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  1. eCQM Issue Tracker
  2. CQM-587

CLONE - Capture of 'prior to admission' elements in STK, VTE measures

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    • Icon: Implementation Problem Implementation Problem
    • Resolution: Answered
    • Icon: Blocker Blocker
    • Certification, Measure
    • None
    • Harshad Patil
    • 6096474490
    • CitiusTech
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      Your issue raises a number of questions, some are specific to the certification procedure, and others more general about the MU2 eCQMs.

      In general, the measures relate to elements that are captured within a provider's EHR as part of a patients' encounters with that provider. There is no assumption of HIE with other providers to learn about treatment at other facilities.

      If information is known (e.g., the palliative care example from STK2) it can be used, and often this is part of exclusion/exception logic.

      The one exception to the general rule is in CMS91/NQF0437 where it is anticipated that the onset of stroke symptoms prior to admission are recorded. It is our understanding that this is common practice.

      Regarding the Cypress test cases used in certification of the EH measures, with the exception of the stoke symptoms cited above, all data elements are within the bounds of an inpatient encounter.
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      Your issue raises a number of questions, some are specific to the certification procedure, and others more general about the MU2 eCQMs. In general, the measures relate to elements that are captured within a provider's EHR as part of a patients' encounters with that provider. There is no assumption of HIE with other providers to learn about treatment at other facilities. If information is known (e.g., the palliative care example from STK2) it can be used, and often this is part of exclusion/exception logic. The one exception to the general rule is in CMS91/NQF0437 where it is anticipated that the onset of stroke symptoms prior to admission are recorded. It is our understanding that this is common practice. Regarding the Cypress test cases used in certification of the EH measures, with the exception of the stoke symptoms cited above, all data elements are within the bounds of an inpatient encounter.

      Most of the CQMs consider certain data elements which are effective before the patient was admitted.
      E.g. :-
      STK 2
      "Occurrence A of Intervention, Order: Palliative Care" starts before or during "Occurrence A of Encounter, Performed: Inpatient Encounter"

      STK 3
      "Procedure, Performed: Atrial Ablation" starts before start of "Occurrence A of Encounter, Performed: Inpatient Encounter"

      and there are other such examples.

      Does CMS expect hospitals to consider only those elements which were captured during the patient's prior encounters with the same hospital, or from prior encounters belonging to other hospitals as well? The only place they might capture labs and meds done prior to admission from MD office or other hospital might be in scanned documents from other provider or potentially in free text note from MD or an answer provided by the patient. In those cases, it is very difficult to capture the exact code and dates and represent them in the QRDA Category I.

      During the certification, will a vendor receive patient data from Cypress which will mandate such 'prior-to-admission' data entry? If an EHR is not able to capture these concepts, will it be regarded as a failure?

            kevin.larsen Kevin Larsen (Inactive)
            cmccorkle Carla McCorkle (Inactive)
            Deborah Krauss (Inactive), Harshad Patil (Inactive), Terry Moore (Inactive)
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