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Performance/Reporting Period
2019
Description:

Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated

Data Elements contained within the eCQM

Diagnosis: Diagnosis of hypertension

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent diagnoses and disorders to identify recent onset or evolving hypertension.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients represented by recent onset or evolving diagnosis of hypertension.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Diagnosis of hypertension value set (2.16.840.1.113883.3.600.263)

QDM Datatype and Definition (QDM Version 5.3)
Diagnosis

Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

Timing: The Prevalence Period references the time from the onset date to the abatement date.

Diagnostic Study, Order: ECG 12 lead or study order

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent electrocardiogram (ECG) 12-lead studies.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Procedure.
Inclusion Criteria: Includes only relevant concepts associated with for ECG 12-lead or study order.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnostic Study, Order: ECG 12 lead or study order value set (2.16.840.1.113883.3.600.2448)

QDM Datatype and Definition (QDM Version 5.3)
Diagnostic Study, Order

Data elements that meet criteria using this datatype should document a request by a clinician or appropriately licensed care provider to an appropriate provider or organization to perform the diagnostic study indicated by the QDM category and its corresponding value set. The request may be in the form of a consultation or a direct order to the organization that performs the diagnostic study. Diagnostic studies are those that are not performed in the clinical laboratory. Such studies include but are not limited to imaging studies, cardiology studies (electrocardiogram, treadmill stress testing), pulmonary function testing, vascular laboratory testing, and others.

Timing: The time the order is signed; Author dateTime.

Encounter, Performed: BP Screening Encounter Codes

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent multiple types of encounters where blood pressure measurement screening can be performed.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter.
Inclusion Criteria: Includes only relevant concepts associated with encounters where the actual procedure of taking a blood pressure is performed.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: BP Screening Encounter Codes value set (2.16.840.1.113883.3.600.1920)

QDM Datatype and Definition (QDM Version 5.3)
Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime - the time the patient arrived at the location;
  • stopTime - the time the patient departed from the location

 

Intervention, Order: Dietary Recommendations

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent dietary management.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Intervention or Procedure.
Inclusion Criteria: Includes only relevant concepts associated with dietary management and nutritional education.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Dietary Recommendations value set (2.16.840.1.113883.3.600.1515)

QDM Datatype and Definition (QDM Version 5.3)
Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Intervention, Order: Followup within 4 weeks

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent capturing the follow-up encounter within four weeks of the initial encounter.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. Intention to represent follow-up visits within a 4-week period.
Inclusion Criteria: Includes only relevant concepts associated with capturing the follow up between 1 day to 1 month of the initial finding.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Followup within 4 weeks value set (2.16.840.1.113883.3.600.1537)

QDM Datatype and Definition (QDM Version 5.3)
Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Intervention, Order: Followup within one year

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent capturing the follow-up encounter within one year of the initial encounter.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. Intention to represent follow-up visits within a one-year period.
Inclusion Criteria: Includes only relevant concepts associated with capturing the follow up between 1 day to 12 month of the initial finding.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Followup within one year value set (2.16.840.1.113883.3.600.1474)

QDM Datatype and Definition (QDM Version 5.3)
Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Intervention, Order: Lifestyle Recommendation

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent the type of interventions relevant to lifestyle needs.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Procedure or Intervention.
Inclusion Criteria: Includes only relevant concepts associated with the type of lifestyle education provided.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Lifestyle Recommendation value set (2.16.840.1.113883.3.600.1508)

QDM Datatype and Definition (QDM Version 5.3)
Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Intervention, Order: Moderation of ETOH Consumption Recommendation

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent the type of interventions relevant to alcohol use.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Procedure or Intervention.
Inclusion Criteria: Includes only relevant concepts associated with indicating the type of education provided, referral to community service or rehabilitation center for alcohol use.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Moderation of ETOH Consumption Recommendation value set (2.16.840.1.113883.3.600.823)

QDM Datatype and Definition (QDM Version 5.3)
Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Intervention, Order: Physical Activity Recommendation

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent exercise, education and nutrition.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Intervention or Procedure.
Inclusion Criteria: Includes only relevant concepts associated with promoting exercise and nutrition regimens.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Physical Activity Recommendation value set (2.16.840.1.113883.3.600.1518)

QDM Datatype and Definition (QDM Version 5.3)
Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Intervention, Order: Referral to Alternative Provider / Primary Care Provider

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent the types of referrals made by the alternate or primary care provider.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Intervention.
Inclusion Criteria: Includes only relevant concepts associated with the different types of services and providers.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Referral to Alternative Provider / Primary Care Provider value set (2.16.840.1.113883.3.600.1475)

QDM Datatype and Definition (QDM Version 5.3)
Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Intervention, Order: Weight Reduction Recommended

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent management and maintenance of weight.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Intervention or Procedure.
Inclusion Criteria: Includes only relevant concepts associated with interventions addressing healthy eating, goal setting, weight management and maintenance.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Order: Weight Reduction Recommended value set (2.16.840.1.113883.3.600.1510)

QDM Datatype and Definition (QDM Version 5.3)
Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Laboratory Test, Order: Laboratory Tests for Hypertension

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent laboratory tests that are commonly used with patients diagnosed with hypertension.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Procedure.
Inclusion Criteria: Includes only relevant concepts associated with laboratory testing for patients diagnosed with hypertension.
Exclusion Criteria: No exclusions.

Constrained to codes in the Laboratory Test, Order: Laboratory Tests for Hypertension value set (2.16.840.1.113883.3.600.1482)

QDM Datatype and Definition (QDM Version 5.3)
Laboratory Test, Order

Data elements that meet criteria using this datatype should document a request for the laboratory test indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime.

Medication, Order: Anti-Hypertensive Pharmacologic Therapy

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent clinical medications prescribed for patients diagnosed with hypertension.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Medication.
Inclusion Criteria: Includes only relevant concepts associated with oral and injectable drug forms that are prescribed for treatment of hypertension.
Exclusion Criteria: No exclusions.

Constrained to codes in the Medication, Order: Anti-Hypertensive Pharmacologic Therapy value set (2.16.840.1.113883.3.600.1476)

QDM Datatype and Definition (QDM Version 5.3)
Medication, Order

Data elements that meet criteria using this datatype should document a request to a pharmacy to provide the medication indicated by the QDM category and its corresponding value set.

Timing: The Author dateTime is the time the order is signed.

Timing: The Relevant Period addresses:

  • startTime - when the first administration of the medication is expected. The first administration may be expected at the time of the order or at a specified future date (i.e., the active time for the order); such information should be identified in the medication order. If the startTime is not specified in the order, the startTime defaults to the Author dateTime (the time the order is signed).
  • stopTime - when the medication supply provided by the medication order is expected to be completed, including all fulfillments covered by the number of refills.

Note that when calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the Relevant Period start and stop times multiplied by (1 + the number of refills).

Negation Rationale: Patient Reason Refused

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent a reason for patient refusal.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Negation Rationale.
Inclusion Criteria: Includes only relevant concepts associated with identifying a patient's reason for refusing treatment.
Exclusion Criteria: No exclusions.

Constrained to codes in the Negation Rationale: Patient Reason Refused value set (2.16.840.1.113883.3.600.791)

QDM Attribute and Definition (QDM Version 5.3)
Negation Rationale
The QDM attribute, negation rationale indicates the reason that an action was not performed. Only QDM datatypes that represent actions (e.g., performed, recommended, communication, order, dispensed) allow the 'negation rationale' attribute. The intent is to indicate a justification that such action did not happen as expected. This attribute specifically does not address the presence or absence of information in a clinical record (e.g., documented absence of allergies versus lack of documentation about allergies). QDM assumes that any information expected will be in a clinical record. The situation is different when something that normally would be expected to be done is specifically not done because of a valid clinical reason (such as the patient is allergic, they are suffering from a complication, or some other rationale. In this case, the 'thing not done' is rarely documented, especially as a code, in the patient record. To express such lack of evidence, an eCQM author should use a CQL 'not exists' expression noted in the examples, and they must also capture the Negation rationale to capture a reason for the absence, i.e., the reason must be included to qualify as a negation rationale type expression. The syntax in the human readable HQMF is described in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, 'Procedure, Performed not done.' QDM 5.5 uses the syntax, 'Procedure, not Performed' and this is then associated with either a DRC or a value set used to identify 'the expected thing,' that in this case was not done. Negation Rationale attribute value indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatype-related actions for a reason always use the author dateTime attribute to reference timing.

Patient Characteristic Ethnicity: Ethnicity

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent whether the patient is Hispanic or not; ethnicity category defined by the Centers for Disease Control and Prevention and National Center for Health Statistics.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Ethnicity.
Inclusion Criteria: Includes only relevant concepts associated with ethnicity defined as Hispanic or Latino, or Not Hispanic or Latino.
Exclusion Criteria: No exclusions.

Constrained to codes in the Patient Characteristic Ethnicity: Ethnicity value set (2.16.840.1.114222.4.11.837)

QDM Datatype and Definition (QDM Version 5.3)
Patient Characteristic Ethnicity

Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set.

Timing: Ethnicity does not have a specific timing. Measures using Patient Characteristic, Ethnicity should address the most recent entry in the clinical record.

Patient Characteristic Payer: Payer

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Payer.
Inclusion Criteria: Includes only relevant concepts associated with payer codes in the code system.
Exclusion Criteria: No exclusions.

Constrained to codes in the Patient Characteristic Payer: Payer value set (2.16.840.1.114222.4.11.3591)

QDM Datatype and Definition (QDM Version 5.3)
Patient Characteristic Payer

Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set.

Timing: The Relevant Period addresses:

  • startTime – the first day of insurance coverage with the referenced payer
  • stopTime – the last day of insurance coverage with the referenced payer

 

Patient Characteristic Race: Race

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent the general race category reported by the patient - subject may have more than one; defined by the Centers for Disease Control and Prevention and National Center for Health Statistics.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Race.
Inclusion Criteria: Includes only relevant concepts associated with the following race categories: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, Other Race, White.
Exclusion Criteria: No exclusions.

Constrained to codes in the Patient Characteristic Race: Race value set (2.16.840.1.114222.4.11.836)

QDM Datatype and Definition (QDM Version 5.3)
Patient Characteristic Race

Data elements that meet criteria using this datatype should document the patient’s race.

Timing: Race does not have a specific timing. Measures using Patient Characteristic, Race should address the most recent entry in the clinical record.

Patient Characteristic Sex: ONC Administrative Sex

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent gender identity restricted to only male and female used in administrative situations requiring a restriction to these two categories.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Patient Characteristic Sex.
Inclusion Criteria: Includes relevant concepts associated with gender concepts for male and female only.
Exclusion Criteria: Excludes any gender identity that is not male or female.

Constrained to codes in the Patient Characteristic Sex: ONC Administrative Sex value set (2.16.840.1.113762.1.4.1)

QDM Datatype and Definition (QDM Version 5.3)
Patient Characteristic Sex

Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set.

Timing: Birth (administrative) sex does not have a specific timing.

Physical Exam, Performed: Diastolic blood pressure

Direct Reference Code

Constrained to 'Diastolic blood pressure' LOINC code

QDM Datatype and Definition (QDM Version 5.3)
Physical Exam, Performed

Data elements that meet criteria using this datatype should document the completion of the physical exam indicated by the QDM category and its corresponding value set.

Timing: The Relevant Period addresses:

  • startTime – the time the physical examination activity begins
  • stopTime – the time the physical examination activity ends

NOTE - timing refers to a single instance of a physical examination activity. If a measure seeks to evaluate multiple physical examination activities over a period of time, the measure developer should use CQL logic to represent the query request.

Physical Exam, Performed: Systolic blood pressure

Direct Reference Code

Constrained to 'Systolic blood pressure' LOINC code

QDM Datatype and Definition (QDM Version 5.3)
Physical Exam, Performed

Data elements that meet criteria using this datatype should document the completion of the physical exam indicated by the QDM category and its corresponding value set.

Timing: The Relevant Period addresses:

  • startTime – the time the physical examination activity begins
  • stopTime – the time the physical examination activity ends

NOTE - timing refers to a single instance of a physical examination activity. If a measure seeks to evaluate multiple physical examination activities over a period of time, the measure developer should use CQL logic to represent the query request.