VTE 1 for SCD's not applied ---- we have orderables built that include the reason for not ordering the specific medication based on a specific reason (and the physician chooses from many choices in a detailed drop down based on the patient individuality).

      The workflow at our Health System is for physicians to use these orderables as documentation and enter either as single orders or as part of a PowerPlan.

      The especifications manuals (for many eCQM's) do not appear to allow for orders to be used this way. Therefore, the vendors do not have this option in their filters for us to map too. (only specific places (or filters) orders may be used as in comfort measures or labs). So there is precedent for orders to be used in these eCQM's as documentation.

      In a document titled "eCQM Negations" near the bottom it states: "When reporting patient, medical, or system reasons, CMS expects providers using these concepts to have a documented reason for these exclusions and could be expected to demonstrate the relevant justification if audited." The Referenced link from which the "eCQM Negations" Document was derived is here:
      https://jira.oncprojectracking.org/browse/CQM-1835

      By using orders with reasons attached (in the details) this accomplishes both.

      Null values or not - using orderables will still allow for this workflow to be an efficient way of capturing the data that is required. The action for "reason for not" AND the required documentation of the actual reason that CMS will be looking for when / if audited. This would apply to all reasons for not - including those that occur inpatient, at discharge, or are medications or anything else.

      We would like to request that the use of "orderables" be added to the espec manuals wherever possible to enhance compliance to meet physician's workflow for any eCQM's that meet the criteria for "Reason to NOT". By adding this to the especs, our vendor would be able to add filters to allow these orderables to be used.

      Please let me know if this is not the correct place to post this request. I need to know an answer to this request soon and would like to submit to the correct authority for resolution.
      (Also posted in another location in JIRA)
      Thanks

            JLeflore Joelencia Leflore
            kim.crady kim crady
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