2021.11.17 EQRS Program Working Group 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/x67_jkNNEq5soW0Zmh1IOh2SV4_Sh5yBO3quEWTBv3ORvWpq-Zo-JMDQuJeVHxGw.VSLnPtW7aJGRG9oh Passcode: f$DQ2&o9 

EQRS Waitlist report

Patient matching algorithm concerns

• The matching algorithm was doing what it is supposed to do; it was not broken; the team just enhanced it
• The patient matching algorithm returns 6 specific codes; it was doing it's job
• There were opportunities to match more patients and send them through that process even for patients that have changed or had done other things
• Anticipating we can match several thousand more patients

Patients removed from the waitlist continue to show as listed on the report

• There are instances were UNOS will send the patient more than once, even for the same listing center and listing date
• Researching, it looks like for people familiar with admission discharges in the way that flows, there are some specific examples that education is a part of it
• For anything that is duplicative were we are inserting an additional record with a removal date were they did not send the removal code or removal date, we are going to enhance the code to change that and stop that process
• Also going to add the active status and what the removal code means

Question from Nathan -

• • Will active or inactive status be added? Per Michael, planning on adding an active status and what it means.
    • There are several letters that they send with that also for the removal codes to add the text there too
  • Need to have a conversation with the NCC on the timing of when they actually update the data set that the EDIs get
    • Per Lisa, yes, this can be discussed when they are on a call with the NCC

Patients who are listed before they start dialysis are not showing as waitlisted at all on the report 

• Until the patient starts some type of treatment (Dialysis or receives a treatment) they won't be in EQRS
• Once the patient is added into EQRS, if they are in the next submission from UNOS, they should match

Question from Vlad -

• • Is there a process if clinic looks at the UNOS data sent to them and they have their own contacts with the transplant centers and they call the transplant center and the transplant center tells them its not really true.  What is the process to reconcile the data?
    • Per Lisa they don't have control over the UNOS data; If the clinic and transplant center agree something is incorrect with the data, the transplant center will have to update UNET
    • UNOS will only deal with the transplant center
    • Per Vlad - Would it be logical to start the process where UNOS would respond not just to transplant center but also to dialysis clinics? Would it be possible to ask them to change the current process?
      • Lisa said she can try to look into it

HCP Flu data source

NHSN doesn’t allow bulk upload

Question from Nathan -

• • CMS/Lisa is working with the CDC to try to get them to implement a mechanism where the EDIs can bulk upload their data?
    • Per Lisa - CMS has actually asked the EDIs to report it to the NCC and CMS can report it to them
    • That is what is on the table, not guarantee what they will come back with
    • If the NCC is not agreeable to that solution, then yes, CMS will pursue having a bulk upload 
  • Because there is ongoing discussions, have they considered messaging to the networks about pulling back a little on the priority of this one compared to there projects?
    • Per Lisa -  they have not considered this because it is flu season and important that patients get their vaccination
    • Per Nathan - there just seems to be a disconnect that the EDIs know they cannot report fully, yet they are pulling data out of the system that the EDIs know is not complete and saying your rates are low, but they're low because the EDIs are not reporting in bulk
    • Facilities have the option to report and keep the networks from calling them, so there is an alternative
    • Lisa will continue to work on towards a solution/answer

Question from Rachelle -

• • Is the network supposed to be measuring monthly, quarterly, or just at the end of the year?  What is their measurements reporting frequency?
    • Per Lisa - their measurement is monthly, therefore if the EDIs did a file upload it would also be monthly

Only annual summary at end of flu season

• CMS is in discussions with CDC to get come changes in place
• At this time there have not been any changes

Identifying Depressed Patients

Data reporting and clinical applicability concerns previously raised

• This is in the network contract and CMS will continue to move forward with it
• CMS/ADOs are working on the screen in EQRS and aware there are some concerns
• Lisa did work with the team to address the concerns
• Per Kathleen - it is not impossible for FKC to get CMS what they need but there are concerns on what they want; the questions they are asking in this module
• For example there is a question, Who is providing the mental health treatment? The options given are options the VP of social work said that they are usually reluctant to tell you
• Therefore, that is information the EDIs will more than likely not have
• Another question asked is the branding medication that they are taking for mental health treatment. Unless the patient reported it to the EDI, the EDI may not have that information
• Suggestion from Kathleen to discuss what the data points that CMS really needs so they can report it
• Lisa will check with Yvette when she can go through the screens related to depressed patients and explain things, what is required, optional, etc (action item)

Vaccinations (Pneumo, HepB, Flu)

EDIs plan to wait until all three are complete to not triplicate work

• At this time, CMS is not planning to move any other vaccinations soon
• So the EDIs still need to do the work for the PPSV23 
• When CMS gets ready to move the other 3 vaccinations, Lisa will commit to moving those all 3 at one time but for now we need the PPSV23 as is delineated in the new collection mechanism
• There are specific things in the contract that require data to be separated
• If the EDIs are not able to do it through the EDSM process, they we need to ask the EDI's facilities to report it
• Per Nathan - there was talk of having an overlap were they could continue to submit in their current format while the new version is there.  Is that still the case and do we know what that overlap time period is going to be?
• When asked how long it will take the EDIs to fix it, move the reporting
  • Nathan replied - its not fixing it, it is creating brand new reporting, it is it's own file and own structure
  • DaVita is still targeting the first quarter
  • Per Scott - the period of overlap is definitely available; based on past conversations with the EDIs, they have penciled in Q1
• Per Kathleen - the IT team and Kathleen were reviewing the updated clinical XSD and XML for after the vaccination modules are moved but there were still 3 questions in there about vaccinations (simple Yes, No questions).  Kathleen was not aware there would still be vaccination questions in the clinical model.  She thought they were all coming out all together.  
• Understanding was that once everything is in production, the vaccination module is there, the clinical module should have zero reference to a vaccination
  • Per Scott - Yvette indicated that what Kathleen is seeing in the files is the development direction that was made before we all agreed to deploying vaccinations all at once, so pneumococcal moved to patient, the other vaccinations are still in clinical because that was the decision at that time
  •  Suggestion is for the EDIs to start working on the patient piece and there will be more to come on clinical as development is picked up for hepatitis and flu moved those to patient
  • Expectation is that at some point CMS will be getting another update on the clinical XSD and XML
  • Vaccinations is becoming its own file, this is not going into the patient demographic file 
•  Per Nathan - Need clarification on the actual migration. Are we not migrating?
  • Per Lisa - her understanding was that everyone was ok with migrating the data
• Per Nathan - Is the expectation that EDIs only report new vaccines?
  • Per Lisa - No, if a patient mentions he/she did have a vaccination in the past, the EDIs should submit that information
  • EDIs are not expected to send in the full record every time

Additional technical questions

• Per Vlad - They agreed that they would receive a periodic report showing them all the vaccination information for their patients 
  • Yes, the NCC will do that
• The plan is to develop all vaccine types and convert them at the same time?
  • Per Lisa - with the exception of PPSV23 because it is already developed and they need to release it
    • PPSV13 will be in the old system and PPSV23 will be in the new system
    • When CMS gets ready to move the vaccines. Lisa hopes to be able to let the EDIs know a PI ahead; develop it in the PI so the EDIs should be aware about it 24 weeks
    • EDIs should be able to start preparing and planning their systems out

Question from Vlad -

• What is the release date on PPSV23?
  • Per Lisa - she will have to get back to Vlad on when the release date for PPSV23 (action item)

Prevent Overwrite of Key Patient Identifiers in EQRS from EDSM

How updates are made and EDIs to know when our data is accurate from EQRS “locked” records

• The EDIs will be given a report back that tells them what's incorrect in their data

How are updates made?

• Once a patient is matched to the EDB the refresh process is place - in the first half the data is pulled down once the connection is made and they populate EDB fields in EQRS
• Once the match is made, they will populate the fields and lock the records so the UI nor EDSM can change something that would break an EDB match and negatively impact coverage
• This is the first step of the patient repository
• In planning this for when EDSM sends something in a patient demographic file and it is different or we already have a patient mapping, a pat org ID, if we're not going to update those 6 or 7 fields that are key patient identifiers (first name, last name, date of birth, date of death, MBI, SSN); they will not be updating.  They will not reject the patient demographic
• They are still going to process the record, they will just ignore anything that is different for what EQRS knows that EDB has that allows for code coverage connection between the two
• A new warning will be created; suggested that the warning messages be distinct for each field
• The changes will be locked down in the SUI for everybody
• Once the record is locked, it will be locked for EDSM and the UI
• This feature is currently being worked on in PI16
• If it is not completed in PI16, it will be done in the early part of the next PI

Admission in Support of a Transplant

Expectations of reporting short stays (e.g. 1-2 treatments)

• Lisa is not ready to discuss this at this time
• She may have more information by the next meeting

Business Requirements documentation

Need for all of the above items

• • CMS should make this become standard practice in each PI for any new EQRS items

Need to create for existing EQRS functionalities

Data Management Guidelines is not a BR document it’s a data reporting expectations guide

• Lisa asked the EDIs what they mean by Business Requirements?
  • Per Nathan, BR are the rules of reporting the data, not just from a technical EDSM structure
  • BR are more of the rules of reporting of the data points; for example the definition of Telemedicine
  • Looking for an official document that explains the expectations of the data
  • What is the workflow CMS expects for a feature? For example Depression screening, what is the workflow, procedures, exceptions