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  2. CQM-6876

Retro Documentation of PC data eCQM PC02/07 Data

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      Thank you for your question about CMS334/PC-02 Cesarean Birth and CMS1028v2/PC-07 Severe Obstetric Complications. Both measure specifications consider the assessment time, as opposed to the author time or the timestamp when data was entered into the system. For these measures, the end of the timeframe in question is the discharge time from inpatient hospitalization.
      The measure specifications have been finalized by CMS, and therefore, no modifications to the measure logic should be made.

      Retrospective charting and associated timelines related to the delivery encounter is a question for your IT department, EHR vendor and clinical partners. We are unable to provide specific guidance related to the conversion of retrospective data or backfills.
      Show
      Thank you for your question about CMS334/PC-02 Cesarean Birth and CMS1028v2/PC-07 Severe Obstetric Complications. Both measure specifications consider the assessment time, as opposed to the author time or the timestamp when data was entered into the system. For these measures, the end of the timeframe in question is the discharge time from inpatient hospitalization. The measure specifications have been finalized by CMS, and therefore, no modifications to the measure logic should be made. Retrospective charting and associated timelines related to the delivery encounter is a question for your IT department, EHR vendor and clinical partners. We are unable to provide specific guidance related to the conversion of retrospective data or backfills.
    • Not measure related
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    • CMS0334v5
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      We use a GE software (which doesn't communicate with our main EHR) along with paper documentation in our Women Hospital. Some of our data is retro-actively documented into our EMR.
       
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      We use a GE software (which doesn't communicate with our main EHR) along with paper documentation in our Women Hospital. Some of our data is retro-actively documented into our EMR.  

      I read from a Q&A documentation following a eCQM webinar that "Gestational age should be documented 24 hours or less before or on the delivery date/time. As mentioned in the webinar, the logic distinguishes between when an assessment is documented in the EHR (author dateTime) and when an assessment is performed (relevant dateTime). So, if you assess a patient’s gestational age at 0200, patient delivers at 0230, and you don’t document until 0300, the assessment relevant dateTime should be mapped to 0200 which is prior to the delivery time. Additionally, some EHR’s calculate gestational age automatically whereby the gestational age may continue to advance after delivery. Therefore, the logic specifically looks for a time prior to or on delivery. We are considering adding additional logic to the measure which would include gestational age assessments performed after delivery but on the same day of delivery.”

      Is this applicable to all elements. If we retroactively document in our EHR at a later date and time the information found on the paper charts, will the fields be accepted, like the Gestational age? Or is there a hard stopped to the timeframe in which retro-inputted data can be placed? 

            JLeflore Mathematica EH eCQM Team
            hhyland Homyo Hyland
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