Hello JIRA,

We have outstanding questions related to the OP STEMI Measure.

According to the current Specs- This measure is creating failures even though current best practice is being provided to patients.

I am going to list these all here as we need guidance on how we are to proceed for 2024 mapping, AND Future specification considerations.

1. (See CQM- 6164) At our health system, we transfer patients to a hospital that can preform the PCI procedure. If the patient received the fibrinolytic at the sending facility – It is not being captured at the receiving facility because there are only RXNORMs in the value set. This means the data element is captured when it is “administered”.  We would not give fibrolytic’s again at the receiving facility, Nor rush them to PCI procedure.

Can you please consider using ICD10 codes to help capture this workflow?

ICD10   Z92.82 Status post administration of TPA in a different facility within the last 24 hours prior to admission to current facility.

This should be added to the value set to help reflect care given to patients and improve outcomes on this measure.

            We currently cannot “Stop” the measure process in a transfer to a different facility – especially if the facilities have different CCN’s.

In August, Cathy wrote: The patient is being appropriately captured per the current logic.

We will be working to refine the logic for transfer patients in the 2024 annual updates with the expectation to exclude transfers added to the logic. Generally, the annual update process takes several months to be approved and rolled out.

 ** We just need to make sure we are mapping correctly and Not worry about the “Transfers” if this is indeed going to be in the upcoming specs.

 * (See CQM-6163)* Hello JIRA,

We have patients whose PCI procedure are overlapping times with the ED encounter or fall into the Inpatient encounter.

Description of issue:

The specs read:

Within 24 hours before start of ED encounter and during ED encounter:

• Suspected aortic dissection
• Severe neurologic impairment
• Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device
• Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation
• Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR

 The issues here are:

• Balloon pumps are never placed in the ED.
• Cardiac arrest sometimes occurs during the procedure and NOT in the ED.
• Intubation sometimes occurs during the PCI procedure NOT in the ED.

Unless there is clarity here on this timing. Some patients will fall into the “ED During” timing. Others will fall into the Inpatient timing.  There is no consistency and some patients will be excluded / or fall into denominator only.

Should there be a Start and stop date/ time for PCI procedure in addition to the other date/times?

There was a great deal of conversation on this ticket. Most of it was not written into the specification- but you have said what the “intent” might be.

We understand how the chart abstraction measure is written, and know that in a perfect world there are discrete fields for what you would LIKE to see.  However, that is not the case.

I also could not find, in the eCQM specs what Cathy wrote on the note from the clinical expert  regarding device deployment time and door to balloon verbiage.

As I wrote in the original ticket:

There is no mention of balloon inflation time, or crossing the lesion or any or of the terms used as with chart abstraction STEMI measure in the electronic measure specifications.

I question this because there are also NO exclusions that would normally apply if using a balloon inflation time such as:

(These possible exclusions)  In this case- there is no way to capture a balloon time if the balloon was not used/inflated, nor the Time of these exclusions.

No blockage found

Clear coronary arteries

No ST elevation on first EKG

 Please advise...  I have discussed this with our vendor who agrees the spec reads as "case start time."

Be aware that we would have to change workflows across multiple hospitals to capture a balloon time by first creating a discrete field and then having someone enter the “Balloon time” at the end of every case.

1. (CQM-6162) Hello JIRA,

Patients who are on anticoagulants at home are not being captured due to the value set containing all RXNORM codes.  This means the anticoagulated medication has to be “administered” in the ED hospital encounter –

The spec’s read:

At the start of ED encounter:

• Bleeding or bleeding diathesis (excluding menses)
• Known malignant intracranial neoplasm (primary or metastatic)
• Known structural cerebral vascular lesion (e.g., AVM)
• Advanced dementia
• Pregnancy
• Active oral anticoagulant therapy

That does not happen in the ED. There are ICD 10 codes that reflect Long term use of anticoagulants that are not in the value set.

For example:     ICD10  Z79.01 Long term (current) use of anticoagulants

Please address this in future releases.

I apologize for re-introducing these issues. But, in order to make sure we are mapping these correctly for 2024- we need to start now.  It is very important to get these answers and not just rehash what is in the eCQM specs.  These are issues that the current specifications do not take into consideration – but need to be addressed.

Thanks, Kim