OneView Hospital Quality Release Notes

What's New in OneView Hospital Quality 4.1.13


Release Date: Friday, December 2, 2016

New Features and Enhancements:

Electronic submission:  Acmeware has enhanced the OneView QRDA service that automates the generation of summary and detail level reporting on patient populations with QRDA reports. We have checked the validity of the QRDA Category I and Category III reports using Cypress and the PSVA tool. The data contained in a QRDA report represent eCQM data in a standard format that can be automatically consumed and submitted to CMS and The Joint Commission ORYX. QRDA Category III reports contain aggregate eCQM data from individual patient data in QRDA Category I reports. OneView supports QRDA reports for Meaningful Use, IQR and ORYX using the June 2015 NLM Value Set Authority Center specifications.

Submission Wizard: The ability to create submission for 2016 has been disabled until the next release. Due to some significant changes to the way OneView locks submissions, we have disabled the lock functionality and this feature will be reinstated in the next release.

New report:  We've added new CQM Summary report to help consolidate CQM measures into one report.

Customer Support Portal:  Acmeware has launched a new, web-based customer support portal. You can create new OneView report requests and other service issues using the system, as well as see the status and all relevant communication about your support tickets.  While use of the portal is optional, as we remain available via telephone and email, we’ve found that the new system has helped us improve our communication with clients, as well as more easily organize their report requests, issues, and questions.  

For more information about the new system and new user registration use the following link. https://support.acmeware.com/User/Register  

Scheduling Live OneView Submissions: Acmeware has launched a OneView submission scheduling for our customers to sign up for a time slot for hospital quality program submissions for Meaningful Use (MU), Inpatient Quality Reporting (IQR) and/or Joint Commission ORYX, and/or a time slot for physician quality program submissions for Meaningful Use (MU) and/or Physician Quality Reporting System (PQRS).  

To schedule your submission, use the following link. http://www.acmeware.com/signup.aspx

Prior to your live production submission, we will be testing your QRDA files and sharing the results with you. During your live production submission time slot, we will prepare and submit your QRDA files. Once we receive confirmation emails from CMS, we will contact you to review the numbers and complete your manual attestation on CMS’ Registration and Attestation Website, if needed.

New Features and Enhancements:

Enhancement:

  • Added new Hospital Settings fields that are required for QRDA Submissions
  • Upgraded the OneView Customer Support Portal ticketing integration for a better user experience.  http://support.acmeware.com

Clinical Quality Measures:

  • Reorganized demographic data for QRDA capture; Added second area to pick up Ethnicity; Corrected map for Race Set; Added separate maps for Payer (Insurance or Financial Class) (TFS# 1198)

Objective Measures:

  • Enhancement to the Objective Measures schema.

Manage Dictionaries:

  • Added a new dictionary to select submission programs (i.e. Meaningful Use, IQR or ORYX) and associate measures to those programs.
  • Added screens under manage dictionaries to allow sites to select their reporting option(s) and measures. (TFS# 1147)
  • Added a new dictionary to select submission programs (i.e. Meaningful Use, IQR or ORYX) and associate measures to those programs.
  • Added sorting so manage dictionaries orders appropriately. (TFS# 1170)

Reports:

  • Updated the ED Detail report to display date/time in military format.  
  • Added new CQM Summary report to the list to show measure population exclusions and measures selection from dictionaries of chosen measures by site for submission options. (TFS# 1145)
  • Updated ED Summary report to include measure population exclusions. (TFS# 1145)
  • Modified reporting and rollup processing code to select measures for sites in prep for attestation measure selection process in manage dictionaries. (TFS# 1113)

Fixes:

Application:

  • Corrected an issue with Subscription in Report Preferences with the Parameter selection not displaying.

Clinical Quality Measures:

Measure Impact Change: Updated ED-1 measure population logic to strictly compare ED Depart to Inpatient Admit dates (not considering observation patient’s hours). If the admit is not within 1 hour of the depart date, then the patient will not be included within the measure population.

See ED Measures Details Below

Measure Impact Change: Updated ED-2 criteria uses the same logic as ED-1 with additional logic applied. The patient will need to have an ED Depart date prior to the Admit date time, will need to be admitted within 1 hour of the depart date time, and the decision to admit date time will need to be before the ED depart date.

See ED Measures Details Below

  • Added Stages selection when setting measures for sites, in prep for attestation. (TFS# 1171)
  • Added newest version number for QRDA submission and updated some measure descriptions. (TFS# 1188)
  • Updated dictionaries to save correctly when changing data for some items. (TFS# 1161)
  • Added Map for Hearing screen to dictionary capture for Newborn measures. (TFS# 1168)
  • Corrected issue with flag calculations as values used for default temporal logic were passed incorrectly to function that processes temporal criteria. (TFS# 1127/1179) Measures: ALL
  • Updated Logic for items that used “AND NOT: Union Of” descriptions to reflect the intended workflow; Added Elective Delivery revised logic. (TFS# 1133/1187)
  • Corrected Decision to Admit flag. (TFS: 1186/1178) Measures: ED-2
  • Fixed index for performance on table that holds sources collected to process within applications. (TFS: 1174)
  • Efficiencies for faster processing, update to ordering and clarification of Category and Attribute Logic items within mapping reports. (TFS# 1136)
  • (MAGIC only) Corrected code for missing sources which are used to pull data within various applications. (TFS# 1132)
  • Corrected surgical Incision date for QRDA output. (TFS# 1202) Measures: SCIP
  • (MAGIC only) Fixed join when gathering Order Queries during precompile of data. (TFS# 1203)
  • Corrected compile time performance issue with Labs and Diagnostic Studies. (TFS# 1165)
  • (CS / MAGIC only) Fixed bug with Scheduling parameters not showing up for Anesthesia and Procedure dates. (TFS# 1166)
  • Corrected Prophylaxis Device start time for flags. (TFS# 1126) Measures: VTE-1, VTE-2, VTE-6
  • Revised data capture for exam items other than symptoms. (TFS# 1185) Measures: STK-4; NB-1; Elective Delivery (PC-1)
  • Fixed exam flags calculations, some needing response values converted to decimals, some flags were missing, wrong flag referenced, index issues, and added columns for exams to calculate numeric values. (TFS# 1201/1183/1209/1180/1206/1176) Measures: STK-4; NB-1, NB-2; Elective Delivery (PC-1) **Not all changes affected all measures listed
  • Performed data validation and format check on labs collected for QRDA output, removing free text data from results. (TFS# 1200) Measures: STK-4, STK-6; VTE-1, VTE-2, VTE-3, VTE-4; AMI-10; Pneumonia (CAP-1)
  • Limited patients for processing to those with FINAL abstract Status. (TFS# 1194) Measures: ALL
  • Removed Observation patients from encounters collected after CMS updated JIRA tickets that were questioning INO process with regard to time spent under Observation status. (TFS# 1195) Measures: ALL ** See further explanation of impacts below for ED-1, ED-2.
  • REMOVED with JIRA ticket Observation issues (previously applied with 4.1.12): When patient admitted for Observation, from ED, but never an actual admit, adjusted encounter times for those ED patients. (TFS# 1163, 1195) Measures: ALL **See further explanation of impacts below for ED-1, ED-2.
  • Corrected dictionary item referenced in logic for Transfer using Admit Source Query. (TFS# 1196) Measures: AMI-7, AMI-8; Pneumonia (CAP-1); SCIP-2
  • During QRDA testing, corrected issues with capture of Discharge Disposition and Service Events. (TFS# 1197) Measures: VTE-1, VTE-2, Pneumonia (CAP-1); SCIP-9
  • Fixed service mapping to accommodate both encounter and attribute types when looking for ICU admissions/transfers. (TFS# 1164) Measures: VTE-1, VTE-2, Pneumonia (CAP-1); SCIP-9
  • For mental health for ED measures, set start of diagnosis to admit not discharge date, as most abstracted dx codes use discharge date. (TFS# 1184) Measures: ED*
  • Limited *transfer to* data for patients as multiple location transfers for one inpatient were causing duplicate entries during minutes’ calculation. (TFS# 1213) Measures: ED-3
  • Risk items were not being evaluated due to typo in name, and added conversion to numeric data for Exams/Lab results. (TFS# 1212/1208) Measures: STK-4; VTE-1, VTE-2
  • Corrected flag naming conventions for stroke scale. (TFS# 1182) Measures: STK-4
  • Corrected flag calculation logic on a couple of flags to be consistent with spec for diagnostic tests within 4 days of encounter. (TFS# 1177) Measures: VTE3, VTE-4, VTE-5
  • Corrected contra reason to medication administration for TPA when setting flags. (TFS# 1204) Measures: STK-4
  • Corrected Expired flags and setting them correctly in template after QRDA testing. (TFS# 1205/1175) Measures: ED-3; STK-2, STK-3, STK-6, STK-10; VTE-3, VTE-4; AMI-2, AMI-10; NB-1, NB-3
  • Corrected Platelet Count items as they should be labs not exam category; clarified flags between SCIP-1 and SCIP-2 populations; added visits to flags using Diagnostic Study items to mark correctly per visit, not patient; Correct NB measure diagnosis for Liveborn/Single Live Birth items; corrected Respiratory Infection Dx; medication admin for Antimicrobial flags had wrong temporal; elective delivery medications removed NOT requirement; added Delivery Time flag; corrected logic for medication admin Fibrinolytic Therapy, Oral Factor Xa, Warfarin, Parenteral Anticoagulant; removed equal from flag looking for an ED Encounter prior to STK INP visit. (TFS# 1210/1207/1191/1181) Measures: STK-4, STK-5; VTE-4; AMI-7, AMI-8; NB*; Pneumonia (CAP-1); Elective Delivery (PC-1); SCIP-1, SCIP-2

ED Measures Details Below

Problem:

You may notice a significant difference in your ED-1/ED-2 measure population numbers. Because of JIRA tickets and CMS QRDA validations we have to modify the way we calculate the ED numbers. Up until now we’ve been able to code in the favor of our clients to ‘force’ patients to meet the measure based on processes (as well as considering observation hours prior to admission). CMS recognizes the issue but is currently stating that these issues will be not be reflected in the specifications until 2018 submissions. Additionally, because QRDA submissions are patient detail data, rather than the summary numbers we’ve submitted in years past, CMS applies strict logic and rolls up the measure numbers according to their logic to process a QRDA file. We have modified our code to reflect the same logic that CMS uses.  

Impact:

So what does that mean for you?  

ED-1:  

You will have fewer patients meeting ED-1 because we will strictly compare ED Depart to Inpatient Admit dates (not considering observation patient’s hours). If the admit is not within 1 hour of the depart date, then the patient will not be included within the measure population.

ED-2:

ED-2 criteria uses the same logic as ED-1 with regard to ED Depart to Inpatient Admit dates with additional logic applied. The patient will need to have an ED Depart date prior to the Admit date time, will need to be admitted within 1 hour of the depart date time, *and* the decision to admit date time will need to be before the ED depart date.

Solution:

We can customize the dates beyond the standard if necessary for your processes however, we’ll need to review the impact of those changes to make sure that correcting one problem does not cause another as ED arrival/departure values are used in other measures and we process data at patient level, not measure-by-measure.

Example:

In this patient example the patient will not meet the specs for either ED-1 or ED-2. After the QRDA update (4.1.13).

Scenario 1: The patient is not admitted within 1 hour of hour of being departed from ED.   

Depart: 3/12/16 16:35  

Admit: 3/14/16 12:57

Scenario 2: The patient does have a decision to admit prior to depart, however the logic evaluation is processed in this order:

Depart: 3/12/16 16:35    

Admit: 3/14/16 12:57

Decision To Admit: 3/12/16 13:48

Is the ED Depart Date Prior to the AdmitDate?  

Is the patient admitted within 1 hour of the ED Depart Date?

If so, patient meets the criteria for the measure population

Is the DTA prior to the ED Depart?

Only evaluated if met #2.