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I love hoops and acronyms. I jump through them all the time. Now I'm going for PCMH and getting my MIPS in a row with PRIME registry which extracts quality indices directly from the AC SQL database. Unfortunately, a lot of the measures don't work because the registry tries to use the Clinical Decision Support (CDS) rules to denote when a condition has been satisfied, such as a diabetic retinal exam or osteoporosis screening. This can't work because the CDS rules do not match the definitions of the quality indices from Medicare. First of all, the CDS rules have no method of excluding patients from the rule. For example, someone with recognized and treated osteoporosis should be excluded from getting screening for osteoporosis. The CDS rules come up over and over again on patients for whom they don't apply. If AC is planning to use the CDS rules to ever help with MIPS, they need to be dramatically reworked.

So this is why CDS is messing us up. On this particular patient, he has previous myocardial infarction, with ICD 10 for previous myocardial infarction in the chart, so aspirin primary prophylaxis should not show up. Ditto high blood pressure screening because of his established history of treated high blood pressure. The PHQ-9 has not worked since 9.2. The screening for lipid disorders should also be excluded as he has established E78.5. And of course, he doesn't qualify for lung cancer screening since he quit more than 15 years ago, and had less than a 30 year history. We have computers so that we specifically don't have to wade through this stuff. Now if we use the CDS for practice improvement or to try and measure MIPS all the denominators are way off. It also means that PRIME registry cannot use the CDS for any measurements.