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CMS Measure ID: CMS71v10    Performance/Reporting Period: 2021    Version: 10    NQF Number: Not Applicable
Description:

Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge

Data Elements contained within the eCQM + Expand all

Value Set Description from VSAC
Clinical Focus: This value set grouping contains concepts that represent diagnoses used to identify patients with a history of atrial fibrillation/flutter or a current finding of atrial fibrillation/flutter.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Diagnosis. The intent of this data element is to identify patients with a diagnosis of atrial fibrillation or flutter.
Inclusion Criteria: Includes only relevant concepts associated with codes that identify patients with a history of atrial fibrillation/flutter or a current finding of atrial fibrillation/flutter. This is a grouping of ICD-10-CM, ICD-9-CM and SNOMED CT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnoses: Atrial Fibrillation/Flutter value set (2.16.840.1.113883.3.117.1.7.1.202)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

Diagnoses

Coded diagnoses/problems addressed during the encounter. The diagnoses attribute has three components:

  • diagnosis (code)
  • presentOnAdmissionIndicator (code)
  • rank (positive integer)

To reference an encounter diagnosis, the expression must include the diagnosis code component. The other components are optional. The expression should only include the presentOnAdmissionIndicator if it is necessary to reference present on admission and should only include the rank if it is necessary to reference principal diagnosis.

The "Encounter, Performed" diagnosis attribute is intended to capture ALL diagnoses, including the principal diagnosis, i.e., all diagnoses addressed during the encounter represented by the diagnosis (code) used in the expression.The presentOnAdmissionIndicator (code) allows the eCQM developer to include criteria about whether each specific "Encounter, Performed" diagnosis was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition for information about using the "Encounter, Performed" diagnosis attribute.

The "Encounter, Performed" diagnosis (rank) replaces the principal diagnosis attribute. To reference a principal diagnosis, eCQM developers should express the "Encounter, Performed" diagnosis with a diagnosis (code) and a rank of 1. See definition of rank attribute.

With an "Encounter, Performed" diagnosis, there is no dependency on the timing of the diagnosis in relation to the encounter.

  • Use of the "Encounter, Performed": diagnoses attribute component and the "Diagnosis" datatype is redundant for relating the diagnosis to the "Encounter, Performed". The "Encounter, Performed": diagnoses component syntax is preferred.
  • Referencing the same diagnosis using "Encounter, Performed" (diagnoses attribute) and "Diagnosis" (datatype) should only occur if the measure must define a specified length of a prevalencePeriod, e.g.,
    • The measure must assure that the diagnoses
      • have been present for at least some defined time period before the encounter, and
      • were addressed during the "Encounter, Performed"
Value Set Description from VSAC
Clinical Focus: This value set grouping contains concepts that represent patients who have had a hemorrhagic stroke, or stroke caused by hemorrhage.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Principal Diagnosis. The intent of this data element is to identify patients who have a diagnosis of hemorrhagic stroke, or stroke caused by a hemorrhage.
Inclusion Criteria: Includes only relevant concepts associated with a diagnosis of hemorrhagic stroke, or stroke caused by hemorrhage. This is a grouping of ICD-10-CM and SNOMED CT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnoses: Hemorrhagic Stroke value set (2.16.840.1.113883.3.117.1.7.1.212)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

Diagnoses

Coded diagnoses/problems addressed during the encounter. The diagnoses attribute has three components:

  • diagnosis (code)
  • presentOnAdmissionIndicator (code)
  • rank (positive integer)

To reference an encounter diagnosis, the expression must include the diagnosis code component. The other components are optional. The expression should only include the presentOnAdmissionIndicator if it is necessary to reference present on admission and should only include the rank if it is necessary to reference principal diagnosis.

The "Encounter, Performed" diagnosis attribute is intended to capture ALL diagnoses, including the principal diagnosis, i.e., all diagnoses addressed during the encounter represented by the diagnosis (code) used in the expression.The presentOnAdmissionIndicator (code) allows the eCQM developer to include criteria about whether each specific "Encounter, Performed" diagnosis was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition for information about using the "Encounter, Performed" diagnosis attribute.

The "Encounter, Performed" diagnosis (rank) replaces the principal diagnosis attribute. To reference a principal diagnosis, eCQM developers should express the "Encounter, Performed" diagnosis with a diagnosis (code) and a rank of 1. See definition of rank attribute.

With an "Encounter, Performed" diagnosis, there is no dependency on the timing of the diagnosis in relation to the encounter.

  • Use of the "Encounter, Performed": diagnoses attribute component and the "Diagnosis" datatype is redundant for relating the diagnosis to the "Encounter, Performed". The "Encounter, Performed": diagnoses component syntax is preferred.
  • Referencing the same diagnosis using "Encounter, Performed" (diagnoses attribute) and "Diagnosis" (datatype) should only occur if the measure must define a specified length of a prevalencePeriod, e.g.,
    • The measure must assure that the diagnoses
      • have been present for at least some defined time period before the encounter, and
      • were addressed during the "Encounter, Performed"
Value Set Description from VSAC
Clinical Focus: This value set grouping contains concepts that represent patients who have had a stroke caused by ischemia, where the blood supply is restricted to an area of the brain by something like thrombosis or an embolism.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Diagnosis. The intent of this data element is to identify patients who have a diagnosis of ischemic stroke, or stroke caused by ischemia.
Inclusion Criteria: Includes only relevant concepts associated with a diagnosis of ischemic stroke, or stroke caused by ischemia. This is a grouping of ICD-10-CM and SNOMED CT codes and concepts.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnoses: Ischemic Stroke value set (2.16.840.1.113883.3.117.1.7.1.247)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

Diagnoses

Coded diagnoses/problems addressed during the encounter. The diagnoses attribute has three components:

  • diagnosis (code)
  • presentOnAdmissionIndicator (code)
  • rank (positive integer)

To reference an encounter diagnosis, the expression must include the diagnosis code component. The other components are optional. The expression should only include the presentOnAdmissionIndicator if it is necessary to reference present on admission and should only include the rank if it is necessary to reference principal diagnosis.

The "Encounter, Performed" diagnosis attribute is intended to capture ALL diagnoses, including the principal diagnosis, i.e., all diagnoses addressed during the encounter represented by the diagnosis (code) used in the expression.The presentOnAdmissionIndicator (code) allows the eCQM developer to include criteria about whether each specific "Encounter, Performed" diagnosis was present at the time of admission (an indicator used to evaluate patient safety and adverse events). See presentOnAdmissionIndicator attribute definition for information about using the "Encounter, Performed" diagnosis attribute.

The "Encounter, Performed" diagnosis (rank) replaces the principal diagnosis attribute. To reference a principal diagnosis, eCQM developers should express the "Encounter, Performed" diagnosis with a diagnosis (code) and a rank of 1. See definition of rank attribute.

With an "Encounter, Performed" diagnosis, there is no dependency on the timing of the diagnosis in relation to the encounter.

  • Use of the "Encounter, Performed": diagnoses attribute component and the "Diagnosis" datatype is redundant for relating the diagnosis to the "Encounter, Performed". The "Encounter, Performed": diagnoses component syntax is preferred.
  • Referencing the same diagnosis using "Encounter, Performed" (diagnoses attribute) and "Diagnosis" (datatype) should only occur if the measure must define a specified length of a prevalencePeriod, e.g.,
    • The measure must assure that the diagnoses
      • have been present for at least some defined time period before the encounter, and
      • were addressed during the "Encounter, Performed"
Value Set Description from VSAC
Clinical Focus: This value set grouping contains concepts that represent diagnoses used to identify patients with a history of atrial fibrillation/flutter or a current finding of atrial fibrillation/flutter.
Data Element Scope: This value set may use the Quality Data Model (QDM) category or attribute related to Diagnosis. The intent of this data element is to identify patients with a diagnosis of atrial fibrillation or flutter.
Inclusion Criteria: Includes only relevant concepts associated with codes that identify patients with a history of atrial fibrillation/flutter or a current finding of atrial fibrillation/flutter. This is a grouping of ICD-10-CM, ICD-9-CM and SNOMED CT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Atrial Fibrillation/Flutter value set (2.16.840.1.113883.3.117.1.7.1.202)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

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 prevalencePeriod references the time from the onset date to the abatement date.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent the discharge of a patient to an acute care facility.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Discharge Disposition. The intent of this data element is to identify the final place or setting to which the patient was discharged on the day of discharge from a particular inpatient encounter. This particular value set intends to identify patients who were discharged to an acute care facility.
Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT codes representing short-term acute care hospitals, including specialty hospitals.
Exclusion Criteria: No exclusions.

Constrained to codes in the Discharge Disposition: Discharge To Acute Care Facility value set (2.16.840.1.113883.3.117.1.7.1.87)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

Discharge Disposition

The disposition, or location to which the patient is transferred at the time of hospital discharge.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent procedures used to represent the discharge of a patient to a health care facility for hospice care.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Discharge Disposition. The intent of this data element is to identify the final place or setting to which the patient was discharged on the day of discharge from a particular inpatient encounter. This particular value set intends to identify patients who were discharged to a health care facility for hospice care.
Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT codes representing health care facilities.
Exclusion Criteria: No exclusions.

Constrained to codes in the Discharge Disposition: Discharged To Health Care Facility For Hospice Care value set (2.16.840.1.113883.3.117.1.7.1.207)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

Discharge Disposition

The disposition, or location to which the patient is transferred at the time of hospital discharge.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent procedures used to represent the discharge of a patient to home for hospice care.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Discharge Disposition. The intent of this data element is to identify the final place or setting to which the patient was discharged on the day of discharge from a particular inpatient encounter. This particular value set intends to identify patients who were discharged to home for hospice care.
Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT codes representing discharge to home for hospice care.
Exclusion Criteria: No exclusions.

Constrained to codes in the Discharge Disposition: Discharged To Home For Hospice Care value set (2.16.840.1.113883.3.117.1.7.1.209)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

Discharge Disposition

The disposition, or location to which the patient is transferred at the time of hospital discharge.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent a patient leaving against medical advice.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Discharge disposition. The intent of this data element is to identify the final place or setting to which the patient was discharged on the day of discharge from a particular inpatient encounter. This particular value set intends to identify patients who left against medical advice.
Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT codes representing leaving against medical advice.
Exclusion Criteria: No exclusions.

Constrained to codes in the Discharge Disposition: Left Against Medical Advice value set (2.16.840.1.113883.3.117.1.7.1.308)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

Discharge Disposition

The disposition, or location to which the patient is transferred at the time of hospital discharge.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent a patient who has died in the hospital.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Discharge Disposition. The intent of this data element is to identify the discharge status of patient expired as an attribute of the inpatient encounter.
Inclusion Criteria: Includes only relevant concepts associated with codes for a patient who had died in the hospital. Codes used are to be SNOMED CT codes only.
Exclusion Criteria: No exclusions.

Constrained to codes in the Discharge Disposition: Patient Expired value set (2.16.840.1.113883.3.117.1.7.1.309)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

Discharge Disposition

The disposition, or location to which the patient is transferred at the time of hospital discharge.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent procedures representing an emergency department encounter.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. The intent of this data element is to identify patients who have had an emergency department encounter.
Inclusion Criteria: Includes only relevant concepts associated with an emergency department visit encounter using the SNOMED CT code system.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Emergency Department Visit value set (2.16.840.1.113883.3.117.1.7.1.292)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

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.

The "Encounter, Performed" participant references the primary participant.

Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here

Timing:

  • The relevantPeriod addresses:
    • startTime - The time the encounter began (admission time).
    • stopTime - The time the encounter ended (discharge time).
  • author dateTime references the time the action was recorded.
  • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

Notes:

  • negation rationale 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 and must not use relevantPeriod.
  • The locationPeriod is an attribute of the attribute facility location that addresses:
    • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
    • stopTime - the time the patient departed from the location.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent procedures for non-elective inpatient encounters.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. The intent of this data element is to identify non-elective inpatient encounters.
Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT codes representing non-elective inpatient encounters.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Non-Elective Inpatient Encounter value set (2.16.840.1.113883.3.117.1.7.1.424)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

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.

The "Encounter, Performed" participant references the primary participant.

Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here

Timing:

  • The relevantPeriod addresses:
    • startTime - The time the encounter began (admission time).
    • stopTime - The time the encounter ended (discharge time).
  • author dateTime references the time the action was recorded.
  • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

Notes:

  • negation rationale 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 and must not use relevantPeriod.
  • The locationPeriod is an attribute of the attribute facility location that addresses:
    • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
    • stopTime - the time the patient departed from the location.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent observation encounter types.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. The intent of this data element is to identify patients who have had an observation encounter.
Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT codes representing inpatient encounter.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Observation Services value set (2.16.840.1.113762.1.4.1111.143)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

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.

The "Encounter, Performed" participant references the primary participant.

Previous versions of QDM included an attribute principal diagnosis, defined as the condition that, after study, was determined to be the principal cause of the admission. QDM version 5.5 addresses that concept using the diagnosis rank=1.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here

Timing:

  • The relevantPeriod addresses:
    • startTime - The time the encounter began (admission time).
    • stopTime - The time the encounter ended (discharge time).
  • author dateTime references the time the action was recorded.
  • Refer to the eCQM expression to determine allowable timings to meet measure criteria.

Notes:

  • negation rationale 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 and must not use relevantPeriod.
  • The locationPeriod is an attribute of the attribute facility location that addresses:
    • startTime - the time the patient arrived at the location. The time the encounter began (admission time).
    • stopTime - the time the patient departed from the location.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent care regimes used to define comfort measure care.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Intervention. The intent of this data element is to identify patients receiving comfort measure care.
Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT regime and therapy codes for comfort measures, terminal care, dying care and hospice care.
Exclusion Criteria: Exclude diagnosis codes that identify patients with Palliative Care.

Constrained to codes in the Intervention, Order: Comfort Measures value set (1.3.6.1.4.1.33895.1.3.0.45)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

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.

Note: negation rationale 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 and must not use relevantPeriod.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent care regimes used to define comfort measure care.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Intervention. The intent of this data element is to identify patients receiving comfort measure care.
Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT regime and therapy codes for comfort measures, terminal care, dying care and hospice care.
Exclusion Criteria: Exclude diagnosis codes that identify patients with Palliative Care.

Constrained to codes in the Intervention, Performed: Comfort Measures value set (1.3.6.1.4.1.33895.1.3.0.45)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

Intervention, Performed

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

Timing:

  • relevant dateTime references the time the intervention is performed when the intervention occurs at a single point in time.
  • relevantPeriod references a start and stop time for an intervention that occurs over a time interval. relevantPeriod addresses:
    • startTime - The time the intervention begins.
    • stopTime - The time the intervention ends.
  • author dateTime references the time the action was recorded.
  • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

Notes:

  • Timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.
  • negation rationale 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 and must not use relevantPeriod.
     
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent medications that are prescribed for anticoagulant therapy at hospital discharge for patients following acute ischemic stroke.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Medication. The intent of this data element is to identify patients who are prescribed anticoagulant therapy at discharge following acute ischemic stroke.
Inclusion Criteria: Includes only relevant concepts associated with oral and injectable drug forms. Includes only relevant concepts associated with warfarin, heparins and direct thrombin inhibitors.
Exclusion Criteria: Excludes codes for enoxaparin and heparin generally given for VTE prophylaxis.

Constrained to codes in the Medication, Discharge: Anticoagulant Therapy value set (2.16.840.1.113883.3.117.1.7.1.200)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

Medication, Discharge

Data elements that meet criteria using this datatype should document that the medications indicated by the QDM category and its corresponding value set should be taken by or given to the patient after being discharged from an inpatient encounter.

Note: the QDM "Medication, Discharge" datatype includes the supply attribute since some EHRs populate some medications on the medications discharge list provided to the patient from prescriptions written at discharge. Therefore, such newly prescribed medications may include the supply prescribed. Other medications on the discharge medication list will not have supply information since they represent medications for which the patient already has a supply at home or those the patient may purchase without prescription (i.e., over-the-counter). Thus, measure developers need to address data availability and feasibility when using the supply attribute with "Medication, Discharge".

Timing: The time the discharge medication list on the discharge instruction form is authored.

The "Medication, Discharge" QDM datatype includes two performers or actors - prescriber and recorder. The list of medications a patient should take after hospital discharge may come from two sources. The first source originates from medications ordered from a community pharmacy directly from the clinical software (e.g., eprescribing). That source will include the prescriber. The second method of providing content for the discharge medication list is via entry of medications known to be present in the home or over-the-counter substances, neither of which result in a prescription. The individual entering these latter medications is the recorder. Hence, content in the discharge medication list may include both performers.

Note: negation rationale 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 and must not use relevantPeriod.
 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent situations that represent medical reasons for not providing treatment.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Negation Rationale or Reason. The intent of this data element is to identify medical reasons for not providing treatment.
Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT codes representing medical reasons for not providing treatment should be included.
Exclusion Criteria: No exclusions.

Constrained to codes in the Negation Rationale: Medical Reason value set (2.16.840.1.113883.3.117.1.7.1.473)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

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 a world view that absence of evidence indicates information does not exist or an action did not happen. To express such lack of evidence, an eCQM author should use the CQL expression not exists with reference to the data element rather than the QDM data model. negation rationale in QDM signifies only a reason for such absence, i.e., the reason must be present to qualify for negation rationale. The syntax in the human readable HQMF is addressed in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, "Procedure, Performed not done." QDM versions starting with 5.3 use the syntax, "Procedure, not Performed." Section A-5 provides examples for expressing negation rationale in CQL.

A QDM Known Issue has been identified related to this attribute. To see this QDM known Issue, please click here.

Note: negation rationale 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 and must not use relevantPeriod.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent situations representing a patient's refusal for treatment.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Reason. The intent of this data element is to identify reasons a patient refuses treatment.
Inclusion Criteria: Includes only relevant concepts associated with identifying refusal of any intervention (including procedures, treatment, medication, counseling, screening).​
Exclusion Criteria: No exclusions.

Constrained to codes in the Negation Rationale: Patient Refusal value set (2.16.840.1.113883.3.117.1.7.1.93)

QDM Attribute and Definition (QDM Version 5.5 Guidance Update)

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 a world view that absence of evidence indicates information does not exist or an action did not happen. To express such lack of evidence, an eCQM author should use the CQL expression not exists with reference to the data element rather than the QDM data model. negation rationale in QDM signifies only a reason for such absence, i.e., the reason must be present to qualify for negation rationale. The syntax in the human readable HQMF is addressed in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, "Procedure, Performed not done." QDM versions starting with 5.3 use the syntax, "Procedure, not Performed." Section A-5 provides examples for expressing negation rationale in CQL.

A QDM Known Issue has been identified related to this attribute. To see this QDM known Issue, please click here.

Note: negation rationale 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 and must not use relevantPeriod.

Direct Reference Code

Constrained to 'Birth date' LOINC code

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

Patient Characteristic, Birthdate

The "Patient Characteristic Birthdate" should document the patient’s date of birth.

Timing: The "Patient Characteristic, Birthdate" is a single point in time representing the date and time of birth. It does not have a start and stop time.

Note: "Patient Characteristic Birthdate" is fixed to LOINC code 21112-8 (Birth date) and therefore cannot be further qualified with a value set.

Value Set Description from VSAC
Clinical Focus: n/a Data Element Scope: n/a Inclusion Criteria: n/a Exclusion Criteria: n/a

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 5.5 Guidance Update)

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.

Value Set Description from VSAC
Clinical Focus: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC
Inclusion Criteria: All codes in the code system
Exclusion Criteria: none

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 5.5 Guidance Update)

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 relevantPeriod addresses:

  • startTime – the first day of insurance coverage with the referenced payer.
  • stopTime – the last day of insurance coverage with the referenced payer.
Value Set Description from VSAC
Clinical Focus: n/a Data Element Scope: n/a Inclusion Criteria: n/a Exclusion Criteria: n/a

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 5.5 Guidance Update)

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.

Value Set Description from VSAC
Clinical Focus: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.
Data Element Scope: Gender
Inclusion Criteria: Male and Female only.
Exclusion Criteria: 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 5.5 Guidance Update)

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.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent atrial ablation procedures.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Procedure. The intent of this data element is to identify patients with a history of atrial ablation procedure.
Inclusion Criteria: Includes only relevant concepts associated with codes that identify patients with a history of atrial ablation procedure. This is a grouping of ICD-10-CM and SNOMED CT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Procedure, Performed: Atrial Ablation value set (2.16.840.1.113883.3.117.1.7.1.203)

QDM Datatype and Definition (QDM Version 5.5 Guidance Update)

Procedure, Performed

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

Two QDM Known Issues has been identified related to this datatype.

  • To see the QDM Known Issue related to QDM Procedure, Performed completion time, please click here.
  • To see the QDM Known Issue related to Differentiating Elective Vs Emergent or Urgent Procedures, please click here.

Timing:

  • relevant dateTime references the time the procedure is performed when the procedure occurs at a single point in time.
  • relevantPeriod references a start and stop time for a procedure that occurs over a time interval. relevantPeriod addresses:
    • startTime - The time the procedure begins.
    • stopTime - The time the procedure ends.
  • author dateTime references the time the action was recorded.
  • Refer to the eCQM expression to determine allowable timings to meet measure criterion.

Notes:

  • Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request.
  • The incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.
  • negation rationale 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 and must not use relevantPeriod.
  • For clarification, see Appendix 6.6 with 2020 guidance about differentiating between successful and unsuccessful procedures.