CMS Quality Reporting

From OpenEMR Project Wiki

MU Requirements

Meaningful Use Measures:

Report ambulatory quality measures to CMS or the States. For 2011, provide aggregate numerator and denominator through attestation as discussed in section II(A)(3) of this proposed rule. For 2012, electronically submit the measures as discussed in section II(A)(3) of this proposed rule.


Certification Criteria for EHR:

  1. Calculate and electronically display quality measure results as specified by CMS or states.
  2. Enable a user to electronically submit calculated quality measures in accordance with the standard specified in Table 2A row 5.(CMS PQRI 2008

Registry XML Specification#,+). see: PQRI XML Output for CQM

  • ICSA says the we need to choose 9 to pass certification. We had 6 listed as mandatory, I added 3 --Tony - www.mi-squared.com 06:08, 14 March 2011 (UTC)
  1. NQF 0013 Hypertension: Blood Pressure Measurement
  2. NQF 0028 Tobacco Use Assessment / Tobacco Cessation Intervention
  3. NQF 0024 Weight Assessment and Counseling for Children and Adolescents
  4. NQF 0038 Childhood immunization Status
  5. NQF 0041 Influenza Immunization for Patients ≥ 50 Years Old
  6. NQF 0043 Pneumonia Vaccination
  7. NQF 0059 Diabetes Control: Hemoglobin A1C >9.0%
  8. NQF 0064 Diabetes Control: LDL < 100mg/dl
  9. NQF 0421 Adult Weight Screening and Follow-Up

Provider Requirements

The following at the minimum needed by a Provider to use a certified system. There are a total of 44 needed by the Vendor (us ...)

  1. NQF 0013 Hypertension: Blood Pressure Measurement
  2. NQF 0028 Tobacco Use Assessment / Tobacco Cessation Intervention
  3. NQF 0421 Adult Weight Screening and Follow-Up
  4. NQF 0024 Weight Assessment and Counseling for Children and Adolescents
  5. NQF 0041 Influenza Immunization for Patients ≥ 50 Years Old
  6. NQF 0038 Childhood immunization Status
  7. Choice of remaining MU/PQRI CQMs (from remaining 32)
  8. Choice of remaining MU/PQRI CQMs (from remaining 32)
  9. Choice of remaining MU/PQRI CQMs (from remaining 32)

Details

Data Mapping Project

Proposed Solution

1. Select a number of reports from CMS PQRI 2008 list, which has a total of 119 reports. Based on SF discussions, we selected 5 quality measures. See the listing.

2. Analyze the selected reports to see if the data is already available in OpenEMR. We propose the creation of a new section in Reports to pull the reports.

CMS1.png

3. Determine how to prepare the reports. A number of changes are required in OpenEMR to make the data available for reporting use.

4. Prepare a test set based on the reporting requirements.

5. Build reporting structure in Administrator section.

Effected Code, Tables, etc

For all quality measures, CPT Category II codes are required. These codes are non-billable. Currently, all CPT codes are stored in "codes" table with a code type of 1. We propose to assign a new code type to Category II codes. There is no change to the table itself.

-- -- Table structure for table `codes` --

DROP TABLE IF EXISTS `codes`; CREATE TABLE `codes` ( 

 `id` int(11) NOT NULL auto_increment,
 `code_text` varchar(255) NOT NULL default ,
 `code_text_short` varchar(24) NOT NULL default ,
 `code` varchar(10) NOT NULL default ,
 `code_type` tinyint(2) default NULL,
 `modifier` varchar(5) NOT NULL default ,
 `units` tinyint(3) default NULL,
 `fee` decimal(12,2) default NULL,
 `superbill` varchar(31) NOT NULL default ,
 `related_code` varchar(255) NOT NULL default ,
 `taxrates` varchar(255) NOT NULL default ,
 `cyp_factor` float NOT NULL DEFAULT 0 COMMENT 'quantity representing a years supply',
 `active` TINYINT(1) DEFAULT 1 COMMENT '0 = inactive, 1 = active',
 PRIMARY KEY  (`id`),
 KEY `code` (`code`)

) ENGINE=MyISAM AUTO_INCREMENT=1 ;


We propose that Category II codes be mapped to the straight codes in procedure_type table using a procedure_panel category for two reasons:

  1. We need the code for reporting and
  2. Make it easier for the provider to order them together. See http://www.openmedsoftware.org/wiki/Computer_Physician_Order_Entry for table details.

CQM Report Development

--Ken Chapple 18:30, 22 April 2011 (UTC)

Setup:

The official rules_develop branch contains sample reports and stubs:

https://github.com/bradymiller/openemr/tree/rules_develop

This is my branch for reference, but you should work by branching from the official rules develop branch.

https://github.com/kchapple/openemr/commits/ken_rules_cqm

Do a fresh install of openemr.

Check your database to make sure you have the 'enc_category_map' table (the install did not insert the table for me.)

If not, import it directly from the database.sql file into your openemr database instance.

Here is the wiki link for the essential rules for MU certification:

http://www.openmedsoftware.org/wiki/CMS_Quality_Reporting

See the list of 9 NFQs under the heading "MU Requirements." These are the reports we must implement.

The goal is to implement the list of 9 rules from the wiki link above.

The file, File:EP MeasureSpecifications.zip contains specifications for the reports. The folder names correspond to the NFQ numbers of the reports. The PDF file contains the human-readable specification for the report (ie: what you have to implement). The spread sheet contains codes that may or may not be required to check for in the report.

Development:

The principal files of interest are:

  • openemr/library/classes/rulesets/ruleSet.class.php
    • contains skeletons or rules to be implemented
    • stub functions are labeled with their NFQ number to correlate these three components:
      • PDF from specifications,
      • NFQ from wiki
      • stub in ruleSet.class.php file.
  • openemr/library/clinical_rules.php
    • "engine" code
  • openemr/library/patient.inc
    • contains helper functions to gather data for implementing reports
  • openemr/library/forms.inc
    • contains helper functions to gather data for implementing reports

Use the already implemented rules as a guide for implementing new rules.

Testing:

Create test patient data to trigger report generation based on the rule's criteria. This may involve creating encounters, entering "vitals" and creating history and lifestyle data.

I recommend saving an export of your database schema and data after you have completed testing for a particular rule.


"Odd Elements:"

Elements of CQM reports that are being ignored and need action
Title NFQ number element initially found Function (ruleSet.class.php) Notes/Actions
Care goal: follow-up plan BMI management 0421 rule_adult_wt_screen_fu_cqm() ...
Communication provider to provider: dietary consultation order 0421 rule_adult_wt_screen_fu_cqm() ...

Owner and Status

Bobby Wen and Thomas Wong (Intesync) John Williams - Garden

Links

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