Multiple Sclerosis Centers of Excellence
Multiple Sclerosis Clinical Resources for VA Health Care Professionals
Rebecca Spain, MD, MSPH, FAAN
CPRS National Quality Indicators
In an effort to improve MS care to all Veterans regardless of their geographic location, clinical notes for patients with definite MS will be reviewed annually for THESE QUALITY INDICATORS:- Diagnosis of MS in the progress note AND coded in the encounter: ICD10: G35
- MS Subtype in the progress note AND coded in the encounter:
- Relapsing remitting MS (SNOMED 426373005)
- Secondary progressive MS (SNOMED 425500002)
- Primary progressive MS (SNOMED428700003) - Discussion of disease-modifying therapy (DMT) in the progress note. This should include which drugs, dates taken, reasons for switching, intolerances, rationales for never taking DMT or for ending use, etc.
Quality indicators improve communication among the care team for the Veteran with MS, and help us track Veterans with MS nationally.
Some tips: Add the current level of activity to MS subtypes (e.g. clinical and/or radiographic relapses) and if there is any progression (e.g. relapse-independent worsening of MS disability).
Not every Veteran fits neatly into MS subtypes. If the diagnosis of MS is still uncertain or undergoing a work-up, make that clear in your text and ensure the encounter is not coded for “multiple sclerosis”. In those situations, code for what can be definitely diagnosed (e.g. “clinically isolated syndrome”, “optic neuritis”, “white matter abnormalities on brain MRI”, “syncope”, etc.).
The MS Centers of Excellence (MSCoE) are here to help. Our video shows how to add MS diagnosis and subtype codes to the encounter Problem Lists in CPRS and examples of MS clinical notes containing the quality indicators. MSCoE is adding these quality indicators to MS note templates coming soon to CPRS and Cerner.
CPRS MS Note Template
The MSCoE Clinical Core has developed a CPRS note template. This template includes the core information suggested by MSCoE for patients with MS or other demyelinating disorders.
We encourage use of this template to standardize the information gathered at clinic visits. The information gathered will likely be the most comprehensive at the first visit and then the historical information can be carried forward from there. There is a space to put a date for "last updated" within the MS History section. We anticipate that in using this template, many components of the MSSR can be captured as well.
The template is hosted on the MSCoE VA SharePoint which is only accessible to VA staff. You are welcome to reach out to the clinical core team (Suma.Shah@va.gov and/or Carolyn.Bevan@va.gov) with any questions.
DMTs in MS VA National Clinical Recommendations Document
The clinical recommendations document Disease Modifying Therapies in MS Clinical Recommendations was created for VA health care professionals through a collaboration of the VA Pharmacy Benefits Management, VA National Formulary Committee and MSCoE. It is intended to provide recommendations to VA health care professionals in selecting a DMT for relapsing forms of MS (including relapsing-remitting MS and active secondary progressive MS) and primary progressive MS. Also, considerations regarding switching, escalating, de-escalating, and discontinuing DMT for MS.
Questions? Contact MSCentersofExcellence@va.gov.
