Tuesday, September 28, 2010

Clarifying the Meaningful Use Quality Measures

As the country prepares for meaningful use stage 1, many are studying the functionality of their EHRs, hospital information systems, and data warehouses to ensure they can produce the ambulatory and hospital quality measures.

This has led to many implementation questions.

The ambulatory measures and guidance are detailed on a previous blog.

The hospital quality measures for 2011-2012 are found in pages 303-305 of the Final Rule, available here.

Additional guidance from CMS is available here.

The detailed HITSP documentation detailing the standards for computing numerators and denominators is available here.

The most useful, focused, and streamlined materials are the definitions of the quality measures. These measures are encoded according to the HL7 Health Quality Measures Format. To view them

1. Download the HITSP_Quality_Measures_20100430.zip file.
2. Create a new folder on your hard drive.
3. Extract the entire contents of the HITSP_Quality_Measures_20100430.zip file into the new folder.
4. Open the new folder.
5. Double click on a file to open and read the individual .xml files using your internet browser

For the two Emergency Department (ED) Throughput measures, ED-1/NQF 0495 and ED-2/NQF 0497, the information on the numerators/denominators/exclusions is available here.  To fall into the admitted to the emergency department denominator a patient must do two things:

1)      Initially present at the ED

Then either 2) be subsequently admitted to the inpatient side or 2) receive observation services.

A patient seen in the ED who is neither admitted or receives observation services would not be in the denominator.

Hospitals have varying rules about where they provide what type of observation services and patients could receive observation services without ever going through the ED just like they could be admitted to the hospital without ever going through the ED. It is not CMS' intent to expand into Place of Service (POS) Code 22 (Outpatient Hospital - A portion of a hospital which provides diagnostic, therapeutic (both surgical and non-surgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.). This is why CMS had to include the first criteria.

I hope these resources are helpful to you.
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