E-QUAL Network FAQ

Emergency Quality Network (E-QUAL) is a collaborative-driven, practice change network tailored to the unique environment of emergency medicine. It is designed to achieve higher quality patient outcomes at lower cost by creating and accumulating meaningful tools targeted at emergency clinicians and quality improvement leaders to advance local quality improvement efforts focused on high-impact areas that demonstrate the value of emergency care.

EDs participate in a virtual learning community by joining a learning collaborative offered annually focusing on a single clinical topic. Each learning collaborative has up to a 9-month learning period in which the ED champion interacts with the E-QUAL virtual portal to report on local quality improvement activities. Activities include completing the online portal activities, engaging eligible providers in the QI local project, utilizing the educational toolkits, webinars, podcasts, and submit benchmarking data.

To engage emergency clinicians and leverage emergency departments to improve clinical outcomes, coordination of care and to reduce costs.

• Earn Improvement Activity Credit for the CMS MIPS program
• Receive benchmarking data in real time
• Feature QI efforts to hospital leaders and payers
• Gain access to toolkits including best practices, sample guidelines and key talking points
• Access to high-quality eCME
• Earn ABEM MOC Credit (LLSA and Part IV Activities)
• Visibility through the E-QUAL Honor Roll

The Clinical Emergency Data Registry (CEDR) is a CMS Qualified Clinical Data Registry (QCDR) designed to accept data from practicing emergency clinicians in order to:

• Provide a unified method for ACEP members to collect and submit quality data
• Meet Physician Quality Reporting System (PQRS) reporting requirements
• Earn MOC, Ongoing Professional Practice Evaluation (OPPE) credit
• Promote the highest quality of emergency care for our patients
• Demonstrate the value of emergency care
• Facilitate appropriate emergency care research

Visit www.acep.org/cedr for more information

No. Participation in CEDR is not a requirement to enroll/participate in the learning collaboratives. However, participating in CEDR can eliminate manual data entry and ensure maximal points in the MIPS program.

 Visit www.acep.org/cedr for more information.

No. E-QUAL metrics are intended for benchmarking and local quality improvement. Actual scores are not reported to CMS.  

Visit the E-QUAL homepage and click on the green ‘E-QUAL Initiatives Portal’ button to begin the enrollment process. For questions on how to enroll contact equal@acep.org and a team member will be in touch within 72 business hours.

E-QUAL will offer learning collaboratives on a single clinical topic once a year to maximize participation and to align our offerings with CMS programs, ACEP & ABEM offerings.

Once the enrollment form is completed, Champions of the participating site(s) will receive an e-mail invite from “Customer Service” to activate their E-QUAL portal account. Each ED site will need to be activated separately. For details on how to navigate the E-QUAL portal, please reference the E-QUAL Portal Access Guide.

Each participating site is required to have at least one Champion (no more than three) who will be responsible for completing that site's E-QUAL portal activities.

All webinars are pre-recorded and posted on the E-QUAL website. Please visit the collaborative homepages for additional information.

Sepsis | Opioid | Stroke

E-QUAL eCME are accessed from each collaborative homepage:

Sepsis | Opioid | Stroke

After clicking an eCME link, you will be asked to sign in with your ACEP ID & Password. If you have not created a free account, please do so here. Once logged in, click the "Launch" button and follow the succeeding prompts to begin your selected eCME.

This depends on how you report to CMS. If your site reports as a group (often the preferred and easiest method for emergency clinicians), then all clinicians that charge Medicare (Part B) under the same Tax Identification Number (TIN) should be included in your group number.

E-QUAL only submits an aggregate of site-specific data to CMS. Since participation in E-QUAL is aligned with the Improvement Activity (IA) category for MIPS, CMS will base reimbursement only upon participation. Please note that the quality category is based on actual quality measure scores, and participation in ACEP's CEDR can support your quality reporting needs.

Completing one of the E-QUAL Learning Collaboratives will meet the CMS IA credit requirement for MIPS. E-QUAL participation does not meet any Quality category requirements. To be eligible for any type of bonus, participation in the Quality category and full participation in Improvement Activity is likely required. For more information, visit the QPP website https://qpp.cms.gov/login

While the CMS MIPS program has a 90-day requirement per IA, no IA-specific time requirement exists for each E-QUAL learning collaborative. As the total length of each E-QUAL's learning collaborative exceeds the 90-day requirement, participation is considered sufficient to fully meet all approved IA requirements.

At the end of the learning collaborative, each participating ED site will receive Certificate of Completion for use as evidence for any audit/attestation of the IAs completed by that site and the ECs/NPIs submitted to E-QUAL as working at that site. Current CMS guidance regarding IA reporting is available on the QPP website. Keep up-to-date with the latest QPP information by subscribing to the QPP listserv. Visit the QPP website, scroll to the bottom of the page and click "Subscribe to Updates".

No. Each provider that is interested in eCME credit will need to review the webinar and take the post quiz. Note that eCME credit is different from IA credit.

Please refer to the linked IA Cross Maps for each collaborative:

Sepsis | Opioid | Stroke

No. Participation in E-QUAL is independent of ACEP membership.

No. E-QUAL is FREE!

Yes. The E-QUAL team will review all data including uploads that are submitted through the E-QUAL portal. The E-QUAL team will be in contact with the champion if there are any questions or if an uploaded document is incorrect.

A site can unenroll from an E-QUAL collaborative at any time without incurring penalties or inhibiting participation in other E-QUAL Waves or IA activities.

No, we do not have a non-disclosure agreement. However, as stated in our Participation Agreement (available in Activity 1 "Kick-Off"), E-QUAL does not collect data with PHI. All analyses and publications are done with aggregated, de-identified data.

ACEP does not have an official definition. Your site will apply the definition associated with the method used for data submission in the Benchmarking activities.

Sites using the SEP-1 method will adhere to the CMS definition.
Sites using the CEDR metric or Quick Chart Review method will adhere to the ACEP CEDR Quality Improvement definition. The ICD-10 diagnostic coding logic for these methods can be downloaded in within the benchmark activity.

The definition used for the E-QUAL Quick Chart Review option mirrors the definition used for the CEDR sepsis measure denominators. To avoid the capture of cases without sepsis, we recommend you limit your query to cases in which the ED clinical impression (not the inpatient discharge diagnosis) maps to the provided code list. Also, please note that in order to ensure better capture of septic shock and severe sepsis while minimizing capture of general sepsis, the denominator logic should include important Boolean logic:

• Septic Shock diagnostic code, OR
• Combination of an Infection AND Hypotension (low blood pressure) diagnostic codes.

Please see the linked data submission guide for Wave IV: Guide (PDF).

Yes. You may also go back up to 6 months in order to meet the case minimum.

Either is accepted by E-QUAL. You should identify cases based on data available to your site.

Yes. This information is found on the bottom of the 1st page of your site-specific SEP-1 report in the sepsis component compliance table. It should be noted that these recommendations are only conditional.

The E-QUAL Sepsis Initiative and Toolkit supports using best practices for these patients. Currently, to improve comparability of benchmarking reports, we are asking all sites to only use the codes provided in our Data Submission Guide. At this time, severe sepsis code R65.20 is not included in the E-QUAL Sepsis Initiative.

Transfer outs are not excluded as the Sepsis Initiative seeks to improve initial identification and sepsis care including initial lactate testing, IV fluids, and antibiotics.

As this is not likely reflecting a care pattern that is using an alternative to opioid, as opposed to adjunctive treatment with an opioid, we consider concurrent administration of an opioid with a non-opioid as not occurring “prior to opioid therapy.” In this case the visit should be considered as “No”.

Select the first or primary opioid given:

• If only two opioids are given, then select first.
• If more than two doses of opioids are given, select the opioid given the most number of times.

Still indicate that a benzodiazepine was administered. Concurrent alcohol and opioid abuse is common. And while BDZ therapy may be indicated for treatment of alcohol withdrawal, such patients may be at higher risk of poor outcomes and should be tracked for quality improvement. Benzodiazepine and opioid co-prescribing increases risk of overdose, irrespective of the indication for each.

For the purposes of this quick review, any fall warranting evaluation for trauma or workup for possible trauma may be considered a fall.

For both the Safe Prescribing and the Overdose chart review options, only discharged patients are to be included. This ensures that benchmarking results are easier to interpret between sites.

Ideally, such cases should be excluded. We have developed denominator definitions using ICD-10 designed to identify cases with atraumatic low back pain as the primary presentation and need for ED care as opposed to alternative pathologies that may cause back pain. Searching by ICD-10 code should only yield charts with that diagnosis.

Since sites can only select one target first included charts with only one type of pain. If your system can select charts by primary code, then use charts with multiple types of pain can be used.

No. The requested SBP recordings are only relevant for the visit of interest (i.e., the ICH visit that is being reviewed). The data elements requested are intended to be entered per case in order to generate statistically stable estimates of performance for comparison.

No. For submission of Benchmark I data only atraumatic or non-traumatic hemorrhage cases need to be included as guidelines for traumatic hemorrhage is distinct