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  2. CQM-6209

Follow up on Clarification for the Numerator criteria Logic of CMS816 (Hospital Harm - Severe Hypoglycemia )

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
    • Resolution: Answered
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      Thank you for your inquiry specific to CMS816v3 Hospital Harm – Severe Hypoglycemia.
       
      Regarding question 1: In your testcase scenario, the numerator is met. Although there is a glucose test with a result of 37 mg/dL on 5/2 at 11:00 followed by a glucose test with a result of >80 within 5 minutes (which is not a harm), there were 3 subsequent hypoglycemic events that qualify as a harm during the encounter.
       
      Regarding question 2: Your understanding is correct. ‘Glucose Test with Result Less Than 40’ returns the 4 labs you have listed, and the ‘Low Glucose Test Followed By Glucose Test Result Greater Than 80’ returns the 1 lab (2345-7) since it is followed by the glucose test >80 within 5 minutes.
      Regarding your statement on what is returned with the [LowGlucoseTest.id in "Low Glucose Test Followed By Glucose Test Result Greater Than 80".id] logic: To clarify, this piece of logic is part of the following definition which is used to help evaluate if the numerator is met:
       
      Severe Hypoglycemic Harm Event:
      "Glucose Test with Result Less Than 40" LowGlucoseTest
        where not ( LowGlucoseTest.id in "Low Glucose Test Followed By Glucose Test Result Greater Than 80".id )
       
      The intent is to capture and return glucose lab tests <40 that are not followed by a glucose lab test >80 (within 5 minutes). Using your scenario, the three lab tests that meet this criteria are returned: 40858-3, 41651-1, 1557-8, as seen in this excerpt from the Bonnie:
      [Laboratory Test, Performed: Glucose Lab Test Mass Per Volume
      START: 05/02/2012 11:10 AM
      STOP: 05/11/2012 11:30 PM
      CODE: LOINC 40858-3,
      Laboratory Test, Performed: Glucose Lab Test Mass Per Volume
      START: 05/02/2012 11:15 AM
      STOP: 05/11/2012 11:30 PM
      CODE: LOINC 41651-1,
      Laboratory Test, Performed: Glucose Lab Test Mass Per Volume
      START: 05/02/2012 11:20 AM
      STOP: 05/11/2012 11:30 PM
      CODE: LOINC 1557-8]
       
      Your understanding of the purpose of the “in” operator is correct. The “in” operator in the
      “( LowGlucoseTest.id in "Low Glucose Test Followed By Glucose Test Result Greater Than 80".id )” condition evaluates if a lab test in the ‘LowGlucoseTest’ list is also “in” the ‘Low Glucose Test Followed By Glucose Test Result Greater Than 80’ list.
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      Thank you for your inquiry specific to CMS816v3 Hospital Harm – Severe Hypoglycemia.   Regarding question 1: In your testcase scenario, the numerator is met. Although there is a glucose test with a result of 37 mg/dL on 5/2 at 11:00 followed by a glucose test with a result of >80 within 5 minutes (which is not a harm), there were 3 subsequent hypoglycemic events that qualify as a harm during the encounter.   Regarding question 2: Your understanding is correct. ‘Glucose Test with Result Less Than 40’ returns the 4 labs you have listed, and the ‘Low Glucose Test Followed By Glucose Test Result Greater Than 80’ returns the 1 lab (2345-7) since it is followed by the glucose test >80 within 5 minutes. Regarding your statement on what is returned with the [LowGlucoseTest.id in "Low Glucose Test Followed By Glucose Test Result Greater Than 80".id] logic: To clarify, this piece of logic is part of the following definition which is used to help evaluate if the numerator is met:   Severe Hypoglycemic Harm Event: "Glucose Test with Result Less Than 40" LowGlucoseTest   where not ( LowGlucoseTest.id in "Low Glucose Test Followed By Glucose Test Result Greater Than 80".id )   The intent is to capture and return glucose lab tests <40 that are not followed by a glucose lab test >80 (within 5 minutes). Using your scenario, the three lab tests that meet this criteria are returned: 40858-3, 41651-1, 1557-8, as seen in this excerpt from the Bonnie: [Laboratory Test, Performed: Glucose Lab Test Mass Per Volume START: 05/02/2012 11:10 AM STOP: 05/11/2012 11:30 PM CODE: LOINC 40858-3, Laboratory Test, Performed: Glucose Lab Test Mass Per Volume START: 05/02/2012 11:15 AM STOP: 05/11/2012 11:30 PM CODE: LOINC 41651-1, Laboratory Test, Performed: Glucose Lab Test Mass Per Volume START: 05/02/2012 11:20 AM STOP: 05/11/2012 11:30 PM CODE: LOINC 1557-8]   Your understanding of the purpose of the “in” operator is correct. The “in” operator in the “( LowGlucoseTest.id in "Low Glucose Test Followed By Glucose Test Result Greater Than 80".id )” condition evaluates if a lab test in the ‘LowGlucoseTest’ list is also “in” the ‘Low Glucose Test Followed By Glucose Test Result Greater Than 80’ list.
    • CMS0816v3
    • Delaying the Product development timeline and impacting the delivery of the release.

      Hi team,

      We have a follow up question to the solution provided for this ticket - https://oncprojectracking.healthit.gov/support/browse/CQM-6171

       

      Please consider the below scenario:

      ElementName ElementCode Starttime Endtime Result attribute value
      Encounter, Performed 8715000 2023-04-30 08:00:00.000 2023-05-11 14:00:00.000  
      Medication, Administered  
      1361493      		 2023-05-02 11:00:00.000 2023-05-11 14:00:00.000  
      Laboratory Test, Performed 2345-7 2023-05-02 11:00:00.000 2023-05-02 11:30:00.000 37
      Laboratory Test, Performed 2339-0 2023-05-02 11:05:00.000 2023-05-02 11:30:00.000 85
      Laboratory Test, Performed 40858-3 2023-05-02 11:10:00.000 2023-05-02 11:30:00.000 37
      Laboratory Test, Performed 41651-1 2023-05-02 11:15:00.000 2023-05-02 11:30:00.000 37
      Laboratory Test, Performed 1557-8 2023-05-02 11:20:00.000 2023-05-02 11:30:00.000 37

       

      1. Can you help us understand how the Numerator criteria is evaluated for this above-mentioned scenario. 
      2. As per understanding, 'Glucose Test with Result Less Than 40' should return the 4 labs (2345-7, 40858-3, 41651-1, 1557-8) and 'Low Glucose Test Followed By Glucose Test Result Greater Than 80' should return 1 lab (2345-7) since it is satisfying the 5 min difference with the FollowUpGlucose (2339-0). According to this, the condition [LowGlucoseTest.id in "Low Glucose Test Followed By Glucose Test Result Greater Than 80".id] will return False since all the ids of the 4 labs (2345-7, 40858-3, 41651-1, 1557-8) are not present in ids list of the latter, hence qualifying for the Numerator. We tried the same scenario in Bonnie which also resulted in Numerator true.

      Can you please help us understand the Numerator qualification in this scenario and if our understanding on the in operator is correct.

            JLeflore Joelencia Leflore
            SS056651 Shravanthi S (Inactive)
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