eCQM: Preventive Care and Screening: Influenza Immunization (CMS 147v6)

eCQM:

Preventive Care and Screening: Influenza Immunization

CMS ID:

CMS 147v6

Measure Type:

Process

MIPS High Priority Measure:

No

Quality ID:

110

Eligible for Quality Programs:

  • Merit-Based Incentive Payment System (MIPS)
  • Medicaid EHR Incentive Program (Meaningful Use)

Performance Benchmark for MIPS:

79.02%

Description:

Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization.

  • Numerator: Patients from the denominator who received an influenza immunization OR who reported previous receipt of an influenza immunization.
  • Denominator: All patients aged 6 months and older with at least two eligible encounters or at least one face-to-face visit (defined in Table 1) during the measurement period who were also seen for a face-to-face visit between October 1st and March 31st.
    • Denominator Exclusions: None

    • Denominator Exceptions:

      • Documentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons);

      • Documentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons);

      • Documentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons).

Table 1. Eligible Visits for CMS 147v6

Eligible Denominator Visit

Acceptable Practice Fusion Encounter Types

Eligible encounters


  • Office Visit
  • Home Visit
  • Email Encounter
  • Letter
  • Nurse Visit
  • Nursing Home Visit
  • Telemedicine Visit
  • Telephone Encounter

Face-to-face visits


  • Office Visit
  • Home Visit
  • Nurse Visit
  • Nursing Home Visit

eCQM Patient Reports

eCQM Patient Reports can help you identify patient care gaps and improve the performance of your quality measures. Click on the blue result numbers in the eCQM Dashboard to see the patient report for this measure.

The eCQM Patient Reports list the individual patients included in the measure’s population, which measure cohorts the patient is in, and contact information for the patient to streamline any downstream communication that may be needed to fulfill the measure requirements. You can choose to print the patient list for a measure or export it as a CSV.

The measure cohorts included in the eCQM Patient Report for CMS 147v6 Preventive Care and Screening: Influenza Immunization are:

  • Initial patient population
  • Denominator
  • Numerator
  • Exception

Practice Fusion Suggested Workflow
Practice Fusion suggests the following workflow to help ensure that you are able to meet the requirements of this measure within the Practice Fusion EHR.

  1. For all patients seen between October 1st and March 31st, ask about whether the patient has received an influenza vaccination.

  2. For patients who have received the vaccine prior to the visit and those who are administered the vaccine by your practice, record the influenza vaccination in the Immunizations section of the patient chart.

    1. See Table 2 for suggested workflows specific to administered or historical vaccinations.

Note: The vaccination must be administered or documented between August 1st of the previous measurement period and March 31st of the current measurement period. For the 2017 reporting year, flu season occurred between October 1st, 2016 and March 31st, 2017.

Table 2. Practice Fusion Suggested Workflow for Recording Vaccinations for CMS 147v6

Vaccination status

Practice Fusion Suggested Workflow

Administered

  • From the patient encounter, click the “Go to…” menu at the top of the page and select Immunizations. Select “Add Vaccine” and then select “Administered.” Search for the administered vaccine in the Vaccine field. Influenza vaccines available in Practice Fusion that meet the numerator requirements are:

    • Fluzone High-Dose / Influenza, high dose seasonal (CVX 135)

    • Fluvirin Preservative Free / Influenza, seasonal, injectable, preservative free (CVX 140)

    • Fluzone / Influenza, seasonal, injectable (CVX 141)

    • FluMist Quadrivalent / influenza, live, intranasal, quadrivalent (CVX 149)  

    • Fluzone Quadrivalent / influenza, injectable, quadrivalent, preservative free (CVX 150)

  • Once selected, complete the required details for the vaccine and save to the patient’s chart.

Historical
If administered by another provider or in another care setting.

  • From the patient encounter, click the “Go to…” menu at the top of the page and select Immunizations. Select “Add Vaccine” and then select “Historical.” Search for the administered vaccine in the Vaccine field. Influenza vaccines available in Practice Fusion that meet the numerator requirements are:

    • Fluzone High-Dose / Influenza, high dose seasonal (CVX 135)

    • Fluvirin Preservative Free / Influenza, seasonal, injectable, preservative free (CVX 140)

    • Fluzone / Influenza, seasonal, injectable (CVX 141)

    • FluMist Quadrivalent / influenza, live, intranasal, quadrivalent (CVX 149)  

    • Fluzone Quadrivalent / influenza, injectable, quadrivalent, preservative free (CVX 150)

  • Once selected, complete the required details for the historical vaccine and save to the patient’s chart.

OR

  • In the Screenings/Interventions/Assessments section of the encounter, search for one of the following applicable terms and select the item:

    • Has influenza vaccination at home (finding) (SNOMED CT 185900003)

    • Has influenza vaccination at hospital (finding) (SNOMED CT 185902006)

    • Has influenza vaccination at surgery (finding) (SNOMED CT 185901004)

    • Has influenza vaccination at work (finding) (SNOMED CT 416928007)

  • Once selected, record and save the following information about the vaccination in the modal window that opens:

    • Status: Performed

    • Start Date: Date the vaccine was administered

Additional Measure Information
  • Please note that custom influenza vaccines do not count towards the numerator for this measure.
  • To be recognized for the denominator exceptions, the patient must have specific diagnosis or procedure codes recorded in his or her chart. Please reference Table 3 for examples, using the suggested workflow for each data type.
  • “Previous receipt” indicates receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st).
  • To access a complete list of the qualifying data that will place a patient in the denominator exceptions, please visit the United States Health Information Knowledgebase (USHIK). This site is produced by the Agency for Healthcare Research and Quality (AHRQ) in partnership with CMS and the National Library of Medicine (NLM). A free Unified Medical Language System® (UMLS) license, available from NLM, is required to access USHIK.

Table 3: Practice Fusion Suggested Workflows for 147v6 Denominator Exceptions

Data Type

Practice Fusion Suggested Workflow

Influenza Vaccination Declined


  • In the Screenings/Interventions/Assessments section of the patient encounter, search for “Influenza vaccination (procedure)” (SNOMED CT 86198006) and select the item.

  • Record the following:

    • Status: Not Performed

    • Reason: Refusal of treatment by patient, Medical contraindication, Procedure contraindicated, OR Treatment not tolerated.

Allergy to Eggs
(Diagnosis)

  • In the Diagnosis section of the patient encounter, search for the applicable allergy to eggs and save the diagnosis. Examples include:

    • Anaphylactic reaction due to eggs, initial encounter (ICD-10 T78.08XA)

    • Allergy to eggs (ICD-10 Z91.012)

Influenza Vaccine Allergy
(Diagnosis)

  • In the Diagnosis section of the patient encounter, search by one of the following specific terms and, once selected, confirm that the SNOMED CT matches the code listed below:

    • Influenza vaccine allergy (SNOMED CT 294647003)

    • Influenza surface antigen vaccine allergy (SNOMED CT 294649000)

    • Influenza split virion vaccine allergy (SNOMED CT 294648008)

Influenza Vaccine Intolerance
(Diagnosis)

  • In the Diagnosis section of the patient encounter, search by one of the following specific terms and, once selected, confirm that the SNOMED CT listed matches the code listed below:

    • Influenza split virion vaccine adverse reaction (SNOMED CT 293112000)

    • Influenza surface antigen vaccine adverse reaction (SNOMED 293113005)

    • Influenza virus vaccine adverse reaction (SNOMED CT 420113004)

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