ExRad eCQM: Why Translation Software is Needed

The world of radiology is constantly evolving, and with it come new measures and standards to ensure patient safety and high-quality diagnostic imaging. One such measure that has recently been implemented by CMS is the CMS1074 Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults eCQM, otherwise known as ExRad. This measure will be reported to the inpatient (IQR), outpatient (OQR), and ambulatory (QPP) programs. In this post, we review the need for translation software to calculate this measure for any program.

Understanding the Electronic Systems of Radiology

In the previous century, imaging devices and storage systems were not interoperable, making it difficult to share and access images. However, the development of the Digital Imaging and Communications in Medicine (DICOM) language in the early 1990s revolutionized the field. DICOM enabled the digitization of images, making them accessible on any computer or system via teleradiology. This eliminated the need for physical films and allowed for seamless sharing and storage of radiological images. Today, this is called the DICOM language.

The DICOM is used and understood by these other radiology systems:

1. PACS (Picture Archiving and Communication System): provides storage and access to radiological images such as CT scans, MRI scans, ultrasound scans, and X-rays. 
2. RIS (Radiology Information System): where procedures are scheduled, patient information is stored, and exams are logged.

The Language Barrier

While PACS and RIS systems communicate using the DICOM language, your EHR utilizes the Health Level Seven International^® (HL7) language. HL7 is a set of clinical standards and messaging formats that facilitate the exchange of electronic information across different healthcare systems. This language barrier poses a challenge because the two systems need to communicate to calculate for the ExRad eCQM.

Just as a language interpreter facilitates communication between two individuals who speak different languages, there is a need for an interpreter in the world of radiology. The ExRad eCQM requires a translation software, which can understand both DICOM and HL7 languages. The software bridges the gap and facilitates seamless communication between the PACS/RIS systems and the EHR.

Functionality of Alara Imaging’s Translation Software in ExRad eCQM Reporting

The measure steward for the ExRad eCQM is Alara Imaging. They have developed software that acts as a translator, converting DICOM information into a format that can be accessed and utilized for eCQM reporting. This software plays a crucial role in getting the data elements required to compute the measure.

The translation occurs before the measure calculation. It pulls the relevant radiology and EHR data and creates data elements that can be used by the eCQM.

This eCQM uses string texts to identify the procedure, rather than the codes typically used in eCQM reporting. The translation software will enable access to primary data elements stored within radiology data systems and translate them into a usable format for eCQMs.

The Alara Gateway resides inside a hospital’s firewall and connects to the required data sources, including the EHR, PACS, and RIS, where it calculates data elements in three areas:

1. CT Category: Only certain CT categories are eligible for the ExRad eCQM. The software assigns the CT to a CT category based on the reason for the scan. Each CT category has a different allowable dose and noise value (below).
2. Size-Adjusted Dose: Ideally, your hospital provides only the radiation dose necessary for the patient based on the CT category (above) and the patient’s size. The software will calculate the patient’s size using the effective diameter from the images. Using this information, the software will calculate the size-adjusted radiation dose. 
3. Image Noise (Quality): The current safety gap is focused on radiation dose, not image quality. However, as a balancing measure, this eCQM wants to ensure there is a minimum floor for image quality so that it doesn’t become a problem in the future. The software will calculate the image noise value.

Once you have those translated values, you will have what your eCQM vendor (like Medisolv 😊) needs to calculate the performance rate. You will need to store these variables somewhere in your EHR system to be picked up as a data element. The eCQM compares the size-adjusted dose and image noise to the CT category-specific thresholds. CT scans that exceed allowable values for size-adjusted dose or image noise are considered out of range. The measure score for each reporting entity (physician, physician group, or hospital) is the proportion of out-of-range exams.

As radiology enters a new era with the first eCQM and CMS reporting, it is essential to understand the components involved and the challenges posed by the language barrier between DICOM and HL7. With the help of innovative software solutions, the seamless integration of these systems becomes possible, ensuring accurate reporting for these CMS measures.

Also read: How to Implement the Inpatient ExRad eCQM