Glossary

A data element is a specific piece of information that is collected and stored in a healthcare system. Each data element is a single unit of data and can include patient demographics, clinical measurements, lab results, or treatment details.

Data element validity is the extent to which a data element or code accurately reflects the concept or event it is intended to represent. For example, using a medication code as a proxy for a diagnosis, or ensuring response options include all values needed to report accurate data.

See also measure validity.

A data model is an abstract model organizing elements of data and standardizing how they relate to one another. For instance, a data model linking guideline information with clinical data for the patient. Taylor, D. (2023). Data modelling: Conceptual, logical, physical model types. Retrieved March 20, 2024, from https://www.guru99.com/data-modelling-conceptual-logical.html

The De Novo Measure Scan (DNMS) is an advanced feature within the Environmental Scan Support Tool (ESST), available through the controlled-access Centers for Medicare and Medicaid Services (CMS) Measures Inventory Tool (CMIT) website. A CMIT login is required to use this functionality.

DNMS is an on-demand tool to support measure developers in conducting early and ongoing environmental scans during the development of new quality measures. It leverages a Clinical Quality Measure (CQM) ontology to define and structure measure concepts. Key ontology components include the target population, health status or utilization focus, change concept, expected outcome of the change concept, and care setting.

Using structured search terminology derived from these concepts, DNMS helps users build and refine new measures. It also applies artificial intelligence to identify, prioritize, and retrieve the most relevant literature from PubMed, PubMed Central, and CINAHL, streamlining the evidence review process.

Decision Model and Notation (DNM) is a standard published by the Object Management Group. It provides a common way to model and describe repeatable decisions so they can be shared and used across organizations. Oliveira, W. (2018, August 21) What is decision model and notation (DMN)? Retrieved March 20, 2024, from https://www.heflo.com/blog/process-modeling/decision-model-and-notation-dmn/

The denominator is the lower part of a fraction used to calculate a rate, proportion, or ratio. It may include the full initial population or a subset of that population, depending on the measure. Continuous variable measures do not use a denominator; instead, they define a measure population.

A denominator exception is a reason to remove a patient, procedure, or unit from the denominator only when the numerator criteria are not met. It adjusts the calculated score for cases with higher risk or valid clinical reasons. It also allows clinicians to use judgment in specific situations.

Measure developers must define denominator exceptions clearly and specify where to capture them in structured data that fits the clinical workflow. The measured entity removes these cases from the denominator but may still report how many valid exceptions occurred.

Denominator exceptions fall into three categories: medical reasons, patient reasons, and system reasons. Only proportion measures use denominator exceptions.

A denominator exclusion is a case that the measured entity removes from the denominator before evaluating the numerator criteria. Denominator exclusions help narrow the denominator to the appropriate population. Proportion and ratio measures use denominator exclusions for this purpose.

For example, a measure may exclude patients with bilateral lower extremity amputations from the denominator of a measure that requires foot exams.

Continuous variable measures may use denominator exclusions but may instead use the term measure population exclusion.

The Health Level Seven International® (HL7®) Data Exchange for Quality Measures (DEQM) Implementation Guide (IG) provides standards for sharing healthcare quality information using Fast Healthcare Interoperability Resources® (FHIR®). It defines how systems can exchange digital quality measure (dQM) data in a consistent and interoperable way. For example, it supports the electronic transfer of quality reporting data from healthcare providers to payers and other organizations.

The DEQM IG supports multiple reporting scenarios, including:

• Individual reporting (data for a single patient)
• Subject list reporting (lists of patients meeting certain criteria)
• Summary reporting (aggregate results for a provider or organization)
• Gaps in care reporting (identifying patients who may need recommended services)

The DEQM Individual MeasureReport profile is designed as a FHIR-based alternative to the Quality Reporting Document Architecture (QRDA) Category I format for patient-level reporting. The DEQM Summary MeasureReport profile serves as a FHIR-based alternative to QRDA Category III for aggregate reporting.

The guide is maintained by HL7’s Clinical Quality Information (CQI) Work Group through an established standards development and balloting process. Updates are coordinated with related IGs, including the Quality Measure IG and the Quality Improvement Core (QI-Core) IG, to ensure alignment across quality measurement standards.

Derivative products of clinical practice guidelines are products that use content from a guideline. Examples include clinical decision support tools, patient and family guides, pocket cards, mobile applications for clinicians, and continuing education programs.

CMS defines digital quality measures (dQMs) as quality measures that use standardized digital data from one or more sources of health information, captured and exchanged through interoperable systems. They apply standards-based specifications that use code packages and are computable in an integrated environment.

A direct reference code (DRC) is a specific code referenced directly in the electronic clinical quality measure logic to describe a data element or one of its attributes. DRC metadata include the description of the code, the code system including the code, and the version of that code system.