UDS – NextGen Best Practice for Asthma

Presented By:Sean Folweiler, Project Manager

Debra Pierce, NextGen EPM Analyst

Presentation Goals

1. Introduce CVC and Presenters2. Review 6B Section H – Asthma

Pharmacological Therapy - UDS Measure3. Review Asthma Data Elements

1. Data Sets

4. Review NextGen Workflow

2

Central Valley Collaborative

• CVC Core Services – EHR Project Management– EHR Analytics– ePM Analytics– EHR Training– EHR Development and Design– Network Support for PMS and EHR– Custom Programming

• CVC Supporting Services (CVC Membership is not required)

– HIT Student Internship

Central Valley Collaborative

NextGen

EHR Training

EHR Support

EPM SupportProgramming

Project Management

Billing Support

StaffingPERSONNEL FTE Member Access

Director 0.5 Ray Parris

Project Manager 1 Sean FolweilerSr. Administrative Assistant 1 Melissa DavisEHR Analyst 1 Gregory WilliamsHIT Workforce Program Coordinator 1 Jamie SwensonePM Analyst 1 Debra Pierce

Programmer 1 Greg Johnson

Senior Application Support Trainer II 1 Teresa Weir

Network Administrator I 1 Juan Garcia

EHR Workflow Design Specialist 1 Lahila Pitts

Application Support Trainer 1 John Smith

Application Support Trainer 1 Saaqib Rangoonwala

Central Valley Collaborative Membership(Core Members)

• Golden Valley Health Centers – Merced, CA• Livingston Medical Group – Livingston, CA• United Health Centers – Parlier, CA• Valley Health Team – San Joaquin, CA• Omni Family Health – Bakersfield, CA• Gardner Family Health Centers – San Jose, CA• Asian Americans for Community Involvement –

San Jose, CA

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Core Members and

QI Members

Our Mission

6B Section H – Asthma Pharmacological Therapy

PERFORMANCE MEASURE:

The performance measure is “Percentage of patients aged 5 through 40 with a diagnosis of mild, moderate, or severe persistent asthma who received or were prescribed accepted pharmacologic therapy.” This is calculated as follows: • Numerator: Number of patients in the denominator who received a prescription for or were provided inhaled corticosteroid or an accepted alternative medication. • Denominator: Number of patients who were 5 through 40 years of age at some point during the measurement year, who have been seen at least twice in the practice and who had at least one medical visit during the reporting year, who had an active diagnosis of persistent asthma OR a sample of these patients. For measurement year 2014, this includes patients with a date of birth between January 1,1974 and December 31, 2009.

***Measure from 2014 UDS Manual Ages are not correct for 2015.http://www.bphcdata.net/docs/uds_rep_instr.pdf

6B Section H – Asthma Pharmacological Therapy

TOTAL NUMBER OF PATIENTS AGE 5 THROUGH 40, COLUMN (A) Criteria: Enter the number of all patients who: • Were born on or after January 1, 1974 and on or before December 31, 2009 AND • Were last seen by health center while they were age 5 through 40 years AND • Have been seen at least twice (not necessarily in the current year) AND • Had at least one medical visit during 2014 AND • Were diagnosed with persistent11 asthma OR have persistent asthma as a current diagnosis on a chronic illness form or template

Exclusions: • Allergic reaction to asthma medications • Individuals with a diagnosis of asthma who are discovered, upon review, to have intermittent mild asthma, not persistent asthma.***Measure from 2014 UDS Manual Ages are not correct for 2015.http://www.bphcdata.net/docs/uds_rep_instr.pdf

6B Section H – Asthma Pharmacological Therapy

NUMBER OF PATIENTS WITH PERSISTENT ASTHMA WITH PHARMOCOLOGIC TREATMENT DOCUMENTED, COLUMN (C) Enter the total number of patients identified in Column B whose 2014 record demonstrates that they had • Received a prescription for or were using an inhaled corticosteroid OR • Received a prescription for or were using an acceptable pharmacological agent, specifically: inhaled steroid combinations, anti-asthmatic combinations, antibody inhibitor, leukotriene modifiers, mast cell stabilizers, or methylxanthines***Measure from 2014 UDS Manual Ages are not correct for 2015.http://www.bphcdata.net/docs/uds_rep_instr.pdf

6B Quick SheetSECTION H: ASTHMA PHARMACOLOGICAL THERAPY – Column A includes all patients between 5 and 40 years of age as of December 31st currently diagnosed with persistent asthma, with at least 1 medical visit in the health center during the measurement year and at least 2 medical visits ever. – Column C includes the number of patients in column B for whom documentation demonstrates that appropriate pharmacologic therapy was provided. – Compliant: Copy of prescription or note that the prescription for inhaled corticosteroids or acceptable alternative was given during the current year is included in the chart of EHR. Acceptable alternative pharmacologic therapy: Leukotriene modifiers, Cromolyn sodium, Nedocromil sodium, Sustained release methylxanthines. – Exclusions: Patients with allergic reaction to asthma meds and intermittent asthma.***http://www.bphcdata.net/docs/uds_factsheet.pdf

Data Elements

Demographic• AgeQualifying Encounter• DateAsthma• ICD Codes (patient_diagnosis)• Patient Problems (SNOMED)• Asthma_.classificationMedication Source• Medication - RXNorm

ICD Data Set

Persistent Asthma• ICD9 – 493.x• ICD10 – J45.30 – J45.52

Patient Problem Data Set

• 426656000 – Severe Persistent Asthma• 427295004 – Moderate persistent Asthma• 426979002 – Mild Persistent Asthma• 427354000 - Exacerbation of Persistent

Asthma

Asthma PersistentClassification Data Set

Medication Data Set

• 144 Medications Currently• https://vsac.nlm.nih.gov/#• Create an account• Search in Name for ‘Asthma’ and code system

‘RxNorm’

NextGen’s Interpretation

Considerations: - The most recent available medication update is required

for accurate reporting. - The Preferred Asthma Therapy drug list is provided by the

National Library of Medicine Value Set Authority Center. - Previous versions of this report required users to select an

asthma severity classification on the Asthma Flowsheet template. This is no longer necessary – users can enter persistent asthma in the Problems Module to avoid using the asthma templates. Users can also specify persistent asthma with ICD-10 codes.

Best Practice Workflow

Best Practice Workflow Cont.

Best Practice Workflow Cont.

Best Practice Workflow Cont.

Outstanding Questions