[CQM-2550] 2017 Annual Update EH Measure Package Posting for Vendor Feedback Created: 03/13/17  Updated: 07/25/17  Resolved: 03/30/17

Status: Closed
Project: eCQM Issue Tracker
Component/s: None

Type: Annual Update Priority: Moderate
Reporter: MathematicaEHUpdates Assignee: Mathematica EH eCQM Team
Resolution: Answered Votes: 0
Labels: None

Last Commented Date:

 Description   

The Centers for Medicare & Medicaid Services invites vendors and stakeholders to review and provide feedback on draft electronic clinical quality measure (eCQM) measure packages that include logic and header changes for eCQMs under consideration for CMS quality reporting and payment programs.

This opportunity will allow CMS to learn from EHR vendors who have the technical capabilities to test the Health Quality Measure Format (HQMF) code by directly consuming machine readable XML files for eCQMs. Testing will help CMS to identify instances in which XML code produces errors so that issues can be resolved prior to posting the fully specified measures this spring. The measures in both HTML and XML formats will be available through March 28, 2017.

The draft measure packages are now available on the [ONC CQM Issue Tracker |ONC CQM Issue Tracker] via the following tickets:

  • Eligible hospital and critical access hospital measures (CQM-2550)
  • Eligible professional and eligible clinician measures (CQM-2551).

Please report questions and comments regarding the draft measure packages to the[ONC CQM Issue Tracker |ONC CQM Issue Tracker] tickets listed above.

*2017 eCQM Annual Update *

  • CMS is updating Eligible Hospital and Eligible Professional/Eligible Clinician eCQMs for potential inclusion in the following programs:
  • The Hospital Inpatient Quality Reporting Program (IQR);
  • The Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs for eligible hospitals, critical access hospitals and eligible professionals; and
  • The Merit-based Incentive Payment System (MIPS).

The updated eCQMs will be posted in Spring 2017 and will reflect 4.3 of the Quality Data Model (QDM). Measures will not be eligible for 2018 reporting unless and until they are proposed and finalized through notice-and-comment rulemaking for each applicable program.

*For More Information *

To find out more about electronic clinical quality measures, visit the [eCQI Resource Center|eCQI Resource Center] or [eCQM Library|eCQM Library].

 Comments   
Comment by Mathematica EH eCQM Team [ 07/25/17 ]

The data elements Time of Delivery and Labor now use the Assessment, Performed datatype. However, the result attribute was not used due to the fact that QDM-based HQMF does not perform temporal operations or calculations based on results values. Rather, temporal operations are performed only on the effective times of the datatype. As a result, the actual timing will use the start of the assessment performed. The intent is to continue to use the start of the assessment performed. When measures transition to CQL-based HQMF, we hope to leverage the new language to more accurately represent event times.

Comment by Anne Coultas (Inactive) [ 03/28/17 ]

We too would like to thank you for the opportunity to see these specifications prior to publication.

At this point in time we do have one question about assessment, performed. Elective Delivery CMS is now using the Assessment performed for both Time of Delivery and Labor. This change was made to allow the result of the assessment to be used in temporal logic calcuations. These two data elements do not specify the result (actual time of the delivery or the start time of labor) in the the data element definition. The logic will use the start of the assessment performed. Is the intent to use the actual timing result for these data element and will the result attribute be specified in the final version?

Anne Coultas - McKesson

RESPONSE The intent is to use the actual time of delivery, however, at this time due to the QDM constraints we cannot express this appropriately with or without the result attribute. This will be resolved in the future with the CQL version of the measure specification. Thank you for your review and feedback.

Comment by Kimberly M. Bodine (Inactive) [ 03/27/17 ]

Thank you for the opportunity to review the EH measure specifications. Other than Carsten's finding discussed in the comment above, we did not see any other issues.

Will we also have an opportunity to review the value-sets for these measures and provide comment, prior to publishing? This would also be a valuable part of this process.

Thank You,
Kim Bodine, DNP, RN

RESPONSE Draft value sets are currently not available for review. Thank you for your review and feedback.

Comment by Carsten (Inactive) [ 03/24/17 ]

I am happy to report that all the EH measures were easily compiled. Analysis of the generated code from RY 2017 compared to these precisely matched the differences in the HTML human readable specification too, so we are confident that the HQMF correctly defines these measures.

The only issues we had were to support the new “Assessment, Performed” template and the use of the “ends before/after or concurrent with” time operation in CMS 108 and 190. Neither of these are issues with the specifications of course, only new for RY 2018 EH measures so we had not supported them before.

-Carsten Quinlan
Software Developer at Epic

Response Thank you for your review and feedback!

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