Identification and Clarification for the CMS meaning "First"

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
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      Thank you for your question. The way the logic term first is used in different measures and within individual measures may vary based upon the context of other associated logic statements.
      For CMS249 to identify whether the patient was a smoker or consumed alcohol during the measurement period, the logic is looking for the first assessment performed during the measurement year where the patient is identified as a current tobacco smoker or the average number of drinks per day is more than two. Based on the requirement that the assessment have specific findings, first is not simply the first assessment, but is the first assessment with these specific findings. The context for how first is used for BMI is slightly different in that the measure logic is looking for the first exam performed during the measurement year with a BMI result, and then evaluating if that particular BMI meets a certain threshold. In this use of the term first the association with other logic is different and the measure is looking for the first exam. These are a couple of ways that first could be used in a measure, but in both cases the measure logic requires you to identify the first event that meets specific criteria.
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      Thank you for your question. The way the logic term first is used in different measures and within individual measures may vary based upon the context of other associated logic statements. For CMS249 to identify whether the patient was a smoker or consumed alcohol during the measurement period, the logic is looking for the first assessment performed during the measurement year where the patient is identified as a current tobacco smoker or the average number of drinks per day is more than two. Based on the requirement that the assessment have specific findings, first is not simply the first assessment, but is the first assessment with these specific findings. The context for how first is used for BMI is slightly different in that the measure logic is looking for the first exam performed during the measurement year with a BMI result, and then evaluating if that particular BMI meets a certain threshold. In this use of the term first the association with other logic is different and the measure is looking for the first exam. These are a couple of ways that first could be used in a measure, but in both cases the measure logic requires you to identify the first event that meets specific criteria.
    • CMS249v2/NQF472
    • Need clarification on the CMS meaning of "First" as it is confusing.

      Per this Jira case https://oncprojectracking.healthit.gov/support/browse/CQM-3578, the definition given to us by Jira for the CMS meaning of First was this _"We use "first" to indicate that there is at least one assessment during the measurement period.​ "_ The problems with this statement are there are many measures that use the word "First" and when to look for a true "First" event.

      The English definition for the word means this:

      First
      1.coming before all others in time or order; earliest; 1st.
      "his first wife"
      synonyms:earliest, initial, opening, introductory, original More

      2.foremost in position, rank, or importance.
      "the doctor's first duty is to respect this right"
      synonyms:foremost, principal, highest, greatest, paramount, top, topmost, utmost, uppermost, prime, chief, leading, main, major; very first one to happen or beginning instance of an event.

      Does the definition you gave for First only apply to CMS 249 or does it apply to all measures?
      How does an EHR know when CMS is truly looking for the very first instance of an event versus just any event when CMS uses the word "First"?

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Sarah Christie (Inactive)
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