["Medication, Administered": "Warfarin"]
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Medication. The intent of this data element is to identify patients who are prescribed warfarin therapy at discharge following acute myocardial infarction.
Inclusion Criteria: Includes only relevant concepts associated with drug forms that are consistent with oral administration, such as tablets. Only single ingredient.
Exclusion Criteria: No exclusions.
Constrained to codes in the Medication, Administered: Warfarin value set (2.16.840.1.113883.3.117.1.7.1.232)
"Medication, Administered"
Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient.
Timing:
- relevant dateTime references the time the medication is administered if it was given or taken at a single point in time.
- relevantPeriod references a start and stop time for medication administration if the administration event occurred over a time interval (e.g., an intravenous infusion). The relevantPeriod addresses:
- startTime - when a single medication administration event starts (e.g., the initiation of an intravenous infusion).
- stopTime - when a single medication administration event ends (e.g., the end time of the intravenous infusion).
- author dateTime references the time the action was recorded.
- Refer to the eCQM expression to determine allowable timings to meet measure criterion.
Notes:
- Measure developers should address multiple administrations over a period of time using CQL logic.
- negation rationale 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 and must not use relevantPeriod.
Refer to Special Cases in Appendix A (Section 5.7) for scenarios to consider in calculating cumulative medication duration.
authorDateTime
The time the data element was entered into the clinical software. Note, some datatypes include both relevant dateTime and author dateTime attributes. When both are present, author dateTime is included to accommodate negation rationale.
The author dateTime addresses when an activity is documented. Documentation can occur at the beginning, during, at the end, or subsequent to the end of the activity. The author dateTime should be used only if the relevantPeriod cannot be obtained or to represent the time negation rationale is documented.
Note: negation rationale 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 and must not use relevantPeriod.
negationRationale
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 a world view that absence of evidence indicates information does not exist or an action did not happen. To express such lack of evidence, an eCQM author should use the CQL expression not exists with reference to the data element rather than the QDM data model. negation rationale in QDM signifies only a reason for such absence, i.e., the reason must be present to qualify for negation rationale. The syntax in the human readable HQMF is addressed in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, "Procedure, Performed not done." QDM versions starting with 5.3 use the syntax, "Procedure, not Performed." Section A-5 provides examples for expressing negation rationale in CQL.
A QDM Known Issue has been identified related to this attribute. To see this QDM known Issue, please click here.
Note: negation rationale 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 and must not use relevantPeriod.
relevantPeriod
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.
Note: negation rationale indicates a one-time documentation of a reason an activity is not performed. Negation of QDM datatyperelated actions for a reason always use the author dateTime attribute to reference timing and must not use relevantPeriod