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Proposed solution
REMOVE THE FOLLOWING DENOMINATOR EXCEPTION LANGUAGE:
Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system).
CURRENT LOGIC:
define "Denominator Exceptions 1"
"Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or [...]
or "Has Medical Patient or System Reason for Not Ordering Beta Blocker for LVSD"
or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"
define "Denominator Exceptions 2"
"Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
or [...]
or "Has Medical Patient or System Reason for Not Ordering Beta Blocker Therapy"
or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"
define "Has Medical Patient or System Reason for Not Ordering Beta Blocker for LVSD"
exists ["Medication, Not Ordered": "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered
with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
such that NoBetaBlockerForLVSDOrdered.authorDatetime during CADEncounterModerateOrSevereLVSD.relevantPeriod
where ( NoBetaBlockerForLVSDOrdered.negationRationale in "Medical Reason"
or NoBetaBlockerForLVSDOrdered.negationRationale in "Patient Reason"
or NoBetaBlockerForLVSDOrdered.negationRationale in "System Reason" )
define "Has Medical Patient or System Reason for Not Ordering Beta Blocker Therapy"
exists ["Medication, Not Ordered": "Beta Blocker Therapy"] NoBetaBlockerOrdered
with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
such that NoBetaBlockerOrdered.authorDatetime during CADEncounterMI.relevantPeriod
where ( NoBetaBlockerOrdered.negationRationale in "Medical Reason"
or NoBetaBlockerOrdered.negationRationale in "Patient Reason"
or NoBetaBlockerOrdered.negationRationale in "System Reason" )
PROPOSED LOGIC:
define "Denominator Exceptions 1"
"Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or [...]
or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"
define "Denominator Exceptions 2"
"Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
or [...]
or "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"
define "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
exists ["Medication, Not Ordered": "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered
with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
such that NoBetaBlockerForLVSDOrdered.authorDatetime during CADEncounterModerateOrSevereLVSD.relevantPeriod
where ( NoBetaBlockerForLVSDOrdered.negationRationale in "Medical Reason"
or NoBetaBlockerForLVSDOrdered.negationRationale in "Patient Reason" )
define "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
exists ["Medication, Not Ordered": "Beta Blocker Therapy"] NoBetaBlockerOrdered
with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
such that NoBetaBlockerOrdered.authorDatetime during CADEncounterMI.relevantPeriod
where ( NoBetaBlockerOrdered.negationRationale in "Medical Reason"
or NoBetaBlockerOrdered.negationRationale in "Patient Reason")
REMOVE VALUE SET:
System Reason (OID: 2.16.840.1.113883.3.526.3.1009)
Rationale for change
Due to the wide availability of beta-blocker therapy, the system reason exception is no longer relevant.
Show
Proposed solution
REMOVE THE FOLLOWING DENOMINATOR EXCEPTION LANGUAGE:
Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system).
CURRENT LOGIC:
define "Denominator Exceptions 1"
"Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or [...]
or "Has Medical Patient or System Reason for Not Ordering Beta Blocker for LVSD"
or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"
define "Denominator Exceptions 2"
"Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
or [...]
or "Has Medical Patient or System Reason for Not Ordering Beta Blocker Therapy"
or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"
define "Has Medical Patient or System Reason for Not Ordering Beta Blocker for LVSD"
exists ["Medication, Not Ordered": "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered
with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
such that NoBetaBlockerForLVSDOrdered.authorDatetime during CADEncounterModerateOrSevereLVSD.relevantPeriod
where ( NoBetaBlockerForLVSDOrdered.negationRationale in "Medical Reason"
or NoBetaBlockerForLVSDOrdered.negationRationale in "Patient Reason"
or NoBetaBlockerForLVSDOrdered.negationRationale in "System Reason" )
define "Has Medical Patient or System Reason for Not Ordering Beta Blocker Therapy"
exists ["Medication, Not Ordered": "Beta Blocker Therapy"] NoBetaBlockerOrdered
with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
such that NoBetaBlockerOrdered.authorDatetime during CADEncounterMI.relevantPeriod
where ( NoBetaBlockerOrdered.negationRationale in "Medical Reason"
or NoBetaBlockerOrdered.negationRationale in "Patient Reason"
or NoBetaBlockerOrdered.negationRationale in "System Reason" )
PROPOSED LOGIC:
define "Denominator Exceptions 1"
"Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
or [...]
or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"
define "Denominator Exceptions 2"
"Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
or [...]
or "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"
define "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
exists ["Medication, Not Ordered": "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered
with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
such that NoBetaBlockerForLVSDOrdered.authorDatetime during CADEncounterModerateOrSevereLVSD.relevantPeriod
where ( NoBetaBlockerForLVSDOrdered.negationRationale in "Medical Reason"
or NoBetaBlockerForLVSDOrdered.negationRationale in "Patient Reason" )
define "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
exists ["Medication, Not Ordered": "Beta Blocker Therapy"] NoBetaBlockerOrdered
with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
such that NoBetaBlockerOrdered.authorDatetime during CADEncounterMI.relevantPeriod
where ( NoBetaBlockerOrdered.negationRationale in "Medical Reason"
or NoBetaBlockerOrdered.negationRationale in "Patient Reason")
REMOVE VALUE SET:
System Reason (OID: 2.16.840.1.113883.3.526.3.1009)
Rationale for change
Due to the wide availability of beta-blocker therapy, the system reason exception is no longer relevant.