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Negation Rationale: Medical Reason

eCQM Data Element

Performance/Reporting Period
2020
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent medical reasons for when a patient does not receive a therapy or service.
Data Element Scope: This value set may use the Quality Data Model (QDM) attribute related to Negation Rationale.
Inclusion Criteria: Includes only relevant concepts associated with medically relevant reasons for not receiving a therapy or service.
Exclusion Criteria: No exclusions.

Constrained to codes in the Negation Rationale: Medical Reason value set (2.16.840.1.113883.3.526.3.1007)

QDM Attribute and Definition (QDM Version 5.4)

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.

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

Last Updated: Oct 17, 2019