Identifying Event Times

The CMS logic used by eCQM measures requires that some events occur before, during, or after other events. Prime Suite Reporting uses a process for stamping an event time on clinical events to help determine when events occur. The following information describes how different clinical events are stamped with a date and time.

Allergies: Note the following about allergies:

For allergies documented on the Allergy List on the Facesheet, the Onset Date is used as the start date. The Onset Date should be entered using the mm/dd/yyyy format. Allergies documented on this list will not have an end date.
For allergies documented in the Problem List, the Onset Date is used as the start date. The Onset Date should be entered using the mm/dd/yyyy format. If an allergy is resolved, the Resolved Date is used as the end date. If an allergy is inactivated, the date the allergy is marked as inactive is used as the end date. If an allergy is inactivated more than once, the most recent date the allergy is marked as inactive is used as the end date. Neither the inactive or resolved date for an allergy can occur before the allergy's onset date.

Assessment Performed:

Results/Flowsheets: The Result Date for the entry in the Flowsheet is used.
Social History (SHx): The Screening Date entered in Social History (SHx) is used.

End of the Measurement Period:

eCQMs: Except for the Medicaid Promoting Interoperability program, eCQMs use the 12-month calendar year, and December 31 is used as the end of the measurement period. The Medicaid Promoting Interoperability program requires eCQMs to be reported for a minimum of 90 consecutive days for the 2020 reporting year. The Prime Suite Reporting 2020 dashboard includes filters that allow you to set a start date and an end date for your eCQM's measurement period. The end date set in the filters will be used as the end date of the measurement period.

If you choose to report for less than the 12-month calendar year for Medicaid Promoting Interoperability, the dates you select can affect your measure results. For example, CMS 147 Preventative Care and Screening: Influenza Immunization requires patients to receive an influenza immunization vaccination during the Immunization Period to qualify for the numerator. If your selected measurement period does not include the Immunization Period, no patients would qualify for the numerator.

Medicaid Promoting Interoperability and Merit-Based Incentive Payment System: The Prime Suite Reporting 2020 dashboard includes filters that allow you to set a start date and an end date for your measurement period. The end date set in the filters will be used as the end of the measurement period.

Frailty Device (Device, Applied): Applied frailty devices include both a start date and end date.

Start Date: The Onset Date field from the Frailty widget is used as the date that the device starts. The Onset Date should be entered using the mm/dd/yyyy format.
End Date: If a frailty device is no longer active, it should be marked as resolved and a resolved date should be entered in the Date Resolved field using the mm/dd/yyyy format. The Date Resolved is used as the date that the device ends. Note that the Date Resolved must occur on or after the start date.

Frailty Symptom: Frailty symptoms include both a start date and end date.

Start Date: The Onset Date field from the Frailty widget is used as the date that the symptom starts. The Onset Date should be entered using the mm/dd/yyyy format.
End Date: If a symptom is no longer active, it should be marked as resolved and a resolved date should be entered in the Date Resolved field using the mm/dd/yyyy format. The Date Resolved is used as the date that the symptom ends. Note that the Date Resolved must occur on or after the start date.

Immunization Grid: The date and time entered in the Date Administered field is used.
Immunization Not Given: The date and time entered in the Date Refused/Deferred field is used.
Intervention

Performed: The value in the Collected Date field from the Edit Results window is used for both the beginning and the end of the intervention.
Ordered: The date the record is created in the Plan or Results section of a Note is used for ordered interventions. When a result is entered on an ordered intervention, it becomes a performed intervention.

Labs: For labs, the date and time that the provider created the lab documentation is used.
Medications: Note the following about medications:

For ordered medications, the date and time the prescription was entered into Prime Suite are used as the create date and time.
Medications on the Medication List are considered active if they had an active status during the time period considered by a measure’s criteria. The medication’s Effective Date is used as the beginning of the prescription and the estimated completion date (the prescription’s duration multiplied by its number of refills plus 1) is used as the end of the prescription. If a reported medication doesn’t include a start date, the date it was entered into Prime Suite is used.
If a medication is discontinued (except if discontinued due to data entry error), the date it was discontinued is used as its end date.

Orders: Depending on the type of order, either the day that the order is scheduled to start (documented in the Date Ordered field in Orders Tracking History) or the day that the clinician documented the order is used.
Patient Problems: Patient problems include both a start date and end date. If the patient problem does not have a valid start date and end date, the patient problem will not be used for measure calculations.

Start Date: The Date Onset field from Past Medical History is used as the date that the problem starts. If there is not a value in Date Onset and there is a resolved date in the Problem List, that date will be used as the start and end date, with a default time of 12:00 am. If the problem has not been entered in the Problem List, the date and time that the problem was documented in Past Medical History is used.
End Date: If a problem is no longer active, it should be marked as resolved in the Problem List and a Resolved Date should be entered in the mm/dd/yyyyy format. Note that the Resolved Date must occur on or after the start date. If a time is entered, it will be used. Otherwise, a default time of 12:00 am is used.

Past Medical History (PMHx) Diagnoses: Note the following about PMHx diagnoses:

For PMHx diagnoses documented in the Past Medical History on the Facesheet, the Onset Date is used as the start date. Diagnoses documented on this list will not have an end date.
For PMHx diagnoses documented in the Problem List, the onset date is used as the start date. If a diagnosis is resolved, the Resolved Date is used as the end date. If a diagnosis is inactivated, the date the diagnosis is marked as inactive is used as the end date. If a diagnosis is inactivated more than once, the most recent date the diagnosis is marked as inactive is used as the end date. Neither the inactive or resolved date for a diagnosis can occur before the diagnosis's onset date.

Procedures:

For CPT and HCPCS codes documented in the Plan section of a Note, the date and time that the procedure's status was changed to Returned or Reviewed is used.
For SNOMED codes documented in the Results or Flowsheets, the Result Date/Time is used, which is the date and time that the procedure was performed.
For procedures that can be documented in Past Surgical History (PSHx), the Surgery Date/Time is used.

Visit Start Time: The date and time entered into the From Date/Time field under Visit Details: Check-In is used as the visit’s start.
Visit End Time: The date and time in the Through Date/Time field under Visit Details: Check-In is used as the visit’s end. If a visit is not checked out by the end of the day on which it was checked in, the default appointment time in Prime Suite will be used to determine the visit end time. For example, if an appointment starts at 3:30 pm and the default visit length is 30 minutes, 4:00 pm will be used as the visit end time if no checkout time is documented.

Ensure that patients are checked out at the end of their visits.

Vitals: The date and time that the vitals are entered into Prime Suite are used.

Amending Signed Notes

As a best practice, Notes should not be signed until they are finalized. Amending a signed Note (by making changes to it in Prime Suite and then re-saving it) will change a patient’s qualification for the regulatory reporting measures. Re-signing the amended Note may allow the patient to qualify again, but only if it is re-signed during the time period required by the measure.

For example:

If a patient qualifies for the denominator criteria based on documentation made in a signed Note, and then the Note is changed and saved (but not signed), the patient will no longer qualify for the denominator.

Signing the amended Note may allow the patient to qualify for the denominator again, but only if the Note is signed during the time period required by the measure: if the denominator criteria must be met during the measurement period, the Note must be amended and re-signed during the measurement period. If the Note is amended and re-signed after the measurement period ends, the patient cannot qualify.

Remember that the different sections of criteria are connected to each other: In order to qualify for the numerator, a patient must meet the denominator criteria. If amending a Note causes the patient to no longer qualify for the denominator, they will also stop qualifying for the numerator.