Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

eCQM / NQF #: CMS135v7 /0081
Measure: Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge.
Numerator: Patients who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge.
Denominator: All patients aged 18 years and older with a diagnosis of heart failure with a current or prior LVEF < 40%
Denominator Exceptions: Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB therapy (eg, hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons). Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB therapy (eg, patient declined, other patient reasons). Documentation of system reason(s) for not prescribing ACE inhibitor or ARB therapy (eg, other system reasons).
Domain: Effective Clinical Care

In ChartMaker Clinical:

In order to qualify for this measure, the provider must have seen the patient, age 18 years or older, at least one time during the reporting period and have the appropriate information documented in the chart:

Required Data Elements for the Denominator:

Plus ONE of the following:

and at least one of the following that occurs before or during the measurement period:  

Required Data Elements for the Numerator:

EXCEPTION DETAILS: 

This measure makes an exception for patients who were not prescribed ACE Inhibitor or ARB therapy due to Medical, Patient or System reasons.  In order to meet the requirements for this exception, the appropriate information must be documented in the chart:

At least one of the following (prior to or during the first encounter of the measurement period unless otherwise indicated):

ADDITIONAL INFORMATION:

•  The only data used to determine the denominator is data from the ChartMaker Clinical Module. If a patient encounter was not entered into the ChartMaker Clinical Module, that encounter is not included in the denominator for the statistical calculations on the Meaningful Use Dashboard. Please add these additional patients to the denominator and recalculate the percentage for Attestation purposes.

•  To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period if seen in the outpatient setting. If the patient has an eligible inpatient discharge during the measurement period, as defined in the measure logic, it is expected to be reported at each hospital discharge .

•  The ACE Inhibitor or ARB must start prior to or during the first encounter of the measurement period.  It must not end prior to the end of the measurement period.

•  The Ejection Fraction result LOINC code can be linked to either an applicable electronic lab result condition or a numeric template field.

•  Any condition being indicated as a result with an attached LOINC code MUST be marked as a result in the properties of that condition.  A condition should NOT be marked as both a result and an order (tracking).

•  The SNOMED codes indicating the diagnosis and/or Severity of LVSD, must be linked to a Diagnosis code.

•  The patient must be 18 years or older prior to the start of the measurement period.

•  The Renal Failure SNOMED code must be attached to a diagnosis.

•  A "Medication Not Ordered" may be undone using the "Undo Medication Not Ordered" option in the Medication button.  It must be done in the same note in which it was originally indicated.