anonymous wrote on Thursday, January 14, 2010:
Bobby Wen and I are doing some work analysis and project planning on this meaningful use requirements. One of the questions we are trying to answer is whether or not all 119 reports would be needed. Please review PQRI 2008 specifications document posted at:
http://www.openmedsoftware.org/wiki/CMS_Quality_Reporting#Links
anonymous wrote on Saturday, January 16, 2010:
We have selected 20 quality measures for further review and consideration. The other 99 measures are either not applicable to primary care or are difficult to do.
1 Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus
7 Beta-blocker Therapy for Coronary Artery Disease Patients with Prior Myocardial Infarction (MI)
39 Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older
41 Osteoporosis: Pharmacologic Therapy
47 Advance Care Plan
53 Asthma: Pharmacologic Therapy
64 Asthma Assessment
66 Appropriate Testing for Children with Pharyngitis
91 Acute Otitis Externa (AOE): Topical Therapy
94 Otitis Media with Effusion (OME): Diagnostic Evaluation – Assessment of Tympanic Membrane Mobility
110 Influenza Vaccination for Patients > 50 Years Old
111 Pneumonia Vaccination for Patients 65 years and Older
112 Screening Mammography
113 Colorectal Cancer Screening
114 Inquiry Regarding Tobacco Use
115 Advising Smokers to Quit
119 Urine Screening for Microalbumin or Medical Attention for Nephropathy in Diabetic Patients
124 HIT- Adoption/Use of Health Information Technology (Electronic Health Records)
125 HIT- Adoption/Use of e-Prescribing
130 Universal Documentation and Verification of Current Medications in the Medical Record
Which 5 would you choose?
tmccormi wrote on Saturday, January 16, 2010:
1,47,110,114,130 - why you say? I think that each of these represents a report that is unique in the business rules related to where the data will need to come from. Subsequently, similar reports can be derived from them.
For instance, 1,7 39, 41, 53, 64, 66, 94, 112, 113, 119 All are, probably, just queries based on Diagnosis Code + Service Code cross referencing…
-Tony
bobby1 wrote on Saturday, January 16, 2010:
Good a reason as any. I agree the reports would represent a cross section of report query and logic types. We wanted to create a starting point that would be fairly simple, and that we could build on. The five would be the first pass that we can learn from and perfect the process for the more difficult reports later.
Thanks
Bobby Wen
jpmd wrote on Saturday, January 16, 2010:
1 Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus
110 Influenza Vaccination for Patients > 50 Years Old
112 Screening Mammography
115 Advising Smokers to Quit
125 HIT- Adoption/Use of e-Prescribing
Here are the five I would say but I agree that they should represent different programming logic so that the module can be tested appropriately.
Thanks
Jude A. Pierre, MD
Phyaura, LLC
www.phyaura.com
blankev wrote on Saturday, January 16, 2010:
This seems to be an another very promissing feature for OpenEMR!!!!.
Question 1: Is there any place where this can be tested during this development phase?
For General Physician there are many options for Coding encounters, tests, and Diagnosis. ICD is a general name for the Hospital coding. For the European GP and also for the WOONCA (World Organization of General Physicians) is accepted as a good standard for GP-Coding we use often ICPC. Both code types are developing codes and are updated with regular intervals. ICD9 to ICD10. Same for ICPC-I to ICPC-II etc with all kind of sub-codings.
Question 2: Has there been any thoughts on how to make connections between the used OpenEMR codings like ICD9 to ICD10 or ICD to ICPC.
In the world of coding there are many tables with relationship between the different coding tables, but a general approach with the option to make connections between the different coding systems would be a great benefit for general acceptance. It could be done with some kind op connection between a general table without definite numbers or it could be done with some kind of interconnection before/after accepting a certain number with the “general”-CMS numbers used.
Let me know if this is of any kind of help for future development, or that it is still too far away from this topic to think of relationships between different coding options.
Pimm
bobby1 wrote on Saturday, January 23, 2010:
Thanks to everyone for their comments.
I am starting with
1 Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus
110 Influenza Vaccination for Patients > 50 Years Old
112 Screening Mammography
113 Colorectal Cancer Screening
115 Advising Smokers to Quit
The criteria for 110, Flu vaccinations is straight forward, but 112 and 113 both require diagnostic codes.
Can anyone point me to where the CPT and ICD diagnostic codes for encounters are? I looked in the tables and files and was not able to find them. This will really help since I am going to try to use them to select patients with specific conditions and tests. I will start a new thread on this topic.
Thanks to Diane Carter for her help determining where Hemoglobin A1c results may be found.
anonymous wrote on Saturday, January 23, 2010:
I haven’t told you how to get a copy of ICD and CPT codes. Will show you how to do it tomorrow.
blankev wrote on Saturday, January 23, 2010:
Code 110 might seem to be straight forward, but when you change Influenza vaccination into H1N1 vaccination (also some kind of Influenza virus, it becomes more like reality.
Worldwide there were differences and even in the Dutch kingdom there were different opinions about vaccination schemes.
For Curacao we adopted the scheme of the Dutch Kingdom with a difference for some groups.
Why this comment? Because the next step to be made after Influenza vaccination is the scheme of all kind of vaccinations, but the importance of this feature will be in the case of the acute implementation of something new like H1N1 viral strain.
Our scheme was:
1. All adults above the age of 60 years
2. All pregnant women with pregnancy of at least 12 weeks
3. All persons with astma treatment
4. All persons with some types of heart disease
5. All persons with immune response problems
6. All persons with diabetes, type one and type two
7. All persons having some kind of medication
Excluded were
1. Persons with any kind of allergy against one or more components of the vaccination fluids
2. Pregnant women with less than 12 weeks pregnancy or persons who want to become pregnant
3. Persons with any kind of severe allergic reactions in the past
4. Persons who were vaccinated with the regular flu vaccination, if this vaccination was within a period of three weeks before the intended H1N1 vaccination, but needed to have their vaccination after this three weeks period.
And than there were certain groups who needed to have a second/repeat H1N1 vaccination after two weeks of the first one.
Hope this comment will help to make a flexible schedule even for something as semingly straight forward as the code 110
;-))
.
Pimm
blankev wrote on Saturday, January 23, 2010:
I visited the mentioned site:
http://www dot medbloom dot com
and was pleasantly surprised with the future possibilities of this solution. It seems to become a very promising feature easy to use and easy to adapt to different treatment plans. Inclusion and exclusion criteria might have to include “age” “gender” “insurance type” and all kind of other inclusions that can give an insight of the patient needs.
For Cholera it might be also inclusion of the place of temporary stay for transients.
If the PLAN type would be an LIST with ADD options this might become a monster since the inclusion criteria will have to be made by some very experienced person. But restriction might give the problems as mentioned in my earlier remark in this topic. Different treatment and health plans for different medical practitioners.
I opt for the more flexible style, but I can understand any fear of giving any user a chance to make their own treatment schedules for all kind of issues.
This could be solved with some kind of “giving rights” to OpenEMR USERS.
Pimm
bobby1 wrote on Saturday, January 23, 2010:
PIMM,
Thank you for your comments on reporting for Flu vaccinations, and you are right, there are many extension to the MU reporting. We are using the 5 reports as a way to get started on developing a rich set of reports, both to satisfy MU requirements and allow practioners to proactively help their patients.
The 5 reports are a starting point where we can learn and build a foundation for more difficult reports. By identifying where the data exists, and how to structure the SQL queries, it can give us ideas of how to enhance openEMR to be able to collect the information.
For example, now that we know we can get immunization information from the immunization table, we can create reports for other immunizations, i.e. DTap, and Hepa A B C. We could add H1N1 as an immunization, and we run reports against them. Or even to put in an “other” text field and be able to track a non-recurring immunization.
As you said, we can then add other conditions and lab results; in some of the other MU reports, we will have to do this. The 5 reports are meant to be a starting point where we can learn, and get feedback from the community on what they want to see. This will also let us perfect our development process while we add feature, and before we take on more difficult reports where we have to make structural changes to the database or add new field to forms.
Thanks,
Bobby1
anonymous wrote on Saturday, January 23, 2010:
Hi Pimm,
Let me address your comments in Clinical Decision Rules.
anonymous wrote on Saturday, January 30, 2010:
Hi All,
After much discussion and analysis, we came up with some solutions. Please review it at http://www.openmedsoftware.org/wiki/CMS_Quality_Reporting.
sunsetsystems wrote on Monday, February 01, 2010:
You speak of getting Category II codes from the procedure_order table, however I think some more flexibility may be required. For example some clinics may send vaccinations through CPOE, others might just do them in-house and skip the hassles of procedure ordering - or perhaps the vaccination was initiated outside of the clinic. So codes should be looked for also in the billing table and wherever else they might be recorded. Make sure there are ways to capture the required data for all situations, and that you query all locations as needed.
anonymous wrote on Tuesday, February 02, 2010:
My understanding is that CPOE will use procedure_order to perform the following types of orders:
1. Medications;
2. Laboratory;
3. Radiology/imaging; and
4. Provider referrals
There is a chance that some orders may be skipped or put on paper. However, I’m not sure if the billing table can be used. If you don’t order an item, then the assumption is that it won’t and shouldn’t get billed. If it happens, then it’s a clinic workflow problem.
As for those patients who get separate immunizations and procedures outside of the clinic, the assumption is that they would not be included in the provider’s reporting because the services are not provided by the clinic.
Here’s a quick description for PQRI:
The Physician Quality Reporting Initiative (PQRI) is part of the Tax Relief and Healthcare Act of 2006. This pay-for-reporting program offers a financial incentive to physicians and other eligible professionals who successfully report quality measures related to services provided under the Medicare Physician Fee Schedule.
sunsetsystems wrote on Tuesday, February 02, 2010:
Not sure I understand. I don’t think it’s acceptable to route all billing through a procedure ordering system, if that’s what you mean.
As for reporting measures related to services provided - if I get a flu shot at my local pharmacy without an order from my doctor, and then tell him about it, isn’t that meaningful for reporting? Surely he shouldn’t get dinged for that.
I’m no MU expert, but this isn’t making sense to my primitive brain yet.