2022.11.30 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://us06web.zoom.us/rec/share/hlpqr7w3Ievj45RETQhDbW2R1zbsyzBmp0_oPKrd2ek1wI5sVxr8CEIxVo307Bc.uSMnHKHrsbvdcd-c
Passcode: .4K2#mrx 

Chris:

• Update/ETA on when ESRD Networks might be able to find patients dialyzing outside their Network scope in EQRS once again? It has not been working for 2 weeks

  • This is a complicated issue and may take some time to resolve
  • Patients can be found by UPI now as long as they are in their local network space
  • Cannot search by name and admitting patients is a problem
  • In two weeks when transplant come in, trying to enter them will be a problem, especially for patients coming from outside of their network area
  • If trying to find a patient for an evaluation ,etc they can look them up in EQRS - this is no longer the case, becoming a problem across multiple areas of their work
  • When will this be resolved? Need a timeframe when this will be fixed. Is there a work around? (Action item Aaron)
  • Per Kathleen - The helpdesk suggested adding a few more search parameters like the State or something like that
  • Kathleen can still find patients with all her roles

Nathan:

• Update on historical vaccination data transformation from old clinical module to new vaccination module. 

  • This in regard to the full data migration
  • The EQRS ADO team is currently testing in their lower environment
  • The data migration process has been updated for phase 2
  • Before the end of this iteration, they will be moving the process to prod preview for more testing before running in production
  • There is no exact date for production but should be by 12/20 when the current PI ends
  • Sarah Filling had a question regarding Hep B defect
    • After the defect fixes are migrated to production, will there be any kind of data clean up associated with that?
    • Per Yvette, there will not be
    • RHA has also run into the same issue with not seeing the vaccine data; manually have to enter which will cause dupes
    • Per Yvette, when the data migration takes place, their goal is to not have any duplicates
    • When will users be restricted from being able to enter manually?
      • Today, 11/30 is the last day; ends with the closure of September

• Creating EQRS Documentation that is what is in Production vs Work in Progress

  • There were talks a while ago about updating the existing public page
  • The request is to show documentation for what is actually in production right now and documentation of what the ADO is working on in the lower environments
  • Today, the public page has everything and not necessarily what is in production right now
  • Adrienne will work with PM3 on what is needed to update the public confluence page (Action Item Adrienne Ray)

• Update on previous action items:

  • Timeline for updated EQRS documentation on confluence page
    • Per Adrienne, updated versions will be available in the next couple of weeks (end of next week); there are still a few outstanding questions to be resolved
  • Updated version of Peritonitis fields, options and status (required/optional)
    • Lisa took the updated UI version of the EDIs and shared it with the CDC
    • The CDC agreed on a majority of the issues
    • There is not a mockup ready that can be given to the EDIs
    • Nathan would like to understand a timeline when they will get information on Peritonitis updates b/c they are trying to work in parallel 
    • Lisa will try to get a final view/list to the EDIs
    • Howard would like to know what was accepted from the EDIs proposal on required vs optional fields
    • If there are any variances he suggested to talk through the differences as a group
    • Per Lisa when she took the proposed updates to CDC they agreed to the following:
      • All of the Demographic suggestions were accepted
      • Risk Factors are only to be entered if there is an incident
      • Alot of the fields where there are the options - Yes, No or Unknown; if there is an Unknown option, the question will be required
      • Howard mentioned an issue - EHR will have to have that data field inside its overall schema; it may or may not be in the EHR, therefore, people will have to scramble to put that in or build logic around it
      • Howard suggests having a meeting to go through with everyone why decisions were made between options vs required
      • Lisa pointed out there were 3 previous sessions where Peritonitis and the PDAP Event Denominator form was discussed between the Program and EDIs
      • CDC agreed they do not have to include positive effluent and negative effluent; it will be picked when other information is identified with the culture
      • Cell count is needed and the neutrophils therefore, both will be required
      • The Signs and Symptoms of abdominal pain, cloudy effluent and other evidence of intraabdominal process will be required
      • Imaging test suggestive of intraabdominal process and Physician documentation of evidence of peritonitis would not be included
      • Loss of PD catheter? will be required
      • Secondary bloodstream infection (BSI) will be required
      • Pathogen(s) identified from effluent will be required
      • There will not be any of the custom fields
      • Will the decision/changes made be in writing?
        • Per Yvette - they are not writing anything up at this time
        • The information received from the EDIs is being used by the HCD team to come up with the mockups
        • When a new transaction is being proposed it has upstream effects on all systems which includes having to design, develop, and test
        • Per Adrienne, the EQRS ADO standard protocol is to have early discussions before development takes place to bring the EDIs up to date on decisions being made
        • Requirements are being finalized and then will got to the ADO teams to code
        • The EDIs will see the progress at the regularly scheduled iteration reviews
        • When information is finalized, EQRS ADO will share with the EDIs
        • Per Nathan, the concern from DaVita is that in the past they have to wait to get information after it has been finalized and the expectation is for the EDIs to make any changes or start submitting the data in two months for example.  They are not given enough time to react to the changes
        • Adrienne from FKC agrees with Nathan's comments
        • Adrienne Ray said they can provide the data elements BUT keep in mind things change as the team is in development
        • There is overhead involved for all of the changes being made during development; documenting and putting it out on confluence
        • Once the requirements are finalized, EQRS ADO will get the EDIs the list of elements agreed upon
  • If peritonitis reporting will have an impact on Clinical Labs XML structure (e.g. removing infections section)
    • EQRS ADO is not far along enough with Peritonitis to determine if Peritonitis reporting will have an impact on clinical labs
    • Lisa is not anticipating it would have an impact because it will have its own section
    • It will be a tab under Patient; totally separate from Clinical
    • Nathan brought up this question because there is an infection section in Clinicals and what happens with that section, what's expected to be reported there
    • Lisa does not think they will be touching the clinical xml; she believes the EDIs will be safe
  • Sharing proposed versions of the new 2728 and 2746 that are in PRA process
    • Lisa has circled back with PRA and she still has not heard anything.  She will keep the group posted on what she finds out

Howard:

• Begin a discussion on the longer-range vision for EDIs being able to access and consume data from EQRS for our clinics via an API or other method.    We have the capabilities to access this data and use it for the betterment of the program and our facilities we represent but relying on a legacy approach of only getting canned reports should be revisited.     We intend to develop out our data warehouse and pursue some benchmarking work but doing this on the current data flow is quite limiting.  
  • There have been discussions in the past about a data lake and the ability to tap into the data lake and pull data out
  • Is this still a vision?
  • Currently they rely on data being sent to the EDIs via the network, but it does not allow them to do creative and innovative things with the data
  • Is CMS still looking at providing access to the data to the end user?
    • Per Lisa, they are working on the data lake
    • The EDIs will not be given access to the CMS data lake
    • Lisa mentioned this to the EDIs a year or two after the Quality Conference
    • The reason for this decision is because it was a security issue
    • Howard suggests having a discussion with the decision makers to talk it through and understand why the EDI are not going to be given access to the data
    • Lisa will go back and revisit this, but the data lake was made for CMS and their contractors.  It was never in the vision for the EDIs to have access to it
    • Nathan pointed out the reporting discussions that have been going on over the years.  How do they make it so they can access their own data in bulk whenever they need it?
    • It was a priority then it wasn't a priority.  How can this become a priority in 2023?
    • Per Lisa there are some reports that will be included in PI21; some reports will be built into the system each PI moving forward.  There is still a lot of other work that has to be accomplished

Next meeting scheduled for 28 Dec 2022