CMS 996v5 STEMI IPP Diagnosis Onset dateTime

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
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      Thank you for your inquiry regarding CMS996v5, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). A patient with a STEMI diagnosis may be captured in the measure in two ways. First, a STEMI diagnosis can be pulled directly from the ED encounter if a STEMI diagnosis was coded during the encounter, as indicated by the measure logic definition below.

       

      ED Encounter with Encounter Diagnosis of STEMI

      “ED Encounter During MP” EDEncounter

        with EDEncounter.diagnoses EncounterDiagnosis

         such that EncounterDiagnosis.code in “STEMI”

       

      Second, the patient can have a diagnosis pulled from a claim, problem list, or other source in the EHR as long as the prevalencePeriod of the STEMI diagnosis started during the ED encounter relevantPeriod. The definition describing this measure logic can be found below.

       

      ED Encounter with a Diagnosis of STEMI

      “ED Encounter During MP” EDEncounter

        with [“Diagnosis”: “STEMI”] DxSTEMI

         such that DxSTEMI.prevalencePeriod starts during EDEncounter.relevantPeriod

       

      To answer your first question, if the STEMI diagnosis is being pulled from the encounter diagnosis as depicted by the ED Encounter with Encounter Diagnosis of STEMI definition, the onset dateTime of the prevalencePeriod is not relevant; the patient would automatically get included in the initial population. In response to the second and third questions, if the STEMI diagnosis is being pulled from a source other than the encounter diagnosis, as depicted by the ED Encounter with a Diagnosis of STEMI definition, we recommend working with your EHR vendor to accurately document the prevalencePeriod onset dateTime and the author dateTime in the EHR, especially if there is uncertainty regarding the prevalencePeriod onset dateTime. We highlight that the QDM allows the author dateTime attribute to be retrieved when the start dateTime of a period (such as the prevalencePeriod) is not known. For more information, please see section 3.2 within the QDM 5.6 PDF found on the following webpage: https://ecqi.healthit.gov/sites/default/files/QDM-v5.6-508.pdf.

       

      We emphasize that the measure assesses time from ED arrival to time of appropriate treatment as defined by three numerator criteria: fibrinolytic therapy within 30 minutes of ED arrival, PCI within 90 minutes of ED arrival, or discharge to a PCI-capable Acute Care Facility within 45 minutes of ED arrival. Therefore, the clock for inclusion in the measure numerator would begin at ED arrival time, regardless of what time this particular patient received the STEMI diagnosis. We highlight that the intent of the measure is to ensure timely treatment of patients with a STEMI diagnosis in accordance with the measure Clinical Recommendation Statement section found on the eCQI Resource Center on the following webpage: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996v5.html.
      Show
      Thank you for your inquiry regarding CMS996v5, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). A patient with a STEMI diagnosis may be captured in the measure in two ways. First, a STEMI diagnosis can be pulled directly from the ED encounter if a STEMI diagnosis was coded during the encounter, as indicated by the measure logic definition below.   ED Encounter with Encounter Diagnosis of STEMI “ED Encounter During MP” EDEncounter   with EDEncounter.diagnoses EncounterDiagnosis    such that EncounterDiagnosis.code in “STEMI”   Second, the patient can have a diagnosis pulled from a claim, problem list, or other source in the EHR as long as the prevalencePeriod of the STEMI diagnosis started during the ED encounter relevantPeriod. The definition describing this measure logic can be found below.   ED Encounter with a Diagnosis of STEMI “ED Encounter During MP” EDEncounter   with [“Diagnosis”: “STEMI”] DxSTEMI    such that DxSTEMI.prevalencePeriod starts during EDEncounter.relevantPeriod   To answer your first question, if the STEMI diagnosis is being pulled from the encounter diagnosis as depicted by the ED Encounter with Encounter Diagnosis of STEMI definition, the onset dateTime of the prevalencePeriod is not relevant; the patient would automatically get included in the initial population. In response to the second and third questions, if the STEMI diagnosis is being pulled from a source other than the encounter diagnosis, as depicted by the ED Encounter with a Diagnosis of STEMI definition, we recommend working with your EHR vendor to accurately document the prevalencePeriod onset dateTime and the author dateTime in the EHR, especially if there is uncertainty regarding the prevalencePeriod onset dateTime. We highlight that the QDM allows the author dateTime attribute to be retrieved when the start dateTime of a period (such as the prevalencePeriod) is not known. For more information, please see section 3.2 within the QDM 5.6 PDF found on the following webpage: https://ecqi.healthit.gov/sites/default/files/QDM-v5.6-508.pdf .   We emphasize that the measure assesses time from ED arrival to time of appropriate treatment as defined by three numerator criteria: fibrinolytic therapy within 30 minutes of ED arrival, PCI within 90 minutes of ED arrival, or discharge to a PCI-capable Acute Care Facility within 45 minutes of ED arrival. Therefore, the clock for inclusion in the measure numerator would begin at ED arrival time, regardless of what time this particular patient received the STEMI diagnosis. We highlight that the intent of the measure is to ensure timely treatment of patients with a STEMI diagnosis in accordance with the measure Clinical Recommendation Statement section found on the eCQI Resource Center on the following webpage: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996v5.html .
    • CMS0996v5

      CMS 996v5: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)

      Regarding the IPP logic for "ED Encounter with STEMI Diagnosis" EDwSTEMI:

      ED Encounter with Diagnosis of STEMI

      • "ED Encounter During MP" EDEncounter
        with ["Diagnosis": "STEMI"] DxSTEMI
        such that DxSTEMI.prevalencePeriod starts during EDEncounter.relevantPeriod

      QDM DataType defines Diagnosis as:

      Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy).

      The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED CT, but diagnoses may also be encoded using ICD-9-CM (for historical data) and/or ICD-10-CM.

      Where prevalence period as:
      Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

      Timing: The prevalencePeriod references the time from the onset date to the abatement date.

      Questions:

      1. If patient gets admitted to the ED at 1/1/2025 at 1pm with present symptoms of STEMI and they indicate to have started at 10am, and the physician confirms the diagnosis of STEMI at 2pm would the prevalence period onset date and time be 1/1 at 2pm as that is what the definition of diagnosis states? If 2pm we would expect this patient to fall into the IPP for this measure correct? If this is not the expected outcome what would be and why?
      2. So typically onset of a problem or diagnosis would indicate when it started or when symptoms started or when the condition first became present for the patient. And many patients that qualify for this measures IPP will probably have a true "onset" of symptoms prior to admission to ED.  So does onset for this measure purpose prevalence period mean something slightly different? Should we look at onset as really the date/time the condition was confirmed or identified by the physician? 
      3. If we are supposed to be using the onset date/Time of symptoms, and using scenario as in #1, how would the physician know (or the patient remember) the specific timing of when the symptoms started?

            Assignee:
            Augustine Weber
            Reporter:
            Becky Crellin
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