Automated measure calculation (MU3))
Automated Measure Calculation MU3
This document is part of our OpenEMR Certification Stage III Meaningful Use Documentation
This item is ready to pass. Reports have been built and there are testing snapshots ready if needed.
Regulation Text
§ 170.315 (g)(2) Automated measure calculation
For each Promoting Interoperability Programs percentage-based measure that is supported by a capability included in a technology, record the numerator and denominator and create a report including the numerator, denominator, and resulting percentage associated with each applicable measure.
External Link - ONC Certification Guide and Testing Requirements
Additional Requirements Information
Health IT Modules that are ambulatory systems only must use the ambulatory test data and test at least one of the two calculation methods: 1) Medicaid Promoting Interoperability Program; or 2) MIPS Promoting Interoperability performance category (TIN/NPI). ... Health IT Modules that test for the MIPS Promoting Interoperability performance category calculation methods must test for both the EC individual and EC Group calculation methods.
Report Format For Testing
Using the functions of the Health IT Module, the health IT developer creates a report that includes the numerator and denominator and resulting percentage for each measure based on the supplied test data from Test Data Scenario 1 (baseline measure report) across all required tests. The report must also include the list of patients included in the numerator and denominator. (bolding added) [Source: §170.315(g)(2) Automated measure calculation in 2015 Test Procedure in For Measure Specific Sections under heading Report]
Resources
ONC Resources
Each year the measures required by CMS change for interoperability requirements. The most update to date measures that can be found programatically currently can be found here: Github QPP Measures Data. Note that the Medicaid Interoperability incentives were discontinued in 2019 and currently only MIPS is eligible. Note that CMS is piloting a new type of MIPS that is based upon one's specialty (certain providers will need to check on [1] for the most up to date information on their requirements.
OpenEMR Resources
Found some relevant wiki pages that will help in creating the GAP analysis and figuring all of this out
GAP Analysis
OpenEMR Supported AMC Required Tests
Required Test 2a,2b,2c - Providing Patient Access, View Download Transmit
- In terms of GAP analysis it looks like the currently implemented AMC_314g_1_2_14_STG2 is very similar to PI_PEA_1. We would need to adjust the patient portal instructions article to explain how to access data via FHIR and we could have nearly identical logic.
- Relevant Specification File:2022 MIPS PI Measures Provide Patients Electronic Access.pdf
- Note we aren't linking to any Medicaid specification as those are no longer operable.
- Patients are granted access to their data automatically via FHIR and the patient portal when the patient chooses to allow portal access and the provider generates patient credentials for the patient to have access to their information.
Required Test 7 - Support Electronic Referral Loops by Sending Health Information (formerly Transitions of Care)
- Gap Analysis. It looks like clinical rule id send_sum_1_stage2_amc or send_sum_stage2_amc is the AMC measures that need to be modified here. This corresponds with class files:
- Relevant Specification File:2022 MIPS PI Measures Support Electronic Referral Loops by Sending Health Info.pdf
- From what I can tell the AMC_304i_STG2 matches very closely the code specification in 2022 MIPS criteria
- We decided we need to calculate whether the CCDA had the relevant data (problems, allergies, medications, prescriptions) at the time the ccda was sent rather than after the fact. Old MU2 implementation inaccurately used current issues list for this.
- We also need to support some kind of confirmation that the referral was received.
Group Calculation Method
Currently the AMC calculations do not support aggregating data by group. We will need to add to AMC a group calculation method and aggregate individual NPI scores connected to a single TIN. We've chosen to use the billing facility as the grouping mechanism as each facility can have its own TIN. This method has to be supported for both Required Test 2 & 7.
Additional notes
So the AMC clinical rules are in the clinical_rules table. There are columns for the 2011 criteria and columns to match AMC for the 2014 criteria. If the same architecture was followed we'd add two new columns for the 2015 criteria. We'd need a amc_code_2015 column and an amc_2015_flag. The code column would contain the referenced ONC criteria text and the flag would be to include that specific code class into the calculations.
It looks like the text descriptions are contained in the clinical_rules' list (stored in list_options). The option_id must match the specific rule id column in the clinical_rules table for that AMC measure.
AMC Skipped Required Tests
- E-Prescribe is not being certified though it may be certified in the 2nd half of the year. This skips the following Required Tests
- Required Test 1 – ePrescribing
- Medicaid Promoting Interoperability program terminated CMS ended the medicaid PI program and the certification tests show they are for 2021 only. This skips over the following tests:
- Required Test 3 – Patient Education
- Required Test 4a, b, or c – View, Download, Transmit
- Required Test 5 – Secure Messaging (Note EHR secure messaging certification ended also which would skip this test for that reason as well).
- Required Test 6 – Patient Generated Health Data
- Required Test 8 – Receive and Incorporate
- Required Test 9 – Medication/Clinical Information Reconciliation
- Required Test 10 – CPOE Medications
- Required Test 11 – CPOE Laboratory
- Required Test 12 – CPOE Radiology/Diagnostic Imaging
- Reconciliation and Incorporation is not being certified though it may be certified in the 2nd half of the year.
- Required Test 15 – Support Electronic Referral Loops by Receiving and Incorporating Health Information
AMC Required Tests Matrix
This table was adapted from the File:ONC 2015 RequirementsMatrix MasterTable.pdf and aligned with the most recent OpenEMR MU3 analysis in 2022.
| ONC 2015 EHR Test and CMS programs | Certification Criteria that Directly Correlate with Utilization Expected by Medicare and Medicaid Promoting Interoperability Programs or MIPS Promoting Interoperability performance category Percentage Based Measures | Comments, Additional Certification Criteria | OpenEMR Comments | MIPS Objective |
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Required Test 1 – ePrescribing
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Electronic Prescribing | |
Required Test 2a, b, or c – Patient Electronic Access
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Provider to Patient Exchange | |
Required Test 3 – Patient Education
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Required Test 4a, b, or c – View, Download, Transmit
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Provider to Patient Exchange | |
Required Test 5 – Secure Messaging
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Required Test 6 – Patient Generated Health Data
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Required Test 7 – Support Electronic Referral Loops by Sending Health Information (formerly Transitions of Care)
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Health Information Exchange | |
Required Test 8 – Receive and Incorporate
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OR
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(b)(2) not supported currently reviewing to determine if we will certify against this criteria during the 2nd half of the year | |||
Required Test 9 – Medication/Clinical Information Reconciliation
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Required Test 10 – CPOE Medications
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Required Test 11 – CPOE Laboratory
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Required Test 12 – CPOE Radiology/Diagnostic Imaging
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Required Test 15 – Support Electronic Referral Loops by Receiving and Incorporating Health Information
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Terminology
- EP = Eligible Professional
- EC = Eligible Clinician
- EH = Eligible Hospital
- AMC = Automated Measure Calculations
Relevant OpenEMR Code Sections
This analysis was last updated on February 3rd 2022
Files and Commits
Files found relevant to this area are: amc.php
This commit introduced the AMC modules: d43cdab06aaaf09847e72c80f2a8bd39206c8fe9
This commit modified the AMC modules: e4f1be061d4ef1e8feefc09fdbebf304da0a29c2
AMC rule calculations can be found in the library/classes/rulesets/Amc/
AMC (g)(1) Automated Measure Recording patient reports seem to be created through this file amc_tracking.php
AMC report is done through the cqm.php file with the type set to amc
AMC Generation Process Flow
A user gets to the AMC generate report page by going to Reports -> Clinics -> Automated Measures (AMC) which opens up a tab for <site_id>/interface/reports/cqm.php?type=amc
From there the user selects their report properties they want and then submits the form which does the following process flow.
cqm.php -> Submit Form -> javascript::runReport() -> ../../library/ajax/collect_new_report_id.php (generate report id) -> cqm.php -> ../../library/ajax/status_report.php (poll status of generated report every 10 seconds) -> ../../library/ajax/execute_cdr_report.php (start report generation) -> cqm.php?report_id=<id> (load generated report).
execute_cdr_report.php flow
- Grabs a report id, date range, type, plan, organize_method, primary provider vs encounter based for the report - calls the function test_rules_clinic_batch_method in library/clinical_rules.php - grabs the patients the report pertains to -> buildPatientArray - breaks the patients up into groups of batches to be done at a time. - calls the function test_rules_clinic in library/clinical_rules.php
