2012 EHR Measure Specifications Release Notes

July 2011; Updated November 2011 The 2012 Electronic Health Record (EHR) Measure Specifications Release Notes details a comprehensive list of revisions made to measures since the release of the 2011 EHR Measure Specifications. The specifications listed in the 2012 EHR Measure Specifications have been updated to reflect clinical practice guidelines and applicable health informatics standards that are the most current available as of July, 2011. These updates have also been carried over to the Electronic Health Record (EHR) Downloadable Resource table. These specifications may be available for potential use in physician quality initiatives, including but not limited to the EHR submission under the 2012 Physician Quality Reporting System (Physician Quality Reporting, formerly known as Physician Quality Reporting Initiative or PQRI). A measures inclusion in this document does not guarantee that measure will be used in any specific CMS (Centers for Medicare & Medicaid Services) program in 2012 or any subsequent year. If a measure is included in the 2012 Physician Quality Reporting System, all measure-related EHR coding/data should be submitted to the EHR Warehouse to ensure accurate performance rates. The EHR Warehouse will calculate the rates based on the data that is submitted in the specified format for this program. In the case of measures that have been used in prior initiatives such as the 2011 PQRS EHR program, the 2010 PQRI EHR program, the 2008 and 2009 PQRI EHR testing projects the specifications detailed in this document supersede any specifications which may have been used in those prior activities. These specifications are not intended for use in the EHR Incentive Program, at this time. The EHR Incentive Programs American Recovery and Reinvestment Acts (ARRAs) Health Information Technology for Economic and Clinical Health (HITECH) Acts Electronic Specifications and related documents can be found on the CMS website. To determine which measures are included in any specific CMS program or demonstration, interested parties should refer to the official documentation for that program or demonstration. Please refer to the Medicare Physician Fee Schedule (PFS) 2012 Final Rule (published in the Federal Register in November, 2011) to identify the measures that are available for data submission through EHRs under the 2012 Physician Quality Reporting System. Global Edits: Updated Introduction Removed the List of EHR Measures containing CPT Category I codes for non-covered services from the PFS. Removed the symbols and footnotes ( Signifies that this CPT Category I code is a non-covered service under the PFS
(Physician Fee Schedule). These non-covered services may not be counted in the denominator population for reporting rate calculations.) within each measure specification for the CPT Category I codes for non-covered services from the PFS.

Removed the symbols and footnotes ( The Percentage of patients who meet the criteria for this measure will be calculated by the EHR Warehouse. All measure-related EHR coding/data should be submitted to the EHR Warehouse to ensure accurate performance rates.) within each measure specification specifying that the EHR Warehouse will calculate

performance rates. A Note on providers submitting raw data to the EHR Warehouse for calculation has been added to the introduction. Removed the codes in the Denominator Inclusions, Numerator Inclusions, Numerator Exclusions, and Denominator Exclusions. Please see the 2012 Downloadable Resource Table for the list of specific codes for each measure. NQF numbers have been added to the measure title when applicable Removed Appendix A EHR Measures with Corresponding Data Elements. Please see the 2012 Downloadable Resource Table for the list of data elements for each measure. List of Physician Quality Reporting measures for 2012 have been updated and measure numbers were assigned for new 2012 EHR measures according to the recently finalized 2012 PFS Rule (11/2011)
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Measure #1 (NQF 0059): Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions Added Note: For performance, a lower rate indicates better performance/control to Numerator Inclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic Specifications Measure #2 (NQF 0064): Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control in Diabetes Mellitus Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Created numerator option for patients with LDL-C test result to align with EHR Incentive Program Electronic Specifications Expanded data element options and revised logic in Numerator 2 to align with the EHR Incentive Program Electronic Specifications Revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic Specifications Measure #3 (NQF 0061): Diabetes Mellitus: High Blood Pressure Control in Diabetes Mellitus Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic Specifications Measure #5 (NQF 0081): Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) (11/2011) Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Expanded data element options in Denominator Inclusions to align with the EHR Incentive Program Electronic Specifications Expanded data element options and revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic Specifications Expanded data element options in Denominator Exclusions to include ACE Allergy Codes and ARB Allergy Codes Updated Measure Owner (11/2011) Measure #6 (NQF 0067): Coronary Artery Disease (CAD): Antiplatelet Therapy (11/2011) Updated Measure Owner (11/2011) Updated Title, Description and Numerator Statement (11/2011) Removed oral prior to antiplatelet therapy when referenced in Numerator Inclusions and Denominator Exclusions (11/2011) Measure #7 (NQF 0070): Coronary Artery Disease (CAD): Beta-blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) (11/2011) Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Revised logic in Denominator Inclusions to align with the EHR Incentive Program Electronic Specifications Expanded data element options and revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic Specifications Updated Measure Owner (11/2011) Measure #8 (NQF 0083): Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) (11/2011) Updated Measure Owner (11/2011) Measure #9 (NQF 0105): Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b) Effective Continuation Phase Treatment (11/2011) Assigned Physician Quality Reporting Measure #9 to NQF Measure 0105 (11/2011)
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Measure #39 (NQF 0046): Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic Specifications Measure #47 (NQF 0326): Advance Care Plan Updated instructions in Denominator Inclusions Measure #48 (NQF 0098): Urinary Incontinence: Assessment of Presence or Absence or Urinary Incontinence in Women Aged 65 Years and Older Updated instructions in Denominator Inclusions Measure #53 (NQF 0047): Asthma: Pharmacologic Therapy (11/2011) Updated Measure Owner (11/2011) Measure #64 (NQF 0001): Asthma: Asthma Assessment (11/2011) Updated Measure Owner (11/2011) Updated Title (11/2011) Measure #110 (NQF 0041): Preventive Care and Screening: Influenza Immunization (11/2011) Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Expanded data element options and revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic Specifications Updated Title, Description, Denominator Statement and Denominator Inclusions to specify appropriate age as 6 months and older (11/2011) Measure #111 (NQF 0043): Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older Updated instructions in Denominator Inclusions and Numerator Inclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Removed Denominator Exclusions to align with the EHR Incentive Program Electronic Specifications Measure #112 (NQF 0031): Preventive Care and Screening: Screening Mammography Updated instructions in Denominator Inclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications. Expanded data element options and revised logic in Denominator Inclusions to align with the EHR Incentive Program Electronic Specifications Removed Denominator Exclusions to align with the EHR Incentive Program Electronic Specifications Measure #113 (NQF 0034): Preventive Care and Screening: Colorectal Cancer Screening Updated instructions in Denominator Inclusions and Denominator Exclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Expanded data element options and revised logic in Denominator Inclusions to align with the EHR Incentive Program Electronic Specifications Revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic Specifications Measure #124 (NQF 0488): Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR) (11/2011) Removed Measure #124 from Physician Quality Reporting System EHR Measure Specifications per the 2012 PFS Final Rule (11/2011)
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Measure #128 (NQF 0421): Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Changed Numerator Inclusion Option # 1 and 2 into Denominator and Numerator 1 and 2 Updated instructions in Denominator Inclusions, Numerator Inclusions, and Denominator Exclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Expanded data element options and revised logic in Denominator Exclusions to align with the EHR Incentive Program Electronic Specifications Measure #154: Falls: Risk Assessment (11/2011) Removed Measure #154 from Physician Quality Reporting System EHR Measure Specifications per the 2012 PFS Final Rule (11/2011) Measure #155: Falls: Plan of Care (11/2011) Removed Measure #155 from Physician Quality Reporting System EHR Measure Specifications per the 2012 PFS Final Rule (11/2011) Measure #173: Preventive Care and Screening: Unhealthy Alcohol Use-Screening Updated instructions in Denominator Inclusions Updated Rationale Measure #197 (NQF 0074): Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol (11/2011) Updated Measure Owner (11/2011) Measure #200 (NQF 0084): Heart Failure: Warfarin Therapy for Patients with Atrial Fibrillation (11/2011) Updated Measure Owner (11/2011) Measure #201 (NQF 0073): Ischemic Vascular Disease (IVD): Blood Pressure Management Control Updated Numerator Inclusions Measure #226 (NQF 0028): Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (11/2011) Created Denominator and Numerator 1 and 2 Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Revised logic in Numerator Inclusions to align with the EHR Incentive Program Electronic Specifications Updated instructions in Denominator Inclusions and Numerator Inclusions (11/2011) Measure #236 (NQF 0018): Hypertension (HTN): Controlling High Blood Pressure Updated Description Measure #237 (NQF 0013): Hypertension (HTN): Blood Pressure Measurement Updated instructions in Denominator Inclusions and Numerator Inclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Measure #238 (NQF 0022): Drugs to be Avoided in the Elderly Updated instructions in Denominator Inclusions and Numerator Inclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Measure #239 (NQF 0024): Weight Assessment and Counseling for Children and Adolescents Updated Measure Description Created Population Stratification 1, 2, and 3 Updated instructions in Denominator Inclusions and Numerator Inclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications
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Revised logic in Denominator Inclusions to align with the EHR Incentive Program Electronic Specifications Removed Denominator Exclusions Updated Rationale and Clinical Recommendation Statement Removed Evidence Supporting the Criterion of Quality Measures

Measure #240 (NQF 0038): Childhood Immunization Status Updated Measure Description Updated instructions in Denominator Inclusions and Numerator Inclusions Updated data elements to align with standard concepts in the EHR Incentive Program Electronic Specifications Updated Numerator Statement Expanded data element options and revised logic in Numerator Inclusions and Exclusions to align with the EHR Incentive Program Electronic Specifications Created new Criterion h; changed Criterion h to i; and changed Criterion i to j Measure #241 (NQF 0075): Ischemic Vascular Disease (IVD): Complete Lipid Panel and Low Density Lipoprotein (LDL-C) Control (11/2011) Replaced Physician Quality Reporting Measure #202 and #203 (NQF 0075) with newly assigned Physician Quality Reporting Measure #241 (11/2011) Updated Numerator Inclusions (11/2011) Measure #305 (NQF 0004): Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (a) Initiation, (b) Engagement (11/2011) Assigned NQF Measure 0004 Physician Quality Reporting Measure #305 (11/2011) Measure #306 (NQF 0012): Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) (11/2011) Assigned NQF Measure 0012 Physician Quality Reporting Measure #306 (11/2011) Measure #307 (NQF 0014): Prenatal Care: Anti-D Immune Globulin (11/2011) Assigned NQF Measure 0014 Physician Quality Reporting Measure #307 (11/2011) Updated instructions and logic in Denominator Inclusions (11/2011) Measure #308 (NQF 0027): Smoking and Tobacco Use Cessation, Medical Assistance: a. Advising Smokers and Tobacco Users to Quit, b. Discussing Smoking and Tobacco Use Cessation Medications, c. Discussing Smoking and Tobacco Use Cessation Strategies (11/2011) Assigned NQF Measure 0027 Physician Quality Reporting Measure #308 (11/2011) Measure #309 (NQF 0032): Cervical Cancer Screening (11/2011) Assigned NQF Measure 0032 Physician Quality Reporting Measure #309 (11/2011) Measure #310 (NQF 0033): Chlamydia Screening for Women (11/2011) Assigned NQF Measure 0033 Physician Quality Reporting Measure #310 (11/2011) Measure #311 (NQF 0036): Use of Appropriate Medications for Asthma (11/2011) Assigned NQF Measure 0036 Physician Quality Reporting Measure #311 (11/2011) Measure #312 (NQF 0052): Low Back Pain: Use of Imaging Studies (11/2011) Assigned NQF Measure 0052 Physician Quality Reporting Measure #312 (11/2011) Measure #313 (NQF 0575): Diabetes Mellitus: Hemoglobin A1c Control (<8%) (11/2011) Assigned NQF Measure 0575 Physician Quality Reporting Measure #313 (11/2011)
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Measure #316: Preventive Care and Screening: Cholesterol Fasting Low Density Lipoprotein (LDL) Test Performed AND Risk-Stratified Fasting LDL (11/2011) Replaced temporary Physician Quality Reporting Measure #M119 with Physician Quality Reporting Measure #316 (11/2011) Measure #317: Preventive Care and Screening: Screening for High Blood Pressure (11/2011) Replaced temporary Physician Quality Reporting Measure #M125 with Physician Quality Reporting Measure #317 (11/2011) Updated Numerator Statement (11/2011) Updated third bullet under Numerator Inclusion to 140 mmHG (11/2011) Updated Note in Numerator Inclusions (11/2011)

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