2615 lines
90 KiB
Text
2615 lines
90 KiB
Text
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<a href="/about-quality/quality-at-CMS/principles">
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<span>Measure Development Principles</span>
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<span>Quality Across CMS</span>
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</a>
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</ul>
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<span><strong>Blueprint Measure Lifecycle</strong></span>
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<span><strong>Measure Conceptualization</strong></span>
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</a>
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<span>Information Gathering</span>
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<a href="/measure-lifecycle/measure-conceptualization/information-gathering/conduct-environment-scan">
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<span>Conduct an Environmental Scan</span>
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</a>
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<a href="/measure-lifecycle/measure-conceptualization/information-gathering/analyze-data-gap-analysis">
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<span>Analyze Data & Conduct Gap Analysis</span>
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<a href="/measure-lifecycle/measure-conceptualization/information-gathering/respecified-measures">
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<span>Respecified Measures</span>
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-conceptualization/information-gathering/justify-creation-new-measures">
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<span>Justify the Creation of New Measures</span>
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</a>
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</li>
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</ul>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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<span>Business Case Development</span>
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<ul id="basic-nav-section-Business-Case-Development" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Business-Case-Development" >
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<a href="/measure-lifecycle/measure-conceptualization/business-case/overview">
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<span>Overview</span>
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-conceptualization/business-case/outcomes">
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<span>Documenting Outcomes, Benefits, & Costs</span>
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-conceptualization/business-case/best-practices">
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<span>Business Case Best Practices</span>
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</a>
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</li>
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</ul>
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</li>
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</ul>
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</div>
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<div class="desktop:grid-col-3">
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<span><strong>Measure Specification</strong></span>
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<ul id="basic-nav-section-Measure-Specification" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Measure-Specification" >
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<a href="/measure-lifecycle/measure-specification/overview">
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<span>Overview</span>
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/specifications-measure-category">
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<span>Specifications by Measure Category</span>
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/define-data-sources">
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<span>Define Data Sources</span>
|
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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<span>Develop Specifications</span>
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<ul id="basic-nav-section-Develop-Specifications" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Develop-Specifications" >
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/develop-specification/overview">
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<span>Overview</span>
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/develop-specification/target-initial-population">
|
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<span>Define the Target/Initial Population</span>
|
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/develop-specification/denominator">
|
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<span>Define the Denominator</span>
|
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</a>
|
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</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/develop-specification/numerator">
|
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<span>Define the Numerator and Exclusions</span>
|
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</a>
|
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|
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</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/develop-specification/stratification">
|
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<span>Define Stratification Scheme</span>
|
|
</a>
|
|
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|
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</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-specification/develop-specification/respecifying-registry-measures">
|
|
<span>Respecifying Registry Measures to Electronic Clinical Quality Measures (eCQMs)</span>
|
|
</a>
|
|
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</li>
|
|
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</ul>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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<span>Specify the Code</span>
|
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</button>
|
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<ul id="basic-nav-section-Specify-the-Code" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Specify-the-Code" >
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/specify-code/overview">
|
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<span>Overview</span>
|
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</a>
|
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</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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<a href="/measure-lifecycle/measure-specification/specify-code/code-systems-vocabularies-terminologies">
|
|
<span>Code Systems, Vocabularies, and Terminologies</span>
|
|
</a>
|
|
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|
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</li>
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-specification/specify-code/encode-clinical-information">
|
|
<span>Encoding Clinical Information</span>
|
|
</a>
|
|
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|
|
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</li>
|
|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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<a href="/measure-lifecycle/measure-specification/specify-code/data-standards">
|
|
<span>Data Standards</span>
|
|
</a>
|
|
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|
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</li>
|
|
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|
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</ul>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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<span>Construct Data Protocol</span>
|
|
</button>
|
|
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|
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|
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<ul id="basic-nav-section-Construct-Data-Protocol" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Construct-Data-Protocol" >
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/data-protocol/overview">
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<span>Overview</span>
|
|
</a>
|
|
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|
|
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-specification/data-protocol/key-terms">
|
|
<span>Define Key Terms, Data Elements, Codes, and Code Systems</span>
|
|
</a>
|
|
|
|
|
|
</li>
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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<a href="/measure-lifecycle/measure-specification/data-protocol/level-measurement-analysis">
|
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<span>Describe Level of Measurement & Sampling</span>
|
|
</a>
|
|
|
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|
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</li>
|
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-specification/data-protocol/risk-adjustment">
|
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<span>Determine Risk Adjustment</span>
|
|
</a>
|
|
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|
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</li>
|
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-specification/data-protocol/time-interval">
|
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<span>Define Any Time Intervals</span>
|
|
</a>
|
|
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|
|
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</li>
|
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
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|
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<a href="/measure-lifecycle/measure-specification/data-protocol/scoring">
|
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<span>Describe Scoring & Calculation Algorithm</span>
|
|
</a>
|
|
|
|
|
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</li>
|
|
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|
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</ul>
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</li>
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|
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
|
|
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<a href="/measure-lifecycle/measure-specification/document-measure">
|
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<span>Document the Measures</span>
|
|
</a>
|
|
|
|
|
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</li>
|
|
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<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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<span>Measure Harmonization</span>
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<a href="/measure-lifecycle/measure-specification/measure-harmonization/overview">
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<span>Overview</span>
|
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</a>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/measure-harmonization/alignment">
|
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<span>Measure Harmonization and Alignment</span>
|
|
</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-specification/measure-harmonization/when-to-consider">
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<span>When to Consider Measure Harmonization</span>
|
|
</a>
|
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</li>
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</ul>
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</li>
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</ul>
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</div>
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<div class="desktop:grid-col-3">
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<div class="usa-nav__headermenu-item">
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<span><strong>Measure Testing</strong></span>
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<a href="/measure-lifecycle/measure-testing/overview">
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<span>Overview</span>
|
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</a>
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</li>
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<a href="/measure-lifecycle/measure-testing/process/overview">
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<span>Overview</span>
|
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</a>
|
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|
|
|
</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/process/develop-workplan">
|
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<span>Develop The Testing Work Plan</span>
|
|
</a>
|
|
|
|
|
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/process/perform-sampl">
|
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<span>Perform Sampling</span>
|
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</a>
|
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|
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/process/implement-and-analyze">
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<span>Implement, Analyze, Refine & Retest</span>
|
|
</a>
|
|
|
|
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/process/summary">
|
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<span>Measure Testing Summary</span>
|
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</a>
|
|
|
|
|
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/process/testing-respecified-measures">
|
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<span>Testing Respecified Measures</span>
|
|
</a>
|
|
|
|
|
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</li>
|
|
|
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|
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</ul>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_expanded">
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<span>Measure Evaluation Criteria</span>
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<ul id="basic-nav-section-Measure-Evaluation-Criteria" class="usa-nav__submenu-list-2 is_collapsed " aria-controls="extended-mmega-nav-section-Measure-Evaluation-Criteria" >
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<a href="/measure-lifecycle/measure-testing/evaluation-criteria/overview">
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<span>Overview</span>
|
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</a>
|
|
|
|
|
|
</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/evaluation-criteria/importance">
|
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<span>Importance</span>
|
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/evaluation-criteria/scientific-acceptability">
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<span>Scientific Acceptability</span>
|
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<a href="/measure-lifecycle/measure-testing/evaluation-criteria/feasibility">
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<span>Feasibility</span>
|
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</a>
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</li>
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<li class="usa-nav__submenu-item menu_level_2 is_collapsed ">
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<div class="views-row"><div class="views-field views-field-field-parent-title"><h1 class="field-content"><span class="glossify-exclude">Measure <abbr tabindex="0" title="<p><span class="glossify-exclude">Specifications</span> are measure instructions addressing data elements, data sources, point of data collection, timing and frequency of data collection and reporting, specific instruments used (if appropriate), and implementation strategies.</p> " class="glossify-tooltip-tip" lang="en">Specification</abbr></span></h1></div></div>
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<h1 class="margin-0">
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<span property="schema:name">SNOMED CT</span>
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<div property="schema:text" class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>SNOMED CT contains more than 357,000 health care concepts with unique meanings and formal <abbr tabindex="0" title="<p><span class="glossify-exclude">Logic</span> is the criteria used to define a quality measure and its key components.</p> " class="glossify-tooltip-tip" lang="en">logic</abbr>-based definitions organized into hierarchies. A unique semantic type, included in parentheses, identifies each hierarchy in the fully specified name of every concept in the hierarchy. The fully populated <abbr tabindex="0" title="<p>A code system is a managed collection of concepts with each concept represented by at least one internally unique code and a human-readable description (e.g., SNOMED CT).</p> " class="glossify-tooltip-tip" lang="en">code system</abbr> list with unique descriptions for each concept contains more than 957,000 descriptions. Approximately 1.37 million semantic relationships exist to improve the <span class="glossify-exclude">reliability</span> and consistency of data retrieval.</p>
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<p>SNOMED CT is a general clinical reference terminology, meaning its intent is to represent clinical concepts across many domains, which includes conditions, diagnoses, symptoms, and signs, all of which are a type of finding. SNOMED CT also represents procedures, observations, and some laboratory tests, drugs, and devices. The table also notes concepts used for ancillary aspects for documentation of the domains. As a general reference terminology, the expectation is for SNOMED CT to provide many of the concepts needed for clinical information encoding, and unless otherwise noted, a specific terminology should be the primary source for standardized terminology encoding.</p>
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<p>There is no intent for SNOMED CT codes to transmit all possible information about a condition, observation, or procedure. The intent is for SNOMED CT codes to identify the condition, observation, or procedure.</p>
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<p>Measure developers should use the <a href="https://www2a.cdc.gov/vaccines/iis/iisstandards/vaccines.asp?rpt=cvx">CVX code set</a> for coding vaccine-allergy-inducing entities.</p>
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<p>Measure developers should use the SNOMED CT substance hierarchy for coding non-medication allergy-inducing entities.</p>
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<dl class="ckeditor-accordion">
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<dt>SNOMED CT-Specific Guidance for Measure Developers for Allergy <abbr tabindex="0" title="<p>A <span class="glossify-exclude">value set</span> is a subset of concepts drawn from one or more code systems, where the concepts included in the subset share a common scope of use (e.g., Anticoagulant Therapy).</p> " class="glossify-tooltip-tip" lang="en">Value Sets</abbr></dt>
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<dd>
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<p>Use SNOMED CT to represent allergen drug class concepts only when following this guidance. Refer to the <a href="/measure-lifecycle/measure-specification/specify-code/RxNorm">RxNorm section</a> and the <a href="https://ecqi.healthit.gov/value-set-information?qt-tabs_vsg=0">Electronic Clinical Quality Improvement (eCQI) Resource Center</a> for additional guidance.</p>
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<p>In addition to the required approach for representing medication allergen (or ingredient) substances using RxNorm ingredient type concepts noted, <abbr tabindex="0" title="<p>An electronic clinical quality measure (eCQM) is a measure specified in a standard electronic format that uses data electronically extracted from electronic health records and/or health information technology systems to measure the quality of health care provided. Electronic Clinical Quality Improvement Resource Center. (n.d.) <em>Glossary</em>. Retrieved May 22, 2024, from&nbsp;https://ecqi.healthit.gov/glossary</p>" class="glossify-tooltip-tip" lang="en">electronic clinical quality measures</abbr> (eCQMs) can add SNOMED CT drug class concepts to represent medication allergens. If deemed appropriate by the measure developer for use in the measure, the expectation is for the drug class concept to include SNOMED CT drug class concepts only when the measure developer anticipates a general drug class concept in patient records as an indication the patient is allergic to all drugs in the class.</p>
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<p>Measure developers should</p>
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<ul>
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<li>Keep in mind that when using a drug class concept, this means that no drug in the class can be an expected therapy for the patient.</li>
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<li>Review all defined drugs for inclusion in the class when choosing to include the SNOMED CT drug class concept.</li>
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<li>Also define an RxNorm Allergy value set with the specific ingredient (IN) and precise ingredient (PIN) term types (TTY) drug ingredients that represent the drug class.</li>
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</ul>
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</dd>
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<dt>Grouping Value Sets</dt>
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<dd>
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<p>While not required, measure developers may create a grouping value set that groups both the RxNorm ingredient type allergy value set and the SNOMED CT drug class allergy value set into one grouping value set referenced in the measure. A grouping value set is a list of several value sets that share a common purpose and similar concepts. For CMS eCQMs, specifically, members of a grouping value set must have the same <abbr tabindex="0" title="<p>The <a href="https://ecqi.healthit.gov/qdm">QDM</a> is an information model defining relationships between patients and clinical concepts in a standardized format to enable electronic quality performance measurement. The model is the current structure for electronically representing quality measure concepts for interested parties involved in electronic quality measurement development and reporting. The <span class="glossify-exclude">QDM</span> provides the language defining the criteria for clinical quality measurement. It allows the electronic definition of a clinical concept via its data elements and provides the vocabulary to relate them to each other. By relating attributes between data elements and using filtering functions, the <span class="glossify-exclude">QDM</span> provides a method to construct complex clinical representations for eCQMs.</p> " class="glossify-tooltip-tip" lang="en">QDM</abbr> Category, but the value set members of the grouping do not need to share the same code system. Using a grouping value set eases development and testing burden on <abbr tabindex="0" title="<p>The <span class="glossify-exclude">electronic health record</span> is also known as the electronic patient record, electronic medical record, or computerized patient record. As defined by the International Social Security Association, an <span class="glossify-exclude">EHR</span> is a “longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, diagnoses and treatment, medications, allergies, immunizations as well as radiology images and laboratory results.” International Social Security Association. (n.d.). <em>Information and communication technology - Guideline 91. electronic health record system</em>. Retrieved November 1, 2023, from&nbsp;<a href="https://ww1.issa.int/guidelines/ict/180156">https://ww1.issa.int/guidelines/ict/180156</a></p> " class="glossify-tooltip-tip" lang="en">electronic health record</abbr> vendors. See also the <a href="https://ecqi.healthit.gov/value-set-information?qt-tabs_vsg=0">eCQI Resource Center</a> for more value set information.</p>
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</dd>
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<dt>SNOMED CT Maintenance</dt>
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<dd>
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<p><a href="https://www.snomed.org/"><em>SNOMED International</em></a> owns and maintains the SNOMED CT technical design, core content architecture, SNOMED CT Core content, and SNOMED CT documentation. SNOMED CT content includes the technical <span class="glossify-exclude">specification</span> of SNOMED CT and fully integrated multi-specialty clinical content. The core content includes the concepts table, description table, relationships table, history table, ICD-10-CM mapping, and Technical Implementation Guide. Each SNOMED CT code for a concept is unique and permanent.</p>
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</dd>
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<dt>SNOMED CT Distribution</dt>
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<dd>
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<p>In the United States, the National Library of Medicine (NLM) distributes SNOMED CT, which acts as the U.S. SNOMED CT Release Center. There are multiple SNOMED CT Release Centers across the globe and many, including the NLM, release a specific edition of SNOMED CT for use in their specific realm. <em>The U.S. Edition of SNOMED CT</em> contains the combination of the International Core (same in every edition of SNOMED CT) and a U.S.-specific extension that contains concepts only in use within the U.S. Thus, the <em>U.S. Edition of SNOMED CT</em> contains some SNOMED CT concepts that do not appear in other editions, such as those used in Canada or in the United Kingdom. Over time, promotion of realm-specific concepts may occur from the realm-specific edition to the International Core and then these concepts are available to all users. When this occurs, the<strong> </strong>concept identifier will not change.<strong> </strong>Only the <em>U.S. Edition of SNOMED CT</em> is available for use in the U.S.</p>
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</dd>
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<dt>Request New SNOMED CT Concepts</dt>
|
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<dd>
|
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<p>At times, a measure developer may need to request a new SNOMED CT concept. The measure developer should submit the request through the <a href="https://confluence.ihtsdotools.org/display/SCTCR/US+CRS+User+Guide"><em>US SNOMED CT Content Request Service</em></a> (USCRS). The requester will need an IHTSDO account to access the USCRS. The U.S. team evaluates the request and determines whether to include a useful addition only in the <em>U.S. Edition of SNOMED CT</em> or also to promote to the International Core. Measure developers should account for contractual timelines when considering applying for new concepts. For information on obtaining the standard, contact <a href="http://www.snomed.org/"><em>SNOMED International</em></a> or the <a href="https://www.nlm.nih.gov/healthit/snomedct/index.html">NLM</a>.</p>
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</dd>
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</dl>
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<div class="views-row"><span class="views-field views-field-changed"><strong class="views-label views-label-changed">Last Updated: </strong><span class="field-content"><time datetime="2023-10-25T10:23:55-04:00">Oct 2023</time>
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