# Seguridad Health Measures Implementation Guide # Chapter 1: Introduction # Introduction Thank you joining Seguridad’s measurement system, Choose My Pharmacy™. Our vision is to help patients choose pharmacies in a transparent, quality-focused manner. We believe choosing a pharmacy is about more than convenience – it’s about high-quality care versus a commodity. We can achieve this vision through our mission to provide a patient-centric evaluation of pharmacies to improve patient outcomes. We believe a community pharmacy should have a star rating or measurement system developed for evaluating pharmacies using measures designed for community pharmacies. Our core values are listed below and represent who we are and what we do for pharmacy practice, healthcare quality, and patient care. We want to help pharmacists be pharmacists and ensure the right patient gets the right drug at the right dose through the right route at the right time for the right reason. Everything we do focuses on helping pharmacies optimize patient care and improve outcomes. **Core Values of Seguridad, Inc** ***Safety*** Advance patient safety in pharmacy practice. ***Education*** Anyone will be able to understand *why* pharmacy quality is essential and *how* to use the information. ***Improvement*** Pharmacies will improve the quality of care delivered through measurement science. ***Entrusted*** A trusted source of pharmacy quality for decision-makers. ***Empowered*** Pharmacies will be able to demonstrate a role in high-quality healthcare. ***Well-Being*** Healthy through fiscal accountability and a culture of excellence We look forward to helping you become a “Five-Star Pharmacy.” Feel free to contact us at **healthequity@choosemypharmacy.com** if you have any questions or if we can help you in any way. # Chapter 2: Implementation # Implementation There are currently eleven (11) Seguridad Health Measures® as part of the Choose My Pharmacy® measurement system summarized in chapter 3. The full measure specifications may be found in chapter 4. A measurement system is a report card, or star rating, evaluating the performance of the stakeholder – in this case, community pharmacies. The pharmacy is encouraged to implement a myriad of diverse services to improve patient outcomes and lower healthcare cost. Choose My Pharmacy® is how well the pharmacy performs in these goals. Every pharmacy that participates in Choose My Pharmacy® shares standard, de-identified data to Seguridad, Inc. Seguridad, Inc uses proprietary calculations and analytics to produce a customized report card for the pharmacy. Each pharmacy receives a calendar year score, reported with four quarterly report cards. Overtime, pharmacies will be able to track progress year-over-year on Seguridad Health Measures® - from the current core set to future measures in development. Seguridad leverages a HIPAA-Secure survey platform, JotForm, to help collect pharmacy information. Each pharmacy pharmacist-in-charge (PIC) will:
1. Receive a Business Associate Agreement (BAA) between the pharmacy and Seguridad. This form will be pre-populated with pharmacy specific details and a digital signature is requested. 2. The PIC will receive the Seguridad PIC On-Boarding Survey after execution of the BAA. 3. The PIC will receive the Seguridad Data Request after the PIC On-Boarding Survey is complete. a. This will be requested on a quarterly basis to update measure results. 4. The PIC will receive a link for the Employee Survey. This is to be completed by each individual involved with the fill and dispensing of medications. 5. Once all data is collected, Seguridad will provide a Choose My Pharmacy® Health Measures Report Card to the pharmacy.
# Chapter 3: Choose My Pharmacy® Core Measure Set # Seguridad Health Measures®
**Title** **Description** **Performance**
Assessment of Renal Function in Older Adults Percent of patients aged 65 years and older with a serum creatine on file at the pharmacy during the measurement year A higher rate is better
Assessment of Weights in Pediatrics Percent of pediatric patients (17 years and less) with an updated weight during the measurement year A higher rate is better
Known Allergy Status Percent of patient records with documented allergy status, including ‘no known drug allergies’. A higher rate is better
Medication Indication Percent of electronic prescriptions with *prescriber-reported* indication based on International Classification of Disease – 10 **This is a reporting measure only**
Electronic Care Plan Accessibility Possession of e-care plan with appropriate training A higher rate is better
Point of Care Testing Structure Possession of a CLIA-waiver in the pharmacy. A higher rate is better
Employee Vaccination Rate Percent of employees in a pharmacy that are vaccinated for influenza and COVID-19. A higher rate is better
Advanced Pharmacy Technicians Percent of pharmacy technicians with advance training A higher rate is better
Improving Pain Management Safety Percent of households at risk for opioid adverse event with naloxone available A higher rate is better
Improving Diabetes Safety Percent of patients with high-risk diabetes with glucagon available. A higher rate is better
Identify Social Determinants of Health Percent of patients with documented demographic information. A higher rate is better
# Chapter 4: Choose My Pharmacy® Measure Specifications # Assessment of Renal Function in Older Adults
Title Assessment of Renal Function in Older Adults
Description Percent of patients aged 65 years and older with a serum creatine on file at the pharmacy during the measurement year A higher score is better
Rationale Older adults have diminished renal function and many medications need to be adjusted based on renal excretion. This measure assesses whether the pharmacy has collected the laboratory information required to assess renal function.
Logic Model [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/RLZimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/RLZimage.png) This measure ensures the pharmacy has the salient information (serum creatine) to ensure patient specific dosing.
Level of Analysis Pharmacy (Patient)
Data Source Pharmacy Data
Denominator Statement All patients aged 65 years or older that received a medication during the measurement year.
Denominator Calculation 1. 1. All individuals in the pharmacy 2. 2. All individuals aged 65 or older at the beginning of the measurement year 3. 3. Must have received a medication during the measurement year 4. 4. Remove an individual with exclusion criteria
Denominator Exclusions Any patient only receiving an immunization at the pharmacy Any non-human patients (e.g., cats, dogs, clinics, office-use, etc)
Denominator Exclusion Rationale Many pharmacies may host immunization clinics and only interact with a patient during these visits. As immunizations do not need to be renally adjusted, assessment of renal function is not a required (valid) assessment. Pharmacies may provide care to pets or other veterinarian needs, or for office-use. This patient profiles should be excluded from the measure calculation.
Numerator Statement Individuals from the denominator with a serum creatine drawn during the measurement year
Numerator Calculation 1. 1. Identify number of individuals with serum creatine recorded 2. 2. Identify number of individuals with serum creatine updated during the measurement year
Seguridad Measure Specification Process [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/Paeimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/Paeimage.png)
Data Stratification The measure rate will be reported as a percent of patients within a single pharmacy. If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care). If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate). Risk adjustment will be applied when available.
Value Sets The value set *Seguridad - CMP Immunizations* will be used to support the exclusion criteria.
Future Iterations Many pharmacy measures are designed as structure or process. Future goals of this concept include measures focused on appropriate dosing based on renal function and assessment of all patients.
Harmonization1 Payors: N/A Providers: N/A
1\. Measures that have either the same target populations (denominator) or the same measure focus (numerators) may be considered related, whereas measures that have the same targeted population (denominator) and same measure focus (numerator), are considered competing measures. Measures being developed should be harmonized, where feasible, to previously established measures to decrease measure burden. Choose My Pharmacy measures are developed for pharmacy evaluation, which is a novel area for measurement science, no current measure evaluates this level of analysis. Choose My Pharmacy measures will be harmonized to the extent possible, recognizing different levels of analysis have different data elements, and instead the focus will be to vertically integrate the Choose My Pharmacy measures with other measurement systems and measures. # Assessment of Weights in Pediatrics
Title Assessment of Weights in Pediatrics
Description Percent of pediatric patients (17 years and less) with an updated weight during the measurement year A higher score is better
Rationale Most pediatric prescriptions are weight-based and the pharmacy should be checking the dose prior to dispensing.
Logic Model [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/Rzmimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/Rzmimage.png) This measure ensures the pharmacy has the salient information (weight) to ensure patient specific dosing.
Level of Analysis Pharmacy (Patient)
Data Source Pharmacy Data
Denominator Statement All patients 17 years and less that received a medication at the pharmacy during the measurement year
Denominator Calculation 1. 1. All patients in the pharmacy 2. 2. All patients age 17 or less during the measurement year 3. 3. Apply exclusion criteria
Denominator Exclusions Any patient only receiving an immunization at the pharmacy Any non-human patients (e.g., cats, dogs, clinics, office-use, etc)
Denominator Exclusion Rationale Many pharmacies may host immunization clinics and only interact with a patient during these visits. As immunizations do not need to be weight-based, assessment of weight is not a required (valid) assessment. Pharmacies may provide care to pets or other veterinarian needs, or for office-use. This patient profiles should be excluded from the measure calculation.
Numerator Statement Individuals from the denominator with a weight (pounds) during the measurement year
Numerator Calculation 1. Identify number of individuals with a weight recorded in the pharmacy record.
Seguridad Measure Specification Process [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/nNuimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/nNuimage.png)
Data Stratification The measure rate will be reported as percent of patients within a single pharmacy. If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care). If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate). Risk adjustment will be applied when available.
Value Sets The value set *Seguridad - CMP Immunizations* will be used to support the exclusion criteria.
Future Iterations Many pharmacy measures are designed as structure or process. Future goals of this concept include measures focused on appropriate dosing based on weight and assessment of all patients.
Harmonization1 Payors: N/A Providers: N/A
1\. Measures that have either the same target populations (denominator) or the same measure focus (numerators) may be considered related, whereas measures that have the same targeted population (denominator) and same measure focus (numerator), are considered competing measures. Measures being developed should be harmonized, where feasible, to previously established measures to decrease measure burden. Choose My Pharmacy measures are developed for pharmacy evaluation, which is a novel area for measurement science, no current measure evaluates this level of analysis. Choose My Pharmacy measures will be harmonized to the extent possible, recognizing different levels of analysis have different data elements, and instead the focus will be to vertically integrate the Choose My Pharmacy measures with other measurement systems and measures. # Known Allergy Status
Title Known Allergy Status
Description Percent of patient records with documented allergy status, including ‘no known drug allergies’. A higher rate is better.
Rationale Community pharmacies are the last step prior to a patient receiving a medication and last chance to verify drug allergies.
Logic Model [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/DEpimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/DEpimage.png) This measure ensures the pharmacy has the salient information (allergy history) to ensure patient specific dosing.
Level of Analysis Pharmacy (Patient)
Data Source Pharmacy Data
Denominator Statement All individuals dispensed a prescription from the pharmacy during a measurement year
Denominator Calculation 1. 1. Identify all prescriptions in a measurement year 2. 2. Identify all unique patients from the prescriptions 3. 3. Apply exclusions
Denominator Exclusions Any non-human patients (e.g., cats, dogs, clinics, office-use, etc)
Denominator Exclusion Rationale Pharmacies may provide care to pets or other veterinarian needs, or for office-use. This patient profiles should be excluded from the measure calculation.
Numerator Statement Individuals from the denominator with documented allergy status on record
Numerator Calculation 1. Number of individuals from the denominator with documented allergy
Seguridad Measure Specification Process [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/bAOimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/bAOimage.png)
Data Stratification The measure rate will be reported as percent of patients within a single pharmacy. If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care). If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate). Risk adjustment will be applied when available.
Value Sets No value set is required for the calculation of this measure.
Future Iterations Many pharmacy measures are designed as structure or process. Future goals of this concept include measures focused on updating the allergy status on an annual basis.
Harmonization1 Payors: N/A Providers: N/A
1\. Measures that have either the same target populations (denominator) or the same measure focus (numerators) may be considered related, whereas measures that have the same targeted population (denominator) and same measure focus (numerator), are considered competing measures. Measures being developed should be harmonized, where feasible, to previously established measures to decrease measure burden. Choose My Pharmacy measures are developed for pharmacy evaluation, which is a novel area for measurement science, no current measure evaluates this level of analysis. Choose My Pharmacy measures will be harmonized to the extent possible, recognizing different levels of analysis have different data elements, and instead the focus will be to vertically integrate the Choose My Pharmacy measures with other measurement systems and measures. # Medication Indication
Title Medication Indication
Description Percent of electronic prescriptions with *prescriber-reported* indication based on International Classification of Disease – 10 **This is a reporting measure only**
Rationale Pharmacies ensure the right patient gets the right drug at the right time for the right reason. This measure will help to evaluate the right reason. Caveats: This measure is not for performance evaluation. Pharmacists may not diagnosis patients (by entering patient-reported diagnosis in the pharmacy system). This measure will evolve over time to ensure every prescription has an indication and said indication is correct.
Logic Model [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/pDmimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/pDmimage.png) This measure is establishing the need pharmacies have for an indication on every prescription. Currently, regulatory barriers exist that prevents the measure from being ‘Every Medication Has an Indication’ however, this measure is headed in that direction.
Level of Analysis Pharmacy (Prescription)
Data Source Pharmacy Data
Denominator Statement All prescriptions electronically submitted to the pharmacy during a measurement year
Denominator Calculation 1. 1. Identify all prescriptions in a pharmacy 2. 2. Identify all new prescriptions denoted as refill number 0 3. 3. Identify all new prescriptions with source field (NCPDP = electronic) 4. 4. Apply exclusion criteria
Denominator Exclusions Any electronic prescription that was canceled by the prescriber. Any non-human patients (e.g., cats, dogs, clinics, office-use, etc)
Denominator Exclusion Rationale Canceled prescriptions were never filled and confirmed to not be valid prescriptions Pharmacies may provide care to pets or other veterinarian needs, or for office-use. This patient profiles should be excluded from the measure calculation.
Numerator Statement Percent of electronic prescriptions with prescriber reported ICD-10
Numerator Calculation 1. Number of prescriptions with supplied ICD-10
Seguridad Measure Specification Process [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/Zu5image.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/Zu5image.png)
Data Stratification The measure rate will be reported as pharmacy. If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care). If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate). Risk adjustment will be applied when available.
Value Sets No value set is required for the calculation of this measure.
Future Iterations Many pharmacy measures are designed as structure or process. Future goals of this concept include measures focused ensuring all prescriptions have an indication and that the indication and medication are appropriate.
Harmonization1 Payors: N/A Providers: This measure is similar to the CMS SNF measure ensuring all medications have an indication.
1\. Measures that have either the same target populations (denominator) or the same measure focus (numerators) may be considered related, whereas measures that have the same targeted population (denominator) and same measure focus (numerator), are considered competing measures. Measures being developed should be harmonized, where feasible, to previously established measures to decrease measure burden. Choose My Pharmacy measures are developed for pharmacy evaluation, which is a novel area for measurement science, no current measure evaluates this level of analysis. Choose My Pharmacy measures will be harmonized to the extent possible, recognizing different levels of analysis have different data elements, and instead the focus will be to vertically integrate the Choose My Pharmacy measures with other measurement systems and measures. # Electronic Care Plan Accessibility
Title Electronic Care Plan Accessibility
Description Possession of e-care plan with appropriate training A higher score is better
Rationale Clinical documentation is required to validate actions occurred and provide patient care notes from one provider to another.
Logic Model [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/kzoimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/kzoimage.png) This measure ensures clinical documentation of patient encounters at the pharmacy. If it isn’t document, it didn’t happen. The E-Care Plan Accessibility measure creates the structure for future process, outcome, and patient-reported measures.
Level of Analysis Pharmacy (Nominal and Structure)
Data Source Survey
Denominator Statement This measure is a structure-based measure evaluate a nominal endpoint. The denominator is the pharmacy.
Denominator Calculation 1. The pharmacy
Denominator Exclusions No exclusions
Denominator Exclusion Rationale N/A
Numerator Statement Accessibility of e-care plan by all members of the pharmacy
Numerator Calculation Nominal endpoint determined by survey results
Seguridad Measure Specification Process [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/vOaimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/vOaimage.png)
Data Stratification The measure rate will be reported as pharmacy. If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care). If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate). Risk adjustment will be applied when available.
Value Sets No value set is required for the calculation of this measure.
Future Iterations Many pharmacy measures are designed as structure or process. Future goals of this concept include evaluating the outcomes from E-Care Plan submissions, type of data within E-Care Plans, and other aspects of safety/quality.
Harmonization1 Payors: N/A Providers: N/A
1\. Measures that have either the same target populations (denominator) or the same measure focus (numerators) may be considered related, whereas measures that have the same targeted population (denominator) and same measure focus (numerator), are considered competing measures. Measures being developed should be harmonized, where feasible, to previously established measures to decrease measure burden. Choose My Pharmacy measures are developed for pharmacy evaluation, which is a novel area for measurement science, no current measure evaluates this level of analysis. Choose My Pharmacy measures will be harmonized to the extent possible, recognizing different levels of analysis have different data elements, and instead the focus will be to vertically integrate the Choose My Pharmacy measures with other measurement systems and measures. # Point of Care Testing Structure
Title Point of Care Testing Structure
Description Possess of a CLIA-waiver in the pharmacy. A higher score is better
Rationale Point-of-care testing (POCT) requires a CLIA-waiver. Pharmacies that offer point-of-care testing may be able to optimize care through patient monitoring (blood glucose, HbA1c, HIV, influenza, COVID-19, pharmacogenomics, lipids, and others).
Logic Model [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/Q5Qimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/Q5Qimage.png) This measure evaluates the pharmacy’s readiness to provide advance services and address gaps in care, healthcare accessibility, and monitoring.
Level of Analysis Pharmacy (Nominal and Structure)
Data Source Survey
Denominator Statement This measure is a structure-based measure evaluate a nominal endpoint. The denominator is the pharmacy.
Denominator Calculation 1. The pharmacy
Denominator Exclusions No exclusions
Denominator Exclusion Rationale N/A
Numerator Statement Possession of a CLIA-waiver at the pharmacy
Numerator Calculation Nominal endpoint determined by survey results
Seguridad Measure Specification Process [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/8Pfimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/8Pfimage.png)
Data Stratification The measure rate will be reported as pharmacy. If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care). If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate). Risk adjustment will be applied when available.
Value Sets No value set is required for the calculation of this measure.
Future Iterations Many pharmacy measures are designed as structure or process. Future goals of this concept include evaluating the outcomes from CLIA-waived tests, the types of tests, patient-reported outcomes, and other aspects of the quality and safety of POCT.
Harmonization1 Payors: Some payors are evaluated on collection of clinical data, like hemoglobin A1c. This measure will help pharmacies align with those measures. Providers: N/A
1\. Measures that have either the same target populations (denominator) or the same measure focus (numerators) may be considered related, whereas measures that have the same targeted population (denominator) and same measure focus (numerator), are considered competing measures. Measures being developed should be harmonized, where feasible, to previously established measures to decrease measure burden. Choose My Pharmacy measures are developed for pharmacy evaluation, which is a novel area for measurement science, no current measure evaluates this level of analysis. Choose My Pharmacy measures will be harmonized to the extent possible, recognizing different levels of analysis have different data elements, and instead the focus will be to vertically integrate the Choose My Pharmacy measures with other measurement systems and measures. # Employee Vaccination Rate
Title Employee Vaccination Rate
Description Percent of employees in a pharmacy that are vaccinated for influenza and COVID-19. A higher rate is better.
Rationale Similar to health systems, pharmacies are frontline workers during pandemics. Ensuring pharmacies are not hot spots of disease will help prevent pandemics.
Logic Model [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/4rAimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/4rAimage.png) This measure evaluates the pharmacy’s role in public health and mitigated infectious diseases. As healthcare providers, pharmacy teams should be immunized as soon as possible to protect themselves, their families, and the public.
Level of Analysis Pharmacy (Employee)
Data Source Survey
Denominator Statement Number of employees (full or part time) at the pharmacy during a measurement year
Denominator Calculation 1. 1. Number of part-time employees 2. 2. Number of full-time employees
Denominator Exclusions Exclude any employee <18 years old; any employee that works ≤6 months.
Denominator Exclusion Rationale Minors may need parental permission. All employees are encouraged to receive immunizations. Data show that to reach herd immunity (often defined as 70% immunized), individuals 17 years old and younger will need to be vaccinated. However, most pharmacies will not have ≥30% of staff ≤17 years old. Employees working ≤6 months may not be employed during the annual influenza immunization period.
Numerator Statement Number of employees vaccinated with influenza and COVID-19 immunizations
Numerator Calculation 1. Count the number of individuals that have received the COVID-19 and influenza vaccines
Seguridad Measure Specification Process [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/Ybnimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/Ybnimage.png)
Data Stratification The measure rate will be reported as pharmacy. If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care). If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate). Risk adjustment will be applied when available.
Value Sets No value set is required for the calculation of this measure.
Future Iterations If other pandemics or required vaccines are authorized/approved, this measure would be updated.
Harmonization1 Payors: N/A Providers: This measure is similar to the CMS Hospital Compare Employee Vaccination rate measure.
1\. Measures that have either the same target populations (denominator) or the same measure focus (numerators) may be considered related, whereas measures that have the same targeted population (denominator) and same measure focus (numerator), are considered competing measures. Measures being developed should be harmonized, where feasible, to previously established measures to decrease measure burden. Choose My Pharmacy measures are developed for pharmacy evaluation, which is a novel area for measurement science, no current measure evaluates this level of analysis. Choose My Pharmacy measures will be harmonized to the extent possible, recognizing different levels of analysis have different data elements, and instead the focus will be to vertically integrate the Choose My Pharmacy measures with other measurement systems and measures. # Advanced Pharmacy Technicians
Title Advanced Pharmacy Technicians
Description Percent of pharmacy technicians with advance training
Rationale Pharmacy technicians are able to expand scope of practice through certifications and credentials. The elevated pharmacy technician provides higher quality care and allows the pharmacy staff to focus on non-dispensing clinical activities.
Logic Model [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/VKvimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/VKvimage.png) This measure evaluates the training and credentialing of a pharmacy technician. When pharmacy technicians are able to advance scope of practice, like product verification, pharmacists are able to advance their role towards medication optimization.
Level of Analysis Pharmacy (Employee)
Data Source Survey
Denominator Statement Number of pharmacy technicians (full or part time) at the pharmacy during a measurement year
Denominator Calculation 1. 1. Number of part-time pharmacy technicians 2. 2. Number of full-time pharmacy technicians
Denominator Exclusions Exclude any employee ≤17 years old, less than 6 months employment, or ≤1 year as a pharmacy technician
Denominator Exclusion Rationale Minors may need parental permission, other technicians may not be eligible for technician exam
Numerator Statement Number of pharmacy technicians with advance credentials and training
Numerator Calculation • Count the number of individuals that have advanced training.
Seguridad Measure Specification Process [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/26uimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/26uimage.png)
Data Stratification The measure rate will be reported as pharmacy. If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care). If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate). Risk adjustment will be applied when available.
Value Sets No value set is required for the calculation of this measure.
Future Iterations As additional training programs and certificates are authorized for pharmacy technicians, the numerator will be updated.
Harmonization1 Payors: N/A Providers: N/A
1\. Measures that have either the same target populations (denominator) or the same measure focus (numerators) may be considered related, whereas measures that have the same targeted population (denominator) and same measure focus (numerator), are considered competing measures. Measures being developed should be harmonized, where feasible, to previously established measures to decrease measure burden. Choose My Pharmacy measures are developed for pharmacy evaluation, which is a novel area for measurement science, no current measure evaluates this level of analysis. Choose My Pharmacy measures will be harmonized to the extent possible, recognizing different levels of analysis have different data elements, and instead the focus will be to vertically integrate the Choose My Pharmacy measures with other measurement systems and measures. # Improving Pain Management Safety
Title Improving Pain Management Safety
Description Percent of households where at least one individual is at risk for adverse opioid event, like overdose or respiratory depression, with naloxone available. A higher score is better
Rationale Many individuals are at increased risk for adverse events associated with opioid use. Additionally, many states have implemented standing protocols for naloxone dispensing without prescription to patients or caregivers of patients at risk for adverse opioid events. This measure ensures, at a household level, naloxone is available to any patient.
Logic Model [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/ibHimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/ibHimage.png) This measure ensures any household at risk for adverse opioid events is evaluated and provided treatment.
Level of Analysis Pharmacy (Patient)
Data Source Pharmacy Data
Denominator Statement Any household with a patient at risk for adverse opioid event defined as patients prescribed opioids and any of the following: - · ≥50 morphine milligram equivalents per day - · Concomitant use of sedating medications, like benzodiazepines
Denominator Calculation 1. 1. All individuals in the pharmacy 2. 2. All individuals prescribed an opioid 3. 3. All individuals with risk factor (≥50 MME or benzodiazepine) 4. 4. Exclude non-human patients 5. 5. Identify each unique household
Denominator Exclusions Any non-human patients (e.g., cats, dogs, clinics, office-use, etc)
Denominator Exclusion Rationale Pharmacies may provide care to pets or other veterinarian needs, or for office-use. This patient profiles should be excluded from the measure calculation.
Numerator Statement Household from the denominator with a naloxone dispensed during the measurement year
Numerator Calculation 1. 1. Identify all naloxone prescriptions dispensed from the pharmacy 2. 2. Identify each household with a naloxone prescription 3. 3. Households that have a match in the denominator are in the numerator.
Seguridad Measure Specification Process [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/F2jimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/F2jimage.png)
Data Stratification The measure rate will be reported as a percent of patients within a single pharmacy. If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care). If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate). Risk adjustment will be applied when available.
Value Sets The value set *Seguridad – Opioids* and *Seguridad – Opioid Risk Medications* will be used to support the exclusion criteria.
Future Iterations Many pharmacy measures are designed as structure or process. Future goals of this concept include measures focused on appropriate dosing based on renal function and assessment of all patients.
Harmonization1 Payors: PQA’s Opioid Measure Set Providers: PQA’s Opioid Measure Set
1\. Measures that have either the same target populations (denominator) or the same measure focus (numerators) may be considered related, whereas measures that have the same targeted population (denominator) and same measure focus (numerator), are considered competing measures. Measures being developed should be harmonized, where feasible, to previously established measures to decrease measure burden. Choose My Pharmacy measures are developed for pharmacy evaluation, which is a novel area for measurement science, no current measure evaluates this level of analysis. Choose My Pharmacy measures will be harmonized to the extent possible, recognizing different levels of analysis have different data elements, and instead the focus will be to vertically integrate the Choose My Pharmacy measures with other measurement systems and measures. # Improving Diabetes Safety
Title Improving Diabetes Safety
Description Percent of patients at risk for glycemia receiving bolus insulin receive glucagon. A higher score is better
Rationale Many patients with diabetes are at risk for hypoglycemia, which can cause hospitalizations or death. Individuals using insulin, particularly meal-time, or bolus, are at increased risk for hypoglycemia.
Logic Model [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/MsJimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/MsJimage.png) This measure ensures patients at increased risk for hypoglycemia have appropriate treatment available.
Level of Analysis Pharmacy (Patient)
Data Source Pharmacy Data
Denominator Statement Patient at risk for hypoglycemia due to bolus insulin use.
Denominator Calculation 1. 1. All individuals in the pharmacy 2. 2. All individuals prescribed a bolus insulin 3. 3. Exclude non-human patients.
Denominator Exclusions Any non-human patients (e.g., cats, dogs, clinics, office-use, etc)
Denominator Exclusion Rationale Pharmacies may provide care to pets or other veterinarian needs, or for office-use. This patient profiles should be excluded from the measure calculation.
Numerator Statement Patients from the denominator with glucagon.
Numerator Calculation 1. Identify individuals from the denominator with a prescription for glucagon
Seguridad Measure Specification Process [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/vBjimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/vBjimage.png)
Data Stratification The measure rate will be reported as a percent of patients within a single pharmacy. If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care). If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate). Risk adjustment will be applied when available.
Value Sets The value set *Seguridad – Basal Insulin* will be used to support the exclusion criteria.
Future Iterations Many pharmacy measures are designed as structure or process. Future goals of this concept include measures will include other high-risk diabetes medications.
Harmonization1 Payors: N/A Providers: N/A
1\. Measures that have either the same target populations (denominator) or the same measure focus (numerators) may be considered related, whereas measures that have the same targeted population (denominator) and same measure focus (numerator), are considered competing measures. Measures being developed should be harmonized, where feasible, to previously established measures to decrease measure burden. Choose My Pharmacy measures are developed for pharmacy evaluation, which is a novel area for measurement science, no current measure evaluates this level of analysis. Choose My Pharmacy measures will be harmonized to the extent possible, recognizing different levels of analysis have different data elements, and instead the focus will be to vertically integrate the Choose My Pharmacy measures with other measurement systems and measures. # Identifying Social Determinants of Health
Title Identifying Social Determinants of Health
Description Percent of patients in the pharmacy that have documented SDOH data elements. A higher score is better
Rationale Pharmacies are often identifying and resolving social determinant of health barriers for patients. However, documentation is vital to showing progress on care. This measure evaluates if a pharmacy is collecting SDOH identifiers at the pharmacy. Once patients are identified, pharmacies will be able to make interventions and bill for these services.
Logic Model [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/GhPimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/GhPimage.png) This measure ensures pharmacies are documenting and collecting the data required for SDOH clinical services.
Level of Analysis Pharmacy (Patient)
Data Source Pharmacy Data
Denominator Statement All patients within a pharmacy
Denominator Calculation 1. 1. Identify all prescriptions in a measurement year 2. 2. Identify all unique patients from the prescriptions 3. 3. Apply exclusions
Denominator Exclusions Any non-human patients (e.g., cats, dogs, clinics, office-use, etc)
Denominator Exclusion Rationale Pharmacies may provide care to pets or other veterinarian needs, or for office-use. This patient profiles should be excluded from the measure calculation.
Numerator Statement Patients from the denominator with documented SDOH data elements, including: Insurance Status, Education level, Race, Ethnicity, Zip Code
Numerator Calculation 1. Identify individuals from the denominator with a documented SDOH data element (composite)
Seguridad Measure Specification Process [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/RcVimage.png)](https://docs.rxsafety.io/uploads/images/gallery/2023-08/RcVimage.png)
Data Stratification The measure rate will be reported as a percent of patients within a single pharmacy. If available and feasible, measure rate will be reported by type of pharmacy (e.g., health-system, community, specialty, mail-order, long-term care). If available and feasible, measure rate will be reported by line of business (pharmacy Medicare rate, pharmacy Medicaid rate, pharmacy Commercial rate, and pharmacy uninsured rate). Risk adjustment will be applied when available.
Value Sets No value set is required for this measure.
Future Iterations Many pharmacy measures are designed as structure or process. Future goals of this measure will be to track additional SDOH data elements, like housing or food insecurity, for eventual Z-code billing and interventions.
Harmonization1 Payors: N/A Providers: N/A
1\. Measures that have either the same target populations (denominator) or the same measure focus (numerators) may be considered related, whereas measures that have the same targeted population (denominator) and same measure focus (numerator), are considered competing measures. Measures being developed should be harmonized, where feasible, to previously established measures to decrease measure burden. Choose My Pharmacy measures are developed for pharmacy evaluation, which is a novel area for measurement science, no current measure evaluates this level of analysis. Choose My Pharmacy measures will be harmonized to the extent possible, recognizing different levels of analysis have different data elements, and instead the focus will be to vertically integrate the Choose My Pharmacy measures with other measurement systems and measures. # Chapter 5: Choose My Pharmacy® PMS Support # PioneerRx **Prescription Report** 1. Go to the **Rx** tab 2. Select the **binocular icon** in the Data Entry section 3. In the **Completed Between** line, enter the date range 4. Press **Search (F12)** to generate the report Once the report has been generated, create a new report design layout. 1. In the drop-down box next to View, select **Expanded with Comments** 2. Select the **Field Chooser icon** [![image.png](https://docs.rxsafety.io/uploads/images/gallery/2023-08/scaled-1680-/S9Bimage.png) o](https://docs.rxsafety.io/uploads/images/gallery/2023-08/S9Bimage.png)n the left side of the screen 3. Check the boxes of the data fields you want to report
**PioneerRx**
Date Filled
Days Supply
Dispensed Item Name
Dispensed Item NDC
Dispensed Item Strength
Dispensed Quantity
Origin
Patient Age
Patient Ethnicity
Patient Gender
Patient Paid Amount
Patient Primary Address
Patient Primary Zip Code
Patient Race
Patient Serial Number/Patient Central ID
Pharmacy NCPDP
Primary ICD10 Code
Primary ICD10 Code Description
Refill Number
Rx Number
Sig Code
4. Select the **blue plus sign** next to the View drop-down box 5. Name the layout 6. Press **Search (F12)** to regenerate the report with new data fields Export the report to an excel file. 1. Select **Menu** in the top right corner of the green results box. 2. Choose **Export to Excel** 3. Name and save Excel document **Patient Weight & Allergy Report** 1. Go to **Patient** tab 2. Select the **binocular icon** in the Patient section 3. In the **Activity Between**, enter the same date range used to generate the prescription report 4. Press **Search (F12)** to generate the report Once the report has been generated, use the steps to create a new report design layout from above that includes **Serial Number, Weight, and Allergies** and regenerate the report. Export, name, and save the report as an Excel document. **Patient Serum Creatinine Report** **\*\*If your pharmacy does not collect serum creatinine, there is no need to submit a report\*\*** Create a patient category. 1. Go to the **System** tab 2. Select the **Category icon** 3. In the Category Scope drop-down box, select **Patient** 4. Press the **green plus sign** on the right side to create a new category 5. Provide a name and description for the category 6. Choose **Auto** in the Type drop-down 7. In **box B (Any of These)**, press the **green plus sign** 8. Choose **Any Lab Greater Than** as a filter 9. Choose **Comprehensive Metabolic Panel – Creatinine, Serum (SCr)** as the lab E. Enter 0 in the **Greater Than** box P. Press **Save (F12)** 1.. Make sure the status of the category is **active** and press **Save (F12)** You must process the category for it to immediately work, or it will not become active until the next day. .1. Select the **Actions** drop in the top right 2. Choose **Process Category Auto Filter Rules** and follow the prompts Use the patient category to generate a patient report ... Go to **Patient** tab 2. Select the **binocular icon** in the Patient section 3. In the **Activity Between** line, enter the same date range used to generate the prescription report 4. From the **Category** drop-down, select the patient category. 5. Press **Search (F12)** This will generate a report of all the patients in your system with a SCr value on file. Choose or create a layout that includes the Serial Number. Export the report to an Excel document. # ComputerRx 1. Create a view for your data. a) You’ll first want to create a “view” including all of the data-points you want, and none of the data-points you don’t want. Run a very limited dispense report (like filled today) by navigating to Reports>Dispensing Report>Detailed Dispensing. i. ComputerRx will pull up your dispense report with your default view. ii. In the top right of the screen, Press the blue + sign next to the view dropdown to create a new “view” - name it something like “Seguridad” iii. Customize the view to match the data request, generally as follows: 1. Include columns (these are the specific data element names in ComputerRx): - Patient Record (please be sure you are selecting Patient **Record** and *not* Patient **ID**, as they are different) - Date - Drug - NDC - Patient Age - Diag. Code 1 - Rx Origin - Day Supply - Quan. - Sig - Patient Address - Patient Zip - Sex - Race - Ethnicity 2. Additional data elements *that may not be available for download. Please find the closest match if possible*: 1. Patient Allergies 2. Patient Serum Creatinine 3. Species 4. Patient Weight 5\. ICD-10 Description 3. You may need a few more or a few less columns depending on the specific data request. iv. Save the “view” as you have it set by clicking the Save button (floppy disk). 2. Pull the data requested a) Put in filters for the specific request. For example: i. In Start Date, put 1/1/2021, and End Date put 3/30/2021. (Quarterly results aid in data pull) ii. The report will build (it may take some time). b) Once the report has loaded and been filtered, press export at the bottom middle left of the screen to generate an excel file. c) Name the excel appropriately per the work order, for example “Seguridad NABP DATE”. # Liberty **Generating Reports for Liberty**
1. Select “Reporting” on the top 2. Select “Rx Data” 3. Right Click Top Row on the pop up box 4. Select "Column Chooser” 5. Add requested Seguridad Data Elements
- Customer ID - Date Dispensed - Drug Name - Drug NDC - Customer Age - ICD Code - ICD10 Description - Origin Code - Customer Allergies - Customer Weight - Customer SrCr - Day Supply - Qty - Sigs - Customer Address - Customer Zip - Customer Species - Customer Gender - Customer Race - Customer Ethnicity
1. Use ‘Advance’ to update the time range 2. Save As Excel on Desktop
# Rx30
**General Field Name** **Rx30 Field Name**
Date Dispensed FILLDATE
Patient Date of Birth PATDOB
Directions DIRECTION 1
Directions DIRECTION 2
Directions DIRECTION 3
Directions DIRECTION 4
Directions DIRECTION 5
Gender GENDER
Patient Address/Household PATADD1
Patient Address/HouseholdPATADD2
Insurance Status PAYTYPE
Medication Days Supply DS
Medication Indication ICD10
RXDIAG 1
Medication Name DRUG NAME
Medication Origin RXORIGIN
NDC NDC
Patient ID PATKEY
Prescription Number RXNBR
Quantity Dispensed QTY DSP
Patient Zip Code PATZIP
# QS/1 QS/1 support is currently unavailable at this time. Please submit your data as best you can using the following generic terms to guide you. Depending on the pharmacy management system, reports may be a single file with all data elements or may be multiple files. Please generate your Seguridad Data Reports from the pharmacy management system and submit the data as **xls**, **xlsx**, or **csv**. - De-identified Patient ID (patient serial number, customer ID, patient record) - Date Dispensed - Drug Name - Drug NDC - Customer Age (patient age) - ICD-10 Code - ICD-10 Description - Origin Code (prescription origin status, walk-in, electronic, telephone) - Patient Allergies - Patient Weight - Patient Serum Creatinine - Days Supply - Quantity Dispensed - Sig/Directions - Patient Address - Patient Zip Code - Patient Species (Human, Cat, Dog) - Gender - Race (White, Black, Asian, etc) - Ethnicity (Hispanic, Non-hispanic) If you are unable to pull a specific data field - that is ok. Some pharmacy management systems do not report or save all data elements. Pharmacy performance may be lower in some measures, but Seguridad will work with the pharmacy management system to make this a reportable data element in the future. Once you have submitted your data, please reach out to support@choosemypharmacy.com stating your pharmacy's NCPDP number and which PMS you submitted data from. A member of our team will reach back out to your with further information. # MicroMerchant MicroMerchant support is currently unavailable at this time. Please submit your data as best you can using the following generic terms to guide you. Depending on the pharmacy management system, reports may be a single file with all data elements or may be multiple files. Please generate your Seguridad Data Reports from the pharmacy management system and submit the data as **xls**, **xlsx**, or **csv**. - De-identified Patient ID (patient serial number, customer ID, patient record) - Date Dispensed - Drug Name - Drug NDC - Customer Age (patient age) - ICD-10 Code - ICD-10 Description - Origin Code (prescription origin status, walk-in, electronic, telephone) - Patient Allergies - Patient Weight - Patient Serum Creatinine - Days Supply - Quantity Dispensed - Sig/Directions - Patient Address - Patient Zip Code - Patient Species (Human, Cat, Dog) - Gender - Race (White, Black, Asian, etc) - Ethnicity (Hispanic, Non-hispanic) If you are unable to pull a specific data field - that is ok. Some pharmacy management systems do not report or save all data elements. Pharmacy performance may be lower in some measures, but Seguridad will work with the pharmacy management system to make this a reportable data element in the future. Once you have submitted your data, please reach out to support@choosemypharmacy.com stating your pharmacy's NCPDP number and which PMS you submitted data from. A member of our team will reach back out to your with further information. # BestRx BestRx support is currently unavailable at this time. Please submit your data as best you can using the following generic terms to guide you. Depending on the pharmacy management system, reports may be a single file with all data elements or may be multiple files. Please generate your Seguridad Data Reports from the pharmacy management system and submit the data as **xls**, **xlsx**, or **csv**. - De-identified Patient ID (patient serial number, customer ID, patient record) - Date Dispensed - Drug Name - Drug NDC - Customer Age (patient age) - ICD-10 Code - ICD-10 Description - Origin Code (prescription origin status, walk-in, electronic, telephone) - Patient Allergies - Patient Weight - Patient Serum Creatinine - Days Supply - Quantity Dispensed - Sig/Directions - Patient Address - Patient Zip Code - Patient Species (Human, Cat, Dog) - Gender - Race (White, Black, Asian, etc) - Ethnicity (Hispanic, Non-hispanic) If you are unable to pull a specific data field - that is ok. Some pharmacy management systems do not report or save all data elements. Pharmacy performance may be lower in some measures, but Seguridad will work with the pharmacy management system to make this a reportable data element in the future. Once you have submitted your data, please reach out to support@choosemypharmacy.com stating your pharmacy's NCPDP number and which PMS you submitted data from. A member of our team will reach back out to your with further information. # FSI Foundation Systems FSI Foundation Systems support is currently unavailable at this time. Please submit your data as best you can using the following generic terms to guide you. Depending on the pharmacy management system, reports may be a single file with all data elements or may be multiple files. Please generate your Seguridad Data Reports from the pharmacy management system and submit the data as **xls**, **xlsx**, or **csv**. - De-identified Patient ID (patient serial number, customer ID, patient record) - Date Dispensed - Drug Name - Drug NDC - Customer Age (patient age) - ICD-10 Code - ICD-10 Description - Origin Code (prescription origin status, walk-in, electronic, telephone) - Patient Allergies - Patient Weight - Patient Serum Creatinine - Days Supply - Quantity Dispensed - Sig/Directions - Patient Address - Patient Zip Code - Patient Species (Human, Cat, Dog) - Gender - Race (White, Black, Asian, etc) - Ethnicity (Hispanic, Non-hispanic) If you are unable to pull a specific data field - that is ok. Some pharmacy management systems do not report or save all data elements. Pharmacy performance may be lower in some measures, but Seguridad will work with the pharmacy management system to make this a reportable data element in the future. Once you have submitted your data, please reach out to support@choosemypharmacy.com stating your pharmacy's NCPDP number and which PMS you submitted data from. A member of our team will reach back out to your with further information. # Chapter 6: Choose My Pharmacy® Report Card FAQs **I submitted my data! When can I expect my report card?** Approximately six weeks after the quarterly data request emails are sent out (these are sent on the 1st of the month or first business day at the start of a new quarter). The time between the email being sent out and you receiving your report is spent gathering data from as many of our participating pharmacies as possible as well as engaging in quality assurance to make sure the data is accurate. **I am going through the onboarding process and submitted my data but never received my Employee Survey. What happen?** This likely means there was an issue with processing your data submission. If someone from our support team has not reached out to you already, please email and include your pharmacy's NCPDP. **I have a measure rating that says N/A. How can I fix this to 'meet the requirements'?** N/A, or not applicable, means that the data provided does not allow for a denominator to be calculated for the specified measure. The reasoning can vary from measure to measure. For example, if a pharmacy does not have any patients <18 years old, the *Assessment of Weights in Pediatrics* score would be N/A. **My entire report card has N/D listed for all measures. What does this mean?** This means there was most likely an issue with processing your data submission. Be it missing required fields or a formatting error or a technical bug on our end. Please email with your pharmacy's NCPDP and our team will be able to identify the error and possibly have you resubmit data to resolve the issue. **How are each of these metrics measured? How do I go about improving my score?** For a detailed explanation of how we calculate our metrics, click to view our [Measure Specifications Guide](https://docs.rxsafety.io/books/seguridad-health-measures-implementation-guide/chapter/chapter-4-choose-my-pharmacy-measure-specifications). We have also provided a chart below that shows which collected data points go into the calculation of each measure. [![Screenshot 2024-06-28 at 10.25.51 AM.png](https://docs.rxsafety.io/uploads/images/gallery/2024-06/scaled-1680-/screenshot-2024-06-28-at-10-25-51-am.png)](https://docs.rxsafety.io/uploads/images/gallery/2024-06/screenshot-2024-06-28-at-10-25-51-am.png) **My overall score in my report card is blank. Why is it missing?** Given that our company is still in the early stages of collecting and analyzing data from all of our participating pharmacies, it is difficult to calculate a grade that accurately reflects overall performance at this time. As we gather more data and are able to compare it to previous quarters, we will be able to create an accurate system for calculating grades. Until such a time, we have decided to leave the overall scores blank to avoid confusion. **My rating for *Known Allergy Status* seems unusually low even though we ask our customers for any allergies. What is causing this?** The numerator for the measure is calculated by the documentation of any allergies OR no known allergies. Leaving the field blank rather than recording it as "no known allergies" negatively impacts the pharmacy's score. We recommend filling out the allergy status field every time to improve this measure rating. **Why is Employee Vaccination Rate is reading N/A even though our pharmacy completed the employee surveys?** As of right now, our engineering team is working through a bug in the calculation that provides an accurate rating for this measurement.