Presenter Kathy Lesh PhD RNBC CPHQ November 1 2017 2 pm Eastern Electronic Clinical Quality Measure eCQM Updates What you need to know Webinar 3 Vision and Goals Webinar Series ID: 1044154
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1. Measure Development Education & Outreach for Specialty Societies & Patient Advocacy GroupsPresenter: Kathy Lesh, PhD, RN-BC, CPHQNovember 1, 2017 2 pm EasternElectronic Clinical Quality Measure (eCQM) Updates: What you need to know.Webinar # 3
2. Vision and Goals: Webinar SeriesAn ongoing process to engage clinical specialty societies and patient advocacy groups in quality measure development. Elicit feedback that will help CMS design toolkits and enduring materials designed specifically for specialty societies and patient advocacy groups interested in measure development. Measure Development Education & Outreach for Specialty Societies & Patient Advocacy GroupsEducation Outreach Frequent CommunicationEnduring MaterialsDedicated WebsitesMeasure Development RoadmapsTargeted Newsletters and CommunicationShowcase Opportunities
3. eCQMs Webinar # 3Measure Development Education & Outreach for Specialty Societies & Patient Advocacy GroupsAgenda Webinar # 3:WARNING: This presentation is acronym and jargon heavy. I will do my best to explain the acronyms and jargon, but please feel free to ask for clarification.Review of electronic clinical quality measures (eCQMs)What’s happened this past yearWhat it means for youWhat’s coming upWhat it means for youQuestions
4. eCQMs Webinar # 3An eCQM is a clinical quality measure specified in the Health Quality Measure Format (HQMF), plus other componentsHQMF is a Health Level Seven International (HL7) standard for representing a clinical quality measure as an electronic document (Extensible Markup Language [XML] format)Ideally, the HQMF provides for measure consistency and unambiguous interpretationHQMF provides the syntax (document structure), but does not specify where in the EHR the data must be/can be foundElectronic Clinical Quality Measure (eCQM) Review (1 of 12 )What is an eCQM?
5. eCQMs Webinar # 3eCQMs require the use of standards and toolsHealth information technology, usually an EHR, is the primary source of data for an eCQMData in the EHR should be captured as part of regular workflowOther electronic data may be captured, e.g., from a laboratory information systemThe logic must be explicitly statedeCQMs require additional steps to map measure data elements to corresponding information model components and standard terminologies to assemble the data criteriaeCQM Review (2 of 12)How is an eCQM different from other types of clinical quality measures?
6. eCQMs Webinar # 3eCQMs have been around for more than five yearsAnnual updates published every spring beginning with 2014 reporting/performance periodUpdates to code systemsUpdates to logicMinor changeseCQM Review (3 of 12)Annual Updates
7. eCQMs Webinar # 3Initially, only the EHR Incentive programs used eCQMsNow eCQMs used byHospital Inpatient Quality Reporting ProgramQuality Payment Program Merit-based Incentive Payment SystemAlternative Payment ModelsMedicare and Medicaid EHR Incentive programs for eligible hospitals and critical access hospitalsMedicaid EHR Incentive Program for eligible professionalseCQM Review (4 of 12) Who uses eCQMs?
8. eCQMs Webinar # 3Initially 29 eligible hospital measures and 64 eligible professional measuresAs of now (2017 reporting):16 eligible hospital measures53 eligible clinician/eligible professional measureseCQM Review (5 of 12)How many eCQMs are there?
9. eCQMs Webinar # 3Quality Data Model (QDM)Provides the grammar to express eCQMsEach QDM element is composed of a category of information, a datatype (or context of use), and a value set The value set defines the specific instance of the category by assigning a set of values (or codes)Existing value sets are available in the Value Set Authority Center (VSAC)Value sets are created in the VSAC using standard terminologieseCQM Review (6 of 12)Standards to Create an eCQM
10. eCQMs Webinar # 3eCQMs rely on standard terminologies to capture data for quality measurementSystems need to support terminology standards such as LOINC, RxNorm, and SNOMED CT Terminology and data element requirements may necessitate EHR vendors to redesign and reconfigure workflows and data entry mechanisms to meet the measure collection requirementsTerminology differences, which define the numerators, denominators, exclusions, and exceptions, create differences in the populations of chart-abstracted measures as compared with eCQMseCQM Review (7 of 12)Standard Terminology
11. eCQMs Webinar # 3Measure Authoring Tool (MAT)A web-based tool for measure developers to author eCQMsUses the QDM, links with VSAC, outputs HQMFhttps://www.emeasuretool.cms.govValue Set Authority Center (VSAC)https://vsac.nlm.nih.goveCQM Review (8 of 12)Tools to Create an eCQM
12. eCQMs Webinar # 3eCQM Review (9 of 12)Measure Authoring Tool (MAT)
13. eCQMs Webinar # 3eCQM Review (10 of 12)Value Set Authority Center (VSAC)
14. eCQMs Webinar # 3eCQM Review (11 of 12)Quality Reporting Document Architecture (QRDA)QRDA is a Clinical Document Architecture (CDA)-based HL7 standard for reporting quality measure dataTwo types in useQRDA category I – patient-levelQRDA category III – aggregated patient data calculated from QRDA category I documents QRDA is the file submitted to and received by the CMS systemFor hospital reporting, only QRDA category I is accepted Eligible professionals and eligible clinicians only submit using QRDA III
15. eCQMs Webinar # 3eCQM Review (12 of 12)Tools for Testing eCQMsBonnie - https://bonnie.healthit.gov/Cypress - https://www.healthit.gov/cypress/National Committee for Quality Assurance eCQM testing resource - http://www.ncqa.org/hedis-quality-measurement/data-reporting-services/emeasure-certificationPre-submission QRDA Validation ToolsPresubmission Validation Application (PSVA)Hospital Quality Reporting Receiving SystemSubmission Engine Validation Tool (SEVT) no longer in useThe Quality Payment Program is developing new tools https://qpp.cms.gov/developers
16. eCQMs Webinar # 3In January, code system updates to eCQMs for 2017 reportingIn September, code system updates to eCQMs for 2017 4th quarter eligible hospital/critical access hospital reportingIn September, code system updates to eCQMs for 2018 eligible hospital/critical access hospital reporting and eligible clinician/eligible professional reportingWhat’s happened in the last year?
17. eCQMs Webinar # 3International Classification of Diseases, 10th Revision – Clinical Modification and Procedure Coding System (ICD-10-CM/PCS)Logical Observation Identifiers Names and Codes (LOINC) RxNormSNOMED CTCode system updates to eCQMs for 2017 4th quarter
18. eCQMs Webinar # 3Code system updates to eCQMs for 2017 4th quarter
19. eCQMs Webinar # 3ICD-10-CM/PCSLOINC RxNormSNOMED CTCurrent Procedural Terminology (CPT)Vaccine Administered (CVX)Healthcare Common Procedure Coding System (HCPCS)Code system updates to eCQMs for 2018 reporting
20. eCQMs Webinar # 3Code system updates to eCQMs for 2018 reporting
21. eCQMs Webinar # 3No changes have been made to the measure logic, the Health Quality Measure Format (HQMF) specifications, the value set object identifiers (OIDs), or the measure version numbers for 2017 or 2018 eCQM reportingMeasure implementers should review these changes to ensure their submissions comply with the updated requirementsWhat it means for you
22. eCQMs Webinar # 3 __Clinical Quality Language (CQL) is replacing the logic currently found in the Quality Data Model (QDM)Measures expressed using CQL logic will continue to use the Quality Data Model (QDM) as the conceptual model to express clinical concepts contained within quality measuresWhat’s happening now
23. eCQMs Webinar # 3Improved expressivityMore precise/unambiguousCan share logic between measuresCan also share logic with decision supportCan be used with multiple information / data models (e.g., QDM, Fast Healthcare Interoperability Resources [FHIR])Simplifies calculation engine implementationWhy CQL?
24. eCQMs Webinar # 3QDM logic limits a measure developer’s ability to express the type of comparisons needed to truly evaluate outcomes of careQDM logic can not request patient results that indicate outcomes and compare if there is improvement over timeFor example, Request the change (delta) in depression scale (PHQ-9) results over time for a single patient, or for each patient in a cohortCQL’s mathematical expression logic allows this type of comparison over timeWhy CQL?
25. eCQMs Webinar # 3QDM logic is unable to express a mathematical expression to derive a desired resultQDM logic can not provide mathematical calculations based on discrete findingsFor example, LDL = Total cholesterol minus HDL + (Triglycerides/5))Therefore, the respective measure in QDM had to limit results to accept only specific LDL resultsCQL’s mathematical expression logic allows the derivation of desired resultsWhy CQL?
26. eCQMs Webinar # 3The measures published in the 2019 Annual Update will use CQLThese measure specifications must be used for CY 2019 eCQM reportingWhat it means for you
27. eCQMs Webinar # 3CMS Measures Management System Blueprinthttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MMS-Blueprint.htmlComments and questions – MMSSupport@battelle.orgElectronic Clinical Quality Improvement (eCQI) Resource Centerhttps://ecqi.healthit.gov/Comment and questions - ecqi-resource-center@hhs.govFor questions related to eCQM implementation, specifications, logic, data elements, standards, or tools, please go to JIRA (online tracking tool): https://oncprojectracking.healthit.govReferences (1 of 2)
28. eCQMs Webinar # 3CMS Measure Authoring Tool (MAT)https://www.emeasuretool.cms.govComments and questions- https://www.emeasuretool.cms.gov/web/guest/contact-us;jsessionid=625D8D32B07075C878A12B27C9E02A67ED65CC6DAF6EAA26833896C34B64CABBNational Library of Medicine Value Set Authority Center (VSAC)https://vsac.nlm.nih.govComments and questions - https://support.nlm.nih.gov/ics/support/default.asp?deptID=28054&category=umls&from=https://www.nlm.nih.gov/research/umls/support.htmlNational Quality Forum (NQF)http://www.qualityforum.org/Home.aspx Comments and questions - info@qualityforum.orgQuality Nethttps://www.qualitynet.orgReferences (2 of 2)
29. eCQMs Webinar # 3Electronic Clinical Quality Measure (eCQM) Updates: What you need to know.
30. eCQMs Webinar # 3Measure Development Education & Outreach for Specialty Societies & Patient Advocacy GroupsPlanned Upcoming Webinars:11/8/2017, 1:00-2:00pm EST: MIPS Program12/6/2017, 2:00-3:00pm ESTNational Quality Forum – Consensus Development Process RedesignHealth Services Advisory Group – Measure Development Plan 1/17/2018, 2:00-3:00pm EST: CMS Measures Inventory and the CMS Measures Inventory ToolSuggestions for future topics?Email: MMSsupport@battelle.org
31. CMS Spotlight OpportunitiesReminder: If you are currently developing quality measures that you would like to present to CMS contact the MMS Support Desk at MMSsupport@Battelle.orgMeasure Development Education & Outreach for Specialty Societies & Patient Advocacy Groups
32. eCQMs Webinar # 3Contact information:BattelleMeasures Management System Contract Holder: BattelleContact: MMSsupport@Battelle.orgCMSGolden Horton: Golden.Horton@cms.hhs.govKimberly Rawlings: Kimberly.Rawlings@cms.hhs.gov Measure Development Education & Outreach for Specialty Societies & Patient Advocacy Groups