pqrs_ehr_measure_specifications_release_notes.pdf

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2012 EHR Measure Specifications

Release Notes

Version 3.1 November 2011

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July 2011; Updated November 2011

The 2012 Electronic Health Record (EHR) Measure Specifications Release Notes details acomprehensive list of revisions made to measures since the release of the 2011 EHR MeasureSpecifications. The specifications listed in the 2012 EHR Measure Specifications have been updated toreflect clinical practice guidelines and applicable health informatics standards that are the most currentavailable as of July, 2011. These updates have also been carried over to the Electronic Health Record(EHR) Downloadable Resource table.

These specifications may be available for potential use in physician quality initiatives, including but notlimited to the EHR submission under the 2012 Physician Quality Reporting System (Physician QualityReporting, formerly known as Physician Quality Reporting Initiative or PQRI). A measures inclusion inthis document does not guarantee that measure will be used in any specific CMS (Centers for Medicare& Medicaid Services) program in 2012 or any subsequent year. If a measure is included in the 2012Physician Quality Reporting System, all measure-related EHR coding/data should be submitted to theEHR Warehouse to ensure accurate performance rates. The EHR Warehouse will calculate the ratesbased on the data that is submitted in the specified format for this program.

In the case of measures that have been used in prior initiatives such as the 2011 PQRS EHR program,the 2010 PQRI EHR program, the 2008 and 2009 PQRI EHR testing projects the specificationsdetailed in this document supersede any specifications which may have been used in those prioractivities.

These specifications are not intended for use in the EHR Incentive Program, at this time. The

EHR Incentive Programs American Recovery and Reinvestment Acts (ARRAs) Health

Information Technology for Economic and Clinical Health (HITECH) Acts Electronic

Specif ications and related documents can be found on the CMS website.

To determine which measures are included in any specific CMS program or demonstration, interestedparties should refer to the official documentation for that program or demonstration. Please refer to the

Medicare Physician Fee Schedule (PFS) 2012 Final Rule (published in the Federal Register inNovember, 2011) to identify the measures that are available for data submission through EHRs underthe 2012 Physician Quality Reporting System.

Global Edits

Updated Introduction: Removed the List of EHR Measures containing CPT Category I codes for non-covered services from the PFS. Removed the symbols and footnotes ( Signifies that this CPT Category I code is a non-covered service under the PFS

(Physician Fee Schedule). These non-covered services may not

Removed the symbols and footnotes ( The Percentage of patients who meet the criteria for this measure will becalculated by the EHR Warehouse. All measure-related EHR coding/data should be submitted to the EHR Warehouse to

ensure accurate performance rates.) within each measure specification specifying that the EHR Warehouse will calculateperformance rates. A Note on providers submitting raw data to the EHR Warehouse for calculation has been added to theintroduction.

be counted in the denominator population for reporting rate

calculations.) within each measure specification for the CPT Category I codes for non-covered services from the PFS.

Removed the codes in the Denominator Inclusions, Numerator Inclusions, Numerator Exclusions, and DenominatorExclusions. Please see the 2012 Downloadable Resource Table for the list of specific codes for each measure.

NQF numbers have been added to the measure title when applicable Removed Appendix A EHR Measures with Corresponding Data Elements. Please see the 2012 Downloadable Resource

Table for the list of data elements for each measure.

List of Physician Quality Reporting measures for 2012 have been updated and measure numbers were assigned for new 2012EHR measures according to the recently finalized 2012 PFS Rule (11/2011)


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Release Notes


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Measure #1 (NQF 0059)

Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus Added Note: For performance, a lower rate indicates better performance/control to Numerator Inclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications

Revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic Specifications


Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions: Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control in Diabetes Mellitus Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Created numerator option for patients with LDL-C test result to align with EHR Incentive Program Electronic Specifications Expanded data element options and revised logic in Numerator 2 to align with the EHR Incentive Program Electronic

Specifications

Revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic SpecificationsMeasure #3 (NQF 0061)

Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions: Diabetes Mellitus: High Blood Pressure Control in Diabetes Mellitus Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic SpecificationsMeasure #5 (NQF 0081)

Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions: Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker

(ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) (11/2011)

Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Expanded data element options in Denominator Inclusions to align with the EHR Incentive Program Electronic Specifications Expanded data element options and revised logic in Denominator Exclusions to align with the EHR Incentive Program

Electronic Specifications

Expanded data element options in Denominator Exclusions to include ACE Allergy Codes and ARB Allergy Codes Updated Measure Owner(11/2011)Measure #6 (NQF 0067)

Updated Measure Owner(11/2011): Coronary Artery Disease (CAD): Antiplatelet Therapy (11/2011) Updated Title, Description and Numerator Statement (11/2011) Removed oral prior to antiplatelet therapy when referenced in Numerator Inclusions and Denominator Exclusions (11/2011)Measure #7 (NQF 0070)

Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions: Coronary Artery Disease (CAD): Beta-blocker Therapy for CAD Patients wi th Prior Myocardial

Infarction (MI)(11/2011)

Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Revised logic in Denominator Inclusions to align with the EHR Incentive Program Electronic Specifications

Expanded data element options and revised logic in Denominator Exclusions to align with the EHR Incentive ProgramElectronic Specifications

Updated Measure Owner(11/2011)Measure #8 (NQF 0083)

Updated Measure Owner(11/2011): Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) (11/2011)

Measure #9 (NQF 0105):

Assigned Physician Quality Reporting Measure #9 to NQF Measure 0105 (11/2011)Anti -depressant medicat ion management: (a) Effect ive Acu te Phase Treatment, (b) Effec tive

Continuation Phase Treatment (11/2011)


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Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions: Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic SpecificationsMeasure #47 (NQF 0326)

Updated instructions in Denominator Inclusions: Advance Care Plan


Updated instructions in Denominator Inclusions: Urinary Incontinence: Assessment of Presence or Absence or Urinary Incontinence in Women

Aged 65 Years and Older


Updated Measure Owner(11/2011): Asthma: Pharmacologic Therapy (11/2011)


Updated Measure Owner(11/2011)

: Asthma: Asthma Assessment (11/2011)

Updated Title (11/2011)Measure #110 (NQF 0041)

Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions: Preventive Care and Screening: Influenza Immunization (11/2011) Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Expanded data element options and revised logic in Denominator Exclusions to align with the EHR Incentive Program


Updated Title, Description, Denominator Statement and Denominator Inclusions to specify appropriate age as 6 months andolder(11/2011)


Updated instructions in Denominator Inclusions and Numerator Inclusions: Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older

Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Removed Denominator Exclusions to align with the EHR Incentive Program Electronic SpecificationsMeasure #112 (NQF 0031)

Updated instructions in Denominator Inclusions: Preventive Care and Screening: Screening Mammography Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications. Expanded data element options and revised logic in Denominator Inclusions to align with the EHR Incentive Program


Removed Denominator Exclusions to align with the EHR Incentive Program Electronic SpecificationsMeasure #113 (NQF 0034)

Updated instructions in Denominator Inclusions and Denominator Exclusions: Preventive Care and Screening: Colorectal Cancer Screening

Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Expanded data element options and revised logic in Denominator Inclusions to align with the EHR Incentive Program


Revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic SpecificationsMeasure #124 (NQF 0488)

Removed Measure #124 from Physician Quality Reporting System EHR Measure Specifications per the 2012 PFSFinal Rule(11/2011)

: Health Information Technology (HIT): Adoption/Use of Electron ic Health Records (EHR)(11/2011)


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Changed Numerator Inclusion Option # 1 and 2 into Denominator and Numerator 1 and 2: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications

Expanded data element options and revised logic in Denominator Exclusions to align with the EHR Incentive ProgramElectronic Specifications

Measure #154

Removed Measure #154 from Physician Quality Reporting System EHR Measure Specifications per the 2012 PFSFinal Rule (11/2011)

: Falls: Risk Assessment (11/2011)

Measure #155

Removed Measure #155 from Physician Quality Reporting System EHR Measure Specifications per the 2012 PFSFinal Rule (11/2011)

: Falls: Plan of Care (11/2011)

Measure #173

Updated instructions in Denominator Inclusions

: Preventive Care and Screening: Unhealthy Alcohol Use-Screening

Updated RationaleMeasure #197 (NQF 0074)

Updated Measure Owner(11/2011): Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol (11/2011)


Updated Measure Owner(11/2011): Heart Failure: Warfarin Therapy for Patients with Atrial Fibrillation (11/2011)


Updated Numerator Inclusions: Ischemic Vascular Disease (IVD): Blood Pressure Management Contro l

Measure #226 (NQF 0028) Created Denominator and Numerator 1 and 2: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (11/2011) Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Revised logic in Numerator Inclusions to align with the EHR Incentive Program Electronic Specifications Updated instructions in Denominator Inclusions and Numerator Inclusions (11/2011)Measure #236 (NQF 0018

Updated Description ): Hypertension (HTN): Controlling High Blood Pressure


Updated instructions in Denominator Inclusions and Numerator Inclusions: Hypertension (HTN): Blood Pressure Measurement Updated data elements to align with standard concepts in the EHR Incentive Program Electronic SpecificationsMeasure #238 (NQF 0022)

Updated instructions in Denominator Inclusions and Numerator Inclusions: Drugs to be Avoided in the Elderly Updated data elements to align with standard concepts in the EHR Incentive Program Electronic SpecificationsMeasure #239 (NQF 0024)

Updated Measure Description: Weight Assessment and Counseling for Children and Adolescents Created Population Stratification 1, 2, and 3 Updated instructions in Denominator Inclusions and Numerator Inclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications


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Revised logic in Denominator Inclusions to align with the EHR Incentive Program Electronic Specifications Removed Denominator Exclusions Updated Rationale and Clinical Recommendation Statement Removed Evidence Supporting the Criterion of Quality MeasuresMeasure #240 (NQF 0038) Updated Measure Description: Childhood Immunization Status Updated instructions in Denominator Inclusions and Numerator Inclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Updated Numerator Statement Expanded data element options and revised logic in Numerator Inclusions and Exclusions to align with the EHR Incentive

Program Electronic Specifications

Created new Criterion h; changed Criterion h to i; and changed Criterion i to jMeasure #241 (NQF 0075):

Replaced Physician Quality Reporting Measure #202 and #203 (NQF 0075) with newly assigned Physician Quality ReportingMeasure #241 (11/2011)

Ischemic Vascular Disease (IVD): Complete Lipid Panel and Low Density Li poprotein (LDL-C)Control (11/2011)

Updated Numerator Inclusions (11/2011)Measure #305 (NQF 0004):

Assigned NQF Measure 0004 Physician Quality Reporting Measure #305 (11/2011)Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (a) Initiation, (b)

Engagement (11/2011)


Assigned NQF Measure 0012 Physician Quality Reporting Measure #306(11/2011): Prenatal Care: Screening for Human Immunodefic iency Virus (HIV) (11/2011)


Assigned NQF Measure 0014 Physician Quality Reporting Measure #307 (11/2011): Prenatal Care: Anti -D Immune Globul in (11/2011) Updated instructions and logic in Denominator Inclusions (11/2011)Measure #308 (NQF 0027)

Assigned NQF Measure 0027 Physician Quality Reporting Measure #308 (11/2011)

: Smoking and Tobacco Use Cessation, Medical Assistance: a. Advising Smokers and TobaccoUsers to Quit, b. Discussing Smoking and Tobacco Use Cessation Medications, c. Discussing Smoking and Tobacco UseCessation Strategies (11/2011)


Assigned NQF Measure 0032 Physician Quality Reporting Measure #309 (11/2011): Cervical Cancer Screening (11/2011)


Assigned NQF Measure 0033 Physician Quality Reporting Measure #310 (11/2011): Chlamydia Screening for Women (11/2011)


Assigned NQF Measure 0036 Physician Quality Reporting Measure #311 (11/2011): Use of Appropri ate Medications for Asthma (11/2011)


Assigned NQF Measure 0052 Physician Quality Reporting Measure #312 (11/2011): Low Back Pain: Use of Imaging Stud ies (11/2011)


Assigned NQF Measure 0575 Physician Quality Reporting Measure #313 (11/2011): Diabetes Mellitus: Hemoglobin A1c Control (


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Measure #316:

Replaced temporary Physician Quality Reporting Measure #M119 with Physician Quality Reporting Measure #316 (11/2011)Preventive Care and Screening: Cholesterol Fasting Low Density Lipoprotein (LDL) Test Performed AND

Risk-Stratified Fasting LDL (11/2011)

Measure #317:

Replaced temporary Physician Quality Reporting Measure #M125 with Physician Quality Reporting Measure #317 (11/2011)Preventive Care and Screening: Screening for High Blood Pressure (11/2011) Updated Numerator Statement (11/2011) Updated third bullet under Numerator Inclusion to 140 mmHG(11/2011) Updated Note in Numerator Inclusions (11/2011)

pqrs_ehr_measure_specifications_release_notes.pdf

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