FAQ Directory: HEDIS

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10.15.2017 ECDS What is ECDS?

Electronic Clinical Data Systems (ECDS) are a network of databases containing plan members’ personal health information and records of their experiences with the health care system. ECDS may also support other care-related activities, directly or indirectly, through various interfaces that include evidence-based decision support, quality management and outcome reporting.

HEDIS 2018

10.15.2017 ECDS Will ECDS measures be used for Health Plan Accreditation or ratings?

ECDS measures are currently not approved for public reporting by NCQA, and are not eligible for use in HPA or health plan ratings. All measures must be approved for public reporting by the Committee on Performance Measurement (CPM) before they can be considered for inclusion in an NCQA program.

HEDIS 2018

10.15.2017 Children With Chronic Conditions When assessing Prescreen Status Code criteria, does the visit code and diagnosis code have to be on the same claim?

Yes; because the Prescreen Status Code criteria requires a code to be in conjunction with another code, the codes must be on the same claim (claims on the same date of service cannot be combined to meet criteria).

HEDIS 2018

10.15.2017 ECDS Is the “care team accessibility” requirement fulfilled if a member’s health record is available online and the provider can access it with the member present or with the member’s consent?

Yes. If a member’s record is available on request to any member of the care team, the requirement is met.

HEDIS 2018

10.15.2017 ECDS Who determines that data “qualify” for ECDS reporting?

Refer to the ECDS general guidelines for information. Request clarification through the NCQA Policy Clarification Support (PCS) system at https://my.ncqa.org or review the proposed systems with your NCQA-Certified auditor. Send requests for individual technical support with ECDS reporting to ecds@ncqa.org.

HEDIS 2018

10.15.2017 ECDS How do EHR vendors submit data and to whom does the submission file go?

10.15.2017 ECDS Clarify “data must be accessible by the health care team at point of care.”

To qualify for HEDIS ECDS reporting, practitioners/practitioner groups that are accountable for clinical services provided to members must be able to access all ECDS data used by a health plan for quality measure reporting.Qualifying modes of access may be as simple as a provider’s phone request for member information, or as sophisticated as an integrated decision support system.

HEDIS 2018

10.15.2017 ECDS If the same data source is used as ECDS and as supplemental data, are health plans required to submit separate Roadmaps/documentation?

Plans should work with their NCQA-Certified auditor to accurately identify all data sources being considered for HEDIS reporting, whether the source is used for ECDS measures or for other HEDIS domain measures. If a plan completed an Audit Roadmap (Section 5) and will use the data source for both supplemental data and ECDS, this should be noted.

HEDIS 2018

10.15.2017 ECDS May we use depression screening performed by case managers who are employees of a health plan and are not part of an external provider group directly serving the member?

Yes. Data collected by care/case managers employed by a health plan are appropriate, and are reported in the Case Management category in the measure report.

Care/case managers are considered part of the member’s care team because they help members manage a condition and/or their use of health care services.

HEDIS 2018

10.15.2017 Use of Opioids at High Dosage and Use of Opioids From Multiple Providers Step 2 of the UOD and UOP eligible population states to exclude “members who had only a single opioid medication (Opioid Medications List) dispensing event.” Does a member who had multiple prescriptions (for the same or different medications) on the same date of service (with no prescriptions on other dates of service during the measurement year) meet criteria for exclusion?

Yes. The intent is to exclude members who were dispensed opioids on only one date of service during the measurement year. If the member had multiple prescriptions (for the same or different medication) on one date of service and had no opioid prescriptions on another date of service during the measurement year, the member is excluded.

HEDIS 2018

10.15.2017 ECDS How do vendors get the ECDS technical specifications for the submission file format?

HEDIS ECDS technical specifications are available in the NCQA store in PDF format: http://store.ncqa.org/index.php/catalog/product/view/id/2822/s/hedis-2018-volume-2-measures-for-electronic-clinical-data-systems/. They are also available in HEDIS 2018 Technical Specifications for Health Plans, which can be purchased at the NCQA store.

Complete digital measure packages for HEDIS ECDS measures will be available for download at a future date.

HEDIS 2018

10.15.2017 ECDS If case management data are used only by behavioral health-care providers (not by primary care providers), may these data be an ECDS data source?

Case management data may be used for measures using the ECDS reporting method if the information collected by case managers is available on request to all providers treating the same member in another setting. 
Data are not required to be accessed to qualify for ECDS reporting, but must be available on request to providers providing care to the member.

HEDIS 2018