Updating your Database
In preparation for CQM reporting, you will need to make adjustments to the following in OP.
LOINC: These are unique identifiers for diagnostic tests, including lab tests, x-rays, ultrasounds, and other procedures. Some specific surveys, like the Edinburgh Postpartum Depression Screen, also are considered diagnostics in this sense and have a specific LOINC code. Most practices were using made-up LOINC codes for in-house tests, like rapid strep EIA tests (“XSTREP” was commonly used) and urine pregnancy tests (“XHCG” and “XPREG”). For send-out tests like urine chlamydia/gonococcal testing, most practices were using a made-up code or possibly the proprietary test ID from Quest or LabCorp’s order book. Getting the proper LOINC diagnostic test codes is important especially for the pharyngitis and chlamydia screening CQMs, but also for depression screening.
Taxonomy codes: These are used to label the specialists to whom you refer patients in a standard way since OP allows you to create shortcut names for specialties that are not standard. For example, your practice might label a specialty DIETICIAN, R.D., NUTRITION, REGISTERED DIETICIAN, METABOLIC CLINIC, or some other specialty name. You can assign the taxonomy code for Registered Dietitian (133V00000X) to your specialty name. OP may not know that a referral to St. Mary's Obesity Clinic meets the metric for obesity follow-up, but it does know that a referral to 133V00000X (Registered Dietitian) does.
Because checking and updating all your codes, for LOINC and Taxonomy, would be very time-consuming when trying to meet the Meaningful Use deadline, it is reasonable to only update the codes that are applicable to your eCQM submissions. For example, LOINC codes for blood tests like CBCs or CMPs are not relevant to any of the 2019 CQMs.
Why is the use of the standard codes so important?
Cleaner and more precise. For example, to report a rapid strep test using the EIA method, OP must find this in your Diagnostics table. One possibility would be to look for every test that starts with Strep. This would include Streptozyme and Strep culture, neither of which are rapid strep tests, and it would exclude Rapid strep and Quick strep, which might be legitimate labels for the strep test. If we know that all practices have labeled their rapid strep tests as LOINC CODE 6557-3 OP knows exactly what to look for, and it’s uniform across all OP practices.
Required for using an external Meaningful Use vendor. In order for DHIT to understand the files we send, we must use a standard nomenclature. This is no different than requiring a practice to bill 99213 (a standard CPT code), rather than letting each practice bill something unique like a mid-level sick visit.
You must complete Step 1 before proceeding to Step 2. The LOINC codes entered in Step 1 will be used to update prior diagnostic tests in Step 2.
Note: Click here for a list of common LOINC codes.
Step 1: Update Diagnostic Tests LOINC Codes
- Navigate to Clinical tab > More button (Customize group) > Diagnostic Tests.
- Click on the Test Name Definitions tab.
- Click on the In House line to expand the list of in house tests.
- Click the Edit button on a test to add the LOINC code.
- Type the code in the LOINC field.
Note: Ignore the instructions that say no hyphen. The LOINC code must be entered exactly, including the hyphen.
- Click the OK button.
- Repeat the above steps to update the LOINC for additional Diagnostic Tests.
Step 2: Update Diagnostic Tests LOINC Codes for Prior Records
- Navigate to Admin tab > Synchronize LOINC Codes button.
- Click the Rename LOINC Codes in the Test Result Table tab.
- Click the Activate button.
- Select the diagnostic test to update in the panel on the left, the panel on the right will fill in 1. Point to a name in the grid.
- Proceed to 2. Choose a LOINC code and confirm the radio button is selected for In House Test Name Database.
- Click into the field below and begin typing the name of the test and select from the list. You may also click the drop-down and select from the list.
- Click the Update button.
- A confirmation window displays, click Yes to continue.
- Once the update is complete, click the OK button.
Survey LOINC Code Update
- Navigate to Clinical tab > More button (Customize group) > Surveys.
- The Survey Forms Explorer window opens, highlight the survey to add/edit a LOINC code.
- Click the Edit button.
- Click into the Equiv LOINC: field and enter the LOINC code.
- Click the Save button.
Risk Assessment LOINC Code Update
You may only update the LOINC codes for Risk Questions that the practice has added to the Risk Assessments Editor.
- Navigate to Clinical tab > More button (Customize group) > Risk Assessments.
- The Risk Assessment Editor opens, highlight the Risk Question to add/edit a LOINC code.
- Click the drop-down arrow for DX Code Type and select LOINC.
- Click into the DX Code field and enter the LOINC code.
- Click the Savebutton.
Assigning Taxonomy Code to Referral Specialists
- Update Address Book Specialties Taxonomy Code using the steps below.
- Navigate to Practice Management tab > More button (Customize group) > Address Book Specialties.
- Highlight the Specialty Name and click into the Taxonomy field.
- Click the drop-down arrow and select the specialty from the list.
- Click the Save button.
- Repeat the above steps for all blank Specialty Names.
- Confirm the referral specialist are assigned to a specialty using the steps below.
- Click here to copy the SQL Query that will be used to located referrals written with a blank specialty.
- Once the SQL is run, confirm there is a specialty listed in the Category field.
- For any lines where the Category is blank, follow the below steps to add the specialist to a Specialty.
- Navigate to Clinical tab or Practice Management tab > Address Book.
- Click into the Search for field and search for a specialist.
- Highlight and click the Edit button.
- Click the Specialties tab.
- Click the drop-down arrow in the Specialty field and select from the list.
- Click the Save button.
Note: For detail information on adding to the Address Book, click here.