One organization has added 75 years of age as a threshold. From age >=76, the strength of the recommendation lessens and shared decision making is emphasized. Another organization did not include age limitations. In part, it depends if the artifact is trying to support the eCQM metric, provide CDS or both. The emphasis is on CDS, while aligning with the eCQM when able. Population 1: can do either way (with or without age threshold). Will need different messages (and possibly logic) for individuals 76 and older to encourage shared decision making and consider a lower intensity statin. This aligns with the ACC/AHA guidelines. Population 2: By the time they are 75, do patients truly have hypercholesterolemia versus a provoked one time bump? Setting this threshold seems advisable. A message will be needed to consider age before determining the intensity of medication that is ordered. Pure Cholesterolemia is not used correctly and may cause misfiring of CDS if used. How is pregnancy (and breastfeeding) captured in various EHRs (i.e., ICD code, flag) to support evaluation as an exclusion? Pregnancy and breastfeeding will likely not be captured as an ICD10 code, except by an OB/GYN doctor. Members were unsure how these concepts are captured on the back end of their systems. They can be mentioned in recommendation notifications as an exclusion, if implementers do not feel strongly that this data is captured as a diagnosis code. Lookback period for Population 2 Consider adding a lookback period for this population also to support processing efficiency Lookback period for Population 3 It is reasonable to translate ‘LDL result <= 2 years starts before end of Measurement Period’ in to a lookback period of 3 years. Feasibility concerns informed the eCQM lookback specifications Due to potential delays in processing time to support a longer lookback, work group members voiced consent to keeping the lookback at 3 years (as opposed to 6 years for an earlier artifact).
One organization has added 75 years of age as a threshold. From age >=76, the strength of the recommendation lessens and shared decision making is emphasized. Another organization did not include age limitations. In part, it depends if the artifact is trying to support the eCQM metric, provide CDS or both. The emphasis is on CDS, while aligning with the eCQM when able. Population 1: can do either way (with or without age threshold). Will need different messages (and possibly logic) for individuals 76 and older to encourage shared decision making and consider a lower intensity statin. This aligns with the ACC/AHA guidelines. Population 2: By the time they are 75, do patients truly have hypercholesterolemia versus a provoked one time bump? Setting this threshold seems advisable. A message will be needed to consider age before determining the intensity of medication that is ordered. Pure Cholesterolemia is not used correctly and may cause misfiring of CDS if used. How is pregnancy (and breastfeeding) captured in various EHRs (i.e., ICD code, flag) to support evaluation as an exclusion? Pregnancy and breastfeeding will likely not be captured as an ICD10 code, except by an OB/GYN doctor. Members were unsure how these concepts are captured on the back end of their systems. They can be mentioned in recommendation notifications as an exclusion, if implementers do not feel strongly that this data is captured as a diagnosis code. Lookback period for Population 2 Consider adding a lookback period for this population also to support processing efficiency Lookback period for Population 3 It is reasonable to translate ‘LDL result <= 2 years starts before end of Measurement Period’ in to a lookback period of 3 years. Feasibility concerns informed the eCQM lookback specifications Due to potential delays in processing time to support a longer lookback, work group members voiced consent to keeping the lookback at 3 years (as opposed to 6 years for an earlier artifact).