The material in this document was developed by Regional Extension Center staff in the performance of technical support and EHR implementation. The information in this document is not intended to serve as legal advice nor should it substitute for legal counsel. Users are encouraged to seek additional detailed technical guidance to supplement the information contained within. The REC staff developed these materials based on the technology and law that were in place at the time this document was developed. Therefore, advances in technology and/or changes to the law subsequent to that date may not have been incorporated into this material.
The National Learning Consortium (NLC) is a virtual and evolving body of knowledge and resources designed to support healthcare providers and health IT professionals working towards the implementation, adoption and meaningful use of certified EHR systems.
The NLC represents the collective EHR implementation experiences and knowledge gained directly from the field of ONC's outreach programs (REC, Beacon, State HIE) and through the Health Information Technology Research Center (HITRC) Communities of Practice (CoPs).
The following resource can be used in support of the EHR Implementation Lifecycle. It is recommended by "boots-on-the-ground" professionals for use by others who have made the commitment to implement or upgrade to certified EHR systems.
This guide provides a summary of how to use the United States Health Information Knowledgebase (USHIK) to access key information on the Meaningful Use electronic Clinical Quality Measures (eCQMs) and is intended to be shared with staff using an electronic health record (EHR).
The first section, Getting Started, provides a general overview of what is available on the home screen, and how a user can navigate to a eCQM of interest.
The following seven sections correspond with available USHIK tabs, and illustrate what can be found in each of those areas on the USHIK site.
The final section, Comparing Measures, provides instructions on how to use USHIK to compare two or more measures, or different versions of a single measure.
USHIK is an online resource developed, provided, and maintained by the Agency for Healthcare Research and Quality (AHRQ).
USHIK provides clinical codes through the Unified Medical Language System (UMLS), part of the National Library of Medicine. Note that the user must create a UMLS account as prompted to access code sets on USHIK.
There are many ways to access information available on USHIK. The following pages contain screen shots of functions that would be most useful to those interested in clinical quality measures. This resource does not represent all the information or functions available on USHIK, nor all the ways to access the information and functions available. Independent exploration of USHIK is encouraged in order to determine how USHIK can best meet the needs of a particular REC or practice.
To access eCQM information on USHIK, click the Meaningful Use tab:
Notice there are tabs for each Stage of Meaningful Use. By default, the Stage 2 tab will be selected, though users can click on the "Stage 1" tab to see information pertaining to the Stage 1 measures.
After choosing the appropriate MU Stage, click on E.P. Clinical Quality Measures.
Clicking on the arrow next to the column name will sort the list in ascending or descending order by the selected column. For example, clicking on the arrow next to NQF heading once will sort the list from lowest NQF number to highest. Click on the arrow again and the list will be organized in descending order, e.g. highest to lowest NQF number.
Hovering over a measure of interest will provide a window with basic details about the measure. Click on the name of the measure of interest from the list provided for further detail.
Because some of the codes sets associated with a measure are provided through UMLS, USHIK will prompt the user for UMLS log-in information before providing further measure details. Either enter your information, or click the link to obtain a UMLS username and password.
Once UMLS information is entered, the next screen provides seven tabs that display different information about the measure. Sections 1.2 through 1.9 provide an overview of the information contained in these tabs.
At a Glance provides high-level information about the measure, such as a description of the measure and its numerator, denominator, and exceptions/exclusions.
Downloads and Resources will provide a series of downloadable PDF, Excel, CSV, and XML documents related to the measure. The resources contain files that include code sets, population criteria, and metadata on each measure.
Population Criteria presents the "logic" of the measure: which components make up the initial population, numerator, denominator, and exclusions/exceptions. Note that each component is a hyperlink. Clicking on the link for any of the indicated elements will bring you directly to the code list for that specific element.
This screen will appear when the hyperlink associated with a component is clicked
Data Criteria provides all codes associated with data elements of the measure. For example, the data element Procedure, Performed: Primary THA Procedure will be fulfilled by documenting any of the HCPCS, CPT, or SNOMEDCT codes shown in the EHR. Hovering the cursor over the code will display its definition.
Sometimes, it can be useful to see if more than one CQM uses the same data element, i.e., to understand if data entry on the same data element affects multiple CQMs. For more information regarding a data element, click on the category in blue:
Additional information about the code set is displayed, including associated CQMs that use the same data element:
Supplemental Data Elements provide the codes affiliated with the more generic data elements, such as sex and race. As described above, clicking on the data element name will provide additional information, including associated clinical quality measures that use the same data elements.
If a measure needs to be stratified when reported, e.g., by age, this tab will display the required strata.
The Metadata tab displays high-level narrative information on the measure, such as the measure steward, the rationale, and clinical recommendations. References for information cited on the Metadata tab are located in the References tab to the right of the Metadata tab.
USHIK allows users to compare different CQMs. From the list of CQMs, check the box in the leftmost column that corresponds with the measures to be compared, and click the Compare button:
Three tabs become available allowing a user to compare the Identifying Attributes, Population Criteria, and QDM Data Elements & Codes across the selected measures. Rows flagged with a red exclamation point and highlighted in grey have differences, while those appearing with a green check mark and highlighted in blue are matching. In the example below, the ID, Measure Version, GUID, Domain, and Description are different between the two measures, but the NQF, Measurement Period, and several other attributes are not. When the cursor is positioned over a Metadata Attribute, a box pops up nothing whether the attribute is the same for the selected measures.
On the Code Comparison tab, codes shared between the measures are shown in blue; while codes unique to one of the selected measures are shown in grey.
Some measures will appear with an icon that looks like stacked papers next to the measure name. This indicates there are multiple versions of the measure:
For these measures, the Compare Versions button is available to view the differences and similarities between them:
This brings the user to a comparison page set up identically to the one described above, but compares the different versions of a single measure instead of different measures.