2022.05.04 EQRS Program Working Group Meeting

1. Vaccinations Recording for this discussion: 05:56 - 18:35 
   1. Has CMS determined how providers are to know what has already been reported in EQRS so we don’t send duplicate records?  The NCC will provide reports until all the data is moved in EQRS.  After the data is moved in EQRS, work will begin on reports to be available in EQRS.

• • • AS EQRS is moving vaccination from clinical out to a patient screen, EDIs can still send what they've been sending just point to a different location
    • Kathleen's concern - it's doable, but her concern is the patient movement
      • Scenario: Patient starts at DaVita and DaVita administers the flu vaccine for this patient and reports it administered at the facility on 10/15; then the patient transfers to FKC and they get the vaccination record; FKC does not have an order for the vaccine b/c they are not the ones that administered the vaccine.  The patient already got the vaccine.
      • FKC documents the patient received the vaccine elsewhere on 10/15 
      • If they send this to EQRS, it will overwrite DaVita's submission so the patient's record no longer say administered at DaVita; it will say FKC is reporting that it was administered somewhere else
      • Therefore, you will not be able to tell where the administration of the vaccine took place accurately
      • So this is where the reporting will be helpful
      • Per Yvette - the new module doesn't record that the vaccine came from DaVita, FKC, DCI, etv.  It just says that this patient has this vaccination data; it does not matter who sent it; there is not tracking of who sent it
      • Fields - "Documented at Facility" and Documented Outside of Facility" are still in the new module; it is used to identify that it was administered at the dialysis facility; received in a dialysis facility vs received at a pharmacy
      • If this is confusing, Yvette and Lisa can talk to HCD, it was requested by one of the user sessions; Yvette can discuss having it moved in the future (Action Item" Yvette/Lisa)

When will the EDIs be provided the technical docs for this data the NCC will be providing? We won’t be able to finalize our requirements to take this data in to account until we know what to expect the data needing to be excluded looks like. The current data for vaccinations from the NCC is individual datasets and we don’t receive all data at this time.  Will the NCC only be providing data until it is moved in EQRS or until the data is available to EDIs directly from EQRS?

1. 1. 1. E.g. DaVita patient gets a Flu vaccine at a Walgreens and DaVita reports it to EQRS.  Patient transfers to a new organization and informs them the vaccine was already received at Walgreens.  How do the other providers know to not report that as ‘Received Outside the Clinic’ because DaVita already reported it? 
   2. How will vaccination rate calculations and the Network QIA be adjusted? The EDI submitters have been provided the data specs for how all of the Network measures are calculated.  We aren’t working on Hepatitis in the contract right now.  I believe you’re thinking of the pneumococcal vaccination.  We are working on revisions at this time and will inform the EDIs of changes.

      You are correct I meant Pneumococcal and look forward to seeing how the new QIA will work with the new data model.

       
      1. Need to account for this new model of data and only having the most recent record migrated from current model to new model
      2. HepB vaccination rates have historically been looked at by individual vaccine but with the newly approved vaccines there may not be a need to administer the series doses
2. PTH Recording for this discussion: 18:37 - 23:00 
   1. Can you share timing on when we will get any official documentation on the new PTH expectations?  Michael’s team almost has documentation complete and I’m sure you will get the XSD, data dictionary, and errors soon. I’m sure he’ll bring you into development discussions as early as next week.

• • • Per Michael, development has not started yet, they have done all the research from the requirements and input from the EDIs
    • The fields will still be: PTH Value; PTH Type; whether its serum or plasma, the date and upper limit for the assay range as a numeric field
    • They are almost done with the XSD and example XML for the EDIs
    • Also working on the data dictionary and the error codes; and script to update the codes and tables
    • When all has been completed, it will be shared with EDIs; development will be in parallel between EQRS and EDIs
    • Michael did a follow up with the sharing of internal data, FKC=no, DaVita=no, DCI=no

Thank you, we look forward to seeing this documentation as soon as possible to get our requirements completed.

1. 1. 1. There was discussion of wanting this data as early as July but at this point I don’t see how that can happen.  So far all that has been provided is conversation, over the last couple months, on what should be coming.

• Per Steve Goodman - 

  PTH XSD and finalized requested field values asap will be very much appreciated :-)

  3. Dialysis in Support of Transplant (DiST) Recording for this discussion: 23:05 - 32:23

1. 1. When will CMS share information on the second discharge reason that is being created?  The documentation is on Confluence.  I’m not sure what else the EDIs need.

      In the below scenario the dialysis clinic would use ‘Delayed Function Unresolved’ when the transplant is determined as failed while receiving DiST, correct?

• • • • Per Yvette, Yes; for example the kickstart for the kidney using an admission of dialysis and supportive transplant
      • Once the transplant facility indicated that the kidney actually failed, then you would discharge that admission with delayed function unresolved
      • There are two new discharge reasons
      • When the kidney is successful you will discharge with delayed function resolved, following a transplant
      • When the kidney is not successful, you would use delayed function unresolved
      • Recovered Function is a current discharge reason; it was used incorrectly in the past; it supposed to be used when function is recovered of a patient's original kidney and so with this feature we will be changing the description of Recover Function to Recovered Function of Original Kidney
      • Tried to provide some clarity because it affected the patient's coverage for their transplant.  Instead of having their three years, their coverage ended after one year

1. 1. 1. This would handle what happens when the patient is receiving DiST but the transplant center determines the transplant has failed.  The transplant center would put in a transplant failed event but there isn’t a valid discharge reason for the dialysis center to use.
   2. The Admit/Discharge grid says you can only have a DiST admission after a New to ESRD or Transplant admission, this seems to limit valid uses cases.  You would use discharge for transplant outside the US in both instances.

Recording for this discussion: 29:11 - 32:23

This question is about the Admission Reason allowed following an admission of DiST, not the discharge reason.

1. 1. 1. E.g patient was on dialysis at their first clinic but then goes overseas to get a transplant.  Previous admission is New to ESRD (dialysis) but EQRS won’t allow DiST.
      2. E.g patient was on dialysis at their second/third/fourth clinic but then goes overseas to get a transplant.  Previous admission is Transfer In but EQRS won’t allow DiST.

Patient-AdmitDischargeReasonRules.xlsx

    4. Clinical ranges Recording for this discussion: 32:30 - 37:29

1. 1. When will new documentation be posted that outlines the changes that were made this week?  File posted to confluence is the original from Oct. 2021 We used the document that was provided to us by the EDI submitters, but I’ll see about getting that posted to Confluence next week.

      Thank you, this detail is needed as the email thread with these changes I found rather confusing.

• • • Yvette will post the clinical range spreadsheet to the EDI public facing confluence page (Action Item: Yvette - completed)

Lab Ranges_04062021_final_Future PI.xlsx

• • • Decided not to change anything for creatinine and clearance, weight (for minors), and height (for minors)

     5. Question from Rachelle Caruthers:

1. 1. In the past, the networks have received modification every year before the new contract starts. Is the Program (Lisa) planning on releasing something new before June that could potentially impact the measures?

• • • Per Lisa, there will not be a modification before June

Next meeting scheduled for 18 May 2022