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Tuesday, April 24, 2012

Harmonizing Value Sets in MeaningfulUse Stage2

Recently in discussions about Meaningful Use Stage 2 Certification criteria and in subsequent discussions on quality measures, someone pointed out inconsistencies in value sets used for smoking and/or tobacco use.  The other day, I posted a list that Cecil Lynch had provided that maps the Meaningful Use terms to SNOMED CT codes.

I took a look at quality measures that CMS proposes for 2014.  I didn't see any references to tobacco or smoking in the Hospital measures, but two measures do reference tobacco or smoking in the EP measures:

One measure: NQF 28, clarifies that screening for tobacco use includes "any kind of tobacco".
Another measure on Preventive Care and Screening from Quality Insights of Pennsylvania/Centers for Medicare & Medicaid Service explicitly references cigarette smoking only in one of the denominators:
Denominator 2: All patients aged 20 through 79 years who have Multiple Risk Factors (2+) of the following: Cigarette Smoking, Hypertension, Low High Density Lipoprotein (HDL), Family History of Premature CHD, or Age (men ≥ 55; women ≥ 65)
The challenge with either of these measures is that they cannot be computed from the Meaningful Use standard for smoking status:
(l) Smoking status. Standard. Smoking status types must include: Current every day smoker; current some day smoker; former smoker; never smoker; smoker, current status unknown; and unknown if ever smoked.
Many clinicians have suggested that the vocabulary standard for smoking status be broadened to include any tobacco use.  That still wouldn't solve the problems across these two measures.  Other clinicians will point out that any kind of smoking should probably be included in the second measure I described.

The real point here is that these and many other terms need to be harmonized across Meaningful Use and the proposed quality measures.  This problem is not isolated to smoking status, it has been reported to be present in a variety of other quality measures.

My hope is that current efforts towards development of a publicly accessible value set registry will go a long way towards making this possible.   But until that is done, and CQM developers take advantage of it, we'll continue to be asked to record one thing, and compute on something else.


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