2024.5.15 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.

Program Working Group Recording 05152024.mp4

2728/2746 Go Live Sync

• The updates to the 2746 pair up with the updates that will already be in place for the 2728
• The 2746 form is ready, but going through some edits and clean up; should be ready to be posted to the website
• Plan is to release the 2728 and 2746 at the same time on October 1
• Kathleen pointed out the issue of the Cause of Death having duplicate numbers.  This is one of the edits being addressed to the 2746
• There are no updates to the content or fields
• The updates/edits being done are just minor fixes
• Nathan pointed out the questions towards the end related to 'Who is completing the form?" (who wrote down the information on the form) and "Who is doing the form?" (who is clicking the buttons in EQRS) there were inconsistencies, and the instructions weren't clear (Jump to recording 00:10:58 - 00:16:42)
  • Is CMS interested in "who is filling out the information" or "who is the person doing it in EQRS?"
  • Request to have clarity in the instruction's b/c there may be 2 separate people for the questions above
  • Nathan and Kathleen mentioned no one signs the 2746; using the language 'Signature" is outdated
  • Per Michael Kennedy, it should be the person completing the form, not the person who supplied the information if they were doing it on paper.
  • Porsche will make a note of this and see if clarification of the instructions can be considered

How do the EDIs use the reports received from the NCC?

• EDIs received several reports from the NCC
• Question #1 - How are the EDIs using the NCC reports?
• Question #2 - Specifically related to the 2728 reports. What is the overall purpose of the EDIs receiving reports from the NCC? 
  • Heather (US Renal) - The NCC reports are incredibly useful reports to US Renal.  They are importing the data and analyzing the data.  They cannot get the data directly out of EQRS.  They are using it to ensure data validity through their facilities and monitoring purposes.  The reports are extremely useful for US Renal
  • Kathleen (FMC) - They use the reports for the same reasons as US Renal Care mentioned above. They use the reports for data monitoring, cleanup, accuracy, integrity, etc.  For 2728 reports, they use the missing one to help with compliance and everything that goes along with the 2728 that impacts billing, and the submitted ones are valuable to their organization to determine what was sent to CMS; how will outside programs use this data that has been submitted to score their facilities; all reports are useful especially b/c they can't get the data out of the EQRS system themselves
  • Nathan (DaVita) - DaVita uses the reports for the same purposes mentioned above by US Renal Care and FMC.  In addition, they use the reports to compare and clarify the data when there are differences in data between the clinics and networks.  Provides insight into the data in EQRS
  • Sindy (Innovative Renal Care) - The NCC reports are very helpful for their organization.  They use the reports and reach out to their clinics to let them now to start submitting their data.  The 2744 is very helpful to keep track of who has not completed
• The understanding is that no one has access to CMS' database to access data
• The plan was to build these reports in EQRS and sunset sone of the NCC reports, we are not there yet

PI27 Features Review: (Jump to recording 00:23:15 - 00:47:56)

Clean Up Unnecessary Roles for Corporate Users

• Remove all of the extra individual facility roles no longer needed from corporate users who have appropriate access to all facilities in their organization through the corporate role.
  • The ADO knows what roles to remove.  These are the roles prior to the corporate roles being created
  • This feature is to clean up the roles that need to be removed as a result of creating the corporate role a few PIs ago
  • This will only impact corporate roles, not all the other individual roles will be removed
  • This is only for the facility editor roles that would be duplicative of the work a user can do through the corporate role; does not impact POC roles or SO roles
  • If the team knows what roles to remove and they know who those users are, Nathan suggest sending them individual organization lists so they can:
    • Make sure that those are the right users that the ADO has
    • There may be national team members who have never gotten the corporate role b/c it didn't provide everything they needed and so they still have a bunch of roles for DaVita clinics and not the corporate role
    • Adrienne will take this cleanup effort into account and get the EDIs the requested information (Action Item Adrienne)

Personnel Module Redesign

• Design and implement a new User Experience and Interface to enhance the personnel module.

Exploration Enabler: Emergency Preparedness/Response Module in EQRS - Continued

• Emergency communications built in so that certain CMS personnel can send emergency guidance to facilities as well as track the functional status of a dialysis facility or transplant center and identify the location and safety of patient. Provide a way to inform networks, facilities, and other stakeholders when an emergency that affects dialysis facilities or ESRD patients occurs or when a disaster is declared.

• The results of this exploration enabler will serve as the starting point for building an Emergency Response module in EQRS by providing key information about the current state of emergency response workflows and how to improve them. The end result of the investigation will provide recommendations for requirements and workflow changes and provide a draft UX design for the new EQRS module - informed by user research conducted during this enabler.

  • It's possible there could be a new role
  • The overall work on the Emergency module will be divided up between the ADO teams to work on
  • The work will not be sequential
  • The EDIs will have a chance to see the development of the overall Emergency Module during the demos held throughout PI27
  • Nathan - Does CMS/Program, see this overall Emergency Module being incorporated into the ECE process?
    • Yes, it is a possibility but cannot provide a definite answer until the Emergency Module gets on its way and further progress. 
  • Kathleen - Would the waivers be displayed in the module? 
    • Not for the Emergency Module features being worked on for this PI
    • Adrienne will take this back the HCD team and see where they are at with the Waivers (Action Item Adrienne)

Emergency Module: Development of MVP - Create Facility Report & Dashboard

• Create a new modernized electronic process for collecting emergency situational status information that can be utilized not only by networks and LDO's but can also be submitted directly by individual facilities.  Collect additional information from affected entities when appropriate to aid in the emergency response and provide an aggregated report of the information collected that gives KCER, the networks and CMS a clear understanding of the situation on the ground without any need to copy and paste information from one place to another or to look for it in multiple places.  

  • For this Emergency feature the team will focus on:
    • Creating a new facility report.
    • Creating a facility dashboard with preset filters.
  • Creating the ability to upload a facility report in csv via EQRS UI

Emergency Module: Development of MVP - Create Incidents and Dashboard

• Provide EQRS users with the ability to:
  • Create, edit, and close new incidents.
  • View an incident dashboard with filters for current and past incidents.
  • View an incident activity log.

Emergency Module: Development of MVP - Roles, Access and Notifications  

• For this Emergency feature the data team will focus on:
  • Creating roles and access required to allow KCER, CMS, ASPR and other super users to view, enter, or edit information specific to emergency incidents and facility status reports.
  • Modify existing roles to allow adding or editing a facility status report related to an active incident for the user's facility when their facility is in scope.
  • Modify existing roles to allow cross-facility viewing of status reports.
  • Modify existing roles to allow viewing of emergency incidents and related details.
  • Create automatic notifications that provide minimum necessary communication to affected parties in order to support emergency response workflows.

EQRS capability for facilities to download their DFCC preview period reports each quarter

• EQRS team will create functionality within EQRS for facilities to download their DFCC preview period reports each quarter.

Exploration Enabler: Transplant Referral Dashboard - Phase I of Communication and Management of Transplant Referrals

• Gather requirements for creating a dashboard that displays the relevant available data which currently exists or could be collected and added in EQRS in relation to whether the patient has been referred for transplant and which transplant center they have been referred to along with other details such as dialysis start date, current medical coverage and more.

Form 2728: Documentation and Bug Fixes

• Provide 2023 version of Form 2728 documentation and support EDI testing.

Forms: Update 2746 UI, Batch and Print Functionality for Dialysis Users

• Update the 2746 form that is used to collect information about patient deaths.

Manage Access and My Profile Redesign

• Redesign Manage User Access and Profile screens that is user friendly, cohesive, and intuitive for our EQRS customers.

The Manage Access pages (My Applications | My Access | Request Access (with tool tips) | Pending Requests | Manage User List), along with the Profile Information page are used by all of our EQRS customers.

Based on previous discovery research conducted by the QIP HCD team in 2021 and feedback received from the user community, there's an opportunity to improve the User Experience of the tasks performed in these areas, such as:

• requesting roles and managing one's own access
• as an SO, managing other users, their roles, and requests
• viewing/maintaining profile information

Portal HCD Enabler: Patient Search/List Redesign Phase II

• Improve the patient search experience by providing a comprehensive list of patients with filters.

Currently, a user must initiate a blind search with many search criteria options and cannot filter the search results to drill down. The new method of viewing and finding patient record(s) will provide users a full list of active patients upon entering the "Patients" page. Users can then filter by name, SSN, facility, MBI, DOB, etc. to drill down on the patient(s) they need to find. The new list would also have additional columns of data that are useful for users (active/inactive, facility they are admitted to, etc.)

• Nathan - Is this only the user interface design or also looking at system performance when it comes to searches?
  • Today, when you are a corporate role and searching there are a number of single variable searches that routinely fail (Action Item Adrienne)
  • Per Adrienne this particular feature is with the HCD team, so it is the overall user experience with searching on a patient

Portal HCD: Authenticated Portal Homepage (cont'd): Corporate Users

• A new and improved landing/homepage for corporate user roles upon signing in that is tailored to what a user would want to see and needs to get done could benefit the users and the program in multiple ways: save users time and clicks trying to search and navigate through the UI.

Portal HCD: Public Portal - Release Notes

• To provide any user the ability to review release notes of past production releases. The EQRS unauthenticated user should be able to view a description of public-facing production releases. The user should be able to view most recent as well as older release contents. 

Reports: Depression Screening Report

• Dialysis providers are required to report on depression screening for all of their patients each year.  This report will provide information about depression screenings that have been submitted and the related details or indicate for which patients the screening is missing, as well as a summary that gives insight into depression screening results for an organization.

What are your 3 top wish list items?

• Asking that the EDIs go back to their organization and provide a list of their top 3 wish list items to share with CMS/EQRS
• Send wish list to Arnie before Tuesday, 5/21
• Changes/updates to your list can still be made by the next Program Working Group Call on 5/29

Where the LDOs/EDIs are when it comes to FHIR-readiness? When does your organization plan to implement FHIR?

• Chris Morici - FHIR stands for Fast Healthcare Interoperability Resources.  It is a standard communication format for healthcare related data
  • CMS is moving towards this standard format to make system to system communication a lot easier
  • The fields are equivalent from one system to another
  • Timeline for this is still years away; could be the next calendar year
  • Just trying to figure out where the stakeholders are in their projections to implementing something like this
  • There is nothing written in policy driving this work or forcing anyone to adopt these standards
  • Completely up to everyone, their timelines, or whether they want to do it or not
  • EQRS is looking into adopting a standard format regardless
  • If any of the stakeholders are interested, then CMS/EQRS might accelerate their schedule
• Laura (Innovative Renal Care) - 1st time she has heard of FHIR
• Revathy (FMC)
  • They do use FHIR in some of their internal exchanges within their clinical systems
  • She is aware of the FHIR standards
  • At this time, they are busy with 2728 and 2746, they have a lot on their plates
  • Now is not a good time for FMC
  • She does suggest exploring it for an interface that is not a daily or weekly interface and do testing. 
  •  Revathy pointed out with the existing EDSM, they have seen 2 challenges and raised tickets for them
    • Vascular Access Submissions - the feedback takes about 4-5 hours to come
    • It was suggested to reduce the size of the files and they did but it did not change anything
    • Another issue is with renewing their credentials, every 90 days; it used to work then it stopped working and there was a delay b/c it happened over a weekend
    • Adrienne requested that Revathy send her any ticket numbers so that she can research these challenges
• Nathan (DaVita)  
  • • • They do have FHIR capabilities for other interfaces
      • As an industry, they have been opposed to EQRS transitioning to FHIR, not because they are against the FHIR protocol or a transition, but because they have spent decades now building the system in the form it is today
      • The amount of effort and cost would take for everyone to transition to FHIR doesn't guarantee that they are going to see any rate of improvement of data, completion, accuracy, etc4
      • Nathan suggested implementing the data points we have but using a data standard
• Vlad (DCI) 
  • They do not have any systems using FHIR at this time
  • They do not communicate with anyone outside of DCI that used FHIR protocol
  • Vlad does not think it will improve any data quality
• Heather (US Renal Care) 
  • They do not use FHIR within the organization
  • Agree with the others in saying it won't improve data quality
  • Should focus efforts on improving what's there today

•  Porsche shared that they are collaborating with QIP on streamlining the SDOH questions between the 2728 and the QIP reporting beginning in January 2025
  • They are reducing the duplication of effort as much as possible pertaining to that section questions 22-29 on the 2728
  • More discussion will take place in the next Program Working Group call on 5/29 

DaVita 

• Nathan asked if with all the enablers mentioned above for PI27, should the EDIs expect more discussion on them with the EDIs for their feedback?
  • The HCD team goes out and does their interviews and consolidates the information gathered
  • Then they usually go back to the user community for usability testing
  • The HCD team setups up their own meetings
  • Nathan suggests that this group (Program call attendees) have the opportunity to provide their input (Action Item Adrienne)

FMC 

DCI

• Geraldine and Vlad found a discrepancy in her Corporate Role.  She is not able to edit
• She will send the issue to Michael Kennedy to investigate

RHA 

US Renal 

Innovative Renal Care

Administrative Reminders

• If any Production issues are encountered, please submit a Helpdesk ticket.  This will allow the EQRS team to better track the issue and progress.
  • Service Center: 866-288-8912 or qnetsupport-esrd@cms.hhs.gov. 
• CMS will refresh data in the EQRS Prod Preview environment on the first Sunday of every month. The planned schedule is below.

• • Sun, 03 Dec 2023
  • Sun, 07 Jan 2024
  • Sun, 04 Feb 2024
  • Sun, 03 Mar 2024
  • Sun, 07 Apr 2024
  • Sun, 05 May 2024
  • Sun, 02 Jun 2024
  • Sun, 07 Jul 2024
  • Sun, 04 Aug 2024
  • Sun, 01 Sep 2024

• • If there are any issues with the scheduled date(s) please notify the team by the Friday before that Sunday when the refresh of data is scheduled to take place
  • If there are any issues encountered with the refresh on Sunday, it will be moved to Monday (next day)

• Next meeting scheduled for: 29 May 2024