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We have notes coming through Secure Messaging that are Office Visit document type. The document is imported into EMR and the MD whom it was sent to signed it. We have not implemented CQR yet but are wondering if these documents are going to negatively affect our MU reporting. Does CQR exclude document that came in from an external sourse?
Posted : February 23, 2015 2:21 pm
CQR won't care about those. It's default denominator is driven by having SNOMED and/or CPT Service Orders on a document. You may also be able to map certain OBSTERMS to those SNOMEDS (ex: BP, HPI). Look at Go>Setup>Settings>System>Data Mapping>GE Functional Measures>Seen By
Posted : February 23, 2015 4:53 pm
I disagree, but looking at detailed unmet item data in your CQR reports will show what's going on. There are also some CPS MU tables you can take a look at.
It looks at Office Visit document types for denominator counts, regardless of how they came in. The SNOMED codes may be necessary to analyze your numerator data, though.
I strongly recommend not using office visit documents for anything but real office visits. We had to change workflows/document types a couple of years back because our numbers were skewed in the MU Crystal reports.
Posted : February 24, 2015 4:05 am
GE stated at the CHUG meeting in October that document types is no longer used with CQR. Like jamessedward notated above, it is driven by SNOMED and/or CPT service orders. Crystal reports uses document types, but CQR does not.
Posted : February 24, 2015 10:28 am
So somewhat in the same vein...
I am trying to get my imported consults to count towards "closing the referral loop" and it looks like it needs a SNOMED code attached to the imported document, we use indexing client. I can add obs terms to a document thru indexing client but I do not see a way to add a SNOMED code. Does anyone have a workflow for this?
Posted : February 26, 2015 12:44 pm
Our CQR is pulling any office visit type document not just those with corresponding CPT and/or SNOMED codes - we in fact just tested this (while testing Patient Reminders) by opening two "office visit" type encounters but not even selecting a form set - just opened then signed - this test patient showed up in the denominator for our test provider.
We have a big issue with this right now - our organization has about 17 specialties and 75 practices who all share the same EMR. We have PCPs and other providers that sign a specialist note as a way of indicating "I looked at this" after their patient sees said specialist - this is counting in the denominator for both the specialist and the PCP. What we've found is that almost any activity that is recorded in the "doccontb" table makes that document "seen by" the provider. We ran into this with another PCP who signed home care notes sent from a home care nurse imported via linklogic as a home care encounter. Let's not even get into NPs and their supervising MDs...
I brought this up on a CQR roundtable and was told that what we had found was correct and GE was "discussing with their lawyers" whether they can tighten up what they pull as seen by - apparently being the authorizing provider of the office visit just isn't enough for some reason but a single PCP having 500 "office visits" in a 25 day period is OK. I also received some other erroneous/misinformation on that roundtable though so I'm taking that statement with a grain of salt. Compounding this is that GE was very ambiguous with their documentation of what "Seen by" meant, at least from what I've seen, so we only found this by reverse engineering the CQR and matching the data via crystal reports.
So, in short, be very careful of what is being marked as an office visit and what your MDs are signing - GE may even decide to change this at some point and flip all of our numbers on their heads.
Posted : February 27, 2015 9:11 am
Hi All,
I have confirmation that the standard office visit encounter (as well as Home Care Visit and Office Procedure) count (with no SNOMED or Service Order) for the Core and Menu measures but SNOMED and/or Service Orders are needed for the CQM "trigger".
Thanks
Mike
Posted : March 4, 2015 11:20 am
