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"Medication, Dispensed"

Performance/Reporting Period
QDM Datatype (QDM Version 5.4):

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.

QDM Category (QDM Version 5.4)


Medication represents clinical drugs or chemical substances intended for use in the medical diagnosis, cure, treatment, or prevention of disease. Medications are defined as direct referenced values or value sets containing values derived from code systems such as RxNorm.

QDM Attributes


The time the data element was entered into the clinical software. Note, some datatypes include both Relevant Time and Author dateTime attributes. The purpose is to accommodate Author dateTime if the actual start and stop times are not available when evaluating for feasibility, and also to allow specification of a time for Negation Rationale.


Details of how medication is taken or is to be taken, i.e., the quantity (mg, cc, tablets) to be taken at a single administration.

NOTE: Although 2020 eCQMs use QDM Version 5.4, the QDM Version 5.5 Guidance Update provides clarification to the definition of this attribute which may be helpful when implementing eCQMs for 2020 Reporting/Performance periods.

QDM Version 5.5 Guidance Update:
Details of how much medication is taken or is to be taken, i.e., the quantity (mg, cc, tablets) to be taken at a single administration.


Indicates how frequently the medication or substance: is administered to a patient for an active medication (Medication, Active), was administered to the patient (Medication, Administered and Substance, Administered), should be taken by the patient or administered to the patient (Medication, Discharge; Medication, Dispensed; Medication, Order; and Substance, Order), is recommended to be given to the patient (Substance, Recommended).


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.


The number of refills allowed by the prescription.


Relevant Period addresses the time between the start of an action to the end of an action. Each datatype using relevant period defines specific definitions for the start and stop time for the action listed.


Refers to the path by which the medication or substance should be taken into the body system, such as intradermally, intrathecally, intramuscularly, intranasally, intravenously, orally, rectally, subcutaneously, sublingually, topically, or vaginally.


The quantity (amount) of therapeutic agent that was provided to a patient (i.e., number of doses, number of tablets or pills, volume of medication). Indicated to be given during a procedure, diagnostic test, or medication or substance administration. Note: Prior versions of the QDM (4.3 and earlier) addressed 'dose' with two potential interpretations – (1) the quantity to be taken or administered with each administration and (2) the quantity of medication supplied (i.e., number of doses). QDM 5.0 and subsequent versions clarify the difference by defining 'dosage' and 'supply,' respectively. Note: Medication, Discharge includes medications the provider has indicated the patient should take after dischange from the hospital. This medication list is part of the discharge instructions provided to a patient. The list may include medication supply if it incorporates medication orders written at discharge even though the supply will not be present for medications the patient already has at home or purchases over- the-counter (without a prescription).
Last Updated: Jan 10, 2022