Difference between revisions of "TMG Meaningful Use"

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7/25/2012
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= Outpatient Meaningful Use for WorldVistA =
  
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Hello.  My name is Kevin Toppenberg, MD.  I am a primary care physician in Greeneville, TN.  I have been active in the VistA community for at least 7 years, and have used VistA in my office during this time.  I have decided to pursue meaningful use certification with VistA.  This page will document my progress towards this, and record notes that I make to myself along the way.  I hope this is helpful to others.
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''Hello.  My name is Kevin Toppenberg, MD.  I am a primary care physician in Greeneville, TN.  I have been active in the VistA community for at least 7 years, and have used VistA in my office during this time.  I have decided to pursue meaningful use certification with VistA.  This page will document my progress towards this, and record notes that I make to myself along the way.  I hope this is helpful to others. ''
  
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In CMS terminology, I am an "Eligible Provider" (EP), not a hospital.  Also, I am going after Medicare (not Medicaid) certification.  So my discussion below will be targeted accordingly.
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''In CMS terminology, I am an "Eligible Provider" (EP), not a hospital.  Also, I am going after Medicare (not Medicaid) certification.  So my discussion below will be targeted accordingly.''
  
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'''Q: Where can I find the certification status of WorldVistA?'''
+
NOTE: This page was originally created by Kevin Toppenberg, whose namespace is TMG. Enhancements have been made to this page, to include more general information for those seeking to attest to Meaningful Use Stage One in an outpatient setting.
 +
 
 +
==Q: Where can I find the certification status of WorldVistA?==
 
* Go to [http://oncchpl.force.com/ehrcert/ehrproductsearch CMS Certified Health IT Products]
 
* Go to [http://oncchpl.force.com/ehrcert/ehrproductsearch CMS Certified Health IT Products]
 
* Search for "WorldVistA"  -- '''NOTE''': the search engine on this page is flaky.  I found that when I clicked the search button, it would return a list of ALL technology.  But when I then simply '''clicked search AGAIN''' (with WorldVistA still in the search term box), then it would find it.
 
* Search for "WorldVistA"  -- '''NOTE''': the search engine on this page is flaky.  I found that when I clicked the search button, it would return a list of ALL technology.  But when I then simply '''clicked search AGAIN''' (with WorldVistA still in the search term box), then it would find it.
  
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'''Q: There seems to be so many steps to be ready to attest meaningful use.  It's overwhelming.  Any overview sites?'''
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==Q: There seem to be so many steps involved in getting ready for Stage One attestation.  It's overwhelming.  Any overview sites?==
−
* When I looked into this a year or so ago, reading the ~80 pages of densely packed legal terms, I gave up.  It seemed too daunting.  But now that I am revisiting this, it seems to not be too bad at all.  I found that I am already doing most of the requirements.
 
 
* I recommend starting with this overview:  [https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html#BOOKMARK7 CMS EHR Meaningful Use Overview].  The information I am posting here is from this site.
 
* I recommend starting with this overview:  [https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html#BOOKMARK7 CMS EHR Meaningful Use Overview].  The information I am posting here is from this site.
 
* Alternatively, here are the slides from a [https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM_Webinar_10-25-2011.pdf CMS webinar presentation.]
 
* Alternatively, here are the slides from a [https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM_Webinar_10-25-2011.pdf CMS webinar presentation.]
−
* Here is another [http://tinyurl.com/bu9n4b9 CMS document (2010)] document with similar detail.  
+
* Here is another [http://tinyurl.com/bu9n4b9 CMS document (2010)] document with similar detail.
 +
* A very good presentation from IHS giving an overview of Meaningful Use can be found [ftp://ftp.ihs.gov/pubs/EHR/Training/Manuals/EHR%20for%20Meaningful%20Use%20-%202011/TAB%2002%20-%20MU%20Overview%20and%20Incentive%20Payment%20Estimator/T2.1%20%20-%20MU_EP_EH-Final.PPTX here]
  
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'''Q: What's the bottom line?  What do I have to do to be ready to attest meaningful use?'''
+
==Q: What's the bottom line?  What do I have to do to be ready to attest meaningful use?==
 
# Meet '''20 of 25 "Meaningful Use Objectives'''" [https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf source]
 
# Meet '''20 of 25 "Meaningful Use Objectives'''" [https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf source]
 
#* Must meet 15 "core" measures
 
#* Must meet 15 "core" measures
 
#* Must also meet 5 of 10 possible "menu" set measures
 
#* Must also meet 5 of 10 possible "menu" set measures
−
# Meet '''6 of 41 "Clinical Quality Measures (CQM's)'''"
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# Meet '''6 of 41 "Clinical Quality Measures (CQM's)'''" [https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html?redirect=/QualityMeasures/03_ElectronicSpecifications.asp source]
 
#* Must meet 3 required core quality measures
 
#* Must meet 3 required core quality measures
 
#* must also meet 3 of 38 possible additional quality measures
 
#* must also meet 3 of 38 possible additional quality measures
 +
# Attest to meeting requirements using Y/N answers and by supplying data from the Quality Measures package.
 +
(TO-DO SMH: Reference and write about the Quality Measures package.)
 +
 +
==Q: Can you tell me more about the 15 "core" meaningful use measures? (all are required)==
 +
Detailed instructions on meeting these will be provided in more detail below. Detailed instructions on reporting can be found here: [[C0Q_Quality_Reporting_1.0 | Quality Measures package documentation]].
 +
{| class="wikitable"
 +
|-
 +
! Measure !! Link to CMS Source !! VISTA fulfillment !! Attestation Type !! Quality Measures Package Logic
 +
|-
 +
| CPOE -- Provider directly enters in orders || [http://www.cms.gov/EHRIncentivePrograms/Downloads/1_CPOE_for_Medication_Orders.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.306.a%20CPOE.pdf Fulfillment] || Rate > 30% || Check for the presence of electronically prescribed medications stored in the Non-VA Multiple in file 55 for this patient
 +
|-
 +
| Implement drug-drug and drug-allergy interaction checks || [http://www.cms.gov/EHRIncentivePrograms/Downloads/2_Drug_Interaction_ChecksEP.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.a%20Drug-drug,%20drug-allergy%20interaction%20checks.pdf Fulfillment] || Yes/No || Not checked. Report YES. Core VISTA functionality. Also part of electronic prescribing.
 +
|-
 +
| Maintain an up-to-date problem list of current and active diagnoses  || [http://www.cms.gov/EHRIncentivePrograms/Downloads/3_Maintain_Problem_ListEP.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.c-%20Maintain%20up-to-date%20problem%20list%20IN.pdf Fullfillment] || Rate > 80% || Checks active problems.
 +
|-
 +
| Generate and transmit permissible prescriptions electronically (eRx) || [http://www.cms.gov/EHRIncentivePrograms/Downloads/4_e-prescribing.pdf Source] || not available || Rate > 40% || Check for the presence of electronically prescribed medications stored in the Non-VA Multiple in file 55 for this patient
 +
|-
 +
| Maintain active medication list || [http://www.cms.gov/EHRIncentivePrograms/Downloads/5_Active_Medication_List.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.d%20Maintain%20active%20medication%20list%20IN.pdf Fulfillment] || Rate > 80% || Check for the presence of electronically prescribed medications stored in the Non-VA Multiple in file 55 for this patient
 +
|-
 +
| Maintain active medication allergy list || [http://www.cms.gov/EHRIncentivePrograms/Downloads/6_Medication_Allergy_List.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.e%20Maintain%20active%20medication%20allergy%20list%20IN.pdf Fulfillment] || Rate > 80% || Check for the presence of allergies for this patient
 +
|-
 +
| Record required demographics || [http://www.cms.gov/EHRIncentivePrograms/Downloads/7_Record_Demographics.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.306.b%20Record%20demographics.pdf Fulfillment] || Rate > 50% || Check for the presence of Sex, DOB, Primary ID, Preferred Language, Race, Ethnicity for this patient. Lack of any one disqualifes you.
 +
|-
 +
| Record required vital signs || [http://http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/8%2520Record%2520Vital%2520Signs%25202011.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.f.1%20Vital%20Signs.pdf Fulfillment] || Rate > 50% || Check vital signs from July 3rd 2011 to present for this patient.
 +
|-
 +
| Record smoking status for patients aged 13 yrs and up || [http://www.cms.gov/EHRIncentivePrograms/Downloads/9_Record_Smoking_Status.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.g%20Smoking%20Status.pdf Fulfillment] || Rate > 50% || Check health factors in the category Tobacco; see if patient will have these. If none found in the category, each possible health factor in a list is tried by itself.
 +
|-
 +
| Report clinical quality measures to CMS || [http://www.cms.gov/EHRIncentivePrograms/Downloads/10_Clinical_Quality_Measures.pdf Source] ||[https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.306.i%20Calculate%20and%20submit%20clinical%20quality%20measure.pdf Fulfillment] || Yes/No (Measures are reportable rates however) || Not checked. Report YES.
 +
|-
 +
| Implement 1 clinical decision support rule || [http://www.cms.gov/EHRIncentivePrograms/Downloads/11_Clinical_Decision_Support_Rule.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.306.c%20Clinical%20decision%20support%20H.pdf Fulfillment] || Yes/No || Not checked. Report YES.
 +
|-
 +
| Provide patients with an electronic copy of their health information || [http://www.cms.gov/EHRIncentivePrograms/Downloads/12_Electronic_Copy_of_Health_Information.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.306.d.2%20Electronic%20copy%20of%20health%20information%20Discharge%20Summary.pdf Fulfillment] || Rate > 50% || '''NOT COLLECTIBLE IN VISTA. NO RELEASE OF INFORMATION PACKAGE. COLLECT MANUALLY'''
 +
|-
 +
| Provide clinical summaries for patients for each office visit within 3 days || [http://www.cms.gov/EHRIncentivePrograms/Downloads/13_Clinical_Summaries.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.v%20Encryption%20when%20exchanging%20electronic%20health%20information.pdf Fulfillment]  || Rate > 50% || '''NOT COLLECTIBLE IN VISTA. NO RELEASE OF INFORMATION PACKAGE. COLLECT MANUALLY'''
 +
|-
 +
| Perform at least 1 test of exchanging key clinical information with another entity electronically || [http://www.cms.gov/EHRIncentivePrograms/Downloads/14_Electronic_Exchange_of_Clinical_Information.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.v%20Encryption%20when%20exchanging%20electronic%20health%20information.pdf Fulfillment] || Yes/No || Not checked. Report YES.
 +
|-
 +
| Protect electronic health information || [http://www.cms.gov/EHRIncentivePrograms/Downloads/15_Core_ProtectElectronicHealthInformation.pdf Source] ||
 +
[https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.o%20Access%20Control.pdf 1]
 +
[https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.p%20Emergency%20Access.pdf 2]
 +
[https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.q%20Automatic%20Log-Off.pdf 3]
 +
[https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.r%20Audit%20logDraft.pdf 4]
 +
[https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.s%20Integrity.pdf 5]
 +
[https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.t%20Authentication.pdf 6]
 +
|| Yes/No || Not checked. Report YES.
 +
|}
 +
 +
==Q: What about the 5 "menu" set of meaningful use objectives? (5 of 10 possible are required)==
 +
{| class="wikitable"
 +
|-
 +
! Measure !! Link to CMS Source !! VISTA fulfillment !! Attestation Type !! Quality Measures Package Logic
 +
|-
 +
| Implement drug formulary checks || [http://www.cms.gov/EHRIncentivePrograms/Downloads/1_Drug_Formulary_Checks.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.b%20Drug-formulary%20checks.pdf Fulfillment] || Yes/No || Not Checked. Report YES. Automatic functionality in VISTA.
 +
|-
 +
| Incorporate lab results into EHR as structured data || [http://www.cms.gov/EHRIncentivePrograms/Downloads/2_Clinical_Lab_Test_Results.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.h%20Incorporate%20Laboratory%20Test%20Results.pdf Fulfillment] || Rate > 40% || Not Checked. If you use Lab Package, report 100%; otherwise, 0%.
 +
|-
 +
| Generate list of patients by specific conditions for quality improvement || [http://www.cms.gov/EHRIncentivePrograms/Downloads/3_Patient_Lists.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.i%20Generate%20patient%20lists.pdf Fulfillment] || Yes/No || Not Checked. Report YES. Automatic functionality in VISTA.
 +
|-
 +
| Send patient reminders per patient preference || [http://www.cms.gov/EHRIncentivePrograms/Downloads/4_Patient_Reminders.pdf Source] || NOT DONE || NOT DONE || NOT DONE
 +
|-
 +
| Provide patients with timely electronic access to their health information || [http://www.cms.gov/EHRIncentivePrograms/Downloads/5_Patient_Electronic_Access.pdf Source] || NOT DONE || NOT DONE || NOT DONE
 +
|-
 +
| Provide patient-specific education resources || [http://www.cms.gov/EHRIncentivePrograms/Downloads/6_Patient-Specific_Education_Resources.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.m%20Patient-specific%20education%20resources.pdf Fulfillment] || Rate > 10% || NOT DONE
 +
|-
 +
| Perform medication reconcilliation || [http://www.cms.gov/EHRIncentivePrograms/Downloads/7_Medication_Reconciliation.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.j%20Medication%20Reconciliation.pdf Fulfillment] || Rate > 50% || If you use electronic prescribing, it is tracked.
 +
|-
 +
| Send summary care record to other providers || [http://www.cms.gov/EHRIncentivePrograms/Downloads/8_Transition_of_Care_Summary.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.v%20Encryption%20when%20exchanging%20electronic%20health%20information.pdf Fulfillment] || Rate > 50% || NOT DONE
 +
|-
 +
| Submit data to immunization registries || [http://www.cms.gov/EHRIncentivePrograms/Downloads/9_Immunization_Registries_Data_Submission.pdf Source] || [https://trac.opensourcevista.net/svn/mu-tests/stage-1/170.302.k%20Submission%20to%20Immunization%20Registries.pdf Fulfillment] || Yes/No || Report YES. Enhanced functionality in WORLDVISTA.
 +
|-
 +
| Submit syndromic surveillance data || [http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CCIQFjAA&url=http%3A%2F%2Fwww.cms.gov%2FRegulations-and-Guidance%2FLegislation%2FEHRIncentivePrograms%2Fdownloads%2F10HM-SyndromicSurveillanceDataSubmission.pdf&ei=7ftpUMLnFqe7iwLx44CwBw&usg=AFQjCNGwj3T8jslE8iVME4Wt7EI4x9NcuQ&sig2=dY6e5UXAq2TvDe_jF932Aw Source] || NOT DONE || NOT DONE || NOT DONE
 +
|}
 +
 +
==Q: What about the required Clinical Quality Measures (CQM)?==
 +
You must report the 3 core measures. If any of the 3 core measures are reported with zero values for the denominator, you are required to
 +
pick an alternate core measure to report in addition, even if these yield zero. For example if: NQF 0028 & NQF 0421 are 0; report 2 measures from the alternate core measures.
  
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'''Q: Can you tell me more about the 15 "core" meaningful use measures? (all are required)'''
+
In addition to the core/alternate core measures, you need to report an additional 3 measures from the additional list of 38 CQMs.
−
They are as follows:
 
−
# CPOE -- Provider directly enters in orders [http://www.cms.gov/EHRIncentivePrograms/Downloads/1_CPOE_for_Medication_Orders.pdf source]
 
−
# Implement drug-drug and drug-allergy interaction checks [http://www.cms.gov/EHRIncentivePrograms/Downloads/2_Drug_Interaction_ChecksEP.pdf source]
 
−
# Maintain and up-to-date problem list of current and active diagnoses [http://www.cms.gov/EHRIncentivePrograms/Downloads/3_Maintain_Problem_ListEP.pdf source]
 
−
# Generate and transmit permissible prescriptions electronically (eRx) [http://www.cms.gov/EHRIncentivePrograms/Downloads/4_e-prescribing.pdf source]
 
−
# Maintain active medication list [http://www.cms.gov/EHRIncentivePrograms/Downloads/5_Active_Medication_List.pdf source]
 
−
# Maintain active medication allergy list [http://www.cms.gov/EHRIncentivePrograms/Downloads/6_Medication_Allergy_List.pdf source]
 
−
# Record required demographics  [http://www.cms.gov/EHRIncentivePrograms/Downloads/7_Record_Demographics.pdf source]
 
−
# Record required vital signs [http://http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/8%2520Record%2520Vital%2520Signs%25202011.pdf source]
 
−
# Record smoking status for patients aged 13 yrs and up [http://www.cms.gov/EHRIncentivePrograms/Downloads/9_Record_Smoking_Status.pdf source]
 
−
# Report clinical quality measures to CMS [http://www.cms.gov/EHRIncentivePrograms/Downloads/10_Clinical_Quality_Measures.pdf source]
 
−
# Implement 1 clinical decision support rule [http://www.cms.gov/EHRIncentivePrograms/Downloads/11_Clinical_Decision_Support_Rule.pdf source]
 
−
# Provide patients with an electronic copy of their health information [http://www.cms.gov/EHRIncentivePrograms/Downloads/12_Electronic_Copy_of_Health_Information.pdf source]
 
−
# Provide clinical summaries for patients for each office visit (at least 50% of patients, within 3 days) [http://www.cms.gov/EHRIncentivePrograms/Downloads/13_Clinical_Summaries.pdf source]
 
−
# Perform at least 1 test of exchanging key clinical information with another entity electronically [http://www.cms.gov/EHRIncentivePrograms/Downloads/14_Electronic_Exchange_of_Clinical_Information.pdf source]
 
−
# Protect electronic health information [http://www.cms.gov/EHRIncentivePrograms/Downloads/15_Core_ProtectElectronicHealthInformation.pdf source]
 
  
−
'''Q: What about the 5 "menu" set of meaningful use objectives? (5 of 10 possible are required)'''
+
[http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/CQM_EPs_2012_02_02.pdf Click here for a list of all measures afrom the CMS website along with the instructions just above.]
−
# Implement drug formulary checks [http://www.cms.gov/EHRIncentivePrograms/Downloads/1_Drug_Formulary_Checks.pdf source]
 
−
# Incorporate lab results into EHR as structured data [http://www.cms.gov/EHRIncentivePrograms/Downloads/2_Clinical_Lab_Test_Results.pdf source]
 
−
# Generate list of patients by specific conditions for quality improvement [http://www.cms.gov/EHRIncentivePrograms/Downloads/3_Patient_Lists.pdf source]
 
−
# Send patient reminders per patient preference [http://www.cms.gov/EHRIncentivePrograms/Downloads/4_Patient_Reminders.pdf source]
 
−
# Provide patients with timely electronic access to their health information [http://www.cms.gov/EHRIncentivePrograms/Downloads/5_Patient_Electronic_Access.pdf source]
 
−
# Provide patient-specific education resources [http://www.cms.gov/EHRIncentivePrograms/Downloads/6_Patient-Specific_Education_Resources.pdf source]
 
−
# Perform medication reconcilliation [http://www.cms.gov/EHRIncentivePrograms/Downloads/7_Medication_Reconciliation.pdf source]
 
−
# Send summary care record to other providers [http://www.cms.gov/EHRIncentivePrograms/Downloads/8_Transition_of_Care_Summary.pdf source]
 
−
# Submit data to immunization registries [http://www.cms.gov/EHRIncentivePrograms/Downloads/9_Immunization_Registries_Data_Submission.pdf source]
 
−
# Submit syndromic surveillance data [http://http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/10_Syndromic_%2520Surveillance_Data_SubmissionEP.pdf source]
 
  
−
'''Q: What about the required Clinical Quality Measures (CQM)?'''
+
NB: If you see the numerator and denomiator logic filled out, it means that the measure is fully supported in the Quality Measurement Package. If they are not there, then they are unsupported; you may still report on them, but you will have to do extra work on your end to make them work.
−
* As above, providers must report '''3 core''' CQM's
+
==== Core Measures ====
−
*# Hypertension: Blood Pressure Measurement -- '''NQF0013''': "Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who has been seen for at least 2 office visits, with blood pressure (BP) recorded."
+
{| class="wikitable"
−
*# Preventive Care Screening Measure Pair: [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=391&print=0&entityTypeID=1 details]
+
|-
−
*#* Tobacco Use Assessment
+
! Measure !! Description !! Sources !! Denominator in VISTA !! Numerator in VISTA
−
*#* Tobacco Cessation Intervention
+
|-
−
*# Adult Weight Screening and Follow-up [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=526&print=0&entityTypeID=1 details]
+
|NQF0013 || Hypertension: Blood Pressure Measurement ||  [http://helpdesk.medteam.net/ClinicalQualitymeasures/NQF0013.pdf details2] || Patients with Hypertenstion || Blood Pressure recorded as a Vital
−
** OR, 3 alternate core CQM's can be reported. These are to be used of unable to use 3 CQM
+
|-
−
*# NQF 0024 -- BMI for age 2-18
+
|rowspan=2 | NQF0028 || Tobacco: Use Asessment || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=391&print=0&entityTypeID=1 details] || Patients || Health factors in NFQ0028AB Tobacco Managment Dialog
−
*# NQF 0041 -- Influenza vaccination
+
|-
−
*# NQF 0038 -- Childhood immunization status
+
| Tobacco Cessation Intervention || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=391&print=0&entityTypeID=1 details] || Patients who smoke || Health factors in NFQ0028AB Tobacco Managment Dialog
−
* An additional '''3 from a list of 38 CQM's''' must be reported. [http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/CQM_EPs_2012_02_02.pdf source]
+
|-
−
*# Diabetes: Hemoglobin A1c Poor Control [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1225&print=0&entityTypeID=1 details]
+
| NQF0421||Adult Weight Screening and Follow-up || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=526&print=0&entityTypeID=1 details] || Patients with high BMI || Health factors in MU NQF0421 BMI DI
−
*# Diabetes: Low Density Lipoprotein (LDL) Management and Control -- [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1228&print=0&entityTypeID=1 details]
+
|-
−
*# Diabetes: Blood Pressure Management  [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1235&print=0&entityTypeID=1 details]
+
|}
−
*# Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=383&print=0&entityTypeID=1 details]
+
 
−
*# Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
+
==== Alternate Core Measures ====
−
*# Pneumonia Vaccination Status for Older Adults [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=492&print=0&entityTypeID=1 details]
+
If you reported 0 for all 3 core measures, you must report on all 3 alternate core measures even if you will report zeroes for all 6 measures.
−
*# Breast Cancer Screening [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=392&print=0&entityTypeID=1 details]
+
{| class="wikitable"
−
*# Colorectal Cancer Screening [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=394&print=0&entityTypeID=1 details]
+
|-
−
*# Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD
+
! Measure !! Description !! Sources !! Denominator in VISTA !! Numerator in VISTA
−
*# Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)  
+
|-
−
*# Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment
+
| NQF 0024||BMI for age 2-18||[http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1247&print=0&entityTypeID=1 details]|| Obese Patients in the Date Range (using Vitals package)|| ICD9/CPT codes V65.3, 97802, G0270, S9449, S9452, S9470
−
*# Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
+
|-
−
*# Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=438&print=0&entityTypeID=1 details]
+
| NQF 0041||Influenza vaccination||[http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=397&print=0&entityTypeID=1 details]||Patients|| Immunization (IM FLU, 3 yrs) in MU NQF0041 INFLUENZA MANAGEMENT DI
−
*# Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=439&print=0&entityTypeID=1 details]
+
|-
−
*# Asthma Pharmacologic Therapy
+
| NQF 0038||Childhood immunization status||[http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=395&print=0&entityTypeID=1 details]|| Patients <= 2 yo || Dialog MU NQF0038 IMMUNE MANAGEMENT DI
−
*# Asthma Assessment
+
|}
−
*# Appropriate Testing for Children with Pharyngitis
+
==== Additional Core Measures ====
−
*# Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
+
An additional '''3 from a list of 38 CQM's''' must be reported. Only the first three are supported by the Quality Measures package right now. If you need to add more, get in contact with George Lilly or Sam Habiel.
−
*# Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients
+
{| class="wikitable"
−
*# Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
+
|-
−
*# Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco # Use Cessation Strategies
+
! Measure !! Description !! Sources !! Denominator in VISTA !! Numerator in VISTA
−
*# Diabetes: Eye Exam [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1223&print=0&entityTypeID=1 details]
+
|-
−
*# Diabetes: Urine Screening [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1226&print=0&entityTypeID=1 details]
+
| NQF0059 || Diabetes: Hemoglobin A1c Poor Control || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1225&print=0&entityTypeID=1 details] || Diabetics via Meds or Diagnosis || Lab HEMOGLOBIN A1C or Health Factor PQRI HBA1C>9 MK
−
*# Diabetes: Foot Exam [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1224&print=0&entityTypeID=1 details]
+
|-
−
*# Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol
+
| NQF0061 || Diabetes: Low Density Lipoprotein (LDL) Management and Control || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1228&print=0&entityTypeID=1 details] || Diabetics via Meds or Diagnosis || Lab LDL CHOLESTEROL or Health Factor PQRI LDL < 100
−
*# Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation
+
|-
−
*# Ischemic Vascular Disease (IVD): Blood Pressure Management
+
| NQF0064 || Diabetes: Blood Pressure Management || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1235&print=0&entityTypeID=1 details] || Diabetics via Meds or Diagnosis || Blood Pressure entered via Vitals Package.
−
*# Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
+
|-
−
*# Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement
+
|colspan=5 | '''The rest of these are not fully supported in the Quality Measures package.'''
−
*# Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
+
|-
−
*# Prenatal Care: Anti-D Immune Globulin
+
| NQF0081 || Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=383&print=0&entityTypeID=1 details]
−
*# Controlling High Blood Pressure
+
|-
−
*# Cervical Cancer Screening
+
| NQF0070 || Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=377&print=0&entityTypeID=1 details]
−
*# Chlamydia Screening for Women
+
|-
−
*# Use of Appropriate Medications for Asthma
+
| NQF0043 || Pneumonia Vaccination Status for Older Adults || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=492&print=0&entityTypeID=1 details]
−
*# Low Back Pain: Use of Imaging Studies
+
|-
−
*# Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control
+
| NQF0031 || Breast Cancer Screening || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=392&print=0&entityTypeID=1 details]
−
*# Diabetes: Hemoglobin A1c Control (<8.0%) [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=944&print=0&entityTypeID=1 details]
+
|-
 +
| NQF0034 || Colorectal Cancer Screening || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=394&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0067 || Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=376&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0083 || Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=384&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0105 || Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=855&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0086 || Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=436&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0088 || Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=438&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0089 || Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=439&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0047 || Asthma Pharmacologic Therapy || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=368&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0001 || Asthma Assessment || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=366&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0002 || Appropriate Testing for Children with Pharyngitis || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=370&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0387 || Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=631&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0385 || Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=628&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0389 || Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=624&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0027 || Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco # Use Cessation Strategies || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=390&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0055 || Diabetes: Eye Exam || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1223&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0062 || Diabetes: Urine Screening || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1226&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0056 || Diabetes: Foot Exam || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1224&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0074 || Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=379&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0084 || Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation
 +
|-
 +
| NQF0073 || Ischemic Vascular Disease (IVD): Blood Pressure Management || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1231&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0068 || Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1229&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0004 || Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a)Initiation, b) Engagement || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1245&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0012 || Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
 +
|-
 +
| NQF0014 || Prenatal Care: Anti-D Immune Globulin -- NQF 0014
 +
|-
 +
| NQF0018 || Controlling High Blood Pressure || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1236&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0032 || Cervical Cancer Screening || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=393&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0033 || Chlamydia Screening for Women || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1253&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0036 || Use of Appropriate Medications for Asthma || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=367&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0052 || Low Back Pain: Use of Imaging Studies || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1220&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0075 || Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=1232&print=0&entityTypeID=1 details]
 +
|-
 +
| NQF0575 || Diabetes: Hemoglobin A1c Control (<8.0%) || [http://www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=944&print=0&entityTypeID=1 details]
 +
|}

Latest revision as of 21:58, 4 October 2012

Outpatient Meaningful Use for WorldVistA

Hello. My name is Kevin Toppenberg, MD. I am a primary care physician in Greeneville, TN. I have been active in the VistA community for at least 7 years, and have used VistA in my office during this time. I have decided to pursue meaningful use certification with VistA. This page will document my progress towards this, and record notes that I make to myself along the way. I hope this is helpful to others.

In CMS terminology, I am an "Eligible Provider" (EP), not a hospital. Also, I am going after Medicare (not Medicaid) certification. So my discussion below will be targeted accordingly.

NOTE: This page was originally created by Kevin Toppenberg, whose namespace is TMG. Enhancements have been made to this page, to include more general information for those seeking to attest to Meaningful Use Stage One in an outpatient setting.

Q: Where can I find the certification status of WorldVistA?

  • Go to CMS Certified Health IT Products
  • Search for "WorldVistA" -- NOTE: the search engine on this page is flaky. I found that when I clicked the search button, it would return a list of ALL technology. But when I then simply clicked search AGAIN (with WorldVistA still in the search term box), then it would find it.

Q: There seem to be so many steps involved in getting ready for Stage One attestation. It's overwhelming. Any overview sites?

Q: What's the bottom line? What do I have to do to be ready to attest meaningful use?

  1. Meet 20 of 25 "Meaningful Use Objectives" source
    • Must meet 15 "core" measures
    • Must also meet 5 of 10 possible "menu" set measures
  2. Meet 6 of 41 "Clinical Quality Measures (CQM's)" source
    • Must meet 3 required core quality measures
    • must also meet 3 of 38 possible additional quality measures
  3. Attest to meeting requirements using Y/N answers and by supplying data from the Quality Measures package.

(TO-DO SMH: Reference and write about the Quality Measures package.)

Q: Can you tell me more about the 15 "core" meaningful use measures? (all are required)

Detailed instructions on meeting these will be provided in more detail below. Detailed instructions on reporting can be found here: Quality Measures package documentation.

Measure Link to CMS Source VISTA fulfillment Attestation Type Quality Measures Package Logic
CPOE -- Provider directly enters in orders Source Fulfillment Rate > 30% Check for the presence of electronically prescribed medications stored in the Non-VA Multiple in file 55 for this patient
Implement drug-drug and drug-allergy interaction checks Source Fulfillment Yes/No Not checked. Report YES. Core VISTA functionality. Also part of electronic prescribing.
Maintain an up-to-date problem list of current and active diagnoses Source Fullfillment Rate > 80% Checks active problems.
Generate and transmit permissible prescriptions electronically (eRx) Source not available Rate > 40% Check for the presence of electronically prescribed medications stored in the Non-VA Multiple in file 55 for this patient
Maintain active medication list Source Fulfillment Rate > 80% Check for the presence of electronically prescribed medications stored in the Non-VA Multiple in file 55 for this patient
Maintain active medication allergy list Source Fulfillment Rate > 80% Check for the presence of allergies for this patient
Record required demographics Source Fulfillment Rate > 50% Check for the presence of Sex, DOB, Primary ID, Preferred Language, Race, Ethnicity for this patient. Lack of any one disqualifes you.
Record required vital signs Source Fulfillment Rate > 50% Check vital signs from July 3rd 2011 to present for this patient.
Record smoking status for patients aged 13 yrs and up Source Fulfillment Rate > 50% Check health factors in the category Tobacco; see if patient will have these. If none found in the category, each possible health factor in a list is tried by itself.
Report clinical quality measures to CMS Source Fulfillment Yes/No (Measures are reportable rates however) Not checked. Report YES.
Implement 1 clinical decision support rule Source Fulfillment Yes/No Not checked. Report YES.
Provide patients with an electronic copy of their health information Source Fulfillment Rate > 50% NOT COLLECTIBLE IN VISTA. NO RELEASE OF INFORMATION PACKAGE. COLLECT MANUALLY
Provide clinical summaries for patients for each office visit within 3 days Source Fulfillment Rate > 50% NOT COLLECTIBLE IN VISTA. NO RELEASE OF INFORMATION PACKAGE. COLLECT MANUALLY
Perform at least 1 test of exchanging key clinical information with another entity electronically Source Fulfillment Yes/No Not checked. Report YES.
Protect electronic health information Source

1 2 3 4 5 6

Yes/No Not checked. Report YES.

Q: What about the 5 "menu" set of meaningful use objectives? (5 of 10 possible are required)

Measure Link to CMS Source VISTA fulfillment Attestation Type Quality Measures Package Logic
Implement drug formulary checks Source Fulfillment Yes/No Not Checked. Report YES. Automatic functionality in VISTA.
Incorporate lab results into EHR as structured data Source Fulfillment Rate > 40% Not Checked. If you use Lab Package, report 100%; otherwise, 0%.
Generate list of patients by specific conditions for quality improvement Source Fulfillment Yes/No Not Checked. Report YES. Automatic functionality in VISTA.
Send patient reminders per patient preference Source NOT DONE NOT DONE NOT DONE
Provide patients with timely electronic access to their health information Source NOT DONE NOT DONE NOT DONE
Provide patient-specific education resources Source Fulfillment Rate > 10% NOT DONE
Perform medication reconcilliation Source Fulfillment Rate > 50% If you use electronic prescribing, it is tracked.
Send summary care record to other providers Source Fulfillment Rate > 50% NOT DONE
Submit data to immunization registries Source Fulfillment Yes/No Report YES. Enhanced functionality in WORLDVISTA.
Submit syndromic surveillance data Source NOT DONE NOT DONE NOT DONE

Q: What about the required Clinical Quality Measures (CQM)?

You must report the 3 core measures. If any of the 3 core measures are reported with zero values for the denominator, you are required to pick an alternate core measure to report in addition, even if these yield zero. For example if: NQF 0028 & NQF 0421 are 0; report 2 measures from the alternate core measures.

In addition to the core/alternate core measures, you need to report an additional 3 measures from the additional list of 38 CQMs.

Click here for a list of all measures afrom the CMS website along with the instructions just above.

NB: If you see the numerator and denomiator logic filled out, it means that the measure is fully supported in the Quality Measurement Package. If they are not there, then they are unsupported; you may still report on them, but you will have to do extra work on your end to make them work.

Core Measures

Measure Description Sources Denominator in VISTA Numerator in VISTA
NQF0013 Hypertension: Blood Pressure Measurement details2 Patients with Hypertenstion Blood Pressure recorded as a Vital
NQF0028 Tobacco: Use Asessment details Patients Health factors in NFQ0028AB Tobacco Managment Dialog
Tobacco Cessation Intervention details Patients who smoke Health factors in NFQ0028AB Tobacco Managment Dialog
NQF0421 Adult Weight Screening and Follow-up details Patients with high BMI Health factors in MU NQF0421 BMI DI

Alternate Core Measures

If you reported 0 for all 3 core measures, you must report on all 3 alternate core measures even if you will report zeroes for all 6 measures.

Measure Description Sources Denominator in VISTA Numerator in VISTA
NQF 0024 BMI for age 2-18 details Obese Patients in the Date Range (using Vitals package) ICD9/CPT codes V65.3, 97802, G0270, S9449, S9452, S9470
NQF 0041 Influenza vaccination details Patients Immunization (IM FLU, 3 yrs) in MU NQF0041 INFLUENZA MANAGEMENT DI
NQF 0038 Childhood immunization status details Patients <= 2 yo Dialog MU NQF0038 IMMUNE MANAGEMENT DI

Additional Core Measures

An additional 3 from a list of 38 CQM's must be reported. Only the first three are supported by the Quality Measures package right now. If you need to add more, get in contact with George Lilly or Sam Habiel.

Measure Description Sources Denominator in VISTA Numerator in VISTA
NQF0059 Diabetes: Hemoglobin A1c Poor Control details Diabetics via Meds or Diagnosis Lab HEMOGLOBIN A1C or Health Factor PQRI HBA1C>9 MK
NQF0061 Diabetes: Low Density Lipoprotein (LDL) Management and Control details Diabetics via Meds or Diagnosis Lab LDL CHOLESTEROL or Health Factor PQRI LDL < 100
NQF0064 Diabetes: Blood Pressure Management details Diabetics via Meds or Diagnosis Blood Pressure entered via Vitals Package.
The rest of these are not fully supported in the Quality Measures package.
NQF0081 Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) details
NQF0070 Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) details
NQF0043 Pneumonia Vaccination Status for Older Adults details
NQF0031 Breast Cancer Screening details
NQF0034 Colorectal Cancer Screening details
NQF0067 Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD details
NQF0083 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) details
NQF0105 Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment details
NQF0086 Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation details
NQF0088 Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy details
NQF0089 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care details
NQF0047 Asthma Pharmacologic Therapy details
NQF0001 Asthma Assessment details
NQF0002 Appropriate Testing for Children with Pharyngitis details
NQF0387 Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer details
NQF0385 Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients details
NQF0389 Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients details
NQF0027 Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco # Use Cessation Strategies details
NQF0055 Diabetes: Eye Exam details
NQF0062 Diabetes: Urine Screening details
NQF0056 Diabetes: Foot Exam details
NQF0074 Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol details
NQF0084 Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation
NQF0073 Ischemic Vascular Disease (IVD): Blood Pressure Management details
NQF0068 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic details
NQF0004 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a)Initiation, b) Engagement details
NQF0012 Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
NQF0014 Prenatal Care: Anti-D Immune Globulin -- NQF 0014
NQF0018 Controlling High Blood Pressure details
NQF0032 Cervical Cancer Screening details
NQF0033 Chlamydia Screening for Women details
NQF0036 Use of Appropriate Medications for Asthma details
NQF0052 Low Back Pain: Use of Imaging Studies details
NQF0075 Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control details
NQF0575 Diabetes: Hemoglobin A1c Control (<8.0%) details
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