The key concepts are PQRS eMeasures vs. MU2 CQM’s, electronic reporting vs. manual reporting in this website.
For the 2015 attestation, the user can choose the electronic or the manual option. See Step 31.png.
Electronic Reporting can be Direct CEHRT Reporting (Rod’s eMeasures link) with submission of the files here or CEHRT Reporting Through a Data Submission Vendor using one of registries.
The PQRS program requires 12 months of data. At best the OpenEMR user will have only 90 days worth of data for MU2.
It would seem to be an inefficient use of time & funds to electronically report 90 days worth of PQRS data. There is presently no mandate for eReporting only, therefore the manual option is simpler & cheaper.
Users have been reporting PQRS measures all year long via claims or registries. In our office adding CPT II codes to the Fee Sheet has almost become reflexive.
Brady,
Would you like me to rework the CQM’s into an adult set & a Pediatric set in one of your Up For Grabs Demo’s?
Note the underlying mechanism for the “Standard Measures” and CQM/AMC rules are different. The screenshot above only shows “Standard Measures”. This is because the Standard Measures are in the database, so user can create/modify them. The CQM/AMC rules are different animals; because of the complexity of the CQM rules they are instead hard-coded in the codebase:
When we were building the CDR engine, CQM was just too complicated to place them in the database and make them configurable.
That being said, the framework is there for a developer to add MU2 CQM rules (and if a rule is the same as MU1, easy to use rule for both). That developer will need to look through above logic specification docs.
Is there any reason why the title of the report cannot be changed from “Standard Measures” to “Clinical Quality Measures”? For MU1 there were Core Measures, Menu Measures, Core CQM’s, Alternate CQM’s & Additional CQM’s; but no such animal as “Standard” Measures.
The only way I was able to get the calculations for the Glaucoma & Diabetic Retinopathy CQM’s was from the Standard Measures Report for MU1 attestation.
For MU2 the AMC report will probably have the Core & Menu Measures, leaving only the report for CQM’s (Standard Measures).
Working within the Rules module, I think multi-part measures should be avoided, e.g. choosing Hypertension over BMI but bearing in mind the daily workflow of the typical Internal Medicine/Pediatric practice.
Standard measures are basically the customizable rules by the users. So, it allows a user to create a rule to be used and also create reports from it. If want to use standard measures for CQM (to be able to create the csv files and possible qrda stuff in the future), could likely do by just giving this as an option in the Plan Set selection on the CQM report (Could put a Standard Rules set there). I don’t think supporting this would be very tough; then would allow users to process their own CQM rules in the editor at their own peril.
Reviewing my MU1 documents, it’s understandable why calculating childhood immunization with 12 numerators was a real dog. Fortunately that CQM has only 1 part in MU2. Best to stay away from CQM’s that are multipartite.
It is more perilous for non-Internists not to add specialty-specific CQM’s. Users cannot expect developers to provide CQM’s for everyone. If all the numerators are zero’s, the EHR Incentive website would boot the attester out. If, for some strange reason, the boot does not occur; the attestation police (x2) will be hot on one’s trail.
Sounds like a cqm_custom toggle in the clinical_rules table will be needed. This toggle could be set in the GUI rule editor. And then could use this toggle to provide a Rule Set collection “Custom Clinical Quality Measures (CQM)” in the CQM report that will then calculate these. This would not be tough to code (couple lines of code in a couple different places).
The current MU2 AMC report (when set “2014 Automated Measure Calculation (AMC)” in Rule Set) supports that measures that didn’t change from MU1. Tony’s group is working on the other MU items that have changed or were added in MU2.
Should wait on moving forward with the above solution(cqm_custom stuff) until see what the CQM solution for MU2 looks like (it may become more complicated considering the need to produce the csv or qrda files).
Vendors: Just a reminder, Please Post your proposal here with whatever terms and conditions, estimated costs etc, that you wish to be considered by the community.
OEMR can afford it and the community agrees with the rest of the proposal an approach
You get paid when OpenEMR CQM components pass certification.
The requirements discussion seems to be headed in the right direction. Perhaps we need to lock down and update a wiki page with the specific deliverables asap so that bids can be realistic…
Tony I think there needs to be an analysis phase. This is too big for just one final deliverable. From my first posting in this thread:
The problem I ran into is that proposing a solution (and its cost) requires a lot of study and analysis and overlaps greatly with the task of actually doing it.
I’m happy to spend some block of time on it at a reduced rate, but that doesn’t meet your “minimum terms” and I can’t say yet how far along that will take us. So feeling a bit stuck here.
Rod,
I get that, so make the proposal. The guidelines are not locked in is stone. Looked like community analysis was proceeding just fine at this point to me.
Considering they say they have already succeeded in certification for another OpenEMR fork, and considering that Ensoftek claims to be there too, what do we think is missing that needs further research?
Don’t understand the allure of generating .csv/QRDA files for e-Reporting. If e-Reporting could fulfill both MU & PQRS requirements for 2015; yes, it would be complex; but it cannot. Why trudge up a mountain when there is a molehill to hop over?
Manual reporting for 2015 MU is half done.
Clinical Process/Effectiveness: Hypertension, Hba1c, Colon CA: all done.
Public Health: Tobacco, 2 parts need combining into 1; Pneumonia vaccine, done.
Standard Report will need 4 more CQM’s, using attachment.
Patient Safety: Fall Risk Screening & Med List.
Care Coordination: Referral Loop.
Patient & Family Engagement: CHF Functional Assessment
If the community insists upon doing it the hard way, would suggest mountain trudging for 2016.
I think you may be confusing attestation with certification. If could drop the qrda requirements, then would be nice, but this does not appear to be an option according to the certification guidelines for the cqm items:
Hi Tony, OK here’s a proposal. Allocate $1200 for me and I’ll spend 16 hours working on deciphering some of the eMeasure specs and starting some of the programming for calculations. Of course that won’t be enough to finish but it should be a useful start and give a much better idea of how much work remains and how to approach it.
There’s more than calculation to be done, so proposals for other pieces are still needed.
Agree with going ahead with Rod’s proposal.
This would get things moving in the right direction and allow more time to settle on the other required pieces.
-brady OpenEMR