In Part 1 we covered basic timelines and goals, in Part 2 we reviewed Core Objectives. Part 3 reviewed Menu Objectives and our 4th installment will briefly review clinical quality measures.
The big year for Clinical Quality Measures (CQM) will be 2014. Due to the parallel requirements for ONC certified EHR technology during the year, it will be busy. Thank goodness we only have to attest for 3 months during 2014! CQMs are focused on conditions that contribute to morbidity or mortality. These coincide with many national public health priorities or common health disparities. Currently Eligible Hospitals must meet 100 %, or 15 of 15 measures. Stage 2 adds 14 new measures to the foray, but only requires 16 of the total 29 to be met. Many of you have implemented a slew of these already, albeit on paper or EHR.
Keep in mind many of these require workflow and process redesign as well as implementation within an EHR. Pharmacists are commonly involved in core measures surrounding medication use; now we get to use the Informatics knowledge to implement them in the EHR.
Here is the list (some broken out for clarity). Green are new for medication use in Stage 2.
1. Aspirin at Arrival: Acute MI patients who received aspirin within 24 hours before or after hospital arrival.
2. Discharge Instructions: Heart failure patients
3. ACEI or ARB for LVSD
4. ASA Prescribed at Discharge
5. Relievers for inpatient asthma
6. Corticosteroids for inpatient asthma
7. Initial ABX selection for CAP in immunocompetent patients
8. Blood Cultures performed in ER prior to first ABX dose
9. Beta blocker prescribed at discharge
10. Fibrinolytic Therapy within 30 min of hospital arrival
11. VTE Prophylaxis within 24h prior or 24 hours after surgery
12. Perioperative Beta blocker admin in surgery patients
13. Home Management Plan for Pediatric asthma caregiver
14. VTE Prophylaxis during Hospital Admission
15. ICU VTE Prophylaxis during Admission
16. VTE Patients with overlap of IV and warfarin therapy
17. VTE Patients receiving Heparin with Monitoring Protocols
18. VTE Discharge Instructions
19. Incidence of preventable VTE
20. VTE Prophylaxis in stroke patients
21. Antithrombotic therapy at discharge in Ischemic stroke patients
22. Anticoagulation therapy at discharge in Ischemic stroke patients with Afib/flutter
23. Thrombolytic Therapy within 3 hours of admission in acute ischemic stroke patients
24. Antithrombotic therapy by end of hospital day 2 in ischemic stroke patients
25. Statin medications written for discharged ischemic stroke patients with LDL > 100
26. Stroke Education
27. Infants 22 to 29 weeks gestation treated with surfactant within 2 hours of birth
28. Prophylactic ABX within 1 hour prior to surgical incision
29. Prophylactic ABX selection for surgical patients
30. Prophylactic ABX discontinued within 24 hours post surgery end (48h cardiac)
31. Statin prescribed at discharge for AMI patients
32. Pneumococcal Immunization prior to discharge
33. Influenza Immunization prior to discharge
34. ED Throughput
For updated information please visit the CMS section on CQMs. Next we will review Certified EHR Technology.
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