["Medication, Dispensed": "ADHD Medications"]

Data elements that meet criteria using this datatype should document that a prescription for the medication indicated by the QDM category and its corresponding value set has been dispensed and provided to the patient or patient proxy. In the ambulatory setting, medications are primarily taken directly by patients and not directly observed. Hence, dispensed, or fulfillment, information is the closest health provider documentation of medication compliance. In settings where patients attest to taking medications in electronic format (perhaps a Personal Health Record), patient attestation of medication taken may be available. The QDM datatype, Medication, Administered addresses medication taken; to address the source of the information, a measure addressing such patient attestation would require use of the dataflow attribute, source.

Timing: The time the medication dispensing event occurs; the Author dateTime.

[For Reference: in QDM 5.5 Guidance Update and QDM 5.6, the time the dispensing occurs is referenced as a new “Medication, Dispensed” attribute: relevant dateTime which references the dateTime the prescription dispensing event occurred. The timing corresponds to the HL7® FHIR® MedicationDispense.whenHandedOver, i.e., the time the prescription was handed over to the patient or patient’s representative. In QDM 5.5 Guidance Update and QDM 5.6 the “Medication, Dispensed” author dateTime is reserved for use only for documentation of negationRationale, the reason the dispensing event did not happen.]

Timing: The Relevant Period addresses:

• startTime - when the first administration of the medication is expected. If not specified. the startTime defaults to the Author dateTime (the time the medication dispensing event occurs).
• stopTime - when the medication supply provided by the dispensing event is expected to be completed.
• [For Reference: in QDM 5.5 Guidance Update and QDM 5.6, the “Medication, Dispense” relevantPeriod addresses the time referenced in the dosage instruction indicating when the medication administration should start and end. The timing corresponds to the HL7® FHIR® MedicationDispense.dosageInstruction.timing.]

Note that when calculating cumulative medication duration, the medication dispensed stopTime may be present directly in the fulfillment record. If the stopTime is not available, the duration in days is the difference between the Relevant Period start and stop times. The record may indicate which of the available refills the fulfillment represents but each dispensing event is unique. Therefore, the measure developer should use CQL logic to address multiple dispensing events over a period of time.