Submitted By: Joel Andress
/ Centers for Medicare and Medicaid Services (CMS) Center for Clinical Standards and Quality (CCSQ)
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Data Element Information |
Use Case Description(s) |
Use Case Description |
Diagnostic studies and exams performed with results are key data elements currently used in CMS eCQMs across hospital and clinician reporting programs. These data are necessary to confirm appropriate care is received for patients across different populations. Similar to labs and vital signs, it is clinically relevant from a care perspective and a quality measurement perspective to have access to and use diagnostic study/exam results for care decision making. This information can support surveillance of appropriate use and adherence to care guidelines for value-based care of patients.
Diagnostic study/exam concepts represented in measures include and eye/disc/macular exams and ejection fraction studies. Results for these types of studies and exams are available in structured fields and exchanged for quality measurement purposes.
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Estimate the breadth of applicability of the use case(s) for this data element
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1 million providers currently capture, access and exchange this diagnostic study/exam information. This information is currently electronically submitted by providers and hospitals to CMS for quality measurement purposes, including QPP.
eCQI resource center, includes measure specifications for CMS program eCQMs (i.e. CMS 143, 135): https://ecqi.healthit.gov/ecqms |
Link to use case project page |
https://ecqi.healthit.gov/ecqms |
Use Case Description |
Data exchange of diagnostic study/exam information is critical for clinical care. Clinician’s need to be aware of recent tests completed to both ensure the patient is receiving appropriate care and reduce duplicity which drives up healthcare costs.
Diagnostic study and exam information including studies/exams performed, result, and the type of test completed via standard terminology can be exchanged via C-CDA for patient care coordination.
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Estimate the breadth of applicability of the use case(s) for this data element
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Majority or hospital and clinical providers are capturing, accessing and exchanging this information. |
Link to use case project page |
http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492 |
Healthcare Aims |
- Improving patient experience of care (quality and/or satisfaction)
- Improving the health of populations
- Reducing the cost of care
- Improving provider experience of care
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Maturity of Use and Technical Specifications for Data Element |
Applicable Standard(s) |
LOINC (i.e. OID: 2.16.840.1.113883.3.526.3.1251)
https://vsac.nlm.nih.gov/valueset/expansions?pr=ecqm
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Additional Specifications |
HL7 FHIR QI Core Implementation Guide STU4 based on FHIR R4, Observation Profile (category= exam) : http://hl7.org/fhir/us/qicore/StructureDefinition-qicore-observation.html and DiagnosticReport profiles
CMS Quality Data Model (QDM) version 5.5 Guidance https://ecqi.healthit.gov/sites/default/files/QDM-v5.5-Guidance-Update-May-2020-508.pdf
HL7 FHIR US Core Implementation Guide v3.1.0 based on FHIR R4, includes Observation-lab Profile, which can be built out further to also identify exams and studies performed. https://www.hl7.org/fhir/us/core/StructureDefinition-us-core-observation-lab.html
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Current Use |
This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders |
Supporting Artifacts |
These diagnostic studies and exams performed are regularly captured by EHR systems across hospitals, providers, and other healthcare stakeholders, and used for CQM quality measurement (eCQMs).
https://fhir.epic.com/Specifications?api=964
https://ecqi.healthit.gov/ecqms https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS129v9.html
https://ecqi.healthit.gov/ecqms
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Extent of exchange
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5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders. |
Supporting Artifacts |
Diagnostic studies and exams performed are electronically exchanged from organization’s EHR systems to CMS for reporting and payment quality measurement programs, via QRDA files.
Diagnostic study/exams can also be electronically exchanges with external organizations via C-CDA.
https://ecqi.healthit.gov/qrda
http://www.hl7.org/implement/standards/product_brief.cfm?product_id=7
https://ecqi.healthit.gov/qrda
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Potential Challenges |
Restrictions on Standardization (e.g. proprietary code) |
No challenges anticipated. This data is available in standard terminology that can be publicly accessed via the VSAC and HL7. |
Restrictions on Use (e.g. licensing, user fees) |
We are not aware of any restrictions. |
Privacy and Security Concerns |
This data, like any patient data should be exchanged securely. Current processes exist, governed by CMS and ONC, to securely transfer this data. |
Estimate of Overall Burden |
Diagnostic study and exam performance is regularly captured as part of EHR systems. Most hospitals, including critical access hospitals, and providers are already capturing and exchanging these data for quality measurement to CMS.
Some additional efforts may be necessary to build out Observation profile or additional resources in FHIR US Core Implementation Guide, though base resources exist in FHIR and profiles exist in QI Core Implementation Guide.
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Other Implementation Challenges |
N/A |
Submitted by brianscarpelli on
Comments of the Connected Health Initiative
The Connected Health Initiative supports adding the Current Procedural Terminology (CPT) code set to the applicable vocabulary standards for Clinical Tests – Clinical Tests, as the CPT code set contains numerous codes for non-imaging and non-laboratory clinical tests.