[CQM-1053] Time precision in measures Created: 02/25/14 Updated: 05/06/16 Resolved: 05/06/16 |
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| Status: | Closed |
| Project: | eCQM Issue Tracker |
| Component/s: | Guidance |
| Type: | EC eCQMs - Eligible Clinicians | Priority: | Minor |
| Reporter: | Becky Henderson (Inactive) | Assignee: | Julia Skapik (Inactive) |
| Resolution: | Approved | Votes: | 0 |
| Labels: | LOGIC | ||
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| Solution: | Thank you for the comments eloquently presented here. The question of time precision is entirely relevant to both the eCQMs themselves, and the standards and structure of the eCQM specifications. I should note that the standard and requirements for eCQMs currently specifies default timing to the minute. The difficulty in dealing with timing precision lies in the need for minute specificity for some measures and clinical scenarios while simultaneously the need for very general granularity of time capture in others. Certainly the specificity of timing for an event reported by a patient that occurred decades ago, such as a history of rheumatic fever in childhood, should be and will be captured much less specifically than an event that occurs in a critical time frame during the measurement period, such as the administration of aspirin at a hospital in a patient suspected to have a myocardial infarction. We would welcome your participation in this discussion as we look at changing the standard to correctly identify a default timing precision without handcuffing the use cases in which more specificity is both appropriate and needed. Please anticipate that this issue is under discussion at ONC and CMS as well as among our stakeholders. Expect that, wherever possible, we will work in the 2014 Annual Update to make changes to measure specifications to accommodate the appropriate timing. |
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| Solution Posted On: | |||||||||||||||||||||||||||||
| 2015 Performance Period EP eCQMs : |
CMS134v1/NQF0062
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| Tracker Notification: |
Balu Balasubramanyam (Inactive), eldred (Inactive), Howard Bregman (Inactive), Kevin Larsen (Inactive), Marc Hadley (Inactive)
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| Impact: | Prevents accurate report results in practical settings using real client data | ||||||||||||||||||||||||||||
| Comment Posted On: | |||||||||||||||||||||||||||||
| Description |
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In testing CMS 146 Version 2 (NQF# 0002) we noticed that in the test data from Cypress the time of certain diagnoses and medication prescriptions is being used as a basis for excluding and including patients. More specifically, the report excludes patients who have a medication for amoxicillin prior to a diagnosis of viral pharyngitis. In the test data, Melinda Sullivan is supposed to show in the denominator of the report and not be excluded. Her medication is prescribed at 12:30 (April 30th) while the diagnosis occurred at 12:05 (April 30th). However, this level of granularity on things like diagnoses and medications is entirely uncommon in practical use of EHRs. A similar issue was brought forth (http://jira.oncprojectracking.org/browse/CYPRESS-231) and was resolved with the following message: "This patient is built to exercise the denominator exclusion logic for measure CMS2/NQF0418. This requires the diagnosis of depression to occur before the adult depression screening, therefore, an additional encounter will be added to this patient that occurs before March 1, 2012 and contains the diagnosis of depression. The risk assessment will remain on March 1, 2012 (after the diagnosis). Data criteria will continue to be evaluated to the minute unless otherwise specified. The patient record will be updated the next time a Measure Bundle update is required for Cypress. In the meantime, this should not be a blocking item for certification. ATLs should allow both outcomes for this patient, included in the denominator and excluded from the denominator." This answer seems to indicate that those involved in the decision agree that the time precision was impractical and that Cypress would update the test data at a later time. Is this stance universal or simply for that particular measure? If measures are calculated using day precision rather than hour/minute, is this incorrect? Are ATLs recommended to allow alternate outcomes based on the discrepancies resulting from differing time precisions for all measures where this becomes an issue? |
| Comments |
| Comment by Becky Henderson (Inactive) [ 02/27/14 ] |
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I'm certainly willing to participate in any discussions that are held! Do you have any recommendations in the meantime for us as we try to get certified? We're currently calculating with date precision only (we're only certifying for EP measures and currently our software doesn't allow for time precision in most places except encounters, though this could technically be changed) and therefore we fail measures where the test data hinges on time intervals to include/exclude patients. Our ATL requested us to get a formal stance from your team that they would look to and follow when certifying us as well as other companies. Would we required to change to calculating with time in the meantime (and overhaul our manual input UI to allow time precision for when users are actually entering real clinical data) or would issues that arise from the disparity between Cypress' time precision and our day precision be something that our ATL could accept without failing us (provided we could create a test patient with the same demographics, adjust the clinical data to be on different days rather than different times on the same day and calculate the report correctly)? Thank you for the quick response! |