QDM Datatype Performance/Reporting Period 2019 QDM Definition (QDM Version 5.3): 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 Data Elements defined by this QDM Datatype: Intervention, Order: Above Normal Follow-upIntervention, Order: Below Normal Follow upIntervention, Order: Comfort MeasuresIntervention, Order: Dietary RecommendationsIntervention, Order: Followup within 4 weeksIntervention, Order: Followup within one yearIntervention, Order: Hospice care ambulatoryIntervention, Order: Lifestyle RecommendationIntervention, Order: Moderation of ETOH Consumption RecommendationIntervention, Order: Palliative CareIntervention, Order: Physical Activity RecommendationIntervention, Order: Referral for Depression AdolescentIntervention, Order: Referral for Depression AdultIntervention, Order: Referral to Alternative Provider / Primary Care ProviderIntervention, Order: Referrals where weight assessment may occurIntervention, Order: Weight Reduction Recommended QDM Attributes Author dateTime The time the data element was entered into the clinical software. Note, some datatypes include both Relevant Time and Author dateTime attributes. The purpose is to accommodate Author dateTime if the actual start and stop times are not available when evaluating for feasibility, and also to allow specification of a time for Negation Rationale. 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. Reason The thought process or justification for the datatype. In some measures, specific treatments are acceptable inclusion criteria only if a justified reason is present. Each of these measures uses a value set (often, but not exclusively, using SNOMED CT) to express acceptable justification reasons. Other measures specify reasons as justification for exclusions. Examples include patient, system, or medical-related reasons for declining to perform specific actions. Each of these measures also uses a value set to express acceptable justification reasons for declining to perform expected actions.