A. Please look for Quality Data Model (QDM) events on the Electronic Clinical Quality Improvement (eCQI) landscape. The User Group coordinates the QDM contents and responds to requests for additional clarification or content from measure developers and others submitting questions or information to the ONC Project Tracking System (Jira) QDM section. Please visit the eCQI Resource Center QDM page Connect tab to learn about QDM and to register for the QDM User Group.
A. Measure developers use the Quality Data Model (QDM) along with Clinical Quality Language (CQL) to develop electronic clinical quality measures (eCQMs) in the Measure Authoring Tool (MAT) and test the eCQM logic using the Bonnie tool. The QDM documentation provides guidance for how to use the information model to express eCQM content. Please visit the Electronic Clinical Quality Improvement (eCQI) Resource Center QDM page Connect tab to learn about QDM and to register for the QDM User Group.
A. You can create an account on the ONC Project Tracking System (Jira). Once you are logged in, click Projects from the top menu bar and chose "View All Projects." Select “QDM Issue Tracker (QDM)” from the list. Click “Create” and enter any necessary details of your question or issue.
A. Many of the acronyms are found on the Electronic Clinical Quality Improvement (eCQI) Resource Center Glossary of eCQI Terms. If you see acronyms that are not explained the Glossary, please send an email to ecqi-resource-center@hhs.gov.
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A. The current version of the Quality Data Model (QDM) is found on the QDM page About tab. Previous versions of the QDM are available on the QDM page Previous Versions tab.
A: CMS updates the QDM annually based on the QDM User Group’s recommendations that evaluate stakeholder requests. To increase transparency, CMS is providing stakeholder access to proposed changes for review and comment. Version 5.6 includes these modifications for potential use in eCQMs for the 2023 reporting/performance period. This draft QDM v.5.6 includes changes recommended by the QDM User Group. We expect implementation of support for QDM v5.6 features and modifications in the production versions of the Measure Authoring Tool (MAT) and Bonnie at a future date. Comments and suggestions are welcome and encouraged. We will accept comments until 5:00 p.m. ET on November 16, 2020 and anticipate finalizing QDM v.5.6 in early December 2020. To submit feedback, go to Jira ticket number QDM-257. You need a Jira account to submit a comment. Currently published QDM versions include:
A. Quality Data Model (QDM) versions prior to v.5.3 included both the conceptual data model (the categories and their context of use) and the expression logic to state measure clauses. QDM versions since v.5.3 include only the conceptual data model. This change occurred with eCQMs designed for the 2019 reporting/performance period when measure developers started using use Clinical Quality Language (CQL) to express logic. The current versions of the QDM can be downloaded from the Electronic Clinical Quality Improvement (eCQI) Resource Center QDM page under "Find the current QDM."
A. Negation has several aspects: (a) assurance that a certain condition does not exist (e.g., no known allergies); (b) lack of evidence that a condition exists (e.g., no information is available in the electronic health record [EHR] about allergies); and (c) that an action was intentionally not performed, with or without a reason (e.g., medication was not prescribed due to interaction with other medications a patient is taking). The Quality Data Model (QDM) negation rationale addresses only the third definition, sometimes called action negation. The QDM includes this concept as negation rationale as an attribute of 34 QDM datatypes. Its inclusion allows a measure developer to express a measure criterion or a measure exception if the clinician expressed a reason for not performing the action expected. The QDM documentation on the Electronic Clinical Quality Improvement (eCQI) Resource Center describes how a measure developer can use negation rationale. Negation rationale is part of the current production version, v.5.4, for the 2020 reporting/performance period and v.5.5 for the 2021 reporting/performance period, and v.5.5 Guidance Update for the 2022 reporting/performance period.
A. This information is provided in the Clinical Quality Language (CQL)-based Health Quality Measure Format (HQMF) Implementation Guide (IG). This document describes constraints on the HQMF Normative edition Release 1 (HQMF R1) header and body elements for the CQL-based HQMF. Volume 3 of the IG references QDM. Note, eCQMs for the 2020 reporting/performance period use CQL-based HQMF STU 3.0 which references QDM v.5.4. eCQMs for the 2021 and 2022 reporting/performance period will use the CQL-based HQMF STU 4.0 as the QDM structure is the same for v.5.5 and the v.5.5 Guidance Update. A new QDM v.5.6 is planned for the 2023 reporting/performance period.
A. The Quality Data Model (QDM) is generally updated annually and there are currently several versions of QDM available, although each for a different CMS reporting/performance period of measures. See the eCQM Standards and Tools Versions table on the Electronic Clinical Quality Improvement (eCQI) Resource Center on the eCQI Tools & Key Resources page for the version by reporting year. Each measure documentation includes the QDM version number in the Clinical Quality Language (CQL) file as well as the HTML human readable file.
A. The Quality Data Model (QDM) specifications provide tables for each datatype available for use. For more information, visit the QDM page on the Electronic Clinical Quality Improvement (eCQI) Resource Center, and retrieve the correct version of the specification under "Find the current QDM".
A. No, “Medication, not Administered” indicates only that the medication was not administered. While most medications may require orders to be placed prior to administration, that is not necessarily true of all medications (e.g., those with standing orders such that the electronic health record [EHR] may not include the order itself). In the Quality Data Model (QDM), negation indicates that an action did not occur for a reason. It indicates that the clinician recorded that they did not administer a medication. In the first implementation of electronic clinical quality measures (eCQMs), measure concepts that allowed negation used the same medication value set to represent the type of medications not administered. Additionally, prior versions of Quality Reporting Document Architecture (QRDA) required that a specific medication be chosen as the one not administered. The issue required a number of discussions in the Health Level Seven International® (HL7) Clinical Quality Information Workgroup about how to represent an action that was not performed for any of the elements in the order set. An interim practice used a medication value set listing the medication ingredient, thus a smaller value set. However, the issue of selecting a single agent remained. QRDA Category I Revision 1 Standard for Trial Use (STU) R4 and subsequent versions allow an indication that the action did not occur for any of the elements of the medication value set. Therefore, the current measure reporting allows negation at the level of the medication category.
A. Nine QDM datatypes include the action “Recommended” which represents the healthcare provider's proposal to the patient about a specific treatment or action. The meaning is implicit. Electronic health records (EHRs) vary with respect to how they might represent recommendations. However, Health Level Seven International® (HL7) Fast Health Information Resources® (FHIR) provides a method to indicate intent in data exchange. An intent = plan represents a recommendation and an intent = order represents an order. Thus, QDM attributes are consistent with evolving HL7® standards for data exchange. “Recommended” does not address a suggested action based on clinical decision support, which is represented in HL7 FHIR® as intent = proposal. The QDM action “Performed” indicates an action has been completed. The comparable concept in HL7 FHIR includes the resource (e.g., Procedure) plus a status = completed.
A. QDM v.5.5 retired the data flow attributes in favor of including a performer and a recorder for each QDM datatype. No measure developers had used the data flow attributes in CMS program measures prior to that change. eCQMs for the 2021 and subsequent reporting/performance periods include QDM datatype-specific performers and recorders, consistent with modeling in Health Level Seven International® (HL7) Fast Health Information Resources® (FHIR).
A. "Medication, Discharge" defines medications intended for use when the patient leaves the hospital. As defined in the Quality Data Model (QDM), "Medication, Order" does not differentiate between an order for medications to be administered immediately prior to discharge from those written to be taken after departure from the hospital. Further, although some discharge medications are ordered (or prescribed), others may already be present in the home setting and still others may be over-the-counter substances for which orders are unnecessary. Hence, "Medication, Discharge" refers to medications that have been reconciled and are listed on the patient’s Discharge Medication List. “Medication, Discharge” events should start and end within the time duration of the episode of care, even though the medication itself may not be started until after the episode ends. It is expected that, at the time of discharge, discharge medications will be the same as the subsequent home medication lists for those medications that are germane to the quality measure, but this cannot be assumed at the time of admission as changes may have occurred since the prior episode of care. United States Core (US Core) representation of Health Level Seven International® (HL7) Fast Health Information Resources® (FHIR) defines a medication list as one compiled from orders (MedicationRequests) with a status = active and intent = order (for physician orders) or intent = plan (for patient reporting or recommended medications). Thus, US Core represents active medications using order and, further, allows indication of the setting in which the medication should be taken as category = community. Therefore, using US Core for data interchange, the order (MedicationRequest) can represent all discharge medications by using the category = community. QDM v.5.5 includes a setting attribute that maps directly to the US Core category for "Medication, Discharge" to assist with the transition to FHIR®. Quality Improvement Core (QI-Core) includes mapping from all QDM datatypes and attributes to FHIR.
A. The Quality Data Model (QDM) v.5.4 and subsequent versions added a prescriber attribute to “Medication, Order”, “Medication, Dispensed”, and “Medication, Discharge” and a dispenser attribute to “Medication, Dispensed”. Therefore, from the 2019 reporting/performance period forward, QDM has enabled expressions indicating a medication’s prescriber and dispenser. QDM v.5.5 and forward further added entities, concepts that can be used to specify details about an actor (or performer) of any QDM datatype. Entities include Patient, Care Partner, Practitioner, and Organization. Each entity has specific attributes such that a “Medication, Order” prescriber can reference a Practitioner with a role = physician and a specialty = internist (as an example). Electronic clinical quality measure (eCQM) expressions can indicate that the “Medication, Order” prescriber is the same individual as the “Encounter, Performed” participant, or add further details indicating the individual’s role or specialty. Measure developers need to test such expressions in real-world settings to determine the feasibility of retrieving such information.
A. There are no formatting conventions specific to the Quality Data Model (QDM), the QDM specification should be reviewed for specific guidance on using the datatypes and attributes in the conceptual model. However, there is information on conventions for formatting statements and expressions in Clinical Quality Language (CQL) which encourage consistency, readability, maintainability, and reusability of the resulting CQL. These conventions can be found on the CQL Formatting and Usage Wiki. Additionally, CMS has published a CQL Style Guide, based on the Formatting and Usage Wiki contents. The CQL Style Guide focuses on a set of common best practices implemented across CQL-based electronic clinical quality measures (eCQMs) in the CMS reporting programs and also promotes the use of consistent language within the framework of CQL, including libraries, aliases, definitions, functions and conventions. Measure stewards or measure developers who are developing or specifying eCQMs for future inclusion in CMS programs should align with these best practices.
A. The Quality Data Model (QDM) is a conceptual data model that helps measure developers and implementers understand the general concepts needed to compute a quality measure. However, QDM only defines the concepts, such as a diagnosis, or a laboratory test (with a result), or a physical examination finding (such as blood pressure readings). A method to relate each concept to other concepts requires an expression language. As an example, the QDM data element is similar to a noun in expressing grammar (e.g., a laboratory test) and related adjectives (the time the laboratory test was performed). But to create a sentence, one must have verbs (e.g., starts) and adverbs (after the beginning of). The expression language provides the verbs and adverbs. Prior versions of QDM (v.4.3 and earlier) included the expression language and the conceptual data model. The expression language portion of QDM was difficult to understand and more challenging to compute. So, Clinical Quality Language (CQL) was developed as a way to express what was needed. CQL can express that some specific activity happened during an inpatient encounter and that it happened before another activity. However, CQL needs a data model to indicate what is related to what.
In the Health Level Seven International® (HL7) community, the Clinical Quality Information (CQI) and Clinical Decision Support (CDS) Work Groups harmonized efforts to express quality measures (QDM) and CDS artifacts (virtual medical record [vMR]). The result is an HL7® Fast Healthcare Interoperability Resources® (FHIR) implementation guide called Quality Improvement (QI)-Core which includes a detailed mapping of QDM concepts. QI-Core-related tooling will allow measure developers to use it directly to author eCQMs in FHIR. QI-Core specifically builds directly on each FHIR® version to assure consistency of measure expressions and the evolving method for data interchange and interoperability. The eCQI Resource Center includes further information about FHIR and transition efforts.
A. Yes, the Measure Authoring Tool (MAT) is a web-based tool that allows measure developers to author electronic clinical quality measures (eCQMs) using the Quality Data Model (QDM) to represent clinical concepts and Clinical Quality Language (CQL) to represent the logic. The tool provides the capability to export measures in several formats that support both human- and machine-reading. Refer to the MAT User Guide for more information.