Balancing value and burden: the Centers for Medicare & Medicaid Services electronic Clinical Quality Measure (eCQM) Strategy Project.

Healthcare is undergoing a digital transformation, and the Centers for Medicare & Medicaid Services (CMS) aims to help providers navigate the clinical quality improvement landscape. In December 2017, CMS launched the Electronic Clinical Quality Measure (eCQM) Strategy Project. This article consists of 2 parts. The first part describes stakeholder outreach aimed to identify burdens and recommendations related to eCQM implementation and reporting. The second part describes how these burdens were addressed by CMS and how to engage in the digital transformation journey. Six themes emerged from the stakeholder feedback: Alignment, Value, Development Process, Implementation and Reporting Processes; EHR certification process; and Communication, Education, and Outreach. CMS and its partners addressed over 100 recommendations to improve the eCQM development, implementation, and reporting experience by creating implementation strategies. This included the development of new tools, such as the Measure Collaboration (MC) Workspace and ongoing testing of Fast Healthcare Interoperability Resources (FHIR)-based standards for quality measurement. CMS is sharing this summary of the eCQM Strategy Project to reflect CMS' interest in stakeholder engagement and burden reduction, increase awareness of available resources, and encourage continued engagement throughout this digital transformation in quality reporting.

Mind the Gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation.

OBJECTIVE: Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. MATERIALS AND METHODS: Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders' perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. RESULTS: We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. DISCUSSION: Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. CONCLUSION: Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation.

Evidence that bears are induced ovulators.

The objective of this study was to determine if black bears are induced ovulators. We conducted a single experiment with two replicates; each replicate was divided into two arms: females exposed to male bears and females without male exposure. We used laparoscopy to examine ovaries for corpora lutea and measured serum progesterone concentrations. Six of the seven isolated females failed to ovulate, while seven of the eight females exposed to males produced one to four corpora lutea. Furthermore, isolated females had significantly lower progesterone concentrations than females exposed to males. Thus, our data suggest that the American black bear is an induced ovulator. These results may aid biologists in their efforts to reproduce ursids in controlled environments.

Long-range oxidative damage in duplex DNA: the effect of bulged G in a G-C tract and tandem G/A mispairs.

Two series of duplex DNA oligomers were prepared having an anthraquinone derivative (AQ) covalently linked at a 5'-terminus. Irradiation of the AQ at 350 nm leads to injection of an electron hole (radical cation) into the DNA. The radical cation migrates through the DNA causing reaction primarily at G(n) sequences. In one series, GA tandem mispairs are inserted between GG steps to assess the effect of the mispair on the transport of the radical cation, reaction (damage) caused by the radical cation at the mispair, and repair of the resulting damage by formamidopyrimidine DNA glycosylase (Fpg). In the second series, a bulged guanine in a G3C2 sequence is interposed between the GG steps. These experiments reveal that neither G/A tandem mispairs nor bulged guanines are significant barriers to long-range charge migration in DNA. The radical cation does not cause reaction at guanines in the G/A tandem mispair. Reaction does occur at the bulged guanine, but it is repaired by Fpg.