CQM for MU2 - Discussion

Archived OEMR Non Profit Organization
#21

sunsetsystems wrote on Thursday, May 07, 2015:

I (or rather my clients) contribute code back because my business model is to sell my time for development services, because supporting the project is consistent with that, and because the GPL pretty much calls for it anyway.

EnSoftek however appears to be offering OpenEMR as a SAS solution that is totally re-branded. If they do not redistribute the software to others then they are not obligated by the GPL to share their improvements. Similarly with ZH I expect (which I’m pretty sure has various proprietary extras that are not shared with the project).

So, just want to understand especially as Ramesh said “contributing”. Don’t see how any rational person would think that unimportant.

Rod
http://www.sunsetsystems.com/

#22

fsgl wrote on Thursday, May 07, 2015:

Did not get a chance to read Rod’s link about eMeasures until today. The guide is mindless. (I can think of some less charitable descriptions.) There is no rational reason to regurgitate all that verbiage back to CMS when it was their concoction in the first place.

We need to get this done by the end of June to allow time for testing. Users must have everything in place & finalized by Oct 1st to have the last 90 day period for attestation.

Given the fact there are two concurrent audits, it would be unwise to rely on modular certification. Figliozzi has said it’s all or none. Quite likely the Office of the Inspector General will apply the same criterion. If they deem that an attestation is something short of 100%, the bonus will have to be returned.

The most efficient way of getting there is to have CQM reporting as part of the Attestation via the EHR Incentive Program. See this & Option 1. We already have the mechanism for reporting CQM’s from MU1. Now it’s just a matter of the user adding 6 more CQM’s.

Medxpress has a fee of $500 per physician to use their registry. A quick survey of approved registries found in a link toward the bottom of this page gives a range of fees from $100 on up for those registries which are not restricted by membership. Some of the registries have a very skimpy listing of supported measures.

I don’t think I’m oversimplifying, so let’s get cracking.

#23

fsgl wrote on Thursday, May 07, 2015:

In 2011 physicians would not have anticipated that they would be subjected to an Office of the Inspector General audit on top of the pre & post-payment Figliozzi audits.

With news of Congressional grumblings about the misuse of taxpayers’ money on the EHR Incentive Program, who can guarantee that modular certification will not become the next target for bonus recoupment?

Thus far there have no posts arguing for modular certification alone & foregoing full certification. Why settle for a piecemeal approach when there is a single solution?

We can worry about MU3 when it has been finalized. There have been enough distractions.

The CQM mountain has turned out to be but a molehill. It’s time to wrap this up & put it to bed.

#24

mbrody wrote on Friday, May 08, 2015:

In order to be certified for Stage 2 OpenEMR must calculate CQM’s

OpenEMR only needs to calculate CQM’s it does not have to e-report CQM’s to be certified. In addition OpenEMR can certify with ‘outside’ programs and achieve full certification as long as the testing is done with use of the outside programs. Many programs are certified with third party software such as Dr First, UpDocs, New Crop etc. Just look at the CHPL website.

OpenEMR will not need to generate the XML for certification at this time, but will for Stage 3. With the commercial products that I work on, we have already started getting ready for Stage 3 certification.

#25

mbrody wrote on Friday, May 08, 2015:

I have represented over 200 providers who have been audited by CMS, Figliozzi, and OIG. I do not understand your comment “Figlozzi has said it’s all or none” As it applies to modular certification.

As long as a provider has access to all modules, they can meet every measure. The difference is with modular certification, the provider must have multiple software packages and provide proof of access to the multiple software packages.

To pass an audit a provider must prove they met or were excluded from every core measure and must meet 5 menu measures. This is true whether the provider uses a complete EHR or uses a combination of modular EHR products.

#26

mbrody wrote on Friday, May 08, 2015:

I am not sure that importing the xml into OpenEMR is the way to go. We are moving from pay for service to pay for performance. As a result calculation of performance and having a high performance is of vital importance. The best practice would be to identify the measures we want to support, and develop workflows that encourage high performance. That involves a manual ‘parsing’ of the measures and using gray matter to make programming decisions. Then utilizing the data in OpenEMR to ‘generate’ the xml files in the appropriate format.

#27

visolveemr wrote on Friday, May 08, 2015:

ViSolve successfully achieves MU2 Full Certification for its EMR Vendor Customer with OpenEMR Codebase
ViSolve is happy to announce that, just last week we helped one of our East coast based EMR Vendor Customer with OpenEMR Code base achieve full MU2 Certification from ICSA Labs.
Infact we have been helping several EMR vendors achieve Meaningful Use Certification for the past few years.
Prior to actual certification, we engaged in extensive GAP Analysis to identify gaps between the Customer’s EMR and proposed MU Standards.
We did identify some gaps and we performed required enhancements and customizations to ensure the EMR is MU ready for certification.
The Actual Certification was scheduled some time last week with ICSA Labs and it is with great contentment we say, we demonstrated Meaningful Use Compliance for all the criterion mentioned http://www.healthit.gov/policy-researchers-implementers/2014-edition-final-test-method
All the CQM (Clinical Quality Measures) were demonstrated successfully in a single shot, deserves special mention.
ViSolve has an expert Meaningful Use Team who has extensive knowledge in Meaningful Use Consulting including GAP Analysis, custom programming and enhancements to ensure your EMR is MU ready, testing with cypress tools and Demonstrate MU Compliance with testing organizations such as Drummond, ICSA Labs etc and help achieve Meaningful Use Certification.
We ensure it is done in a systematic manner and make the journey easy for any EMR Vendors looking for successful MU certification.
Anyone looking for assistance in successful Meaningful Use Certification please let us know, we would be more than happy to assist.
Thanks
OpenEMR Customization/Support Team
ViSolve Inc
services@visolve.com | Phone: 408-850-2243
www.visolve.com

#28

bradymiller wrote on Friday, May 08, 2015:

Hi Ramesh,

If plan is to contribute, then feel free to post it to github asap. Can then get a feel whether the code will be workable for OpenEMR and won’t spin our wheels on other solutions.

-brady
OpenEMR

#29

bradymiller wrote on Friday, May 08, 2015:

Hi Visolve,

The OpenEMR project is looking for assistance in successful Meaningful Use certification… :slight_smile:

-brady
OpenEMR

#30

bradymiller wrote on Friday, May 08, 2015:

Hi Michael,

Would be very nice to sidestep the QRDA stuff. What would be the estimated pricing for OpenEMR users that wanted to use the service and can we get the details on the required elements in the csv file.

thanks,
-brady

#31

mbrody wrote on Friday, May 08, 2015:

As far as discount pricing, the person I need to speak to is out of the office today and I am leaving tomorrow for the HL7 Work Group Meeting in Paris. So I will not have an answer to that question for at least 1 week.

Before we can determine the required elements of the csv file we need to select the measures. Each measure tracks different data points. Later today I will post some samples for a few measures.

#32

sunsetsystems wrote on Friday, May 08, 2015:

Dr. Brody,

Regarding selection of eMeasures, the following is from my old notes:

OpenEMR currently implements 9 CQMs for MU1:

NQF 0013 Hypertension: Blood Pressure Measurement
NQF 0024 Weight Assessment and Counseling for Children and Adolescents
NQF 0028 Tobacco Use Assessment / Tobacco Cessation Intervention
NQF 0038 Childhood immunization Status
NQF 0041 Influenza Immunization for Patients ≥ 50 Years Old
NQF 0043 Pneumonia Vaccination
NQF 0059 Diabetes Control: Hemoglobin A1C >9.0%
NQF 0064 Diabetes Control: LDL < 100mg/dl
NQF 0421 Adult Weight Screening and Follow-Up

All but the first (0013) are on the 2014 list (have matching NQF numbers). Of course they are all different in details due to changes. NQF 0013 seems similar to NQF 0018 which is on the 2014 list.

At http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html we see: “There is also a new requirement in 2014 that the quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains […]”.

The currently implemented list covers 2 of these domains (“Population / Public Health” and “Clinical Process/Effectiveness”).

Looking at the lists of “recommended” CQMs (9 for adults and 9 for pediatric) I see this one in the “Care Coordination” domain which we do not cover:

CMS50v1 Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred.

We already have a Referral form that contains this information. So just implementing that one and fixing all the others would seem to cover 3 domains.

Rod
http://www.sunsetsystems.com/

#33

tmccormi wrote on Friday, May 08, 2015:

Rod, you seem to have no since that contributions to the community can be altruistic all by themselves, but they are also very good marketing regardless of what kind of OpenEMR fork or value add services a Vendor might be selling to make a living.

#34

tmccormi wrote on Friday, May 08, 2015:

This post from Visolve is relevant to this discussion

https://sourceforge.net/p/openemr/discussion/202504/thread/02dd06be/?limit=25#ac43

–Tony

#35

fsgl wrote on Friday, May 08, 2015:

Both the recommended sets have this advisory:

“If one or more of these measures are not relevant for your organization, please utilize other measures from the approved 2014 CQM set to meet the reporting requirement.”

Other approved CQM’s are found here

16 CQM’s come pre-loaded in OpenEMR. See attachment.

Brad Gregg’s well written Clinical Decision Rules Manual enables a user to add CQM’s.

For our MU1 attestations we added Chronic Open Glaucoma & Diabetic Retinopathy to the pre-loaded Diabetic Eye Exam.

#36

mbrody wrote on Friday, May 08, 2015:

Just FYI, I have a flight to Paris in a few hours to attend the HL7 working group meeting so that we can publish more documents like the IG for e-CQM reporting referenced earlier in the discussion :). (Please dont throw rotten tomatoes at me).

I will have limited access to internet but will check in on the discussion when I can.

Michael

#37

sunsetsystems wrote on Friday, May 08, 2015:

Yes people do notice who the contributors are and that is good marketing. But I’ll let EnSoftek speak for themselves. :slight_smile:

#38

sunsetsystems wrote on Friday, May 08, 2015:

Fsgl, I think that attachment is alerts and reminders, not quality measures.

Rod
http://www.sunsetsystems.com/

#39

bradymiller wrote on Saturday, May 09, 2015:

Hi,

Seems like next step would be to sponsor a developer to get the MU2 rules that Rod mentions above into the current CQM framework in OpenEMR. Note there is a mechanism/framework to add the MU2 CQM rules now; even though the rules “appear” the same, I think there are minor(and maybe major) changes in most of them for MU2, so it will not be entirely straightforward. When have more information can then sort out how to get the csv (or qrda) stuff going in the near future.

-brady
OpenEMR

#40

fsgl wrote on Saturday, May 09, 2015:

Right church, wrong pew. See attachment.