Brief Description of Measure:
​CMS529/HWR: Core Clinical Data Elements for the Hybrid Hospital- Wide Readmission (HWR) Measure with Claims and Electronic Health Record Data:
This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWR outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from encounters for adult Medicare Fee-For-Service patients admitted to acute care short stay hospitals.

CMS844/HWM: Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM):
This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from encounters for adult Medicare Fee-For-Service patients admitted to acute care short stay hospitals.

Description of Issue:
​Currently, CMS 529 and CMS 844 (Hybrid HWR and Hybrid HWM) require submission of appropriate core clinical data elements (CCDE), or laboratory and vital sign results, with associated units of measurement. The MAT specifications do not specify which units should be submitted for each CCDE. The original rationale for this decision was to allow for flexibility, to allow implementers to submit data in whichever unit the EHR stored the data in. However, there have been many stakeholder questions requesting guidance on unit of measurement. We aim to add additional clarity into the MAT specifications surrounding unit of measurement for CCDE, and are requesting feedback on the draft additional guidance.
 
To note, in the 2022 CMS QRDA I Implementation Guide, the following guidance is stated:
"For hybrid measure voluntary submissions, it is recommended for the submitters to submit “unit” of the laboratory test result or physical exam result for each of the core clinical data elements using appropriate UCUM codes, but submitters may submit units in the forms used in their EHRs for the 2022 reporting period. "

Proposed Solution:
We request feedback on adding the below language and information to the guidance section of the MAT Header for Hybrid HWR and Hybrid HWM regarding unit of measure for each CCDE. We also request feedback on the included units listed for each CCDE:
For the HWM measure, add the following guidance: 
For each CCDE, please report values using one of the appropriate units of measurement listed below, which represent valid UCUM codes:Platelet: 10*3/uL (conventional unit); 10*9/L (SI unit)Heart rate:

{Beats}/minSystolic blood pressure: mm[Hg]Temperature: Cel; [degF]Oxygen saturation: %{Oxygen}Hematocrit: %White blood cell count: {cells}/uL (cells per microliter); 10*3/uL (conventional unit); 10*9/L (SI unit)Sodium: mEq/L (conventional US unit); mmol/L (SI international unit)Bicarbonate: mEq/L (conventional US unit); mmol/L (SI international unit)    Creatinine: mg/dL (conventional US unit); umol/L (SI international unit)”
For the HWR measure, add the following guidance: 
For each CCDE, please report values using one of the appropriate units of measurement listed below, which represent valid UCUM codes:
 Respiratory rate: {Breaths}/minWeight: kg; [lb_av]Potassium: mEq/L (conventional US unit); mmol/L (SI international unit)    Glucose: mg/dL (conventional US unit); mmol/L (SI international unit)Heart rate: {Beats}

/minSystolic blood pressure: mm[Hg]Temperature: Cel; [degF]Oxygen saturation: %

{Oxygen}

Hematocrit: %White blood cell count:

{cells}

/uL  (cells per microliter); 10*3/uL (conventional unit); 10*9/L (SI unit)Sodium: mEq/L (conventional US unit); mmol/L (SI international unit)Bicarbonate: mEq/L (conventional US unit); mmol/L (SI international unit)    Creatinine: mg/dL  (conventional US unit); umol/L (SI international unit)
We also request feedback on the specific questions related to unit of measurement:
1. For platelet count: are the units listed (10*3/uL and 10*9/L) the appropriate units for reporting platelet count (i.e. for reporting 'Platelets /volume in Blood' for a platelet value of 271.0 x 10*3/uL)? Is there an addition UCUM code for ‘count’ that should be included?
2. For weight: should grams (g) also be listed as an appropriate unit for reporting weight?
3. Are there any other suggestions regarding how to incorporate this guidance into the measure specifications?

Rationale for Change:
​Provide clarification for which units of measurement are acceptable for each CCDE value.