"Medication, Order"

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 thought process or justification for the datatype. In some measures, specific treatments are acceptable inclusion criteria only if a justified reason is present. Each of these measures uses a value set (often, but not exclusively, using SNOMED CT) to express acceptable justification reasons. Other measures specify reasons as justification for exclusions. Examples include patient, system, or medical-related reasons for declining to perform specific actions. Each of these measures also uses a value set to express acceptable justification reasons for declining to perform expected actions.

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).