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Hello and welcome everyone to another MMS Info Session. As you know, these sessions are offered under the CMS Measures Management System (MMS) contract which is led by Battelle. I'm Brenna Rabel and I oversee education and outreach on this project. Today’s session is going to be on the topic of CMS’ eCQM strategy and the updated Collaborative Measure Development Workspace or CMD Workspace. We’re joined today by a number of guest presenters from the eCQI strategy team, including representatives from the Centers for Medicare and Medicaid Services (CMS); Rose Almonte and Bridget Blake from MITRE and Edna Boone who coordinates the eCQI Resource Center on behalf of Battelle. So as you know by now, these Info Sessions are part of an ongoing effort to engage measure developers and other stakeholders in quality measurement topics. This is an effort that also includes a series of newsletters and bulletins, along with special announcement emails, public webinars and routine updates to the Measures Management System (MMS) website. A big change this year is that these sessions are being held bimonthly rather than monthly, but they’re still going to focus on a wide range of topics related to quality measure development. Before we jump into the presentation, I do just want to cover a couple of housekeeping items. The first is that today’s session is being recorded. Second, all participants will be muted during the call. We will have an opportunity for Q&A at the end of the call, during which the lines will be unmuted for questions. That said, if when we unmute the lines there’s a lot of background noise, we may end up just remuting everybody and asking you to submit questions via the chat feature in WebEx. We’ll provide instructions for doing so at that time. And then finally, the presentation slides from today’s session will be posted to the MMS website by the end of this week, and the recording of today’s presentation will be posted to the CMS YouTube page at a later date. So at this time I’m going to go ahead and advance the slide. I’m going to pass the ball over to Debbie Krauss from CMS to kick us off. Deb, I’m turning it over to you and don’t forget to unmute, thanks. So hi, everyone. Thanks for joining today, and my team and I are excited to present this work to you all. I'm going to give you a little bit of background on the eCQM strategy project, which helped to drive the updates to the electronic clinical quality improvement (eCQI) resource center or the eCQI Resource Center, and specifically as a result we developed the Measure Collaboration (MC) Workspace and so I want to tell you all about that, and then have a little bit of time for Q&A. Hopefully, by the end of this presentation you’ll be able to describe the resource center and how it can benefit those of you involved in implementation and reporting, data mapping of eCQMs, and be able to navigate through the resource center and then understand the Measure Collaboration (MC) Workspace and especially its new components or modules. Okay, so first I’m going to talk a little bit about the eCQM strategy project background. So our administrator, Seema Verma, a couple of years ago had heard from multiple stakeholders that reporting eCQMs is complex and very burdensome. I’m sure many of you have heard it and felt it throughout the years. We at CMS have certainly heard it all along in the journey when we started with eCQMs and our high tech over ten years ago. So things are still burdensome, and what we were asked to do was to reduce those burdens, and so we also wanted to have as a goal to increase the value of eCQM usage, and the value to the stakeholders reporting on it so that they could be able to use that data for internal quality improvement initiatives and patient outcomes improvements. We also wanted to increase stakeholder involvement in all of this work. We wanted to listen and hear from the stakeholders about their burdens, and then come up with recommendations on how to reduce the burdens. So in this project we specifically had three items in our scope. The first, we looked at the measure development process from the time the measure is proposed as a concept until the measure is ready for the MUC List or the measures under consideration (MUC) List. We also looked at electronic clinical quality implementation and reporting requirements for eCQMs from the time they are implemented and the data is captured in the EHRs by the various clinicians until the time it’s reported to CMS programs. And then we also looked at the tools that we use for the development and reporting of eCQMs. So we looked at the Bonnie and the MAT tool, and we looked at the Cypress certification tool. So we interviewed hundreds of stakeholders not only at their sites, at their places of work, but also at a couple of conferences, the CMS quality conference and the HIMSS conference. We had many interviews and face-to-face discussions. We sent representatives from MITRE, and sometimes CMS went to the sites to speak with the stakeholders, but we were certainly on all the calls together with the sites and heard firsthand the issues that the stakeholders described to us as being major burdens that they had to deal with. So with all of this information we organized it into five issues, five main areas of burden. You see them listed here. So there was alignment issues with reporting requirements being confusing and changing reported care settings. Also, eCQM specifications, value sets. There were multiple value sets that were confusing or duplicative or/and needed to be sort of cleaned up, and so the next area of burden is value. We heard from folks, “Why do we need eCQMs? It’s really a lot of work to just report.” So we wanted to make sure that people were able to use the data that they got from gathering eCQM results and performances; use them in dashboards for their internal QI initiatives and really be able to see the benefit of using that electronic data. There also needed to be increased value in the data element definitions, because it was very confusing for and took a lot of time for implementers and their vendors debating what was meant in the electronic specification and what was meant by each data element that was being requested, so we’ve been working on that area of burden. There was also issues related to development of eCQMs. Folks wanted to give us, give CMS feedback early in the process, early in the measure development cycle. They wanted clarification on data elements. They wanted to provide input on workflows that the measures would require, and they wanted us to hear early on what could work and what really didn’t work, what was not feasible with their workflow, what was not a reasonable data element to capture. So the whole development process of measures, they wanted to give us input frequently and early in the process. Another area of burden is the implementation and reporting processes of eCQMs. Folks wanted clear specifications tools and resources. They wanted data elements that were feasible to implement, and they wanted submissions to CMS to be more streamlined and efficient; thus, the request for us to implement using FHIR APIs and the FHIR standard. There was also an area of problem with attribution, so especially on the outpatient side that’s a problematic way to report and to assign attribution to physicians for care of the patient in certain eCQMs. So we’ve been working on trying to improve attribution guidelines and how we represent certain logic in eCQMs to improve attribution. The last two areas where there were concerns with burdens are the certification process, and we heard folks say that when they get certified —have their EHR certified—they want to make sure that should mean that that EHR can then report to CMS. So they wanted certification to include use of the CMS implementation guide for reporting, so ONC has actually proposed that in their latest NPRM, and that final rule should be coming out in the near future to support these certification requests by stakeholders. And then education and outreach and communication. You know, we always feel like we’re communicating things a lot, but it’s not enough, and also we need to really focus on more E&O to our stakeholders and also providing presentations and any guidance documents for using eCQMs, providing that in plain language. It’s very complex, but it’s really important that we try to speak in an understandable way when we’re talking about eCQMs and any guidance and support we can give stakeholders. As a result, we’ve involved stakeholders in reviewing these documents now before we publish them, so that’s also been very helpful as we’ve identified this burden issue and tried to come up with recommendations to reduce all these burdens. So as a result of this work and the issues that were identified, the MITRE team and myself came up with a number of recommendations, like well over a hundred recommendations, to reduce burdens in all these issues, all these areas. Over the past year, year and a half, the work of the addition of information to the resource center and the addition of the collaborative measure development workspace are a direct result of this project and the feedback that we received from stakeholders. So I’m very excited for our team to present this information to you, and I will turn it over to Edna. Thanks, Debbie. I believe that we have presented the resource center to this group in the past, but I’m assuming there may be some new members. So we’re going to do a little bit of an overview but try to focus on some of the new functions and features. So the eCQI Resource Center serves as the one-stop shop for the most current resources to support electronic clinical quality improvement. Okay, so as I was saying, this is the one-stop shop. In some cases the site serves as the source of truth for a particular piece of information, and in other cases it points to external resources or external sources of information. The goal is not to duplicate existing resources on the site, but to give users one place to be able to find all eCQI resources. So Martin I will grab the ball. Actually, yes, let’s hold here for a minute. So some of the resources that are available on this site are the eCQMs themselves. That includes the specifications, supporting materials, technical release notes (TRNs), et cetera. There is also a fair amount of information on eCQI standards, and that’s important because these standards, some of them are new. Some of them are unique to eCQM or to quality measurement, so we have a lot of information regarding the standards. And then general tools and education implementation resources, et cetera. And then Rose will do a presentation on the Measure Collaboration (MC) Workspace. Okay, Martin, now I will take the ball and provide a demonstration. So you're looking at the homepage of the site. The URL is: eCQI.healthit.gov The homepage provides news and events regarding eCQM, eCQI activities. Users are encouraged to submit news and events via the email that is found on the bottom of each page in the “contact us” section. There is also an advanced search feature so you can search on keywords. So by searching on “QDM, Quality Data Model,” if I search on that, the site will return all of the references to QDMs. The advanced search, the reason I’m showing this is that you can limit that return, so we had 389 returns. You might say, “Well, I’m only really interested in what CMS has to say about QDM, or I’m interested in just the beginner stuff. I’m not an advanced user.” This will automatically reduce the sort down to 81 items, so I just wanted to highlight that advanced search feature on this site. There is this “easy access” blue topic bar across the top of the website, which allows for navigations to the major topics, so we've got the eCQMs, also information about eCQMs and various resources that we’ll go over in a minute. Again, you can see this functionality. So if you’re looking for the eCQMs themselves, where are the measures located? You have two ways to get there. One is to go to the eligible professional (EP) or clinician (EC) page, or the eligible hospital (EH), critical access hospital (CAH) page, or you can also select the large boxes on the homepage. So when you select one of the pages, and I selected the eligible hospital (EH), the default will always be the current reporting year. So the information that is presented to you on the page is the current reporting year. You can use this dropdown to look at past years, or to look at measures that are in the queue for reporting on 2020. Again, the default is the current year. There is a list of these key eCQM materials, and these are to support implementation for that given year. You’ve got things such as the ZIP specifications, the files themselves, links to various value sets, technical release notes (TRNs), guides, implementation guides, et cetera. Again, most of these materials are updated each year based on that reporting cycle. At the bottom you see the actual measures for that given year. Something that’s changed is we have added this new total of eCQMs. It’s a little bit easier on the hospital side. There’s just 16 for 2019 reporting, but you know when you go to eligible professionals (EPs), sometimes you’re like how many are there that I can choose from? Again, you’ve got that marker here. You can sort the columns, you know, just by using these up and down arrows. They will sort them however you’d like. And then if you’re interested in seeing a measure, you can just click on the detailed page and you’ll see information that’s contained within the measure’s specification, so within the XML and HTML. Also on this page you will see the specifications for that individual measure, and a link to the Data Element Repository (DERep). So again, this is a new resource that Rose will be going over, but you see a direct linkage from the individual measure pages. On most pages or sections of the site you have this ability to receive updates on this topic. So if you’re interested in receiving updates on anything that changes within this hospital page or within these tables, you would click on this. If you’ve got an account, it’s going to ask you —I’m not logged in, and so it’s going to ask me to log in. If I don’t have a login, I can create a new account. Again, that will provide me with anytime there’s a change or an edit on that page, it will send me an email. You can do that on many of the pages, so I’m going to go back and look at again, an individual measure. This would be if I’m just interested in tracking any changes to this rehab measure, or any of the measures that you might be working on. You have that ability to do that and receive updates on that particular piece of content. The other item that’s new since I think the last time we talked is there are pre-rulemaking eCQMs, so these are measures that are developed, but the specifications aren't final. They have not been finalized for particular reporting years, but there might be opportunities for feedback in JIRA or through public comment periods, so that is also some information that was not available last time we met. A couple of the key features. One item is this eCQM annual timeline. Again, I got there from the drop-down menu. This particular resource is interactive, so it allows you to select by quarter what are some of the main milestones that are happening in the eCQM space, the measures themselves what’s happening, what’s happening in terms of reporting or final rules. So again, you can kind of click on this and get a sense of what’s happening on any given quarter. If you scroll down, you see all of the information available as well. These also will link out to the various resources. If you’ve got new staff that are working on measures or working in this space, this is a nice resource to get a flow of the kind of annual cycle that happens with the measures. Another item to point out under resources. If we go to eCQM tools, we’re presented with the eCQM tools resources and collaboration tool or InfoTRAC. So this provides a listing of all of the tools and resources that are used within the development, implementation, reporting cycles. There are also links to help and feedback mechanisms, so these go directly to the tools. There are both hover-overs and links to the tools that you might need. For those that might be more advanced users, the standards and tools versions provides for each year. Again, you’ve got the option to go back. What were the versions of the tools and the standards that were used for that reporting performance year? So if you’re helping to support anyone with their health IT or EHR, your vendor will normally want to know what version are these particular measures based on. You can use that for some troubleshooting. There’s also a list of a library which has again, all of the various tools and resources. There’s information on each one of those, the links out to them, what they are, and who they might be used by. I also want to point out the amount of information we have on standards, so the main standards that I pointed out earlier. So CQL, FHIR, HQMF, QDM, QRDA, and then some information on clinical decision support and eCQM harmonization. So the new resource that we’ve just recently posted is on FHIR. All of the standards are set up this way. There’s some information about it. There are some key tools and resources that you’ll use with that standard, any education on that standard, and then an opportunity to connect with the community that’s working on that standard. If you’ve heard about FHIR, you’ve probably noticed that there’s a lot more information about FHIR out there. This is focusing on the potential use of FHIR for quality measurement. So again, you can see information on that work. There are also some education pages, so we want to highlight those resources. The page is categorized into six subsections, so there is general eCQM and eCQI education, education on the tools. And then the key standards have their own education pages. There are new resources kind of continuously being added here, so we do recommend that you come back and take a look at these. And then lastly, there is a little bit of information on CDS. This really focuses on some of the work that’s being done by other federal agencies to make sure that CDS and the eCQMs are aligned from a technical standpoint, so any of the technical artifacts that you might use in CDS can be reused in eCQMs and vice versa. So this goes over a little bit of that work, as well as some information on standards being used. And then lastly, there is this opportunity to engage in eCQI. So this provides end users with a table of various opportunities. You can sort this by the type of user you are. If you are aware, these are groups that you can join or participate in, provide feedback, et cetera. So if there are public facing groups that you want us to add or any additional information that you’d like on the site, again use this “contact us” down below. We’re always looking for ways to improve the site to expand, you know, pertinent content to both clinicians and quality improvement specialists. So again, you would use the “contact us” down here, and there is the email on the “contact us” page. So with that I am going to turn it over I think to Bridget to talk a little bit more about what is coming next regarding the Measure Collaboration (MC) Workspace. Thanks, Edna. Yes, this is Bridget. Rose and I will share information on the measure collaboration or MC workspace. I’ll just wait for the slides to get queued up. There we are. Thank you so much. Yes, so as I mentioned, Rose and I and as Debbie shared, have been working on the Measure Collaboration (MC) Workspace team so we’ll give you some introductory information and then move into a demonstration. Next slide, please. So the Measure Collaboration Workspace, also known as the MC Workspace, was developed based on feedback from the CMS eCQM strategy project. You just heard a little bit about that. The workspace is hosted on the eCQI Resource Center, again the one-stop shop to access the most current eCQI resources. The Measure Collaboration (MC) Workspace has three major aspects. First, it brings together interconnected resources, tools, and processes to centralize information for those of you implementing eCQMs. So again, the goal is to have the information at your fingertips and make it easier to access from this collaboration workspace. Second, it provides clarity and transparency to help in data mapping. You’ll see some of that when Rose shows you some of the site. Third, it promotes improved interaction across stakeholder communities for getting involved earlier in the development and testing processes, which is something we heard from stakeholder feedback. And then also to share lessons learned across communities that develop, implement, and report eCQMs. So overall the MC Workspace is a collaborative portal that helps make it easier for quality and IT staff at hospital and provider organizations to implement and use eCQMs. So this diagram show the four modules that comprise the MC Workspace. Starting at the top and moving clockwise, eCQM concepts is the module that allows users to search existing measure inventories and submit new measure concepts for consideration. Next, the new eCQM clinical workflow module allows users to review sample clinical workflows associated with new eCQMs, and an opportunity to provide feedback on expected challenges. So through that module, users are able to both provide feedback and have a detailed look at those workflows. Next, we have eCQM test results. This will provide transparency into how eCQMs are tested and allow users to participate in testing activities. Again, here it’s meant to be interactive and allow users to download a template and submit their results so measure developers have that information as they move forward. The fourth module is the eCQM Data Element Repository (DERep). This module provides data definitions to aid in measure implementation and data mapping, again centralizing many of the resources that you might typically access from multiple sources. So in 2018, after the team gathered requirements and conducted focus groups, Debbie mentioned that. That resulted in the initial launch of the MC Workspace landing page and Data Element Repository (DERep) module, so those have been live since December 2018. The team continued to gather requirements this year, and the remaining modules will be available actually next week as part of our December 2019 release. So Rose will step you through some of what was just mentioned in more detail, and again it’s accessible via the eCQI Resource Center as well as the link shown here: eCQI.healthit.gov/mc-workspace So now I will turn it over to Rose. Thank you, Bridget, and I will share my screen. I will walk through the Measure Collaboration (MC) Workspace and hopefully share some tools that you’ll find helpful as you do your work. For the Measure Collaboration (MC) Workspace I’ll start here from the eCQI Resource Center to show you how there are multiple ways to access the tools. From the homepage you can click on this link to the eCQM Data Element Repository which is part of the MC Workspace, as well as under the eCQMs menu. There is a link to the Measure Collaboration (MC) Workspace and under resources as well, the Measure Collaboration (MC) Workspace. So I will click on that. As Bridget mentioned, there are three of our tools—eCQM concepts, new eCQM clinical workflow and eCQM test results. These three modules are in the final stages of testing. We anticipate the announcement of those next week. So I am in our dev environment, our development environment so I can give you an idea of how those look. But upon clicking that link for Measure Collaboration (MC) Workspace, you’re brought to this landing page, which includes the diagram that Bridget explained prior. And then across the top you’ll see tabs to access the different modules of the Measure Collaboration (MC) Workspace. Scrolling beneath the diagram is a brief description of each of the modules, a brief description of the workspace overall, and a description of each of the modules. As Bridget mentioned, currently the Data Element Repository (DERep) is in production so there is a link, an additional link to launch that Data Element Repository (DERep), an alternative launching site from the tabs that I showed at the top. I’ll go ahead and launch the Data Element Repository (DERep). And as Debbie mentioned, and I’ll do that from production since we are live with the Data Element Repository (DERep). As Debbie mentioned, this site was created in response to stakeholder feedback. The Data Element Repository (DERep) was one of the first sites that went live, because of the multiple sites who reported a request for more clear data definitions, tools to help in the data mapping activities that they perform at their various organizations. So this Data Element Repository (DERep) provides data definitions for currently the 2019 and 2020 performance and reporting period measures that are using in CMS quality reporting programs (QRPs). The tool centralizes information from multiple sources specified here from the measure specifications, the Quality Data Model (QDM) and the Value Set Authority Center (VSAC). So this Data Element Repository (DERep) includes information from those three sites and allows you to filter the information by eCQM data elements, unions, by eligible hospital (EH), critical access hospital (CAH) eCQMs, or eligible professional (EP)/eligible clinician (EC) eCQMs or QDM attributes and QDM categories and data types. I will use one of the filters and apply it for the 2019 eligible hospital (EH), critical access hospital (CAH) measures. It will display the 16 measures that are currently available for 2019 reporting. In clicking on 2020 to view 2020 measures, I see the eight measures that are available for reporting for next year, 2020. To give you an idea of the information that is displayed for a measure, I’ll go ahead and click on one of these measures. CMS 108, the venous thromboembolism prophylaxis (VTE-1) measure. For this measure as I mentioned, it’s centralizing information from multiple sources. This measure description is coming from the measure specification, and this listing of data elements as well as data element attributes, if those attributes are constrained to a value set, this list will include those items based on the measure specification. And then for each of those data elements, information is pulled from the Value Set Authority Center (VSAC) like this. Whether the item is a direct reference code, it will state that it’s a direct reference code and give you a link to the specific LOINC code that’s used by—for that data element in that measure. Of course, you need NLM access and Value Set Authority Center (VSAC) access to view that code, but these links will take you to the specific location in VSAC to view the code or codes that are used for that measure. For this particular element, it does use a value set. So in addition to the OID, it is providing the additional clinical focus data element scope, inclusion criteria and exclusion criteria that is stored in VSAC. In clicking on this OID, I’m brought to the respective expansion version for that particular year of measure and a display of all of the codes of that value set are also listed. Now I’ll go back to that—this measure listing. So in addition to the VSAC information there is the QDM information. So depending on that data element and which QDM data type is used, you’ll see a definition. You’ll see what that data type is and a definition for that data type. One last thing I wanted to point out on this measure page is that this measure title is actually a hyperlink, and as Edna presented earlier, there are measure pages available on the eCQI Resource Center. In clicking on the measure title, I’m brought to the eCQI Resource Center measure page that contains more detailed information for that measure, as well as its artifacts and any release notes pertaining to that measure. And finally I wanted to point out, though this is centralizing information from those multiple sources, this is not meant to replace those. So if you are looking for more detailed information for the measure specification or for that value set, or more context around the QDM data type, we encourage you to refer to those source documents for that additional information. So that is the data element repository. The additional modules that we are working on—eCQM concepts, new eCQM clinical workflow and eCQM test results—we’ve been spending most of this year gathering feedback on requirements to build out the first versions of these modules for deployment next week. The eCQM concepts module came out of feedback from those in the field who are interested in submitting measure ideas for consideration. We learned about the resource intensiveness of pulling together a measure that could be presented for CMS to consider, and they were requesting an easy way just to submit a quick idea that might align with CMS program priorities. So this tool will provide users an opportunity to submit an idea for an eCQM concept. At the bottom of this eCQM concepts page there are resources to these existing tools so that users can take a look and search through existing concepts to identify whether a similar concept is already in progress. Perhaps they can contact stewards for those measures. But if they don’t locate a measure concept that is in progress, they could propose that concept using this tool. One of the examples, as Debbie mentioned, we participated and gathered stakeholder feedback from various conferences and a hospital representative suggested that COPD was a big problem with their patient population. They were interested in performance improvement, quality improvement initiatives around COPD. So this would be an opportunity for them to click on “propose an eCQM concept,” and they would be brought to this form to provide just some basic information about their idea, a description rationale. They could collaborate with colleagues at their organization to complete this information. They would be able to submit that to CMS to see whether it aligns with program priorities. In addition these additional modules—new eCQM clinical workflow and eCQM test results—these modules will allow measure developers who have a measure that is in a phase where public comment can inform the specification of that measure, ideally with the goal to achieve a more clinically feasible measure where data element capture as well is more feasible. They could use this tool to create an entry that contains basic measure information on something they’re working on. Perhaps they have workflow or dataflow artifacts that could be published and stakeholders would then be able to log in and post comments in response to those workflows. Similarly, for eCQM test results a measure developer could submit an entry that contained some basic information about their measure under development, along with a spreadsheet of anticipated data elements to be captured as part of that measure. They could seek feedback from stakeholders on the feasibility of capturing those data elements. So as a stakeholder out in the field if I am interested in something like acute kidney injury (AKI) and have been tracking on getting notifications when something related to that is entered into the Measure Collaboration (MC) Workspace, I could access this record. I can download the template that was provided by the measure developer, complete it based on my organization’s EHR and my organization’s process, and I could upload that to this space where it would be visible to the measure developer for consideration as they continue the specification of that measure. So, and those submissions would not be visible to the public. The submissions would be visible just to the measure developer. As Bridget mentioned, the primary goal of this Measure Collaboration (MC) Workspace is for it to increase stakeholder engagement and to increase transparency and allow for stakeholders to get involved and share feedback earlier in the process to hopefully lead to more clinically feasible, less burdensome measures that are used in CMS programs. With that, I think we can go back to the slide deck, Martin? Great. So yes, this slide shows the high-level plan for development that we’ve been tracking on. As I mentioned, we’ve spent most of this year gathering feedback and developing the initial launch of the remaining modules for the Measure Collaboration (MC) Workspace. We hope to launch that next week. As Edna mentioned, we encourage you to share feedback. The goal is to continue to refine the tool to make it valuable in decreasing the burden associated with eCQM use and implementation. This is a link to the Measure Collaboration (MC) Workspace. We encourage you to access it, explore it and share feedback. In addition to the links that Edna shared, you can also email any questions, comments to this email address, and next slide. At this time if there are any questions that we can answer for you. Well, thank you so much guys. Yes, so at this time we have already gotten a few questions that have come through the chat function, but before we do those we’re just going to unmute the lines briefly. We ask again that folks mute themselves if they’re not planning on talking. If we get a lot of background noise, we will need to remute everyone and just limit questions to the Q&A feature in the textbox. So Martin, you can go ahead and unmute. Let’s give folks a couple of seconds in case you have a question you’d like to ask; otherwise, we’ll start with the ones on the phone. Okay, from the phone. “Can you go over how stakeholders are informed about measures that are under the clinical workflows in the MC Workspace? So, for example, are we advertising through other means? Only if they subscribe to updates on the page or other?” When those modules are deployed, there will be a subscription feature for folks to elect to receive notifications when new content is added to the site. Great, thank you very much. This question I think is probably for—is related to the earlier part of the conversation. “Who would you say are the main stakeholders that you spoke to in the development of the eCQM strategy recommendations?” So this is Debbie from CMS and I’ll start off. The stakeholders included clinicians, hospital and provider practice administrators, chief technology officers (CTOs). So there were a number of folks from the executive level suite of staff that took the time to speak with us. And then after the clinicians, there were folks from the IT side who are the historically known as the implementers who work with the systems and the clinicians. They gave us—and then they worked with the quality teams, and the quality teams were also some of the stakeholders, and they provided valuable feedback. Again, we did not limit this to the hospital side. We also looked at the ambulatory programs and the MIPS participants. I will ask Rose and/or Bridget, did I leave anybody out? I think you got them for the most part. Yes, I think you covered them. Oh, and EHR—we also spoke to EHR vendors at the various conferences, too. Thank you very much. We have another question on the line. “Is there a specific area where implemented measures can receive feedback from a provider’s user experience?” So this is Edna and the answer to that is yes. Throughout the site you will see linkages out to the ONC project tracking system or JIRA. So when you’re talking about the implementation of the measures, questions you have, the recommendations, et cetera, would go into JIRA. Thank you very much. Okay, with that, if there are no other questions we can just go to the last slide. I would just reiterate, the slides from today’s presentation will be posted to the MMS website by the end of this week. If you'd like them sooner, just shoot us an email at MMSsupport@battelle.org and we can send those out to you. In terms of the upcoming announcements, we do have our next MMS Info Session on February 12th from 2:00-3:00 pm EST. It's going to be co-presented by folks at Battelle and also Mathematica Policy Research on ways to make measures more person- centered, specifically related to applying human-centered design principles to measure development. So with that, we can depart for the day. If you have any questions that we weren't able to get to, feel free to email us and we will get those sent out to the appropriate respondents. Thank you, everyone.