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  1. eCQM Issue Tracker
  2. CQM-5078

Unable to Implement CMS 996

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    • OQR eCQMs
    • Status: Closed
    • Moderate
    • Resolution: Answered
    • None
    • None
    • Hi, we are trying to implement CMS 996 based on the published specification (eCQI) and are unable to do so. See description below for details and please advise on how to move forward. Thanks!

    Description

      We can't do this measure as it is currently written.
      The CQL expression

      ```

      /Active and Recent Bleeding/

        or exists ( ["Encounter, Performed": "Active Bleeding or Bleeding Diathesis (Excluding Menses) (01)"] activebleed

            where activebleed.relevantPeriod during "ED Encounter".relevantPeriod

        )

      ```

      does not work as intended, it should have been written using a ‘with’ relationship, like this:

      ```

      or exists ( ["Encounter, Performed": "Active Bleeding or Bleeding Diathesis (Excluding Menses) (01)"] activebleed

      with ("ED Encounter") edencounter

        such that activebleed.relevantPeriod during edencounter.relevantPeriod

          )

      ```

      The problem is the “ED Encounter”.relevantPeriod member access expression.  The ‘relevantPeriod’ property is being accessed from the “ED Encounter” expression, which returns a list of ED Encounters.  CQL has an implicit demotion from a list to a singleton, but there will be patients with more than one ED Encounter in the measurement period, so that will cause run time errors.

      I looked into how the CQL -> ELM translator is working for Bonnie and the MAT, but that is converting this statement to an “In” expression.  An “In” checks for membership using equality semantics.  In other words the relevantPeriod of the active bleeding encounter and the ED encounter would have to be 100% identical for the expression to return true and place the patient into the denominator exclusions.  When I tested this in Bonnie that is the behavior we see.

       

       

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            ednaboon@gmail.com Edna Boone
            kbeatson123 Kristen Beatson
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