2021.10.29 EQRS EDI Submission Testing - Meeting

This session will be recorded for the purpose of documenting the meeting minutes and action items. If there are any objections to the recording of this session, please make it known now. Absence of an objection to the meeting being recorded will count as consent to recording this meeting.

https://zoom.us/rec/share/WMTJVHxiKHhM_eTV2bsQ_P1-lrwFr5Hbtyormo8OmpgT43603S6cBSs7WvfWjrjj.Minr5UpyvbPwp-3p Passcode: .efRQ^B6 

Pneumococcal Functionality 

• Today's meeting is a continuation discussion from the 10/15 meeting regarding concerns with the new pneumococcal feature - how CMS/ADO plans to deploy it and the data migration
  • 2021.10.15 EQRS EDI Submission Testing - Meeting - EQRS Communications Hub - HCQIS Confluence (cms.gov)

Proposal to the EDIs:

Note: This proposed plan is a rough draft to discuss with the EDIs.  Yvette will write up a final document of the plan after receiving feedback from the EDIs (Action Item)

• Deploy only the UI to production turned on
  • Users will be able to enter pneumococcal vaccine data in the UI
  • Clinical UI would still contain pneumococcal under the vaccination section so EDIs would not need to make any changes to the clinical XSD
  • The team would need to create a story to put the removal of pneumo from the clinical UI under a separate feature flag
  • Updated clinical XSD would also be behind a clinical flag
  • When EDIs are ready to make changes to the clinical XSD, we would then deploy the clinical UI and XSD changes.
  • Makes the migration of pneumo data from clinical to patient more difficult but still doable

Kathleen -

• Likes this plan and was going to propose this same plan
• It will be separate work on their end.  They will need to build the code to the new module and they will need to enhance the code to stop reporting to the clinical module
• Questions:
  • #1 Yvette said facilities can report in the new module if they want to.  Does that mean no one will be forcing them to do so?
    • The ADO cannot force anyone to submit this data.  That would have to come from CMS and Lisa in terms of the process. But it would be available in UI if anyone wishes to enter the information.  The file would also be available for them to submit the data when they are ready. It would be deployed in the same way in prod preview so the EDIs can play around with it and test it while they are updating their systems. With the exception the ADO would have the clinical piece active too
  • #2 Does that mean that the networks will still be getting the pneumo extracts from the clinical module to continue whatever QIA they are working?
• Lisa would like to know from the EDIs when they would be ready to switch over to the new process?
  • Per Vlad, for DCI it would take about 3 weeks
  • Per Nathan, for DaVita it will definitely take longer than 3 weeks
    • Prefer to make the switch when all of the vaccinations are moved so they don't have to create the new file and then mess with their current clinical file 3-4 different times; it will take capacity of the team doing the same thing 3 different times
    • Suggest DaVita will not do anything until flu and Hep B are live
    • Lisa will have to take the suggestion on switching over to the new process when all the vaccinations are ready to be moved, back to CMS/leadership and have an internal discussion (Action Item)
  • Per Kelly, for NRAA she agrees with Nathan's suggestion, do all the vaccines all at the same time so they can concentrate on nursing home and telemedicine now and get that part working, tested, and out the door
    • Per Howard, any schema changes and business logic changes are going to take 4-6 months.  The time frame can be shortened if they get real specifications earlier
  • Per Revathy, for FKC she agrees with Nathan's suggestion.  It would make it easier.  Anything before mid to late Q1 wouldn't be possible

Vlad -

• Question: Is there a mandate to have pneumo vaccination data in the database at a certain point in time?
  • Per Lisa, there is no required time frame but she will talk to leadership and see if we can do it when we move all vaccinations
  • Vlad agrees it would be easier to move everything at the same time

Data Migration Discussion -

Vlad -

• Sees a problem with the migration for active patients that are actively dialyzed in DCI
  • He believes that in 95% of the cases, DCI has better and more accurate data in their system than what is available in EQRS
  • For active patients, Vlad would prefer CMS/ADO to NOT migrate any data and put the responsibility on DCI
  • DCI would be responsible for entering all the data
  • He feels the data would become a mess if DCI would try to submit data on top of what CMS/ADO migrated
  • Howard, NRAA, is not in favor of doing some retrospective clean up for NRAA.  Suggestion to set a data and time in the future (near the end of Q1) when new data sets will go in.  He is ok if CMS wants to convert and migrate the data.
  • Vlad's point is that he does not know what is in EQRS
  • Vlad wants to put what's in his system into EQRS all together for the active patients not expecting anyone to go back and re-enter anything
  • This may be challenging for the other EDIs that have a high volume of patients to maintain
  • In the end, Vlad is ok with whatever migration the group chooses
  • What is important to Vlad is to have a report (monthly) that would show they pneumococcal vaccinations status for all DCI patients.  The NCC can send this report to Vlad/DCI
  • Vlad would like to get the complete history for a patient
  • Per Lisa, they are not going to make the EDIs go back and report anything at the clinic except the networks going to be working on this as a quality improvement activity
  • Howard is on board 100% as long as we develop the xml in a way to get that data in a seamless way
  • Per Lisa, they were trying to make this as easy as possible by migrating the data and not requiring everybody to try to resubmit everything

Kelly -

• Question: Are ALL dialysis facilities predominantly giving these pneumococcal vaccines to their clients or do their clients go someplace else to get pneumococcal vaccines? 
  • Per Vlad a good proportion of their clients will get vaccines at the DCI facility
  • They can report that a patient received a vaccine somewhere else.  They get this information by asking the patient 
  • Per Kathleen, it becomes part of the admission process. They get the information from the patient as well.  They also validate/ask for proof of vaccines from the patient
  • Per Yvette, you will be able to indicate that the patient had a vaccine but you are not aware of the date

Nathan -

• Still has a concern about their ability to submit historical data
  • Recommend listening to recording from ~32:47 mins to ~44:12 mins for detailed scenarios
• We need to discuss the "what", "why", the "how" the historical data will be handled
• Then everyone needs to agree on a timeline for doing it
• Per Lisa the business reason is that they are doing a QIA on patients being vaccinated for pneumococcal; there are several areas in the contract where they are looking at vaccinations
• This was presented in June and everyone was invited to come see what they were working on for this contract year for the networks.  It's been out there for a while now that they have been working on pneumococcal, flu and covid vaccinations
• Per Howard's question: How far back does CMS/the program need data to satisfy their needs?
  • Lisa has some concerns about the EDIs having to resubmit the data
  • Concerned that a patient did have a vaccination but when they move to another clinic, they forget to tell the clinic
  • Concerned the data will be lost that has been entered in EQRS b/c a patient may or may not be a good historian

Data Migration Recap -

• The data will be migrated and a pneumo report will be provided to the EDIs so they can determine what they need to report historically
  • Kathleen is fine with this
  • Nathan is fine with this
  • Howard suggest CMS document this proposal and schedule a meeting with a focused group to discuss
• Yvette will share the rough draft of the proposed pneumo functionality to the feature page and confluence public space (Action Item)

• Duplicate records created during the emergency fix/DVA submission collision
• Large increase in unexpected 606 errors in HD Labs
  • The above items have been resolved
  • Per Nathan the response and resolution has been wonderful

• The public EDI website (confluence page) has been redesigned for better organization and access to EDI documentation/information.  Link below:
  • Electronic Data Interface Submitters - EQRS Communications Hub - HCQIS Confluence (cms.gov)
    • Getting closer to a change management process
    • The public space on confluence has three EDI sections - Meeting Minutes, Resources and References, and Documentation Repository
    • Resources and References will have a list of Feature pages and supporting links to XSDs; also included on this page are the EQRS System & Solution Demo Recordings
    • Documentation Repository will have the list of most current files sorted by section with a modified date
    • Feedback
      • Recommend putting a comment field/column for the files to provide description of the file or status of the file (for example, draft or final version, testing, pre prod, demo, dev, etc)
      • Recommend to see all the files that are retired and "future" files being worked on today
      • Make sure there is a version that is the current production version and clearly identified/labeled
• REMINDER: For any issues encountered, send an email to the help desk using the following email address:  qnetsupport-esrd@hcqis.org with URGENT in front of subject line for urgent matters
• Question from Revathy - Do the EDI's need to continue coordinating the submission of data on alternate dates?
  • No performance issues/concerns have been encountered so Yvette will follow up with Preston and get back to the group on whether the EDIs need to continue to coordinate their submission of data (Action Item)
• Howard suggest we start having dialogue on where everybody is at with submission of 2021 data
• Per Nathan the clinical compliance reports from the NCC are helping them.  He would like to get them more frequently