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Key Clinical Interventions and Documentation Summary for Cardiovascular Care Measures

The successful documentation and completion of clinical quality measurement requirements requires many interventions to take place within a practice. The following resource provides a summation of the key clinical interventions that can be used for cardiovascular quality improvement and includes the general data elements needed for measure calculation. This resource is intended for educational purposes only. Practices should work with their vendor to determine which CQMs their EHR system are certified to report on, and any specific workflow changes needed to ensure CQMs calculate properly in their specific EHR system.

The following information is presented in a series of tables:

For more information on the specific data elements required for clinical quality measures, visit the Meaningful Use portal in USHIK.

For further information on CQMs and Meaningful Use, please visit: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/

Meaningful Use Cardiovascular Measures

This table lists most of the Meaningful Use measures applicable to patients with cardiovascular conditions, with the associated National Quality Forum (NQF) number noted parenthetically.

Meaningful Use Cardiovascular Measures
Controlling High Blood Pressure (NQF# 0018; CMS165v7)
Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic (NQF# 0068; CMS164v7)
Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (NQF# 0070; CMS145v7)
Pneumonia Vaccination for Older Adults (NQF# Not Applicable; CMS127v7)
Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control (NQF# Not Applicable; CMS182v6)
Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (NQF# 0081; CMS135v7)
Adult Weight Screening and Follow-up (NQF# 0421; CMS69v7)
Heart Failure: Beta Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) (NQF# 0083; CMS144v7)
Hypertension: improvement in blood pressure (NQF# Not Applicable; CMS65v8)
ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range(NQF# Not Applicable; CMS179v5)
Preventive Care and Screening: Cholesterol-Fasting Low Density Lipoprotein (LDL-C) Test Performed (NQF# Not Applicable; CMS61v6)
Preventive Care and Screening: Risk-Stratified Cholesterol-Fasting Low Density Lipoprotein (LDL-C) Test Performed (NQF# Not Applicable; CMS64v6)

Key Clinical Interventions

This table lists key interventions to be completed during a patient’s visit. Documentation of these activities in the electronic health record will help ensure all of the necessary information needed to calculate Meaningful Use cardiovascular measures is available. For interventions that correlate to a specific cardiovascular measure, the applicable NQF number is noted parenthetically. Practices may find assigning responsibility for each of these activities to specific staff members helpful in integrating each activity into the practice workflow. Technical information regarding specific diagnoses and procedures associated with cardiovascular measures can be found in the Meaningful Use portal of USHIK.

Key Clinical Interventions
All Cardiovascular Conditions
  • Confirm the patient's date of birth
  • Record the type and date of visit
Coronary Artery Disease (NQF 0070)
  • Check patient record or assess patient for active diagnosis of CAD with no MI or check record to see if patient has received cardiac surgery (NQF# 0070; CMS145v7)
  • Check patient record for or assess for diagnosis of myocardial infarction resolved (NQF# 0070; CMS145v7)
  • Check patient record for or assess for active diagnosis of arrhythmia, hypotension, asthma, bradycardia, or atresia and stenosis of aorta (NQF# 0070; CMS145v7)
  • Check patient record for or assess patient for active diagnosis of atrioventricular block; if present, check for cardiac pacer (NQF# 0070; CMS145v7)
  • Check patient record or assess patient for cardiac monitoring procedure (NQF# 0070; CMS145v7)
  • Check patient record for two consecutive heart rate measurements or measure patient heart rate (NQF# 0070; CMS145v7)
  • Check patient record for prescription of beta blocker therapy or, if appropriate, prescribe beta blocker therapy (NQF# 0070; CMS145v7)
  • If applicable, ascertain why medication is not ordered or active (NQF# 0070; CMS145v7)
High Blood Pressure (NQF 0018)
Heart Failure (NQF 0018) (NQF 0083)
  • Check patient record for or assess for medication adverse event, allergy, or intolerance to beta blocker therapy (NQF# 0083; CMS144v7)
  • Measure and document heart rate (NQF# 0083; CMS144v7)
  • Check patient record for documentation of beta blocker therapy prescription (medication active or ordered) or, if appropriate, prescribe beta blocker therapy (NQF# 0083; CMS144v7)
  • Check patient record or assess patient for active diagnosis of heart failure (NQF# 0081; CMS135v7) (NQF# 0083; CMS144v7)
  • Check patient record for LVSD result or ejection fraction result or, if appropriate order diagnostic study (NQF# 0081; CMS135v7) (NQF# 0083; CMS144v7)
  • Check patient record for or assess for pregnancy, deficiencies of circulating enzymes, disease of aortic and mitral valves, non-rheumatic mitral (valve) disease, chronic kidney disease with and without hypertension, hypertensive renal disease with renal failure, atherosclerosis of renal artery, renal failure and ESRD, acute renal failure, or atresia and stenosis of aorta (NQF# 0081; CMS135v7)
  • Check patient record for or assess for medication adverse event, allergy, or intolerance to ACE inhibitor or ARB therapy (NQF# 0081; CMS135v7)
  • Check patient record for active ACE inhibitor or ARB prescription or, if appropriate, prescribe ACE inhibitor or ARB (NQF# 0081; CMS135v7)
  • Check patient record for or assess for active diagnosis of arrhythmia, hypotension, asthma, or bradycardia or active diagnosis of atrioventricular block; if present, check for cardiac pacer (NQF# 0083; CMS144v7)
  • If applicable, ascertain why medication is not ordered or active (NQF# 0070; CMS145v7) (NQF# 0081; CMS135v7) (NQF# 0083; CMS144v7)
Ischemic Vascular Disease (NQF 0068) (NQF 0075)

Numerator Elements

This table specifies the information that needs to be documented in the electronic health record to appropriately calculate the numerator. The specific measure to which the element applies in noted by the NQF number in parentheses. Technical information related to the measure numerators can be found in the Meaningful Use portal of USHIK.

Elements Needed for the Numerator

Denominator Elements

This table specifies the information that needs to be documented in the electronic health record to appropriately calculate the denominator. These elements apply to all Meaningful Use cardiovascular measures. Technical information related to the measure denominators can be found in the Meaningful Use portal of USHIK.

Elements Needed for the Denominator

Exclusion/Exception Elements

This table specifies the information that needs to be documented in the electronic health record to appropriately determine measure exclusions. These elements apply to all Meaningful Use cardiovascular measures. Technical information related to the measure exclusions/exceptions can be found in the Meaningful Use portal of USHIK.

Elements Needed for Exclusions/Exceptions
  • Active diagnosis of pregnancy (NQF# 0018; CMS165v7)
  • Active diagnosis or procedures indicative of ESRD (NQF# 0018; CMS165v7)
  • Active diagnosis of arrhythmia, hypotension, asthma, bradycardia, or atresia and stenosis of aorta; OR Active diagnosis of atrioventricular block, without cardiac pacer; OR Cardiac monitoring; OR Beta blocker therapy allergy, adverse event, or intolerance; OR Patient, medical, or system reason; OR Heart rate < 50bmp (NQF# 0070; CMS145v7)
  • ACE inhibitor or ARB medication allergy, intolerance, adverse event; OR Active diagnosis of pregnancy, deficiencies of circulating enzymes, disease of aortic and mitral valves, non-rheumatic mitral (valve) disease, chronic kidney disease with and without hypertension, hypertensive renal disease with renal failure, atherosclerosis of renal artery, renal failure and ESRD, acute renal failure, or atresia and stenosis of aorta; OR Patient, medical, or system reason medication not done (NQF# 0081; CMS135v7)
  • Active diagnosis of arrhythmia, hypotension, asthma, bradycardia; OR Active diagnosis of atrioventricular block, without cardiac pacer; OR Beta blocker therapy allergy, adverse event, or intolerance; OR Patient, medical, or system reason for medication not done; OR Heart rate < 50bmp (NQF# 0083; CMS144v7)
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