Appendix E-1: EXAMPLE of Audit Checklist Template

Home , Cluster headache, Tension headache

Appendix e-1: EXAMPLE of Audit checklist template Axon 15: Headache: Quality of life assessment for patients with primary headache disorders Measure description: Percentage of patients with a diagnosis of primary headache disorder whose health-related quality of life (HRQoL) was assessed with a tool(s)* during at least two visits* during the 12-month measurement period AND whose health related quality of life score stayed the same or improved***. Site name: Date of site visit: Chart Reviewer: EMR Expert at Site Patient’s Initials: Patient’s Year of Birth:

Table 1: Audit checklist

Area Does the data Observations/ element match? Notes (Yes/No)

1.0 Demographic Data

1.1 Verify that the MRN matches between EMR system and registry data

1.2 Verify that the following data elements match: • Patient name • Birth Year • Sex • Race 1.3 Verify that provider information matches: • Encounter date • Physician name • Physician NPI 2.0 Diagnosis of primary headache

2.1 Verify that diagnosis of primary headache matches. IF data element 7060 in Axon Registry data set is 1 – Yes (denominator): • SNOMED is 103011009 - Benign exertional headache

124081000119107 - Menstrual status migrainosus 124171000119105 - Chronic intractable migraine without aura 193030005 - Migraine variants 193031009 - Cluster headache 22253000 - Pain 230462002 - Migraine with typical aura

1 230471006 - Chronic tension-type headache 230472004 - Episodic cluster headache 230473009 - Chronic cluster headache 230476001 - Atypical cluster headache 230481005 - Idiopathic stabbing headache 23186000 - Menstrual migraine 25064002 - Headache 37796009 - Migraine 398057008 - Tension headache 423279000 - Refractory migraine without aura 423683008 - Intractable migraine with aura 424699007 - Migraine variants, not intractable 425007008 - Migraine without aura, not refractory 425365009 - Migraine variants, intractable 443095000 - Hemicrania continua 445322004 - Migraine variant with headache 4473006 - Migraine with aura 56097005 - Migraine without aura 59292006 - Hemiplegic migraine 699314009 - Persistent migraine aura 95658004 - Benign cough headache 95660002 - Thunderclap headache

OR • ICD09 is 307.81 - Tension headache 339.00 - Cluster headache syndrome, unspecified 339.01 - Episodic cluster headache 339.02 - Chronic cluster headache 339.03 - Episodic paroxysmal hemicranias 339.04 - Chronic paroxysmal hemicranias 339.05 - Short lasting unilateral neuralgiform headache with conjunctival injection and tearing 339.09 - Other trigeminal autonomic cephalgias 339.10 - Unspecified 339.11 - Episodic tension type headache 339.12 - Chronic tension type headache 339.41 - Hemicrania continua 339.42 - New daily persistent headache 339.43 - Primary thunderclap headache 339.44 - Other complicated headache syndrome 339.81 - Hypnic headache 339.82 - Headache associated with sexual activity 339.83 - Primary cough headache

2 339.84 - Primary exertional headache 339.85 - Primary stabbing headache 339.89 - Other headache syndromes 346.00 - Migraine with aura, without mention of intractable migraine without mention of status migrainosu 346.01 - Migraine with aura, with intractable migraine, so stated, without mention of status migrainosus 346.02 - Migraine with aura, without mention of intractable migraine with status migrainosus 346.03 - Migraine with aura, with intractable migraine, so stated, with status migrainosus 346.10 - Migraine without aura, without mention of intractable migraine without mention of status migrainosus 346.11 - Migraine without aura, with intractable migraine, so stated, without mention of status migrainosus 346.12 - Migraine without aura, without mention of intractable migraine with status migrainosus 346.13 - Migraine without aura, with intractable migraine, so stated, with status migrainosus 346.20 - Variants of migraine, not elsewhere classified, without mention of intractable migraine without mention of status migrainosus 346.21 - Variants of migraine, not elsewhere classified, with intractable migraine, so stated, without mention of status migrainosus 346.22 - Variants of migraine, not elsewhere classified, without mention of intractable migraine with status migrainosus 346.23 - Variants of migraine, not elsewhere classified, with intractable migraine, so stated, with status migrainosus 346.30 - Hemiplegic migraine, without mention of intractable migraine without mention of status migrainosus 346.31 - Hemiplegic migraine, with intractable migraine, so stated, without mention of status migrainosus 346.32 - Hemiplegic migraine, without mention of intractable migraine with status migrainosus 346.33 - Hemiplegic migraine, with intractable migraine, so stated, with status migrainosus 346.40 - Menstrual migraine, without mention of intractable migraine without mention of status migrainosus 346.41 - Menstrual migraine, with intractable migraine, so stated, without mention of status migrainosus 346.42 - Menstrual migraine, without mention of intractable migraine with status migrainosus 346.43 - Menstrual migraine, with intractable migraine, so stated, with status migrainosus

3 346.50 - Persistent migraine aura without cerebral infarction, without mention of intractable migraine without mention of status migrainosus 346.51 - Persistent migraine aura without cerebral infarction, with intractable migraine, so stated, without mention of status migrainosus 346.52 - Persistent migraine aura without cerebral infarction, without mention of intractable migraine with status migrainosus 346.53 - Persistent migraine aura without cerebral infarction, with intractable migraine, so stated, with status migrainosus 346.60 - Persistent migraine aura with cerebral infarction, without mention of intractable migraine without mention of status migrainosus 346.61 - Persistent migraine aura with cerebral infarction, with intractable migraine, so stated, without mention of status migrainosus 346.62 - Persistent migraine aura with cerebral infarction, without mention of intractable migraine with status migrainosus 346.63 - Persistent migraine aura with cerebral infarction, with intractable migraine, so stated, with status migrainosus 346.70 - Chronic migraine without aura 346.71 - Chronic migraine without aura, with intractable migraine, so stated, without mention of status migrainosus 346.72 - Chronic migraine without aura, without mention of intractable migraine with status migrainosus 346.73 - Chronic migraine without aura, with intractable migraine, so stated, with status migrainosus 346.80 - Other forms of migraine, without mention of intractable migraine without mention of status migrainosus 346.81 - Other forms of migraine, with intractable migraine, so stated, without mention of status migrainosus 346.82 - Other forms of migraine, without mention of intractable migraine with status migrainosus 346.83 - Other forms of migraine, with intractable migraine, so stated, with status migrainosus 346.90 - Migraine unspecified 346.91 - Migraine, unspecified, with intractable migraine, so stated, without mention of status migrainosus 346.92 - Migraine, unspecified, without mention of intractable migraine with status migrainosus 346.93 - Migraine, unspecified, with intractable migraine, so stated, with status migrainosus 784.0 - Headache

4 OR • ICD10 is G43.001 - Migraine without aura, not intractable with status migrainosus

G43.009 - Migraine without aura, not intractable without status migrainosus G43.011 - Migraine without aura, intractable with status migrainosus G43.019 - Migraine without aura, intractable without status migrainosus G43.101 - Migraine with aura, not intractable with status migrainosus G43.109 - Migraine with aura, not intractable, without status migrainosus G43.111 - Migraine with aura, intractable with status migrainosus G43.119 - Migraine with aura, intractable, without status migrainosus G43.401 - Hemiplegic migraine, not intractable with status migrainosus G43.409 - Hemiplegic migraine, not intractable without status migrainosus G43.411 - Hemiplegic migraine, intractable with status migrainosus G43.419 - Hemiplegic migraine, intractable without status migrainosus G43.501 - Persistent migraine aura without cerebral infarction, not intractable with status migrainosus G43.509 - Persistent migraine aura without cerebral infarction, not intractable without status migrainosus G43.511 - Persistent migraine aura without cerebral infarction, intractable with status migrainosus G43.519 - Persistent migraine aura without cerebral infarction, intractable without status migrainosus G43.601 - Persistent migraine aura with cerebral infarction, not intractable with status migrainosus G43.609 - Persistent migraine aura with cerebral infarction, not intractable without status migrainosus G43.611 - Persistent migraine aura with cerebral infarction, intractable with status migrainosus G43.619 - Persistent migraine aura with cerebral infarction, intractable without status migrainosus G43.701 - Chronic migraine without aura, not intractable with status migrainosus G43.709 - Chronic migraine without aura, not intractable without status migrainosus G43.711 - Chronic migraine without aura, intractable, with status migrainosus G43.719 - Chronic migraine without aura, intractable without status migrainosus G43.801 - Other migraine, not intractable, with status migrainosus

5 G43.809 - Other migraine, not intractable, without status migrainosus G43.811 - Other migraine, intractable, with status migrainosus G43.819 - Other migraine, intractable, without status migrainosus G43.821 - Menstrual migraine, not intractable with status migrainosus G43.829 - Menstrual migraine, not intractable without status migrainosus G43.831 - Menstrual migraine, intractable with status migrainosus G43.839 - Menstrual migraine, intractable without status migrainosus G43.901 - Migraine, unspecified, not intractable with status migrainosus G43.909 - Migraine, unspecified, not intractable without status migrainosus G43.911 - Migraine, unspecified, intractable with status migrainosus G43.919 - Migraine, unspecified, intractable without status migrainosus G43.B0 - Ophthalmoplegic migraine, not intractable G43.B1 - Ophthalmoplegic migraine, intractable G43.C0 - Periodic headache syndromes in child or adult, not intractable G43.C1 - Periodic headache syndromes in child or adult, intractable G44.001 - Cluster headache syndrome, unspecified, intractable G44.009 - Cluster headache syndrome, unspecified, not intractable G44.011 - Episodic cluster headache, intractable G44.019 - Episodic cluster headache, not intractable G44.021 - Chronic cluster headache, intractable G44.029 - Chronic cluster headache, not intractable G44.031 - Episodic paroxysmal hemicrania, intractable G44.039 - Episodic paroxysmal hemicrania, not intractable G44.041 - Chronic paroxysmal hemicrania, intractable G44.049 - Chronic paroxysmal hemicrania, not intractable G44.051 - Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), intractable G44.059 - Short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), not intractable G44.091 - Other trigeminal autonomic cephalgias (TAC), intractable G44.099 - Other trigeminal autonomic cephalgias (TAC), not intractable G44.1 - Ascular headache, not elsewhere classified

6 G44.201 - Tension-type headache, unspecified, intractable G44.209 - Tension-type headache, unspecified, not intractable G44.211 - Episodic tension-type headache, intractable G44.219 - Episodic tension-type headache, not intractable G44.221 - Chronic tension-type headache, intractable G44.229 - Chronic tension-type headache, not intractable G44.51 - Hemicrania continua G44.52 - New daily persistent headache (NDPH) G44.53 - Primary thunderclap headache G44.59 - Other complicated headache syndrome G44.81 - Hypnic headache G44.82 - Headache associated with sexual activity G44.83 - Primary cough headache G44.84 - Primary exertional headache G44.85 - Primary stabbing headache G44.89 - Other headache syndrome R51 - Headache

ELSE IF • data element 7060 in Axon Registry data is 0 (no): • Patient does not meet any of the requirements above. 3.0 Assessment for health related quality of life (HRQoL)

3.1 Verify that an assessment for health related quality of life (HRQoL)was performed: IF data element 7170 in Axon Registry data set is 1 – Yes (numerator): • SNOMED is 273421001 - Disability rating scale

273530006 - Impact of event scale 273725009 - Quality of life scale 273831003 - Quality of life index 405152002 - Quality of life

OR • ICD-9 is 780.97 - Altered mental status V40.1 - Problems with communication (including speech) V40.9 - Unspecified mental or behavioral problem OR

7 • ICD-10 is F69 - Unspecified disorder of adult personality and behavior R41.82 - Altered mental status, unspecified Z86.59 - Personal history of other mental and behavioral disorders OR Progress notes contain the following keywords: continues to have daily headache

Disability rating scale

having headaches all day

Headache Impact Test – 6 (HIT-6)

headache that lasts 3 days every month

headaches have improved dramatically

HIT-6 score of

Impact of event scale

MIDAS

MIDAS and HIT Questionnaires

MIDAS Questionnaire

MIDASASCORE

Migraine Disability Assessment

Migraine Disability Assessment (Midas)

Migraine Specific Quality of Life Tool (MSQ)

mild relief from sphenocath

pain on the back of her head

PEDMIDAS

Quality of life

Quality of life index

Quality of life scale

she has been getting daily dull headache

she has had 3 migraines since last visit

significant improvement in her headache

ELSE IF

8 data element 7170 in Axon Registry data set is 2 (no - medical reason): • SNOMED is 228150001 - Mental health impairment

386806002 - Cognitive impairment ELSE IF data element 7170 in Axon Registry data set is 3 (no - patient reason): • SNOMED is 288600000 - unable to use verbal communication 289197000 - lack of fluency in speech 307126008 - Unable to write 309252004 - Unable to read ELSE IF data element 7170 in Axon Registry data set is 4 (no - system reason): • SNOMED is 161637005 - Insurance refused ELSE data element 7170 in Axon Registry data set is 0 (no): • No assessment for health related quality of life (HRQoL)was performed 4.0 Documentation of health related quality of life score

4.1 Verify that documentation of health related quality of life score matches: IF data element 7180 in Axon Registry data set is 1 (yes). OR • Progress notes contain one of the following phrases: Disability rating scale

Headache Impact Test – 6 (HIT-6)

Impact of event scale

MIDAS

MIDAS and HIT Questionnaires

MIDAS Questionnaire

Migraine Disability Assessment

Migraine Disability Assessment (Midas)

Migraine Specific Quality of Life Tool (MSQ)

9 PEDMIDAS

Quality of life

Quality of life index

Quality of life scale

ELSE data element 7180 in Axon Registry data set is 0 (no): • No documentation of health related quality of life exists 5.0 Cognitive Impairment Diagnosis

5.1 Verify that cognitive impairment diagnosis matches: IF data element 11495 in Axon Registry data set is 1 (yes): • SNOMED is 386806002 - Cognitive impairment 702956004 - Severe cognitive impairment OR • HCPS is G9635 - Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the HRQoL survey, patient has the inability to read and/or write in order to complete the HRQoL questionnaire) OR • ICD-10 is G31.84 - Mild cognitive impairment, so stated ELSE data element 7180 in Axon Registry data set is 0 (no): • No documentation of cognitive impairment exits 6.0 Score of health related quality of life

6.1 Verify that the score of health related quality of life matches data element 11195: • Verify that data element 11195 matches between the Axon Registry data set and the EMR system OR • Progress notes contain the following keywords: Health-related quality of life (HRQOL); Quality of life, score; MIDASBSCORE; MIDASTOTSCOR; Total MIDAS Score:

10 7.0 Tool for measuring health related quality of life

7.1 Verify that the tool for measuring health related quality of life matches: • Verify that data element 11210 matches between the Axon Registry data set and the EMR system OR • Progress notes contains the following keywords: Headache Impact Test (HIT-6) HIT MIDASBSCORE MIDASTOTSCOR Migraine Disability Assessment (MIDAS) Migraine Specific Quality of Life Tool (MSQ) Neck Disability Index (NDI) and McGill Questionnaire Pediatric Migraine Disability Assessment (PedMIDAS) Total MIDAS Score: 8.0 Score of health related quality of life improves during 12 month measurement 8.1 Verify that the health related quality of life was assessed with a tool(s) during at least two visits during the 12 month measurement period and that the health related quality of life score stayed the same or improved IF data element 11585 in Axon Registry data set is 1 (yes): • HCPS is G9634 - Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved ELSE IF data element 11585 in Axon Registry data set is 2 (no- medical reason): • HCPS is G9635 - Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the HRQoL survey, patient has the inability to read and/or write in order to complete the HRQoL questionnaire) ELSE data element 11585 in Axon Registry data set is 0: • HCPS is G9636 - Health-related quality of life not assessed with tool during at least two visits or quality of life score declined Health-related quality of life not assessed with tool during at least two visits or quality of life score declined

11 8.2 Verify that date when health related quality of life was assessed with a tool(s) during at least two visits during the 12 month measurement period AND whose health related quality of life score stayed the same or improved matches: • Verify that data element 11590 matches between the Axon Registry data set and the EMR system

End of checklist

12 Appendix e-2: EXAMPLE of AAN Measure Logic Specification: Axon 20

A. Axon 20: Counseling for Women of Childbearing Potential with Epilepsy Measure description: All female patients of childbearing potential (12-44 years old) diagnosed with epilepsy who were counseled or referred for counseling for how epilepsy and its treatment may affect contraception OR pregnancy at least once a year.

B. Measure Components 1. Numerator Statement: Female patients or caregivers counseled* at least once a year about how epilepsy and its treatment may affect contraception OR pregnancy. *Counseling should include a discussion about folic acid supplementation, contraception, potential anti-seizure medications effect(s) on pregnancy, safe pregnancies, and breastfeeding.

2. Denominator Statement: All females of childbearing potential (12-44 years old) with a diagnosis of epilepsy. Excluded: patients diagnosed with menopause or surgically sterile.

3. Denominator Exceptions: Patient has a diagnosis of neurodevelopmental disorder, encephalopathy, hydrocephalus, brain injury, or cerebral palsy. Patient has a diagnosis of severe cognitive impairment or severe intellectual disability.

C. DIAGRAM of MEASURE LOGIC/SPECIFICATIONS

Axon 20/ PQRS 268: All female patients of childbearing potential (12- 44 years old) diagnosed with epilepsy who were counseled or referred for counseling for how epilepsy and its treatment may affect contraception OR pregnancy at least once a year.

1. Start

2. Set enc-reported= 0 enc-elig= 0 enc-perf-met= 0 enc-perf-not-met= 0 enc-den-excl= 0 enc-den-exp= 0

Stop Yes 3. End of File? Continue File Processing

No 14. Performance Not Met Set enc-perf-not-met= 1

4. Read Next No/ Reason not specified Encounter

12. If counseling for 13. Denominator Exceptions effects due to epilepsy Yes 5. System checks Set enc-den-exp= 1 was not done was it due current encounter to a medical reason? for DOB, if missing checks all other encounters for DOB

10. Patient counseled or referred for 11. Performance Met counseling for how epilepsy 6. Age (Encounter Yes Date – DOB) >= 12 Set enc-perf-met= 1 and its treatment may affect and <= 44 years? contraception OR pregnancy at least once a year?

Yes

Eligible

No 8. Wa s the female 7. Encounter date in 9. Set enc-elig= 1 Yes patient diagnosed with Yes reporting period? enc-reported= 1 epilepsy?

Not Eligible No

Data Dictionary References

Element ID Element name 1510 Encounter Date 2050 Date of Birth 1 Denominator 2060 Sex 11225 Encounter AAN 02, 20 9000 Diagnosis of epilepsy 9005 Date of diagnosis of epilepsy

Element ID Element name 11275 Counseling for effects due to epilepsy Numerator 11280 Date of counseling for effects due to epilepsy 11275 Counseling for effects due to epilepsy- 5- No- Reason not specified

Denominator Element ID Element name exception 11275 Counseling for effects due to epilepsy- 2- No- Medical reason

Aggregation of Encounters for a Given Patient

Denominator = pt-elig = max(enc-elig) Numerator = pt-perf-met = max(enc-perf-met) pt-perf-not-met = max(enc-perf-not-met) and not max(enc-perf-met) Denominator Exclusion = pt-perf-excl = max(enc-den-excl) and not max(enc-perf-not-met) and not max(enc- perf-met) Denominator Exception = pt-perf-exp = max(enc-den-exp) and not max(enc-perf-not-met) and not max(enc- perf-met) pt-reported = max(enc-reported)

Aggregation of Patients for a Given Provider

eligible-instances = sum(pt-elig) performance-met-instances = sum(pt-perf-met) performance-not-met-instances = sum(pt-perf-not-met) performance-exclusion-instances = sum(pt-perf-excl) performance-exception-instances = sum(pt-perf-exp) reported-instances = sum(pt-reported) reporting-rate = reported-instances / eligible-instances performance-rate = performance-met-instances / (performance-met-instances + performance-not-met instances)

© 2016 American Academy of Neurology Axon 20/ PQRS 268: All female patients of childbearing potential (12- 44 years old) diagnosed with epilepsy who were counseled or referred for counseling for how epilepsy and its treatment may affect contraception OR pregnancy at least once a year.

1. Start

2. Set enc-reported= 0 enc-elig= 0 enc-perf-met= 0 enc-perf-not-met= 0 enc-den-excl= 0 enc-den-exp= 0

Stop Yes 3. End of File? Continue File Processing

No 14. Performance Not Met Set enc-perf-not-met= 1

4. Read Next No/ Reason not specified Encounter

Yes

Eligible

No 8. Wa s the female 7. Encounter date in 9. Set enc-elig= 1 Yes patient diagnosed with Yes reporting period? enc-reported= 1 epilepsy?

Not Eligible No

D. DATA DICTIONARY REFERENCES

Data Dictionary References

Element ID Element name 1510 Encounter Date 2050 Date of Birth Denominator 2060 Sex 11225 Encounter AAN 02, 20 9000 Diagnosis of epilepsy 9005 Date of diagnosis of epilepsy

Denominator Element ID Element name exception 11275 Counseling for effects due to epilepsy- 2- No- Medical reason

Aggregation of Encounters for a Given Patient

Aggregation of Patients for a Given Provider

2 Appendix e-3: Axon RegistryÒ Measure-Level Results Across All Patients Axon IQVIA Measure Measure Description N Mean % N Mean % Axon 01 Epilepsy Sz Freq 46,862 31.8% 52,281 4.1% Axon 02 Epilepsy Sz Type 46,887 83.5% 52,310 78.5% Axon 03 Epilepsy Psych 46,862 56.7% 52,281 9.3% Axon 04 PD Psych 3,453 71.1% 3,886 28.0% Axon 05 PD Sleep 3,453 69.6% 3,886 25.9% Axon 06 PD Autonomic 3,453 69.7% 3,886 43.7% Axon 07 Fall Screen 27,297 31.3% 31,499 1.4% Axon 08 Dementia Staging 3,986 24.1% 4,868 20.6% Axon 09 Dementia ADL 3,986 14.6% 4,868 6.8% Axon 10 Dementia Psych 3,986 54.6% 4,868 10.6% Axon 11 DSP Diabetes 1,931 10.1% 3,986 0.0% Axon 12 DSP Alcohol 1,931 55.8% 3,986 0.0% Axon 13 Migraine Attack Meds 16,452 46.2% 18,725 5.5% Axon 14 HA Barbiturate O/U 23,522 98.3% 26,634 98.9% Axon 15 Headache QOL 10,481 0.7% 15,675 3.0% Axon 20 Epilepsy Childbearing 2,969 4.1% 3,521 0.2% Axon 21 HA Opioid O/U 11 0.0% 191 0.2% Axon 22 HA Imaging 26,801 2.6% 29,351 0.0% Axon 23 MS Exercise 4,922 14.9% 5,669 5.1% Axon 24 OSA Sleep 16,332 36.6% 17,020 30.5%

Appendix e-4: Physician-Level Comparison of Measure Results for Axon RegistryÒ and IQVIA

Axon Performance IQVIA Performance Measure Measure Description (Sample Size) (Sample Size) Axon 01 Epilepsy Sz Freq 29.6% (n=173) 7.3% (n=141) Axon 02 Epilepsy Sz Type 60.2% (n=173) 78.6% (n=141) Axon 03 Epilepsy Psych. 45.4% (n=173) 30.3% (n=141) Axon 04 PD Psych 46.5% (n=173) 48% (n=119) Axon 05 PD Sleep 45.1% (n=173) 33.5% (n=119) Axon 06 PD Autonomic 42.4% (n=173) 62.8% (n=118) Axon 07 Fall Screen 23.4% (n=173) 2.7% (n=162) Axon 08 Dementia Staging 23.2% (n=173) 16% (n=135) Axon 09 Dementia ADL 11.9% (n=173) 18.9% (n=135) Axon 10 Dementia Psych 37.4% (n=173) 30.6% (n=135) Axon 11 DSP Diabetes 13.4% (n=173) 0.1% (n=119) Axon 12 DSP Alcohol 24.5% (n=173) 0% (n=126) Axon 13 Migraine Attack Meds 36.4% (n=173) 16.6% (n=126) Axon 14 HA Barbiturate O/U 76% (n=173) 98.7% (n=152) Axon 15 Headache QOL 1.6% (n=173) 8.8% (n=152) Axon 20 Epilepsy Childbearing 7.8% (n=173) 0.3% (n=129) Axon 21 HA Opioid O/U 0% (n=173) 4.1% (n=25) Axon 22 HA Imaging 5.6% (n=173) 0% (n=153) Axon 23 MS Exercise 19.3% (n=173) 8% (n=131) Axon 24 OSA Sleep 30.6% (n=173) 50.2% (n=119) Sample sizes for Axon performances are the same because the provided results didn’t distinguish between 0% performance rate and no result. IQVIA performance sample sizes recognized and removed when provider had no result for a measure.

Appendix e-5: Axon RegistryⓇ and IQVIA Comparison of Intermediate Denominator to Evaluate Measure Logic Effect

A. Denominator Level Comparisons for All Patients in the B. Numerator Level Comparisons for All Patients in Intermediate Intermediate Denominator Denominator

Axon 01: Epilepsy Sz Freq Axon 01: Epilepsy Sz Freq Axon 02: Epilepsy Sz Type Axon 02: Epilepsy Sz Type Axon 03: Epilepsy Psych. Axon 03: Epilepsy Psych. Axon 04: PD Psych. Axon 04: PD Psych. Axon 05: PD Sleep Axon 05: PD Sleep Axon 06: PD Autonomic Axon 06: PD Autonomic Axon 07: Fall Screen Axon 07: Fall Screen Axon 08: Dementia Staging Axon 08: Dementia Staging Axon 09: Dementia ADL Axon 09: Dementia ADL Axon 10: Dementia Psych. Axon 10: Dementia Psych. Axon 11: DSP Diabetes Axon 11: DSP Diabetes Axon 12: DSP Alcohol Axon 12: DSP Alcohol Axon 13: Migraine Attack Meds Axon 13: Migraine Attack Meds Axon 14: HA Barbituate O/U Axon 14: HA Barbituate O/U Axon Registry® Measure Measure Registry® Axon Axon 15: Headache QOL Measure Registry® Axon Axon 15: Headache QOL Axon 20: Epilepsy Childbearing Axon 20: Epilepsy Childbearing Axon 21: HA Opioid O/U Axon 21: HA Opioid O/U Axon 22: HA Imaging Axon 22: HA Imaging Axon 23: MS Exercise Axon 23: MS Exercise Axon 24: OSA Sleep Axon 24: OSA Sleep 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percent of Denominator Percent of Numerator

Denominator Match IQVIA Denominator Only Axon Denominator Only Numerator Match IQVIA Numerator Only Axon Numerator Only Appendix e-6 Supporting Language for Data Privacy Statement In providing these health care operations support services, which rest on AAN’s ability to extract data in an effective and accurate manner, the AAN is a business associate to each registry participant. AAN entered into a business associate agreement (“BAA”) with each participant and downstream BAAs with FIGmd and IQVIA, each of which constitutes AAN’s subcontractor with respect to any use and disclosure of protected health information in connection with the data validation assessment. Among its data protection provisions, AAN’s BAA with Axon Registry participants requires participants to make available to patients a notice of privacy practices that complies with HIPAA. As a business associate to the participants, AAN, FIGmd, and IQVIA may use and disclose protected health information only for purposes of performing specified health care operations support services to the participants (or supporting AAN’s performance of such services, with respect to FIGmd and IQVIA) and as otherwise required or permitted under the applicable BAA in accordance with HIPAA and other applicable law. Only data that Axon Registry participants collected or generated in the ordinary course of clinical care is disclosed to AAN for purposes of the Axon Registry, and only such data was used and disclosed in connection with this data validation assessment. To further minimize the extent to which protected health information was used and disclosed in connection with this data validation assessment, the authors of this manuscript received and used only de-identified data for purposes of their assessment. Further, the AAN did not receive federal funding for the data validation assessment.