So, next is to write the SQL that will do the reports .. and to create the XML as per The CMS Physician Quality Reporting Initiative (PQRI) 2009 Registry XML Specification. And then to create a page to run the queries. .
PQRI 128 is now done. When you calculate the BMI, you have the option of checking a box that indicates you have initiated some action. There is a new report page which will display this test. This relies on the patients being correctly allocated to each doc.
Encounters are currently classified by tags and we will be keeping this. But because people might not use the same tags, we need a more explicit way of categorizing them. This is for PQRI. So, I think it will be useful to add an event table. So, when you create a new encounter, an encounter event is created automatically in the event table. So, this would mean that the results table would not be overloaded with PQRI events.
Ok, added a clinical events table to use instead of the digital results table. So, we can use this to populate PQRI events and other interventions such as seeing an outpatient or inpatient.
NQF 0013 has now been done - see http://www.vistapedia.net/images/4/4f/NQF_HQMF_HumanReadable_0013.pdf These are the codes I am using from ICD-9-CM ["401.0" "401.9" "402.00" "402.10" "402.90" "403.00" "403.10" "403.90" "404.00" "404.10" "404.90" "404.01" "404.11" "404.91" "404.03" "404. 13" "404.93" "G20z." "G201."] Let me know if more are needed. The last two codes are READ codes and not ICD9.
NQF 28 is now done. You can see all unique patients seen over the 2 year period and how many of them you initiated a smoking cessation intervention.
NQF 41 measures those patients who were >= 50 at any point during the flu season who were seen and given a flu shot. It also requires we measure those who were not given a shot due to an exclusion eg. allergy or declined. So, we have to capture an exclusion event as well. So, we have to look at all patients seen over the study period, measure their age when they were seen, and if they were age >= 50, they get added to the denominator. This is a little different from the other ones which define age only at the start of the study period. We remove from the denominator all the excluded patients. However, it seems from reading the criteria that if you got a flu shot in the flu season age 49 and then turned 50 in the flu season, and were seen, you would appear in the denominator ie. you don't have to be 50 when you get the flu shot as long as you turn 50 over this period.
NQF 24 reports on BMI and counselling. Pregnancy is an exclusion. Age range is 2 - 17, and includes 3 reports, 2 - 17, 2 - 10, and 11 - 17
It seems you have to record why a child did not get a vaccination .. ie. create a non vaccination event for each relevant vaccine. That way we can calculate the exclusions.
All the vaccines have been done now .. but I need to do some complicated maths on it for reporting so will leave that to a later date.
NQF 61 is now done and this completes the basic required set of 6 core and 3 alternates. I now need to double check the queries and conditions, and to create the XML required for reporting.
This PQRI stuff is a mess. The certification requirement is that you implement the XML specification for 2009, but if you want to actually implement PQRI reporting, you need to use QRDA, which is a form of CDA .. and nothing to do with the 2009 XML specifications. Also the XML spec requires a PQRI number, but over half of the core measures do not have PQRI numbers, only NQF numbers.
Since we have to report on smoking status, it looks like we have to create a specific field in the database for this as opposed to storing the information in the social history. And I'll make it so that when you save the social history, it will automatically a tobacco use disorder diagnosis if you specify that the patient is a known smoker.
Does the USA have so many pre-teen pregnancies such that pregnancy in an under 11 y/o child is listed as an exclusion for measuring her BMI?
