Request: The Health Resources and Services Administration (HRSA) requests changes to the Uniform Data System (UDS) Information Collection (OMB #0915-0193, expires 02/28/2018).
Purpose: These clarifications are critical to align clinical quality measures (CQMs) and data standardization with national and federal programs, including the National Quality Forum (NQF) and the Centers for Medicare and Medicaid Services (CMS) EHR incentive program.
Time Sensitivity: UDS data collection begins January 1, 2016. If approved, the Bureau of Primary Health Care must notify health centers of data collection changes in December 2015.
PROPOSED CLARIFICATIONS FOR CY2016 UDS REPORTING
Staffing and Utilization – Table 5 (clarification)
The following staff is reported on Table 5: Quality Improvement (QI) staff (line 29b), Community Health Worker staff (CHW) (line 27c), Dental Therapists staff (line 17a)
Rationale: Health center staffing patterns are evolving to better meet the needs of patients and communities. The UDS includes information about different types of staff but does not specifically include information about new types of staff that health centers routinely employ including QI staff, CHWs, and dental therapists. These clarifications will allow more precise evaluation the Health Center Program and measure ongoing investments that support overall team-based care including quality improvement, use of CHWs, and oral health.
Selected Diagnoses and Services Rendered – Table 6A (clarification)
All Table 6A diagnosis codes for selected diagnoses and services rendered are edited from ICD-9 to ICD-10 codes.
Rationale: The U.S. Department of Health and Human Services (HHS) released a final rule on July 31, 2014 (http://cms.hhs.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-07-31.html) that requires Health Insurance Portability and Accountability Act (HIPAA) covered entities to use ICD-10 beginning October 2015. The UDS reporting requirements follow the edited ICD-10 implementation schedule.
Sexual Orientation and Gender Identity (SO/GI) – Table 3A, 3B (clarification for alignment)
Sexual orientation and gender identity are reported on Table 3A, 3B.
Rationale: Clarifications to SO/GI data collection improves the UDS’ alignment with the 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and The Office of the National Coordinator for Health Information Technology (ONC) Health IT Certification Program. The use of an ONC-certified EHR is a priority goal for the Health Center Program, and 98% of health centers have adopted an EHR as of 2014. Aligning UDS SOGI data elements with ONC certification criteria improves standardization of data reporting and contributes to reducing health center reporting burden. Additionally, the EHR standards for collecting SOGI data under the ONC Health IT Certification Program align with National Health Interview Survey (NHIS) categories, further supporting data standardization and comparability. Addressing health disparities is an important priority for the Health Center Program. Given sexual orientation and gender identity play a significant role in health behavior and outcomes, understanding more about SOGI among populations served by health centers is a critical piece in reducing health disparities overall.
Quality of Care Measures – Table 6B, 7 (clarification for alignment)
The measures specifications of the Quality of Care and Health Outcomes and Disparities Measures listed below have been edited to fully align with existing CMS (Centers for Medicare & Medicaid Services) e-CQMs (electronic Clinical Quality Measures) to improve Department-wide standardization of data collection, streamline reporting, and reduce reporting burden.
Rationale: Data-driven quality improvement and full optimization of EHR systems are strategic priorities for the Health Center Program. Lack of measure alignment across national programs causes significant increases in reporting burden and leads to inconsistent data. Minor edits of these measures to fully align with other national programs such as the National Quality Forum (NQF) (http://www.qualityforum.org/QPS/QPSTool.aspx) and the Medicare and Medicaid EHR incentive program (http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms) (i.e. meaningful use) improves measure alignment and data standardization and reduces grantee reporting burden.
Childhood Immunizations has been edited to align with CMS117v4
Cervical Cancer Screening has been edited to align with CMS124v4.
Tobacco Use Screening and Cessation Intervention has been edited to align with CMS138v4.
Asthma Pharmacologic Therapy has been edited to align with CMS126v4
Depression Screening and Follow-up has been edited to align with CMS2v4.
Hypertension has been edited to align with CMS165v4.
Diabetes has been edited to align with CMS122v4.
Weight assessment and counseling for children and adolescents has been edited to align with CMS155v34.
Adult weight screening and follow-up has been edited to align with CMS69v4.
Ischemic vascular disease: Use of Aspirin or Another Antithrombotic has been edited to align with CMS164v4.
Colorectal Cancer Screening has been edited to align with CMS130v4.
Dental Sealants for children has been edited to align with CMS277v0.
Telehealth – Appendix D (clarification)
Questions in Appendix D are edited to capture health center telehealth capacity and use.
Rationale: Telehealth is increasingly used as a method of health care delivery for the health center patient population, especially those hard-to-reach patients living in geographically isolated communities. Collecting information on telehealth capacity and use of telehealth is essential for the provision of necessary and appropriate technical assistance for health centers and positioning these health centers to better meet their mission of improving the health of the Nation’s underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services.
Medication-Assisted Treatment (MAT) – Appendix D
Questions in Appendix D are edited to capture Medication-Assisted Treatment (MAT).
Rationale: Addressing America’s opioid misuse crisis and epidemic is a national priority. Medication-Assisted Treatment (MAT) is a comprehensive method of helping patients overcome addiction through the use of medication, counseling, and other behavioral health services. Increasing the use of MAT in primary care, including HRSA-funded health centers, is a federal priority. Greater understanding of the use of MAT in health centers is necessary both to understand existing services and identify gaps.
Attachments:
1. Proposed Updates to UDS Tables 3B, 5, 6A, 6B, 7, 8A, Appendix D
Attachment 1: Table 3B: Demographic Characteristics
Reporting Period: January 1, 2016 through December 31, 2016
Patients by Hispanic or Latino Ethnicity
Line |
Patients By Race |
Hispanic/ Latino (a) |
Non-Hispanic/ Latino (b) |
Unreported/ Refused to Report Ethnicity (c) |
Total (d) (Sum Columns a+b+c) |
1. |
Asian |
<blank for demonstration> |
<blank for demonstration> |
|
<blank for demonstration> |
2a. |
Native Hawaiian |
<blank for demonstration> |
<blank for demonstration> |
|
<blank for demonstration> |
2b. |
Other Pacific Islander |
<blank for demonstration> |
<blank for demonstration> |
|
<blank for demonstration> |
2. |
Total Native Hawaiian and Other Pacific Islander (Sum Lines 2a + 2b) |
<blank for demonstration> |
<blank for demonstration> |
|
<blank for demonstration> |
3. |
Black/African American |
<blank for demonstration> |
<blank for demonstration> |
|
<blank for demonstration> |
4. |
American Indian/Alaska Native |
<blank for demonstration> |
<blank for demonstration> |
|
<blank for demonstration> |
5. |
White |
<blank for demonstration> |
<blank for demonstration> |
|
<blank for demonstration> |
6. |
More than one race |
<blank for demonstration> |
<blank for demonstration> |
|
<blank for demonstration> |
7. |
Unreported/Refused to report race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
8. |
Total Patients (Sum Lines 1+2 + 3 to 7) |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
Line |
Patients by Language |
Number (a) |
12. |
Patients Best Served in a Language Other Than English |
|
Line |
Patients by Sexual Orientation |
Number (a) |
|
Line |
Patients by Gender Identity |
Number (a) |
13. |
Lesbian or gay |
|
|
20. |
Male |
|
14. |
Straight (not lesbian or gay) |
|
|
21. |
Female |
|
15. |
Bisexual |
|
|
22. |
Transgender Male/ Female-to-Male |
|
16. |
Something else |
|
|
23. |
Transgender Female/ Male-to-Female |
|
17. |
Don’t know |
|
|
24. |
Other |
|
18. |
Choose not to disclose |
|
|
25. |
Choose not to disclose |
|
19. |
Total Patients (Sum Lines 13 to 18) |
|
|
26. |
Total Patients (Sum Lines 20 to 25) |
|
Note: The sum of Table 3B, lines 22 through 25, Column A must equal Table 3A, line 39, Column C.
|
||||||
Table 5: Staffing and Utilization
Reporting Period: January 1, 2016 through December 31, 2016
Line |
Personnel by Major Service Category |
FTEs (a) |
Clinic Visits (b) |
Patients (c) |
1 |
Family Physicians |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
2 |
General Practitioners |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
3 |
Internists |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
4 |
Obstetrician/Gynecologists |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
5 |
Pediatricians |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
7 |
Other Specialty Physicians |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
8 |
Total Physicians (Lines 1–7) |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
9a |
Nurse Practitioners |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
9b |
Physician Assistants |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
10 |
Certified Nurse Midwives |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
10a |
Total NPs, PAs, and CNMs (Lines 9a–10) |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
11 |
Nurses |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
12 |
Other Medical Personnel |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
13 |
Laboratory Personnel |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
14 |
X-ray Personnel |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
15 |
Total Medical (Lines 8 + 10a through 14) |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
16 |
Dentists |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
17 |
Dental Hygienists |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
17a |
Dental Therapists |
|
|
|
18 |
Other Dental Personnel |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
19 |
Total Dental Services (Lines 16–18) |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
20a |
Psychiatrists |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
20a1 |
Licensed Clinical Psychologists |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
20a2 |
Licensed Clinical Social Workers |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
20b |
Other Licensed Mental Health Providers |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
20c |
Other Mental Health Staff |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
20 |
Total Mental Health (Lines 20a–c) |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
21 |
Substance Abuse Services |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
22 |
Other Professional Services (specify___) |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
22a |
Ophthalmologists |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
22b |
Optometrists |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
22c |
Other Vision Care Staff |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
22d |
Total Vision Services (Lines 22a–c) |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
23 |
Pharmacy Personnel |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
24 |
Case Managers |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
25 |
Patient/Community Education Specialists |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
26 |
Outreach Workers |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
27 |
Transportation Staff |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
27a |
Eligibility Assistance Workers |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
27b |
Interpretation Staff |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
27c |
Community Health Workers |
|
|
|
28 |
Other Enabling Services (specify___) |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
29 |
Total Enabling Services (Lines 24–28) |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
29a |
Other Programs/Services (specify___) |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
29b |
Quality Improvement Staff |
|
|
|
30a |
Management and Support Staff |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
30b |
Fiscal and Billing Staff |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
30c |
IT Staff |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
31 |
Facility Staff |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
32 |
Patient Support Staff |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
33 |
Total Facility and Non-Clinical Support Staff (Lines 30a–32) |
<blank for demonstration> |
<cell not reported> |
<cell not reported> |
34 |
Grand Total (Lines 15+19+20+21+22+22d+23+29+29a+33) |
<blank for demonstration> |
<blank for demonstration> |
<cell not reported> |
Table 6A: Selected Diagnoses and Services Rendered
Reporting Period: January 1, 2016 through December 31, 2016
Line |
Diagnostic Category |
Applicable ICD-10-CM Code |
Number of Visits by Diagnosis regardless of primacy (a) |
Number of Patients with Diagnosis (b) |
Selected Infectious and Parasitic Disease |
Selected Infectious and Parasitic Diseases |
|
Selected Infectious and Parasitic Diseases |
Selected Infectious and Parasitic Diseases |
1-2. |
Symptomatic / Asymptomatic HIV |
B20, B97.35, O98.7, Z21 |
<blank for demonstration> |
<blank for demonstration> |
3. |
Tuberculosis |
A15- thru A19- |
<blank for demonstration> |
<blank for demonstration> |
4. |
Sexually transmitted infections |
A50- thru A64- (Exclude A63.0), M02.3-, N34.1 |
<blank for demonstration> |
<blank for demonstration> |
4a. |
Hepatitis B |
B16.0-B16.2, B16.9, B17.0, B18.0, B18.1, B19.10, B19.11, Z22.51 |
<blank for demonstration> |
<blank for demonstration> |
4b. |
Hepatitis C |
B17.10, B17.11, B18.2, B19.20, B19.21, Z22.52 |
<blank for demonstration> |
<blank for demonstration> |
Selected Diseases of the Respiratory System |
Selected Diseases of the Respiratory System |
|
Selected Diseases of the Respiratory System |
Selected Diseases of the Respiratory System |
5. |
Asthma |
J45- |
<blank for demonstration> |
<blank for demonstration> |
6. |
Chronic obstructive pulmonary diseases |
J40- thru J44- and J47- |
<blank for demonstration> |
<blank for demonstration> |
Selected Other Medical Conditions |
Selected Other Medical Conditions |
|
Selected Other Medical Conditions |
Selected Other Medical Conditions |
7. |
Abnormal breast findings, female |
C50.01-, C50.11-, C50.21-, C50.31-, C50.41-, C50.51-, C50.61-, C50.71-, C50.81-, C50.91-, C79.81, D48.6-, R92- |
<blank for demonstration> |
<blank for demonstration> |
8. |
Abnormal cervical findings |
C53-, C79.82, D06-, R87.61-, R87.810, R87.820 |
<blank for demonstration> |
<blank for demonstration> |
9. |
Diabetes mellitus |
E10- thru E13-, O24- (Exclude O24.41-) |
<blank for demonstration> |
<blank for demonstration> |
10. |
Heart disease (selected) |
I01-, I02- (exclude I02.9), I20- thru I25, I26- thru I28-, I30- thru I52- |
<blank for demonstration> |
<blank for demonstration> |
11. |
Hypertension |
I10- thru I15- |
<blank for demonstration> |
<blank for demonstration> |
12. |
Contact dermatitis and other eczema |
L23- thru L25-, L30- (Exclude L30.1, L30.3, L30.4, L30.5), L55- thru L59 (Exclude L57.0 thru L57.4) |
<blank for demonstration> |
<blank for demonstration> |
13. |
Dehydration |
E86- |
<blank for demonstration> |
<blank for demonstration> |
14. |
Exposure to heat or cold |
T33.XXXA, T34.XXXA, T67.XXXA, T68.XXXA, T69.XXXA |
<blank for demonstration> |
<blank for demonstration> |
14a. |
Overweight and obesity |
E66-, Z68- (Excluding Z68.1, Z68.20-24, Z68.51. Z68.52) |
<blank for demonstration> |
<blank for demonstration> |
Selected Childhood Conditions (limited to ages 0 thru 17) |
Selected Childhood Conditions (limited to ages 0 thru 17) |
|
Selected Childhood Conditions (limited to ages 0 thru 17) |
Selected Childhood Conditions (limited to ages 0 thru 17) |
15. |
Otitis media and Eustachian tube disorders |
H65- thru H69- |
<blank for demonstration> |
<blank for demonstration> |
16. |
Selected perinatal medical conditions |
A33-, P20- thru P29- (exclude P22.0, P29.3); P35- thru P96- (exclude P50-, P51-, P52-, P54-, P91.6-, P92-, P96.81), R78.81, R78.89 |
<blank for demonstration> |
<blank for demonstration> |
17. |
Lack of expected normal physiological development (such as delayed milestone; failure to gain weight; failure to thrive); Nutritional deficiencies in children only. Does not include sexual or mental development. |
E40-E46, E50- thru E63- (exclude E64-), P92-, R62- (exclude R62.7), R63.2, R63.3 |
<blank for demonstration> |
<blank for demonstration> |
Selected Mental Health and Substance Abuse Conditions |
Selected Mental Health and Substance Abuse Conditions |
|
Selected Mental Health and Substance Abuse Conditions |
Selected Mental Health and Substance Abuse Conditions |
18. |
Alcohol related disorders |
F10-, G62.1 |
<blank for demonstration> |
<blank for demonstration> |
19. |
Other substance related disorders (excluding tobacco use disorders) |
F11- thru F19- (Exclude F17-), G62.0, O99.32- |
<blank for demonstration> |
<blank for demonstration> |
19a. |
Tobacco use disorder |
F17- |
<blank for demonstration> |
<blank for demonstration> |
20a. |
Depression and other mood disorders |
F30- thru F39- |
<blank for demonstration> |
<blank for demonstration> |
20b. |
Anxiety disorders including PTSD |
F40- thru F42-F43.0, F43.1- |
<blank for demonstration> |
<blank for demonstration> |
20c. |
Attention deficit and disruptive behavior disorders |
F90- thru F91- |
<blank for demonstration> |
<blank for demonstration> |
20d. |
Other mental disorders, excluding drug or alcohol dependence |
F01- thru F09-, F20- thru F29-, F43- thru F48- (exclude F43.1-), F50- thru F59- (exclude F55-), F60- thru F99- (exclude F84.2, F90-, F91-, F98-), R45.1, R45.2, R45.5, R45.6, R45.7, R45.81, R45.82, R48.0 |
<blank for demonstration> |
<blank for demonstration> |
Table 6A: Selected Services Rendered
Line |
Service Category |
Applicable ICD-10-CM Code or CPT-4/II Code |
Number of Visits (a) |
Number of Patients (b) |
Selected Diagnostic Tests/Screening/Preventive Services |
Selected Diagnostic Tests/ Screening/Preventive Services |
|
Selected Diagnostic Tests/Screening/Preventive Services |
Selected Diagnostic Tests/Screening/Preventive Services |
21. |
HIV test |
CPT-4: 86689; 86701-86703; 87390-87391 |
<blank for demonstration> |
<blank for demonstration> |
21a. |
Hepatitis B test |
CPT-4: 86704, 86706, 87515-17 |
<blank for demonstration> |
<blank for demonstration> |
21b. |
Hepatitis C test |
CPT-4: 86803-04, 87520-22 |
<blank for demonstration> |
<blank for demonstration> |
22. |
Mammogram |
CPT-4: 77052, 77057 OR ICD-10: Z12.31 |
<blank for demonstration> |
<blank for demonstration> |
23. |
Pap test |
CPT-4: 88141-88155; 88164-88167, 88174-88175 OR ICD-10: Z01.41-, Z01.42, Z12.4 |
<blank for demonstration> |
<blank for demonstration> |
24. |
Selected Immunizations: Hepatitis A, Hemophilus Influenza B (HiB), Pneumococcal, Diphtheria, Tetanus, Pertussis (DTaP) (DTP) (DT), Mumps, Measles, Rubella, Poliovirus, Varicella, Hepatitis B Child) |
CPT-4: 90633-90634, 90645 – 90648; 90670; 90696 – 90702; 90704 – 90716; 90718 - 90723; 90743 – 90744; 90748 |
<blank for demonstration> |
<blank for demonstration> |
24a. |
Seasonal Flu vaccine |
CPT-4: 90654 – 90662, 90672-90673, 90685-90688 |
<blank for demonstration> |
<blank for demonstration> |
25. |
Contraceptive management |
ICD-10: Z30- |
<blank for demonstration> |
<blank for demonstration> |
26. |
Health supervision of infant or child (ages 0 through 11) |
CPT-4: 99391-99393; 99381-99383; |
<blank for demonstration> |
<blank for demonstration> |
26a. |
Childhood lead test screening (9 to 72 months) |
CPT-4: 83655 |
<blank for demonstration> |
<blank for demonstration> |
26b. |
Screening, Brief Intervention, and Referral to Treatment (SBIRT) |
CPT-4: 99408-99409 |
<blank for demonstration> |
<blank for demonstration> |
26c. |
Smoke and tobacco use cessation counseling |
CPT-4: 99406 and 99407; HCPCS: S9075, CPT-II: 4000F, 4001F |
<blank for demonstration> |
<blank for demonstration> |
26d. |
Comprehensive and intermediate eye exams |
CPT-4: 92002, 92004, 92012, 92014 |
<blank for demonstration> |
<blank for demonstration> |
Line |
Service Category |
Applicable ADA Code |
Number of Visits (a) |
Number of Patients (b) |
Selected Dental Services |
Selected Dental Services |
Selected Dental Services |
Selected Dental Services |
Selected Dental Services |
27. |
I. Emergency Services |
ADA : D9110 |
<blank for demonstration> |
<blank for demonstration> |
28. |
II. Oral Exams |
ADA : D0120, D0140, DO145, D0150, D0160, D0170, D0171, D0180 |
<blank for demonstration> |
<blank for demonstration> |
29. |
Prophylaxis – adult or child |
ADA : D1110, D1120, |
<blank for demonstration> |
<blank for demonstration> |
30. |
Sealants |
ADA : D1351 |
<blank for demonstration> |
<blank for demonstration> |
31. |
Fluoride treatment – adult or child |
ADA :, D1206, D1208 |
<blank for demonstration> |
<blank for demonstration> |
32. |
III. Restorative Services |
ADA : D21xx – D29xx |
<blank for demonstration> |
<blank for demonstration> |
33. |
IV. Oral Surgery (extractions and other surgical procedures) |
ADA : D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7251, D7260, D7261, D7270, D7272, D7280, D7290-D7294 |
<blank for demonstration> |
<blank for demonstration> |
34. |
V. Rehabilitative services (Endo, Perio, Prostho, Ortho) |
ADA : D3xxx, D4xxx, D5xxx , D6xxx, D8xxx |
<blank for demonstration> |
<blank for demonstration> |
International Classification of Diseases, 2014, Complete Draft Code Set (ICD-10-CM). American Academy of Professional Coders
Current Procedural Terminology, (CPT) 2014. American Medical Association.
Current Dental Terminology, (CDT) 2015 – Dental Procedure Codes. American Dental Association (ADA).
NOTE: x or - in a code denotes any number including the absence of a number in that place. ICD-10 codes all have at least 4-digits.
Table 6B: Quality of Care Measures
Reporting Period: January 1, 2016 through December 31, 2016
Section A - Age Categories for Prenatal Care Patients:
Demographic Characteristics of Prenatal Care Patients
Line |
Age |
Number of Patients (a) |
1 |
Less than 15 years |
[blank for demonstration] |
2 |
Ages 15-19 |
[blank for demonstration] |
3 |
Ages 20-24 |
[blank for demonstration] |
4 |
Ages 25-44 |
[blank for demonstration] |
5 |
Ages 45 and over |
[blank for demonstration] |
6 |
Total Patients (Sum lines 1-5) |
[blank for demonstration] |
Section B - Trimester of Entry into Prenatal Care
Line |
Trimester of Entry into Prenatal Care |
Women Having First Visit with Health Center (a) |
Women Having First Visit with Another Provider (b) |
7 |
First Trimester |
[blank for demonstration] |
[blank for demonstration] |
8 |
Second Trimester |
[blank for demonstration] |
[blank for demonstration] |
9 |
Third Trimester |
[blank for demonstration] |
[blank for demonstration] |
Section C - Childhood Immunization Status (CIS)
Line |
Childhood Immunization Status (CIS) |
Total
Patients with 2nd Birthday |
Number
Charts Sampled |
Number
of Patients Immunized |
10 |
MEASURE: Percentage of children 2 years of age who have received age appropriate vaccines by their 2nd birthday. |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
Section D - Cervical Cancer Screening
Line |
Cervical Cancer Screening |
Total
Female Patients |
Number
Charts Sampled or EHR total |
Number
of Patients Tested |
11 |
MEASURE: Percentage of women 21-64 years of age, who received one or more Pap tests to screen for cervical cancer. |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
Section E - Weight Assessment and Counseling for Nutrition and Physical Activity of Children and Adolescents
Line |
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents |
Total Patients Aged 3 through16 (a) |
Number Charts Sampled or EHR Total (b) |
Number of Patients with Counseling and BMI Documented (c) |
12 |
MEASURE: Percentage of patients 3 17 years of age with a BMI percentile, and counseling on nutrition and physical activity documented |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
Section F – Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
Line |
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan |
Total Patients Aged 18 and Older (a) |
Number Charts Sampled or EHR Total |
Number of Patients with BMI Charted and Follow-Up Plan Documented as Appropriate (c) |
13 |
MEASURE: Percentage of patients aged 18 and older with (1) BMI documented and (2) follow-up plan documented if BMI is outside normal parameters. |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
Section G – Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Line |
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention |
Total
Patients Aged 18 and Older |
Number
Charts sampled or EHR total |
Number
of patients assessed for tobacco use and
provided Intervention if a Tobacco User |
14a |
MEASURE: Percentage of patients aged 18 years and older who (1) were screened for tobacco use one or more times within 24 months and if identified to be a tobacco user (2) received cessation counseling intervention. |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
Section H - Use of Appropriate Medications for Asthma
Line |
Use of Appropriate Medications for Asthma |
Total
Patients Aged 5 through 63 with Persistent Asthma |
Number
Charts Sampled or EHR Total |
Number
of Patients with Acceptable Plan |
16 |
MEASURE: Percentage of patients 5 - 63 years of age identified as having persistent asthma and were appropriately prescribed medication during the measurement period. |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
Section I - Coronary Artery Disease (CAD): Lipid Therapy
Line |
Coronary Artery Disease (CAD): Lipid Therapy |
Total
Patients Aged 18 and Older with CAD Diagnosis |
Number
Charts Sampled or EHR Total |
Number
of Patients Prescribed A Lipid Lowering Therapy |
17 |
MEASURE: Percentage of patients aged 18 and older with a diagnosis of CAD who were prescribed a lipid lowering therapy |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
Section J - Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
Line |
Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic |
Total
Patients 18 and Older with IVD Diagnosis or AMI,
CABG, or
PTCA Procedure
|
Charts
Sampled or EHR Total |
Number
of Patients With
Documentation of Use of Aspirin
or Other Antithrombotic Therapy |
18 |
MEASURE: Percentage of patients aged 18 and older with a diagnosis of IVD or AMI, CABG, or PTCA procedure with documentation of use of aspirin or another antithrombotic therapy. |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
Section K - Colorectal Cancer Screening
Line |
Colorectal Cancer Screening |
Total
Patients
Aged 50 through
74
|
Charts
Sampled or EHR Total |
Number
of Patients With
Appropriate Screening For Colorectal Cancer |
19 |
MEASURE: Percentage of patients 50 - 75 years of age who had appropriate screening for colorectal cancer |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
Section L - HIV Linkage to Care
Line |
HIV Linkage to Care |
Total
Patients First Diagnosed with HIV |
Charts
Sampled or EHR Total |
Number
of Patients Seen
Within 90 Days of First Diagnosis of HIV |
20 |
MEASURE: Percentage of patients whose first ever HIV diagnosis was made by health center staff between October 1, of the prior year and September 30, of the measurement year and who were seen for follow-up treatment within 90 days of that first ever diagnosis |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
Section M – Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
Line |
Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan |
Total
Patients Aged 12 and Older |
Charts
Sampled or EHR Total |
Number
of patients Screened for Depression and Follow-Up Plan Documented
as appropriate |
21 |
MEASURE: Percentage of patients aged 12 and older who were (1) screened for depression with a standardized tool, and if screening was positive (2) had a follow-up plan documented |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
Section N – Oral Health Sealant for Children between 6-9 Years
Line |
Oral Health Sealant for Children between 6-9 years) |
Total
Patients Aged 5 through 8 Identified as Moderate to High Risk for
Caries |
Charts
Sampled or EHR Total |
Number
of patients with Sealants to First Molars |
22 |
MEASURE: Children aged 6 - 9 years, at moderate to high risk of caries, who received a sealant on a first permanent molar |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
Table 7: Health Outcomes and Disparities
Reporting Period: January 1, 2016 through December 31, 2016
Section A: Deliveries and Birth Weight by Race and Hispanic/Latino Ethnicity
Line |
Description |
Patients |
0 |
HIV Positive Pregnant Women |
<blank for demonstration> |
2 |
Deliveries Performed by Health Center’s Providers |
<blank for demonstration> |
Line
|
Race and Ethnicity |
Prenatal
Care Patients Who Delivered During the Year |
Live
Births: |
Live
Births: |
Live
Births: |
<blank for demonstration> |
Hispanic/Latino |
<section divider cell> |
<section divider cell> |
<section divider cell> |
<section divider cell> |
1a |
Asian |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1b1 |
Native Hawaiian |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1b2 |
Other Pacific Islander |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1c |
Black/African American |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1d |
American Indian/Alaska Native |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1e |
White |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1f |
More than One Race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1g |
Unreported/Refused to Report Race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
Subtotal Hispanic/Latino |
<cell not reported> |
<cell not reported> |
<cell not reported> |
<cell not reported> |
<blank for demonstration> |
Non-Hispanic/Latino |
<section divider cell> |
<section divider cell> |
<section divider cell> |
<section divider cell> |
2a |
Asian |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2b1 |
Native Hawaiian |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2b2 |
Other Pacific Islander |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2c |
Black/African American |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2d |
American Indian/Alaska Native |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2e |
White |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2f |
More than One Race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2g |
Unreported/Refused to Report Race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
Subtotal Non-Hispanic/Latino |
<cell not reported> |
<cell not reported> |
<cell not reported> |
<cell not reported> |
<blank for demonstration> |
Unreported/Refused to Report Ethnicity |
<section divider cell> |
<section divider cell> |
<section divider cell> |
<section divider cell> |
h |
Unreported/Refused to Report Race and Ethnicity |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
i |
Total |
<cell not reported> |
<cell not reported> |
<cell not reported> |
<cell not reported> |
Section B: Controlling High Blood Pressure by Race and Hispanic/Latino Ethnicity
Line # |
Race and Ethnicity |
Total Patients 18 through 84 Years of Age with a Diagnosis of Hypertension (2a) |
Charts Sampled or EHR Total (2b) |
Patients with HTN Controlled (2c) |
<blank for demonstration> |
Hispanic/Latino |
<section divider cell> |
<section divider cell> |
<section divider cell> |
1a |
Asian |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1b1 |
Native Hawaiian |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1b2 |
Other Pacific Islander |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1c |
Black/African American |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1d |
American Indian/Alaska Native |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1e |
White |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1f |
More than One Race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1g |
Unreported/Refused to Report Race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
|
Subtotal Hispanic/Latino |
<cell not reported> |
<cell not reported> |
<cell not reported> |
<blank for demonstration> |
Non-Hispanic/Latino |
<section divider cell> |
<section divider cell> |
<section divider cell> |
2a |
Asian |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2b1 |
Native Hawaiian |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2b2 |
Other Pacific Islander |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2c |
Black/African American |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2d |
American Indian/Alaska Native |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2e |
White |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2f |
More than One Race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2g |
Unreported/Refused to Report Race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
|
Subtotal Non-Hispanic/Latino |
<cell not reported> |
<cell not reported> |
<cell not reported> |
<blank for demonstration> |
Unreported/Refused to Report Ethnicity |
<section divider cell> |
<section divider cell> |
<section divider cell> |
h |
Unreported/Refused to Report Race and Ethnicity |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
i |
Total |
<cell not reported> |
<cell not reported> |
<cell not reported> |
Section C: Diabetes: Hemoglobin A1c Poor Control by Race and Hispanic/Latino Ethnicity
Line
|
Race and Ethnicity |
Total
Patients 18 through 74 Years of Age with Diabetes |
Charts
Sampled or EHR Total |
Patients
with HbA1c <8% |
Patients
with HbA1c >9% Or No Test During Year |
<blank for demonstration> |
Hispanic/Latino |
<section divider cell> |
<section divider cell> |
<section divider cell> |
<section divider cell> |
1a |
Asian |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1b1 |
Native Hawaiian |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1b2 |
Other Pacific Islander |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1c |
Black/African American |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1d |
American Indian/Alaska Native |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1e |
White |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1f |
More than One Race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
1g |
Unreported/Refused to Report Race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
Subtotal |
Subtotal Hispanic/Latino |
<cell not reported> |
<cell not reported> |
<cell not reported> |
<cell not reported> |
<blank for demonstration> |
Non-Hispanic/Latino |
<section divider cell> |
<section divider cell> |
<section divider cell> |
<section divider cell> |
2a |
Asian |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2b1 |
Native Hawaiian |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2b2 |
Other Pacific Islander |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2c |
Black/African American |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2d |
American Indian/Alaska Native |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2e |
White |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2f |
More than One Race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
2g |
Unreported/Refused to Report Race |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
Subtotal |
Subtotal Non-Hispanic/Latino |
<cell not reported> |
<cell not reported> |
<cell not reported> |
<cell not reported> |
<blank for demonstration> |
Unreported/Refused to Report Ethnicity |
<section divider cell> |
<section divider cell> |
<section divider cell> |
<section divider cell> |
h |
Unreported/Refused to Report Race and Ethnicity |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
<blank for demonstration> |
i |
Total |
<cell not reported> |
<cell not reported> |
<cell not reported> |
<cell not reported> |
Reporting Period: January 1, 2016 through December 31, 2016
Line |
Cost Center |
Accrued Cost (a) |
Allocation of Facility and Non-Clinical Support Services (b) |
Total Cost After Allocation of Facility and Non-Clinical Support Services (c) |
[blank for section divide] |
Financial Costs for Medical Care |
[blank for section divide] |
[blank for section divide] |
[blank for section divide] |
1. |
Medical Staff |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
2. |
Lab and X-ray |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
3. |
Medical/Other Direct |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
4. |
Total Medical Care Services (Sum Lines 1- 3) |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
[blank for section divide] |
Financial Costs for Other Clinical Services |
[blank for section divide] |
[blank for section divide] |
[blank for section divide] |
5. |
Dental |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
6. |
Mental Health |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
7. |
Substance Abuse |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
8a. |
Pharmacy not including pharmaceuticals |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
8b. |
Pharmaceuticals |
[blank for demonstration] |
[Cell not reported] |
[blank for demonstration] |
9. |
Other Professional (Specify: ______) |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
9a. |
Vision |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
10. |
Total Other Clinical Services (Sum Lines 5 through 9a) |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
[blank for section divide] |
Financial Costs of Enabling and Other Program Related Services |
[blank for section divide] |
[blank for section divide] |
[blank for section divide] |
11a. |
Case Management |
[blank for demonstration] |
[Cell not reported] |
[blank for demonstration] |
11b. |
Transportation |
[blank for demonstration] |
[Cell not reported] |
[blank for demonstration] |
11c. |
Outreach |
[blank for demonstration] |
[Cell not reported] |
[blank for demonstration] |
11d. |
Patient and Community Education |
[blank for demonstration] |
[Cell not reported] |
[blank for demonstration] |
11e. |
Eligibility Assistance |
[blank for demonstration] |
[Cell not reported] |
[blank for demonstration] |
11f. |
Interpretation Services |
[blank for demonstration] |
[Cell not reported] |
[blank for demonstration] |
11g. |
Other Enabling Services (Specify: _____) |
[blank for demonstration] |
[Cell not reported] |
[blank for demonstration] |
11h. |
Community Health Workers |
|
|
|
11. |
Total Enabling Services Cost (Sum Lines 11a through 11h) |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
12. |
Other Related Services (Specify:_______) |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
12a. |
Quality Improvement |
|
|
|
13. |
Total Enabling and Other Services (Sum Lines 11 and 12a) |
[blank for demonstration] |
[blank for demonstration] |
[blank for demonstration] |
[blank for section divide] |
Facility and Non-Clinical Support Services and Totals |
[blank for section divide] |
[blank for section divide] |
[blank for section divide] |
14. |
Facility |
[blank for demonstration] |
[Cell not reported] |
[Cell not reported] |
15. |
Non-Clinical Support Services |
[blank for demonstration] |
[Cell not reported] |
[Cell not reported] |
16. |
Total Facility and Non-Clinical Support Services (Sum Lines 14 and 15) |
[blank for demonstration] |
[Cell not reported] |
[Cell not reported] |
17. |
Total Accrued Costs (Sum Lines 4 + 10 + 13 + 16) |
[blank for demonstration] |
[Cell not reported] |
[blank for demonstration] |
18. |
Value of Donated Facilities, Services, and Supplies (specify: __________________) |
[Cell not reported] |
[Cell not reported] |
[blank for demonstration] |
19. |
Total With Donations (Sum Lines 17 and 18) |
[Cell not reported] |
[Cell not reported] |
[blank for demonstration] |
Appendix D: Health Center Electronic Health Record (EHR) Capabilities and Quality Recognition
The Electronic Health Record (EHR) Capabilities and Quality Recognition Form includes a series of questions on health information technology (HIT) capabilities, including EHR interoperability and leverage for Meaningful Use. The EHR and Quality Recognition Form must be completed and submitted as part of the UDS submission. It includes questions about the health center’s implementation of EHR, certification of systems, how widely adopted the system is throughout the health center and its providers, and national and/or state quality recognition (accreditation or PCMH).
The following questions will be presented on a screen in the Electronic Handbook to be completed before the UDS Report is submitted. Instructions for the EHR questions can be found in EHB as you are completing the questions.
Does your center currently have an Electronic Health Record (EHR) system installed and in use?
Yes, at all sites and for all providers
Yes, but only at some sites or for some providers
No
This question seeks to determine whether or not an EHR has been installed by the health center as of December 31, 2015, and, if so, which product is in use, how broad is access to the system, and what features are available and being used. While they can often produce much of the UDS data, do not include practice management systems or other billing systems. If the health center has purchased an EHR, but had not yet placed it into use, answer “No.” If it has been installed, indicate if it was being used, as of December 31, 2015, by:
All sites and all providers: For the purposes of this response, “providers” mean all medical providers including physicians, nurse practitioners, physician assistants, and certified nurse midwives. While some or all of the dental, mental health, or other providers may also be using the system, as may medical support staff, this is not required to choose response “a.” For the purposes of this response, “all sites” means all permanent sites where medical providers serve health center medical patients and does not include administrative only locations, hospitals or nursing homes, mobile vans, or sites used on a seasonal or temporary basis.
At some sites or for some providers: Select option b if one or more permanent sites did not have the EHR installed, or in use (even if this is planned), or if one or more medical providers (as defined above) do not yet use the system. When determining if all providers have access to the system, the health center should also consider part time and locum providers who serve clinic patients. Do not select this option if the only medical providers who did not have access were those who were newly hired and still being trained on the system.
No: Select “no” if no EHR was in use on December 31, 2015, even if the system had been installed and staff was training on how to use the system.
If a system is in use (i.e., if a or b has been selected above), indicate if your system has been certified under the Office of the National Coordinator - Authorized Testing and Certification Bodies (ONC-ATCB).
1a. Is your system certified under the Office of the National Coordinator for Health IT (ONC) Health IT Certification Program?
Yes
No
Health centers are to indicate in the blanks the vendor, product name, version number, and certified health IT product list number. (More information is available at ONC-ATCB.) If you have more than one EHR (if, for example, you acquired another practice which has its own EHR), report the EHR that will be the successor system.
Vendor
Product Name
Version Number
Certified Health IT Product List Number
1b. Did you switch to your current EHR from a previous system this year?
Yes
No
If ‘yes, but only at some sites or for some providers’ is selected above, a box expands for health center to identify how many sites have the EHR in use and how many (medical) providers are using it. Please enter the number of sites (as defined above) where the EHR is in use, and the number of providers who use the system (at any site). Include part time and locum medical providers who serve clinic patients. A provider who has separate login identities at more than one site is still counted as just one provider:
1c. How many sites have the EHR system in use?
1d. How many providers use the EHR system?
1e. When do you plan to install the EHR system?
With reference to your EHR, BPHC would like to know if your system has each of the specified capabilities which relate to the CMS Meaningful Use criteria for EHRs and if you are using them. (more information on Meaningful Use). For each capability, indicate:
Yes if your system has this capability and it is being used by your center;
No if your system does not have the capability or it is not being used; or
Not sure if you do not know if the capability is built in and/or do not know if your center is using it.
Select (a) (has the capability and it is being used) if the software is able to perform the function and some or all of your medical providers are making use of it. It is not necessary for all providers to be using a specific capability in order to select (a).
Select (b) or (c) if the capability is not present in the software or if the capability is present, but the function has not been turned on, or if it is not currently in use by any medical providers at your center. Select (b) or (c) only if none of the providers are making use of the function.
Does your center send prescriptions to the pharmacy electronically? (Do not include faxing.)
Yes
No
Not sure
Does your center use computerized, clinical decision support such as alerts for drug allergies, checks for drug-drug interactions, reminders for preventive screening tests, or other similar functions?
Yes
No
Not sure
Does your center exchange clinical information electronically with other key providers/health care settings such as hospitals, emergency rooms, or subspecialty clinicians?
Yes
No
Not sure
Does your center engage patients through health IT such as patient portals, kiosks, secure messaging (i.e., secure email) either through the EHR or through other technologies?
Yes
No
Not sure
Does your center use the EHR or other health IT system to provide patients with electronic summaries of office visits or other clinical information when requested?
Yes
No
Not sure
How do you collect data for UDS clinical reporting (Tables 6B and 7)?
We use the EHR to extract automated reports
We use the EHR but only to access individual patient charts
We use the EHR in combination with another data analytic system
We do not use the EHR
Are your eligible providers participating in the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program commonly known as “Meaningful Use”?
Yes, all eligible providers at all sites are participating
Yes, some eligible providers at some sites are participating
No, our eligible providers are not yet participating
No, because our providers are not eligible
Not sure
If yes (a or b), at what stage of Meaningful Use is the majority (more than half) of your participating providers (i.e., what is the stage for which they most recently received incentive payments)?
Adoption, Implementation, or Upgrade (AIU)
Stage 1
Stage 2
Stage 3
Not sure
If no (c only), are your eligible providers planning to participate?
Yes, over the next 3 months
Yes, over the next 6 months
Yes, over the next 12 months or longer
No, they are not planning to participate
Does your center use health IT to coordinate or to provide enabling services such as outreach, language translation, transportation, case management, or other similar services?
Yes
No
If yes, then specify the type(s) of service: ____________
Has your health center received or retained patient centered medical home recognition or certification for one or more sites during the measurement year?
Yes
No
If yes (a), which third party organization(s) granted recognition or certification status? (Can identify more than one.)
National Committee for Quality Assurance (NCQA)
The Joint Commission (TJC)
Accreditation Association for Ambulatory Health Care (AAAHC)
State Based Initiative
Private Payer Initiative
Other Recognition Body (Specify ________________)
Has your health center received accreditation?
Yes
No
If yes (a), which third party organization granted accreditation?
The Joint Commission (TJC)
Accreditation Association for Ambulatory Health Care (AAAHC)
Medication-Assisted Treatment (MAT)
How many physicians, on-site or with whom the health center has contracts, have obtained a Drug Addiction Treatment Act of 2000 (DATA) waiver to treat opioid use disorder with medications that have been specifically approved by the FDA for that indication?
How many patients received medication-assisted treatment for opioid use disorder from a physician with a DATA waiver working on behalf of the health center?
Are you using telehealth?
Yes
No
If yes (a), how are you using telehealth? (Choose all that apply)
Provide primary care services
Provide specialty care services
Provide mental health services
Manage patients with chronic conditions
Other (Please specify: ________________)
If no (b), please explain why you are not using telehealth: __________________________
2016 Draft UDS Tables
OMB Number: 0915-0193, Expiration Date: 02/28/2018
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ngai, Heather |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |