["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 entity fulfilling the role of the performer attribute for the administration event.

Timing:

• relevant dateTime references the dateTime the prescription dispensing event occurred, i.e., the time the prescription was handed over to the patient or patient’s representative. This timing corresponds to the HL7® FHIR® MedicationDispense.whenHandedOver.
• relevantPeriod addresses the time referenced in the dosage instruction indicating when the medication administration should start and end. This timing corresponds to the HL7® FHIR® MedicationDispense.dosageInstruction.timing.
• author dateTime is reserved for use only for documentation of negationRationale, the reason the dispensing event did not happen.

Notes:

• 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 relevantPeriod 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.
• 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 relevant dateTime or relevantPeriod.

Refer to Special Cases in Appendix A (Section 5.7) for scenarios to consider in calculating cumulative medication duration.