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We have an open ticket with GE on an issue with CMS-164 but I am wondering if anyone else has noticed this issue. What we noticed was that many patients that had Aspirin on the medications list were not being counted in the numerator for the measure. I traced it down to the fact that the CCDA being generated did not include the RXNORM code for the Aspirin that was on the patients medlist.
It appears that if the Aspirin in the patients medlist is no longer an active medication in the MEDISPAN database (if it was removed from MEDINFO table), the RXNORM code does not populate in the CCDA. It looks like we actually have more patients with inactive versions of Aspirin in their charts than we do active. (by about 2 to 1) Since it is unlikely that a provider would remove Aspirin and add it back with the new NDC number, the problem is likely to get worse over time.
I am curios to know if other people are having the same issue. I wrote an Oracle/EMR query to find patients that should be meeting the measure but are not. We spot checked a few of the patients and it does appear to have a correlation to whether or not the Aspirin is currently in the Medispan (kb) database. Changing the second to last line of the query from "AND MEDINFO.DDID IS NULL" to "AND MEDINFO.DDID IS NOT NULL" would give you patients that are likely meeting the measure.
SELECT P.SEARCHNAME, P.EXTERNALID, RXN.RXNORM, MEDICATE.DESCRIPTION, RXN.DDID, MEDICATE.NDCLABPROD || MEDICATE.NDCPACKAGE NDC FROM DDID_RXNORM RXN
INNER JOIN MEDICATE ON MEDICATE.DDID = RXN.DDID AND MEDICATE.CHANGE = 2
INNER JOIN PERSON P ON P.PID = MEDICATE.PID
LEFT JOIN MEDINFO ON MEDICATE.DDID = MEDINFO.DDID
WHERE RXNORM IN ('1537021','198466','198467','198471','198475','198477','199274','212033','243663','243670','246460','252380','308409','308411','308414','308416','308417','309362','313406','318272','349516','403924','432389','435504','435521','646434','747211','749196','853499','855812','855818')
AND P.PSTATUS ='A'
AND EXISTS (SELECT * FROM APPT WHERE P.PID = APPT.PID AND APPT.APPTDATE > ADD_MONTHS(TRUNC(SYSDATE,'YEAR'), -12) AND APPT.APPTSTATUS = 3)
AND EXISTS (SELECT * FROM PROBLEM PR INNER JOIN MASTERDIAGNOSIS MD ON PR.ICD10MASTERDIAGNOSISID = MD.MASTERDIAGNOSISID WHERE PR.PID = P.PID AND PR.CHANGE =2 AND MD.CODE IN ('I21.01','I21.02','I21.09','I21.11','I21.19','I21.21','I21.29','I21.3','I21.4','I20.0','I20.1','I20.8','I20.9','I24.0','I24.1','I24.8','I24.9','I25.10','I25.110','I25.111','I25.118','I25.119','I25.5','I25.6','I25.700','I25.701','I25.708','I25.709','I25.710','I25.711','I25.718','I25.719','I25.720','I25.721','I25.728','I25.729','I25.730','I25.731','I25.738','I25.739','I25.750','I25.751','I25.758','I25.759','I25.760','I25.761','I25.768','I25.769','I25.790','I25.791','I25.798','I25.799','I25.810','I25.811','I25.812','I25.82','I25.84','I25.89','I25.9','I63.00','I63.011','I63.012','I63.019','I63.02','I63.031','I63.032','I63.039','I63.09','I63.10','I63.111','I63.112','I63.119','I63.12','I63.131','I63.132','I63.139','I63.19','I63.20','I63.211','I63.212','I63.219','I63.22','I63.231','I63.232','I63.239','I63.29','I63.30','I63.311','I63.312','I63.319','I63.321','I63.322','I63.329','I63.331','I63.332','I63.339','I63.341','I63.342','I63.349','I63.39','I63.40','I63.411','I63.412','I63.419','I63.421','I63.422','I63.429','I63.431','I63.432','I63.439','I63.441','I63.442','I63.449','I63.49','I63.50','I63.511','I63.512','I63.519','I63.521','I63.522','I63.529','I63.531','I63.532','I63.539','I63.541','I63.542','I63.549','I63.59','I63.6','I63.8','I63.9','I65.01','I65.02','I65.03','I65.09','I65.1','I65.21','I65.22','I65.23','I65.29','I65.8','I65.9','I66.01','I66.02','I66.03','I66.09','I66.11','I66.12','I66.13','I66.19','I66.21','I66.22','I66.23','I66.29','I66.3','I66.8','I66.9','I70.1','I70.201','I70.202','I70.203','I70.208','I70.209','I70.211','I70.212','I70.213','I70.218','I70.219','I70.221','I70.222','I70.223','I70.228','I70.229','I70.231','I70.232','I70.233','I70.234','I70.235','I70.238','I70.239','I70.241','I70.242','I70.243','I70.244','I70.245','I70.248','I70.249','I70.25','I70.261','I70.262','I70.263','I70.268','I70.269','I70.291','I70.292','I70.293','I70.298','I70.299','I70.92','I74.01','I74.09','I74.10','I74.11','I74.19','I74.2','I74.3','I74.4','I74.5','I74.8','I74.9','I75.011','I75.012','I75.013','I75.019','I75.021','I75.022','I75.023','I75.029','I75.81','I75.89'))
AND MEDINFO.DDID IS NULL
ORDER BY P.PID
Posted : January 6, 2017 4:27 am
Topic starter
It looks like the SQL cut off the page but if you copy it to your clipboard you will get the whole thing.
Posted : January 6, 2017 4:29 am
We noticed the same thing. Patients we've seen for many years have an 'uncoded' aspirin entry in their med list but there is no indication that it is uncoded. If the strength or insructions haven't changed, there is no way of knowing. . Also many patients have an aspirin that is coded but is not picked up by the report. The only aspirin we know for certain counts are "Aspirin EC 325 MG TBEC:" and "Aspirin EC 81 MG TBEC". We found that out with the help of snother CHUG member. Our support team had contacted GE but apparently did not get a response. If you look at the data mapping, the data codes for the 'Aspirin and Other Anti-thrombotics' value set are very confusing. I can't figure out how what is listed in the data codes section matches what a provider would choose when entering aspirin from the Reference list.
Posted : January 6, 2017 5:01 am
Topic starter
The SQL query I provided will likely show you all of the patients that should have met the measure but likely didn't.
The largest number of our patients on Aspirin (abou 7k of them) that doesn't count are on “ASPIRIN 81 MG TABS” and the valid version of this medicine is now “ASPIRIN TABS 81 MG”.
I think that any Aspirin currently able to be added to the patients chart should work towards the measure. It is just outdated Aspirin's that don't work.
Posted : January 6, 2017 6:03 am
